any tips to care 24 residents in LTC ?

[SoNan, BSN]

I got a job in an LTC/SNF, even though my main unit or I prefer subacute unit, but I was told I may float around in LTC as well.

So Friday (9/11) was my last day of orientation. The nurse who should orient me called out. And it is an LTC unit. I will care about 24 residents. I thought I will be fine because I just take vital signs, and pass meds. However, it is much hard than I thought!

First of all, I took temp and pulse ox on all my residents, and BS on some that required, it took me around 30 to 40mins to finish. Then I start to pull all the meds, some need to crushed, some don't, and some need BP, some do not, so I have to go to the pt get BP before pulling out some med. Then some people have fever, I need to report to the supervisor. some residents are not in the room, I need to go look for them, some resident asking what meds they are taking, and I have to explain. Sometimes the BP cuff does not work, or the BP is way too high or too low, I need to redo it. I am super behind the schedule. Finally, after I finished the 4-6pm meds, it is almost 8:30pm. 

Then I had some water, then went back to the laptop to do some document, and prepare for the 8 to 10pm meds. I guess my supervisor cannot suffer me being super later, so she helped me to pull the meds, and I pass those med to the pt, do BS, BP as needed. And she also helps me to set up IV, antibiotics infuse for the pt who has fever. 

Finally, we finished pass all the med around 10pm. I sit down to do all the documents. Then I found out, I miss some BP, so I went back to the Pt to get BP. Some people are on the nebulizer tx, I forgot to recheck them/stop the machine, so I need to go back to turn off the machine and reassess them. Then again, I found there are two pt need wound tx. So I went back to see if the pt still awake, one already sleeps, one still awake. So I did one of them. Then back to my laptop continue doing documentation.

Finally, I finished everything around 12:00 am (my shift end at 11:00 pm). 

I cannot believe I did not cry. I do not know if I can do LTC or not. 

[amoLucia]

Rule #1 - with time, things go faster! Remember this!

Even with all my years in LTC, incl supervisor, IC, SD, UM, all shifts, etc, if I got thrown a curve ball, it would knock ME off-kilter too. But I'd recover and by next shift, I'd be back to my reg smooth shift stuff.

Think, it's when the unexpected pops up that the sh*it hits the fan, like a fall, fire drill, multiple admissions, an expiration, a serious change in status of a pt you need to transfer out fast, a bottoming out diabetic, someone is missing, etc. (And I'm only touching the surface here!) That's the nature of our job - you prioritorize, do the regular stuff, and handle all the crazy stuff as it happens the best you can. Nsg is 365/24/7. Others are there to pick up the slack as you will do also in time.

Remember rule #1!! You REEEALLY will handle things better. It just doesn't seem that way now!

[SoNan, BSN]

On 9/13/2020 at 2:22 PM, amoLucia said:

Rule #1 - with time, things go faster! Remember this!

Even with all my years in LTC, incl supervisor, IC, SD, UM, all shifts, etc, if I got thrown a curve ball, it would knock ME off-kilter too. But I'd recover and by next shift, I'd be back to my reg smooth shift stuff.

Think, it's when the unexpected pops up that the sh*it hits the fan, like a fall, fire drill, multiple admissions, an expiration, a serious change in status of a pt you need to transfer out fast, a bottoming out diabetic, someone is missing, etc. (And I'm only touching the surface here!) That's the nature of our job - you prioritorize, do the regular stuff, and handle all the crazy stuff as it happens the best you can. Nsg is 365/24/7. Others are there to pick up the slack as you will do also in time.

Remember rule #1!! You REEEALLY will handle things better. It just doesn't seem that way now!

Thanks for your comfort.

Yesterday, I was totally working alone with 24 pt in LTC unit, except there is an other nurse also with other 24 pts. He helped me a little bit when I do not know how to set up the tube feeding machine. 

my shift is 3-11pm. I finish all the meds pass about 11:15pm. then I start to do all the documents, which I finally end around 12:30 am. I arrived home around 1:20am. Then the whole night I was dreaming about meds pass.

It is hard to pass meds when pt all on the beds sleep (after 9pm). I can wake up a few pts, and they will take their meds nicely, some pts semiconsciously take their meds. Some pts just don't wake up, or wake up very angry, or they wake up confused and only take half of the meds (crushed mixed in apple sauce) or just refuse to take any.

I feel so bad to wake them up and ask them to take the meds. 

 

[amoLucia]

You'll learn as you go along. And as you become more familiar with your residents' habits and their meds, some adjustments may be able to be made that will facilitate your med pass.

Remember to lean on your CNAs. They will provide you the BEST-EST info re pts' habits, likes & dislikes, general health/phys status. If they come to tell you something that's concerning them, take them SERIOUS. And FAST. Always thank them. Rule #2 - compliment in PUBLIC, critique in PRIVATE!

And I know you're not super ready for this, but also be aware of your bldg and environment. Doors that should be locked, toilets making odd noises, light bulbs flickering, funny odors, esp smoky kind. You want to be safe for yourself & your pts. I don't believe it's your job to do supervisor/safety rounds, just BE AWARE!

You've already experienced this problem, so Rule #3 - know your equip! Feeding pumps, IV pumps, IV box, crash cart esp SUCTION SET-UP!  I'm serious about this one; make the time each shift for a few minutes to go over equip until you're a pro and can see the equip in you sleep!  There was a recent post here about a newbie having trouble with setting up emergency suction, and the pt wound up being sent out. You need to become an expert with every whistle & bell & knob & tube. As a shift super, I used to drill my staff so they all became experts.

I know you asked specifically re 24 pts, but all these tips will make your care for those 24 pts safer & easier for them and you.