Returned to chaos today

[chellelynn25]

I work in a LTCF. I have a permanent assignment that I work on 5 days a week. I recently took a week of PDO time for no reason other than that I just needed a break. My facilty is understaffed to say the least. We use agency to fill un-covered shifts. During my time off an agency nurse was assigned to my hall. Today was my first day back and it was chaos. To start I get 3 calls from the lab with critical values. I start my med pass and get to my first resident room and discover her potassium as been changed to the liquid form. I don't really think much of it, b/c sometimes this little lady can be difficult to get her medicine in. I get to another residents room and find that her K as also been changed to liquid form. I flip thru my MAR to find that all of my resident on K+ have been switched to the liquid form. I go to the charts to find some answers and ask the nurse working my unit if she knew anything about all of the K+ being changed. I made a phone call to our MD to see if he could fill me in b/c no one else seemed to know what it all was about. As I proceed with my med pass I see days worth of residents whose meds have been circled as refused. People who normally take the meds with no problems at all. And it's stuff like Dig, Coreg, Lasix. I'm starting to get mad. When I'm finally done I page the RN supervisor. She comes and I speak with her. Apparently a agency nurses got orders to change all of my K-Durs to liquid form b/c she told the MD that none of my residents were able to swallow them and kept refusing their meds. I explain to the RN supervisor that for practically the whole week that I was on PDO that ppl have their meds circled as refused. I finally speak with the MD and get orders to change it all back to K-dur pill form. He said that the agency nurse has called him probably 50xs in the week that I was off, wanting this and wanting that and that she had made it out like no one could take the pill form.

I appreciate agency coming to our facility in order to help us out. I'm irked that and agency nurse who does not know my residents, took it upon herself to change things that didn't really need to be changed. This is my place of employment I come her daily and she will be gone when ever she choosed to do so. I'm also irked that so many of my resident "supposedly" refused there meds. There was no documentation as to why or if she attempted more than once. Makes me wonder if she even attempted to give them their meds at all! There were incident reports out the wazoo while I was gone. Most of my resident have weekly blood work done and I had 3 criticals this morning alone. Doses of ATBs that were missed all together. It was a disaster. I was 2hrs late leaving today b/c of all the orders I had write alone. It's going to take me a week alone just to clean up her mess.

*To any agency nurses, please don't take this offensively, I truly do appreciate what you do for facilitys like mine.*

[PAERRN20]

Sounds awful. Who was letting the agency nurse change all the orders? Where was the RN supervisor when you were gone? Aren't there other nurses on the floor who are regular staff and could intervene. I'm glad that you are a caring nurse and took the time to change the orders to what the residents are used to. As for the agency nurse, perhaps the supervisor could speak to her, if she even comes back.

[summerrose_10]

Your awesome! Wish you worked with me. The pts. are lucky to have you as their nurse. Working in LTC for, OMG, not even 2yrs, I can not believe the care I have seen given(or, rather, not given) by other "professionals".

I wanted to have a pts. fingersticks of QID decreased to q-bid, as the paper record indicated his blood sugar always WNL. While gathering objective info. to send to DR. I discovered, high B.S. in the electronic record, yet the nurse had written normal fasting blood sugars on the paper (we still document paper style Obviously, she does not know the glucometers identify the pt. and record the B.S. Not sure why she would do this, did she think she would be in trouble if B.S. was high???????

This was not the first time I have found falsification of this type, which is why I always check the electronic documentation. I have also found a nurse signing off as med given, but, the same amount of that drug is in the drawer as the day before??? I don't get it.? Why would a nurse do that? If she doesn't have time to get things done, she needs to speak up. That is the only way things/systems get changed.

On hospice pts., I have seen numerous accounts of nurses documenting p.o. drugs given, yet when I attempt some p.o meds with them, there is NO WAY that pt. is going to take anything p.o.?

I'm not pointing fingers, and I know I am no better of a nurse then any other out there. I also appreciate all the help from fellow nurses. I would just like to understand why this happens, and how to support co-workers, so they will take initiative to work as a team. I know there are good/bad in every profession, yet I believe nurses are a bit more caring and selfless then most, so it surprises me when I read post like yours, and see this occuring at my place of employment also.

Looking forward to reading about others experiences and how they "overcome" some of these obstacles.

[GiGiOm]

Bless your heart! That sounds like a nightmare first day back. I was a supervisor in LTC, and I have to agree with the other comment. Where was your nurse supervisor during all this? It sounds like the facility got stuck with a lemon from the agency, and that she just didn't want to be bothered with it. Wow!

[systoly]

Certainly the cost issue should not dictate what Rx is best suited, but why in the world replace a tab with a liquid that costs x times more when the tab has been working for the regular staff.

[caliotter3]

Sometimes less than desirable employees work agency for the amount of time it takes to identify them as substandard and they are let go from the agency. This person sounds like one of that type. Quirky to say the least. Why she would ever want to go through all that trouble in the first place, quirky. Be glad she is not there on a permanent basis. Maybe your supervisors have enough info to identify her as Do Not Return to the agency.

[NotFlo]

On hospice pts., I have seen numerous accounts of nurses documenting p.o. drugs given, yet when I attempt some p.o meds with them, there is NO WAY that pt. is going to take anything p.o.?

I do totally understand what you're saying but in this particular situation I have learned to give other nurses the benefit of the doubt. I've done 12 hr shifts where a hospice patient will take PO meds at 9am and then at 2pm they are so lethargic/unable to swallow etc. they can't take a thing. Those pts. condition can change quickly.

Also, to the OP, I've never worked agency but I used to float within my own building. Whenever I got put on a long-term floor I hadn't been on for a couple of months, the first few days I had a HORRIBLE time getting people to take their pills. I don't know if it's a new face, the sheet that says how they take them being inaccurate and not updated for six months, etc. but I would have people refusing that never refused for their regular nurse, at least until I figured out how to coax them into taking stuff.