Potential night LTC/ subacute needs advice!

[RNnextstopDNP]

Hi! For night shift nurses, how many patients is too much and are you the only nurse at night?Any advice for a new grad at night? Thanks in advance!

[lindseylpn]

I'm not in LTC anymore but, when I was our ratios were: 25 in the skilled units, 40 in the lockdown unit and 55 in LTC. 25-40 seemed okay but, 55 was a bit much in my opinion.

Yes, we were the only nurse on the unit but, not the only nurse in the building. We had 2 CNAs per unit.

Time management is key. Try to schedule your night out, make a list of the things you have to do and mark them off as they're done. Med pass will take the biggest chunk of your time, at first it'll take you longer than you think.

[amoLucia]

Delegate if you can.

If you can do some task early, do it then, EARLY!!! You'll be amazed when time gets scrunched because of some other priority and you still have some routine-y task (that you COULD HAVE DONE EARLY) is left over.

Learn where everything is! Like extra batteries, phone lists, location of stuff on shelves in supply closet, your crash cart contents.

[GrandmaSqueak]

If you can do some task early, do it then, EARLY!!! You'll be amazed when time gets scrunched because of some other priority and you still have some routine-y task (that you COULD HAVE DONE EARLY) is left over.

Make a check list and use it every night. There are a lot of small tasks and bits of paperwork that get assigned tonight shift that are easily forgotten. Like refrigerator temps, staffing lists, etc.

I work night shift in a Continuing Care Community on the Health Care Center. I am the only nurse in the building, but I am responsible only for my 38 bed unit. We usually run a census of about 25-30. Even if it were full, it would still be ideal for me. I have 2 CNA's that are great!

[GrandmaSqueak]

Though night shift sounds great for a new grad, it might be just the opposite. If you are the only nurse in the building, you are in charge of everything. I would recommend getting at least a year of experience on day or evening shift with a seasoned nurse to sharpen your organizational and decision making skills. At night you have to be prepared for any emergencies that come up and act quickly. Not only medical emergencies, like low blood sugars or falls with injuries, but non-medical emergencies like severe weather, fire alarms, or the smell of gas coming from the kitchen. You need to have a realistic confidence in your skills that comes from experience.

[amoLucia]

... At night you have to be prepared for any emergencies that come up and act quickly. Not only medical emergencies, like low blood sugars or falls with injuries, but non-medical emergencies like severe weather, fire alarms, or the smell of gas coming from the kitchen...

Spoken like a veteran NOC worker!! You forgot to mention the stopped up toilets, warped ceiling tiles leaking from heavy rainfall, 'funny noises coming from the locked front office', you need extra oxygen (no more tanks avail and a concentrator isn't working), the 3r kitchen worker (incl the cook) just called out, etc etc

[kbrn2002, ADN, RN]

It's hard to say how many residents are too many. It depends on their acuity. If they're all medically stable without complicated procedures and minimal meds 50 or even a few more is ok as long as you have enough CNA's.

But whether that's ok for an inexperienced nurse is another matter. If there is good support from another night nurse when you are in too deep it'll be doable if you're confident and self sufficient. Only you can decide if this is something you're prepared to try

[caliotter3]

I was the only licensed nurse at night in a facility with 52 residents. I took that position after one year working in a 165 bed facility with 21 to 80 residents.