nursing home routine

DG5 · Jul 15, 2005

My usual day goes like this:

Try to get there at least fifteen minutes early

0645 - 0705 get report from night and prior evening shift

0705 - 0715 look at latest orders, labs, consults over last few days, get a general idea of what is happening on the floor, find out what staff mix you have, if any staff shortages etc. find out how/who will cover and which residents each one has.

0715: Start preparing first round of medications (ac breakfast). Find out about any Insulin dependent diabetics and what insulin to administer - also find out about any narcs to administer - sign and double check etc.

As I go around on the first round of meds, I check in on others that may be palliative, acute, had fall from previous shift or two etc. , check which residents may need to be kept in rooms and given trays for breakfast, keep in touch with the CNA's as you go around

0800: Doors open for breakfast, 0800 meds are started and administered. This can take up to 0900 or even 1000 if you are not too familiar with the residents. I say, a BIG RULE is to NOT RUSH the medications - take your time, make sure the 5 R's are done. (Right med, Right route, Right dose, Right resident, Right time) Follow instructions for crushing med or how res will take the med -this is more important than rushing to finish.

1000-1015 breaktime!

1015 - Noon - I use this time to do treatments, dressings, send faxes to physicians, request dietary / physio consults, follow up on orders etc.

1200-1230 Noon medications

1230-1300/15: lunch! I take my afternoon break with my lunch because after this break, I will be motoring on into the afternoon to tie everything up for the shift, of course, charting as I go along.

1315-1400: I may receive answers from doctors, process their orders etc.

1400: Administer some 1400 meds, not too many

1400-1500: Finalise all the outstanding work to be done - consult with your staff for any oustanding issues etc. on the floor, finalise charting, getting report ready for next shift.

Of course, this sounds nice and smooth, but there are ALWAYS a million interruptions in between! Just keep a cool head, smile a lot, care a lot. Go home and leave it all behind!

katwoman7755 · Jul 15, 2005

I was going to say pass meds from 7-3....lol. At least that's what it seemed like when I have to fill in on the floor....so many meds..and pt's without wrist bands...just trying to find those people can be an all day job. Not to mention treatments if there isn't a treatment nurse. Good luck!

inwyte · Jul 15, 2005

My usual day goes like this:
Try to get there at least fifteen minutes early
0645 - 0705 get report from night and prior evening shift
0705 - 0715 look at latest orders, labs, consults over last few days, get a general idea of what is happening on the floor, find out what staff mix you have, if any staff shortages etc. find out how/who will cover and which residents each one has.
0715: Start preparing first round of medications (ac breakfast). Find out about any Insulin dependent diabetics and what insulin to administer - also find out about any narcs to administer - sign and double check etc.
As I go around on the first round of meds, I check in on others that may be palliative, acute, had fall from previous shift or two etc. , check which residents may need to be kept in rooms and given trays for breakfast, keep in touch with the CNA's as you go around
0800: Doors open for breakfast, 0800 meds are started and administered. This can take up to 0900 or even 1000 if you are not too familiar with the residents. I say, a BIG RULE is to NOT RUSH the medications - take your time, make sure the 5 R's are done. (Right med, Right route, Right dose, Right resident, Right time) Follow instructions for crushing med or how res will take the med -this is more important than rushing to finish.
1000-1015 breaktime!
1015 - Noon - I use this time to do treatments, dressings, send faxes to physicians, request dietary / physio consults, follow up on orders etc.
1200-1230 Noon medications
1230-1300/15: lunch! I take my afternoon break with my lunch because after this break, I will be motoring on into the afternoon to tie everything up for the shift, of course, charting as I go along.
1315-1400: I may receive answers from doctors, process their orders etc.
1400: Administer some 1400 meds, not too many
1400-1500: Finalise all the outstanding work to be done - consult with your staff for any oustanding issues etc. on the floor, finalise charting, getting report ready for next shift.
Of course, this sounds nice and smooth, but there are ALWAYS a million interruptions in between! Just keep a cool head, smile a lot, care a lot. Go home and leave it all behind!

thanks a lot for a comprehensive reply..at least i have some idea now as to what my day will look like tom..hopefully i can survive it and will say "im going back into that nursing home again... "

dotty865 · Jul 16, 2005

How did your day go ? I work first shift also and my routine is pretty much the same as was described. busy busy busy :nurse:

inwyte · Jul 19, 2005

How did your day go ? I work first shift also and my routine is pretty much the same as was described. busy busy busy

i was agency and my nursing home experienced was like 2 years ago . i was excited when i arrived at the facility but as soon as reports were given and i was on my own it faded. i started my meds for 9 at quarter to 8 ,got finished at 11 ,just in time to start giving meds again.i have 20 pts halft of them on peg feedings.i got bunch of treatments, bunch of docs orders,bunch of confused patient, that i had no time to eat lunch ,and the staff just doesnt care.all in all it was a nightmare..i went home tired and depressed saying i wont go back to long term care anymore..argh..maybe it was just me being pregnant and not too young anymore for this kind of work..thus for all long term care nurses, i salute you!

Blackcat99 · Jul 19, 2005

If a patient is going to fall on your shift he will be sure to fall at your most busiest time or when you think you are ready to go home. :angryfire

DG5 · Jul 19, 2005

Don't be disheartened on this first shift. I have also been an agency nurse and some facilities are lousy, others are great. Sounds this was a lousy one, no support, maybe disorganised, and shortstaffed. You'll know not to accept another shift there, but there are other places out there which are better than that where you can really feel that you are part of the team. I know how you must feel! :eek: Hang in there, though, don't give up on LTC, it can be a very rewarding area to work in. In a situation like you were in, you can only put one foot ahead of the other and do your best with the time and energy you have been given. You probably did the best you could.

Mister Chris, MSN, NP · Jul 21, 2005

.............................................................but there are ALWAYS a million interruptions in between! Just keep a cool head, smile a lot, care a lot. Go home and leave it all behind!

Love your day - yes you can have bad days and even worse days. Always keep that last quote in mind.

If it can happen it will so learn to go with the flow! Deal with it. Cool head - always, smile constantly and be the carer fit to win a gold medal.

When you go home you must learn to swich off - or you will find you will get sick yourself and age faster.

Love to work with some of you carers - you all sound terrific. :)

Best wishes

Mister Chris:specs:

ZZTopRN, BSN, RN · Jul 22, 2005

Love your day - yes you can have bad days and even worse days. Always keep that last quote in mind.
If it can happen it will so learn to go with the flow! Deal with it. Cool head - always, smile constantly and be the carer fit to win a gold medal.
When you go home you must learn to swich off - or you will find you will get sick yourself and age faster.
Love to work with some of you carers - you all sound terrific. :)
Best wishes
Mister Chris:specs:

Is 39 patients a large workload for one nurse to give meds all evening + 6 tube feeders and then do charting?

dotty865 · Jul 23, 2005

I think the legal limit is 50 patients to one nurse in Ohio . Might be different in other states .