Skating on thin ice?(at my job)

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I'll try to get to the point but this is a little complicated for me. I'm a BSN and am actually halfway through a nurse practitioner program. It became necessary to find a job a few months ago and I began working at a very large nursing home. I've worked in a nursing home before, but it was small and a lot less busy compared to this one. The place is so crowded with laundry pushing carts up and down the hall, janitors buffing the floor, housekeeping pushing their carts and you pushing yours. It's literally like trying to maneuver through an obstacle course. Anyway, being a newbie I don't have the luxury of choosing where I want to work, so I'm usually floated wherever a nurse is needed. This is where medication errors are coming in. I don't have a problem on this particular hall where I usually work, but I got a phone call from the boss and was scolded because they had found holes in the MAR I had not signed and when the carts were audited they had found some medications I had not given.

She also told me she knew I had been moved around a lot but I was going to HAVE to be very careful. She also told me there are a lot of others guilty of the same thing (which you can look through the MARS at any time and see holes everywhere) so I was not just being singled out. Still, I can't shake the feeling I'm skating on thin ice, and it really stinks because I'm trying hard. It's bad coming home, sore and exhausted after running 12 hours and in the end you still get flogged for not being good enough. I'm on the schedule tomorrow and feel like I need to go talk to the supervisor, but I don't know what to say. I want to let her know I'm willing to do what I need to so I can be what they want me to be. I did tell her I was sorry I turned out to be a disappointment and she told me I wasn't a disappointment but it sure sounds like I am. Jobs aren't easy to come by around here so I'll be up a creek if I lose this one.

Any advice?

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Specializes in Mechanical Circulatory Support.

I'm still in school for my BSN so I don't have much to say other than speaking from general work experience; there is always a learning curve with new employment that always feels like failure. Just keep going in and doing your best and you'll find your way. It's not going the be the last time your boss stomps on your ego so take criticism to a good place, learn from it, and do your best. It'll work out in the end. :)

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Go over the MAR with a fine toothed comb and fill in holes even if doing so pushes you over the end of your shift. The best time to do this is at the end of the med pass. Make yourself do it. This is the only way to cut down on or eliminate holes in the MAR. You have to do this if you fear for your job. Best wishes.

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does you place use the bubble pack with neds? if so, be sure to go back over all your meds at the end of your med pass, and make sure the meds were all given - and go through the MARs 2 times-- to be sure you signed everything, also a cheat sheet may help, if the unit you are on has one, to just use as a cross reference. When you are licensed , it is your job to give what is ordered, and to sign everything. I know how hard it can be, I work in a place that has over 500 residents. We have all the housekeeping things, and floor machines, ect... and that can make it very hard to concentrate, and constant interuptions- are the norm. Good Luck to you!!!

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Go over the MAR with a fine toothed comb and fill in holes even if doing so pushes you over the end of your shift. The best time to do this is at the end of the med pass. Make yourself do it. This is the only way to cut down on or eliminate holes in the MAR. You have to do this if you fear for your job. Best wishes.

I think I see what you are saying. Give the med out of schedule, and sign. Or sign so everything looks good. Management might say "you know the rules, give the med when you are suppose to". But what they really want is all those spots signed. I've heard that there is a $1000 penalty for each unsigned med, when surveys discover. I hope for all of us that things get better. Slow down stay calm.

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Specializes in Emergency Department.

I agree with caliotter3, go over your MARs extensively. Double..triple check. I have been in LTC for 3 years and everyone makes mistakes. I am sure you have heard this a million times, and if you have not, if it is not documented it did not happen. LTC is crazy busy with meds, amongst other things, but you must take time and care with all aspects of med pass. I wish you the best. If you have concerns or just need to vent message me.:hug:

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I think I see what you are saying. Give the med out of schedule, and sign. Or sign so everything looks good. Management might say "you know the rules, give the med when you are suppose to". But what they really want is all those spots signed. I've heard that there is a $1000 penalty for each unsigned med, when surveys discover. I hope for all of us that things get better. Slow down stay calm.

I am not saying that at all. The best time to remember that you gave a med or to find out that you missed a med is at the end of that med pass. That is what I am saying.

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Specializes in LTC.

Pop it...sign it....pop it..sign it. It's easiest to not mess up that way. IF You have time to make your initials sqiggle int he hole.

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I would have a second one-on-one conversation with your Manager/Supervisor. I am 1st year Nursing student, so excuse me but I don't know what's a "MAR". However I've held several management positions and I would strongly urge you to speak to management and set the record straight. Perhaps they can reach some sort of agreement where you won't be moved around as much..... If something happens, the 1st thing mgmt will say, "You never told me your issues." You seem pretty well educated in your field, you'll be fine, than to be termed for errors/performance issues.

Good luck!

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I agree with you Sparrowhawk. I pop and sign as I go. In between grabbing narcotics from the lower drawers, I stick my pen behind my ear to remind me to double check that I've gone through all of the med sheets for that given patient. I sign the meds in order from the MAR, so that it's unlikely that I will miss popping out a med or omit my signature.

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The bottom line is that I wonder if I should be looking for another job. I always try to be consciencious about signing the records, but they also apparently are going behind us counting meds.. I also know from experience it is a lot easier to point out others' mistakes. I could go through there now and find tons.

Another thing they are harping on is getting done and getting out of there on time.

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Specializes in home health, dialysis, others.

These issues are not new ones for any NH/LTC business, especially the for-profit ones. Of course they want you out on time, they don't want to pay a penny more than they have to.

And med passes are constantly being interrupted by everyone and their aunt. It is very hard to keep on track. Truly do not take all of this too hard, they are probably harping on everyone.

Best wishes.

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