eyeheartNP

Do you work with a group/physician and could perhaps schedule time to meet with some allies by your side? This may sound rather formal, but necessary since the feedback you're getting is not at all productive or conducive to patient safety. Approach is so important - remember "why" questions tend to bring on defensiveness.

Woa! sounds like you're doing a great job as a unit nurse! Not all of the assigned tasks you have to do allow for the kind of "quality" time you may prefer to be giving your patients, but I'm sure they recognize this too. Practicing a little "zen" nursing may help you though - being aware in the moment - being there as you put it - while you're interacting with so-and-so, you're physically present...remember that your trained mind is also assessing too...it's so much more than "passing meds" isn't it? You're taking responsibility for that patient's safety, and probably passing them a smile if you can squeeze that in too. I'd say you're doing a fantastic job, but just need to realize that you are.

If you have safety concerns about medication administration, please bring them to the attention of someone who can do something about it from a systems perspective, like the DON. I've worked for years in LTC facilities, and have come across errors on a MAR - despite the many steps in place to avoid med errors. I once supervised an NP who was not monitoring INRs though a patient was on warfarin; when it was finally checked, the INR was too high to calculate, and the NP blamed the doctor for ordering the warfarin without INR lab orders. If you're the one signing the MARs each month, you're responsible for what they contain, and you want the orders followed safely. The actions you take aren't to punish anyone, but to maintain patient safety. Bring documentation and specific examples to the DON's attention, and ask how you can help. Perhaps offer an in-service on non-pharmaceutical management of agitation/dementia. When I've been asked for orders to sedate a patient with a benzo, I use that encounter to educate about risks associated with that prescription, or to figure out what else is happening that may be the cause of the behavior, i.e. UTI. Maintaining open communication and healthy working relationships in nursing facilities is a major part of success at your job, and there's no need to be anonymous when working through safety concerns.