I currently work LTC/short term rehab. Time management skills are not be underestimated in this environment. I worked med surg prior to coming to LTC/short term rehab and I just thought I knew what time management skills were about. While there are some days when I don't manage to leave on time, those are usually the days when the you know what has hit the fan and I find myself dealing with a fall, an admit, a transfer to the ED, and family drama all at once. However, those days aren't every day, so I am usually able to survive on my own time management skills and some hard work.
A few tips:
- If you have a fall, go by your facility policies. At our facility, it sufficient to perform a neurological check, assess for any injuries, and then continue on with the med pass - incident reports, notifying family members, etc. can wait until later as long as the resident is okay. The same can be said of finding bruises, skin tears, etc. I will usually go ahead and apply the tx for a skin tear and then move on. I can fill out paperwork later, but the meds have to be passed in a timely manner. To help with the paperwork, I will usually write down any pertinent times and information.
- If you have to send somebody out to the ED, call to give report to the ED, fill out your paperwork for EMS, then call EMS last. EMS can show up anywhere from 5-20 minutes from the time that you call them, depending on where they are and who takes the call. Unless it's an emergency, you want to make sure that you have your packet of paperwork complete to hand to them. (If it is an emergency, then do the very best that you can but understand that you may only be able to get the essentials down before they show up.)
- Support from your coworkers and charge nurse is nice, but don't come to depend on it. I have had charge nurses who stayed several hours after to help clean up the mess from a shift from hell, and I've also had charge nurses who walked out the door at 11pm. The same can be said of coworkers. At some point you have to be able to stand on your own two feet, even if that means staying over to ensure the next shift doesn't inherit a nightmare.
- Develop a routine for your shift. If I'm on the short term rehab unit, I usually do assessments during the 4pm med pass since it's usually pretty light. Then I do Medicare charting during dinner time, since there are usually no meds during that time. After the 8pm med pass & any tx, I chart PRNs and any changes or new information. If I'm on LTC, I chart as I go along because otherwise I will always be behind. On both units, I do my treatments after I've finished passing meds.
- Assess any new orders at the beginning of your shift. If you're not sure if the nurse giving you report has taken care of them, ask. If you're still unsure, go ahead and fax them to pharmacy, notify the family, etc. Assume that it hasn't been taken care of until you have concrete proof that it has indeed been dealt with.
- Document everything. Any refusals, skin assessments, family drama, abnormal VS, communication w/providers or what have you. Document what you know and what interventions or actions you took. CYA at all times.
- Don't be afraid to contact a provider. Trust your instincts. If you think your full code resident is circling the drain (or that your DNR resident has had a change in condition and needs a change in care plan such as a hospice referral, or whatever it may be), don't wait for your supervisor or DON to climb on board. Advocate for your resident's well being, your reputation as a nurse, and your nursing license.