Nursing home nurses, time saving tips?

[treeye]

As a new nurse new to nursing home, I find myself running out of time easily. Each resident has ten to twenty five pills to pass in the morning, it usually takes me 3.5 hours for the AM med pass for thirty residents. Then I have to do insulin, help with feeding in the dinning hall and pass all 2pm pills. Charting takes 1.5 hours at least. I barely have any time doing the treatments. Leaving the floor on time sounds like a joke.

Just want to know how to save some time. Some seasoned nurse here pop pills without even looking at the MARS. They said they know the residents. I wonder what will happen if someone from the previous shift misplaced a med package? During orientation, I did find a med error because of med misplacement.

I feel so bad that I don't have time assessing pts unless they c/o something wrong. I don't have time standing still while they talk to me. I don't have time watching them finish their pills.

Any tips will be appreciated.

[kmarie724]

One thing that helps me a lot is to look through my tx book early in the shift and get some tx done while I'm doing my 2000 med pass. If it a cream or dress to their coccyx, I ask the CNA to come get me when putting the resident to bed so I can do it then rather than coming back to it later and having to get them undressed, find someone to help me turn them, etc. I also do any VS or assessments I need when I'm in the room with their pills rather than coming back later.

[lumbarpain, ADN, RN]

I have just recently orientated to a nursing home and found that the nurse wasnt even checking the MAR and just punching out meds and said "she knew what they got" I find this irritating. In nursing homes most of the residents may not question how many, what color, shape or how many times they should get something. ITS DOWNRIGHT DANGEROUS . Plus this puts you in a bad practicing habit that you may not be able to repair. Not reviewing the MAR each time you give meds on possible changes that may have occurred or maybe even meds that shouldnt be given anymore is a very serious act. Nurses have forgotten to tell me on report that a med dose was changed or Dc'd and then I find it when I start giving the meds. If there is a good Nurse manager, good aides, good nurses, your report should be ideal and everyday you should be kept up on the constant changes in meds/treatments on every patient. I found that during report, the patients main diagnosis, chronic or acute complaint, tests, recent labs, any hygeine problems, etc should be a list that each nurse goes down over and over each day.....this impales it into your brain, makes you remember and helps you flow a little more faster each day.

This is what I did for myself. took some time....but I kept my own report book that I reviewed before the shift started with each patients name in it. Helped me remember lots of things I would normally forget.. Just the facts were included and any follow ups, pertinent stuff.

I prefer doing rounds with the nurse before me, going to rooms if its possible, I know finding residents at certain times is hard, but if they are in their rooms already, a quick round will help.

I always tried to get my Aides to listen to report. I typed out a special report sheet with the patients names on them, for each one and kept copies so if for some reason they left early they could just give it to me or leave it at the desk. I always kept the aides up to date. This way I didnt have to run and remind them all the time of things I wanted them to do and they didnt have to ask me all the time, They would just report to me.

I would (when and if I had time) flip through the MAR to find out if there were any drugs or treatmetns that were just LINGERING for some strange reason that no one seemed to care about.....colaces that havent been given since the year of the flood, treatments that no one ever does and the patient doesnt need anymore. Usually the pharmacy will alert you on these but to cut down on the strenous eyeball work you already have, omitting unused drugs or drugs that just arent doing anything for the patient and treatments like, raise the head up every 15 minutes to ease back pain when the patient can do it himself or there is no more back pain will relieve you of checking things off that are useless.

I was always striving to make less paperwork, more of a routine, less stress for all and had lined up all my aides at once in a straight line on the floor for 1 minutes (me included) to give a nice neck/shoulder massage. It looked strange but it was a good moral booster on a stressful hectic day. Beleive me they loved it. Sadly, some missed out. But we usually got them the next day.

It may take a little extra effort on your part, but if you want a tight running ship you will dedicate yourself to making your shift run like clockwork, Aides will look up to you, you will love them to death for their outstanding work and the higher ups will commend you. If you spend a little more time to organize your work outside of the nursing home, in the privacy of your own home where its quiet and relaxed hopefully, you can devise a system that you and your aides will feel comfortable with.......and dont forget to talk to them about their ideas that will make your and their jobs easier....this way its a team thing and everyone is a happy camper and feels productive and useful. Good luck, hope I helped.

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[lots2care4]

:yelclap: your words of encouragement are awesome! i will be starting a new job in ltc and, while being a bit anxious about the staffing to resident ratio, i am excited to get back into it. absolutely love the 'shortcuts' you've mentioned and the idea to get your staff to work together as a team .... it's all great!

especially the neck/shoulder massage! :thankya: i thankyou in advance and will keep you all updated on my findings!

[lumbarpain, ADN, RN]

Lots 2 care 4. I can tell you really have that extra uumpf in you for LTC. It is a challenging position and you have to be REALLY Interested and have your total heart into helping the elderly population. If you put yourself in their shoes...picture yourself being in bed most of the day, sitting in a wheelchair most of the time, having someone feed you, change you, yanking you out of bed at 6am in the morning, waking you up for meds when you just got that best sleep in the world down pat, being poked, probed, stuck, almost against your will at times....then you will come to realize what being a REAL NURSE means. This really puts you in a different perspective for the job. I had been a patient after having surgery in a hospital once. I was 21. I wasnt a nurse yet, in fact I wasnt even close to even THINKING about going into the medical field...BUT.....this one horrid Nurse Ratchett type of nurse was MY Nurse.....and I remembered her very well. She had the Worse attitude, the most horrid bedside manner, and was just totally COLD. I vowed to myself NEVER EVER TO BE LIKE HER when I became a nurse.......Its funny, if I would have gotten her name off her nametag I would have tried to find her and tell her what she did for me.....it was a positive thing from her negative attitude....STRANGE ISNT IT....You would never think something positive would arise from something negative, BUT IT HAPPENS ALL THE TIME IN THIS WORLD!!!!!! I have found that BEING a patient and looking out from the other side of the spectrum puts a nurse into a different type of caring mode. Not saying YOU NEED TO BE A PATIENT AND HAVE A TERRIBLE NURSE for Care, but it just opens your eyes up to the other world of patients, And FEELING that helplessness and aloneness when you are sick. When I nurse is upbeat, knowledgeable, caring, and empathic and compassionate and most of all has a great sense of humor(at the most optimum time of course) then you KNOW you are doing the right thing. Good luck, we need more great LTC Nurses out there right now....Its a tough world. Lumbarpain

[egglady, LPN]

my suggestion would be to make lists. lots of them.. list what time accu checks are due, what time meds and tx are due, etc. and as you do them cross them off your list! time management is everything, and it will come to you!!