New LPN in LTC. Time mgmt tips/tricks? Med pass advice? etc....

Nurses LPN/LVN

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Hi everyone,

I'm a new grad, new LPN, on my very first job, at a LTC facility. I love the people, like the facility, but I feel so unorganized & after my first stab at the med pass I am terrified.

I know it's going to take some time to get familiar with the names & faces of my residents & get to know who is up first, whose meds I can knock out quickly, & who I will have trouble tracking down or getting to cooperate, etc.

I'll be on day shift 7am to 7pm, with about 20 residents. My very first preceptor has been a LTC nurse for a really long time. She is great - she makes everything look so easy, she's so light on her feet, such a bubbly, positive attitude, great with all of the residents & all of the other nurses & CNAs. I call her the "people whisperer." She is so efficient, she seems to whiz through her morning med pass, do some treatments, takes time to stop & interact with her residents, helps other nurses when needed, & even has time for breaks & lunch.

I guess all of this comes with her many years of experience. I'm learning a great deal from her, but after my first test on the car myself, I felt like an utter failure. Like I was spinning my wheels & ended up 2+ hours into my med pass, missed some treatments, & two other nurses ended up helping me. Thank God for them!

Would any of you have any advice/experience to offer on time mgmt, tricks to help a new nurse be more efficient, etc? I feel like I just can't hurry any more than I already am or I'll risk med errors. Any advice for taking/giving report? I don't seem to know enough about my residents to give a full report & not just read off of their chart, but the oncoming nurse seems to look at me like I'm a moron if I tell her there were no changes, vitals were WNL, a certain issue has been resolved, or just report the MD orders that were given during my shift & changes to care plan.

Also, any tips for dealing with CNAs who are testing to see how little they can get away with while the "new nurse" is on?

Thanks!

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20 residents is a breeze in LTC. You'll be fine.

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I just graduated as a LPN but not working yet. I guess I'll be feeling just like you. It would helpful to read some good advices.

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Specializes in LTC and School Health.

LTC can be very overwhelming, especially for a new grad. One thing that helped me when I was in LTC was having a list of the residents' names and writing down how they took their meds. That is a battle in itself. Some meds need to be crushed, some taken with certain beverages, you will have to know how the resident takes their meds so it will save you time from running back and forth. Ask the previous shift to quickly give you this information.

Make sure your cart is stocked before you start, once again can save you time. Ask your CNAs to get vital signs for you, for your patients that take BP meds. Once again, a time saver.

It will take time to have a routine. Some meds can be grouped together as well. If you have 5 and 7 pm meds give them both at 6, you have an hr. window, use it.

Jot every thing down as you go. Cluster your tasks. It will take time, hang in there. :hug:

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I fully agree with brandonlpn!!!! 20 pt. In LTC Is more than a breeze more than a walk in the park.lol I would more or less describe it as "taking candy from a baby". Wait until u go somewhere else and u have 30-40 pt. And more than half of them require insulin via sliding scale eye gtts. Nebulizers. And extensive treatments that have to be done twice a shift constant calls from Dr. With new orders and several complaining family members. Why do u think ur preceptor is so happy? I would b to if I was her.......just my thoughts ..........

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Thanks. I guess I am pretty fortunate to have a report sheet with all of the residents, room#s, how they take their meds is abbreviated by their names, & diabetics are flagged as well. The overwhelming part for me is having CNAs who do not really do anything but change, turn, feed, & bathe/shower patients. At my facility I was told they don't do vitals for us. So when we have a patient (or in my case this week, multiple patients) who has fallen & is now on 30 minute vitals, then 1 hour vitals, etc., we can't ask our CNAs to do those to help us. The other nurses have made it clear that for some reason we don't ask the CNAs to do things like that, or anything at all not pertaining to changing a patient. I'm confused by that, but...guess I'll have to roll with it, as that is the way this facility operates. Perhaps I'll find out why later.

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Also, I understand it's coming from nurses who have experienced 30 or more patients at a time. I can't imagine that, I'd probably politely resign. But I'm new to this, so 20 is difficult for me & it can be overwhelming, no matter how easy a more experienced nurse thinks it is. I'm just trying to do my best in a place where I don't really have CNAs to help. They do their thing, we do our thing. Unless it involves transferring or changing a patient, they don't really help us. It doesn't make sense to me.

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I can understand y u feel ur work load is overwhelming for u. Trust me u will be fine. Just ask questions take notes and do ur best! Don't go into work thinking the worst will happen or ur going to have a bad day cuz that's how ur shift will go. Keep ur head up stay positive........U WILL PREVAIL! One of my nursing instructors in l.p.n. school told me " the ideal is not the REAL".

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We have a sheet in front of each patients med log that tells us how they take their pills.. I also leave small notes on these sheets for the fill in nurse's if there is a special trick to getting someone to actually TAKE their meds. Maybe you could incorporate one of those sheets to help you memorize your patients med preferences.

I also highlight under each patients name on the census sheet that needs chem sticked. I write their number in the highlighted box I made and have a circle next to that for the amount of coverage given.

I put a dot next to all the ones that leave the floor for dinner. number 1 in the color dot for first seating and 2 for second seating. I always get the ones that are leaving first done first. I put a slash next to each patient that is complete so I do not miss anyone and then back slash over it for second med pass. I have an x next to each patient by the end of the night indicating no one missed meds.

There are a lot of tricks you can personalize that will help you along the way. It just takes some time to get used to everything and create your own personal "system".

Speed comes with time. I will tell everyone that is willing to listen NOT to focus on that when you are first learning something. Accuracy first. ALWAYS accuracy first! You do not want to be putting bad habits into your subconscious.

As you do repetitive things it gets burned into memory. Memory is where the subconscious pulls from to "start without you" Teach your subconscious the proper way right from the start and you will have a lot less trouble down the line. Speed in anything we do comes from the subconscious mind working faster than the conscious mind does. Pulling open the next drawer for meds AND pulling the RIGHT drawer open without even thinking about it for example. Keep your med cart organized so your subconscious CAN help you pick up speed. Speed comes with time. Do not try to force it that is when you make serious errors.

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I didn't mean to be glib in my first post, sorry. I know even 5 residents can seem overwhelming when you're brand new.

All you need is time. Time to learn the residents, the meds, how to work with the CNAs. What seems impossible now will be cake in a couple months. A LTC with good ratios and bubbly, happy nurses is pretty rare. Just hang in there. Too many nurses quit LTC quick because they can't get past the "numbers" aspect of it. I think it's because nursing school preconditions us to view pt assignments I'm terms of 3 or 4 pts. Not 30 or 40.

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I'm not really sure what you mean by the CNAs not being able to help with your job. Be careful what you wish for.... If these administrators could get away with paying a CNA nine bucks an hour to pass meds they would in a heartbeat....

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Specializes in Gerontology, Med surg, Home Health.

Brandon, they're called med techs or med aides. They take a class,pass a test, and can hand out meds. Here's the thing....they make fewer mistakes than nurses because no one bothers them with 18 different things while they're passing meds.To the OP, take your time and find your own rhythm. Those of us who've been doing this forever think 20 is a cakewalk, but I can guarantee when we were as new as you, we were freaking out, too.

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