Trying to rearrange/prioritze my schedule each night - page 2
Hello all, New grad in LTC... each night after work I go home and try to re-arrange my schedule in an effort to complete all the things that need to be done in an 8 hour period. I feel like it's just not working, no matter how... Read More
- 1Aug 13, '12 by RN1822I worked LTC for the last 9 years and the first year was the most difficult. It will get better. I agree that clustering activities is one of the keys. If you are on a medcart, overstock it as soon as you hit the floor with any bedside small treatment items you can do while you are giving your pt meds (skin prep, bacitracin, telfa, kling, NS bullets, medicated creams, etc....). It might not seem like a lot of time is saved that way but, you really can get all the priorities completed with a little planning and some support.
At the first of the shift, when you are giving your CNA's report, delegate what is appropriate to your support staff. You may also have to get comfortable with having a pt wait a few minutes for a CNA to assist them with ADL needs ( when this is reasonable). Remember that while you can certainly do what a CNA does, they can not do what you do. If you are spending a lot of time with ADl's you are going to have a hard time staying in compliance with a med pass. Are you able to identify what is slowing you down, is it the whole assignment or do things go smoothly until a certaion part of the shift?
Ask questions of the nurses who seem to be doing it successfully. I don't mean the nurse who seems to have a ton of down time and is alway on break or on the phone. That nurse is just skating by and probably signing treatments and assessments she has not completed. Find the nurse who is steadily busy but seems unruffled, the nurse who takes her lunch but is back on time and ready to go. Even if people don't have answers to your questions as to how they do it all, I think just asking the questions demonstrates that you are focusing on improving your performance and are eager to learn.
Good Luck and Hang in there it does get better!!
- 0Aug 14, '12 by Isitpossiblethanks for the responses: when i arrive on shift, I count narcs/get report. then i walk to all rooms for quick check, next is looking over medications that need to be re-ordered... if low, fax orders to pharmacy..look over labs and contact physicians if needed.. by now its 4:30 - time for med pass and accucheks... by now its 5:15, get VS on all residents who are qs vitals... (honeslty never know where the CNAs most of the time, and toooo time consuming trying to hunt them down)... then its time do assessments on four patients that need to be documented daily...also need to check who needs Bowel protocol procedures.. oh gosh by now its 6pm... start trying to document the assessment... then i need to do skilled notes on a few of my patients...can not possibly document that fast...now its 6:30 and i need to take a lunch, they are adamant about nurses taking lunch... come back at 7pm and start 9pm med pass... finish med pass 9:30 - 9:45 depending on how long it takes to coax the resident to actually take them.... its now 9:45 and i have NOT completed one single treatment!! try to do treatments... it never seems to work for me...oh did i forget that i didnt document in the MARS/TAR yet, and circle and document who refused? did I have to run down to pxysis b/c some meds arent in the cart? oh... and i havent documented any changes in condition that require follow up every shift? its 11:00pm and time to turn over to oncoming nurse-- whats a new nurse to DO??? help........
- 0Aug 15, '12 by Esme12, BSN, RN Senior ModeratorThe first year after school is the hardest......nursing is a unique profession because learning how to actively care for patients themselves is after you graduate.
Organization is key.......you need a brain sheet.
brain sheets.......here are a few.
mtpmedsurg.doc 1 patient float.doc
5 pt. shift.doc
day sheet 2 doc.doc
critical thinking flow sheet for nursing students
student clinical report sheet for one patient
I hae made some for nursing students and some other an members (Daytonite) have made these for others.....adapt them way you want. i hope they help
- 2Aug 16, '12 by bbuerkeWow! I did not expect such a visceral response from everyone. I think I may have given the wrong impression with my description of a kid on a long car ride - poor analogy I guess. The idea I was really trying to put across was what FMF Corpsman said in their first response:
" A well organized nurse or aide sees to their patients needs preemptively, insuring that most needs and comforts are met before the patient even request them, that way they aren't tied up with call lights most of the evening, but are freed up to do patient care."
That is exactly what I do with regular toileting. If a patient doesn't want to go, they certainly don't have to, and I will return later. I always frame it in a way that does not give the impression of me "ordering them around". I say something like, "I think it would probably be a good idea to go to the bathroom now. With all those fluids running, I don't want you to have to rush to get to the bathroom." That way I am there to help them, and I do part of my skin and mobility assessment while they're up.
I really started doing this as a way to reduce falls among my patients. Our data/incident reviews showed that 90% of patient falls were related to toileting. I also cluster it around other activities - I don't just barge into my patient's rooms insisting they get up to the bathroom. I go in when the NA is getting vitals or phlebotomy comes in to draw labs. That way they're already awake and I can help them.
Lastly, I would like to say that I do these things out of a genuine sense of care and concern for my patients. I am by no means trying to make my own life easier, rather, keep my patients safe and well cared for, with all their needs met before they even have to ask.