Prioritizing in LTC, what is normal?

Specialties Geriatric


I've only oriented to my floor for about two days now, but I am scared to death. It is a subacute floor with a max of 22 pts per nurse, but Ive shadowed my nurse who has had about 13 pts both days and it already seems chaotic. She doesn't really have a rhyme or reason to her order of medications/treatments/assessments and whatnot. She just kind of runs around and periodically forgets/remembers things and then freaks out. Plus, she mentioned that sometimes she stays like 2 hours late to fill out paperwork.... Does anyone have any tips/tricks to caring for a huge patient load efficiently?

I've seen some pretty disturbing stuff in the facility too. Or at least... I think it's disturbing but it might me considered "normal" in LTC? The nurses don't use the sharps containers and just throw them in trash. They frequently run out of essential supplies in the whole building - today, they ran out of syringes to flush the g-tubes... so we used a luer lock syringe. The turnover rate is huge, in fact, I am one of three new grads who were all hired full time for the same shift. The majority of the nurses are miserable - and constantly complaining. The nurse I'm shadowing is actually interviewing for a new job... Are these issues considered to be the norm in LTC?

They don't use sharp bins? That's a massive issue you should address straight away!

They don't use sharp bins? That's a massive issue you should address straight away!

I couldn't even tell you where they're located on the floor. I've checked patient's rooms and the supplies room and the nurse I'm working with hasn't put any of her needles (insulin, and to check blood sugars) in a sharps bin. They're the retractable type - but they still belong in a sharps bin, right?

Specializes in LTC, home health, critical care, pulmonary nursing.

The lack of sharps containers and needed supplies is ridiculous.

As far as prioritizing, when I was in LTC, I probably looked like there was no rhyme or reason why I did things in the order I did. But when you have the same patients every day, you learn who your diabetics are, so you can give insulin at the right time rather than suddenly finding the order on the MAR an hour after lunch. You learn their habits and preferences, and that saves a LOT of time. I imagine being new you'll be a bit like a chicken with the head cut off for a bit, but once you have the unit's routine down and you know your residents, things go more smoothly, even if it doesn't look like it from the outside.

Specializes in LTC.

I would ask your DON about the sharps container. You want to get organized and get a routine down as soon as possible. It will be so much easier and once you get a good routine going, you wont be staying so late after your shift. Also what works for you, may not work for someone else. I can share my routine and then maybe you can tweak it for your style and your patients.

I just recently relocated and currently looking for a job, but my last job was in a LTC and I worked day shift (6am-230pm) on the sub acute/ rehab unit. I averaged about 26-30pts with a team of 3 CNAs.

The first thing I did in the morning after recieving report was check the calendar for appointments and/or doctor rounds and made sure the proper paper work was ready. (Sometimes the night nurse was too busy to complete the paperwork.)

Then, I would make sure the med cart was stocked and ready to go. I also made sure my partner and I had enough supplies in our coolers (juice, applesauce, puddings, water ect...)

Then, I would take all vitals that were scheduled for the day and those that needed to be checked prior to meds; start any breathing tx that were scheduled, and any blood sugars that needed to be done (most were done on the night shift except those who were with sliding scale). I would also check on any patient concerns that came across during report (ie..someone had a fall, SOB during the night...)

At the same time, if any of my AAOx3 patients were up and waiting for me at my med cart, I would go ahead and give them their 7am meds.

I would also try to change any dressings that needed to be done prior to the patient getting up for the day.

I would have all the above done by 0730am on a good day with no major problems and then start my major 8am med pass and on a good day complete around 1030am. Now I had my fair share of interruptions, patients fall, the phones are always terrible and assist the aides with their patients. Trust me, I have had days that were only takes one patient to throw the whole routine off. There was this one patient I had, I literally spent the first two hours of my shift on...she was very unstable and i was doing my best to get stable while at the same time trying to get her shipped off to the hospital...but the doc wanted to try everything to keep her with me first...

You will have days like that...lots of them ...but you have to remember two things: ALWAYS ASK FOR HELP and YOU ARE ONLY HUMAN!!

You also need a good cheat sheet. You can find some good templetes on this site or you can google them. I had on the top of mine the vitals that was needed, a space for bloodsugars, input/outputs, daily weights, and a space for my notes. A good cheat sheet saved my life. Trust me, once you get into a good routine, it wont seem so crazy. Good luck, hope this helped.

At the same time, if any of my AAOx3 patients were up and waiting for me at my med cart, I would go ahead and give them their 7am meds.

This is a huge issue where I work. Like certain ones know when you are about to "man" your cart. I would go ahead and give them their meds first. Then I would hear the same person yell "Percocet and Ativan" on the other end of my hallway. I would feel bad for those who were unable to yell, use their call light or even complain because most times they were last.

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