NEW LTC RN- 3-11pm Shift

surfnbeagle · Jul 27, 2011

Congratulations! Typically, on 3 to 11 you will receive most of your admissions. You also will probably have 2 med passes at 5 pm, and hs. Keep a clipboard with you, with your report sheet, so you can make notes as you pass meds. Find out who your diabetics are, so you can do your blood sugars before they are taken to the dining room. Check if labs came in, have the pts chart and MARS at your fingertips if you have to call the doctor. Oh and make sure your cart is stocked before you start your med pass. Not everyone is considerate to stock the cart for the next shift. The less steps you take the better. Good luck! You will do fine!

NurseLoveJoy88, ASN, RN · Jul 27, 2011

I used to work in LTC and I made out a schedule for myself ( ofcourse everyday is something new and things don't always go as planned).

First thing I do when I arrive is get report and count ofcourse. Then after that I immediately do rounds, I like to lay eyes on my residents to make sure everyone is there and ok and if they are off the unit I like to know with who and where ( some residents are elopement risks).

After rounds- I like to follow up on anything critical such as labs because sometimes labs will result in a medication change. Many doctors offices close around 5pm so If I have to follow up with the MD with anything from day shift, now is a good time to call.

After calls to MD, I do a chart check if there were any new orders. I like to double check right before I start my med pass.

After my chart check with new meds, I now prep the med cart ( water, juice, icecream, applesauce, supplements, bulk meds, and etc) and I'm ready to start meds which is around 4pm.

I try to do my 5pm med pass between 4-6.

After the first med pass I like to sit down and start charting and signing of on TAR ( if things are done by that time and flag anything for later)

After that I take a break which is around 6:30pm

At 7pm I start with my HS med pass

Around 9pm I'm done and I finish charting and do any dressings changes and etc. while the resident is in bed.

From 9-11pm its basically charting, rounds, and getting ready to report to the next shift. I also clean the medcart for the next shift and empty the trash from the med cart.

In between all of these steps I'm constantly eyeballing my residents, if I have time I do toilet the residents , especially if they are a fall risk and the aides are super busy.

You will do fine. It will take a while to get a routine down. Good luck.

Forever Sunshine, ASN, RN · Jul 27, 2011

Thats basically it above. And it doesn't look like much but 3-11 is a very busy shift. Especially if theres an admission. or two. or three :sofahider

Get there at about 2:50 so you can count and receive report and be ready to start giving CNAs their assignemnts and report at 3:15. Call any doctors. You will get to know your doctors as you go. Call the ones that answer their phones right away first. Then call the ones that you page and leave a message. So while you are waiting for their call back, you can set up your cart,(cups, spoons, straws, pudding, applesauce, juice, water, insulin, needles, alcohol pads, etc). Start your meds with the residents who want their meds right away and fingersticks. If the doctor hasn't called back in an hour. Give another call. Our policy is two hours and we call the medical director. Yours might be different.

From now until dinner do as much meds as you can. You may have to go into the dining room to "babysit" and you may or may not be allowed to do meds. Its frowned upon where I work but I usually help feed during dinner since the floor is always short CNAs

Finish up your 4:30 meds after dinner(yes they will be late most of the time). Once the meds are done do any MD orders that are sitting around, and start your charting. I usually go to dinner around 7:30, 8pm. and when I get back I do the rest of the meds, and treatments and finish aorund 9:30 and finish up charting and any other leftover orders or labs and count and get the hell out of dodge

Thats basically 3-11. A good one. A bad one would have admissions, many phone calls, residents going the hospital, dietary not doing their job etc.

tyvin, BSN, RN · Jul 28, 2011

All good advice and I will reiterate about finding out who your diabetics, sliding scale etc... Sometimes it's hard to find them, they don't stay in their rooms and you want to be able to do the blood sugars before they go to dinner. Then there are insulin's at night so it' just smart to know who is who in that aspect.

Know the code status of your residents. You never know what may happen. Good luck.

Momto2boys2011 · Jul 28, 2011

I am a LTC RN and have been for a few years. I work first and second shifts. I work at a smaller facility with about 70 beds, total. We also have an assisted living (9 apartments), and an independent living (30 apartments). I take care of about 35 people and either the assisted living, or the independent living (which usually don't need much).

A typical 2-10 shift for me usually consists of the following:

From 2-4: I count narcotics, get report, review medication schedule and treatment records, set-up my medication cart, get treatment supplies ready. Then, I check on any unstable residents, and assess all of my skilled residents. I fax the physicians any issues or questions regarding the residents. Obviously, unless it is an issue that needs prompt attention, then I call. I review Labs as they come in, and write orders as I receive them.

From 4-6 I pass all 4pm medication, chart, and help the CNAs (if I have time) get residents out to supper and feed.

I will start passing my 7pm medication at 6pm, and I will start 8pm medication at 7pm. You will get the feel of who goes to bed early, and how each person likes things done.

Once, everyone is done eating and has left the dining room (a nurse must be present in the dining room while the residents are eating), I take my medcart and treatment supplies down the hall and get the rest of my medications passed and treatments completed.

I usually do not get done with that until between 8:30 and 9:30 depending on the residents' needs. Then, I chart anything I haven't yet charted, and write up any orders that haven't been written up.

This is just a normal 2-10 without many complications. There are also things to consider like new admits, emergencies, falls, behavioral issues, skin tears, excoriation, constipation, pain, and death and dying to consider. All of these things will change the course of the evening. I enjoy my job very much, and have been working LTC since I received my LPN a few years ago. I think my next career step may be hospice, but I am happy where I am for the time being. Get to know your CNAs, they are your eyes and ears. They also have one of the hardest jobs in the world. I work with a great group of CNAs, and I hope you are as lucky.

nurse0520 · Jul 28, 2011

Be sure you count as soon as possible when you get there. I hate it when I am done and waiting to go home but the nurses coming in for PM shift (or any shift for that matter) take off and I have no idea where they are or they are talking to another unit while I am waiting for them so I can go home and can not until they count the Narcotics with me.

jvoeRN · Jul 28, 2011

Great replies so far! I worked in LTC for a while and loved it. I worked the 3-11. I found that being nice to your CNA's and not being afraid to dig in and get dirty goes a long way. Always answere a call light if you see it, you never know what you will find! The CNA's are your eyes and ears. I likes to be presant when they did thier report as well. I also tried to do basic cares as often as I could. It can be a very busy shift but I loved it. My favorite times were when I could sit and assist someone with meals or to get ready for bed.