Issue link: https://digital.copcomm.com/i/1130164
Working Nurse l WorkingNurse.com 17 In that moment of eye contact, no words were spoken, but we both knew: ◗ What I was doing was wrong. ◗ I would not have time to administer all medications according to protocol during my shift. ◗ She did the same thing when passing meds on this unit. ◗ We would never talk about it. THE ABOVE IS A TRUE STORY, a memory I have of several years ago when I was working as a per diem RN in a long-term care facility that was chronically understaffed, with a pervasive culture of blame. I started that job with the knowledge and skills necessary for safe medication administration, which every nurse learns in school, and I had every every intention of following those safe procedures. As I went through orientation, I began to notice that while my fel- low nurses could demonstrate the correct protocol, many had short- cuts they followed when busy — and they were always busy. They didn't talk about those shortcuts. As I graduated to a charge nurse role and managing my own med cart and unit, I still attempted to follow protocols. Sometimes, I'd start out a shift doing everything by the book. Then, someone would fall, or we'd get a new admission or a nurse would go home sick. That meant I'd be extremely late with some meds while accruing lots of overtime, which was frowned upon. Soon, I was getting messages that I needed to work smarter to get out on time. I was told that if I needed help, I should contact the supervisor. Of course, the supervisor was typically just as busy as I was and not really available to help. I felt trapped between a rock and a hard place. Over time, it became clear that staffing throughout the facility was so lean that you could pretty much bank on someone calling out or leav- ing early due to sickness or some sort of emergency. This meant con- stantly pulling staff from one unit to help cover another. I can't even remember a shift there that felt like a reasonable workload. I tried to adjust to these expectations and be a good employee, team player and patient advocate. More than once, I even expressed concerns about staffing to the director of nursing, but my worries seemed to fall on deaf ears. Gradually, I found myself taking shortcuts more and more.