slow med pass? am I really being unreasonable?

[inthesky]

I work a combination of day and evening 8 hour shifts. I worked an evening 3-11 shift last night with a night nurse who is a straight-up bully. For those kindly reading all my posts, she is the same nurse who nearly got me fired for handing injections to her to give to a psychotic scared unwilling patient. She told me in a very authoritative way last night before med pass that I need to speed up my pass. This is extremely offensive to me because I'm the med nurse and this is my only little domain of autonomy. I go over the meds very carefully and especially the new ones. I ask about effectiveness. I ask about their day. We sometimes go over what they are going to talk to the doctor about. If they discharge the following morning, this will be my last exchange with them! Also, nearly every patient gets a good deal of meds and wants additional PRNs so that adds to the time.

It usually takes me no more than an hour and a half to pass the night meds plus PRNs to 15 patients. This includes the patients that don't come to the desk and I have to hunt down (usually about 5). Is this really that slow? Is med nurse supposed to be a nursebot pill dispenser? and maybe it is selfish, but I derive some personal enjoyment and job satisfaction from this pass. Is that so wrong? and I get everything done!! I leave work on time with everything done! and I even help the night nurse with charting! This nurse has alluded to wanting me to speed up so I have the time to do even more of her charting! She probably also doesn't like to hear me talk and sometimes makes faces and will interrupt me to correct me in front of the patient or to tell me what she wants the patient to have. Night med pass is done right beside where the night nurse is sitting. During the morning, there is a med room (box) and I am alone.

I told the nurse "ok" and walked away to do something else because I was so angry that I was about to say something that would get me fired. Hell..I am on such thin ice here that she might even get me fired for appearing like I might have been angry. NP school in the fall or bust.. I can't take much more of this.

[DesertKat]

The only problem that might really arise is being out of compliance for med times. Something that is, frankly, a bit of a reality for psychiatric nursing at times. But if you are consistently out of compliance and creating med errors, then learning how to be more timely might be good for you. But just interacting with the patients and answering their questions in and of itself isn't a problem.

From what you describe, my only concern would be regarding the med time window. Other then that, you appear to be doing what a med nurse is supposed to do- interact with patients, answer questions and assess efficacy of the medications prescribed.

[Whispera, MSN, RN]

Are you within your med time window. If so, try to let her remarks roll off your back. It's awesome that you talk to the patients during med pass. I'm proud of you for that.

[RochesterRN-BSN, BSN, RN]

When I worked inpatient psych we all passed meds for our own patients. We didn't have a med nurse. So it's hard for me to help a whole lot. I guess they used to do it that way on that unit but had changed because the nurses assigned to the patients didn't feel like they had the whole picture...they were charting and didn't have any clue what meds the patient was on, didn't give them, and so on. They decided it was safer to have one nurse do all the care. The only thing I could say you might try if you need to cut down the time is to maybe keep the chat with the patients limited to assessment of any issues specifically related to the meds....so this can be relayed to the primary to be charted, the doc if need be and so on. How the patients day is going and that kind of thing--though certainly a nice thing is what the primary should be taking the time to sit down to talk to each patient and find out how things are going, how he/she is feeling, and so on...an assessment. Honestly this more indepth interaction with the patients....being the one responsible to help a distraught, upset, angry or out of control patient--doing the de escalation..... that is what I enjoy so I wouldn't like just passing the meds.....I like doing everything for my patients. A more all inclusive kind of care. that is just me.

Good luck and keep your chin up -- I gotta figure nurses like this nasty one you are dealing with will get what they deserve! lol What goes around comes around right?!?!

[inthesky]

It is slightly out of the window, but most of the meds any med nurse passes are slightly out of the window due to the sheer numbers of patients. All meds are usually passed by 2130. I usually pass my first night meds at 2015 due to the patient schedule and having to shlep all the patients upstairs (2 story unit). *I actually have improved my speed within the last few months. Amazing what practice does!*

I actually prefer the split patient model as well and did that at my first job. It makes for better continuity of care and instead I feel like I have 15 patients. By my second shift.. i usually know all patients and their treatment plans, goals, and meds (or that is my goal). I'm probably wandering out of 'med nurse' scope. I love pharmacology, but I feel like my nursing ambition and talents are being wasted sitting in a med box; I didn't go to nursing school for that.

That nurse has actually gotten her karma. She fell off a ladder and really messed up her knee. She was out of work for months and still have pain and future surgeries. As much as I don't like her, I felt pretty bad for her. and I'd feel really bad if she fell off another ladder *sigh*..but she is such a bully.. I wish I didn't work with her.

Thank you all so much for listening and supporting me as I post over and over again. It is helping me a lot in keeping my strength to survive this job with my principles intact.

[wonderbee, BSN, RN]

Our med window has just been cut in half to one hour total. We work on the med nurse/charge nurse model with MTs out on the unit. The med nurse has up to 15 patients. To do it within the allotted time, that comes out to just over 4 minutes per patients. So other than pills and insulins, other treatments such as dressing changes, creams, hanging fluids, forced injections and let's not forget delivery of meds to patients rooms, etc., the task cannot possibly be handled within the one hour time frame. Addtitionally, our med window cannot accommodate more than 1 nurse at a time and we have 2 teams of 15 patients.

On the other side of the coin, patients safety is being stressed with a particular eye to med errors. We're being told to "take your time". I can't stand it. I'm going to scream.

[Whispera, MSN, RN]

...feel free to scream prn!

[inthesky]

Aren't you already preparing to leave that job? I hope you do. :trout: I think those expectations are not only unfeasible, but cruel.

[wonderbee, BSN, RN]

Aren't you already preparing to leave that job? I hope you do. :trout: I think those expectations are not only unfeasible, but cruel.

Yes, I have applications out. But until something clicks, I just have to deal with it.

[Meraki]

It does seem slow to me but I'd rather you be slow and right then fast and make med errors.

I used to work on a very busy acute psych unit. We had a one hour (30 mins either side) window to work in. I did meds for 18 patients - and the med pass would take me between 30 - 45 minutes. If there were a lot of new orders or new admissions then sometimes it took the better part of the hour. None of our patients some to a window so I had to track them down all over the unit. Even more of a deadline was that a therapy group started at the 45 minute mark so you pretty much had to get them done before group started. I'm a bit of an adrenaline junkie so I liked the fast pace of that unit.

If the only issue you have with being slower is that someone is being a bully about it then I would say ignore her and do what feels right to you. Now if you are outside the window or not able to perform your other tasks and people have to wait or pick up slack because of being slow then you might want to take some time with a NICE mentor who does meds faster and see what strategies they use to get the work done.

Is it possible (if you do actually need to be faster) to just do the med pass with basic questions and then come back and chat later about their day when you have the time?

[Mr Ian]

If there was a game on TV we all wanted to watch I've knocked out a 20 pt pass in about 15 minutes.

The patients had to help out a lot - like shout out what they were on and I'd not have to keep checking the prescription charts. :icon_roll

Sometimes I'd even get the patients to run the meds to other patients save me getting out the pill room. :uhoh21:

When it was a good shift tho I'd have all the pills ready just after dinner so I could give them all out in one go by lining all the patients up - that took 20 mins to prepare and about 3 mins to give them all out.

Perhaps ask your nurse manager if you can do any of those things to try speed up your med pass?

Or perhaps I'm being to cynical?

Don't do any of those and keep your license instead.

I like the way you do your med rounds inthesky - that nurse is task totally orientated and, while there's a place for being task focussed - it should be on things that don't involve direct patient care. As soon as you involve a patient in the procedure the emphasis moves to patient-centred.

[Whispera, MSN, RN]

I've been thinking about the OP's style awhile and think that you might irk the boss or those you work with if you're slow in med-passing, BUT you're caring for the patients in a very very therapeutic was, and I applaud her! Way to go, inthesky!