My 3-11 routine...any advice?

wearingmanyhats, RN · Jun 5, 2008

Sounds pretty typical.

I am an agency LPN, and find that if the "regular" staff get done much quicker than I do, it usually means they are cutting corners somewhere.

I try to make sure that the cart is stocked before I start, so I don't have to keep making trips back to the med room.

One LTC I work at , the meds are in room order, the other ABC -- I can pass meds much smoother when they are in room order.

I try to do several things at once when I enter a room.... if one of the residents needs a neb tx, I start that first, then do the other resident's meds, so that when the neb is done, I am coming back in with that person's meds (have to come back anyway so might as well make it productive.) Use a timer to remind me to come back to turn off the neb.

Will keep thinking and post more....

Faye

mama_bird · Jun 5, 2008

I have always multi-tasked every where in my life and I am getting it down here as well. When I come back from dining room at 6pm, I put my one guy on his nebulizer, grab vitals on the five or so people who need them, and then shut him off before I go to lunch at about 6:20.

When I get back from lunch and start passing at 7, I put all of the creams on my cart and do them as I do the pills. I tried doing meds and going back and doing creams and I ended up taking longer, constantly re-checking my list, and waking people up to put periguard on their groin. Some nurses do all the meds then go do their creams, I just can't be as efficient that way.

I have learned who goes to bed early, eats in their room, etc. and plan for that now. It has taken time but it is getting easier every day. Also, many of the things in the tx book are done by the aide (taking out hearing aids, taking off teds, so I check when I go in the room but I don't actually do it (although I initial it in the book at the end of the night).

Most of the nurses there have been there for more than ten years. Morale is good and people seem to get along well. We have a few agency staffers to cover but now that I was hired FT, it has cut down on the need.

I know my 30 residents so well now that I am afraid of getting thrown on the other side and taking 5 hours to pass meds! Or getting thrown on the desk!! LOL!!!

CoffeeRTC, BSN, RN · Jun 5, 2008

Mama Bird....sounds like you are doing great! I only work prn, but that is how I do things too. I try to combine treatments with my last med pass and get the residents after they are changed or at the same time the aids are doing care. Good way to see the residents and assess skin etc.

I chart most stuff at the end of shift or when I get a free minute too.

nurse_clown · Sep 14, 2008

I recently started doing double shifts (3-11 then 11-7). One of the regular part timers is off on sick leave so, I've been doing a couple of doubles here and there. The evening shift used to scare me but, I found that getting and settling on a routine very helpful. It takes a little while to get to know the residents and find out who's going to be earlier, creams, dressings etc. I've been working there for four years on the night shift and could tell you all about their sleeping habits, fall risk, meds etc. Doing an evening shift is completely different. I love it. I love the night shift too.

You sound like you are doing well.

SuesquatchRN, BSN, RN · Sep 14, 2008

You're doing well! I've never had that many for meds without a treatments nurse, which you are also doing.

mariyahsmommy · Sep 29, 2008

Well, as you can see, I haven't posted in a while and that is because I just finished my 13th shift yesterday at a LTC facility (the job I wanted) :loveya:I start at 2:45 and work until 10:45.
The first day I watched. The second day I watched in the am and was shadowed in the pm. The third and fourth day I was shadowed/helped with popping and passing. The fifth day I had help near the end. The sixth, seventh and eighth day the nurse didn't shadow me at all but was there to help with treatments toward the end if I needed it. On the ninth and tenth day (Sat and Sun) I was on my own (from there on) and got out at 11:25 pm. Monday I finished at 11:05pm, Tuesday I finished at 10:52 pm and last night (my 13th shift), I finished on time, did house report, charted in the computer, counted narcs and punched out at 10:50!
I have 30 patients. Two have g-tubes and alot of meds. Two have dressings for sacral wounds and one has diarrhea all the time and sometimes needs more than one change. About 12 people are a crush.
I get in about 1/2 hr early, fill out my sheet, etc, so I am ready to push the cart at 3. At 5:15 I have to go to the dining room and feed/supervise with another nurse until 6. I come back, do a few treatments, go to lunch, come back and start pushing 8pm meds at 7 and try to integrate the treatments. Now I can pretty much get done by 10:15 and that leaves me a half hour to chart, enter it into the computer, put narcs away, fill out house report, and sign the treatment book plus clean up my cart, etc.
Any advice would be appreciated. I was out of clinical nursing for 9 years. I did have to take a medication test (100 questions) and I scored a 95 so needless to say, that God I am just a smart cookie. All of that crap pounded in my head from 1993-1997 really did come back to me.
Thanks for the help!!!

Hi! Just read your thread. I just started a 3-11 LTC job. Never worked LTC before. (See my thread on med Timing) I am a nervous wreck! I need to figure out a system, too--but I will be floating and only part time. There are 180 residents where I work. I'll never get a routine at this rate! Any advice would be MUCH appreciated. Thanks

rnlately · Oct 7, 2008

I used to float at a LTC and hopefully will start back again soon. My routine involved checking the TAR for required tx while the nurse that I'm relieving is finishing her rounds. I would also check the cart for needed supplies while I waited and also check on the tube feedings to see if they are about to run out. After I get report I make rounds and make note of residents that are MDS/MCR charting and that are requesting prn meds (pain, etc.). Then I start checking blood sugars and drawing up insulin as needed. By then it is close to 7:45/8:00 pm and I'm ready to roll with the med cart and usually finish passing meds, doing treatments and shower/skin checks by 10pm but no later than 10:15. It can be done but as stated before you must establish your own efficient routine.

mariyahsmommy · Oct 7, 2008

I used to float at a LTC and hopefully will start back again soon. My routine involved checking the TAR for required tx while the nurse that I'm relieving is finishing her rounds. I would also check the cart for needed supplies while I waited and also check on the tube feedings to see if they are about to run out. After I get report I make rounds and make note of residents that are MDS/MCR charting and that are requesting prn meds (pain, etc.). Then I start checking blood sugars and drawing up insulin as needed. By then it is close to 7:45/8:00 pm and I'm ready to roll with the med cart and usually finish passing meds, doing treatments and shower/skin checks by 10pm but no later than 10:15. It can be done but as stated before you must establish your own efficient routine.

Thanks! I really appreciate your advice. Actually, I worked this past weekend and it all began to click! I am so happy! I was done passing meds at 9:45. I felt like I rocked it! So I'm getting there! :nurse:

luvtosmile · Oct 7, 2008

I would love to have routine down by now but I just graduated in May and have been working at the same LTC since July. I have never been able to get a routine down because they move me on a different hall every night and I have just moved from nights to 3-11. Once in a while they will leave me two or three nights but I am floundering. It takes me hours to pass the medications and I am always late clocking out. Any advice for me?

mariyahsmommy · Oct 7, 2008

I would love to have routine down by now but I just graduated in May and have been working at the same LTC since July. I have never been able to get a routine down because they move me on a different hall every night and I have just moved from nights to 3-11. Once in a while they will leave me two or three nights but I am floundering. It takes me hours to pass the medications and I am always late clocking out. Any advice for me?

I am new to 3-11 also. But I like it because there are no big shots on the floor. It is mostly quiet and you are on your own schedule.

What I did (as I said this past weekend I seemed to "get it") but it could have been just that particular floor. The patients are mostly "with it". But, I went through the MARs to check who has blood sugars and Tube feedings. Then I went down one end of the hall to the other and started giving 4, 5's and 6pm meds. By the time I finished those, it was about 7pm. I took my 30 minute brak, and started back up the hall again. I finished at 945. But, mind you, I still had my "preceptor" on the floor. She fed residents. Also, she seems to have her aides "trained" to do her treatments. So all I had to do was 2 charts and I was done. I'm thinking this won't be the norm. But, we'll see. Good Luck. And any advice you can give me, I also would appreciate. I also will have to float.

JB2007, ASN, RN · Oct 7, 2008

You better be careful about "training" your aids to do your tx. If it is in the TAR and you are signing for it, it had better be you doing it. You are held accountable. I know several nurses have the aids put on medicated powders and creams, but they are not suppose to. You need to be monitoring these areas of breakdown every shift. I have seen residents breakdown in less than 8 hours and it takes forever to get them to heal. Good luck with the job, but be very careful which short cuts you decide to take.