What is a typical day working in a nursing home?

Pangea Reunited, ASN, RN · Apr 28, 2016

How many friends do you have that "barely passed nursing school and passed NCLEX on their 5th try"? You make it sound like a lot.

Pat_Pat RN · Apr 28, 2016

Hit the floor running, give meds none stop, do treatments (change dressings, wipe skin prep on heels....), chart on a couple of people, give meds none stop, pick someone up out of the floor, call a gripey doctor, give report to the next shift, go home and crash. Get up and do it all over again the next day. It will make you old fast and likely make you hate your job and nursing in general. YMMV.

middleagednurse · Apr 28, 2016

You said it Pat_Pat. And throw in narcotic counts, glucose monitoring, vital signs, insulins, tube feedings, new orders, a new admission, family mbrs throwing tantrums, staff meetings, patients crashing on you, the list goes on and on. But it can be interesting also.

Mscoleman78 · Apr 30, 2016

Exactly, what you said Pat_Pat:up:!!!! I'm a New nurse as well, I'm a month in and I understand the concern, but it's nothing to it, but to do it!!!!

RNBearColumbus, BSN · Apr 30, 2016

OK. I've been a SNF/LTC nurse for 11 years, so let me try and give an actual answer to your question OP:

As a nurse in a SNF/LTC facility you will be responsible for a larger group of patients than you would be in a hospital setting. For example, I have 33 patients on the long term care unit I work on.

Now, I can already hear you saying, 'But that's impossible!" But it isn't really.

Morning starts with the AM med pass. That usually takes me from 7:30AM until about 10AM or so, depending on if I've had any interruptions. (On a really good day, I can finish at 9:30AM)*

After med pass, I have time to chart and return any phone calls that come in during med pass. (The staff at our facility takes messages for the nurses between 7AM and 10AM so we can concentrate on passing meds.)

2nd med pass starts at 11:30AM, and that includes lunch time accuchecks. Usually lasts until 12:15 or so. It's not a big med pass, usually just pain meds and TID/QID meds that don't fit into the set med pass times.

Then I get to go to lunch myself.

After lunch, I have about 2 hours to complete any charting I wasn't able to finish in the morning, and do any treatments the need done. I also use this time to review lab results and contact the doctors and nurse practitioners. Sometimes I do rounds with the CNP or MD, if they need me to.

Last med pass starts at 3:30PM, and also includes afternoon accuchecks. Takes me until about 5PM to finish that, and then the last 2 hours of my shift are for any follow up charting, phone calls to families about new orders / changes in condition and making sure that the STNAs have completed their charting. Sometimes I have time to help the aides in the dining room during dinner.

Here's a secret: In SNF / LTC, most of your patients aren't going to need anything from you other than their meds, and maybe a bandage change. Do it and move on. You are not expected to assess every single patient every single day. There will be a small number of patients that need more attention.

You will need to develop excellent time management skills in SNF/LTC. It will be hard at first, but once you have a routine down, you'll be OK. The key to being successful in SNF/LTC is working smarter, not harder.

Don't let a few negative people scare you away from SNF/LTC. It can be very rewarding.

*Our facility uses a BID Med Pass program. Meds are scheduled to be given in three standard blocks: 7:30AM to 11:30AM, 3:30PM to 5:00PM and 7:30PM to 11:30PM. For example, meds that are given once daily, are scheduled in the AM pass. HS meds are given in the night pass, TID and QUID meds are scheduled within those times if possible. This really helps to eliminate meds being due at every hour of the day.

lindseylpn · May 1, 2016

It's been many years since I've worked in a nursing home but, let me try and remember my schedule.

Nightshift- 10:45p-7:15a (25-30 patients on skilled wing, 40-55 patients on non-skilled wing)

Beginning of shift- get report, count narcs with 2nd shift. See who I had to chart on and make vitals sign sheet for CNAs. Check to see what treatments I had to do, what labs I needed to do, who I needed to get skin assessments on etc. Test the glucometer and make sure the crash cart was stocked (3rd shift duties).

Check the fax machine to see if there are any orders that 2nd shift didn't put in.

11:30ish- start 12a blood sugar checks and med pass, it was a short med pass, usually took around an hour or so.

Change any o2 or feeding tubing or bags due to be changed.

Routine peg flushes.

Look at vital signs CNAs got to see if anyone needs Tylenol etc. Do assessments on who I needed to chart on.

After med pass- take quick break.

1a-4a: do any treatments, draw any labs or get specimens, trach care, change Foleys, do skin assessments, give prns or attend to anything that pops up (falls, er visits etc.)

Chart

Sign off on CNA charting.

4a-take lunch or quick break if possible (we usually just ate while we charted)

4:30a-get very ready for med pass. Stock cart with med cups, juice, Apple sauce, water etc.

4:45ish/5a-7a: med pass, blood sugar checks, insulin injections, tube feedings and peg flushes. Run back to nurses station to answer the phone if family called or take call ins, pull out the phone book and try to find coverage for call ins (will totally ruin your morning), attend to anything that pops up during med pass (this is when your falls, prn requests mostly happen as people are waking up for the day). Finish med pass and take out the trash and straighten up the med cart.

After med pass: 7a-7:15a give report and count narcs.

After shift: finish up on anything I didn't get finished, charting, incident reports, calling family etc.

I usually left between 7:30-8:30am.

metallaces · May 4, 2016

I'm still in school and work as a pcw in a nursing home. I work 12 hour nights almost exclusively. Obviously your responsibilities will be different than mine but a typical night for me:

1850 - arrive on floor to get report. i usually come early so i can pee after my walk to work and sit for a few minutes

1910 - night lunch. we hand out snacks and drinks to the residents

2000 - get the majority of residents into their pajamas, incontinence systems, and into bed. This is very time consuming as we're also answering all of the call bells. I have yet to see an LPN or RN answer a call bell where i work.

2200 - review everyone's toileting and turning schedules for the night and plan accordingly. have a light snack if we can

2300 - get the "later" residents ready and into bed

0000 - hourly safety checks start at this point. this is where the night starts to wind down and we just answer call bells

0200 - wash and disinfect the wheelchairs of the residents who will be getting a bath or shower during the day shift

0300 - stock all the rooms

0430 - start morning rounds of peri care and changing incontinence systems

0530 - charting and flow sheets

Then it's pretty much answering call bells until day shirt arrives. We're also giving bedpans, turning people, recording catheter output, etc, as needed throughout the night.

I think that's pretty much it!

NutmeggeRN, BSN · May 4, 2016

I usually do eves in LTC

Get report, count narcs, review MAR and note and CBGs or treatments, note who needs a TEMP or VS, check bath schedule (they get a full set of VS and a nursing note), check to see if there are any changes in orders, we keep a copy of the new orders clipped for review, check updates on transfers or dietary changes. I personally round on all my patients so I can say for sure they were alive when I started!

Then start the 1600 med pass, I try to do any dressings or treatments at this point if possible, help w dinner when possible, eat

start evening and HS meds, finish charting, double check the MAR to make sure everything was given, get report from the LNA, give report to incoming and then count narcs. Then I check my pockets for anything I should not be bringing home, pager, cellphone, call bell resetters etc

Punch out and go HOME.

littlespitfire · May 5, 2016

SNF rehab nurse on midnight shift here... It really depends on how your staffing looks. Our day shift rehab unit by itself has 4 nurses, 6 CNAs, a treatment nurse, 1 or 2 admission and discharge nurse(s), 3 MDS nurses, clinical coordinator, assistant cc, nurse assistant who is a cna with extra training... Usually our CNAs in nursing school. They do accused checks, manual vitals, change out O2 tubing and neb equipment, stock carts, help the floor CNAs, and a full rehab dept of pt/ot/speech and our in house np. We have 60 beds. Their days get pretty insane, with doctors, new orders, care rounds meds and Medicare charting. Our whole unit is skilled so everyone has full head to toe documentation daily. Nights we are a skeleton crew... 3 nurses 3 aides a nurse assistant we share with the building... We have about250 beds total and at night have max 7 nurses in house, one being the building super. Let's just say we are really efficient at running our codes now. Anyway, at night my schedule usually goes like this:

1900- report and count, takes an hour.

2000- start med pas... Put in vitals the CNAs got and recheck manually any that are off.

2130- accuchecks and insulin a at hs.

2200- last tid med pass. Usually cardiac meds and abt/iv meds.

2230-0000- process orders that didn't get done on days and double note orders that were already done. That's our rehab policy, not like that On long term side. Glance over late labs if they're in yet, we get labs faxed bid except stats. Page on anything concerning. Check if any creatinine clearance forms came over with med changes and new abt from pharmacy.

0000-midnight med pass. Qid meds, ivabt and cardiacs usually again.

0030-really dig in to orders, processing labs (our docs like last values written on them for reference, along with any meds that could possibly affect values that they're on, or if they're not on anything like a low hgb and no iron, or vit levels drawn but no ordered supplements etc... Check ua c+s results and decide if docs need to be paged, make sure everything's been faxed to docs offices for morning) help aides toilet And sprint for alarms, snack on something and pee. This keeps us busy along with reading up on pt history, dx on medline, checking drug books, looking over labs and X-rays and charting on abt and by exception. Pass out prns when people start waking up and asking for them. We're usually taking down our tube feed equipment once it runs out at this time to hang new sets, checking dates on iv tubing and line dressings. Med shipment comes around midnight so that gets signed in and put int he right places. We check supplies for day shift and raid the stock room.

0500- am meds pass starts.

0630- start accuchecks for days if the NA isn't available.

0700- days comes in and eats their breakfasts in front of us and does report.

0800-usually still ther, finishing crap up. We have q6 straight caths, a few pvr bladder scan patients, and someone usually goes to hell at some point though the night, and gets shipped to hospital. I run back to the desk to clicks out theostomy appliance I changed because it magically fell off all by itself, the dressings I fixed or re did because they got covered in bm, or urine...

0830- I clock out on a normal day. If it's really bad or someone crashes right at the start of days, we stay to help ship.

i work with the most kick ass team... We are like family. It's crazy, we laugh, we cry and we have a great time no matter how ****** it gets. Our night shift rounding docs make a huge difference too, were all a slap happy team who can get **** done and make it fun.

Now with it all written out, I sound busy lol

downsouthlaff, LPN · May 6, 2016

I'm in LPN in LTC. I work as the night nurse at a 100 bed facility. There's 2 night nurses for roughly 80 residents and we work 7pm-7am 12 hour rotations. The shift begins with getting report from the day nurse around 6:30pm. Then I stock my med cart with OTCs, liquids such as Mylanta,Protein supplements, ensure, MOM etc. then I log onto the EMAR and begin the HS med pass around 7pm. Give a lot of sleep aids such as Trazadone, restorill, some cholesterol meds such as Lipitor. Come back from that med pass around 9pm.

From there I will complete my MAR. Check with the unit clerk for any important calls, fax, labs, staffing issues. Then I will begin doing all my nurses notes for the night. The ones on skilled patients, periodic charting, ABX etc.

From there I will do the CBG QA just enduring the glucose machines are functioning properly. Then I will change the bags and syringes on the PEG tube residents who receive enteral feelings.

From here I do the QA on the medication cart. Must pull stickers to reorder blister packs of medication. Must make sure no meds, eye drops or Insulins are expiring.

I then return to the station and and complete chart checks and new order checks. After this I begin the small am med pass Wich usually consist of PPIs and antacids, synthroid, and a select few TID or QID eye drops or meds and long acting Insulins. Return from med pass clean cart and get ready to give the day nurse report. Depending on what happened that night may have to stay over an hour or hour and a half give or take.

gardenpartyy · May 20, 2016

It really depends on the facility you work at and the shift you're on. Some are less staffed than others and some require more of the nursing staff than others.

You pretty much will get report, count your narcotics, start your first med pass, get interrupted 100 times by residents, other staff, families, etc.., chart, MAYBE get a lunch, next med pass, get interrupted some more, finish charting, make sure CNA's charted, give report, go home.