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?

[msn10]

I also think you will be hard pressed to find a NP or even a doctor who does not make mistakes, I don't get the shock and head shaking over a nurse practitioner student making mistakes. Being a np doesn't mean you are flawless by any means. We find md and np mistakes more than once in awhile.

It is okay nursep2b. Deep breath, and release.

Okay...you are going to make mistakes now and in the future. I applaud the nurses who admit their own mistakes and support you with their kind words. If someone kicks you when you are down, then maybe following their advice is a bad idea.

Like I said before, maybe the MAR needs to be revamped or you can talk to you co-workers to come up with a solution. Just you posting on this thread tells me you care about your job and your profession and you are courageous to ask for help.

As someone who owned their own business for years, I can tell you that management will see things that no one else sees, but that is not your problem, it is theirs. I loved when my employees came to me with ideas, as long as they weren't totally negative about their wishes.

For example "This is the stupidest process ever. Who was the idiot who came up with this?" Isn't quite as effective as "You know, I have noticed a problem with X and a few of the other nurses are also discussing it, could we trying do Z instead? LEt me show you what I am thinking." Guess what employee I am going to want to deal with?

Just try to do the best you can and if your manager is not open to new ideas, then maybe it is time to look elsewhere. I know that is difficult right now, but you have to make sure you can comfortably work there, otherwise, you will make even more mistakes.

Good luck.

[msn10]

double post

[carolmaccas66, BSN, RN]

I defy anyone on here to put a post saying they have never made a med error, or any other error, or have not nearly made some sort of error.

I am agency and I see mistakes all the time & alert the NM or whoever is in charge that day. But because the staff are permanent, nobody is ever sacked or made to be held responsible. It all seems to get swept under the carpet.

Esme12 we all know meds are very important. But have you never ever nearly even made a mistake, or felt so harrased you did make one? It also depends where you work - a busy surgical floor might be different from say outpatients for example. Depends on staff-patient ratios etc also.

And Drs do make mistakes all the time - I know many nurses who have picked them up on their errors, but of course no-one does anything about it. I mean for example, how many of you get frustrated and angry because the med chart is perhaps not signed, it is illegible, you ask for a new med chart to be written up 2 days b4 the old one expires and it doesn't get done, etc. I could go on, but the point is we do check meds again & again and we can still make errors, because it just gets so incredibly busy. Nobody on here is probably a bad nurse, just stressed and harrased, and definitely overworked.

Maybe the whole culture of nursing and how meds are done needs to be looked at and investigaed.

And those old med carts are impossible to push around - heavy, clunky things that are always disorganised and messy cos no-one has the time to re-organise them or tidy them up. They should all be got rid of - I hope I never have to push another one ever again.

[jkaee]

Yes, I was a little insulted at the assumption I can't see the bigger picture.QUOTE]

Ok, I lied, I will say one more thing....

I was not making any assumptions about "floor nurses" not seeing the bigger picture, nor was I singling anyone out. The OP stated she was a fairly new nurse who was still in school going for her NP. When I was a newer nurse, I didn't see the "big picture" because budgets and all that goes along with determining a budget was not something that we learned in school. I was simply trying to explain a different side of the whole situation, as well as try to give her some advice to decrease med errors/holes in the MAR.

I see a lot, and I mean A LOT of defensiveness on these boards lately, and I can see why a lot of the "old timers" don't post on the general boards a lot, if at all.

[Esme12, ASN, BSN, RN]

It's especially frustrating when you're trying to pass morning meds and therapy whisks your patient away, sometimes for the whole morning. We nurses do not have time to chase patients down when they are not on the hall. It's also hard for everyone not to show their frustration as the hallways are constantly packed with not just employees but patients and wheelchairs, you literally cannot walk through the mess, we're all on top of one another. The carts are a mess, too. So much time is wasted looking for things. The meds are in drawers, and scattered around the cart. This is a place with two kinds of staff; those who stay a short time and those who have been able to stick it out awhile. I really think this is the kind of job where there should basically be the same nurse assigned to one or two halls. A lot of the patients are high acuity (dialysis, brittle diabetics, etc) and there is just so much to know about these people and their needs.

There are also a lot of errors due to miscommunication. Doctor's appointments are frequently missed because someone failed to arrange transportation or sometimes the ambulance will show up and there will be nothing on the appointment book about any appointment (I suggested a case manager to the boss people after I noticed this. Guess it isn't in the budget).

Sometime's, I have wondered if Mcdonald's owns the facility because they are running the place like a fast food joint. I've gotten attached to the patients and feel like I could like it there, but it's hard to swallow the finger-pointing and criticism after you've spent most of the 12 hour shift running your legs off, sweating and really trying to see your patients have been taken care of. The bosses will acknowledge floor work is exhausting and can be very difficult but in the same breath berate you and make you feel like...you're skating on thin ice.

Welcome to healthcare!!!!!!!!!!!!!!!!!! If you can't stand the heat get out of the kitchen! I have made med errors....but thankfully,very few because I am an over achiever and I have a deep sense of the heavy reponsibility of the tasks at hand. That I hold someone's life in the palm of my hand. I check and re-check......over and over and over again.............I do skip that break and when I did smoke I'd skip that smoke, I would chase the patient down the hallway to be sure they got their meds. Multitask? that term had a whole new meaning when I became a nurse.....NO ONE said this was an easy job because IT IS NOT! I have a lot of concerns the longer I read this post. Getting an advanced degree will only increase your work load, not lighten it. Your responsibility to "GET IT RIGHT" will increase tenfold.......You will be prescribing drugs! If you make mistakes giving them............how will you prevent mistakes prescribing them? I think you maybe a little frustrated with a lot on your plate.:redbeathe Family, school,work......but From a manager's point of view I am responsible for my staff. I will check up on the staff to be sure to get it done right because I am responsible for the staff, patients,and the saftey of all involved. If I see someone struggling I would be remorse to ignore that the patients are not recieveing the proper care in a safe enviorment. I too would let a nurse know if she missed meds....wouldn't you? It is my responsibility to be sure everyone is giving the best quality possible:nurse: Electronic delivery will someday come.....bar code is the best was to avoid errors but you still need to check and re-check. In a court of law when you are being sued for improper medication administration, negligence, malpractice, and delay of treatment that caused an adverse outcome.............the excuse you are busy, the hallway was crowded, or the place was unsafe and blaming everything else will not absolve you of blame and responsibility. I hope you carry malpractice insurance. If in fact the problem is with the facility.....maybe you need to look for another job. If it is truly that bad you are placing yourself at risk of losing your nursing liscence because if another reasonable and prudent nurse would find it unsafe...so should you. There is always an anonymous phone call to the board of health or Joint Commision. I am sorry that this sound harsh but I am really passionate about patient saftey and timliness of care especially after recently living a waking nightmare when my father was ill.....:redbeathemiss you Dad:crying2:...If you heard a nurse saying this post to another nurse and your father mother or child has not recieved their meds :crying2:and they were not getting better

What would your response be to that nurse?

What would you do?

How would you feel?

Just curious....

[Esme12, ASN, BSN, RN]

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.

If they are doing this. Something and someone is on their back. Something happened and they are trying to bridge the gap. They are counting pills because they are bored:idea:

[Esme12, ASN, BSN, RN]

Yes, I was a little insulted at the assumption I can't see the bigger picture. As a matter of fact, I have worked as a part of administration in a small LTC facility but left because I felt guilty taking a paycheck.

Double and triple checking yourself is great but there are only so many hours in the day. I had someone in the floor today and that set me back a good hour. The bottom line is that in a LTC setting continuity of care through having the same nurses on the same floor is imperative to reducing and eliminating errors as much as possible. To the newbie who could never imagine not giving a med...I think you may be in for a rude awakening. No one is immune to med errors, I don't care who you are.

I also think you will be hard pressed to find a NP or even a doctor who does not make mistakes, I don't get the shock and head shaking over a nurse practitioner student making mistakes. Being a np doesn't mean you are flawless by any means. We find md and np mistakes more than once in awhile.

To accept that there will be errors and there is nothing wrong with that, I find appalling! and sad. To accept that it is going to happen......So Whatever:rolleyes: Frightening. Yes mistakes happen but that does not mean you stop trying. I strive for perfection and accept (begrudgingly)that I am not perfect. I accept that I am fallible but refuse to accept defeat! I have made mistakes in the past THIRTY years and thankfully I have never hurt anyone nor have I EVER repeated that same mistake twice!

The first rule in medicine is DO NO HARM!

Not DEFICATION OCCURS!

[Esme12, ASN, BSN, RN]

Yes, I was a little insulted at the assumption I can't see the bigger picture. As a matter of fact, I have worked as a part of administration in a small LTC facility but left because I felt guilty taking a paycheck.

Double and triple checking yourself is great but there are only so many hours in the day. I had someone in the floor today and that set me back a good hour. The bottom line is that in a LTC setting continuity of care through having the same nurses on the same floor is imperative to reducing and eliminating errors as much as possible. To the newbie who could never imagine not giving a med...I think you may be in for a rude awakening. No one is immune to med errors, I don't care who you are.

I also think you will be hard pressed to find a NP or even a doctor who does not make mistakes, I don't get the shock and head shaking over a nurse practitioner student making mistakes. Being a np doesn't mean you are flawless by any means. We find md and np mistakes more than once in awhile.

Being a Nurse Means...

You will never be bored

You will always be frustrated

You will be surrounded by challenges.

So much to do and so little time

You will carry immense responsibility

And limited authority.

You will step into people's lives

And you will make a difference.

Some will bless you,

Some will curse you.

You will see people at their worst

And at their best.

You will never cease to be amazed

At people's capacity for

Love, courage, and endurance.

You will experience resounding triumphs

And devastating failures.

You will cry a lot.

You will laugh a lot.

You will know what it is to be human

And to be humane.

Melody C.

AMEN:twocents:

[Esme12, ASN, BSN, RN]

I did not mean to post like crazy.........this really hit a nerve