Allison RN

First of all, I don't think anyone who has ever worked in LTC would laugh at you. Most likely, they're nodding their heads thinking, Oh my gosh...I totally feel her pain! LTC today is vastly different than LTC 10 years ago (at least from my experience). I had no trouble doing everything expected of me and more when I started 13 years ago. When I quit three years ago, I felt like I was an awful nurse who did nothing but satisfy MCR and MCD documentation requirements while I did drive-by med passes on people I should have known much better than I did. That being said, here are some things I would do or check in to: 1. Laptop battery...have you notified mgmt of the issues? Maybe it needs a new battery or an additional one so you can change them out instead of recharging. That may save you a little bit of time. And a few new batteries are cheaper than OT. 2. Does the insulin have to be kept in the fridge? The hospital I work at allows us to store it in the rooms. It does last longer in the fridge, but if you just have it out during your med passes and keep it locked in the cart, I wouldn't think it would cause a problem. 3. Is there any way you can combine some of the things for one trip down the hallway? For instance, doing health shakes and glucose checks during one of your trips down the hall? 4. Health shakes: a. can your aides help distribute? b. Can you get a small bucket of ice and keep the shakes in it on the cart? We were able to do that at the facility I worked in and it really helped us out. 5. The 1100 insulin..is that one of your 1130 checks with coverage? If so, can you combine those? We are able to give meds 30 min before or after time due and still be in compliance. I'm assuming that's the same for you because I think it's a federal CMS thing. You could start at 1130 with that pt. 6. The pts that you have to take into shower room for sticks, shots, etc: if this is happening prior to mealtimes (as it did for me) can you speak to them or your aides and have the pts stay in their rooms until you get to them? I know it may not work for all of them, but most of my pts were completely fine with doing that. Lastly, don't be afraid to speak to your mgmt team. There are always exceptions, of course, but most will really try to help you. Maybe other nurses are having the same problems and they need to look at a different way to do things. And it's always in their best interest to keep their employees happy and productive. High turnover rates cost facilities a lot of money in advertisement, orientation periods, etc so it's always helpful to retain the employees you have. Not to mention the continuity of care for their residents. And if they can streamline the job in some way it cuts down on any OT someone may be getting staying over to complete their work. I hope some of this helped. If you can take nothing else from it, again, please know that you're situation is not unique and don't get discouraged. LTC is an incredibly hard job to do and it takes very special people. Good Luck!

I work on an IRF that averages 8 patients to 10 patients. My co-workers and I generally find it very difficult to get everything done that's expected of us. Obviously there are the usual things that are consistant from unit to unit: VS, meds, assessments, admissions, discharges, etc. In addition to those things we have unit specific documentation to complete: FIM scores, narrative shift summaries, updating pt treatment plans (in addition to medical care plans), making narrative notes daily re: morning stand-up meeting, weekly progress notes, etc. And, or course, we're getting patients up, bathed, and dressed. We're to get the patients to the dining room for three meals a day, we do BP checks during tilt table exercise, occasional wheelchair follows when PT is ambulating a pt; take off orders and enter them into the computer when there's no secretary, manage medical issues, talk to doctors....etc, etc, etc. I'm sure all of you do these exact same things. My question is: How do you get it all done? We work through breaks, rarely if ever get lunches, and still leave past the end of our shift. We feel as if we have very little interaction with our patients and we're frustrated by all the repetitive documentation that takes up that time. I feel as if we are staffed fairly well--typically 2 nurses, usually RNs, and an aide for 8 to 10 patients--but we can't seem to be the nurses we want to be to our patients. Obviously it's easier with a lower census or patients with fewer medical issues, but that doesn't happen often. We get no help from our manager when we're swamped and only have a secretary for part of the day so we answer the phones, do the orders, etc. And we aren't a group of people who have time management issues so we're not sure what to do. How involved are your managers? How much, if any, therapy involvement is there in getting pts to and from the dining room? Does night shift get anyone up or does day shift do all the patients therapy doesn't get up? Any and all help is greatly appreciated!!!!!