Time Management in LTC

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    I recently graduated from nursing school in January with a BSN. Got my RN and am now working FT (day shift) on a sub acute floor within a nursing home.

    I like my job and feel so lucky to actually HAVE A JOB in this economy. I love my patients, and it is so nice to get to know their personalities, quirks, habits, etc. However, everyday I end up getting stressed out because I cannot see how I can possibly get everything done by the end of the day shift. Like most places, overtime is frowned upon. In fact they recently implemented a new policy where you have to get someone to sign off on the fact that you missed your punch and had to stay late. I think this is their way of making it very difficult for nurses to stay late. Trust me I don't want to stay late, the OT isn't worth it to me. I end up staying late because I cannot manage to write all my nursing notes by change of shift, so I usually end up giving report and then going to write my notes.

    So, my question for all nurses is how do you possibly manage 20+ patients who are on a lot of meds, have a lot of wound care treatments, treatment documenting and nursing notes. There is hardly ever a day where I can do my med pass without getting roped into toileting, listening to patient complaints, answering phone calls, talking to families, etc. It doesnt halp that we only have 3 aides for 35 + patients. Additionally we are expected to take vitals on nearly every patient, regardless of whether they are on meds with parameters. I sometimes have to float to the other straight nursing home floor, and it seems to be much easier there. Not as many treatments, notes etc. I feel like management holds our floor to the same standards as the nursing home floors but yet we have so much more work it seems. On the days I have off I am sure the per diem nurses get out on time, but then when I go around to do my treatments, the same tape with my initals from the previous day is still on the pts even though these dressings have to be done every day, and they don't do nursing notes even though we have to. So, what is the secrect/trick? Should I start to sign off on treatments even though they really weren't done? Should I just stop doing nursing notes? I know that's not the right thing to do but I have been told that in order to survive in LTC, you have to learn how to cut corners. Any suggestions or tips for a stressed out, exhausted, new grad? I would like to find some balance so that I can get out on time, keep my job and not be dead to the world every night at 9:30...
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    #1, I am a per diem nurse in LTC and am required to complete treatments and document my care. I belong to the facility though, I'm not agency, maybe it's different for them.
    #2: There's cutting corners dangerously and there's cutting corners safely. In LTC, there are some things you can do to save time, and there are those things you have to do no matter what. You must do wound care. You must pass meds.
    You can delegate a lot of little things to the CNAs. Skin checks, creams/ointments, VS, I&O...lots of things. This depends on where you work, however, so I'd ask your supervisor what's acceptable to delegate and what's not.
    Learn this phrase: "I'm sorry, but I'm in the middle of something I can't put down right now. If you can wait just a few minutes, I'll have someone in to help you shortly." You've answered the call light, and are taking some action, if not the ideal action. Yeah, it's not gonna make you any friends among the aides, but I tell the aides I work with that they have their jobs, and I have mine. If I have a moment, I'm happy to help them with toileting, transfers, etc., but sometimes I just can't because I have stuff I have to do too. Generally, if you and the aides can work as a team, and you trust them with the things you delegate, then things will go more smoothly.
    Maybe this helps, or maybe you've done all this already and are still struggling. I know when I was brand new, it took me at least a year before I felt like I could hold my own on the floor.
    ec2703 and BrandonLPN like this.
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    I agree with NurseDirtyBird. Working as a team makes your shift better. Delegating eases your workload; however ensure that the work is done. Once the aides and patients know you and you know them it gets better. Remember, be safe and document everything. Don't sign off in interventions you haven't done.
    I also didn't feel competent for a year. However I always did my best and have learned so much in the past year.


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