New LPN doing med pass in LTC

[lifeisgood2012]

Hi all - this is my first job as an LPN - I am still in orientation phase - I am on 2nd shift - today will be my 4th day on 2nd shift, I worked 1st shift initally to learn the patients/routine. I am left on my own with med pass for the most part - but I dont see how am going to be able to get any faster. For example, when I have an admission or discharge - or incident report - or something comes up that needs to be addressed (new foley needs to be inserted, etc.) I start running behind on meds, then charting, then I am not out of there until after midnight. I know I am new, and I am trying not to be too hard on myself - but there has got to be a way where I feel like I am getting everything done without compromising patient care. I am thankful that I will usually have 20 patients or less - and I am definitely not complaining because I love my job - I also feel like I have gotten some good training and everyone had to start out new somewhere - I just want to be sure I am going in the right direction and doing what is best for the patient. I am finding that its not the med pass - its the details - in fact, its the details in everything. I can do med pass on time if I dont check vitals, dont do assessments, dont ask about pain levels, check their bed alarms, etc. but its not best for safety or patient care - and I am not willing to compromise that. Will I ever get into a routine? Will I ever feel like I am doing what is best for the patient and being thorough? I am grouping things together as much as I can, but when I run into something like I mentioned above - admission, foley insertion, etc. I run behind. I know this is part of the process, but how do you cope? I am trying not to beat myself up too much. I am there for my residents and want to do right by them. Thanks for any input.

[newrnltc]

Maybe instead of doing all these things at once you can break it up into segments.

When i used to go on the floor before i started, i quickly round on pts:

said hello, eyeballed them for anything emergent (i.e. distress, change from baseline behavior/safety risk)

if they're awake asked "how are you?"

they will tell you fine or i'm in pain or i need ___. (make a note on your brainsheet for pts that need follow up)

for the one's that can't talk - assess facial expression.

Back then this took me about 10 min for 60 res after i knew them for about 3 months.

when you start on the med pass focus on the med pass (get to know who is hard to get to after a certain time, who doesn't want to take meds til later, who wants them before they eat/sleep, time sensitive meds (i.e. q6h bp or antibiotics - prioritize)

when you're falling behind remain calm. know that at home, pts probably don't take their meds exactly at 8 or 10 or whatever. just keep going. you'll get it done.

think of every obstacle (admission, procedure) as a way to do it more often so you'll get faster at it. practice makes perfect! you don't have to sacrifice safety for speed because you'll definitely get into a routine! best of luck LTC can be very rewarding!

[newrnltc]

also get to know your staff and the ones you can trust. you're not in this alone! coworkers can be your eyes and ears and those who've been there longer can give you valuable insight on residents. help each other! soon you will get to know everyone like your own family. by the time i left, i knew all the residents very well... even down to who gets up to pee at night and how many times haha

[Labor RN]

I have worked LTC for about 3 1/2 years now PRN. I used to live in DFW but now I live in El Paso and I transferred over with my company. I will say that after I got to know my patients and my routine in Denton, it was all routine for me and now that I have a completely new set of residents I wonder how I ever got it down. BUT YOU WILL.

First, whatever hall you are on, make a cheat sheet the night before. That way, you know who your gtubes are and room number and you can quickly check their meds and admin them. (It always took me a lot of time to go through my nurse book to see what I needed to do for the day. If you know ahead of time what you need to do then you will save yourself lots of time.)

When you make your sheet, you will see the gaps in your schedule and know when you have down time. This way if you do have a fall or something, you know when you can get your paperwork done.

With med pass, listen to the advice above. Just figure out who your difficult patients are and get them done first. Believe me after a month or so you will feel more comfortable.