Hopefully helpful advice!

[WittySarcasm, BSN]

I know there are several of these out there. But as I have just hit my year's experience (yay! No longer am I a new Grad nurse) I thought I would share what I have learned. Especially since I went the backwards way by being an agency nurse (they were the only ones that after almost two years of looking would take me with no experience). Therefore I had to self teach myself some of the stuff because I was never trained. And so I wanted to share what tricks I found to help make my job easier.

1) The first thing I learned is to always ask questions. When you are new- whether it be a new grad or new to the place- you won't know everything about the residents. What you may think is abnormal you will find to be normal. And vice versa. So the best way to learn is to ask questions. And don't just ask other nurses. Ask the aides too. Believe me they know so much medical stuff. It may not be in their scope of practice but they do know when to give breathing treatments or ivs or what is normal or abnormal for the resident.

2) After report, ask the other nurse for just a quick rundown on how each resident takes their meds. This will make it faster if you know if the person needs crushed meds. Or if Resident A only takes meds with crystal lite. It saves laps and lets you get the meds ready before you walk into that room.

3) Take a breath! You have gotten report and how they take their meds. Now before you freak and flutter through the med book like crack head trying to get their next hit, take a deep breath. And remember that the first hour of your shift the meds are most likely done. For example if you do the 3-11 shift, the 7-3 nurse has most likely done the meds, just like how you will do the 11pm meds before you leave. So for that first hour you are ok. Instead of running around take this time to figure out when you have meds to pass.

Here's what I found that works for me, however everyone has a different way of doing it (some mark pages, others use sticky notes). What I do is on the report sheet I take a different color (like blue or something) and I write in the times that meds are due. I will stand there and take an extra 10-15 mins and write down any times that fall between 1500-2300 (including those times) in blue on my report sheet. Or if I don't have room, I will grab a scrap sheet and write the room numbers and then write the med times. This way you save yourself numerous trips.

4) Now this one may not be as wonderful as a tip but it will save you stress. Remember you have an hour before and an hour later for meds. So a 1700 med can be given between 1600 and 1800. So just because it's 6pm when you finish your 5pm meds, you are fine.

5) Along with the above one. Try to group some of your meds together. Working at a LTC you will get meds almost hourly. I've had residents that have meds at 4pm, 5pm and 6pm. Instead of making three trips, if it is not too much try to give the 4 and 6pm meds at 5pm. Experience says that it most likely will be one or two meds for each hour. This will help save you odd trips. There will still be an odd trip alone, for one pill at a odd time, but you will reduce it a lot.

6) When you have the time to- in a break or something (you can also do this when you do your med times)- do the same thing with your TARS that you did with your MARS. Most treatments are just the shift (7-3 or 3-11) however there are some that are timed. But even if it isn't timed, just write on the report sheet- treatment, in the same color as your med times. This will help you remember who needs treatments and keep you from frantically flipping through the book.

7) Charting is usually by exception. Meaning antibiotics or abnormal findings or mental problems or things like that. For antibiotics the most simple charting should be something along the lines of "Vitals for this shift are- (vitals). Resident on (antibiotic name) for (why they are on it). With no adverse reactions noted." As one of my bosses stated at orientation- When a resident is on an antibiotic I want to be able to look into the chart and read the vitals, what antibiotic and why, and if there was any adverse reactions from it." If you want to chart more, chart based off of the reason for the antibiotic. For example if it's a UTI- does the resident have burning? Is the urine clear? Does it have an odor? And as you get to know the resident- do they seem "off" mentally? Sometimes that's the only symptom. If the resident has a foley look at the bag to see if it looks ok.

8) For rounds, do a fast walk around before meds. Remember that first hour, so if you take 15 mins to write down MARS and TARS time on your report sheet. That gives you another 45 minutes to do a quick walk around. Just look in on your residents. Check and see if they are breathing or in any pain- bring your report sheet with you. The report sheet will give you the PRN time of pain or anxiety meds, give a time that they can have the next one. This way they know you have not forgotten them. Also this quick round will let you at least put a name to a face. Because really those pictures NEVER look like the resident!

9) You will not be as fast as the other nurses who have been there for years. At first you will be running either late or just barely on time. Don't worry, it's normal! I promise. There are still times I run late and have to stay behind and finish charting.

These are just some things I have found to help me. They are in no way the exact way to do nursing. You may find your own way. But these are the ways I have found that are helpful.

And remember to do as what you would want done on the cart! When you come onto a cart would you like it cleaned, stocked, and the meds for the first hour of your pass done? If so then do it back. Clean and stock your cart before you leave. And just grab the 11pm meds with your 10pm pass.

[j621d]

Another tip: take your lunch/dinner break earlier than the others. It will free up the last part of your shift, giving your more time.

[NaKcl, BSN, RN]

Remember to drink and use the bathroom. That is very important.

[Esme12, ASN, BSN, RN]

OP>>>>well said!

[Forever Sunshine, ASN, RN]

One tip I learned tonight..

Don't **** off the CNAs.

It wasn't me who ****** them off so I didn't learn that the hardway.

[CapeCodMermaid, RN]

Congratulations on your first year! Your suggestions are wonderful. Just one more from someone who has been doing this forever....when you get the chance to take a break, take a BREAK. Get off the unit, drink some water, take a walk outside. Please don't use your break to catch up on paperwork. Take a lunch break as well. Yes, we're all busy and sometimes feel the need to stay on the unit, but it's better for you and your residents if you get off the unit and relax even if it's only for a short amount of time.

[tewdles, RN]

Stay calm...

[Havin' A Party!, ASN, RN]

... Take a lunch break as well...

Yup. This is important, as it's illegal to not do so, per labor board regs. Management should insist on it, if for no other reason, because of the potential liability.

Thanks everybody for sharing your tips.

[tiroka03, LPN]

Good for you. You sound like you have really learned your stuff. I wish I could have heard from you when I first started nursing. I was a wreck. Thank you for sharing your list, even us old timers can learn from you.

[Chin up]

I know there are several of these out there. But as I have just hit my year's experience (yay! No longer am I a new Grad nurse) I thought I would share what I have learned. Especially since I went the backwards way by being an agency nurse (they were the only ones that after almost two years of looking would take me with no experience). Therefore I had to self teach myself some of the stuff because I was never trained. And so I wanted to share what tricks I found to help make my job easier.

1) The first thing I learned is to always ask questions. When you are new- whether it be a new grad or new to the place- you won't know everything about the residents. What you may think is abnormal you will find to be normal. And vice versa. So the best way to learn is to ask questions. And don't just ask other nurses. Ask the aides too. Believe me they know so much medical stuff. It may not be in their scope of practice but they do know when to give breathing treatments or ivs or what is normal or abnormal for the resident.

2) After report, ask the other nurse for just a quick rundown on how each resident takes their meds. This will make it faster if you know if the person needs crushed meds. Or if Resident A only takes meds with crystal lite. It saves laps and lets you get the meds ready before you walk into that room.

3) Take a breath! You have gotten report and how they take their meds. Now before you freak and flutter through the med book like crack head trying to get their next hit, take a deep breath. And remember that the first hour of your shift the meds are most likely done. For example if you do the 3-11 shift, the 7-3 nurse has most likely done the meds, just like how you will do the 11pm meds before you leave. So for that first hour you are ok. Instead of running around take this time to figure out when you have meds to pass.

Here's what I found that works for me, however everyone has a different way of doing it (some mark pages, others use sticky notes). What I do is on the report sheet I take a different color (like blue or something) and I write in the times that meds are due. I will stand there and take an extra 10-15 mins and write down any times that fall between 1500-2300 (including those times) in blue on my report sheet. Or if I don't have room, I will grab a scrap sheet and write the room numbers and then write the med times. This way you save yourself numerous trips.

4) Now this one may not be as wonderful as a tip but it will save you stress. Remember you have an hour before and an hour later for meds. So a 1700 med can be given between 1600 and 1800. So just because it's 6pm when you finish your 5pm meds, you are fine.

5) Along with the above one. Try to group some of your meds together. Working at a LTC you will get meds almost hourly. I've had residents that have meds at 4pm, 5pm and 6pm. Instead of making three trips, if it is not too much try to give the 4 and 6pm meds at 5pm. Experience says that it most likely will be one or two meds for each hour. This will help save you odd trips. There will still be an odd trip alone, for one pill at a odd time, but you will reduce it a lot.

6) When you have the time to- in a break or something (you can also do this when you do your med times)- do the same thing with your TARS that you did with your MARS. Most treatments are just the shift (7-3 or 3-11) however there are some that are timed. But even if it isn't timed, just write on the report sheet- treatment, in the same color as your med times. This will help you remember who needs treatments and keep you from frantically flipping through the book.

7) Charting is usually by exception. Meaning antibiotics or abnormal findings or mental problems or things like that. For antibiotics the most simple charting should be something along the lines of "Vitals for this shift are- (vitals). Resident on (antibiotic name) for (why they are on it). With no adverse reactions noted." As one of my bosses stated at orientation- When a resident is on an antibiotic I want to be able to look into the chart and read the vitals, what antibiotic and why, and if there was any adverse reactions from it." If you want to chart more, chart based off of the reason for the antibiotic. For example if it's a UTI- does the resident have burning? Is the urine clear? Does it have an odor? And as you get to know the resident- do they seem "off" mentally? Sometimes that's the only symptom. If the resident has a foley look at the bag to see if it looks ok.

8) For rounds, do a fast walk around before meds. Remember that first hour, so if you take 15 mins to write down MARS and TARS time on your report sheet. That gives you another 45 minutes to do a quick walk around. Just look in on your residents. Check and see if they are breathing or in any pain- bring your report sheet with you. The report sheet will give you the PRN time of pain or anxiety meds, give a time that they can have the next one. This way they know you have not forgotten them. Also this quick round will let you at least put a name to a face. Because really those pictures NEVER look like the resident!

9) You will not be as fast as the other nurses who have been there for years. At first you will be running either late or just barely on time. Don't worry, it's normal! I promise. There are still times I run late and have to stay behind and finish charting.

These are just some things I have found to help me. They are in no way the exact way to do nursing. You may find your own way. But these are the ways I have found that are helpful.

And remember to do as what you would want done on the cart! When you come onto a cart would you like it cleaned, stocked, and the meds for the first hour of your pass done? If so then do it back. Clean and stock your cart before you leave. And just grab the 11pm meds with your 10pm pass.

You did learn a lot in one year. Your advice was excellent and how it has to be done in order to finish your shift! You sound like a seasoned LTC nurse and now have the ability to run ANY floor. I too went from school to agency, my reasons was the money. (yep, I said it). My first 7 years out, I was doing med-surg as an agency nurse in all the major Boston hospitals. It wasn't as difficult, because I always found a mentor to take me under their wing. I think they felt bad for me, but I learned sooo much! After 7 years and wanting to be closer to home, I entered LTC as an agency nurse. How I did what I did, I will never know. Looking back, I was crazy and would not recommend this path, to anyone. But because I had to learn in secret, I did. And eventually got so good, facilities would call and request me or my agency would send me first, when they got new accounts. I tell you this, because self teaching gives you a whole other set of skills. It wasn't till I had been a nurse 15 years, when I had a proper orientation. By then, I didn't want people telling me what to do. I was burnt out by then and decided to go into administration, where I remain. My experience working in different facilities, environments, personalities, socio-economical backgrounds, acute,subacute,LTC etc...is what makes me a competent manager today. Sorry for sharing so much, but you sooo remind me of me. Take care, Peace!

[Chin up]

Ps- I especially loved your comment about using the CNA's. They are a wealth of info and since I did not know the patients, I went to them all the time. I tell new nurses to treat them right and they will go out of their way, to make you look good.

[marthyellen]

Ps- I especially loved your comment about using the CNA's. They are a wealth of info and since I did not know the patients, I went to them all the time. I tell new nurses to treat them right and they will go out of their way, to make you look good.

If you respond to their requests, they will notify you of the smallest but significant changes in the residents. If you ignore their requests they will quit telling you anything and you will miss important first signs of illnesses.