Rn: what's your typical daily routine

RN-APNstudent · Jun 9, 2015

That sounds like a very scary job... One that would put your license at risk. I would seek a position in an acute care or a better ran LTC facility ASAP!!!!

sroseo · Jun 9, 2015

That sounds like a very scary job... One that would put your license at risk. I would seek a position in an acute care or a better ran LTC facility ASAP!!!!

I work tomorrow, friday, and then the last week of the month and I'm done with that facility and I don't think I'll accept any more days from them but I know that nurses have too many pt's a lot of the time and I'd like to know how to give them ALL good care.

On a side note: my second day there they tried to have me train a GN. I went to the administrator laughing.

silverbat · Jun 23, 2015

first things first! Prioritize. First thing in the am would be glucose monitoring and insulin, then your AM med pass. OR, if it is early enough, maybe some treatments while the resident is still in bed. Then you gotta take as it comes, knowing you have meds at certain times and glucose monitoring and insulin again around 11 am and 5 pm. As well as your other treatments.

Be sure to chart as you go as much as possible, so you aren't leaving it till then end of your shift. Be aware that you are only human, and nursing is a 24/7/365 job. If you can't get to it and have to leave it for the next shift, apologize, tell them what needs done and move on. Don't make a habit of it and be gracious when the preceding shift leaves you something...unless it bcomes a habit..then you will need to adress this ASAP.

It does get easier the longer you do it!!!!!!!!!!!!!

organicnurse24 · Jun 24, 2015

I'm an RN on a rehab floor. We have approx 18 residents. There are usually 3 cnas, sometimes 4 if the acuity is high and I beg administration. I am in Massachusetts, we don't have med techs so I administer all meds.

Here is a run down of my typical day:

7:00 peek in on all my residents, then get report

7:45 take all my vitals so I know everyone is stable for now

8:00 try to get my AM meds out as quickly as possible (safely). I do some quick treatments (sure prep, g tube dsg) as I'm administering meds. The cnas know to call me before they get a resident up if he needs a treatment to his butt

9:30 finished with meds, do all remaining treatments

10:15 do paperwork/ follow up stuff-calling doctors, following up on consults, doing any assessments that are due

11:15 pass out 12:00 meds

12:30 lunch for residents. I do NOT administer insulin until the lunch truck is actually on the floor. You don't want to give insulin at 11:30 and then not have lunch come up until 12:45!

1:00 my lunch

1:30 pass out 2:00 meds

2:00 finish up paperwork and follow-up stuff. Do all notes and documentation

3:00 give report and run home before the 4:00 admission pulls up ;-)

organicnurse24 · Jun 24, 2015

If you have several residents that you know are very time-consuming, save them for last. That way you won't get you backed up. I usually save my g tubes and IVs for last during each med pass. As for cnas doing treatments, it depends on the aide. Most of my aides are fantastic and I know the barrier cream, nystatin, etc is getting applied. For the ones I don't know or don't trust, I always check with them or do it myself

JBMmom, MSN, NP · Jun 24, 2015

OP, I guess you've moved on by now, but I hope you know that not all LTC facilities are like that. I don't think I would have made it in the situation you describe. Just for feedback to your initial question, our facility has 30-40 residents to a unit, the skilled nursing and dementia units have a dedicated med nurse from 8am-1pm and 4pm-8pm. The long term units have only a charge nurse. There are the two med passes, treatments and routine charting on a regular basis. On an unlucky day there will be incident reports, lab results, residents being admitted or sent to ER, etc. You were definitely thrown in with way too much for a new nurse, and 4 days orientation is ridiculous. When I started I got 10 days, and now they give three weeks at my facility, which is great. I can't give a good time estimate because I'm the world's SLOWEST at med passes. The first pass usually took me 2 1/2 hours or so and the second was about an hour and a half with an hour and a half for treatments as well. You had asked about creams, etc. and the aides doing that. If I am signing off on a treatment, then I am responsible for knowing that it happened. I do have some fantastic aides that I know will do dimethicone/calmo/anitfungal/OTC creams etc. and I trust them to the point where I will sign even if I didn't lay eyes on it because I know they will alert me to any change in condition or issue. The logistics of seeing everyone and every thing within 8 hours just isn't possible. Anything that's prescribed to them (nystatin, rx creams, etc) I make sure to do myself. Good luck with your career! Hope your next facility is a ton better.

sroseo · Aug 5, 2015

Thank you for taking the time to respond :)

sroseo · Aug 5, 2015

I thought that replying on one would put it right under and not just a blanket reply. So, I will try again.

Thank you all for your responses.

When you said that it gets easier the longer you do it you were right! I worked as a waitress for 12 years before becoming a nurse and honestly, I knew everything there was to know about that job and had no questions on how to do something. There is still so much to learn and to know. I find myself taking "notes" at work for things I want to look up when I get home and for things that I need to do AT the facility I just ask a lot of questions. I work with people that have been there for so many years...like my med tech..hes been there for 14 years and when I have a question about who to call or what paperwork needs to be done he usually knows the answer.

Its amazing how much more comfortable I feel now even though its only been a short time since my original post. AND I have even trained 3 nurses since then and feel pretty comfortable doing it. I have noticed that a lot of people want to rush through treatments and I like being able to train them to tell them the certain "ticks" of some of my residents. I was told by a seasoned nurse who was new to the facility that she could tell I was still new because "old" nurses arent afraid to take shortcuts. I told her I am all about shortcuts as long as they dont interfere with patient care....It felt really nice later to stop her in her tracks when she thought she had drawn up 50 units of lantus but actually drew up 50 units of novalog and I mentioned that the not double checking the bottles was probably not a shortcut she wanted to continue taking.

If I start at another facility I would love to have more orientation, but this ONE time it was actually kind of good for me. It was like they threw me in the pond and said SWIM! I "proved" myself and I actually get compliments all the time from the administrator and the DON. I was offered the DON position at a sister facility already and when I declined I was offered the ADON position. I have only been a nurse for 6 months and feel that I am not ready for that. I also LOVE the hands on aspect of nursing but the paperwork aspect not so much and that is all the DON and ADON do!

Sorry this is so long but I wanted to give an update and again, thank you all for taking the time to respond and try to calm me...I can actually hear the panic in my post and it seems so silly now