Ask the nursing expert: Juggling 'one more thing' syndrome

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Ask the nursing expert
Ask the nursing expert

Q: At what point can directors of nursing say, “Not one more thing!”?

A: I am sure you are asking in reference to being asked to do “one more thing.” With the onset of MDS 3.0 and training, stricter oversight, etc., management system changes, budget cuts, and more and more frequent visits from the corporate office to evaluate “how we are doing,” this is a tough question to answer.

Someone once said to me, “The more you do, the more you will be asked to do.”

I ask myself, every now and then, where I draw a line in the sand between doing a “good” job and doing a “job.”

Make a list of all of your responsibilities and compare it to your job description and see where you stand. Just be careful of the line item that states “and any other tasks assigned by your supervisor.”

I get very frustrated at times with my nurses who do not understand the importance I place on proper documentation of medication administration. How do you think that this area of practice is best handled?

This is a longstanding problem. Nurses are interrupted during med pass, many residents have multiple kardexes, and sometimes nurses do not go back and double-check their documentation at the end of the shift.

My nurses aren't perfect, but I do insist on trading their MARS and TARS at the end of the shift, to review each others' kardexes. The checking nurse can then flag any concerns. You can do that for a month and then if you see the same issue occurring at the end of the first week of the next month, I would recommend that you begin progressive discipline.

Do we really want to surround ourselves with nurses who either miss giving medications or don't sign for them?

Please send your resident care-related questions to Sherrie Dornberger at