How to be faster/more efficient?

[JenniferSews]

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 pain documentation. We have to sign out the narc on the narc sheet, sign it out on the back of the MAR sheet, initial it on the front of the MAR sheet, complete the pain flow sheet and document it's effectiveness on said flow sheet and in our nursing notes. Needless to say the process is cumbersome. There's always SOMEWHERE that I miss, but I just flat out do not have time to double check every single pain med given to make sure I filled in every spot. I'm working hard to get there but right now there's undoubtably something I've missed somewhere. I can say for certain the med is always signed out on the narc sheet and documented in my nursing notes as given and the effectiveness.

If I'm lucky I can get report and hit the floor at 6:30am. I do my treatments then and then start on my 8am meds. But I never, ever, ever finish passing my morning meds before 10:30am. I then try and chart on a few patients and inhale some food before starting to get blood sugars and passing my noon meds. The noon meds predictably run into the 2pm meds, along with trying to cram in the random treatments I didn't get at 6:30am for one reason or another. Throw in a change of condition and it's all out the window. I generally give report at 2pm and then chart for an hour after my shift is over. I am not that far off the other nurses on my unit, but some of them do seem to do a better job with time management.

I'll be honest, I have tried prepouring. But I don't find it to be a huge time saver. I keep my OTCs in alphabetical order so I never have to search for something. All my breathing tx are clearly labeled to save time from pulling 4 different advairs out to find Mr Smiths. But just about every patient is on 9+ meds and many need a BP monitored before giving meds. Part of my problem may be customer service related. If I know that someone likes to sleep in or take their meds after breakfast, I always respect that desire. Time wise it would probably be easier to just go room to room and person to person and give them all their meds right away.

I need some suggestions from experienced nurses on how to streamline things and make it all faster.

[Chin up]

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!

[CapeCodMermaid, RN]

Money aside, and yes I've done MMQs, controlling blood sugars with sliding scale insulin is not in the best interest of the resident.

[lesliel]

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! :D

[wannabenk]

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.

[NurseGuyBri]

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.