To stay or not to stay

[shlay51]

I just finished my 3rd day of orientation at a new job. It's in a nursing home which I have previous experience in. However, this nursing home doesn't do anything on the computer, which I was okay with up until today. My last place of employment was all computerized, MARS, TARS, nursing notes, etc. This place has none of that. With that being said one would think that there would be all kinds of checks put into place to make sure that meds were written correctly, treatments were written correctly, etc. There aren't. The only check that is done is the nurse calling the MD to verify the med orders before writing them out. So there is still a huge risk of them being written wrong and multiple med errors occurring. At my old facility ALL orders were double checked by two nurses before any treatments were done or meds were given.

I'm uncomfortable knowing that there is a risk that I could harm someone unintentionally because orders/meds weren't written right or checked. I feel like I will need to check everything a million and one times just to make sure that everything is okay (and we all know there isn't usually time to do this). The DON has told us a couple stories of things that have gone wrong with meds and that legal action as been taken, which kind of scares me. The facility itself is great, it just that aspect of it really bothers me and I don't know if I want to put myself in a possible bad situation. I'm actually considering looking for a different job because of all of this.

I had intended on staying at this job for a year or so because it was my foot in the door to the state that I just moved to. All the hospitals that I applied for in this state told me that once I moved down to reapply. I'm assuming a lot of this had to do with the fact that I was living out of state, which I understand. My question is, do I have valid concerns and would it be a bad idea to try and find a different job that actually implements checks to ensure that orders/meds are put in correctly before my administered? I'm just trying to cover my own ass and I only want the best for the people I am caring for.

[Multicollinearity, BSN, RN]

I do not work LTC. That said, I do not automatically believe that systems in a healthcare environment must be computerized for care to be good. In my practice environment we do not have anything computerized except a database for current prescriptions. We do not have a second nurse double check meds like insulin. We just don't - often because only one RN is on the property or at a particular location. Surprisingly, problems are few and far between. When I first started at my job, coming from the hospital, I felt disoriented and like I landed in 1980. Then I adjusted and found that everything actually worked.

Do you think you are just adjusting to a new way of doing things? Do you see quality problems? I know you mentioned the legal action from a couple med errors, but every facility will have its skeletons of mistakes. It's just a matter of how many skeletons or how bad.

[nurse2033, MSN, RN]

Get yourself a quick drug reference guide, I use Epocrates on my iPod touch (it's free at epocrates.com). That way at least you will know the safe range of dosages, even if they don't match exactly a MD order. It only takes a few seconds to use and I use it all the time.

[shlay51]

I'm good at adjusting, so I don't think that is really the issue. I'm also pretty open to trying things a different way. When I say double check the meds, etc I meant once the orders are put in, not every time before the med is given. It's a one time check when a person is admitted. I also don't believe that everything has to be computerized for the care to be good, there can be mistakes even with them.

I will be on the floor training starting next Tuesday so right now I can't say if there are quality problems since I've spent the majority of the last 3 days in a room, but just hearing about all the med errors that have occured and the legal action that has been taken on some of them freaks me out a bit.

[Morainey, BSN, RN]

I would stay. It's only your third day. See how often these mistakes actually happen, and then you can re-evaluate. As far as meds go, I always carry the Nurse's Pocket Drug Handbook. It only takes a second to find what you need, and it's small enough to fit in a scrub pocket.

They might have been trying to hype things up to scare you too.