I'm not "experienced" - I've only been working for about 2 years so I'd probably be considered more "junior" than anything ^^; However, I keep a basic structure to my shifts. As you said, there are always interruptions and things that change, so I try not to lay down a detailed and strict plan, because that's just asking to get thrown off completely!
0715-0730: A little before my shift starts, I come in, see which patients I have, and then get report. I note down certain things I must do with my patients, such as how often I need to take vital signs, any dressings that need to be done, see if they have a radiation or dialysis appointment today, etc.
0730-0800: I pop in and see each of my patients, taking vitals for whom they're due and doing any relevant assessments (i.e. if they require oxygen, I'll listen to their lungs; if report said they are constipated, I'll do an abdominal assessment; if they have dressings, I'll look at the dressings and assess CSM if applicable). Also, breakfast trays arrive around 0800, so I check blood sugars for those who need it.
0800-0900: Morning medication pass.
0900-1130: Look up any lab work. Note anything abnormal and take appropriate action. With my floor looking after a lot of oncology patients, sometimes I have to do blood or platelet transfusions based on this lab work, so I prepare for that if I have to. During this time, I try to get at least one bath done - on average, I'd say I have about 1 or 2 baths to do in a day (either the others are independent or require just a set up/min. assistance, or they are covered by a PSW). However, during this time, the doctors are also on the floor, writing orders that need to be processed, some patients require help with toileting, I have to send patients for tests and treatments, etc. If I need to transfuse blood products, I get those ordered as soon as possible.
1130-1230: More vitals and blood sugars to be checked as needed. More medications to be passed.
1230-1630: This is my "free" zone, where I do whatever I haven't gotten done yet, keeping in mind that some patients have 1400 meds. I bathe anyone who hasn't been bathed yet, I get my dressings done, I do my charting, check my incontinent patients, etc. Similar to the 0900-1130 timeframe, I continue to check and process doctor's orders, send patients for tests/treatments, put out any "fires", etc. If I have blood products, I tend to have these started by now, which means doing vitals at least every hour on these patients.
1630-1730: More mealtime stuff, like blood sugars and dinner time meds.
1730-1900: Check any vitals that are due, change incontinent patients, empty Foleys, clear PCA pumps, etc. - all the end-of-shift things that need to be done.
1900-1930: Give report to night shift. Re-check my patients one last time to make sure everything is ok. Then, say goodbye, see ya later!
Basically, I note things that are time-based. For example, blood sugars, vitals, and medications need to be done at specific times. Everything else is far more flexible and I complete them as needed and depending on how my day is going, prioritizing as I go. As you know, suddenly someone might take a turn for the worse or you might have an unexpected discharge. What are you going to prioritize? A lot of it, too, is dependent on each nurse. I know some nurses who have to have their baths done in the morning, whereas I have no problem doing a bath as late as 1600. As you continue to work, you'll develop your own system that'll work just for you.
Sep 6, '12 by AeternaI'm not "experienced" - I've only been working for about 2 years so I'd probably be considered more "junior" than anything ^^; However, I keep a basic structure to my shifts. As you said, there are always interruptions and things that change, so I try not to lay down a detailed and strict plan, because that's just asking to get thrown off completely!
Sep 7, '12 by BringonthenightQuote from That GuyLaughed out loudStep 1: Arrive to floor with crisp brains out ready to start the day