More charting, paperwork and chores than is humanly possible

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I absolutely need your experienced thaughts on this:

Night shift, one nurse, 3 CNA's, 60 residents.

-update allert sheet, make out new 24 h VS flow sheet

-make out new 24 hour report for DNS

-count narcotics with three nurses on three different carts

-obtain report from three different nurses on all 60 pts.

-Check for changes in MARs

-rounds, meds, BS at different times throughtout the night and prn pain meds (of course, there is allways plenty of those chronically dependent pts. standing around the nurses station anxiously waiting for their Percocet at the most inconveniet times, often times chatting your ear off as though wanting to make the "drug transaction" seem more casual.)

- check for BM issues on flow sheets and address - suppositories on MOM

- check, address and note orders left over from eve shift, sometimes order labs and obtain samples (Sure, night shift is slower than other shifts, night shift nurses don't do anything than sit around, so let's just leave it to the night shift nurse)

- receive and file new meds from pharmacy

- check off a multitude of safety checks, ie. that doors were locked, temperatures of refridgerators, crash cart, functioning of suction machines, glucometers. Of course, all of these things should be physically inspected and checked for proper functioning before I sign my name under it.

- check of Oxygen, tab alarms, wander guards on on basically all 60 pts. As a rule, either they have one or the other, if not both.

- sign of inspections of skin issues, O2 sats, cath care, G/J tube care in treatment sheets. Again, all of these things should be physically performed before signing off on them (approx. 20 pts.)

-Charting on pts on allert, MDS, medicare or Hospice, usually amounts to approx. 20 pts.

-Chart all the VS, BMs and I&Os.

- 0600 rounds : more meds, BS on 18 pts.

- Count narcs with three nurses on three carts

- Give report to three nurses

- I'm sure I forgot something and God forbid something out of the ordinary, like a fall, a new skin issue or a death happens.

Yeah, night shift nurses have it made :rolleyes:

I'm new to LTC (not new to nursing) and I am a very fast (yet thorough) worker. In the hospital, I had allways everything done first. But this is humanly impossible. Yet the supervisors act like yes, this all is required by State, this all has to be dome. I think the other nurses must just omit stuff or lie about doing it... How else could it all be done? Wthout superhuman powers IT CAN'T!!!!

...And what is most frustrating to me, where are actual assessments, observation and interaction with pts? (No, not every pt sleeps at night.) The very thing we should be doing instead of checking off boxes and charting essentially that nothing has changed on this pt. since last shift, because the all mighty State (or medicare, or hospice or whoever) require it? :banghead:

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Specializes in Gerontological Nursing, Acute Rehab.

Yep, that's usually the way it is on nights in LTC. I used to have to do all that and be the house supervisor when I worked nights. I know, all that Medicare charting is crazy when you wind up writing the same thing day after day, week after week when they are considered skilled. It certainly is a waste of time.

You definitely need to have your "system" down when working nights in LTC...otherwise you'd be constantly running back and forth checking this and doing that. At times, I liked the routine....but other times I was just bored with the same old thing. I recently left LTC and went into an acute rehab hospital. I still love the elderly, but after 10 years of the LTC rules and regs I'd just had enough.

I hope you come to love LTC as much as I did....we are all those residents have sometimes, and they do love us!

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Yep...that sounds about right....just a question, why are you doing medicare charting at night? and the blood sugars? Medicare charting needs to be done on a daily basis and all of our 11-7 accu checks are done at 6am.

We have to draw the blood too for the labs in the am.

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You should check out my thread, unsafe staffing, I know how you feel. I don't work 11-7 except once but for our 100+ patients there is one RN or LPN and one med aide. The same as on the 3-11 shift. You can't get it all done and like you I wont fabricate. The sh** will fly if something happens because of 2 patients having serious problems at the same time. :doh:

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Specializes in Gerontology, Med surg, Home Health.

Do you work at my facility?? Seems 11-7 is busy on a big unit. However, why are y'all doing Medicare charting on 11-7? After the first 72 hours you only need to chart once a day. We split ours up between days and evenings...the night nurse has enough to do.

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Specializes in Gerontological Nursing, Acute Rehab.
Do you work at my facility?? Seems 11-7 is busy on a big unit. However, why are y'all doing Medicare charting on 11-7? After the first 72 hours you only need to chart once a day. We split ours up between days and evenings...the night nurse has enough to do.

That's what I thought, too, but at the facility that I was referencing they had every shift document on skilled/change in condition/post incident residents. The change in condition and post incidents qshift charting I can understand, but qshift charting on skilled residents was a bit much. I think the way they broke it up was that each shift had to chart on a different topic each day. It was confusing and redundant.

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I've been told that we have to chart on medicaid, MDS, Hospice and alerts every shift. Did I misunderstand? Does charting VS in the VS section count?

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Specializes in home health.

At the facility where I work, it is corporation rules that say we have to chart on medicare patients q shift.. Where I work in Michigan, the 84 bed Medicare unit charting was divided into 3rds..for the 1st 10 days of the month you'd chart on the 1st 3rd, and swap every 10 days. Days, PM s and nocs all charted, but each medicare pt just once a day

sucks big time

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- check off a multitude of safety checks, ie. that doors were locked, temperatures of refridgerators, crash cart, functioning of suction machines, glucometers. Of course, all of these things should be physically inspected and checked for proper functioning before I sign my name under it.

-Chart all the VS, BMs and I&Os.

:idea:

Can CNAs do these things? I know the CNAs at the hospital I work at are allowed to do environmental rounds.

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- check off a multitude of safety checks, ie. that doors were locked, temperatures of refridgerators, crash cart, functioning of suction machines, glucometers. Of course, all of these things should be physically inspected and checked for proper functioning before I sign my name under it.

-Chart all the VS, BMs and I&Os.

:idea:

Can CNAs do these things? I know the CNAs at the hospital I work at are allowed to do environmental rounds.

I agree that CNAs should be able to help do these things. I would check you policies and procedures to see if it is possible to delegate some of the tasks Cute CNA mentioned. Does it have to be an RN/LPN signature on these checkoffs?

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not to stir any thing up, but I wouldn't trust my aids to check all of these things.

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I'm affraid that it's company policy or something, that LPN/RN has to do it (they are all LPN/RN signatures) and that CNAs are not allowed to chart. They have to give me a list of VS and a list of I&O and BMs and then I have to copy the values in the charts and sign my name under it, as if I personally did it all... I know, redundant, ridiculous, wrong :uhoh3:

In the hosp that I worked at, the CNAs charted too.

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