ltc desk/treatment nurse newbie

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so I've been working on this job for almost 3 months till now. And the main thing is that I need to learn better time management. thing is, i am a newbie desk&treatment nurse, at the same time charge nurse. this is my very first nursing job and i am so like crawling. I feel sad & frustrated at times whenever i felt incapable because I haven't experienced this situations and that so I try my very best to stay put & remember most of it if not all. I always knew Im fit to do paperwork& treatment, as I was ok with it. Then later on I figured out, when I work by myself, it seems I need more time figuring things out, calling MD's, transcribing orders, families, hospitals, labs etc.sometimes there's just alot that verbal report alone at the end of the shift everytime,you would like to have everything written out. There is pressure as I am managing a 50+bed unit then you have interruptions while you're doing your job. There are times I go blank during work because it was overwhelming. Yet I continue despite of that. Why so? I care for my patients thats why. I just feel like I needed more advice in this field of nursing like how you will manage yourself with time, & doing your job properly.

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I've learned to never trust a facility that puts a brand new nurse in a charge position. If I had one piece of advice to give a new grad, it would be to not accept a charge nurse position. However, that's easy for me to say with the job market the way it is. Sometimes you have to take what you can get.

Learning how to manage your time as a nurse is something that comes with experience. My first six months, I went home late every night. After that, I figured out what I needed to do and when in order to get out on time. You just have to do it. You'll find ways to multitask and minimize the amount of time you spend during certain things (like getting all your supplies before you go in the room, checking heart, lung and bowel tones all at the same time even though they're two pages apart on your assessment form, etc). When you become more familiar with the job, you'll also start remembering things better. Like when I pull someone's meds, I am usually able to tell them what pills are in that cup, even if there's 15 of them. I couldn't do that my first year without having to write it down. Being able to do a quick assessment and remembering your findings will save you a bunch of time, and again, that comes with experience.

Be patient with yourself and realize these skills will come with time. Nobody is born with them. Even the best, fastest, most accurate super-nurses were once new and slow.

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When I was new, I remember having the same thoughts and feeling so incompentent, slow and frustrated....

I can't begin to tell you how many days I would punch out on the clock and then stay for a couple of hours to complete my work (illegal to do with labor laws, I know) It was probably 2 years before I started to feel confident and up to speed.

Other than time, the one thing that really helped me was finding someone to act as my sort of unofficial mentor. I was lucky to find a nurse that was very near retirment, and literally had "been there, done that" and was delighted to teach me all of her little "tricks" and secrets. She was a lifesaver and helped boost my confidence 1000%. 25+ years later I can still hear her voice in my head when I run up against a problem!

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When you have 50 residents and two (let's say) nurses, there are a couple different ways you could handle the staffing/assignments. The most common way is to just give each nurse 25 residents and call it a day. Where I work (49 residents) one nurse (the LPN) is assigned meds/treatments and the other (the RN) is assigned charge. I love this system, because I can focus on my meds and treatments. All the other stuff is handled by the RN. The CNAs know not to interrupt me, they go to the charge. Nursing really should go back to a model where nurses are assigned not so much a specific group of patients, but instead each nurse is assigned a specific task for the shift. It's more efficient.

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Specializes in Gerontology, Med surg, Home Health.

Brandon-it's not about efficiency. It's about resident centered care and what's best for the residents.

We are nurses...we need to do more than be task oriented. I hate the med nurse/charge nurse model and am trying to change it where I'm at now. Team nursing is far better for the residents.

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Specializes in LTC, Hospice, Case Management.
Brandon-it's not about efficiency. It's about resident centered care and what's best for the residents.

We are nurses...we need to do more than be task oriented. I hate the med nurse/charge nurse model and am trying to change it where I'm at now. Team nursing is far better for the residents.

Not sure everyone sees it this way. My bluntness got away from me yesterday when I told a nurse that I could train a monkey to pass meds....I needed someone who could think like a nurse to do the job. (Got the stink eye for that comment)

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Specializes in Rehab, LTC, Peds, Hospice.
Brandon-it's not about efficiency. It's about resident centered care and what's best for the residents.

We are nurses...we need to do more than be task oriented. I hate the med nurse/charge nurse model and am trying to change it where I'm at now. Team nursing is far better for the residents.

Why? Explain exactly how it is better? Not disagreeing altogether, but most of the nurses in LTC are frustrated that I know, because they have 'tasks' they must get done and way too many distractions and responsibilities. And all of them are important and most you can not delegate. Dividing up the tasks means taking care of your Resident's needs safely. Efficiency is not a dirty word, the more efficiently you can get done, the more time you have for your Resident.

I've been fortunate over the years to wear a number of hats - supervisor, admission nurse, preceptor, float, charge, unit manager and have worked agency at a number of facilities and been staff at a number of facilities. Our 'tasks' are what keep the residents healthy.

The places that made their floor nurse do everything rounds, admissions, discharges, meds, treatments, answer phones, orders, with little support and high amounts of patients meant things did not get done - such as treatments, orders got missed, meds didn't get given, things were signed for that didn't get done.

I'm lucky where I work now, I have a great patient ratio and a supportive unit manager. Otherwise it would be ridiculous trying to get done all that I'm responsible for, safely, timely with attention to my Residents.

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I can see why some people dislike the med nurse/charge nurse model.

But I've worked in facilities where I've had far fewer residents. I've had only 28 or so residents at another facility. And the other nurse had the same. But we had to do everything for those 28. It was too scattered, too many interruptions. The med pass was impossible because you couldn't just buckle down and focus on meds.

On a floor of 50 residents, I say it's better to assign one nurse to do all the meds and the other nurse directs the CNAs, calls the doctors, notes the orders, does the vitals and of course helps out the med nurse when it's slow. And the med nurse can obviously help the charge once meds are done or in emergencies.

The main issue with this system is that the med nurse can become "pigeonholed". You have to assign the med nurse to being charge once in a while or he becomes no more than a pill machine. And you have to put the charge on the med cart once in a while or else she will have an emotional break down when the day comes where she does have to pass meds.

I know efficiency isn't everything, but when you have to figure out the best way to allocate 2 licensed people for 50 residents (industry standard staffing there) this is the best way to do it, IMO.

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