By Carrie Mortrud, RN
“MY BRAINS” or what I used to call my Assignment Sheets. Oh, how I wish I would have kept you all in a binder or folder or something so I could look back and recall how crazy some of the shifts were. Of course, I’m talking about the old pieces of paper, doubled sided that many nurses used to carry around in our scrub pockets to keep track of everything we were to get done in our shift. This was long before electronic medical records. Specifically, I remember writing down the times medications were due for each of my patients during my shift.
On a day shift, in the box or section titled “meds” I would mark down 08, 10, 12 and 14 which would remind me my patient had meds due at 8 and 10 AM, 12 and 2pm. These sheets were an easy way for us to do a quick check to see if we were on course, on time, keeping up, and remembering everything. I wish I knew how many times I had to cross off the time listed on my sheet at the beginning of the shift and make adjustments so when it came time to chart I would know what time I actually gave the medication late. Administering medications late were and probably still are one of the most common occurrences when staffing is short. I would bet there wasn’t a shift where that at least one of my patients’ medications were administered late.
Delays in medications are just one of the negative patient outcomes that results from short staffing. This includes scheduled medications, which means those that are time sensitive and it includes pain medication. A recent survey found that 42 percent of Minnesota nurses said that patients experienced unnecessary or prolonged pain because not enough staff were scheduled to attend to medications and other needs on time.” In addition to the needless suffering the patient endures from extended unrelieved pain or slow recovery from an infection, think about the administrative time nurse now spend on medication reconciliation and making adjustments to scheduled med times so that it truly reflects in real time when the patient received their meds.
In nursing school, Registered Nurses are taught to follow six “rights” in administering medications: right patient, right medication, right dose, right route, right documentation and right time. Unfortunately, low levels of RN staffing mean some of these rights can be neglected when nurses are busy treating other patients. On one shift in 2015, staffing was so bad that patient’s heparin drips ran dry, nurses were unable to chart, turns didn’t happen at their prescribed time, and nurses did not have time to answer tab alarms—safety alarms to alert staff that a patient who needs assistance while up has gotten out of bed alone.
In the past year, MNA nurses documented 883 instances of patients receiving delayed medication. These delays cause unnecessary pain and delays in other areas. Recently, a patient was forced to wait one hour and fifteen minutes to have an IV inserted so that she could receive pain medication. Because of this, testing was also delayed because there was no IV access. The patient was so upset she was in tears and unable to speak to the IV RN. During the same shift, another patient was forced to wait four hours for their IV placement to receive fluids ordered by their doctor.
When nurses talk about medication delays in hospitals and nursing homes they are not referring to patients waiting for Tylenol for a headache. It means antibiotics to treat infections were delayed and sometimes missed altogether. Blood thinners were postponed and delayed putting patients at risk for clots. Pain medications post-surgery were delayed leading to unnecessary suffering or heart medication was not given on time which could lead to problematic heart rhythms or high blood pressure. Administering medications is a fundamental function of nursing care. It’s ridiculous to think we have to fight and argue to try to get more staff so that nurses can complete this basic yet critical aspect of their job.