RN for 18 years and I'm completely lost with my new LTC job when it comes to Med Pass

[OldNurseNewTricks]

I worked in LTC when I was a younger nurse in the late 90's early 2000's. I was the "charge nurse" on 3-11 shift, we had 60 residents and ONE charge nurse! It was hard work but I enjoyed it. I had one med tech or LPN/RN med nurse in addition to 4 CNA's + me. I was responsible for the charting, 3-11 treatments (which was few because the treatment nuse did most on days), narcotic admin, g-tube meds and feeds, accuchecks, insulins, skilled care, etc. The CNA did ALL other meds...and that's ALL they did (which was fine because it took 8hrs to complete the job). Everything seemed to run smoothly.

I left LTC to gain other experiences eventually ending up in a hospital setting in various rolls from med/surg to ICU to house supervisor and ER. I got really burned out toward the end of my hospital career and opted to return to LTC.(a less stressful, laid back, manageable field of nursing--I THOUGHT)

My new position is in a very nice skilled nursing facility with 50+ beds/ residents divided into 2 halls. One hall is the "skilled" hall where most acutely ill, dying, and total care patients reside. About 28 residents all together on this hall(my hall). The other hall is the movers and shakers and less acutely ill folks with about 24 total residents, no Medicare A's, and only a few that need toileting.

SOUNDS EASY, I thought to myself during the interview and tour. Then, I GOT TO WORK! I discovered that the RN/LPN or "Charge Nurse" had to be responsible for ALL the meds, All the treatments, PLUS All the charting and administrative nursing duties I expected. In addition and often in the middle of my MED PASS-- I still have to make rounds with the Dr, call the Dr, take off orders, answer the phone, secure appts, draw labs, do IV's, extensive wound care, aid in the dining room, and assist the CNA when needed, not to mention ADMISSIONS AND DISCHARGES! This job would be WONDERFUL and manageable if it werent for the medications. If I pass meds the "correct" way on day shift I'm WAY outside my legal time limits, it takes me 2 1/2 -3hrs! The other nurses set there meds up early, or come in 1hr early OFF THE CLOCK to get the med set up done and sign their MAR! I WON'T DO THIS!! Instead, I make med errors, cry a lot, worry more, and stay 2-3 hours after work to do charting and skin assessments and monthly summaries: ON THE CLOCK!

AM I JUST A CRYBABY OR IS THIS COMMONPLACE? Any advice, tips, LEGAL TRICKS! How can you protect your patient and your license with this kind of set up? Im far from a new nurse...so, this should be EASY! RIGHT?

[RN_2012, BSN, RN]

You are the only nurse on your shift for both halls? That is insanity. I just left a LTC job because at 11pm two nurses had to split a 3rd hall. So, 1 1/2 halls each. It is fine if everything is going smooth. Not safe if the **** hit the fan. I worked 7P-7A.

[creamcheesepuff]

I am a 17 year veteran of the 3-11 shift......I did everything, Cnas only did patient care....not even vitals....I did meds, admissions, doctors orders, assist the doc if necessary if they came in unnannounced....discharges...enough treatments to as long as my arm...had tobe NEAR the dining room(not actually give out trays) but in ear shot.......bathroom patrol(if aides werent to be found) going to the kitchen for snacks for diabetics if they didnt bring it up......try to get coverage when an aide or Nurse called in...this was especially wonderful when you get a call at 1030 pm for a nurse not coming in at 11pm....accepting meds from the pharmacy( which was located 2 hours away) oh, lots of things....that arent even nursing jobs I did.....ordering outside food for patients....emptying a room when a patient died or was discharged.....shall I keep going????? It was a nightmare at times...and I DID get burned out.....now I have an interview for a DON position in an assisted living place.....at 57 I am thinking ....maybe I shouldnt do this anymore....but its not LTC/sub acute.....if they want me.