ICU night shift nurses - how do you organize your shift?

[MB37]

I'm a relatively new nurse (~8 mo.), and am about to switch from days to nights. I'll be working 12s, from 1900-0700. Night shift on my unit typically provides baths and does routine labs, in addition to everything I was used to doing on days. I work on a neuro/trauma unit, so frequent neuro checks are a must. We typically have two patients - I've never had three, although it can happen in extremely rare circumstances, and occasionally I'll only have one if they're very sick, or there's a 1:1 in the room next door. Med schedules vary, so aside from 2000 I don't know when I'll have anything due. I'm just curious how some of you with experience on nights plan out your shifts to best get everything done, while clustering care as much as possible to avoid completely depriving pts of sleep. Thanks so much in advance, and I do of course plan on asking my coworkers as well when I have any specific questions. Appreciate any help!

[SteffersRN87, BSN, RN]

When I worked in ICU, I worked a lot of 7p to 7a. I got report and then looked over orders and labs from that day. We had MAR's that printed out for each shift, and I would hi-lite my meds times. By 8p, I was ready to go. I spent about 30 minutes on each patient - assessing, giving meds, turning & positioning. We had bedside computers for charting. I would throw in vitals and I & O while in the room. After seeing bother patients, I would chart my assessment. Dinner time was usually around 10p. Then when midnight hit, I would do it all over again. Except, this was bath time for each patient. We had beds that rotated side-to-side, so we only truly turned and reposoitioned every 4 hours. At 4a, I would draw labs and change out tube feedings and suction equipment. After that, I would clean up rooms, replace lytes, and do any orders that were written before I left. It is hard to cluster care in the ICU, because the patients generally require such intense and constant care.

[Kyrshamarks, BSN, RN]

I get report on my two patients 9sometimes 3 even) I IMMEDIATELY go and see my patients to at least lay eyes on them and their lines, fluids and vent settings. I usually can get my assessments done during this time. Then since we still use paper charting and get our nest day med sheets by 6 pm, I chart my assessments and do the chart review and check the new med sheets and get the next days notes ready. this usually takes till around 9 pm. I then passs meds and accu check my patients finishing by 9:30. Then I gather the linen for baths and get them started. I also do any dressing changes due at this time. That generally takes another 90 minutes so I am done with that and the turning by11:30 pm. All our patients are on air beds/turning beds normally. Do any midnight meds due and then I usually eat dinner and have a bit of down time till around 2 am the I usually start get the tubes ready for blood draw and and by 3 do my blood draws and turn again. I then make sure my cahrting is fully caught up by 4 am and start the end of shift work by five. I empty the foleys and empty the trash and clean up a bit. Change the tube feeding bags, and accu checks by 6 am I am closing out the notes.

[SandBetweenMyToes, BSN, RN]

I would take a piece of paper, line down the middle and 6 hours on each side. Label the times on each cell, and fill in all the labs, baths, dressing changes, "fluffs and puff" at 5am, meds, etc. That's how I organized. It was my little bible each night...