New Rehab nurse

TheCommuter, BSN, RN · Oct 8, 2014

I am an extremely task-oriented person, so when I used to work in SNF rehab, I always wrote my tasks on a to-do list and crossed them off as I completed them. After all, rehab/SNF nursing entails a huge workload of tasks that must be completed.

I worked on a rehab unit at a large rehab/SNF several years ago and here is how I used to organize for the day. I worked 16 hour weekend double shifts from 6am to 10pm.

I normally had about 15 patients to care for. At the beginning of the shift I would look through the MARs and TARs and, as I went, I jotted down the tasks that needed to be done in my notebook. My to-do list in my notebook was how I organized my shift, and as a result, I wouldn't forget to do anything.

Here is how an old notebook page from 2007 appeared (names have been changed due to HIPAA):

9-23-2007

DIABETICS, FINGER STICKS: Agnes (BID), Norma (AC & HS), Bill (AC & HS), Pauline (AC & HS), Rex (BID), Jack (BID), Ethel (AC & HS), Marjorie (0600, 1200, 1800, 2400)

NEBULIZERS: Marjorie, Ethel, Bill, Jack, Pauline

DRESSING CHANGES: Pauline, Bill, John, Jack, Lillian, Rose, Lucille

IV THERAPY: Pauline (Vancomycin), Agnes (Flagyl), Rex (ProcAlamine)

COUMADIN: Agnes, Rose, John, Lucille

INJECTIONS: Agnes (lovenox), Lillian (arixtra), Rex (heparin), Bill (70/30 insulin), Ethel (lantus), Mary (vitamin B12 shot)

ANTIBIOTICS: Pauline (wound infection), Rose (UTI), Rex (pneumonia),

1200, 1300, 1400 meds: Marjorie, Lillian, Rose, John, Jane, Jack

1600, 1700, 1800 meds: Rose, John, Rex, Lucille, Lillian, Laura, Louise

REMINDERS: assessments due on Agatha, Jill, and Louise; restock the cart; fill all holes in the MAR; follow up on Norma's recent fall, fax all labs to Dr. Smith before I leave, order a CBC on Rex...

peramos12gmail.com · Oct 8, 2014

So by having it all written down it was easier to get it all done in time? I have thought of that and I will try it on my next shift. I work three days in a row 13 to 13 1/2 hour shifts.

CapeCodMermaid, RN · Oct 9, 2014

A month is not enough time to learn everything. Take your time, learn your residents, and you'll be great.

LadyFree28, BSN, LPN, RN · Oct 10, 2014

So by having it all written down it was easier to get it all done in time? I have thought of that and I will try it on my next shift. I work three days in a row 13 to 13 1/2 hour shifts.

After 9 years in this business, I STILL organize what needs to be done; it helps me ensure that I can complete and anticipate anything else that may come along. :yes:

eggyweggy, MSN, RN · Oct 10, 2014

I'm in the same boat -- I'm a little over a month into my rehab nursing job (have a year of RN experience in a different area) and I just can't get it all done in 8 hours yet. I also have to pass all of the meds and do all of the treatments for 12 residents. I have observed some of my co-workers cutting corners to get things done, which I'm trying my hardest not to do. The ones that I would like to be like are crazy efficient and very good at staying on task and not getting sidetracked by things that can wait, which I'm finding is my weakness. I need to learn to say "Ok, I'll address that when I'm done passing the morning meds." or "Let's push your call light so that the aide can help you with that." instead of addressing it right then and there and putting myself behind by 5 minutes here and 5 minutes there. It adds up! There's a fine line between staying on task and not meeting residents' needs, so I'm trying to figure out what I can say "later" to without compromising quality of care.

I have a "brain" that I use to keep track of what needs to be done for each patient and that helps a ton. I go through the MAR right away and jot down med times, BG checks, treatments, assessments, weights, and other "to-do" tasks that need to be completed for each resident during my shift. When I'm done with the task, I cross it off the list. My current "brain" is organized by resident, but I'm wondering if I should try another "brain" organized by time or type of task so that I can get a better handle on my day as a whole.

I'll be interested to see what suggestions you get!

eggyweggy, MSN, RN · Oct 13, 2014

I just thought I would update that my "brain" that is organized by task instead of resident worked a lot better for keeping me on track for my last few shifts. The problem I was having with clustering my tasks with each resident was that doing tasks during my med passes inevitably put me behind. I found this weekend that it was more efficient for me to do a few of the faster treatments before the AM med pass and then saving the rest for after the AM med pass but before the lunch rush. I also found it was more efficient for me to go around and do my VS on my half of the residents all at the same time instead of trying to cluster it with medications and treatments. When I went around to do VS, I also assessed pain and asked those who tended to utilize their PRN pain meds whether they needed one and if they wanted me to bring it with their scheduled medications within the hour. I also end up wasting a lot of time running for missing supplies, so I made a point of eyeballing the supplies while I was in the room doing VS and jotting down a note to grab things out of the treatment cart so that I knew what to grab out of the treatment cart. Taking the time to do a thorough inventory of my med cart before starting med passes also cut down on my running around this weekend.

LadyFree28, BSN, LPN, RN · Oct 13, 2014

I just thought I would update that my "brain" that is organized by task instead of resident worked a lot better for keeping me on track for my last few shifts. The problem I was having with clustering my tasks with each resident was that doing tasks during my med passes inevitably put me behind. I found this weekend that it was more efficient for me to do a few of the faster treatments before the AM med pass and then saving the rest for after the AM med pass but before the lunch rush. I also found it was more efficient for me to go around and do my VS on my half of the residents all at the same time instead of trying to cluster it with medications and treatments. When I went around to do VS, I also assessed pain and asked those who tended to utilize their PRN pain meds whether they needed one and if they wanted me to bring it with their scheduled medications within the hour. I also end up wasting a lot of time running for missing supplies, so I made a point of eyeballing the supplies while I was in the room doing VS and jotting down a note to grab things out of the treatment cart so that I knew what to grab out of the treatment cart. Taking the time to do a thorough inventory of my med cart before starting med passes also cut down on my running around this weekend.

Sounds great! :yes: