on call on different floor that too once a week....help..

SquishyRN, BSN, RN · Feb 7, 2011

I feel you! I'm a new grad, licensed in December, working my first nursing job in LTC on a per diem basis too. My orientation was only 2 days long for the same shift and station. After that, I had to literally hit the ground running. This post will be long, but I just wanted to share what I do in case it might help you since I'm in the exact same boat.

It's important to ORGANIZE AHEAD OF TIME and PRIORITIZE. I've worked both 7-3 and 3-11 shifts on each of the different stations, each with 40+ patients. I try to arrive at least an hour early so I can plan my day. I have blank "cheat sheets" for each station and shift that I made and keep in my car, so that when I get called I can just pull one out to fill up in the time before my shift starts. On my paper I have every room on that particular station listed. I then mark off what time everyone has meds. If I have a lot of time, I go through each med sheet in the med book. If I don't have a lot of time I look directly in the cart who has meds outside of 9am and note those since the 7:15 meds and 11/12/1/2 meds are separate from the 9am meds. It's pretty much a given that everyone gets 9am meds. I just make sure to be polite and stay as much out of the way as I can for the night nurse still giving her 6am meds. For our facility, for 7-3, meds generally tend to be given at 7:15, 9, 11,12,1, and 2. I particularly note which patients get the same med twice in that shift. For example, some patients get BP meds at both 9 and 1, and most patients on Sinemet get a dose at 9 and 1. And of course BS and insulins at 11:30. I know typically we're supposed to just go room by room, but I found that not knowing the patients' peculiarities in taking their meds really slows me down, so I priortize when I give each patient their meds. During my morning round I note which G tube feedings look like they're going to run out in my shift so I can get new ones ready on my cart to save myself time later in the day. After I make rounds, I give the 7:15 meds right away since they're usually due w/ breakfast. I then start my 9am's, which take the longest. I give the ones who receive the same med twice first b/c I don't want to overdose them if I give them their 9am dose too late and then give them their 1pm not long after. Then I just go room by room finishing the 9am meds until 11, even if I'm running late with the 9am meds I still stop at 11 and finish it after the BS and insulins. At 11 I go around and start turning off the G tubes per facility protocol for an hour during lunchtime as I make the round to do BS checks and insulin, doing the ones who eat first and then the ones who are on G tube last. Once BS and insulin is done, I pass my 11 and 12 meds together since no one usually has both an 11 AND a noon and turn the feedings back on as I pass by. And then I pass my 1 and 2 meds together. Then I sit and do all my charting until the shift is over. I don't worry about treatments during 7-3 since there is a designated treatment nurse for that shift.

3-11 shift is much easier as there are far less meds, but I pretty much organize and prioritize the same way. Although I use a different cheat sheet since the priorities of the 3-11 shift are different than 7-3. For example, I do BS and insulins before med pass and I do the treatments due for that shift during my round passng the 5pm meds. I interrupt my 5pm med pass to do 6pm breathing txs, but resume and finish when those are done. By 9pm usually all my meds are passed and I just sit and do all my charting.

It's worked for me so far, but I'm still learning and have worked through every lunch to finish everything on time... That's my goal right now, not just to finish on time but to get a lunch in there somewhere too =P

sweetjellies1 · Feb 8, 2011

I feel you! I'm a new grad, licensed in December, working my first nursing job in LTC on a per diem basis too. My orientation was only 2 days long for the same shift and station. After that, I had to literally hit the ground running. This post will be long, but I just wanted to share what I do in case it might help you since I'm in the exact same boat."
It's important to ORGANIZE AHEAD OF TIME and PRIORITIZE. I've worked both 7-3 and 3-11 shifts on each of the different stations, each with 40+ patients. I try to arrive at least an hour early so I can plan my day. I have blank "cheat sheets" for each station and shift that I made and keep in my car, so that when I get called I can just pull one out to fill up in the time before my shift starts. On my paper I have every room on that particular station listed. I then mark off what time everyone has meds. If I have a lot of time, I go through each med sheet in the med book. If I don't have a lot of time I look directly in the cart who has meds outside of 9am and note those since the 7:15 meds and 11/12/1/2 meds are separate from the 9am meds. It's pretty much a given that everyone gets 9am meds. I just make sure to be polite and stay as much out of the way as I can for the night nurse still giving her 6am meds. For our facility, for 7-3, meds generally tend to be given at 7:15, 9, 11,12,1, and 2. I particularly note which patients get the same med twice in that shift. For example, some patients get BP meds at both 9 and 1, and most patients on Sinemet get a dose at 9 and 1. And of course BS and insulins at 11:30. I know typically we're supposed to just go room by room, but I found that not knowing the patients' peculiarities in taking their meds really slows me down, so I priortize when I give each patient their meds. During my morning round I note which G tube feedings look like they're going to run out in my shift so I can get new ones ready on my cart to save myself time later in the day. After I make rounds, I give the 7:15 meds right away since they're usually due w/ breakfast. I then start my 9am's, which take the longest. I give the ones who receive the same med twice first b/c I don't want to overdose them if I give them their 9am dose too late and then give them their 1pm not long after. Then I just go room by room finishing the 9am meds until 11, even if I'm running late with the 9am meds I still stop at 11 and finish it after the BS and insulins. At 11 I go around and start turning off the G tubes per facility protocol for an hour during lunchtime as I make the round to do BS checks and insulin, doing the ones who eat first and then the ones who are on G tube last. Once BS and insulin is done, I pass my 11 and 12 meds together since no one usually has both an 11 AND a noon and turn the feedings back on as I pass by. And then I pass my 1 and 2 meds together. Then I sit and do all my charting until the shift is over. I don't worry about treatments during 7-3 since there is a designated treatment nurse for that shift.
3-11 shift is much easier as there are far less meds, but I pretty much organize and prioritize the same way. Although I use a different cheat sheet since the priorities of the 3-11 shift are different than 7-3. For example, I do BS and insulins before med pass and I do the treatments due for that shift during my round passng the 5pm meds. I interrupt my 5pm med pass to do 6pm breathing txs, but resume and finish when those are done. By 9pm usually all my meds are passed and I just sit and do all my charting.
It's worked for me so far, but I'm still learning and have worked through every lunch to finish everything on time... That's my goal right now, not just to finish on time but to get a lunch in there somewhere too =P

Thanx!!! I am getting hang of MEDPASS alone itself but its when alongwith medpass I have to do treatments too and practically all the residents have treatment:os. do you sign off on shampoo treatments etc. which have nothing to do with wound care tx? do you find out if it was actually done ??? sorry I know I have lots of questions but I really need to clarify these.. will appreciate if you can thanx.. :confused:

SquishyRN, BSN, RN · Feb 8, 2011

we have a separate treatment book where all the treatments are listed pretty much the same way the meds are in the med book. We would know if the treatment was given bc it would have been initialed like the meds are initialed. Since there's only a treatment nurse for 7-3 and no other shift, when I have to do the treatments for 3-11 I just do it with my medpass as well. For example I'll go in, take bp if needed, do the treatment, give the med and then move on to the next patient. Everything i would need for all the treatments i stick in one of the big drawers before getting started so i dont need to do any back and forth getting materials btwn patients. A cheat sheet really helps bc I can see with a single glance everything scheduled for each patient for the shift.

sweetjellies1 · Feb 10, 2011

thanx for taking out time and answering. I plan to start work early and get my paperwork in order and make a cheat sheet bfore starting my medpass. thanks for all the great tips...

ComeClarity · Feb 12, 2011

My orientation was only 2 days long for the same shift and station.

Only 2 days long? I guess if you were an experienced nurse with years of LTC experience, that'd be acceptable, but geez, you're a new grad. Honestly, I'm not sure I would accept an LTC job that offered only 2 days of orientation for a position where I would be responsible for 40 residents.. I hope most LTC's offer more orientation time than that.

SquishyRN, BSN, RN · Feb 12, 2011

Only 2 days long? I guess if you were an experienced nurse with years of LTC experience, that'd be acceptable, but geez, you're a new grad. Honestly, I'm not sure I would accept an LTC job that offered only 2 days of orientation for a position where I would be responsible for 40 residents.. I hope most LTC's offer more orientation time than that.

It varies among LTC facilities (at least from what I've read on these forums), but what they have in common is that when it comes to LTC, it's definitely short, at least when compared to hospitals. It was definitely baptism by fire. I was in tears and shaking at the end of my very first day. But I was lucky to have very supportive co workers. The nursing supervisors did all my charting and other duties for me my first few times so all I had to do was worry about the meds. The cnas and other staff were helpful and never made me feel like I was bothering them when I asked for help, and they would always give me a heads up on the patients' temperments and peculiarities. In LTC, the learning curve is definitely as steep as it's gonna get in nursing IMO. I've only been working 2 months per diem, but if you knew me then and now in terms of work related-knowledge, you'd notice a DRASTIC difference.

SquishyRN, BSN, RN · Feb 12, 2011

Hmm... I can't seem to edit my above post, I forgot to at something.

Don't get me wrong, there is no way I think 2 days was enough in any circumstance, but the job market is extremely tough. Especially where I am (so cal). If youre not willing to take such a job, someone else will just bc jobs are that tough. So I took the job and made it my initiative to get extra orientation by coming in on my own time unpaid.