Can anyone help with routine at skilled nursing?

  1. I am acute care experienced trying to accustom myself to long term care. I find it amazing that anyone could actually give 30+ patients their medications on time and do treatments...esp when you are from an agency and don't know them....any tips? thanks!
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    Joined: Aug '03; Posts: 287; Likes: 196


  3. by   Nurset1981
    Ahh this one is right up my alley. I worked for a 38 bed LTCF for 5 years on 3-11 shift. These are my tips:
    1. When we used agency, I would write down pertinent info on a census sheet about each pt ie. meds crushed, whole, if they frequently use prns like ativan, pain mgt, etc. along with numbers for DON and MD's. They all commented how helpful this was. Maybe one of them can do that for you, if not get your MAR and go through and write down info so you have it "at a glance".
    2. Befriend the CNA's they will make or break your shift. They know more about the patients than people give them credit for.
    3. Locate important phone numbers right away
    4. Locate supply closet/storage so you know where to go.
    5. Find the facility policy book and look up the death policy...I know talk about worst case senario, but in LTC its gonna happen. some facilities still have the old school way of wrapping the body etc. and you'd wanna know that. Also find the death certificates while you're at it so you can prononounce and relase the body.
    6. Med passes can be crazy. I always start with sugars and insulins and AC meds. then go on to 5-6pms monitor dinner etc. I save treatments until patients are in bed, its just easier then. If you notice certain patients get antsy or have outbursts etc. try to anticipate and medicated them if they are prone to anxiety. You don't want to find yourself short an cna because you had to pull one to do 1 on 1.
    thats it for the moment, hope it was helpful!
    good luck
  4. by   geniann
    I agree with everything Nurset1981 said- those are great ideas. A good report sheet can save ALOT of time and mental stress. I always check for odd timed meds a the beginning of the shift- I would write a little 1p or 2p by there name- some nurses flag the MAR. Then when I get done with my initial pass, I go thru the TAR and write the treatments on the back of my report sheet. That way when I go in to do the treatment, I don't have to lug the whole TAR in and flip through the pages- especially in LTC because so many of them will have Dc'd orders and wind up with alot of pages you must go through. I worked agency right out of nursing school and I learned alot just because I had NO orientation. Even though pre-pouring is frowed upon, I have done it if I have had a really hectic day and am running behind. I just write the room no. or the residents last name inside the paper souffle cup. Unlike Nurset1981, I work 7a-7p so I do have 2 major med passes that are both in the middle of the already crazy day. If a resident is declining when you get report make sure to know their code status- one less worry if they do stop breathing. Also if Ms.X ONLY gets a MVI and an aspirin, make sure they have them to be given together - why have to chase someone down at 9a when they can take both at 5p.

    Most of all- STOCK YOUR MED CART WELL! This will save your poor feet a few extra miles throughout the day- and don't forget the insulin needles and tube feeding. Just my If you want you can PM for more help- I have a ton of little tricks that may help you. Best of luck and remember to pee- I can't tell you how many days at 2 or 3pm, I realize I have not went to the bathroom all day.