Trying to rearrange/prioritze my schedule each night

lifeisgood2012 · Aug 13, 2012

Yes. I will be anxious to see responses to this as well. I am a new LPN and keep trying to find new ways to get out on time too. In the 3 months I have worked there I have gotten out on time maybe 3 times - meaning - I have left after my shift nurse relieves me, gets report and we count narcs - which is still half an hour or less over. I hope I can figure out how to flag this - because I am seriously feeling inept as a new nurse. Good topic! Thanks for posting.

Sparrowhawk · Aug 13, 2012

How long do you take lunch? How many other breaks do you take? Doyou have a CMT? How big a facility is it?

jasorts · Aug 13, 2012

It's so sad that your facility is like that... Our hospital pays for overtime. I don't know what to say cause I've never had that experience in 5 yrs of nursing. I hope it gets better, otherwise go somewhere else where you'll love your job. I couldn't work in those conditions.

Have you asked your preceptors or manager about what THEY suggest you should do? How many patients do you have under you? Are you in the Midwest or East Coast? I know that unions and laws are SO different than here in the West Coast.

Hope you find your answer. I'd like to see what others post.

Nightnurse89 · Aug 13, 2012

I worked LTC for almost twenty years. Here was my general routine: Report and count with the 3-11 nurse. Then rounds which consisted of what I called "breathing checks". With rounds I took vitals and other assessments of residents that were "on report", meds or 12am meds or treatments. That usually kept me occupied until the 2am meds or gtube feedings. At that point, the med man would show up with the day's medication/equipment delivery. Lunch would be 3 or 330 (and I agree with you about lunch - only an axe that's been sharpened can cut wood). After lunch is the 4am assessments and meds. Sometime after this is charting until 5 or so when the 6 am med pass is started. Glucose checks are around 630 with insulin as needed. Then day shift comes in at 645am and it's time for report and count. That was the routine and you'll get into a rhythym that fits you. Never leave early without doing documentation, even under the threat of getting written up. I'd rather loose my job, than loose my license. Good luck!

sherdk · Aug 13, 2012

Hello all, New grad in LTC... each night after work I go home and try to re-arrange my schedule in an effort to complete all the things that need to be done in an 8 hour period. I feel like it's just not working, no matter how hard I try.
My facility does not like to pay overtime, so I feel pressured to leave on time, whether or not I document everything I completed on my shift. When I get to work each day, I'm literally busy every moment, and NOT taking lunch is not an option for me!! How you seasoned nurses in LTC get it all done in a mere 8 hours?

Hi

I do understand your problem. I have been a nurse for over 40 years and have worked in LTC for the last 5 with years of experience in acute care, and several as a nursing professor at at commuity college. I believe that the problem in completing your work on time particularly in LTC is the numerous distractions.

Just a few suggestions-:

write a list of what absolutley has to be done on that shift and what could wait until the next shift or your next shift.

delegate some of your tasks if possible

go to a quiet area to complete charts or documents or reorganize your list

make rounds so you are on top of the resident needs ahead of time so you dont have unexpected interruptions

get family involvement

try to work as a team if possible-- it sure beats trying to do everything by yourself and is less exhausting physically and emotionally!!!!

bbuerke · Aug 13, 2012

Don't be disheartened! Time management/prioritization is often one of the hardest things to adjust to in your first job as a nurse. Anyone will tell you it takes 6 months to a year before you finally get a consistent rhythm down and feel comfortable in your job. This can also be true when experienced nurses go to a new setting. Just keep your eyes and ears open, and listen/watch for those little gems that the other nurses use to manage their time. Take what works for you, and develop your own system that makes you comfortable. A good manager/supervisor knows that there is an adjustment period for new grads and will not expect you to finish everything on time, at least for the first several weeks/months after orientation. Someone who is not so understanding won't care, and will harass you about being overtime because of budget concerns.

I've been a nurse for 7 years and hit my stride at about 9 months where I was consistently getting out on time. Luckily I had an understanding manager. I work on the floor in an acute care setting, not LTC, but I would imagine many of the principles are the same. Some techniques that work for me:

1) Cluster activities. If you know your patient will need a tube feed and dressing change, gather all supplies and get it all done while you're in there. Sometimes this means putting off something for someone else, but you save time in the end.

2) Real time charting. I assess my patients while I pass meds and either document the assessment immediately (usually while I walk to the next room) on a computer on wheels or write it on the piece of paper I keep in my pocket to chart later. Sometimes this is necessary when computers are scarce or running slow.

3) Do safety rounds/regularly toilet my patients. You would be amazed how much this cuts down on call lights! When working night shift I make a point to toilet all my patients between 10pm-midnight and again between 3am-5am. This keeps them from trying to get up overnight/helps them sleep/keeps them from calling. It also keeps them from trying to get up to the bathroom when I'm in report at 7am, which is a huge help. I usually partner with the aides for this, and we split the work between us. - Also, we don't ask the patients to go to the bathroom, we tell them. "It's time to go now..." I know it's a bit paternalistic, but when you're on a schedule, sometimes you have to treat it like little kids on a long car ride...and there's no exit for 50 miles.

Don't know if any of this helps, but it's certainly worked for me over the years. Good luck to you both! You can do it!

FMF Corpsman, MSN, RN · Aug 13, 2012

3) - Also, we don't ask the patients to go to the bathroom, we tell them. "It's time to go now..." I know it's a bit paternalistic, but when you're on a schedule, sometimes you have to treat it like little kids on a long car ride...!

Young lady the first time you came into my room and told me to get up and go to the bathroom, you would end up with my foot firmly implanted in your ... you are free to utilize your own imagination as to where it might be implanted. I don't think they taught you in school that it was okay to treat your patients this way, in fact, I know they didn't. You have no more right to insist your patients get up and go to the bathroom on your schedule than they would to insist you give them their medication on theirs. It's just wrong. The patients are not there to be manipulated into your particular convenience. The call lights are there for the patients convenience, not to annoy the staff, but to alert the staff when one of the patients needs or desires something, and then should be responded to, in a timely basis. A well organized nurse or aide sees to their patients needs preemptively, insuring that most needs and comforts are met before the patient even request them, that way they aren't tied up with call lights most of the evening, but are freed up to do patient care. It is all up to organization. You don't need to get your patient to do your work if you are organized.

CapeCodMermaid, RN · Aug 13, 2012

FMF Corpsman...you said it before I could. They are NOT little kids going on a trip and most everything should be based on their needs not ours.

FMF Corpsman, MSN, RN · Aug 14, 2012

Exactly, if I came in and found out my family was routinely being ordered about by some Nurse, there would indeed be hell to pay. I take it her Administrators know nothing of these activities either, because I'm certain they wouldn't stand for it either. Any of you new Nurses, please, Do not follow this advise. Our patients deserve our care and respect and they are not in the Hospital to be ordered about as if they were children. I can only hope that Nurse BBUERKE's intentions were only to cut back on a busy schedule and perhaps limit the number of call lights they might have to answer during specific times. I don't understand why a nurse would be answering call lights while trying to give report in the first place, but perhaps that is facility policy, I don't know. At any rate, the staff, any Staff, be they Nurses, Doctors, Aides, Even Administrators, are there to be of service to the Patient, most certainly, not the other way around. If you don't want to be of service to patients, perhaps, you need to find another line of work.

RN1822 · Aug 14, 2012

I worked LTC for the last 9 years and the first year was the most difficult. It will get better. I agree that clustering activities is one of the keys. If you are on a medcart, overstock it as soon as you hit the floor with any bedside small treatment items you can do while you are giving your pt meds (skin prep, bacitracin, telfa, kling, NS bullets, medicated creams, etc....). It might not seem like a lot of time is saved that way but, you really can get all the priorities completed with a little planning and some support.

At the first of the shift, when you are giving your CNA's report, delegate what is appropriate to your support staff. You may also have to get comfortable with having a pt wait a few minutes for a CNA to assist them with ADL needs ( when this is reasonable). Remember that while you can certainly do what a CNA does, they can not do what you do. If you are spending a lot of time with ADl's you are going to have a hard time staying in compliance with a med pass. Are you able to identify what is slowing you down, is it the whole assignment or do things go smoothly until a certaion part of the shift?

Ask questions of the nurses who seem to be doing it successfully. I don't mean the nurse who seems to have a ton of down time and is alway on break or on the phone. That nurse is just skating by and probably signing treatments and assessments she has not completed. Find the nurse who is steadily busy but seems unruffled, the nurse who takes her lunch but is back on time and ready to go. Even if people don't have answers to your questions as to how they do it all, I think just asking the questions demonstrates that you are focusing on improving your performance and are eager to learn.

Good Luck and Hang in there it does get better!!

Isitpossible, LPN, LVN · Aug 14, 2012

thanks for the responses: when i arrive on shift, I count narcs/get report. then i walk to all rooms for quick check, next is looking over medications that need to be re-ordered... if low, fax orders to pharmacy..look over labs and contact physicians if needed.. by now its 4:30 - time for med pass and accucheks... by now its 5:15, get VS on all residents who are qs vitals... (honeslty never know where the CNAs most of the time, and toooo time consuming trying to hunt them down)... then its time do assessments on four patients that need to be documented daily...also need to check who needs Bowel protocol procedures.. oh gosh by now its 6pm... start trying to document the assessment... then i need to do skilled notes on a few of my patients...can not possibly document that fast...now its 6:30 and i need to take a lunch, they are adamant about nurses taking lunch... come back at 7pm and start 9pm med pass... finish med pass 9:30 - 9:45 depending on how long it takes to coax the resident to actually take them.... its now 9:45 and i have NOT completed one single treatment!! try to do treatments... it never seems to work for me...oh did i forget that i didnt document in the MARS/TAR yet, and circle and document who refused? did I have to run down to pxysis b/c some meds arent in the cart? oh... and i havent documented any changes in condition that require follow up every shift? its 11:00pm and time to turn over to oncoming nurse-- whats a new nurse to DO??? help........