Advice and tips needed- New to LTC & mid-night shift Advice and tips needed- New to LTC & mid-night shift | allnurses

Advice and tips needed- New to LTC & mid-night shift

  1. 0 hello fellow nurses,

    i am so elated that i got the rn job offer to a new facility and next week be starting the orientation. i am new to ltc and be working 11-7 shift. .....definitely, i will have lots of coffee or tea. :d

    please give me some tips, advice and all your knowledge - greatly appreciated :redpinkhe. i'm getting a bit nervous and been browsing about meds, treatments and some nursing procedures....... thanks.
    •  
  2. 14 Comments

  3. Visit  jnrsmommy profile page
    #1 5
    Wow, there's so much to cover on that.

    1. Work load wise, how many pts are you going to be responsible for? There aren't that many meds scheduled through the first half of the shift generally. Mostly prns. If your facility does your thyroid meds early, then you will have those to pass, and w/ LTC, that's A LOT of people (our facility, we have approval from medical director and pharmacy that they can be given at 4pm). You will also most likely have morning blood sugar checks/insulins to give.

    2. Paperwork wise, get to know your facility paperwork. LTC generally chart by exception, meaning anyone on antibiotics, any falls/incidents/skin tears. If you have medicare pts, they are charted on every shift. Learn what paperwork is required if you have to send someone out or if an incident has occurred.

    3. Treatments generally don't happen, most are just q shift creams that need to be applied. I know some nurses will pass that on to the aides, I don't like that habit. If there's something there, I want to see it.

    4. Over the course of a few shifts (mine took me about 2 weeks total), make up a cheat sheet for your residents. Diagnosis, code status, allergies, meds/treatments, any equipment, oxygen, etc. I kept that list with me at all times until I became familiar with the residents.

    5. Ask your aides about the residents, they can tell you sooo much. Make sure to go behind them and check that their work is being done. (I know I'm gonna get flamed for this). You are new to them, you don't know them, they don't know you. A good aide is worth their weight in gold tenfold, but you won't learn that sitting behind a desk. My aides are my right and left arms, but they know that I do periodically mark briefs/pads to make sure they are being done.

    6. If this is not a normal shift for you to work, make sure you get your uninterrupted rest during the day (cannot stress that enough). There is usually a down time during the night when you become tired (I'm a night owl, but 0330-0400 still catches me sometimes), get up and walk around. Also, do not let yourself go w/o eating/taking a break.

    There's loads more that can be said, but I hope this at least helps you some.
  4. Visit  bethann27 profile page
    #2 2
    I would just add to the previous post to remember to treat others as you would like to be treated. Your support staff can make or break your night & the quality of care given. Also, DON'T UNDERESTIMATE THE IMPORTANCE OF HYDRATION FOR YOURSELF.

    LTC is very stressful @ times, but also one of the most rewarding areas to work. Good Luck
  5. Visit  GirlnextdoorRN profile page
    #3 0
    Hello jnrsmommy and bethann27,

    Thank you very, very much for your advice and tips!!!!...Your support really means a lot me. Being a foreigner and trying to figure out how everything works here in the US is such a big challenge and I am so grateful that I still have good support here and it really means a lot to me.....Yes, I was a CNA before and I know how it can get overwhelming sometimes, but still I believe with good team work, doing the job right the first time and with lots of communication within the staff......Again, thank you very much.....I will still bug you for more advice and tips, if that's okey?
  6. Visit  Forever Sunshine profile page
    #4 1
    11-7 is the best shift to work. (Work wise, not sleep wise). Most residents are sleeping most of the shift. (I said most.. some nights.. everybody will be jumping out of bed).

    If you have a 6am med-pass(you probably will).. start it EARLY! I don't mean 5. I mean 4am. If you are feeling tired, or have alot of charting left to do.. start some at 3:30, then finish the rest at 5, so you don't get behind. So this way when 7-3 comes in you can count narcotics asap and go home.

    Delegate creams to the CNAs, they do changes twice a night. It makes no sense for you to do a treatment, and then the resident gets changed. Coordinate this with the CNAs, if they are the worlds greatest. they already know to ask you for the creams.

    Have tons of patience with 3-11. We get so much dumped on us and we have a very overwelming shift.
  7. Visit  GirlnextdoorRN profile page
    #5 0
    Soooo sooo happy getting information from you fellow nurses and I'm taking notes as my guide.

    Monday I will start the orientation and right now, I'm having palpitations barf02:....mixed emotions....Part of me say, 'do you think you can do it?' and then the other side will say, 'you can do it!"....Keep learning and ask questions......Is this normal?

    I may sound kinda stupid but I have to ask, what important questions during orientation that I needed to ask?.....(I will be asking for the facility's policy).....Need some hints.

    Do anyone of you have spreadsheets (for cheat sheet) so I can be organize and have a good time management. Hope I'm not asking too much.
  8. Visit  CoffeeRTC profile page
    #6 0
    I second the PP suggestions but would also recomend going with the CNAs and instead of following them and checking up help them out with a few pts. Maybe those with the wounds or creams. You get your assessment done and you work with the CNAs as a team.

    As far as the med pass in the am.....it can be brutal. I have to disagree with the poster that said start at 3:30 am (sorry). I worked the 11-7 shift for quite a few years so I get it. Honest. But if you would try to wake me up at 3:30 in the am to give me my prilosec or synthroid...you better do it from the distance cause I will be hitting you. If the pass is that heavy..there are other ways around it. A good bit of our meds like that were put on the 9pm pass. They were getting meds anyway.

    Good luck.
  9. Visit  Forever Sunshine profile page
    #7 0
    Quote from michelle126

    I have to disagree with the poster that said start at 3:30 am (sorry). I worked the 11-7 shift for quite a few years so I get it. Honest. But if you would try to wake me up at 3:30 in the am to give me my prilosec or synthroid...
    Know your residents.
  10. Visit  GirlnextdoorRN profile page
    #8 1
    hello fellow nurses!!!....i'm now working on my own. it was overwhelming one time, but i know i will survive. made some cheat sheet and during my shift, made notes for my residents that need accu check, treatment, med pass and those that had their specific time to when they will wake up and shower. i'm learning and will not stop learning. my body is still in shock, at least i was able to sleep well today.....tips for nutrition, healthy supplements and etc - greatly appreciated!.........


  11. Visit  Forever Sunshine profile page
    #9 0
    Quote from girlnextdoorrn
    hello fellow nurses!!!....i'm now working on my own. it was overwhelming one time, but i know i will survive. made some cheat sheet and during my shift, made notes for my residents that need accu check, treatment, med pass and those that had their specific time to when they will wake up and shower. i'm learning and will not stop learning. my body is still in shock, at least i was able to sleep well today.....tips for nutrition, healthy supplements and etc - greatly appreciated!.........


    good to hear you are surviving.

    i've been doing weight watchers for 3 years and starting their new points plus plan. its very friendly for those who work nights, as we can have fruits and vegetables for 0 points.

    so this weekend instead of bringing pretzels i will bring fruit. around 3-4am i get nauseous (for some odd reason every time i work that shift) so i have ginger ale. during my 6am medpass i have a special k smoothie.

    i don't remember if i told you this in my last post but start your medpass early. know which residents you can sneak in and give meds to at 4:30am.
  12. Visit  joanna73 profile page
    #10 0
    I am also new, now on my own at night. I like night shifts, but in general, there is so much to learn. We have 30 residents. I find the med passes take a long time (2 hrs) since they are completed by one RN. So far, I am enjoying LTC, and caring for seniors.
  13. Visit  Hoosiernurse profile page
    #11 0
    Quote from dajulieness
    Good to hear you are surviving.


    I don't remember if I told you this in my last post but start your medpass early. Know which residents you can sneak in and give meds to at 4:30am.
    I will sneak in some hand held nebs at 4:30AM so they are not in my way when I pass the 6AM's, but our facility doesn't let us start before 5AM with 6AM meds, so I'm stuck there. It hasn't been a problem, really, because the pass is light and I get it done within the hour and still end up taking a few people to the bathroom or getting someone dressed. It all works out.

    Cara
  14. Visit  gentlegiver profile page
    #12 4
    On the 11-7 shift, the first thing I did after report, go thru your MAR, flag all meds due during your shift, (I always put the 0000-0300 med page sticking out the top & the 0301 - 0700 to the bottom). Saves time and allows you to see any changes that may have been made. Also find out if there are any specimens that need collecting during your shift, UA & BM specimens can be collected when the CNA's do thier rounds, (why keep waking up people when you don't need to & they need to rest?). Do the same for your TAR, you never know when they schedule a treatment on your shift, better to find out at start shift than end shift.
    If your CNA's can, let them apply creams, if not ask them to let you know when they will be working on a pt, this is also a good time to do any VS you may need. Most faculities have a 0000 med pass then again at 0600, I always started my Med Pass at about 04:30, pts are starting to wake up (due to most going to bed at 19:00 or right after supper) I usually do straight caths first, then Nebs, then meds, if a BS is required I do them last and save thier meds to be given when I do the BS. Get to know your pts, some will refuse meds if offered before 0530, some would rather get thier meds when the CNA's come in for rounds so they can go back to sleep.
    I start charting after 0300, if I still need to enter BS or VS I flag the chart so I remember which ones I have to go back to. If anything should happen (a fall, or other emergent situation) you can always chart on that pt again.
    After my 0000 med pass I restock the cart, empty water from the pitchers & fill with ice which I then put into the freezer, this way I don't have to run around at next pass to get it done. By following this schedule I was rarely late for clocking out. If possible (if you have time) maybe do a treatment (or 2)for the 7-3 shift if you know of any that need to be completed before the pts get OOB, the day shift will LOVE you for the help! Good Luck & God Bless!
    Last edit by gentlegiver on Feb 9, '11

close