I am a LTC nurse also and I have been full time charge on the same unit for nearly six years. I don't know if this will help at all but what I did was to divide our unit in half. I am charge but I also work half the hall, as well as handling admits, orders, discharges, emergencies, you know, all the extra stuff. You must remember that being in charge only means that you are the organizer that finds the most efficient way to get everything done in the allowed amount of time.( oh yea, we also get blamed if things go wrong! smile) This often means that changes must occur. By dividing the hall, you will be able to spend more time with each resident and while you are passing meds, you can do a visual assessment for any changes that may have occurred. Remember the person on the other end is a nurse and she can just as easliy handle her end as you can, so cut the work load in half and ease the stress some. I always work the most critical end on my unit. That gives me more time available to assess residents and give the extra one on one that their needs require. If the nurse on the other end has a concern, she comes to me and I assist her in handling it but as I said, she is a nurse and can handle most things on her own. Your facility would have to be willing to provide 2 med carts to the unit but for our facility it has benefited greatly, by keeping the med passes in compliance and also by letting the nurses have more time with each resident. I will admit that it does get hectic at times working an end and being charge but the nights go faster and I get a lot of quality time with the residents that need it most. Just a thought and I wish you luck but don't give up and like you said, organization is the key. I have always said, if I can organize it, I can master it!