Then the nurse rationalises the decision and the doctor agrees. It may lead to increased freedom and flexibility when performing tasks, but may also lead to less structure, less use of guidelines, checks and regulations. Then you feel more responsible as a nurse, because you have to lead the way somehow, and that is not how it should be, Medication administration perceived as complex by RN’s, Takes on more responsibility than necessary. Nursing home surveys are conducted in accordance with survey protocols and Federal requirements to determine whether a citation of non-compliance appropriate. In general, barriers in medication monitoring scored the strongest. Data collection was performed by a single researcher with a nursing background, which may introduce bias. Evening shifts, night shifts and weekends were often reported as vulnerable depending on workload and status of the current patients. The freedom to ask colleagues for help during medication administration is reported as crucial by most staff members and depends on a shared understanding of the situation and that all staff members report on their location at all times. There are three nurses in the nurse station, allocating tasks at the start of the morning shift. Figure 1 illustrates the balancing act of safe medication administration documented in the study. This discussion served to vent frustration, to reflect on recent events, but also to discuss and delegate patients and specific tasks among the staff members. The teams were formed so that professions complemented each other with the aim of always having a nurse on all shifts. If they considered the doctor to be “weak,” they compensated by taking on tasks that were not theirs initially. The law of requisite variety states that WAI should be as complex or varied as WAD, meaning that one should strive to increase the knowledge and competence of the staff to enable them to cope with unforeseen activities. Fundamentals of Nursing, Medication Administration, College of Southern Maryland. The relationship with co‐workers is illustrated in the following excerpt from an interview with a nurse assistant: Both nursing home wards reported staff levels to be adequate during the day shifts on weekdays. Examples of additional tasks could be how the nurse offered to take on documentation tasks belonging to the doctor (transcribing), merely to ensure that this was done. Recent reforms have led to increased collaboration between primary care and specialist health care. Right patient. In cases where the doctor had strong opinions and openly discussed the patients with the nurses, they were included and empowered. Medication administration errors (MAE) may occur anywhere along this chain and cause an adverse drug event (ADE; Carayon et al., 2014; Choo, Hutchinson, & Bucknall, 2010; Odberg et al., 2017; Smeulers, Onderwater, Zwieten, & Vermeulen, 2014). The study underscores the importance of first‐hand knowledge of the clinical setting before implementing interventions or enforcing any organizational changes. The Norwegian Social Science Data Service (NSD; No. 2. An excerpt from an interview with an MD follows: The managers seemed aware of the inadequate resources that inhibit competence development in the staff, placing them between a rock and a hard place. The NA’s acknowledge the nurses’ workload: Although the staff are supposed to update on the patients on their own by reading from the electronic medical record, they also had an informal roundtable discussion before commencing each shift. After each observational session, all notes were transcribed and expanded on while the memory of the events was clear in the mind. 1. Medication management is a strategy for engaging with patients and caregivers to create a complete and accurate medication list using the brown bag method. (717) 697-3223 info@KeystoneElderLaw.com Facebook Assigning the task of medication administration to the CMA allows for the nursing staff … The nurse role is highly regulated, but the unpredictable nature of healthcare systems often forces RN’s to improvise, to find workarounds and adapts to the conditions offered by the current situation (Lindblad, Flink, & Ekstedt, 2017). No data from the pilot study were used in the current study. “Patients and tasks are in fact assigned in advance, but we sit there during the time of the report and distribute tasks and patients among ourselves as well. The interview guide was constructed in line with observational findings and from elements in the work system in Human Factors theory (Carayon et al., 2006). Nursing homes experience increased pressure to receive more patients needing more complex active medical treatment, compared with a few years back (Syse & Gautun, 2013). Experiences and findings from the pilot study resulted in a more detailed observation guide and interview guide. At other times, the nurses make changes or adjustments themselves, based on observations and patient needs and inform the doctor on a later occasion. The leadership and style of management seem to affect how the staff perform and delegate tasks. NURSING HOME SAMPLE POLICY & METHODS Drug Administration POLICY: All medications are to be administered only as prescribed and only by licensed medical or nursing personnel. 45389) approved the study. One nurse (IRN‐C) said during observations that “when it is busy we prioritise medication to the patients most needing it.” At the same time, several stated that they like working when it is busy since it gives them a feeling of higher self‐worth. This duality gave rise to the nurses compensating for how the doctor behaved. The interviews were digitally recorded and lasted from 30 min ‐ 1 hr. Check the medication label. The first author then coded openly in the margins of the transcribed material, extracting meaning units pertaining to the research question. A stable staff also know the patients and can work more efficiently and may provide better care. These categories reflect an intrinsic ability to confront and adjust to a dynamic and challenging workday. Nursing facility residents have special care needs that in many cases require more intensive medication management and alternative forms of medication administration. When the staff know each other’s skills and competencies and trust each other, there is less need for communication to coordinate medication administration tasks. An example of analysis is shown in Table 1. The medication administration process is not to be taken lightly. There is limited funding to send staff to courses and conferences and maintaining competence largely depends on personal initiative. Keeping up to date is an individual responsibility, IRN‐D Yeah…internal education, we have some of that. However, they are trained in-house to handle medication in general and the robot packages in specific. How do community health services receive the increased amount of patients submitted from hospitals? Many tasks during a shift are indirectly care‐related or related to medication administration; these are perceived as administrative tasks. Working off-campus? A lack of task redundancy often resulted in task vulnerability, and medications or treatments sometimes had to be postponed or were interrupted. Individual adaptive behaviour manifested itself in the degree of flexibility nurses exhibited about the medication administration responsibility and how they compensated for the other staff members. I started out as an NA, which I appreciate. Situations observed were noted between sessions, while excerpts from relevant conversations between staff members were written down verbatim immediately. METHODS: 1. If they considered the doctor “strong,” they let the doctor handle things as they stood. If we have a nurse on that shift, she will have the final say. Symbicort or other inhaled steroid combo is given with patients having respiratory issues with Covid-19. Check the order. Findings in the current study document this complexity and elaborate on how the staff and particularly the RN’s … In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of medication administration in order to: Safety Challenges in Nursing Homes: Medication Administration. These areas are on an individual level (Need for Competence and Shifting Responsibility), team level (Leadership and Available Competence) and organizational level (Staff Stability and The Vulnerable Shifts). The two nursing home wards included were intentionally different, to provide a broad picture of the nurse role in medication management. Most observations took place in the daytime shift and a few on the evening shift and opening hours of the night shift. That is not okay. ™u’Åı¶$œ;?¡ÈO—Dì�mp/ä;Y$ç'Ø}û=È~�ñgô *h[°8²Ñ«�ozF�Evè,ã.mÖÜ_[DhÊ\_Â˜`q‰Ú i?¡PWêÌÕ Staff stability and shared mental models are often recognized as a key factor to ensure safe care in healthcare environments (Salas & Frush, 2013). The use of specially trained CNAs in nurs… One nurse manager described it in an interview as: Some shifts may experience staff lacking the competencies to administer certain medications. The first author collected all the data in two nursing home wards in Eastern Norway. ôöşpQ £ùÑ$TıÂÜæé±n¹?ßûªj²Ky²Ë•ŸıøÛpkV"ÎYvSæhÎãm}1D`U>âO€ Betc endstream endobj 32 0 obj <> endobj 33 0 obj <>stream Due to the complexity of medication administration, the acknowledgement of MAE’s in primary care and the essential role of the RN, the objective of this study was to expand knowledge of the nurse role during medication administration in the context of nursing homes. Everything has consequences if we are not thorough in following up. Human Factors focus on the interaction of the elements in the sociotechnical work system and how people perform processes in this system (Carayon et al., 2006). H‰. Nurse managers had indirect control of staff allocation and task delegation in that the staff often made their own decisions and planned contrary to prior assignments. The nurse managers were in charge of the team composition on the individual shifts, distributing staff across the various shifts, weeks in advance. We continuously receive new guidelines relating to medications, with new demands on documentation. Consequently, some shifts end up being vulnerable. I feel that I lose control and when Monday finally arrives, I send a silent thanks that everything went well.”. In nursing homes, medication errors are one of the most common types of mistakes made by staff members. 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