Nursing home nurses, time saving tips?

  1. 0
    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.

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  2. 16 Comments...

  3. 2
    Quote from treeye
    Any tips will be appreciated.
    I worked as a CNA in a nursing home and I know a lot of nurses who work in LTC and/or have worked in LTC.

    The only tip I have is tough it out until you find another job.
    OnlybyHisgraceRN and paddler like this.
  4. 0
    Moved to Geriatric Nurses / LTC Nursing for more response.
  5. 3
    The biggest thing I find is knowing your residents and their habits or at least who they are when you see them. I try to catch residents as they pass my cart in the hall, on their way to meals or other activities. Even if I am working on someone else's med pass, I will set that aside if I see Mr. Smith scooting down the hall in his wheelchair and get his meds all ready by the time he gets to me, after that I will resume the previous med preparations and go track that patient down. If I don't approach it this way I waste a lot of time hunting for patients. Also, I keep my charting minimalist. It usually takes me 30-45 minutes depending on what's going on with whom and how many patients I have (which ranges from 28-34). I feel your pain, it's not the kind of nursing I want to do. No real assessments being done unless something happens (emergency) during which you have to push all the 10,000 other things you have to complete aside. Honestly, if there was adequate staffing and time to do assessments regularly as a preventive measure, I think it would reduce the shipping out of many patients. They, unfortunately, seem to get put on the back burner until something unignorable happens. It's terrible. But, really, there is no other way to get through the day. 30 patients is too many to provide good, sound care and I don't care how long you've been a nurse.
    tokidoki7, lots2care4, and esperanzita like this.
  6. 1
    They don't look at the MAR? What if the patient has a D/C or change? They change all the time in some cases.
    lots2care4 likes this.
  7. 2
    Thank you treeye for posting this. I graduated a year ago with my ASN. Have been working in LTC since July. I normally work on a dementia unit which averages 15 residents. Acuity is low and the workload is pretty easy, but there isn't much opportunity for learning new skills.

    Today I picked up a shift on a unit with 27 residents. Hadn't worked there before. It was a horrible day. As you said med pass about 3.5 hours, passing trays in the DR (which I don't do on my regular unit), another med pass taking about 2 hours, sent someone to ER. By the time I left I felt like a total failure. Totally defeated. I thought I could handle it, but I was overwhelmed. I literally did nothing but pass meds all day. Not one assessment or treatment done. I went home and cried. I told my husband, "Today is one of the days I hate nursing. I just hate it."

    As someone else also pointed out, it doesn't matter how familiar you are with residents, or how experienced you are, there is no way everything is getting done. It's a sad truth. I even said that to my unit manager today. LTC needs a serious makeover. Staffing ratios are ridiculous, and the residents seem to be the least priority.

    Days like today are difficult. I know it isn't my fault the way things turned out; I'm not superhuman. But at the same time I expected to do better, and this feels like a personal failure. It seems they keep racking up since I started this whole nursing thing.
    Kisabelle and tokidoki7 like this.
  8. 0
    A few tips that could help.

    Get to your unit a few minutes early. Get a report sheet/ census sheet or whatever you use for your notes. Skim thru the last few shifts of report (if you have a 24 hr report book), check the appt book or lab book, pull up your list of res with no bms etc. Jot this down before your verbal report. While you wait for the next shift to get report...stock your cart (if it needs to be done) Skim thru your treatment book and make a few notes too.

    If you need to do staffing/ assignments do it now.

    These few minutes can mean the difference of a good vs bad shift. I try toget to work at least 15-20 minutes early since I don't work that often and catch up.
  9. 2
    I work nights, 30 residents: when im going through the mar i flag the meds i have to pass on my shift and at the same time have the cart next to me, pull out the resident's drawer, put their pills (which are individually wrapped) in a med cup, 2 cups if there's two passes for that resident, then close the drawer, locking it in the end. At the same time I have the unit head count, after the residents name i put 12a, 6a.. so I can cross the completed cups off as I go when I'm passing the meds. Then I look at who is on report/for what and put an R next to their name so I know to do a focus assessment when I see them. Same with finger stick and treatments, I put FS, Tx and cross those off as I go. It's time consuming to start off but makes the pass faster when I'm going. That being said, the staffing at LTC is bad. One emergency and it's downhill from there. Everyone is scheduled for 6am meds and 6am fingersticks... its logistically impossible. Perhaps when things go electronic and they see that it cannot be done in that time frame they will consider better staffing. Until then.. have a good shift! :/
    tokidoki7 and dblpn like this.
  10. 0
    Quote from arallenrn11
    Thank you treeye for posting this. I graduated a year ago with my ASN. Have been working in LTC since July. I normally work on a dementia unit which averages 15 residents. Acuity is low and the workload is pretty easy, but there isn't much opportunity for learning new skills.

    Today I picked up a shift on a unit with 27 residents. Hadn't worked there before. It was a horrible day. As you said med pass about 3.5 hours, passing trays in the DR (which I don't do on my regular unit), another med pass taking about 2 hours, sent someone to ER. By the time I left I felt like a total failure. Totally defeated. I thought I could handle it, but I was overwhelmed. I literally did nothing but pass meds all day. Not one assessment or treatment done. I went home and cried. I told my husband, "Today is one of the days I hate nursing. I just hate it."

    As someone else also pointed out, it doesn't matter how familiar you are with residents, or how experienced you are, there is no way everything is getting done. It's a sad truth. I even said that to my unit manager today. LTC needs a serious makeover. Staffing ratios are ridiculous, and the residents seem to be the least priority.

    Days like today are difficult. I know it isn't my fault the way things turned out; I'm not superhuman. But at the same time I expected to do better, and this feels like a personal failure. It seems they keep racking up since I started this whole nursing thing.
    Reading some of these comments is why i want to leave LTC. i hate it, just absolutely hate it. its not the residents, its the workload. at my job i do nites. i'm always on my feet doing nebs, meds, med A charting for like a million residents, ifu's, new admits. and in the morning theres med pass, leg wraps, treatments...you name it. there is not enough time to get everything done. you are right LTC does need a serious makeover fast.
  11. 3
    This is one of the reasons I left LTC. I had 30 residents and a med tech and still struggled. The only advice I have is to try to group tasks together. I.E. If you have a diabetic that also takes PO meds, try to do everything at one time while in the room. Chart as you go along if you can. It really is tough. Honestly, I don't see how nurses stay in LTC for 20-30 years at a time. Not all facilities are bad but most do have a problem with staffing. I got tired of LTC for the same reason you mentioned in your post. It was heartbreaking for my residents to c/o of something( nothing urgent) and I didn't have time to assess them because I was too busy trying to please the state. Hope things get better for you.
    tokidoki7, dblpn, and paddler like this.


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