Skating on thin ice?(at my job)

[nursep2b]

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?

[Hospice Nurse LPN, BSN, RN]

When I worked in LTC I would, of course, sign my meds as I went. After med pass another nurse and I would swap MARS to see if either of us missed anything. Can you try something like that?

[gentlegiver, ASN, LPN, RN]

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.

This is how I do it too, I look at the MAR, look at the drug, sign the MAR, then pop the drug. Haven't mess up yet doing it this way. It takes 2 seconds longer, but, it's worth it. We have a Nurse where I work who signs out all the meds during the 1st med pass, we find alot of mistakes have been made this way. We have others who don't sign off until the end of the last pass. Lots of mistakes there too. Compare, Pop, Sign, is really the best way.

[NotFlo]

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.

Honestly from what you posted it doesn't sound like you're job is on thin ice. Issues of holes in the MAR, not being able to leave on time and meds not given are issues in just about every LTC facility on the planet.

I also think it's normal for the DON/supervisor etc. to be auditing the MARs. It sounds like they aren't doing it to single you out, they are probably just trying to reduce errors facility wide. Every job I've had has had somoene auditing the MARS for holes.

All the issues you describe make day shift crazy...housekeeping, floor stripping, multiple carts out on the unit (and I'm ALWAYS in someone's way no matter where I try to position my cart!) but it can be done. I was also the "float" for over a year when I started at my facility. I covered other people's days off and was on a different unit each day I worked. It sucks! But it is doable.

Anyway, the best thing to do is what others have suggested, go over the MAR at the end of the shift with a fine-toothed comb. Even better if another nurse is willing to switch with you...a fresh set of eyes really helps.

[msn10]

You said that a lot of the other nurses are making mistakes/omissions too. Is there a problem with the MAR itself? There are always going to be distractions in health care environments but maybe you could offer some suggestions for improving the MAR.

Also, you are not on thin ice if everyone else is having the same problems as you are. Good luck!

[Scarlette Wings]

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.

it doesn't sound like you are on thin ice, more like they are trying to help teach you the things you need to focus on. so many places will just let you flounder like a fish and never tell you the areas you can improve on until they are ready to give you walking papers. it is hard to get and keep good nurses anywhere, but most especially in ltc.

hospise nurse had a great idea, switch your mars with someone and have them look them over after med pass. the pop-sign -pop-sign idea was another good one. i worked ltc for a few years right after my mom died and i would go over the mar with a fine toothed comb but ours were hand writen and added onto or not filled out completely sometimes. it was more of a challenge to document meds given than crush them up and give them. lol.

on another note:

kaplanstudentrn wrote: "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.....

please take this with all due respect.

mar's referes to the medicine administration record.

e-mar is an electronic medicine administration record in places that have computerized charting and med passes.

i would hesitate to confront management and "set the record straight" and i do understand how administration and management work. (been there and done that.)

management may actually be trying to help, not attack. i always want to know what it is i am doing wrong so that i can improve and fix whatever it is. i resent management that act like everything is just "wonderful" and will give you glowing yearly evaluations and then boom! here's your ticket for the door way out.

on the other hand i want the correction to be real, not "made up" or just because the manager is in a snitty mood.

[flashpoint]

I like the "pop-sign, pop-sign" idea, however...a lot of facilities have a policy that says, "pop-pass-sign," so make sure it is alright to sign it before you actually witness the resident taking it. I used to bribe the CNAs I worked with to check mine...they don't have to know what they are looking at, they just have to know where the initials were supposed to be. They found my holes and kept track of how many they found...after they found fifty, I had to buy supper for them. I checked their ADL book for hole and got to subtract from my total for every hole they left.

[kayern]

Absolutely sign as you go. Do not falsify records. If you didn't give it, don't sign for it. I don't care what your supervisor says, its your license, protect it, sign as you go.

We nurses take pride in everything we do and when we make a mistake it slaps us across the face and then we beat ourselves up for it repeatedly. Be careful, check and double check yourself. I have concerns that you state your halfway through your NP program and you're making med errors!!!!!

[Nurseinprocess]

Your post makes me grateful for the E-MAR system at my hospital. Everything is on the computer, the med turns red if it is late or not given. Beautiful thing! I still make myself a cheat sheet with a paper that has a label from each pt, I write next to that label what meds are due and what time at the beginning of my shift, usually before I even have punched in. I cross off the meds on that sheet when I have given them. I don't have 20-30, pts, though. I have no idea who's auditing my med administration or how often. When I can't get a med to scan and I have to click it manually I wonder if anyone's going to notice or care. So far I haven't heard anything from anyone . If you think your license is in jeopardy then maybe you should find another job, but if you feel you are just still trying to find your groove and figure out how to get the meds passed and documented correctly and as efficiently as possible then I would talk to other nurses you work with who are able to do it and see if you can figure out a better method for yourself.

[K+MgSO4, BSN]

If your workplace has a pop-give-sign policy mark each med on the MAR with a dot from your pen as you drop it into the cup. This shows you what meds you have given, give the meds and if they are all taken you can just sign over all your dots.

I really dont think you are skating on thin ice at all. It is probable that management is having a crack down on everyone about holes in the MAR. "Next month it will be how many pads that the residents are using each day and the linen bill the month after that.

[Nascar nurse, ASN, RN]

I'm management.. we audit for holes everyday. That's what management is responsible for..to make sure things are getting done according to state/federal regs. Just imagine what would happen if state would walk in and no one had looked to make sure things were done correctly.

Are you on thin ice...probably not. If you have any kind of a realistic boss, they will know these things happen and are really pretty routine. 1. I recently worked a shift & passed meds. They laughed at me for having a few holes and this was despite the fact that I did double check for holes at the end of the shift. 2. I only start getting angry when I appears that a particular nurse is not making any effort to correct the problems and despite having a consistent hall to pass meds on will have 20-30 holes every night.

Just work on fixing the problem and you will probably be OK. We encourage the nurses to trade books to double check. We are also starting to have the on-coming nurse flipping thru the book during shift report as a way to catch concerns.

[carolmaccas66, BSN, RN]

I had a horror shift like this on Saturday. I was pushing a very heavy med cart, looking after 50 patients and supposed to be supervising carers - I didn't know any of the patient's diagnoses cos the NH didn't write it anywhere, didn't get a proper handover, and didn't have time to sit in front of a computer to look up Dx. When I got home, I felt shattered to and that was only 6 hours work!

Anyway you will have to do what I do; stay back and check if all the meds are done. If even one med is missed here they ring you up and grill you like a crack army sargeant. I didn't finish till 9.30 pm last week and was supposed to be off at 9. I actually missed some 4pm meds cos I was so busy and the patients were being toileted, or weren't in their beds, etc. Then they complain they have pain later on! It annoys me when the cares know patient's need med's, take them away somewhere, and don't come and get you for them until the patient has got bad pain!

I don't know what a MAR is - can you enlighten me? Does it stand for medication something?

[cecilsgirl]

MAR ---- is a "Medication administration record", It is what you sign when you give a medication, its the "book" that you look at to give your meds, I guess I'm suprised some don't know that, or maybe it is called something else in other States??