New to LTC, How do I organize?

lovingtheunloved, ASN, RN · May 23, 2007

You don't. You don't do a full assessment for every resident every day. You'd never get done.

PR_Nurse30 · May 24, 2007

You will find your own niche' on how things are done at LTC. I'm new at LTC also & have 30 residents. You will make your own way of working it!! Gets easier as time goes on!! Good Luck

Oh yeah you dont do assessments on all the residents everyday just like "lovingtheunloved" had posted!!

Dolce, RN · May 24, 2007

When I did LTC I started out my day after report by organizing all of my supplies that I would need for the day on my med cart--ice water, applesause, forms that needed complete, extra blank fax sheets, extra incident report forms (seemed like I was always filling them out), etc. Then, in the half hour or so before your med pass starts go check on all your residents and make sure they are still alive. Make sure the ones who need TED hose or lotion on their feet get dealt with. Then, start your lengthy AM med pass. Hopefully you should be done with the med pass in about 2 1/2-3 hours. Next, start doing your assessments and treatments. Complete your charting. Take a lunch break. Next, do your noon med pass. You will probably have a number of treatments left to complete after lunch so work on those. Keep charting throughout the day so that you don't have to stay overtime. Continue passing meds until your shift ends. Before you give report to the oncoming nurse be sure you go through the med book and treatment/BM/activity books to make sure everything has been charted. Check with the CNAs to ensure you are not missing anything. Give report and go home!

Rizpah · May 24, 2007

I am a Nursing student and graduate in a few weeks. I will more than likely be working in LTC. I have a scholarship from a hospital and the main positions they have open are in LTC. How do you organize your day to take care of 30 patients. So far, the most I've taken care of is 3, but that was doing total care. It would take me all day to assess 30 pts. How do you do it?
MedicGA

In LTC you will have CNAs working with you who will be doing a majority of the hands on care. They will be your major eyes and ears during the shift. Gain their trust and respect and they will be your most valuable asset on the job. They will be the first (usually) to notice changes in a resident's status and report it for you to assess and treat.

You don't. You don't do a full assessment for every resident every day. You'd never get done.

I started out in my role of charge nurse and even RN supervisor by trying to "see" every resident when I'd come on duty. Due to the multitude of responsibilities you will have, you simply cannot assess every single resident. However, as you gain experience in your role as charge nurse, you will "know" your residents and many times be able to tell "at a glance" or even a casual touch - hand shake, pat of the hand, expression on a face if there is something, changes, going on with that resident and proceed from there.

When I did LTC I started out my day after report by organizing all of my supplies that I would need for the day on my med cart--ice water, applesause, forms that needed complete, extra blank fax sheets, extra incident report forms (seemed like I was always filling them out), etc. Then, in the half hour or so before your med pass starts go check on all your residents and make sure they are still alive. Make sure the ones who need TED hose or lotion on their feet get dealt with. Then, start your lengthy AM med pass. Hopefully you should be done with the med pass in about 2 1/2-3 hours. Next, start doing your assessments and treatments. Complete your charting. Take a lunch break. Next, do your noon med pass. You will probably have a number of treatments left to complete after lunch so work on those. Keep charting throughout the day so that you don't have to stay overtime. Continue passing meds until your shift ends. Before you give report to the oncoming nurse be sure you go through the med book and treatment/BM/activity books to make sure everything has been charted. Check with the CNAs to ensure you are not missing anything. Give report and go home!

Dolce, you worked like I did! Nice routine! I also kept a sort of a running report sheet / notes so that if I was off for a couple of days, I would be reminded of things that were pertinent a few days prior and remember to ask about them.

Good luck in your new position and :smiley_aa Congratulations on graduation!:balloons:

Daytonite, BSN, RN · May 25, 2007

one thing you will definitely learn in ltc is how to organize and prioritize your time. i started out working in ltc and eventually moved to acute care. i have always been a list maker because i can't trust myself to remember everything. i started by making a list of the things i had to get done each day and then arranging the list in order of the time things had to be done and their priority. in today's world you can use your computer to help you out.

http://www.ehow.com/how_3812_make-list.html - how to make a todo list

the two main things that need to get done in ltc are the medications and treatments. pretty much your entire shift revolves around getting those two very big tasks done. you'll read about the medication passes here on this forum. at first they seem like a monumental task, but the saving grace of them is that the meds don't change that much and there is a routine to them. within a couple of weeks, you begin to realize that certain patients always want their meds at certain times, that it's easier to give some medications when patients are clustered together in one place (like the dining room) and little things like that.

outside of those two big tasks, the other things you have to do you learn as you go. these are things like making patient assignments with your aides, what to do when patients have a fall, a skin tear or come up with a fever, how to transcribe doctor's orders, and a whole bunch of other things. i have always found that learning who the cnas were, what they are each capable of and doing their daily assignments took me a long time to become proficient at. even when i was a hospital supervisor, doing the staffing took 6 months to learn and i was reassured that this was normal.

so, make a todo list (there's a link on how to do that above). if you save it in a word file on your computer you can make changes to it and save them as you find it necessary. just print out a new one every day. i used to cross things off as i completed them each day. here is a link to the skeleton for a report sheet for 30 patients. print the report sheet on one side of a piece of paper and your todo list on the other side for each day. more recently, i used to print in the patient names on the word file of the report sheet when i made my own report sheets along with their doctor's name and their code status and just print out a new sheet each day. it saved a whole lot of time in the long run. your computer can be a great tool if you put it to use. if you've ever seen my hospital report sheet, you'll see i also included the date at the very top as well (because i could never remember the date when i first started my shift).

[attach]5566[/attach] ltc report sheet for 30 patients