Concerns about routines

AmbCareRN · Aug 4, 2008

I did LTC for a long time as a CNA then as an RN. First of all, get to know the residents. Sit down with a nurse that if very familiar with the residents and ask about routines, making notes as they go. Do they take pills whole, crushed in applesauce or whatever. Then ask if certain residents prefer their meds at certain times. Some of mine wanted to wait until they had their meal to take meds. As the saying goes, They do not live in your facility, You work in their home so try and think about that and what they might have been doing at home. It will get better and I hope you enjoy it. I sure did! I still do PRN work there just so I can see my old residents.

Take care and hang in there. It will come.

luvtosmile · Aug 4, 2008

I too am a new RN in a LTC facility and it is very intimidating. My coworkers are very helpful but at the same time they have work that has to get done and the best I can do is watch and assist whenever I can.

I am starting on nights so there is really not a chance to assess the residents, all I have done so far is pass meds. I hope there is more to LTC nursing than this. I am scared of being on my own and having no real experience but passing pills. Also, I don't really know what I am giving these residents. I try to look up the ones I don't know but at the same time there is a lot of meds to pass and very little time to do it in.

I am sure other nurses have been in our shoes, I hope you get lots of answers to your thread so I can learn as well.:typing

rhondaa83 · Aug 5, 2008

Apparently I have been very lucky at my LTC facility. I was orientated for 5 weeks. Everyone I work with is extremely nice and very patient. I always asked the nurses about the residens habit's. Do not be afraid to ask them, you want what is best for your patient even if you feel uncomfortable asking a crabby nurse. I work with amazing wonderfull nurses who make me {horribly insecure} feel very comfortable. I am very fortunate. Rhonda

CapeCodMermaid, RN · Aug 5, 2008

At the risk of sounding like a broken record...why are you giving 'lots of meds' on the night shift? People should sleep at night not be woken up for medication.

Sometimes it is easier to develop one's own routine. The med pass is the med pass no matter what unit you work. You still must abide by the 5 rights. I found it very helpful to formulate a work sheet. It had one block for each patient. In the block was listed their name, doc's name, pills crushed. whole, in applesauce or what ever, code status, and diagnoses. There was space to take notes. I always wrote the report from the off going shift in the left half of the box in red and MY shift notes on the right hand side. If there was something I thought I might forget to do, I'd write it in the box with a little mark that I would check off once I had done it. I'd check my paper before I did count with the next shift to make sure I had done everything.

You will find your way if you give yourself time. My way doesn't work for everyone nor does their way always work for me. If the staff nurses won't answer you, find the SDC and ask her/him to help you out. That's why they're there.

Good luck.

CoffeeRTC, BSN, RN · Aug 5, 2008

Depending on what shift you work, you will have different routines. YOu might want to look to the CNAs for some info too.

3-11 shift for me (weekends, but mostly the same during week days)

check staffing/ make out schedules and the vital list

report/ count narcs and load my med

do a quick once over to see where the residents are (room, activites, etc)

start meds....this is where CNAs will help...ask them who eats dinner where or who might be going back to bed. I start on the pts who are out of the room and in the lobby or dining area and who will be staying up..I also get the diabetics before dinner. Then I will go down the hallway and get the ones who will be in the room. then I will get the tubefeeders last.

charting/ doc calls etc

After dinner I will do a few treatments and start meds again. Depending on the info I find out from the CNAs...I will plan my meds/ treatments based on who goes to bed late etc.

This is my basic routine. When I worked prn at another place, I was floated around and the only way I was able to get stuff done was to ask the cnas about the residents. Every unit was different, but still the same. Watch what the other nurses do and I would still continue to ask questions.

Skeetersmom119 · Aug 7, 2008

Your CNA's are your lifeline..establish a good working relationship with them. They will let you know everything. Also, you will have to take the bits and pieces of what is given to you, and put it together in your own style. Staff development can give you direction for policy and procedures. There are some nurses that are very patient, and will help you out. They are hard to find though.

rmarz · Aug 16, 2008

What I do is this: Whatever gets me thro the shift!

As you get to know the people, the meds, the txs, the BSs, the Br Txs, and individual routines... you can revise what you are currently doing to save more time.

I usually start out a place going straight through the MAR/TAR, front to back (no skipping around), so I don't miss anything. I tend to stick to that routine, but cater to the residents as I get to be able to anticipate needs better.

I have made up some sheets for all shifts that I take with me. I call them my "Hey Dummy, Do This" sheets. Helps on days I'm tired, or too busy to keep on track. They really help on agency shifts!

As far as CNAs... I try to make sure I see a trend and habitual behavior before I start attempting to effect change in how they perform their jobs. I also try not to jump on them on a day when everyone has called in and half the building has the runs! I will let my head spin around and flames shoot outta my ass tho in the case of habitual neglect!!

WVStarFish · Aug 18, 2008

I'm new too, and working at a LTC home. My "orientation" consisted of taking on the med pass for whatever nurse I was with that day. A few days before I was put out on my own, another nurse did show me how to get into the computer and do some charting.

Where I am, we have a sheet for our med pass with each residents name, code and room number, in order. At report, at shift change, I ask the previous nurse things like who is crushed, who gets grouchy if their meds aren't on time, who "routinely" gets PRN meds (that saves me lots of time)...

I make those little notes on the paper and keep it on my med cart. When I have all the notes for a hall, I use it the next time.

One thing I've noticed...we had an agency nurse come in one day and she finished up her med pass in lightening speed even though she had never been to our facility before. While we all had raised eyebrows, it seemed to be a silent understanding that "at least we have staff".

Sad, I know.

The nurses I work with have told me that I am going to feel like quitting and I am going to feel overwhelmed and then I'll eventually develop my own routine and it will get somewhat easier. I'm relying on that heavily, because I am very, very unhappy and overwhelmed at my job.

I also keep telling myself that there are problems every where you go, reminding myself of the bonus I'm "supposed" to get and how close to home my job is located.

I know what you mean about the nurses not knowing what to tell you or them being so busy themselves. The ONLY way I've learned anything at all is when I HAD to do something, knda like learning to swim by being thrown in the water all at once.

Just yesterday I posted a question about how to get through med pass with such talkative residents. It seems my whole shift is med pass, and I work 3-11.

I've completely forgot what the topic was here but I hope some of the things I said will help you.