New nurse, extremely late on my med pass

[baby_nurse-]

I'm a recently-licensed LPN working 3-11 at a LTC facility. After a month-long orientation, I have been on my own for 10 shifts. My patient load is usually anywhere from 20-24 patients, depending on which cart I work. However, I've been on the same cart for 6/9 days I've worked.

I'm struggling so badly with completing my 2100 med pass on time. We have a three hour window to pass these, but I'm usually not done until 2345. My worse day was yesterday (I had a fall and had to sent the pt out); I didn't finish the med pass until 2430.

My days always start out well, and I get my first med pass done on time. I also do any vitals, assessments, treatments, and calling physicians during this time. I try to make it so that everything's finished early and I can just focus on my final med pass, which I start at 2000.

I'm not sure what I'm doing wrong. I'm going as fast as I can manage; if I go any faster, I worry I will risk making med errors. Being so late makes me extremely stressed out, especially when I see next shift come because I put them behind on THEIR duties. Then by the time I give report and finish charting, I rarely clock out before 130. I also never have time to take breaks. I've spoken with other nurses and taken their advice to heart, but I'm still so painfully behind every day.

[Missha]

It can be like that for the first month on your own. With me, at my LTC I usually give meds to all the "easy" residents first. By easy I'm talking about the ones you only need to spend a couple of minutes on and then move on to the more difficult or resistive residents. If you need to take vitals for your 2100 med pass, try to do all the assessments before 2000 so you don't have to lug around your cart and additional equipment.

Aren't your residents mostly asleep by 2100 though? At my LTC, the heaviest evening med pass is at 1700, after dinner the aides start putting residents to bed and by 2000, around two thirds are already snoring away

[heron, ASN, RN]

One thing I had to learn was to be very strict about interruptions. The CNAs I work with are pulled every which way, so it's hard on them when I have to ask them to see to something like fetching ice or toileting a resident. However, my morning med pass has a hard deadline and I must get the right drugs into the right people before then, so they and the residents have had to accept that I will say no to everything but a resident in trouble.

[mlolsonny]

Unless your start time is absolutely set at 2000, try starting earlier. Group some tasks together, like starting nebs, giving supplements to people that are getting only supplements, etc. Don't get hung up on going to rooms in order.

I suspect that some of the difficulty is because as it gets later, you're needing to wake people, sit them up in bed, etc. That was a huge issue when I was a new LPN on PM shift.

Talking to the other nurses is helpful, but don't forget your biggest asset....talk to the CNAs! They know that Mrs Jones likes to go to bed at 1830, while Mrs Smith doesn't go until later. They can help you get to people while they are still awake.

If there are certain residents that are very difficult to get meds into (or unsafe), closely look at admin times and discuss with the clinical manager. They may just need admin times adjusted.

[mlolsonny]

Also a difficult lesson to learn, but until you can get your own work done on time, you can't do anyone else's work. I.e. helping with transfers, bringing people to the BR, etc. Your scope of practice is much broader than a CNAs, so anything that they can do, you can do, but they can't do your work for you.

[NurseVal93]

Hi nurse friend. I worked LTC as my first nursing job, and was there for 14 mos.

I have always been high-energy, a GO GO GO until I hit the wall type. I am very efficient passing meds and with time management.

At my facility we had 1 hour before and 1 hour after the time the med was to be given (with certain exceptions), with a patient load of 50.

I'm delighted to see that you have 30 and get 3 hours, this is not the norm from what I've experienced and heard of from my nurse-pal's, but this is so great for a new nurse to help get your footing. I know its difficult now, but i swear it gets easier.

1)know your PT's MAR like the back of your hand. Once you know that Mr.Jones gets X,Y,Z, you are now just flipping through the MAR for any changes in orders.

2)you need to time yourself. How long does it take to pass to each resident? mine was about 2-3 mins. In, out, done. If youre taking more than 6 minutes for each (since you have 30 and 3 hrs) you will be late. So aim for 4 or 5 minutes per resident.

3) do not chit-chat with the residents or their families.. It's ok to say hello but get right to the passing of the meds and then get out. If any family has issues or something they'd like to speak to you about, let them know that you are doing med pass and have a tight deadline, and they can head on down to the supervising RN for any general questions or whatever. If they must speak to you, let them know "ill be available at ____ time, after my med pass, I apologize, but I need to ensure every patient gets their medications; just as i ensure your loved one does, every day."

Also, I saw that you say that you have 3 hours for med pass @2100, but you are starting at 2000...

so that would mean you're passing meds from 2000-2300?

Ask admin what the earliest you can start 2100 meds at? If youre given this 3 hour window, i would assume that means you have 1 1/2 hrs before 2100 and 1 1/2 hrs after to administer, meaning you can probably start at 1930 and end at 2230..

Ask your facilitys admin or your supervsor.

GOOD LUCK!

Hope this helps friend!!