What Do You Think?????

Specialties Geriatric

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hi I'm new here but have been reading every ones post for all long time. I'm also in longterm care, most days I love it. I just changed jobs and wanted to know what every one thought about the 7p-7a nurse waking up residents at 4 am to give all of there routine am meds. this came about because the two nurses on this unit will not give meds and the cmt said it was too much work for her. we have 49 residents on this unit. we work 12 hr shifts. The 7p nurse is having to awken 15 residents every morning at 4 am to give any where from 5-20 routine meds that were being given at 7,8 or 9 am. these residents are being awaken enough, besides that many meds on an empty stomch? also what is every ones thought on an lpn working as a cna. several times a week we have a lpn that works passing meds from 7p to 10pm. Then she has to go the floor to work as a cna till 7am. she has her own group for 8 hours and gets her 6 residents up in the morning just like the cna. we are all protesting. not that is has helped, but several nurses quit and new hires leave. the nurses left are looking, including me. we all feel that it is only right to help answer lights and such as time permits. however we feel we went to nursing school to be a nurse. administration is telling us that we are still making the same amount of money just do what we are told if we want to keep our jobs. would appreciate your thoughts.

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Waking people up at 0400 is just stupid! But that is just my opionion.

Unless the nursing staff were warned that they would be expected to fill in frequently in the CNA role, I think it's unreasonable to have nursing staff split their job up like that. Many nurses go into nursing from being a CNA just to get out of the heaving lifting and don't feel that they could do that anymore. I will be the first one to step up to the plate and admit that I could not handle the constant physical labor that is required in the job description for the CNA.

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It is stupid to wake people up at 4AM but there are facilities that have one night nurse for 100 people.

It's more stupid for a facility to expect one nurse to pass out AM meds to 100 people.

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I worked at one facility for a very brief time that sounds much like what you're describing. I had an average or even less than average number of residents as compared to the other facilities I've worked at, but the med pass was absolutely horrendous. I had about 40 residents to medicate at 6AM and the majority of them had at least one full med cup to take. Some even had to have two med cups to hold all the pills. Of course these weren't just the normal AC meds. I am still amazed that anyone could take that many pills and it not really hurt them. This was the one place that I've worked that didn't have a med reduction policy after a resident gets 10+ med orders. It took 3 hours to pass them out and that was if you were able to get a good pace set. It isn't surprising to me that giving IM/PR Phenergan was a routine event in the early morning. I stayed at this hole for a whopping four weeks. I hate it being on my job history, but rather than regret quitting I only regret that I didn't leave the first week.

As for the CNA issue...I have worked at facilities that would ask nurses to fill in CNA spots if the CNA staffing was really bad. This has always been fairly rare as the facilities don't like having to pay the nursing wages. I don't know of anywhere that has forced nurses to work as CNAs; I don't think they should be able to as that isn't what you were hired for. Sometimes we'd have more nurses than we absolutely had to have, but not enough CNAs and they'd ask for volunteers to work the floor. Personally, I'd always jump at the opportunity because when you worked as a CNA you weren't expected to keep the regular nursing responsibilites. I found it to be a really nice break, but then I don't mind the lifting and bed changing. Some of my nursing co-workers did have reasons that they didn't want to function as the CNA. I respect that and think it should always be their choice.

I totally disagree with management expecting you to do both. That is completely unrealistic. They need to figure out if they need a CNA or if they need a nurse. I answer call lights and such when I can, but most of the time I am racing along trying to get everything done for the morning. In today's LTC the nurse has more than enough tasks assigned to keep her busy for the entire shift without trying to squeeze an extra person out of her.

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Specializes in PeriOp, ICU, PICU, NICU.

I'm not a nurse so no real advice. Just want to welcome you aboard. Good luck. :)

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What about quality of life issues...like SLEEP. I'm sure the ombudsman or state would love to here of this. It is just down right mean to wake people up at 4 am to give them meds because it is a convinience to the nursing staff. If the daylight nurse won't pass meds..um that is her job. Management needs to deal with this. Are the meds timed this way on the MAR? How many day nurses are there? 2 nurses should be able to pass meds for 49 residents. We have 48 and do meds, treatments etc. This is just so absurd. I'm sure not one of these pts woke up at home to take all their meds at 4 am.

As far as the LPN working as a CNA..Does she mind? Does your staffing regs allow for it or when she is a CNA are you short a nurse? That's the only problem I see. Heck...I would love to be bumped down..Yep I'm sure I'd be sore and feeling it the next day, but it would be a nice change and I'm not afraid to get my gloved hands dirty:p

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Thanks for every ones opinion. Yes the meds are timed at 0500 in the mar. The night nurse must start to pre set meds about 0330. then we give them between 0400 and 0500. this is in addition to our many g-tube meds also. On 7 am to 7pm shift there is 2 nurses and another nurse or cmt for meds. this for the whole unit of 49 residents. There is no reason the nurses can't pass meds. the other side of the building has the same amount of residents and staff. one hall of meds is passed by the nurse while the other nurse does the skilled assessments. Mangement has been approached, they will not change any thing as to not upset "dayshift". It is sad. i worked days there and found that I had several hour on my hand to help the med nurse. For the sake of my residents I felt like I had to contact the state ombudsman.

as far as pulling a shift as a cna none of the nurses I work with mind, including myself. However management is sending our third cna home at 10 pm instead of letting her work till 7 am. this makes no sense to us.

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I work in a facility with 44 residents and the one day shift nurse comes in at 6am and passess all these res. their meds at breakfast and it is not a problem.

Unfortunately some of our night shift employees get up people at 4am, but usually there are 2 or 3 alzheimer's res. that are already up wandering who get dressed first. Then they get up the rest of the people who are confused and not aware of the time, many of these people also go to bed between 7and8pm also so they are still getting 8 hours of sleep, although interrupted a couple times, then they take naps after breakfast and lunch.

When I first became an LPN I worked many night shifts as a CNA, and I really loved it because it was like getting a really long orientation, I felt a lot more comfortable having another nurse there and not being the only nurse in the building. (we staff one nurse and 1 CNA on night shift.) since graduating from RN school, I haven't worked many nights at all and only twice as an aid, some nights I prefer to be the aid and have less responsiblity.

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Specializes in Gerontology, Med surg, Home Health.

I'd love to hear more from the person who worked at a place with a med reduction policy if the patient took more than 10 meds. We have one lady coming in tomorrow who routinely gets 31!!...and one nurse practitioner with many of the LTC residents whose motto is "better living through chemicals"....I agree with you....please, if I have to be an old lady living in a center...DON"T wake me up at 4am to give me pills!!

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I would definately be concerned with possible drug interactions with so many medications being given at one time. Aside from the fact that some are best taken with food.

It sounds like this facility is only concerned with having a body that just does as its told without question.

It does bother me to see LPNs utilized as CNAs, because I see this happening where I live. Many LTCs will only hire LPNs as CNAs in the area I live in (Canada) and pay them the rate a CNA would make. According to the College of Nurses of Ontario, if a LPN/RPN is hired as a CNA, when it comes to accountability, they will be held to the same standards as an RPN/LPN would be. Alot of LTCs take advantage of this fact and hire LPN/RPNs as CNAs and then have them work as LPN/RPNs.

Kudos to you for involving the state ombudsman, I'd like to know the results of that.

Best of luck Clorinda

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Just wanted to say thanks to everyone for your opinion. I know there is no perfect place to work, however I just felt like some of the residents where I work at are not being treated the way they should. That is why I had to contact the state ombudsman. I don't know what, who or how this agency works. All I do know is that next week all of our department heads and supervisors are meeting to discuss the early am med pass. The night nurses have tried several attempts to discuss this with administration with no results. I am glad for the meeting. Perhaps something will be done so our residents won't have to choke down meds at 4 am.

This is a "GREAT" forum. Everyones knowledge, thoughts and experience so welcome and refreshing.

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Just wanted to say thanks to everyone for your opinion. I know there is no perfect place to work, however I just felt like some of the residents where I work are not being treated the way they should. That is why I had to contact the state ombudsman. I don't know what, who or how this agency works. All I do know is that next week all of our department heads and supervisors are meeting to discuss the early am med pass. The night nurses have tried several attempts to discuss this with administration with no results. I am glad for the meeting. Perhaps something will be done so our residents won't have to choke down meds at 4 am.

This is a "GREAT" forum. Everyones knowledge, thoughts and experience so welcome and refreshing.

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