How to be faster/more efficient? - page 2

by JenniferSews 8,114 Views | 16 Comments

I have been working sub acute rehab for a year now. I carry 12-15 patients, generally 14 on any given day. I have an 8 hour shift and work 6-2:30 but NEVER leave on time. Today I was called to come in and fill in holes on the... Read More


  1. 0
    Quote from NotFlo
    Those are good tips. My facility did come up with a policy regarding BPs and APs. We have to do them q shift for a week, at least daily and before any BP meds for a month, and then weekly thereafter. For the patients that do stay for more than a month that is helpful. I know it sounds beyond silly that knocking one or two BPs off a med pass could make me happy but honestly I'll take the five or ten minutes anywhere I can get it!

    I wish something could be done about the med situation. I think they've moved meds around on the LTC floors, but on subacute every q d med still gets written for 9 am unless it's specifically ordered for HS (like a sleeper, or sometimes simvastatin or an antidepressant). We also get all the inhalers and the lidoderm patches and eyedrops (again, I know I sound really petty but having all this stuff on the med pass in addition to all the pills is what really slows it down to a crawl...and I love having to apply a lidoderm patch or voltaren gel to the lower back of someone who is already fully dressed and up in their wheelchair by the time I get to them...).

    I know the DON at my facility is also trying to promote the docs reducing the number of accuchecks per day and working to control the blood sugar as much as possible basally, reducing the amt. of sliding scale insulin we have to give. ANY reduction in the insane amt. of accuchecks we do is helpful.
    The patches and back creams its easier for me for them to be in their chair. All I have to do is lift up the back of their shirt and apply. (In their room with the door closed of course).

    We got a new MD who has most of the residents and unless the resident is known to run high.. their sliding scale starts at 200. Its good for us because at 4pm, they usually have had happy hour and sweets or snacks and their blood sugar is between 150-200 most of them.

    The eye drops are a pain in the tush. Unless its for conjunctivitis.. are they really necessary?
  2. 5
    I find no matter how efficient we are, there is just simply too much to be done. I've stopped worrying about it, and I do as much as I can. I work 12 hours, and aside from all the routine stuff, I now have MDS computer work to do. If I actually took my full break, (1 hour and 40 min), I'd never leave on time. I take 30 minutes and make sure my work is done by the end of the shift.

    They don't want to pay overtime, and I don't want to stay. The way I see it, try to get the most important stuff done and charted. The rest can be left for the next shift, since it is 24 hour care. I am also a relatively new nurse, but this is my second career. I refuse to get sucked into all the issues. Staffing really is THEIR problem, not ours. You just do what you can. We aren't robots, after all.
    MedChica, esperanzita, Chin up, and 2 others like this.
  3. 0
    Quote from NotFlo
    Those are good tips. My facility did come up with a policy regarding BPs and APs. We have to do them q shift for a week, at least daily and before any BP meds for a month, and then weekly thereafter. For the patients that do stay for more than a month that is helpful. I know it sounds beyond silly that knocking one or two BPs off a med pass could make me happy but honestly I'll take the five or ten minutes anywhere I can get it!

    I wish something could be done about the med situation. I think they've moved meds around on the LTC floors, but on subacute every q d med still gets written for 9 am unless it's specifically ordered for HS (like a sleeper, or sometimes simvastatin or an antidepressant). We also get all the inhalers and the lidoderm patches and eyedrops (again, I know I sound really petty but having all this stuff on the med pass in addition to all the pills is what really slows it down to a crawl...and I love having to apply a lidoderm patch or voltaren gel to the lower back of someone who is already fully dressed and up in their wheelchair by the time I get to them...).

    I know the DON at my facility is also trying to promote the docs reducing the number of accuchecks per day and working to control the blood sugar as much as possible basally, reducing the amt. of sliding scale insulin we have to give. ANY reduction in the insane amt. of accuchecks we do is helpful.
    I agree with most everything you stated. Those 10 mins here and there are needed. But, I am coming from an MMQ/MDS position, only accuchecks without need of a sliding scale should be eliminated. Sliding scale is money! And accuchecks that are qod or twice a week, with a stable resident can be eliminated. But, daily accuchecks that require a sliding scale, I would fight to keep. Sorry. Peace!
  4. 0
    Money aside, and yes I've done MMQs, controlling blood sugars with sliding scale insulin is not in the best interest of the resident.
  5. 2
    I'm a new graduate, that just started my career in LTC nursing. I have only been working for a month and I can relate to everything that has been written in the previous posts!! I sometimes feel used and abused by the management of the facility. They expect us to give medications, finish treatments, do dressings for an unbelievable amount of patients, all while adhering to policies and procedures AND leave on time?!? I'm sorry, I did not know that I had to sacrifice my physical well-being and sanity for the efficiency of the institution. At times, I feel like there is not one soul within management that care enough for the residents to try and change something. I learned SO much in nursing school that we need to advocate and "be the change you want to see" but, how is this possible when there is barely enough time to perform the most basic care?? My apologies for the rant!
    One thing that I found that helped me was that I cut down on conversation. As terrible as that sounds, I keep interaction with the residents to a minimum. I found that many of the elderly have tons of stories! If I stop to engage, I could be held up for an extra 2 minutes that I just can NOT spare! Right now, as I am adjusting this is something that I found is helping, as my skills improve I hope that this something that will change! I know I have a tendency to be chatty as well, so this is something I definitely need to work on as well!
  6. 0
    I am in the same position as you right now. I am working in a rehab area that has long terms mixed in. Right now I have 8 rehab and 8 long term care. There really isn't enough time to really assess the patients. You are suppose to assess the individuals mental well being as well as physical but how can you do that when you don't talk to them. You can't just walk in heres your med and leave. Right now I have a patient that when he came in was a thriving happy go lucky man. Now I notice he has been sleeping my whole shift and not eatting. I took the time to talk to him and he asked me "why am I sleeping so much, could I be depressed?" and asked if a priest comes around. I took the time to talk to him. He was concerned about going home with a foley in place and other things. I do not want to just start popping pills like I have seen people do. I have been told don't get attached to my patients but I am sorry that is why I got into nursing.
  7. 0
    I will say this and take from it what you want (I'm being a little silly). It is unfortunate that I tell my staff this: I have to ask 150% from you because that's what we have to do. I know you can only give 90%, because you're human. Everyone makes mistakes. Be honest with me and let me know the 10% you are having trouble with and we'll work it out.

    Know this- your managers know it's impossible, but corporations do not. Corporate makes the managers act like you just have to do it. We share it down the line. A good manager, however, will attempt to help as much as possible or even (gasp) help streamline a few things.


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