Published May 19, 2009
I just graduated in March and was offered a job in a LTC/sub-acute rehab facility about 45 mins from my house. I accepted of course, and am looking forward to starting my nursing career next week. I was hired to full time 3-11 shift, but will be doing part of my orientation on 7-3 at first. I was hoping for some advice from experienced nurses about some of all of the following questions:
1. My schedule is 40 hrs/week and every other weekend. How should I try to structure my days/sleeping patterns to adjust to this?
2. Can you give me a sort of timeline I can try to shoot for once I'm on my own for what things should be done in the 3-11 time frame?
3. ANy suggestions for making the switch to these hours easier?
4. Any particular nursing things I need to be aware of in this time frame? I know people will have dinner and be going to bed, but I will also be responsible for approx. 30 residents with 3 CNAs during this time.
5. Anything else you think would be very useful to know as a new grad?
Thank you so much! I'm excited to finally be able to use my nursing skills!
congratulations! long term care is a wonderful place to be. you will be fine. the hardest thing is trying to unwind after a shift, some nights are better than others. i always lay off the caffeine after 5. after report i would do rounds, check the treatment book, incident reports, and do all my assessments. i would use the time before i started my med pass to chart or notify drs if i had to, and always check the fax machine for orders so if i had to notify the pharmacy of new meds i would get them on time. the busiest time is your first med pass. know your diabetics and who has insulin and gluco cheks. most med books have dividers with flags to flag your residents who get meds. there are meds that have to be given on an empty stomach also, so be aware of those. make your life easier by knowing whose meds have to be crushed and be sure those meds can be crushed. when you're done with your first med pass you probably can take your supper and when you come back work on your charting. now its time for your second med pass. as you do your pass, make sure the cnas are doing their job; this can be done as you go passing your meds. your staff will respect you more if you show teamwork and they understand your expectations. i always tell my cnas i can not do my job without them-they are my eyes and ears. when i am done with my last pass i clear off my cart and start my treatments. remember you will have countless interruptions from residents, staff, visitors, and the telephone. i am getting older, so i have to write everything down on my "paper brains", which i tape to my med cart, that way i can be sure i have taken care of everything i need to. this is only a very watered down example, but you will be fine, i have trained new grads for years. best of luck to you
VivaLasViejas, ASN, RN
Boopette nailed it!!
I can't really add much to this most excellent post. LTC is all about organization and time management, and the only way to get those skills down is to jump in and do them, day after day. Priorities have a way of shifting suddenly---admissions come in the middle of dinner, someone falls while you're doing your accu-checks, or the phone is ringing off the hook all through the busiest part of the shift---and you have to be able to change gears swiftly. In the early going this can be really rough, and there'll be times when you'll question your sanity.......but in the end, everything (usually) gets done.
I am not really an experienced nurse (I graduated in Dec '08), but i have been working 3-11 in LTC since April. Here's how a typical shifts goes:
Get on the floor, get report, count narcs, check if there are any orders or lab results that need to be followed up on before the clinic closes for the day, look though the MAR and use paper clips to mark my meds (a clip in the left side means there is a 1600 med on that page, middle for 1800 and right side for 2000)
Then I start my 1600 med pass and also get my BG checks and insulins for the diabetics. After I get my med pass and insulins done, I help the CNAs bring residents to the dining room and make sure they have enough people to help feed. (Of course some days I'm chasing after the diabetics that are headed to the dining room when I haven't gotten the BG yet!) Once everyone is settled in the dining room, I take my dinner break.
When I come back from break, I get out the tx book and see what kind of tx I have to do. Some of the less time consuming things (e.g. diabetic foot checks, creams/lotions) I do with my 2000 med pass.
Then I start my 1800 med pass. The 1800 med pass is pretty light, so sometimes I will sit down for 10-15 min and work on my charting after the 1800 med pass, but most nights there are too many distractions and it's almost 1900 when I finish, so I start on the 2000 med pass right away. I've learned which residents get crabby when you wake them up to give them their meds as well as which ones have a much easier time swallowing pills sitting up in their W/C vs. laying in bed, so I try to get to those people first.
On a good day, it's 2130 or so when I finish my 2000 med pass so then I go take a 15 min break. After that I finish up with my txs, check over the MAR to be sure I didn't miss anything, tape report for the next shift and do my charting.
Of course, things rarely go this smoothly. There's usually a fall, a new admit, a residents having major behaviors, calls from family wanting to know how their mother is doing, etc. putting a wrench in my plans. I've learned to just go with the flow and do my best to get my work done.
As far as my sleep schedule, I've always liked staying up late and sleeping in, so it's been great for me. I have a 5 month old dtr, so that can make getting enough sleep difficult if she wants to get up early. But usually I get home around midnite. Sometimes my dtr will wake up and want to nurse when I get home, but if she is sleeping soundly I just let her sleep. I am always starving when I get home, so I usully have a snack and watch some TV or read to wind down. I get to bed sometime between 0100 and 0200. Most morning my dtr wakes up sometime between 0600 and 0700. Since I'm nursing, there's no delegating the AM feeding to my husband, so I have to get up with her. But she goes down for a morning nap aroud 0900 until 1100 or so, so I usually take a morning nap with her. So I kind of feel like a bum since I don't get up and get going until 1000 or 1100 most days. On my days off I keep the same schedule for the most part, although I might take an afternoon nap with my dtr instead of the morning nap.
Good luck with everything. Even though I am so busy and sometimes it just seems impossible to get everything done, I do love my residents and enjoy my job. After a few weeks, you'll develop your own routine that works for you.
First off, CONGRATS jellocorp! Just a few things to consider:
1) Will you have a med aide or another nurse to pass the meds or not? If not, get a handle on those meds and who your diabetics are soon after checking for new orders, etc. Also check on any with IVs, peg tubes, G-tubes, trachs, right away.During your orientation, definitely get a list of which pts take their meds crushed, in applesauce, etc.
2) EXPECT that you may not be getting out of work "on time" due to having to help CNAs(by the way if there are not enought CNAs on the floor, be prepared to take on a pt load also--no--it won't be fair with all of your other assignments but a very real possibility). EXPECT that you may frequently NOT get a lunch or breaks due to pt falls, phone calls, admissions, family visits/calls but as many will tell you, it's the LAW that you take your breaks so do your best to take them. Have another nurse watch your pts and staff while on your breaks.
3) After work, try to stay up as long as you can--treat swing shift like day shift if you can--sleep until an hour or so before you leave for work. This will also be helpful if night nurse calls in sick and you are required to stay an extra shift, you ill feel more rested than if you rose early in the morning.
I DO NOT tell you these things to alarm you---they are very real possibilities and you need to be prepared for them. At my job there is a chance every single day that the next nurse will call in and I'll be required to stay for another shift; it doesn't happen often but it does happen. Best of luck to you. LTC needs great nurses!
s Since I'm nursing, there's no delegating the AM feeding to my husband, so I have to get up with her. .
Way to go! I think it is so great that you are making the best choice for your baby even though it may be harder for you. What a great mom! I hope your place of employment allows you time and space to pump-it is often the law, or should be.
30 years ago, it was great working 3-11 because we brought clothes and changed after report, and went out dancing and drinking to the 70's Disco music till the bars closed at 2 am. Then we went to a diner for breakfast. Got home around 4 am. Slept till noon, got up and showered and started all over again. Yes, we were single! So much for the "good old days"........:hehe:
SuesquatchRN, BSN, RN
3-11 is my favorite shift, actually. It's most in tune with my internal clock.
Good luck. You'll be fine.
That's the other great thing about working 3-11 for me, all the office type people have gone home, so I can use the NM's office to pump in. I've worked some day shifts and it is always such a hassle to find somewhere to go and I usually have to kick someone out of their office for a while so I have a place to pump. Everyone has been understanding and no one has given me a hard time, but I'd rather work evening or night shifts so I don't have to deal with finding a place to pump.
Thank you ALL for sharing your advises. I am also looking into working in a LTC, as no hospital wants to hire a new grad like me. I have applied and waiting for an interview call. And was really wondering if it will be a good choice to get in there as a new grad, and IF I do what would a day be like. this thread is an fantastic. Thank you all very very much :)
On days you start with report, count your narcs, and start your am med pass. You will probably have gluco checks and insulin to give. After the med pass I always did my assessments, notified Drs, and faxed drs. I would do my treatments. Before the noon pass I would take a break and come back and start my noon pass. After the pass I would check to see if I had any labs, or Dr. visits that needed my attention. Day shift is a good shift for new grads because there are more seasoned nurses there to help you get organized and help lead you in the right direction. Second shift and noc shift are a little harder because there are less staff.
This is about how my day starts, too, and this is a great timeline to follow. I start meds as soon as I see people getting up because there is ALWAYS something/someone interrupting. If you have 7am, 8am and 9am meds, as I do, I start them all as soon as possible. Don't wait until 7am to start giving your 7am meds. I was a new grad and my first job was in LTC 2p-10p. (and I am still at the same job) been there for almost 4 years. I am planning to start the LPN-RN in the next few months thru the Univ. of Phoenix.
It will take you awhile to get into a routine (took me about a month, with only 3 days orientation.) Try to relax and take your time. You definately won't get all your meds passed in 2-3 hours. You'll feel like you've gotten nothing done, and angry residents and families will always whine and complain that you didn't get their meds on time, mom's bed isn't made, so-and-so needs to be changed, so-and-so wants a pain pill, so-and-so just fell, now you have to do neuro checks and fill out an incident report, etc., etc. Make sure you take your breaks and if you can't at least take 20 minutes to eat something, and always carry a water bottle for you on your cart. If I don't do that, many days my shift will be over and I will just realize my mouth is so dry, I haven't taken a drink in 8 hours (or more). Congrats on your first job, you'll do great!
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