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 
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? 
Chel
45 Posts
Yep ~ some things are ridiculous. I had a resident pull a hang nail that bled a little the other day. According to policy, it's an incident. That means filling out the form, calling the doc, and the family. Incident charting is done q shift for three days. Skilled charting is q shift until the resident is discharged from all therapy services, new admits are charted on q shift for seven days, re-admits for 5 days. Antibiotic charting is done q shift until they're off the antibiotic...and any other little changes in condition.
Fun, fun, fun.