Need help


Im currently working in rehab\skilled nursing facility. I'm currently on orientation, 5th day to be exact. Dont have a floor yet so I'm floating from longterm care floor and sub acute units. I'm very overwhelmed right now, I only handled max 10 px for now but everyday my preceptor increases my patient count. I dont know how to be quick on my med pass. I finish my 8am meds at 11 and then there will be another batch of medications in the after. Then there will be treatments to be done, orders to be carried out, coumadin results to be relayed and charting to be done. I dont know how other staff nurses do it, they have 25-30 patients at sometimes and they finish the medpass on time, i start doing meds at 7:30 so I can finish fast but I cant still do it. Nurses on my floor even have time to chat on the station and check their facebook. i dont know how they do it. Any tips for me? i'm scared next week probably they will start giving me 15-20 px then the week after that I'll be on my own. i dont know how I can pull this off

When you first start, you're going to be slow. Once you learn your patients and get a routine you will finish quicker and have a little extra time to breath. Don't be afraid. We have all been in your shoes. Good luck!

TheCommuter, BSN, RN

226 Articles; 27,608 Posts

Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 17 years experience.

In the SNF rehab setting, you can speed up your medication pass by limiting the amount of time you spend with each resident.

These patients are not our friends, so there's no need to spend more than a few minutes per person on the medication pass unless an emergency is occurring.

If you spend five minutes medicating each resident, you will have passed meds to 24 people in approximately two hours.


7,735 Posts

Specializes in retired LTC.

One thing I learned about med passes - they were always harder when you were new to the facility and unit because you had NO IDEA what you were looking for and where.

Like how much time did I lose looking for a med, only to find out it was kept in the refrig? Or that some liquid was in a pinkish bottle, not a blue one (diff mfr). Or I couldn't find one of the Dilantin calibrated administration syringes (or worse, it was so gooey because of sloppy prev nurse use). And where are the NTG patches kept on this cart? Is this med house stock? Once you get used to these variances, med pass goes faster.

And you'll learn how to stock the cart like YOU like it to be - with enough lancets and glucometer strips (pet peeve of mine when the bottle has been left with maybe 2 strips :banghead: ). And you stock up your Ensure, Glucerna, Nepro cans. Enough tissues? It does get easier and quicker after a while.

One thing - I usually did not stop a med pass to check something out. I'd make a cheat sheet note to check some order or med location. But I'd keep moving on (unless something critical or emergent).

Just to let you know - even after all my years, I was NOT FAST. I wondered how all those other nurses did finish so quickly, I really did wonder. (But let's not go there!)

rehab_nurse, LPN, RN

2 Articles; 7 Posts

I'm about 6 months into my job at an SNF and while I still feel slow, I can tell you it does get a bit easier. Caring for 21 patients at a time does feel ridiculous about 75% of the time but that seems to be the standard for SNFs!

As the other responses mention, once you get to know your patients (they like their pills whole in applesauce, start the IV well before therapy at 9 so it won't be late, they like chocolate Ensure instead of vanilla) you can anticipate things a lot easier and become more efficient with your time. You also learn where everything is so you don't spend so much of your time looking. And a lot of the things you have to think through now and double check as a beginner become a part of auto-pilot for better or worse - what are all the supplies you need to take into a room so you're not going in and out, what are the things you need to do when you get an INR, etc.

At at the start of my shift I like to go through the MAR and TAR and write down all of the special things I will need (how many applesauce containers, Glucerna, etc.), and important med pass times so I can stay on top of everything without getting behind (7 AM blood sugar checks, 8 AM IVs, when you think patients will next want their PRN pain meds so you can check in with them).

As annoying as it is to hear, it does get better. You have to accept that there is a steep learning curve and sometimes you will feel overwhelmed but it's part of the learning process. I hated hearing that from my elders but surprise surprise it's true ;)


135 Posts

Im starting tomorrow on my own, coming out of orientation. Help me god.


11 Posts

Specializes in acute rehab.

You got this.


2 Posts

Starting tonight on my own too.