What is a typical day working in a nursing home?

vintagemother, BSN, CNA, LVN, RN · Jun 9, 2016

Oh f***! This topic! [emoji23] But I'm happy to oblige; as I'm a new hire in an SNF!![emoji23]

I hit the ground running at 0630!

I grab a report sheet and a med refill sheet and I'm supposed to sign into the employee binder.

Count narcs, get report.

Start taking BPs and FSBS. Done by about 0730

Start passing meds and giving SS insulin. Hopefully done by 8.

0900 med pass can start at 0800 and if I'm lucky, I start prepping meds by 0745!

Start my big med pass! 0900 scheduled meds can be given between 8-10. 1 hr before or 1 hr after. As a newbie, I finish at 10 or 1030

Lunch! Required to be take at 1030 or 11.

Get back! Start taking after lunch FSBS and giving insulin and/or meds to approx 1/4-1/2 of my 20+ residents.

Finish.

Chart check offs and daily required charting.

Now it's 1330/1400! I have to Check my narc book to make sure it's correct! And clean the cart and get it ready for the next shift!

1430- give report to the oncoming staff!

1500-try to go home.... If nothing unusual happened-like a fall, sudden change to condition, or mandatory meeting! Oh, wait, those things aren't unusual! They occur about half the days I've worked!

nightstalkerRN · Jun 9, 2016

The facility where I work has 3 shifts 8 hours each. I have been on noc shift for 5 years now. My shift starts with report, then narc count.

We often sign for Pharmacy delivery and we always have to go through the manifests and then put the medications away. We print the nightly census and nursing and CNA coverage sheet for the day as well as the schedule for the next day with all hall/unit assignments. We have a lab service that comes and draws blood around 5 am so we have to print out the list of the day's lab draws and make sure the lab reqs are filled out and ready. All new orders that come in during the day are checked by noc shift. When there are admissions all of the admission orders and paperwork are also checked by noc shift. If anything is incomplete or wrong with these things we are expected to correct or finish them. Which happens more often than I would like. We have a few midnight meds to give but mostly give PRN meds through the night until 4am when our med pass begins. We have treatments, generally skin treatments that would be difficult to do after residents are up and dressed. We also must make sure all O2 portables are full for the coming day. If we have resident's with PICC lines that need blood drawn I have to do that rather than our lab service because I am the only RN, working with LPN's and our facility requires that an RN do this. I am also the only nurse on nights that can run IV meds @ noc through PICC lines for the same reason. I have had anywhere from 18 to 103 patients to myself depending on staffing and census. Our facility has a 28 bed Dementia locked unit, a 27 bed Long term hall (90 % of which also have dementia but need too much care to qualify for the locked unit), one 15 bed private room hall that is equally long term and Medicare, one 20 bed hall that is exclusively Medicare and another 27 bed hall that is half long term and half Medicare. All halls but the exclusively Medicare hall currently have Hospice patients.

The nights I dislike are when there are 5 Medicare admissions on one hall and the admissions were done by a new or lazy nurse, all my Hospice patients are crawling out of bed despite Haldol, Ativan and Morphine. Dementia gentlemen are pulling out their Foley's fully inflated, wound vacs won't keep suction, PEG tubes are clogged, JP drains are leaking, I have to stop my AM med pass to draw blood from 3 PICC lines, and I have several falls or skin tears. The new admissions don't have any medications so I have to call the backup pharmacy and wait 4-6 hours for delivery. And in the middle of all this somewhere I have event charting, Medicare charting, patient observations, skin checks, monthly summaries. Heaven forbid we have to call an on-call doctor and wake them up in the middle of the night.

Our facility also has an assisted living facility next door with a connecting corridor. Only CNA's work the night shift there. If anything happens there on noc shift (for example- fall, change of condition, signing for meds and putting narcotics away, new orders, sending resident's to ER or accepting returns from ER) it is our responsibility to got over to their building.

I have worked 1st, 2nd and 3rd shift and none of them are "easy", they all have their different challenges.

Labelle13 · Oct 9, 2017

Your lucky your facility requires staff to take breaks at the facility I used to work at the nurses never take their breaks and almost always stay past their shift. During my orientation, one nurse told me she has to beg another nurse to take her break so she could eat!