New grad/New hire needs 3-11 LTC advice.

josinda421 · Oct 26, 2008

Girl, you and I are in the same boat. I just received a LTC job from 3-11 also. Like you I'm still orienting, so I'm currently just working day shift. I did things by the book while passing out meds and it took me forever. I didn't get to eat anything until after 2pm and I get off at 3pm. So, it would be help if I also received some advice as far as time management; what I need to do first and what I should save till close to end of shift. thanks

WingsEarned21, LPN, RN · Oct 27, 2008

You should carry the med reference book that is available through many nursing supply stores or even college bookstores.It is kinda thick but very quick looking up meds and right to the point.Nothing like a PDR. It usually contains the year in the title.Also always have a bp (manual ) cuff on your cart and a stethescope,pulse ox machine if available.You will need to check bp's before a lot of your meds especially in the am and before bed.Tissues on hand also.Of course make sure your cart is stocked before you start your med pass(cups,applesause or pudding for crushed meds,insulin needles and plenty of accucheck strips and alcohol wipes).Remeber too that if these people were at home they would NOT be going back to the kitchen every hour to take a pill.You need to combine your 4,5, and 6 meds at your 4 p.m med pass and your 8,9,and 10 meds at your hs pass.If you know a particular patient takes a sleeper every night then ask before pouring their meds to save yourself a trip back to the cart and more time from your pass.As you work LTC and get to know your patients and have the same patients all the time it will get easier and faster.:wink2: hope this helps.

3sodapop · Oct 27, 2008

"If you know a particular patient takes a sleeper every night then ask before pouring their meds to save yourself a trip back to the cart and more time from your pass."

Question: What is a sleeper?

TIA:heartbeat

SuesquatchRN, BSN, RN · Oct 27, 2008

I can tell you your schedule right now.

4 pm, Coumadin. Maybe some Sinemet. Know Sinemet and Cogentin and Requip, for Parkinson's. And know Aricept, dementia.

6 - 8 pm HS meds. Some prils, olols, and know your seizure meds. Know the benzodiazepines, PO pain meds, lots of Tylenol and ibuprofen. If you see Lasix or HCTZ on your shift question it because you're goinna have an up-all-night-peeing-and-wet resident. Know your anti-psychotics - Zyprexa, Seroquel, Risperdal in particular, Haldol PRN for agitation. Some might be on Elavil for pain, strangely enough. You'll see some Fentanyl patches. Know your anti-seizure meds - Dilantin, Tegretol (carbamazepine). Also Detrol for bladder spasms.

Dig we always gave am shift.

OgopogoLPN, LPN, RN · Oct 27, 2008

When you start your shift, know your residents who are diabetic, on Sinemet and narcs. Be sure they get their meds/insulin on a strict schedule.

If a resident doesn't get HS meds, give them theirs last during 1700 pass.

If a resident goes to bed very early (1900-1930), try to do their 1700 pass early so they get their HS pass early, but also spaced out enough between their 1700 pass.

I 2nd what was said about being prepared. Even if one resident need their meds in thickened fluid, have that on the med cart so you're not walking back to the kitchen/fridge to get it when it's time for their meds.

If you have a moment before you start, check to make sure you have all the insulins and there is enough left in the pens/vials before you start. Keep a blood glucose machine, strips and lancets on your cart.

If a resident for example only has say a calcium pill at 1700 and then has other HS meds, see if you can get the calcium changed to HS timing so you're not doing two passes on the resident who really only needs one.

WingsEarned21, LPN, RN · Oct 28, 2008

A sleeper is a sleeping pill.Ambien,restoril,etc.Also know your pain meds.Lyrica,vicodin,tylenol with codeine aka t3's,percocet,darvocet,ms contin,etc.

josinda421 · Oct 29, 2008

You should carry the med reference book that is available through many nursing supply stores or even college bookstores.It is kinda thick but very quick looking up meds and right to the point.Nothing like a PDR. It usually contains the year in the title.Also always have a bp (manual ) cuff on your cart and a stethescope,pulse ox machine if available.You will need to check bp's before a lot of your meds especially in the am and before bed.Tissues on hand also.Of course make sure your cart is stocked before you start your med pass(cups,applesause or pudding for crushed meds,insulin needles and plenty of accucheck strips and alcohol wipes).Remeber too that if these people were at home they would NOT be going back to the kitchen every hour to take a pill.You need to combine your 4,5, and 6 meds at your 4 p.m med pass and your 8,9,and 10 meds at your hs pass.If you know a particular patient takes a sleeper every night then ask before pouring their meds to save yourself a trip back to the cart and more time from your pass.As you work LTC and get to know your patients and have the same patients all the time it will get easier and faster.:wink2: hope this helps.

I like that suggestion about passing the 4,4,6 meds at 4pm...that really saves alot of time. So what how would you suggest in morning as to how to develop time management when you have 8AM med pass, Accucheck, tube feeding, dressing and so on. Because I usually find my self at the end of the day still giving 8AM med passes at 11AM and not completing dressing changes till 2pm when it's due at 11AM. Basically, can you suggest to me how you organize things so I'll be more efficient. thanks

WingsEarned21, LPN, RN · Oct 29, 2008

Well dressing changes get done after med pass.Not really important as to when they are scheduled as long as they get done on 7-3.Also pass 8,9 and 10 a.m's at once.Accuchecks are usually done by night shift adn insulin is either given by day shift or night shift as the last thing they do.Charting usually doesn't get done till end of shift unless something dire happens and you want to take the time to chart it if you can't remember everything or make notes to yourself while it happens or right after so you can chart later.Learn or make yourself notes as to who gets accuchecks and insulin in the morning and do them first also while you do that give them their a.m. meds at the same time.

josinda421 · Oct 29, 2008

Well dressing changes get done after med pass.Not really important as to when they are scheduled as long as they get done on 7-3.Also pass 8,9 and 10 a.m's at once.Accuchecks are usually done by night shift adn insulin is either given by day shift or night shift as the last thing they do.Charting usually doesn't get done till end of shift unless something dire happens and you want to take the time to chart it if you can't remember everything or make notes to yourself while it happens or right after so you can chart later.Learn or make yourself notes as to who gets accuchecks and insulin in the morning and do them first also while you do that give them their a.m. meds at the same time.

I like the idea of making a list of who gets accuchecks, but my problem is, what if the order changes and your so used to doing the same old routine, that could put you into trouble. SO what would you suggest about that. I tried today to go through the whole MAR and just write every med, treatment, accucheck, insulin, long-acting insulin and so forth down. And that off course took me forever to do because I kept re-organizing it and starting all over. For now, I have planned to give in the AM: FIRST:long-acting insulin, SECOUND: narcotics,THIRD: neb-treatments, FOURTH: g-tube meds and flushes and feedings, FIFTH: dressings, SIXTH: lunch time finger stick and insulin, SEVENTH: 12, 1, 2 pm g-tube meds, flushes, feedings. Off - course I could NEVER finish doing the dressing by the time lunchtime fingerstick and insulin comes around so the person who's orienting me helps me out. But I know by myself....I would be domed!!! My other problem is the paper work and all the different documentations and what you have to do when the doctor writes an order or when you get a lab result---what do you do with it, as far as the process. I know that once I get packed down the meds...., my next challenge is the different documentation. ITS JUST SO MUCH TO DO!!!!!!!. At times I feel like quiting although I just started my nursing career. I have to say it was a whole lot easier being a technician/cna than being a nurse, hands down!!!

WingsEarned21, LPN, RN · Oct 29, 2008

You have to give it time.You will find yoru own routine that works for you,honest.Just remember LTC the patients usually don't change too much so you don't have to worry about getting a new patient or hsving all new patients for your assignment.You will get to know their little quirks and when they like their meds and how and that will make it easier.Like I said the insulin thing is usually night shift's thing or day shift and if it is day shift then night shift usually does the accuchecks so all you have to do is give insulin.You have to trust your fellow nurse's also and do not be afrais to ask for help even when you are on your own.They need to remember they were there once themselves.Just be patient with yourself adn let yourself get a routine..

mamato3 · Oct 29, 2008

What I find that helps me with the accu checks is, I open( just tear open not out of the package) all my swabs put them in a small cup, get all the my cotton balls put them in a cup,prep my lancets put them in a cup, and put my test strips I need in a small cup. So when I am going down the hall all I have to do is take one cotton ball from the cotton ball cup, one swab from the swap, lancet already set from its cup and the strip from its cup. So it saves me the time of opening multiple packages and prepping the lancets at EVERYONE bedside. Hope that wasn't too confusing.

Take care Shannon