Advice needed! Nursing home tips

mmc51264, BSN, MSN, RN · Nov 24, 2014

You'll figure out a routine. Just takes a little time. Watch others when you can and you'll find things that work for you. I worked in a rehab unit that was within a LTC facility and same issues. I got more efficient so I could fit everything in without feeling overwhelmed

KimRN24 · Nov 24, 2014

Thanks so much! I hope so, I guess it gets easier with experience

NurseMellie · Nov 25, 2014

Definitely a tough place to start... For me it depends on what shift you work. Days you hit the ground running with blood sugars and meds. I usually do diabetics first.... then the folks who are up in the dining room for breakfast or who have specifically timed meds. If its evenings you have some time to get settled and check on orders etc. But basically the same routine at the dinner med pass. Its going to take time for you to develop your own sense of organization.

flowerly · Nov 26, 2014

Hi! I feel you. I'm gonna start my work this Wednesday at the nursing home too and it will be my first time in LTC since most of my experiences are in the hospital. What shift are you? How's the med pass?

4boysmama · Nov 26, 2014

it will take a while to find your own routine, but it will come. A few things I do to make sure my day goes smoother: check the cart first thing for supplies and meds. I make sure I've got insulin for each pt, and that it is not expired. I stock insulin needles, alcohol pads, lancets, test strips, etc. I make sure I've got a functional BP cuff, pulse ox, thermometer (and enough probe covers for it). I pull together treatment supplies, and put the supplies needed for each patient into a ziplock bag, ready in the cart so that I can grab it when I'm ready to do the treatment (or, when the CNA suddenly tells me that the pt is ready RIGHT NOW lol). I chek house stock meds to make sure theres enough to get through the day (it's so annoing to get through half a morning med pass and realize you've run out of multivitamins, colace, and tylenol!) If you are dealing with physical therapy and pts who ight be leaving the floor - find out the therapy schedule and get th pts who go early to therapy done first, even if it means going "out of order" down the hallway. It wastes time to have to chase down a pt in therapy to give them scheduled meds.

In terms of charting - I found that a lot of the nurses on my unit (sub acute, rehab-focused) leave their notes and charting for the end of the shift, which often means that they stay late to get them finished. I've gotten into the habit of charting as I go whenever I am able. We're using PCC, so it's very easy to click open and do a progress note while I'm in a pt's emar. I find that it's quicker to write the note right there while I'm "in it" than to wait till later when I can sit down and do a bunch at the end of the day. I keep track of who I've charted notes on in my brain sheet - I put a "c" next to each name at the beginning of the shift, and then cross it off when I've written a note for them; so I can see at a glance who needs to be finished.

alt_one · Nov 26, 2014

It takes a little time as you learn about the residents you are caring for. A good orientation with a nurse who works the floor regularly would help. I've worked for 10 years on a 21 bed nursing home unit. We use electronic charting. I usually review the meds and the treatment records for any changes since my last shift and then chart the meds as I give them out. The treatments I chart at the end of shift. We chart by exception on this unit so I usually only have 3 or 4 residents that require detailed charting for new admits, behavior issues or change in status. The only other thing I would say is that this is the resident's home. I'm the visitor coming to work there. I try to learn their routine and adapt to their needs as much as practical. This can be difficult considering the level of dementia at times.

bluegeegoo2, LPN · Nov 26, 2014

Go into it with the understanding that the workload usually remains fairly constant, but your ability to manage your time will improve. My personal method of time-management is after I have been on the unit for a couple weeks and have a general feel for what needs to be done when, I begin to break up tasks by time blocks. A, B, & C need to be done by 4 p.m. (I work 2p-10p), then D, E, F by 6p, etc. If 1, 2 or 3 occur during that time, I try to get them handled during my "down time" which is the dinner hour or after evening med pass unless it's emergent. I use meal time to take off orders, make phone calls, address issues, etc. I make a valiant effort to finish my evening med pass with enough time left on shift to do tx's and finish up what needs to be addressed and or charted. All time frames are relative, as any and everything can go wrong in a shift and throw off my schedule. But using that tactic gets me through shifts fairly well, even the crazy ones. Hope that makes sense.