Time management and delegation

[pinkiepieRN]

I'm new to LTC and have been out of practice for a year and a half. I'm doing well and coming along with my meds, but something happens in the middle to end of my med pass and I get side-tracked, dragging with my last 2 rooms (quad occupancy rooms - yay!). Now my last 2 rooms are almost all crushed meds, so I find myself doing my rehab/easier patients first. Is that a bad idea for me?

Usually it's not a simple request, like a straw or something. I guess I get sucked into feeling like every patients' whim is a priority for me. I know one patient in particular who is a time sucker and I'm going to work on streamlining her, but I feel bad telling a patient to wait when the CNAs are all in the middle of doing their cares. In the 3 weeks I've been on orientation, I don't think I've ever felt like I was going to be able to administering all of my meds within the +/- 1 hour time frame.

How do you deal with time management during your shift? I'm 7-3 and my patient load right now is 16-17 patients. I work with another nurse on my unit who has the same patient load and 2-3 CNAs who do feeding, bathing, etc. I realize that this is a pretty decent assignment and staffing, right? I know time management will come with more time but I'm super scared of staying over past my shift and getting in the way of 3-11. I find myself getting anxious and wanting to rush even though I know I have to go through the MAR and do my 5/6/7 rights. Do I just have unrealistic expectations of myself?

[chrisrn24]

I work overnights so its different but eventually to will get on a good routine. I learned who should get meds when. For example, if someone is very sleepy and has trouble with meds I wait until they push their call light for something else and then go in with the pill.

You'll get a good routine down. My suggestion is to get your meds and urgent things first and put your charting off til the end of the shift so 3-11 can set off with the med cart and you don't need it anymore.

[pinkiepieRN]

I work overnights so its different but eventually to will get on a good routine. I learned who should get meds when. For example, if someone is very sleepy and has trouble with meds I wait until they push their call light for something else and then go in with the pill.

You'll get a good routine down. My suggestion is to get your meds and urgent things first and put your charting off til the end of the shift so 3-11 can set off with the med cart and you don't need it anymore.

Wow...for some reason this didn't dawn on me. I find the charting really easy anyway (yay electronic medical records!). If only the medications were computerized too! I also hate that our facility doesn't use military time, so sometimes if I'm reading fast, I find myself with a 9P med instead of a 9A med. Thankfully I re-read my MAR but it's annoying!

[chrisrn24]

Wow...for some reason this didn't dawn on me. I find the charting really easy anyway (yay electronic medical records!). If only the medications were computerized too! I also hate that our facility doesn't use military time, so sometimes if I'm reading fast, I find myself with a 9P med instead of a 9A med. Thankfully I re-read my MAR but it's annoying!

We have EMAR too which is awesome. I find the EMR easy to write in so charting isn't as bad as it was with paper charts.

[bluegeegoo2, LPN]

If a resident asks for something that you can handle quickly, like grabbing a blanket or giving them a drink, that's fine. But if a resident needs something more involved or time consuming, it's perfectly OK to say, "I have several people who I still need to give their meds to, but I'll let (CNA) know that you need them." Otherwise, you'll be working the floor as a CNA and trying to get your med passes done. Very difficult if not impossible to do. And there are some residents who will "use" you for all they can. "Get this, do that, I need this/that/the other, and one more thing before you go"...In other words, they'll run you ragged. You must draw the line and delegate.

[Pat2012]

I agree with bluegeegoo. You need to set boundaries, or you will be doing a lot of extra work that your CNAs should and can do. If it's not something that will take less than a minute or so to do, I will say that I can't get that for them right now, but I will put their call light on, so the CNA is aware that you need something.

Also, have you tried crushing those meds ahead of time? Or doing that hard room first? I vary it on my hall, I have 24 residents. Sometimes doing someone who requires more time, is better for me, because then I can whip through the other quicker med passes. Depends on the day. I work 3-11.