Feeling extremely discouraged

[NurseNykole]

I'm a new LVN, worked 7 weeks over the summer as a camp nurse for special needs. Absolutely loved that job! Even though there were many challenges and I was tired a lot! Lol now I'm working at a SNF for a little over a month. I'm float, and mostly working pm shifts. I usually have 30-38 patients and I know I'm going to be slower than the seasoned nurses but I just can't figure out how to care for that many patients and get everything done on time. Some nurses there just tell me it takes time to get you're routine, but I feel like I'm constantly doing med passes with extremely heavy meds, 10+ diabetics, along with treatments and everything else I need to do. Can I just get some advice from those of you working in SNFs?

[TheCommuter, BSN, RN]

I worked in various SNFs before leaving them behind for good in 2012. Here is how I organized my shift. I worked 16 hour weekend double shifts from 6:00am to 10:00pm every Saturday and Sunday. At the start of the shift I flipped through the MARs and TARs, and jotted down all tasks that needed to be accomplished in my personal tablet.

My notebook was my main way of staying organized each shift, and because of it, I normally did not forget to complete tasks that needed to be done. Here is how one of my old notebook pages appeared (names were changed due to HIPAA):

9-23-2007

DIABETICS, FINGER STICKS: Agnes (BID), Catherine (AC & HS), Bill (AC & HS), Wilma (AC & HS), Rex (BID), Jack (BID), Edith (AC & HS), Margie (0600, 1200, 1800, 2400)

NEBULIZERS: Margie, Edith, Bill, Jack, Jane

WOUND TREATMENTS: Jane, Bill, John, Jack, Lillian, Rose, Lucille

IV THERAPY: Wilma (Vancomycin), Linda (Flagyl), Rex (ProcAlamine)

COUMADINS: Agnes, Catherine, John, Lucille

INJECTIONS: Agnes (lovenox), Jane (arixtra), Rex (heparin), Bill (70/30 insulin), Edith (lantus), Mary (vitamin B12 shot)

ANTIBIOTICS: Wilma (wound), Linda (C-diff), Rex (pneumonia), Catherine (MRSA)

1200, 1300, 1400 meds: Margie, June, Rose, John, Jane, Jack

1600, 1700, 1800 meds: Rose, John, Rex, Lucille, Lillian, Linda

REMINDERS: assessments due on Catherine, Jill, and Louise; restock the cart; fill all holes in the MAR; follow up on Jane's recent fall, fax all labs to Dr. Smith before I leave, order a CBC on Rex...

[anewsns]

Woah that's a crazy amount of patients. I tended to want to keep things sort of open ended about when I was going to do them. So I would have like an ongoing list. So as I was quickly moving through meds and treatments (computerized at my job ) i wojld have this ongoing list of anything extra that I could miss , I would write the room number and then the thing - "145- admit 151- check TB" and write them in the order I became aware of them. Then if I was doing meds and treatments on someone, I would try to do anything important that I saw on my list as well and cross it off. any paperwork tasks are always left to the end with me.

[clvn23]

I feel your pain I'm new in a snf also and had 48 patients to pass meds to I just couldn't do it and had to resign its way too much for one person

[melai12]

I worked at SNF too.. My shift is from 3-11 and sometimes i do cover 7-3 shift. Its hard! But youll get used to it. I have 30-36 patients everyshift and i do med pass with some cna job' too! And carrying out orders at the end of the shift and also charting! If you are lucky you will also do incident report and a change of condition!

What i do on my med pass is i start passing my meds at 3:30pm! And i will be done at 6:30pm or sometimes 7pm and that will be my lunch time.. During lunch time, while eating im transcribing or signing the MAR and prep my GT feeding. Need to do multi tasking to finish early.

2nd batch of meds is i will start at 7:30pm and i will be done by 10pm. Sometime by 10:30pm. I will be clocking out at 11:30pm but most of the time that will not happened coz of too much paper works! I always do 1 hour OT!