[Kashia]

Any seasoned nurses out there, would love to hear what your routine is at your job. From beginning of shift....I am transitioning from acute care to long term care and desperately looking for pointers. Thank you

[TheCommuter]

I work 16 hour weekend double shifts every Saturday and Sunday at a nursing home. Here is my general routine, assuming that there are no codes, injuries, or anyone needing to be sent out to the hospital.

My shifts are from 6am to 10pm. At 6am I will receive a quick report from the offgoing nurse and count the narcotic drawer to ensure there are no discrepancies. Bewteen 6:15 and 7:00 I will set up 18 little medication cups (since I have 18 patients) with each patient's name and prepare the meds beforehand. At 7:00 I will obtain the blood sugars, and at 7:15 I will begin passing out the medications. At 8:00 I have to be in the dining room to monitor the residents and ensure no one is choking.

By 9:30 I have finished passing out all of the medications. Between 9:30 and 10:00 I administer the breathing treatments and dress wounds. From 10:00 to noon I use the downtime to study schoolwork, check the charts, or chat with my coworkers. At noon I obtain more blood sugars before monitoring the lunch feeding in the dining room. The noon med pass is extremely small and I usually complete it in 30 minutes.

From 12:30 to 2:00 there's more downtime to study for an upcoming test, do some leisure reading, or chat with coworkers. At 2:00 I will assign the oncoming CNAs a work assignment, and at 2:15 I do charting. From 3:00 to 4:00 I take a lunchbreak. At 4:00 I obtain blood sugars and do a small medication pass. By 5:30 I am in the dining room monitoring the dinner feedings. From 7:00 to 8:30 I am in the middle of a large medication pass. I obtain the HS blood sugars at 8:30. From 8:30 to 10pm I am making sure I haven't missed or overlooked anything; usually the last hour of my shift is downtime to read or study.

[geniann]

The Commuter did an excellent job of answering your question for double shifts- I work 12 hour shifts and do a few things differntly. I don't prepour my meds and I have 31 residents. I also am not required to monitor the dining room(which is great!). After the initial am routine (getting report,counting narcs, and stocking my cart) and then passing my 9am meds, which take from 8-10, I then look over my labs/x-rays and if the ARNP is not there I call the doc with any abnormals. I also answer the phone a million times and call pharmacy because there is always something someone is out of. After my 1100 accuchecks, I do any 12-1300 meds and then I do my treatments. I spend quite a bit of time talking with family either on the phone or in person. I try to squeeze my lunch in there but miss it quite often. After my 1600 accuchecks I pass my 1700 meds, which take me until about 1745. I then clean off my cart, wipe it down, empty the trash and stock it for the next nurse. Then I begin the tedious chore of charting.UGHThen I pass on the madness to the next nurse!!

[vonxojn]

When I would work the floor at the LTC facility, I would do 12 hours nights. Initially I would come in at 6pm get a 30 minute report on 31-35 patients for the night. Do narcotic count (which would take forever). Do my CNA assisgnment sheets and help pick up dinner trays. I don't start my med pass til 7pm. I don't pre-pull my meds because I don't want to make a mistake with having so many patients. Meds are not suppose to be left out and unattended, being I have a med cart to go from room to room. My med Pass usually takes from 7p-10p if I'm not stopped and depends on how many tube feedings I have. I then do treatments,and the dreaded medicare charting which is a B---ch!!!!! After all my work is done, I'll help my CNA's do their rounds. I have a lot of down time at this one facility that I do PRN work at.

[TheCommuter]

Originally Posted by vonxojn

I don't pre-pull my meds because I don't want to make a mistake with having so many patients. Meds are not suppose to be left out and unattended, being I have a med cart to go from room to room.

My 'pre-pulled' medications remain locked in my medication cart until I'm ready to administer them.

[Elektra6]

I work 3-11 shift, care for 30 residents on a mixed Alzheimer's, skilled nursing, rehab floor (yeah its a mess). Come on shift at 3pm (floor is usually in chaos) get report from offgoing nurse & unit manager, count narcs, stock cart. Start getting 4 pm blood sugars + 4 pm meds, continue giving 5 + 6 pm meds along with insulin coverage (residents eat at 5:30), try to take off some dr orders before dinner, go to dining room & help feed for 1 hour. Transport residents back to floor. Eat dinner for 5 minutes and take off the rest of orders. Start my night med pass for 8 pm meds around 7 or 7:30. Administer any treatments or wound dressings while patients are in bed (I know, don't interrupt your med pass but this is the easiest way to do it). Continue giving out meds until 9:30-10 pm provided do not have any problems. 10-11 pm, chart until next shift comes in, stock cart for them. 11 pm (or when the next shift comes in) give report and count out narcs. 11:30 clock out.

Sometimes I work days and it is the same only in reverse with 2 mealtimes and more treaments ordered. Jealous of you guys who have 12 hour shifts! With 8 it is hard to get all you need done.

Good luck, you'll get a routine in LTC and won't have to plan as much since the core of my residents don't change.