How does night shift differ @ LTC?

At my facility the nurses have to put all the new med that come from the pharmacy in the carts. They have to get some paperwork completed for the next day. They file, and they have to pass all the 6-6:30am meds. They have to do the fingersticks in the morning. Each nurse has 60 patients. Oh and they also give PRN's if someone needs them.

Most LTCs do not have housekeeping or maintenence on nocs- if a toilet overflows or gets stopped up, the nurse deals with it. Working LTC nocs is how I learned to unclog a toilet with a coat hanger.

In the LTCs where I have worked, there are 2200, 2400, and 0300-0630 med passes, as well as monthly summaries, body checks, treatments, and am lab/specimens to obtain. Rounding and incontinace care, turning and repositioning are big on nocs. Also, getting them up and dressed in the am. I've never worked nocs where there has been downtime- lots and lots of paperwork to do- always.

I have never agreed with scheduling meds and tx for nocs unless there is no alternative.

The residents need uninterupted sleep.

I'm a new nurse working in LTC and I am pretty busy all night. I get report, do census, get paperwork ready for lab draws in am, residents going out in am, anyone being discharged. I have 5 G-tubes which require either bolus feedings, or cont feedings. I have a resident with a trach, which requires trach care and suctioning. I sometimes have treatments. between 5-15 people on the 24hr board that I have to get vitals, do focus assessment and chart on. Blood draws in am, med pass around 5am. PRN meds. Any falls require about an extra 45 min worth of work. I have to check all new orders for the day and make sure they are all followed up on and in books. pharmacy delivers at night. I have to put all away and do reorders. clean carts, empty garbage, stock treatment cart, monthly summaries, between 2-5 skin assessments. If there were any new admits, I am responsible for checking the new chart and all meds. Rewrite all boards with any new orders included. I'm sure theres more but let me tell you, sometimes I feel like I can't possibly get it all done. It's crazy. Forgot to mention IV's, sometimes we have to hang them at night. also there are usually flushes to do. I can't imagine it being any more stressful. but there are good nights and bad. I think the facility I'm at has a lot of high acuity residents. I actually think working at a hospital might be easier. who knows

good luck

The one piece of advice I wish someone would have given me when I was a new nurse was don't be afraid to ask for help. Also at night, depending upon what acuity you have, there may be a few resident's that suffer from Sundowner's. I have yet to work in a nursing home without at least one resident like this. They are up most of the night and sometimes need 1-on-1 care...but generally nights are a good place to start for a new LPN. Good luck!!

P.S. Make sure that you respect your aides but let them know who's boss. A lot of aides may walk all over you if you let them.