Out of the frying pan, Into the fire.

amoLucia · Feb 18, 2017

(((Holding good thoughts out for you & wishing you good luck (am NOT being smarty).)))

NotMyProblem MSN, ASN, BSN, MSN, LPN, RN · Feb 19, 2017

Go in a few minutes early to get your lists and times together: blood sugars/insulins, crushed meds, tube feeders. Organize this list chronologically and then make copies so that you won't have to do this ever again (you'll only update the list as admits/discharges occur).

4:30pm accuchecks. 9pm accuchecks. 3am accucheck. 6am accucheck

Patient A. Patient A

Patient B. Patient B

Etc.. Etc..

Crush meds

1.

2.

3.

PEG tubes

1.

2.

15.(LOL...hey, reality!)

Anyway, create something similar to this, adding whatever tasks you feel you'd need reminders on. Fill in the names for your shift. Make plenty of copies and hang them on a clipboard or put them in a drawer for easy access at the beginning of your shift. The key to success is early organization. Keep the original copy with no names on it for later use. It will come in handy as you grow in your career....trust me. Do a separate sheet (or incorporate) for each shift you plan to work....especially nights shift (you never know when a you'll be forced to stay over due to a call-out). Better to be prepared and not need it, than to need it and not having prepared for it.

When I was an agency nurse, I created a blank 'cheat sheet' just for myself and filled in a copy (then made copies to be left on a clipboard) at every facility I was sent to. This one move carried me many places with confidence over my 24-year LPN career because I developed that routine years prior.

LunaTunaPineapple · Feb 19, 2017

Go in a few minutes early to get your lists and times together: blood sugars/insulins, crushed meds, tube feeders. Organize this list chronologically and then make copies so that you won't have to do this ever again (you'll only update the list as admits/discharges occur).
4:30pm accuchecks. 9pm accuchecks. 3am accucheck. 6am accucheck

Patient A. Patient A
Patient B. Patient B
Etc.. Etc..
Crush meds

1.
2.
3.
PEG tubes
1.
2.
15.(LOL...hey, reality!)
Anyway, create something similar to this, adding whatever tasks you feel you'd need reminders on. Fill in the names for your shift. Make plenty of copies and hang them on a clipboard or put them in a drawer for easy access at the beginning of your shift. The key to success is early organization. Keep the original copy with no names on it for later use. It will come in handy as you grow in your career....trust me. Do a separate sheet (or incorporate) for each shift you plan to work....especially nights shift (you never know when a you'll be forced to stay over due to a call-out). Better to be prepared and not need it, than to need it and not having prepared for it.
When I was an agency nurse, I created a blank 'cheat sheet' just for myself and filled in a copy (then made copies to be left on a clipboard) at every facility I was sent to. This one move carried me many places with confidence over my 24-year LPN career because I developed that routine years prior.

Thank you! That's a great idea, I'll def create a sheet for that! I've made a few cheat sheets for procedures and codes, so that will def be a great add on!

TheCommuter, BSN, RN · Feb 19, 2017

In LTC subacute/rehab, time management is imperative. As cold as this sounds, be mindful that the subacute residents are not your personal friends.

Though you should always be kind and treat residents respectfully, you have no need to socialize with the same individual for more than a few minutes. In sum, hurry up, pass the meds, change the dressings, and quickly move onto the next resident.

A 'to-do' list kept me organized. Keep reading to see one of my old to-do lists with names changed due to HIPAA. I worked 16-hour weekend double shifts (6am to 10pm) on a rehab unit at a LTC/SNF years ago and that's how I stayed organized.

I usually had about 15 residents. At the start of the shift I would look through the MARs and TARs and wrote down all tasks that needed to be done in my notebook to formulate my to-do list. As a result, I wouldn't forget to do anything.

9-23-20XX

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...

LunaTunaPineapple · Feb 19, 2017

In LTC subacute/rehab, time management is imperative. As cold as this sounds, be mindful that the subacute residents are not your personal friends.
Though you should always be kind and treat residents respectfully, you have no need to socialize with the same individual for more than a few minutes. In sum, hurry up, pass the meds, change the dressings, and quickly move onto the next resident.
A 'to-do' list kept me organized. Keep reading to see one of my old to-do lists with names changed due to HIPAA. I worked 16-hour weekend double shifts (6am to 10pm) on a rehab unit at a LTC/SNF years ago and that's how I stayed organized.
I usually had about 15 residents. At the start of the shift I would look through the MARs and TARs and wrote down all tasks that needed to be done in my notebook to formulate my to-do list. As a result, I wouldn't forget to do anything.
9-23-20XX
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...

That's exactly what I need ! A list to stay in order! I've noticed that residents love to chat, but I'm pretty good at cutting short and running like the wind! Do you suggest doing dressing changes while I'm in or coming back to perform the dressing change?

TheCommuter, BSN, RN · Feb 19, 2017

Do you suggest doing dressing changes while I'm in or coming back to perform the dressing change?

Pass the medications and change all dressings while you are in the room at the same time. Do not schedule multiple trips to the same resident's room because this wastes valuable time. It only takes a minute to clean an incision and another 30 seconds to apply the dressing if all supplies are ready.

The occasional resident might say, "I am not ready for __ (e.g., medicine, wound care, etc.). Come back later." Gently warn the resident that if (s)he's not ready now, you might not be able to get to her/him in a timely manner at the moment they decide they are ready for you.

MiAmorPickles · Feb 19, 2017

My first night as a new nurse in med/surg, I showed up and was given an assignment. No preceptor, nothing. I didn't know better. This was almost 30 years ago. I did the best I could. Looking back, I am surprised I managed to make it through the shift--halfway through the the supervisor showed up and apologized saying she didn't realize I was a new nurse and I needed a preceptor. But they still had me work the rest of the shift alone. Very rough. I wound up getting an peptic ulcer and losing 40 pounds during the first few months on the job there. I then got one week of precepting and then got told I wasn't ready and needed another week of orientation (geez, ya think!) My daughter just got her license and is taking hospital classes mixed with on the floor training that lasts for four months. I can only shake my head when I think about how us new nurses used to be thrown out there to sink or swim.

LunaTunaPineapple · Feb 25, 2017

My first night as a new nurse in med/surg, I showed up and was given an assignment. No preceptor, nothing. I didn't know better. This was almost 30 years ago. I did the best I could. Looking back, I am surprised I managed to make it through the shift--halfway through the the supervisor showed up and apologized saying she didn't realize I was a new nurse and I needed a preceptor. But they still had me work the rest of the shift alone. Very rough. I wound up getting an peptic ulcer and losing 40 pounds during the first few months on the job there. I then got one week of precepting and then got told I wasn't ready and needed another week of orientation (geez, ya think!) My daughter just got her license and is taking hospital classes mixed with on the floor training that lasts for four months. I can only shake my head when I think about how us new nurses used to be thrown out there to sink or swim.

I'm sorry you had to go through that, I couldn't imagine being put there alone! Today I was with another preceptor. She had me pull meds and along side her, then she would leave me alone for extended periods. It was rough to say the least. It's still a lot. I ended the night with a crappy report amongst other things ! Wish me luck for tomorrow! Lol

Workingitgirl · Feb 25, 2017

When I started my first job I was 18 years old and scared to death. Since the facility is now gone, you can't imagine what I went through but it was a poor, indigent care trauma center. Anything was possible in there and I saw a lot for 18 years of age! I made $2.25 cents an hour back then. Can you imagine? I left there to get a big raise and made $3.25/hour. But let me tell you back in 1974 and 1975 all people wanted you to do was to succeed. Titles weren't so important back then. Plus I was younger than most of the people I was working with and they needed my energy. You always have to focus on "What does this employee need from me?" Plus I was 18 years old on an oncology ward watching people die like flies. Yes Luna Tuna let me tell you, you do usually get thrown to the wolves, but hopefully there is some place you can run for help. Perhaps another nurse on another floor..to be-friiend and help you out. On 3/11 shift you have to get your meds out and follow up on your CNA's and make sure your patients are comfortable. If you have any "troublesome patients" they just usually need you to stop, talk or joke with them for a minute. Imagine being their age with sundowner's and all the sudden you feel confused- just give them something in the night that is routine. They really do appreciate it. And good luck my fellow nurse. You will do just fine!