- 1Aug 30, '11 by CrazyCatLadyRNSO I'm a new graduate and I'm all done with orientation but I feel like I still can't get a handle on how to start out my shift. Typically I get my pt assignment and make a quick round to say hello and update their communication board/ make sure they are all breathing and not in distress. From there I begin getting report from day shift (approx. 1910 at the latest and depending on if day shift is ready) then once that is done I do a quick run over the paper charts for any important orders and check the PAL (computerized charting component of powerchart) to make sure nothing was missed by day shift or no critical labs. After that, about 1945 I start my assessments with the most critical pts first. Here is my problem. By the time I finish assessing everyone and getting any immediate concerns/issues resolved it's almost 2100, then I have to go pull meds. typically each pt (5-7) has anywhere from 1-5 meds. at 2130 we have "huddle" and it seems to always cut me off half way in getting meds then I never seem to get them all out within that 1 hour window. It really stresses me out when I don't get my meds done on time, especially when it is HS BGL's and insulin too. I know some nurses stop after a couple pts and go pull meds then come back and assessmore, but it freaks me out not to have all my assess charted within that first hour. I have seen a couple pts "go bad" then and not have anything charted on them and it just doesn't look good, nor is it safe. What do you guys do? Maybe I'm totally missing something here? I seem to have the whole rest of the shift down pretty good, but the begining gives me anxiety! What's even worse is getting a new admit in that time frame!
- 0Sep 3, '11 by JRP1120, RNI'm currently precepting in my first RN job and what I've seen my preceptor do at times like you're describing is if she hasn't gotten all her assessments done and it's time for meds is she'll pull meds for those pts she still needs to assess (we report at bedside so she's already met patients and prioritized who should be assessed first from this). She'll go in to give meds and do her assessment at the same time. If it's particularly crazy for some reason, she will jot down the time she assessed her pts and then go back and chart once all 2100-2200 meds have been given (but, that rarely happens, she's been a nurse for 30+ yrs so she pretty much has her time management thing down pat!). It's been an honor learning from her!
- 0Sep 3, '11 by CorazonDeOroI had to learn real quick when I began orientation that charting can wait, and medications often cannot. You can chart an assessment later, but if you are giving medications late, it throws off med times, it can effect the patient (BP meds, insulin, antibiotics, etc), and you can get in trouble based on the hospital's policy. My preceptors are all for me charting if I have time right after my assessment, but I have found I can be a lot more productive if I wait until my meds are done to sit down and chart my assessments. As long as you jot down the important stuff right after. My routine in the morning is, make rounds and see all the patients (see who needs pain medications, check to make sure IV fluids are running, etc), pull meds and assess patient when I take the meds to the room, get through all my patient's new orders/treatments, and chart before and after lunch.
This was a hard thing for me to get used to because I felt that I had to chart that assessment immediately after I did it (because as an Extern I always did...its so easy when you don't have meds to pass!)
- 2Sep 5, '11 by turnforthenurseRNWe do bedside report at my hospital...and we have COW's so the day & night RN's are both reviewing the chart during report to make sure things aren't missed (but of course sometimes things still get missed...). Sometimes I'm not done getting report until 1945! It just depends on how the assignments are made...some days they are ready to go and other days the assignments aren't made until 1915...it can be really disorganized.
But anyway, I digress. I don't really like bedside reporting; however, the nice thing about it is that while I am in there I can already make a mental note on how my patient is doing and it helps me prioritize. Once I am finished getting report I jump on the computer and quickly review meds and make a list of what is due and when, then I go in and do my assessments, starting with the least stable patient first. If I'm running behind, I will go ahead and pull my meds and do my assessment and then give the meds, instead of having to do the assessment, run out and get the meds, go back in and administer them, etc. I chart my meds the moment I give them, but as far as assessments go, I usually don't get to chart that stuff until 2200-2300 (and by 2300 it's already time for another assessment). It just depends on the night, but I'm usually running around until then.
And I think new admits at shift change should be illegal
- 0Sep 6, '11 by CrazyCatLadyRNthanks for all the advice! I'm definitely trying to not be so crazy about charting everything right away. We have computers mounted to the walls in all of our pts rooms, so it does make things a little easier to chart at the time of assessment. And yes, I agree, new admits should be illegal at shift change. There is supposed to be a "no fly zone" for like an hour and a half, but it seems to never happen. It just isn't safe and those pts are always the one's I've seen that have a huge list of problems and/or wind up being sent to the CCU.
- 0Sep 12, '11 by turnforthenurseRNQuote from CrazyCatLadyRNyes, if I have something important to note, I will scribble it down and note the time...it makes charting it much easier, because sometimes you won't be able to chart until 4-5 hours later!thanks for all the advice! I'm definitely trying to not be so crazy about charting everything right away. We have computers mounted to the walls in all of our pts rooms, so it does make things a little easier to chart at the time of assessment. And yes, I agree, new admits should be illegal at shift change. There is supposed to be a "no fly zone" for like an hour and a half, but it seems to never happen. It just isn't safe and those pts are always the one's I've seen that have a huge list of problems and/or wind up being sent to the CCU.
and I agree it is NOT safe! One night our floor got slammed with 4 admissions all at the same time...it was already around 2100-2130 and I still haven't seen my patients yet! It's ridiculous.
- 0Sep 13, '11 by nursenick20You said it takes from 1945-2100 to do 5-7 assessments. Does that include the charting? When you go into the room to say hi to your patient at the beginning of the shift do you scan the room and do a quick check. You can ascertain what IVF are running, how much O2, if they are alert and oriented, if they are in any pain, and sometimes some psycho-social factors of the assessment. Then you have less to assess when you walk in there the 2nd time.
I used to assess my patients very quickly and thoroughly at the beginning of the shift and get it charted while I was doing the chart check/ organizing.
I hope this helps... It may not, I haven't worked M/S in a few months.
- 0Sep 19, '11 by LifeofanurseI'm definitely not an expert..in fact new grad LVN ...but we were taught by most nurses to do the quick "breathing check" and then pull labs before doing anything else.
How do ya'll feel that works in relation to reality of trying to assess fully, give morning meds and charting?