Nursing home rehab: Need tips on how to organize PM shift and new admissions!

TheCommuter, BSN, RN · Jul 1, 2013

You stayed nine hours past the scheduled end of your shift when you only received two admissions during that time? Take a deep breath and relax. I might be wrong, but this seems like a time management problem.

To be fair, the 3:00-11:00pm shift is probably the busiest in nursing home rehab because you get slammed with admissions. In addition, the family members who accompany the newly admitted residents want to talk to you forever and monopolize your time when you've got multiple other things to do. On top of that, you've got 15 residents who are already there and demanding things from the nurse.

To save time, prioritize the residents who are already there. Do their assessments, pass their meds, perform their treatments, obtain their blood sugars, and take care of them first. If a new admit rolls into the building, quickly introduce yourself to the new resident and tell them you'll return to them later. Finish up with the other residents before working on your new admits. Save the admit paperwork until med pass is over.

When assessing new admits during evening shift in nursing home rehab, I'll do a quick 10-minute assessment, look over the skin, ask a few questions, and redirect the conversation if the new resident or their family wants to tell me their life's story. Then I'll quickly do the admit paperwork, verify new orders, write out the MAR/TAR, and so forth.

Remember: nursing is a 24-hour job. Once the essentials of the admit packet are done, you can pass on any unfinished work to the next shift, even if they huff and puff about it. At all facilities where I've worked, we have 24 hours to complete the admission. Orders must be verified by the nurse who receives the new admission, and initial doses of meds must be given at the right time, but most parts of the new admit paperwork can be passed on.

Good luck to you!

sweetpeamax1206 · Jul 1, 2013

Hello. I understand your pain. I am working the night shift and days away from being done with orientation. I can't wait. I feel that I am not ready, but I need some time to be my own nurse and person. I guess I am tired of people telling me today that I am doing "charting" wrong and then the next day, it was fine. I feel like once I get the organization part down, the rest I can handle. I am also looking for advice on assessment and great charting tips!!! Also- I dont know if this is what the new nurse above is going through, but for me, I hear different ways of doing things, but need to know the protocols. I am going to ask to take the protocol book home for a week and study it - so I know for myself what is right and what is wrong. Maybe that would help you too! Any advice to that anyone???

NurseKatie08, MSN · Jul 3, 2013

You stayed nine hours past the scheduled end of your shift when you only received two admissions during that time? Take a deep breath and relax. I might be wrong, but this seems like a time management problem.
To be fair, the 3:00-11:00pm shift is probably the busiest in nursing home rehab because you get slammed with admissions. In addition, the family members who accompany the newly admitted residents want to talk to you forever and monopolize your time when you've got multiple other things to do. On top of that, you've got 15 residents who are already there and demanding things from the nurse.
To save time, prioritize the residents who are already there. Do their assessments, pass their meds, perform their treatments, obtain their blood sugars, and take care of them first. If a new admit rolls into the building, quickly introduce yourself to the new resident and tell them you'll return to them later. Finish up with the other residents before working on your new admits. Save the admit paperwork until med pass is over.
When assessing new admits during evening shift in nursing home rehab, I'll do a quick 10-minute assessment, look over the skin, ask a few questions, and redirect the conversation if the new resident or their family wants to tell me their life's story. Then I'll quickly do the admit paperwork, verify new orders, write out the MAR/TAR, and so forth.
Remember: nursing is a 24-hour job. Once the essentials of the admit packet are done, you can pass on any unfinished work to the next shift, even if they huff and puff about it. At all facilities where I've worked, we have 24 hours to complete the admission. Orders must be verified by the nurse who receives the new admission, and initial doses of meds must be given at the right time, but most parts of the new admit paperwork can be passed on.
Good luck to you!

Right on the money as usual, Commuter. I had four years of experience doing nursing home rehab at my previous job, and everything you advised I couldn't agree more with. 3-11 is the busiest time in this type of setting (I should know...I did it full time Mon-Fri x 4 years!). It is very easy to get burned out, and the number one way to do that is staying so far past your scheduled shift to get work done. I often stayed late finishing paperwork, but admissions are a 24 hour job, and sometimes the next shift just has to finish up. We had certain parts of our admission packet that were required to be done by the admitting nurse, and others that could be done by any nurse within the next 24 hours. We signed off on that sheet and kept it in the front of the chart so everyone knew where we were with the admit. Try to implement this if your floor doesn't have something similar.