Overwhelmed, is it too much work or just me?

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Started LTC a few months ago and I am struggling with my time management. I have med aids, who pass the scheduled meds... but I do all the PRNs and IM/IV. My biggest struggle is doing blood sugars in a timely manner. I start them at 11:00 (lunch served at 12), and I have to chase 16 residents around the building to get their accucheck and sliding scale. Of course we cannot do checks/injections in the dining room, so I am pulling residents out of the dining room and into a room. Usually I can make it through the lunch time accuchecks on time, as long as I am not interrupted. However, when I start the 4pm blood sugars (dinner served at 5), I am chasing the same 16 residents, and also need to do 8 neb treatments. Ironically, none of the neb/blood sugar residents are the same, so I am chasing 24 patients in 1 hour. Technically, the nebs are due at 5, but obviously, nobody wants a neb treatment during dinner. I am required to supervise in the dining room for all three meals, so that takes about 1.5 hours each- some of these folks eat SOOOO SLOW!!! Then, filling out the rest of my day is treatments for 50+ residents, an occasional feeding tube or IV.

Also, its frustrating when I cant find the people I need... because they are still in therapy or the main dining room (WAY other side of the building)

And I gotta say, my CNA's are NEEDY! dang, there is so much squabbling and drama, I am constantly putting out fires with them. Add in a fall that needs neuro checks and my schedule is thrown right out the window.

I feel really overwhelmed! My manager keeps saying I need better time management, but I am worried that maybe it is just too much work for the allotted time?

Can somebody give me some suggestions? I carry a 'cheat sheet', so I can tell at a glance what is coming up, but it seems like the distractions/minor emergencies are what throw me off course. Help please!

(oh, and I run my butt off from when I clock in until I clock out... no smoke breaks, no 15 minute breaks and definitely no facebook! LOL)

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Specializes in PACU, OR.

Is it necessary for you to "chase" the residents yourself? Can't you request that the CNAs bring those residents to a designated area for you to do their blood sugars and nebs?

A wise woman once told me that "it's the job of the person in charge to delegate."

Maybe it's something you need to get into the habit of doing.

As for staff squabbling and bun fights, I would suggest you make it clear to them that they are welcome to nurture their personal animosities, but the moment they do it on company time, they will be reported.

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Specializes in LTC, OB, psych.

Do you also have leeway to tweak neb schedules. It is just harebrained to have them on the MAR for suppertime. Better around 1600, so they're breathing easy and able to eat well.

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Specializes in Give me a new assignment each time:).

Sounds like you are sticking to the book a lot. It'll be impossible to get it done. Start your a little sooner. Have a list of the the run-away patients. If you have your kit with you, check their blood sugar when you are close to them and the time is reasonable. Here is an example. For a BS of 300gdl, you can still give the insulin if you have an idea of how much of a drop it will reflect in the BS reading post insulin (fast acting). If lunch will be arriving in 90 mins, you can think ahead and realise that the patient will be fine. If you are new, patients' right to refuse can really stress you out, because you know what will happen if they don't take xyz meds

I used to work at in LTC where all the CNAs disappeard from 10am to 11am. No, it was not their luch breaks. Four of them can call in sick at the same time. Their work is low-paid and difficult. You wonna be on their good side or you'll have a bad, bad day! Beware of sabotage. It's the truth in LTC

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I heartily agree w/GHG - the CNAs AND the patients need to be trained to gather in one place for their fingersticks whenever possible. And the pm nebs should be finished about 30 min before dinner, so start them a little earlier.

Stop chasing the patients - most of them KNOW that they need their fingersticks and nebs, and should be reasonably trainable!!!

Best wishes.

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Specializes in Case Management.

Got to love LTC. This, unfortunately is a common scenario. One thing I would try is to tell you CNAs to bring resident A, B, and C to you before lunch or supper. You have 50 residents to chase, your CNAs have fewer residents to chase. Same with therapy. If they are carrying your residents away, they can carry them back to you to have their sugars checked. Also, I just love administrative nurses telling you about time management. How many ADONs or DONs could get done in 8 or 12 hours, what you have to get done?? Especially if they do it the way the are supposed to. And before I start getting alot of negative responses from CNA's...been there done that. I started as a supply clerk in the purchasing department of a hospital, then CNA, then LPN, then RN.

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Our cna's always make sure they get a lunch break and 2 ten minute breaks. I on the otherhand have many nights worked without stop, because there is no one to relieve me, and the needs are never ending. I was a cna for 15 years. It IS alot different being the nurse and having 40+ pts needing something from you.

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You cannot be in two places at one time! How can you watch them while eating and do neb treatments at the same time? Can't you just ask the CNA to watch them while you do neb treatments? Also, 15 minutes to 4, ask your CNAs to round the patients up so that you don't have to chase them. Then do your accuchecks and give the coverage accordingly. Be vocal if you need help. Delegate and make sure that they will be dealt with by you and your boss if they don't do their job.

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Specializes in A myriad of specialties.

Sorry, but "time management" is nonexistent in LTC. There will always be fires to put out amongst the CNAs, interruptions, admits, falls, etc. You do the best you can do. I recall vividly no breaks no lunch yet were supposed to always leave on timen so clocking out for lunch still meant no lunch..we WORKED our lunches...in trouble if you worked the lunches, in trouble if worked overtime. Get out of there!

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Specializes in LTC.

It's so the workload.

Last night we had 3 nurses as opposed to two and another nurse to help with admissions. All 3 of us left together at 11pm. Our workload was actually for once workable and I felt on top of my game.

Time management isn't always possible. You could be right on time with meds and then someone falls on the floor or has to be sent to the hospital and thats it.. there goes your time. Hours fly by.

Don't be afraid to draw the line with the CNAs. Don't let them run all over you and complain about things. "This is what we have.. and this is how its going to be and theres nothing we do to change it."

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Specializes in Give me a new assignment each time:).
Our cna's always make sure they get a lunch break and 2 ten minute breaks. I on the otherhand have many nights worked without stop, because there is no one to relieve me, and the needs are never ending. I was a cna for 15 years. It IS alot different being the nurse and having 40+ pts needing something from you.

Many, many CNAs have being doing their jobs for several years. If you are a new grad, you'll learn a lot of time management from them. Just watch how they work in LTC. You will know what I'm talking about. Usually many CNAs I don't negotiate with a patient or try to justify the abuse they get from patients. If you need to be repositioned at this time, then you need to be reposition. 40 residents get turned, get diaper changed q2 or q3. It was too hard for me cos I spent too much time negotiating with the residents.

You have to set boundaries. What can wait has to wait. You need to take your luch break, eat, refresh yourself and come back with better energy. Let the lead CNA know where you are taking your break. So they can come get you or telephone you if it really can't wait. You have to employ better time management and prioritisation.

If you are trying to address everybody's "little" needs, well, there're plenty of those. You will never get done on time.

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Ask your peers. What does the other nurse do who works your shift when your off? Maybe they have a better plan. Either way management will always tell you that u need better time management but in LTC its always a struggle. We all feel it. We in the same boat. And management wants to save money so they gunna say the same stuff to get us to hurry our butts.

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