I just started a job in LTC last week. I never worked LTC before. I have been a nurse for 3 yrs but I worked in Rehab and only had 15 patients on day shift. Now I am working 3-11 and have 30 pts. I am to be part time in a facility with 180 beds. I will be a floater.
I oriented 4 shifts so far. The last 2 shifts, I was told by my preceptor to go ahead and do the med pass since she watched me already.
I am having a hard time #1 getting done on time (My preceptor had to jump in at 10:30 to help me finish up and she did the treatments and there was a re-admission to the floor) I was getting upset. She said to me "Now you know why I give all my meds at one time" "otherwise, you'll never get done." I simply nodded my head in agreement but I am bothered by this. 9 pm meds should not be given at 5 pm just because they are "going to go to bed eary" "just give them everything"
What should I do? I ended up going back to patient's rooms at 10pm waking them up and they were angry. I tried to explain I was new, etc. but--- HELP!
Don't compromise your license. Most homes will tell you to work faster, no overtime, along with having to do more work. I work with many nurses that I know don't do all there work just to get out in time. How do I know this. No meds in cart and singing off they where given along no evidence of being ordered. Creams that should be put on residents and are being signed off for days. Hmmm- the tube of cream has not even been opened. Swish and swallow medication ordered and signed off for days but seal on bottle has not even been broken. The nurses work some of the same units I do and are sitting at nurses desk at 8.30 pm and I am still down the hall at 10.00pm doing treatments or fishing meds. No I am not slow. I just address things that keep getting missed, put the creams that are ordered. I Don't expect my CAN's to do all my treatments as it my responsibility to monitor the skin issues. I worked with a nurse who would preset up her meds and say "I have to cut corners to get out of here on time." She would frown upon me when I could not get out on time. Management calls you on not getting out on time. I'm not a backstabber . Do I rat out other nurses 'No". I just do my job to the best of my abilities and if they don't like it then fire me. I will report on my unemployment claim that I was not allowed sufficient time to do what was expected of me. It's a very stressful job working in LTC and It seems that it has gotten worse over the years. Good luck, you will get faster, wish I could say it will get better but those days where gone a long time ago.
This is one of the major problems in the LTC unit....Time management and the amount of work that is more than you can handle by your 2 hands and 10 fingers.
Always use your own judgment! Some residents have their own "biological clocks" to take the meds. Some don't take anything after certain time because they have to sleep before the hours of sleep. You must know all the side-effects of the meds. Certain meds cannot mix with others; so you have to know that too.
You are still new to the unit and when you get to know all the patients, things will be getting easier.
Of course, as I stated, use your own judgment...I think Coumadin is not one of those meds you can mess up with or should you give the 6 P.M. and 10 P.M. B/P meds all at once? Insulin given at 9 P.M. is another one you cannot mess up with. Other than those...you must know your patients and you must use your own judgment. The most tricky one is the neb. treatment for COPD, especially the one that is given Q6 hr. Some patients refuse the 12 midnight neb. tx. even you give it to them at 11 P.M. In this case, I will discuss it with the M.D. and see if he/she could make the 12 MN neb. tx become a PRN.
I have in the past been responsible for passing meds to 30 - 40 residents during any given 7-3 or 3-11 shift. The documented med administration times were split into 2 groups so that for the 1st 15 - 20 residents all am meds were scheduled at 8 am (which allowed for actual administration times between 7 am and 9 am) and for the 2nd 15 - 20 residents am meds were scheduled for 9 am (which allowed for actual administration times between 8 am and 10 am).
Usually passed meds by room number during am pass and then by bedtime during pm shift. Certainly takes some coordination for the 3-11 shift so that the nurse writing med orders must know which residents go to bed before others, but collaberation with 3-11 med nurses and CNA's in this process was invaluable.
This, of course, does not take any time off the total time spent on med pass. It does, however, bring you into compliance with med pass timing.
As far as meds are concerned in LTC a med can be given one hour before until one hour after the time ordered unless it is insulin, or a med that must be given before meals, after meals or with meals.
What someone can do is change the time of meds to more convienant times if possible.
If you are new somewhere it takes some time to get familiar with the routines, meds and priorities. After a while you should be able to arrange your dutities so you can get your work done in a timely manner.
On the topic of insulins and accuchecks, how long before or after the scheduled time do you do your accuchecks? Do you do your blood sugars way early? I figure I can catch a resident bottoming out early, and get all my checks done before I do my med pass it helps me a lot in the morning (I do 11-7). I wonder if the accucheck timing (hour before or after) works with the same time frame that meds do... I always do my insulins at the end of my med pass around 6:15-6:30am... there is no way I would do that early..
Just curious since surveyors could be in my facility in June.
On the topic of insulins and accuchecks, how long before or after the scheduled time do you do your accuchecks? Do you do your blood sugars way early? I figure I can catch a resident bottoming out early, and get all my checks done before I do my med pass it helps me a lot in the morning (I do 11-7). I wonder if the accucheck timing (hour before or after) works with the same time frame that meds do... I always do my insulins at the end of my med pass around 6:15-6:30am... there is no way I would do that early..
Just curious since surveyors could be in my facility in June.
What time is the accuchecks scheduled for? What time do your residents eat breakfast? Make sure they are not getting their insulin too early before they eat so they do not bottom out.
My accuchecks are scheduled for 6am. I usually find that if someone is bottoming out, I can catch them early (around 4:45-5am). My insulins always come last at the end of my med pass, between 6:15 and 6:30 usually. Breakfast for the residents is at about 7:45am (I think).
Generally most of my residents are on long-acting insulins, very few get regular insulin unless it's per sliding scale, and even then it's usually less than 10 units (more like 2-6).
My accuchecks are scheduled for 6am. I usually find that if someone is bottoming out, I can catch them early (around 4:45-5am). My insulins always come last at the end of my med pass, between 6:15 and 6:30 usually. Breakfast for the residents is at about 7:45am (I think).
Generally most of my residents are on long-acting insulins, very few get regular insulin unless it's per sliding scale, and even then it's usually less than 10 units (more like 2-6).
Just be careful with the insulins. I had one of my residents that is on Novlin 70/30 that by time she got her supper tray and was in the dining room her blood sugar dropped to 21. She got her insulin of 10 units just before going in the dining room full of people and it was about an hour from when I gave her insulin when they opened they dining doors to when she got her tray. Turns out she was one of the last people to get her tray. With state watching I would give the insulins closer to breakfast. What time are they scheduled for?
The insulins are scheduled for either 6am or 6:30am. Most of them are sched. for 6:30am (about 1:15 before the announcement for breakfast).
It's been this way for at least the year that I've worked here. Some of these residents get accuchecks 2-3x a week, and others have them 2-3x/day. I do my best to give the insulins as late as I can before the day shift gets in. It might be interesting to retest blood sugars at 7:30am to see how low the sugars go before the residents even get a chance to eat.
Wow, why isn't first shift giving the insulin. At least in our facility aand the couple of other facility I have worked in, 3rd shift checks the blood sugars and 1st shift gives the insulin just before breakfast. Exactly what type of insulin are you giving? That is a long time between getting the insulin and getting breakfast, especially if they are running late on any given day.
You will get faster with time. Just hang in there.
As for insulins, I check blood sugars at 4:30a, and report findings to first shift who gives the insulins.
I don't like this way, but it's the way the famility does it.
Wow, 4:30am is early to be checking blood sugars and then giving insulin hours later based on that blood sugar isn't it? I understand that it is the way your facility does it but so that is what you have to do but isn't that a long time in between for the blood sugar to change?
ElderCare Nurse
11 Posts
Don't compromise your license. Most homes will tell you to work faster, no overtime, along with having to do more work. I work with many nurses that I know don't do all there work just to get out in time. How do I know this. No meds in cart and singing off they where given along no evidence of being ordered. Creams that should be put on residents and are being signed off for days. Hmmm- the tube of cream has not even been opened. Swish and swallow medication ordered and signed off for days but seal on bottle has not even been broken. The nurses work some of the same units I do and are sitting at nurses desk at 8.30 pm and I am still down the hall at 10.00pm doing treatments or fishing meds. No I am not slow. I just address things that keep getting missed, put the creams that are ordered. I Don't expect my CAN's to do all my treatments as it my responsibility to monitor the skin issues. I worked with a nurse who would preset up her meds and say "I have to cut corners to get out of here on time." She would frown upon me when I could not get out on time. Management calls you on not getting out on time. I'm not a backstabber . Do I rat out other nurses 'No". I just do my job to the best of my abilities and if they don't like it then fire me. I will report on my unemployment claim that I was not allowed sufficient time to do what was expected of me. It's a very stressful job working in LTC and It seems that it has gotten worse over the years. Good luck, you will get faster, wish I could say it will get better but those days where gone a long time ago.