I really have to take my hats off to the great nurses in the LTC area, how do you do it all? I am a new RN, this is my first month on the job after 5 days of orientation, I am the charge nurse on nights with 3 sometimes 4 CNAs and 40 residents. The night nurse has to pick up orders, do monthly renewals, do meds and treatment sheets, review all the CNA assignments, then chart..chart..chart.
Last night for example 2 residents fell during the night, after I finished the mounds of paperwork required I barely had time to do my 6am med pass!!! The 8 hours are just not enough to get ready for 7am morning rounds. I find myself constantly behind and can't seem to get all my charting and paperwork done. Any advice on how to be more effective? I loved helping people and that's why I became a nurse but after 3 weeks I'm ready to QUIT... Please help. any time management tips that worked for others would be appreciated
Jul 2, '01
The main thing to help with managing your time as a nurse involves one word : ANTICIPATION
Check what pts you have on IVF and how much you have starting out. Get all the ivf you will need to complete your shift and take them into the pts room if possible. Check your meds and make sure you have what you need for your shift - we all know how hard it can be to obtain meds from pharmacy. When I finish my assessments I make a "shopping List " of supplies : fluids, meds from the med room, tube feeding , new tube feeding containers. Because of the way my unit is set up this can save me more than 20 trips a night to the same place. Try it.
Jul 2, '01
I don't know if this will help you at all, and I don't work LTC, but this is what I try to do..... I work as if things could go to heck at any time, I am kind of paranoid that way. I chart on my initial assessments as soon as I can, you can always add on if need be, but many times I don't have to do that and it really keeps me ahead of the game. I have come to find out that if I come in to a slow night and count on it, this expectation always comes back to haunt me.
I came in to work the other night and the PM shift just had a terrible shift, there was no way they could have finished everything, they had many admissions. They appologized for not having everything done, but we all have to realize that nursing is a 24 hour a day job and sometimes you just cannot possibly get everything done. I don't like leaving things for other people either, but sometimes you just have to prioritize and do what is most important, unless your facility does not mind paying OT, which I doubt.
Jul 11, '01
Hi. Don't worry. Everything will fall into place for you. Give it some time. Little by little you will find out what your CNAs are capable of, you'll get your routine down, and you'll get to know your residents, and their behaviors, as well as the ones who try to get up without help, etc. And sometimes, no matter how long you have been doing this, you will run late, just as everyone else has. I, too, worked LTC, night shift for a long time, 40 residents, usally only 2 CNAs. A lot of times it only takes one resident to be sick, fall, or whatever, and your whole night goes to sh--. Take a deep breath and keep going. Eventually the shift will end.
Jul 12, '01
Sounds like you are doing a great job! Just by reading your post I can tell you have the ability to anticipate the needs of your pts. Soon you will find your self in a routine. You are not alone!! We have all been there!! In fact my first job out of nursing school was Night Shift Working Supervisor. Here are a couple of things that I have done to help me organize my "known" tasks:
I have designed a report sheet that includes space for the report I recieve, treatments, special concerns, even code status for quick reference. I also make a shopping list space...as I recieve report I note what I will need, ie: Jevity Plus / tubing/Drain Guaze, Lancets / Glucometer, D5NS / tubing / Flushes, Alcohol pads, I.V. ABX at Room Temp. etc...
Immediately after report I assemble my shopping list.
I carry tape EVERYWHERE! I also carry measuring tape, clamps, scissors, penlight EVERYWHERE.
I always put a Blood Pressure Cuff & Pulse Oximeter on/in my med cart (I hate trying to track them down in a pinch)
When I document I flip through the treatment sheets as I go, this helps me remember points, and document efffectively, and prevents "brain cramps"!! lol
You may want to make sure you have some "fall packets", "Emergency Transfer Packets", "Death Packets", made up and stashed for your own use in these circumstances. It is such a pain trying to collect all the necessary paperwork in a pinch only to find that you have to go make copies etc...
Hang in there....We need you!! Hope this helps.
Jul 12, '01
Thank you all for the encouragement and great ideas. I have made up an hourly schedule of the activities I need to get done by certain times. e.g. All vitals need to be documented by 12am, New orders picked up by 2AM, Labs done , 24hour report by 5AM etc.. This seems to help a lot when it gets busy. As I deal with issues that come up, I update my list. I have a long way to go yet but things are looking a lot better than they were a few weeks ago.
Aug 9, '07
Hi - I am also new to LTC and a new nurse. I'm in a transitional program, CNA to LPN to RN and just completed the LPN and all RN pre-reques. Passed my boards in June, finished my summer with micro and advanced ANP - at any rate - just started my first job as a LPN in LTC.
This past weekend was my first time ever working as an LPN. I am an orientee and shadowed a nurse from 2p to 10p Friday night on one floor. Then, Saturday I shadowed another nurse from 6p to 10p on that same floor and then was on my own from 10p to 6a on that floor - I just about lost it passing meds to 31 people in addition to 6 diabetic patients, 2 tube feed patients that had to be taken care of.
The next night I worked from 6p to 6a on another floor with 18 patients, one on a vent and another psych patient that was on 15 minute checks because of elopement the night before - again . . . it was a rough night - although I did learn more.
It probably sounds crazy to experienced nurses, but I was pretty overwhelmed with all of the newness of it all and then trying to come up with a time management plan. I did take notes and I'm creating a template to work from - but this was really something else!!! I feel like I've been thrown into the middle of a war zone - with very little equipment and I'm still not real secure in my skills for trach care or diabetes management - I can do the acu checks - that is not a problem - just a little afraid of the insulin admin. At any rate - I sure appreciate those of you that posted on this thread as I now feel that I'm not alone in this.
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