In nursing school, you will most likely not get much training in med pass and treatments. Therefore, most of your learning will be on the job when you start working. It will be important to get a mentor and learn as much as possible and as quickly as possible.
Trying to establish a routine will take time and be easier once you get experience. You will soon learn what questions to ask during your report. You will learn the tips and tricks to make yourself successful.
Learning who will be leaving for appointments so that you can get them their medications before they go will help prevent the emergency run to the cart when transportation shows up.
When you first start, your day may feel overwhelming, but you will develop skills to get you through the day with time.
General Tips for working as a nursing in nursing home
- Have extra pens
- Get a clipboard to take notes
- Get a washable bag
- Bring drinks and snacks
- Always count your narcotics. Never trust that the count is correct, so make it happen.
- Check for medications needing refills as you do your narcotic count
- Keep cleaning supplies close to wipe things down.
- Get your med cart stocked with everything you need before you start. Drinks, OTC meds, etc.
Time management
All nurses need to create their routines when working the floor. Try to create systems that will make you more efficient during your shift. There may be hiccups and glitches that throw your shift off balance. Don’t let them ruin your entire shift. Take care of the problem, then get back on track.
Divide your shift into specific tasks that need to be done. Whenever possible, group tasks together. Check blood sugars, give meds and perform quick treatment orders when with the patient. Try to do everything at one time while in the room, so you don’t have to keep coming back.
Sometimes you will not have time to take a break to eat a meal. You are bringing snacks that are easy to carry in your pocket. Nuts, protein bars, cut up vegetables, then I’ll provide a quick energy boost to get you through your shift see.
More important than eating is staying hydrated throughout your shift. Have a large water bottle ready to go and keep it full. When you fill your patient’s water, bring your water bottle to keep it full. If you’re looking for a great water bottle we recommend yeti brands. They may not be the cheapest but they are the best at keeping your water cold. YETI Rambler 20 oz Tumbler, Stainless Steel, Vacuum Insulated with MagSlider Lid, Seafoam
Take Notes
Write down notes as you round on your patients. You may forget key information by the time you can chart on your residents. Use breaks in medication pass to chart on patients. It is very challenging to remember the details after a long busy day. If you use any downtime to chart, you will have less charting to complete at the end of the shift.
Respect your staff
Treating other staff members with respect usually will result in them treating you with the same respect. When times get tough, aides that you have treated well in the past will usually step up and help you when you need it.
If you have a CNA struggling to provide care for the residents and have some downtime, take a few minutes to help them.
It will be hard not to take it out on the other staff when you’re having a hard day. Work with them, and don’t be afraid to say thank you.
Hold other staff members accountable for their actions.
The best way to do this is to lead by example. Try to arrive early, so you have time to review charts and assignments. Others will notice if you’re an early bird.
Sometimes you will run into situations where your staff is not working. You will see them talking on the phone, heading in certain rooms, or just not doing the assigned activities.
It may be challenging, but you need to hold them accountable for their actions.
Suppose they are not doing their job, which puts more responsibilities on your shoulders. Plus, the other CNAs may grow resentful. They have to pick up the other person slack.
Make sure to voice the expectations of your staff at the beginning of the shift and take charge. However, make sure to be very thankful to the staff members. Do a good job and assist you during your shift.
Ask lots of questions.
What are the first things you should do when you become a nurse in a nursing home? It would help if you tried to identify a mentor. Most experienced nurses will give advice when asked genuinely. Almost every nurse I’ve ever spoken with has some tip or trick up their sleeve to make their shift easier.
The flip side is don’t ask too many questions during the report unless something is missing. The quicker you get through the report with the answers you need, The quicker you can get started with your shift.
Listen to others
Don’t be afraid to ask questions from those that have been doing this for a long time. You’ll be amazed at how much you learn just by asking questions and, more importantly, listening to what they have to say. You have two ears, two eyes, and one mouth. Therefore you should be doing twice as much listening and observing.
Don’t be afraid to ask your CNAs for advice and to let them know to tell you if your patients are not doing well.
Take good notes when you are getting report. Then spend a few minutes seeing who had bowel movements, due for lab work, wound treatments, and more. Try to prioritize your most important activities, so they get completed.
You can’t always get everything done.
You will need to learn to prioritize what is most important to get through your day. Just like you were taught in nursing school, try to identify the ABCs of nursing:
1. Airway
2. Breathing
3. Circulation.
After you do that, it’s all about making sure people get what they need to survive. Make sure your residents are getting their medications. Then you can start to prioritize what is most important, wound treatments, blood sugar checks, vital signs, or all of the above.
Most days, you should get through most of the duties that are required of you. However, on some shifts or days, you won’t be able to get to everything. Working in a nursing home as a 24-hour seven-day-a-week position. This means you may have to delegate some responsibilities to the oncoming nurse.
Make sure that whatever you’re not able to get done in time is put in the 24-hour report so that the next shift can get to it in a timely fashion.
If possible, get your blood pressures and blood sugars done first to administer the diabetic and hypertensive medications. Many of these meds will need to be administered after checking vitals.
Come up with a system for pulling meds. Maybe start with narcotics so you can sign out, then pull OTC meds, then regular meds, and then administer. At this point, ask patients if they need any PRN medications with the following medication pass.
Pay attention to the finer details.
Make sure you get a good report from the previous shift nurse. If they don’t answer the questions, make sure you ask the right ones. Try to figure out how your residents are doing and what has not been done in a prior shift.
Try to learn what your residents like and don’t like. You can improve the speed and efficiency of your med pass. Identify who your blood sugar checks are ahead of time so that when you’re doing your med pass, you can combine your activities.
If you’re working on a skilled unit, sometimes getting the pdpm sheet to use as your guide can lead to improved trip documentation. Make notes while you’re passing your medications on the sheet so that your documentation matches your day.
When you are in a hurry, you run the risk of making a medication error. We all want to finish our shift along with the assigned tasks, but not at the expense of patient harm. You need to pay attention to the finer details to avoid these errors.e
Avoid medication errors by following the rule of the “five rights”:
- The right patient
- The right drug
- The right dose
- The right route
- The right time.
By maintaining these rights for the patients, you lessen your chances of making an error.
- Check the name on the medication and order.
- Use two identifiers of the patient before administration
- Make sure the medication you’re about to give is appropriate for the patient. If you don’t know, then look the medicine up.
- Make sure they can swallow pills if giving the med by mouth, don’t assume.
- Double check the timing of when the medication is due before giving it.
- Check to see if the medication worked on the patient.
- Be sure to document your monitoring of the patient and any other nursing interventions.
- Take enough time to do the above, and don’t rush.
When you are in a hurry, you don’t want to cut corners to save time. Make sure you lock your cart when unattended. Position your cart in front of the door when in a room. Make sure there are no medications on top of the cart that another resident could take.
Not all your patients will require a lot of your time. Some patients don’t need many medications and can be cleared off your list quickly.
Avoid Interruptions when possible.
Learn to set boundaries with staff, families, and patients that interrupt you when completing your medication pass. Give them a quick education that you need to stay focused to avoid medication errors. Be sure to let families know their concerns will be addressed once your med pass is complete.
Know your residents
Get to know your residents/patients if you are consistently on the same unit. The better you learn their habits or at least who they are, your med and treatments will be easier. Try to take care of patients as they pass the cart on their way to activities. This saves you time having to hunt the patient down later.
When the patients know and trust you, they are much less likely to refuse their meds or question all their prescribed medications. When you explain the medicines, they are taking. If they know and trust you, it should reduce the time spent with education.
Stay healthy!
Nursing is a challenging career and even harder when you’re not in good physical and mental health. Get yourself some comfortable shoes and compression stockings. If you would like some recommendations, you can check out our resource page for links to great shoes and stockings.
Make healthy food choices and take time in your life to exercise. You will never regret working out either by lifting weights or performing cardio.
Spend time with family and use your vacation.
Things improve with time.
When you first start nursing, everything takes forever to complete. However, I promise that with time you will become more efficient with your day. You will learn how to manage patients and their families.
Your ways of talking to families will lessen the angst of calling families with updates. You will also learn the medications you are giving and know what to look for when giving. All things nursing become easier with experience.
Conclusion
Congratulations on learning some tips on a more efficient and safe medication pass in the nursing home. You will spend many hours working, therefore knowing how to be more efficient will allow you to spend time doing what you enjoy. Now you can spend time making friends with your residents and staff and develop the bonds that will last a lifetime.
Things can get crazy in a minute, and you can start to feel overwhelmed. Just take a minute to breathe and prioritize what is most important, and you will get through your shift.
Resources:
F.Federico. 2021. The Five Rights of Medication Administration
http://www.ihi.org/resources/Pages/ImprovementStories/FiveRightsofMedicationAdministration.aspx Retrieved September 15, 2021
L.Bonsall. 8 rights of medication administration. 2011.
https://www.nursingcenter.com/ncblog/may-2011/8-rights-of-medication-administration Retrieved September 15, 2021
