Oh God. Two hours? How rude. Here's what I'd do, but I've only ever worked at one facility so I don't know how much it would vary.
1) CHEAT SHEET Print out a census of every person you will be caring for. Have the orienter/ offgoing nurse mark every person who has..
-Insulin and Accuchecks
-Peg tubes/ feeding tubes/ IV medication
-Disruptive behaviors, or little rituals that will throw grandma completely off her rocker if disturbed. (ie: I get my pills one at a time with fruit punch or I go socking staff in the kidneys for the rest of the shift)
-Fill your cart. Ask the offgoing nurse to help you make sure all of the supplies you'll need are there. Serious time saver.
-Don't stand around gossiping and giggling with everyone at the desk. I see co-workers doing this, they end up two hours behind, and then they gripe and complain when management cracks down on OT.
2) CHECK LABS We do our own labs here. Note any abnormals and call them in. I do this right off the bat because I usually get all of the PT/INRs on my shift
3) ACCUCHECKS AND INSULIN
Our check times are scheduled like 30 minutes before the medpass. I do them first, some nurses do it with the medpass. I'd recommend doing it before you start meds.
4) MED PASS #1
Start at the beginning, and work your way down. I can't stand a group of people pawing at my cart, and demanding to be next. Nope. I start at the beginning of the book and work my way through. Much reduced risk of med error IMO. IT'S GOING TO TAKE YOU WAY TOO LONG THE FIRST TIME. Don't panic. It takes everyone forever when they first start. You are throwing out meds to 30 people at an average of 10 pills a pop, and you only have a couple of hours to do it.
5) Chart/ Treatments
How did your first medpass go? Did you finish more than an hour before time for the next medpass? Great! Sit down and chart. The CNAs can help you out with how much Ms So-and-So ate, or anything strange that came up. If you have treatments, you can also do them here. Don't go alone, ask a CNA to give you a hand.
6) MED PASS #2
If your facility is like mine, you'll have two medpasses, and this one is not terrible. Still, I'd stay start it an hour before the scheduled times. It's still legal, and it will make sure you don't run over.
7) Finish it up
Finish charting, finish treatments, hit your cart with a bleach wipe and get out of there.
I've been LTC for about a year and a half, and very rarely stay late. I have thirty residents.