My team has 21 beds. I keep my own clipboard which I use like the now-defunct kardex so that I am up to date on orders/condition changes/etc. I check as I go and write notes to myself on this and sign out/off everything on the MAR/TAR as I do it. Most assessment can be done while interacting with patients, but one needs to be present in the moment with them and acctually pay attention to what they say and do and how they present. The number ONE problem with time is actually the "help" I have.... aides on cell phones, hiding out in rooms, gone off the unit, refusing assignments,resenting being asked to do anything,insisting they are :grown: and can't be directed to do other than what they want to do at that moment. I end up having to empty dirty trashcans, reposition people, etc,etc while my aides are sitting around "waiting for meal carts to come up" ordering food eating or just generally hanging out. Sadly,more gets done when there is understaffing that fully staffed because then its celebration time. Management is blind to it, throw out write-ups,refuse to have a proper orientation. The administer advised me that the best way I could help was to "stop bitching". As for the "real" work? It does get faster as you go along, get to know people and how they like to be cared for. The difficulty does indeed come from management and corporate consultants. At least that's where I work. I hope that isn't how it is everywhere. But after about 10 years of being banished to LTC from the hospitals, I'm afraid this place isn't much of an exception.