VENTING HERE !!! I’m frustrated with the general group of people I used to work with. I love nursing, and am SO thankful I’m from the ‘old school’ of nursing. I still have my license even though I’m disabled, because it means something to me. I worked hard for it. And it was my main identity for the 20+ years I was able to work. We still had to do things that are done by machine now, but actually had to DO them ourselves (vitals, handwritten charting, doing our own orders, etc- no techs or CNAs in most hospital jobs when I started… on an acute neuro floor, I had 14 patients on the night shift). IV pumps weren’t used much- we had to count the drops with our wristwatch, and know when the bag was due to run out BEFORE it did, so we didn’t risk a line clotting off. We didn’t have pulse ox monitors- so we had to look at skin color, and other symptoms, and then call the doc to see about getting ABGs done. Older nurses get mocked, but we did a lot with much less mechanical help. When something breaks down, who knows how to improvise? When I graduated, I had to test urine to determine how much insulin to give. Blood sugar monitors were not common, and even in hospitals, an entire floor (neuro and OB/Nursery in my situation; NICU got their own) shared the monitor when they first came out.
But my major beef when I go to the doctor’s office now is the lack of understanding and interest in medication proficiency when the nurses review my meds with me. It’s a huge part of their job- and yet pronunciation is abysmal, and knowing what the meds are for is worse.
I am constantly stunned at how few nurses I encounter are able to pronounce the names of medications, and know the generic names of brand drugs. It’s appalling. I graduated from an ADN/RN program in 1985, and in order to do so, our entire class (standard practice in all nursing schools I knew of back then) had to memorize brand and generic names of ALL meds our clinical patients were taking, the reason for the meds, usual doses, side effects, SPELLING, etc.- and hand write them on index cards, which were checked by our instructors- no boxed sets of cards from the bookstore. No apps. An index card and pen, with a drug reference book was our ‘app’.
Take some pride, dear nursing students- and full-fledged nurses! Make yourselves sound like you have the education you paid for
(generally too much, if you started with some big school). Don’t stumble over the names… learn how they’re pronounced. Ask. Sound like you’re in command of any medication review, or at least go look it up later if you don’t have to give an unfamiliar med yourself- then look it up before. For hospital and nursing home nurses, know your patient base, and get familiar with the most common meds. Generic, brand, what they look like, etc. I’ve caught the wrong meds in those bubble cards in nursing homes more than once, just by knowing what they normally look like. And hospital pharmacies aren’t perfect…. know what you work with ! Sometimes it’s just a new supplier. Don’t be afraid to call and clarify something, or send it back to the pharmacy to be double checked. If you give the wrong med, it’s on YOU. Nobody else.
I’m at medical appointments more often than I care to think about because of multiple disabling diagnoses, and a routine part of each appointment is reviewing my current medications. I have to keep track of two types of insulin, and around 10 ‘scheduled’ prescriptions, and more OTC meds that I take routinely. Then there are the routine supplements and many PRN meds- prescription and OTC (that’s ‘over-the-counter’). And I can pronounce all of them, in their generic and brand forms. It’s not rocket science. It’s medical literacy. It’s also the JOB of any working nurse who has to review or give medications. How do nurses make notes about new orders if they can’t spell the name of the meds? When checking meds against MARS, how do they know FOR SURE they’re giving the right med, if they can’t pronounce or spell the names ? Or do you just figure you can look it up later and hope for the best? Never stop actively learning (not just hearing things passively). 😉
When talking to the hospital pharmacy, do you know the difference between Xanax and Zanaflex? Do you know which one is tizanidine and which is alprazolam? In an emergency, do you know which one can be reversed with Romazicon (flumazenil) ? Or do you need a few minutes to go check, as the patient’s respirations drop to the point of needing intubation, when knowledge of the meds (and knowing where they are in the crash cart or emergency box) could save time and unnecessary procedures ? If not, you really are not competent to give or review medications. If it’s a weird med, or something given for a condition that isn’t common where you work, then ask the patient. They might not know- but you might learn something if you take a few minutes after work to look it up. Patients can be huge resources with oddball meds.
Nobody can know every last medication out there- there are times when reference books (or apps… I liked actual books when I was working) are absolutely needed and a necessary part of being competent and conscientious. But the medications that are commonly prescribed for various conditions typical to your work environment should be part of any nurse’s engrained memory. If you work neuro, know the meds for epilepsy, Parkinsons, MS, CVAs, increased ICP, etc. If you work pediatrics, know the general ‘rules’ for Tylenol and ibuprofen, and the different code meds that should be posted in the patient room with their weight and appropriate doses. If you work drug and alcohol rehab, know the meds needed for ODs, detoxing, and what symptoms to look for during withdrawal for the various categories of drugs. You should be able to pick up on mistakes- including those given to you when taking or checking orders. I’ve had to call doctors back, and verify doses, when they just didn’t seem right when I was checking orders. Especially when working in pediatrics, geriatrics, and with patients with renal insufficiency or outright renal failure.
I learned the most about brand/generic information during the time I worked in nursing homes (so don’t squawk if you have to take a job in a nursing home- you will learn medications in such a way that you will be better in ANY nursing job you have later on). I learned about the fragility of doses in pediatrics- and how to dilute meds to give the precision doses required of a 2kg newborn. I always double checked my calculations with another nurse, and the pharmacy (we had a pediatric pharmacist available at all times, which was wonderful- but not having that is not an excuse to double check doses). And, never to give any dose to any patient if it just didn’t seem right.
In general med-surg nursing, I learned about how IV drugs should be given safely (so if you think that you’re wasting time in a med-surg job instead of your ‘dream position’, consider it what your nursing school didn’t teach you- after you have to complete an ‘internship’ that didn’t exist 30 years ago). Don’t skip the saline flush before giving the IVP, even if you know it still has saline in the lock from the last flush- you don’t know for SURE it’s patent- things shift, and meds can HURT if they go into the tissues. My dad complained about his IV site for 2 days when he was given nausea meds, and there was never a saline flush before the med- just after. It wasn’t an overt ‘blow’, but it wasn’t patent in a normal way. He was treated like he was clueless about his own pain during the medication administration. SAS(H) is still protocol in any place I’ve been (check your facility P&P Manual). Don’t be lazy. Meds that are pushed through infiltrated veins hurt (yeah, I said that before). Take a couple of minutes to do it right. It takes much less time to check patency than it does to clean up a patient and full bed change from the nausea med never getting a chance to work, and the patient puking his toenails up. And some compassion? That will go a LONG way.
If we didn’t know the information that made us ‘floor ready’ by the time we were to graduate, we didn’t graduate. Period. Very simple. Our orientation was ‘here are the narc keys, there’s the bathroom, here’s where you punch in, and good luck’- as the off-going nurse snickered. If I was lucky, the ADON was still around until about 6 p.m.- after that, I was the only R.N. educated person in the BUILDING of 150 nursing home residents (I had the skilled wing of 30 by myself for 3-11, and another 30 dementia patients if I worked a double on 11-7). Three to four days tops for orientation back in the 80s. A couple of weeks in the 90s, and then ‘babysitting’ for 6 friggin’ weeks with a preceptor in the 2000s, because nobody trusted that someone with a license actually knew what the job required. Very sad. I had a nice preceptor who ‘got it’ that the job there wasn’t my first rodeo- and it was nice to have someone paid just to be a resource for me (my main ‘needs’ were: how to call a code, how to deal with the abuse cases and social services when a parent visited a kid who’d been on the news for being beaten or burned, and dealing with the general procedures for dealing with new orders, which docs are user-friendly, etc). Very sad to see the need for internships; when nursing schools do their jobs, nurses graduate with enough knowledge to not need internships. Most places have a skills checklist that has to be completed to a respectable degree before being turned loose, but those were pretty basic. Nursing school used to teach us how to not kill someone on purpose- and be safe upon graduation. Boards weeded out the rest. We still had things to learn, but we could take care of a patient without a babysitter. Now many schools are for-profit institutions that really don’t care about your education or if you did or didn’t learn something… it’s on you to be the best you can be. Some schools are better than others- and some still care, but it seems that actually doing procedures has gone the way of the pterodactyl.
The entire six weeks I was inpatient for leukemia (on neutropenia precautions, so isolated), not one student nurse ever did anything but follow my assigned nurse around. Most didn’t speak. When did this happen? We were giving meds the second week of class (with supervision) and added any procedure from catheters and NGs to IVs and wound care as soon as we got patients who needed them. Hands on. School should teach you that !
Technology is a great thing. It’s great to be able to look up various disorders and meds, but it should never be a replacement for actual knowledge. Passing boards in 1985 meant getting at least %60 of 1000 questions (ONE THOUSAND) correct (which I thought was horribly low- that’s a ‘D’ percentage-wise), during a two-day, four-part hand answered test (little boxes were filled in for computer scoring). There was no ‘luck’ in getting 75 questions right, and then getting a license. We had to get 600 or more questions right. It took about 3 months to get results. And the next chance was 6 months away if you blew it. Three tries, and back to school if you couldn’t figure it out by then. The way it should be. Competence… not laziness with looking something up, and then forgetting about it. When someone is crashing, there’s no time for the internet or computers. You need to MOVE, and do it right. Knowing meds is a huge part of that.
Have you been the only nurse at a code on a neuro floor who knew to ask the doc running the code if he wanted a Foley inserted BEFORE giving mannitol? (and why?). Then have him ask YOU what the dose should be? Have you HAD to find an IV site in a vein as proximal to the heart as possible, to give adenosine to a 13-month old who went into SVT, and had crappy veins- and knew WHY it was important to get that vein so close to the heart? Have you known how long D50 lasts after giving it for hypoglycemia (and that every patient is different, both in how fast their sugars come up- and drop, and how ‘low’ they can be and still take something orally instead?). Do you know that D50 is unpleasant, with a warm, ‘gotta pee now’ feeling? Do you know that D50 will wear off before the cab gets there to take the patient home from the ER if you don’t give them some protein to stabilize their blood sugar? If you work on a floor where someone can code, could be diabetic, have reactions to meds, etc., YOU need to know the possible meds you may need to help them, and anticipate what the doc may order. And anywhere you work, there is the possibility of someone having multiple medical conditions and medications. All medication knowledge is valuable.
Do you know that the elderly can have paradoxical reactions to things like diphenhydramine? Or that they can even get delirium from meds like cimetidine? Or that they are not great candidates for most psychotropics, because of reactions, as well as fall risks? Do you know that benzodiazepines that are discontinued abruptly (in anyone who has taken them regularly, but with even smaller doses in the elderly) it can very likely lead to seizures? Do you know what meds are benzodiazepines?
Maybe things are overall better than I’ve encountered, but with my own experience with more than one doctor’s office and more than one nurse, the medication knowledge is poor. Nursing communication websites also talk about how nursing school glosses over a lot of things. Get the pronunciation right. Know how to spell meds, and what they’re for- even if just a ballpark idea. READ your nursing medication reference books (or apps). Know what to anticipate if you have a 12 week pregnant 15 year old with diabetes, kidney failure, and constipation after an appy… what will you do if you get an order for Milk of Magnesia from the doc on call, if you forget to mention that she has renal problems? Will you question orders for NSAIDs if she has any type of pain?
Newbies, NEVER let someone rush you into giving something that you have questions about. New nurses who don’t ask questions are very scary beings. I’ve worked in staff, charge, supervisory, and department head positions (with an ADN). And my first question when I was in charge or supervising, when asking the current nurses about any newbies, was if they asked questions or not. IF they didn’t I was following them like white on rice.
Be proud of being a nurse. Knowledge is power, and it will never be anything but a benefit. It will make you a more valuable employee. And respected by your peers and supervisors. Patients also hope that you know at least as much as they do about most of their meds. 🙂
OK. Done venting. It’s 6:30 a.m. and I haven’t been to bed yet… I’ll come back and be my own grammar warden later on 😉