7a-3p Shift Organization


Hi Everyone,

I've recently started a job in a LTC facility and I'm going to be put on my own for the first time soon. I have 27 residents who have A LOT of meds each. I'm worried about doing my med pass on time and getting everything done. One of my super awesome coworkers gave me a cheat sheet outline for the 3p-11p shift which I'm sure will help tremendously, but I was wondering if someone had some suggestions for the first shift? Any advice on organization tricks and time management would be super super helpful!!!


Has 33 years experience.

Hello EA 23 and welcome to the real world of nursing!!! Having 27 patients to get a ton of medications into is not going to be an easy task. First of all, do not pull more than one patient's medications at a time, focus on one patient at a time, remember the 5 Rs of giving medications. The elderly take a little longer to give medications simply because they take so many and usually there are some type of swallowing issues. Ask when you get report from the off-going shift how the pt takes their medications, whole with water or whole with applesauce, or crushed etc. I found some patients liked their meds crushed better with pudding than with applesauce. We also had to pass the nutritional supplements while giving meds, so I would usually place the Ensure on my med cart along with the ice water pitcher. Remember to lock your cart whenever it is not in your field of vision. You do not want any one to get into a drawer of meds and accidently take someone else's meds. I use a visual brain to help keep me on tract. I do not write down the name of the medications but just the time it is to be given. Most facilities let you have an hour before or after the due time to give meds. Start your med run early because it will most likely take longer than you think it should. Make sure you still check arm bands for identification purposes, many LTC facilites do not use these, which I think is wrong. Good Luck!!!

Thanks so much for the advice! It's scary to be alone for the first time on a crazy busy am shift :)


74 Posts

Has 3 years experience.

7-3 is usually the busiest shift; you'll have all the staff running around getting in your way, taking your MARs, etc. 3-11 has the heaviest med pass (5 + 9pms are heavy, 1pms are usually not), but in most facilities 7-3 gets all of the once daily treatments and you'll be taking off the majority of the orders. It's very important that you stay organized. Make sure all of your papers are stapled together because they can get mixed up with everythign else. Behind the nurses station, try to keep your charts together and know where everything is located (this takes time). Your charts will inevitably get taken by dietary, doctors, therapy, etc, but do your best to keep your own area to yourself where you can be organized. I always bring a multi-colored pen, scissors, a pen-light, and a highlighter and rubberband them together and keep them in one of my pockets.

You'll get to know the residents' meds and treatments with some experience, and you'll get to learn their preferences pretty quickly. Once you can do this, and once you feel confident in your nursing skills, LTC usually becomes (relatively) easy as long as you don't have too many problem patients/families. But even then, you'll learn how to deal with them. It will always be a lot of work, unless you're really lucky and get an easy unit - but you won't if you're a new grad.

If any of your LTC residents go out to therapy, get to know their schedule. The good thing about LTC is you know when things are off with your residents, because you see them almost every day. The bad side is that many of your skills can get stagnant, and you can become complacent. Being slow out the door and asking a ton of questions is normal for a while, so try not to feel bad about that, even if other nurses get on you about it. If you plan on going to a hospital one day, I recommend doing sub-acute rehab in your facility after you feel comfortable with LTC.