SNF daily routine for night shift?

[Tanny22, BSN]

I am a fairly new nurse. I am a RN with 3 years of experience on a surgical trauma unit at a level 1 trauma hospital and 1 year of experience in an outpatient infusion clinic. I am picking up a few per diem nursing shifts at a SNF and for some reason I am terrified! I have never worked at a SNF before and never had any Clinical’s at a SNF so I really have no idea what to expect. I will get a brief orientation 30 minutes before my shift. It is a 35 bed unit and it will be me the only RN plus 3 CNAs. Can anyone tell me in detail what exactly their routine is on night shift for a SNF?  Also I saw that many people say they create schedules for the CNAs. What does that mean? I’m used to delegating tasks to CNAs when needed but do I actually write out a schedule for them?  Any advice and tips is much appreciated. Thank you all in advance! ?

[lilblue, LVN]

I worked in a nursing home as a new grad and I'm still a fairly new nurse so I don't know if an SNF is the same thing as a nursing home but I did work nights there so this is what I remember doing (although I did block out a lot of memories of 2020 for obvious reasons):

1800- receive report, grab a cordless phone because there was no receptionist on nights or weekends, do narcotics count with outgoing nurse and start med pass after going down the hall first to briefly check on everyone. I had 45 residents although not all of them needed meds or treatments. I did have 9 g-tubes and 3 trachs though so they took up most of my night. I shared 3 CNAs with another nurse who had about 24 residents on his side of the hall. I would answer the phone in between residents when I could, usually family members asking how the resident had been that day. If I had time I would wheel residents back to their room when they were still allowed out of their rooms for dinner but later they all had to stay in their rooms all day.

2200- Start the next med pass which was much smaller and was mostly the last neb treatments or an insulin and one g-tube bolus feed. Usually around then the phone didn't ring as much or the other nurse had more down time and could answer it.

2300-- If anyone needed their Foley changed, I'd do it after the second med pass. I'd try to do some of the TARS (I've forgotten what that stands for but it was time consuming and involved a lot of clicking).

0000-- About 3 people had meds/treatments at this point, it might have been all the trach pts needing nebs, I don't remember but it took very little time.

0030-- 8 g-tubes needed their milks and pump tubing changed. This took a bit of time because I would lay out all the different milks, need to label each formula bottle with pt info and then the pump tubing also needed to be labeled. Some residents had their formula in cans, so these had to be poured into bags that attached to the pumps. While there I would also change the g-tube split gauze and again label it with my initials, the date and time and some also needed zinc or A+D cream.

Every 3 nights at my nursing home was "neb night" which means they needed new tubing and masks for their nebulizers (for those that had one whether PRN or daily). Anyone receiving oxygen also needed a new mask, nasal cannula or trach collar mask and/or new "water" for the O2 condenser or air compressor. Those also had to be labeled with the time, date, my initials, the pt's initials and their room number.

0100-0400-- Documenting. I took my time and was pretty thorough but some nights if I didn't finish during this time I would stay after my shift like if there had been any emergencies or new admits or any of that that threw me off timewise. If I finished documenting early, I was reordering meds at this time (we could click to reorder with our software or if I needed to I would fax info to the pharmacy and if it was urgent, I would have to call the nights/weekends number.)

If I had downtime I'd do all my skin assessments for the week, if not I only did the assigned one I had for the night.

During this time the night CNAs would come to me and ask if I needed vitals on anyone (evening CNAs would refuse to do this) so I'd grab the list of residents and highlight anyone I didn't get to who I didn't see during med passes. If they were a new CNA and the vitals looked wonky I'd ask some follow up questions or I'd go take the vitals myself.

0500-- I'd go to central supply and bring back anything I or the other nurse needed or that we were running low on. Then I'd go to our unit's supply room and restock what was needed there and then restock my cart. That included med cups, water cups, little wooden stirrer things, sleeves for crushing meds, flushes if anyone had IVs, etc. Later into my working there a couple of people had early morning meds I needed to give but it didn't take long. Right before the end of shift I'd dump the old water from my pitcher and put fresh water and label the pitcher.

0600-- Give report to the day nurse and count narcotics with them and usually finish any documentation.

Sorry it's super long but that's what I remember doing. Of course this would vary if anyone fell or any emergency happened but you get the idea. Good luck!

[Tanny22, BSN]

Thank you so much for being so thorough!!