Organizing the day shift (transition from nights)
- 0Aug 27, '11 by bootheel.bldI'm finally going back to day shift after working nights for over a year. I'm busy on nights with 6-8 patients-definitely not much sitting around. On days, there will likely be 4-6 Med-Surg patients.
Any tips on how to organize the day shift routine and "stay afloat"? (I've searched the threads and found some helpful info ... but nothing real detailed on organizing the day).
I recall the specific day shift duties are:
- 3 meals a day (none on nights)
- Surgery prep, pt's to OR in the early morning; postops in the afternoon
- Procedures (xrays, MRI.... ) during the day
- Dr orders to check off
- Lots more meds on days, espec 9am
- Dressing changes
- Discharges to home / nursing homes
- Multiple new admissions at times
- Draw labs / IV starts for new admits /IV restarts for expired IV's
- Update POC / Teaching plans
- 3 blood sugars on days vs 1 on nights
- Baths / beds on days vs PRN on nights (but 3-4 cna's on days vs 1-2 cna's on nights)
- Deal w/ families, case managers/social workers, upper mngmnt making 'rounds'
- 1Aug 27, '11 by woohAs someone that has gone back and forth between both shifts:
Keep up with your charting as much as possible as you go. On nights, the busiest time is always at the beginning of the shift, then of course the sprint at the end. On days, it tends to be a sprint to start, then at the end of the shift it's go go go.
The hardest part for me when I went to days was figuring out how to know which doctor to call for which patients. Once I got that down, life was much easier!!
- 0Aug 28, '11 by shygoofyoneQuote from dadfirstThe first hour of your day sets the tone for the rest of the shift. Getting report, vitals, assessment, and meds passed by 10am is the benchmark that I use. Some days I get it some days I don't.
Good luck to you!!
Totally agree! The first thing I do is get my papers together. We each get a patient summary printout in the AM (0640-0645), which I "tab" by cutting or folding away parts of the margin so I have a tab for each patient. I then print out a scheduled med report for my patients, and write the med admin times at the bottom. It really doesn't take as long as it sounds...I'm often done before the NOC RN is ready to give me report. So then, at a glance to my clipboard, I can easily see what times my meds are due and flip to the appopriate patient's 24-hour summary (where I write notes during report). So helpful throughout the day! I also add a blank sheet of paper over those sheets to jot down my "to-do list" that I make during report and cover confidential info.
If report goes smoothly (done by 0700!), I check for abnormal labs prior to assessing my patients, so that I can include that information in my talk with the patient re: our plan for the day.
If report runs long (still not done by 7:20), I go see each patient, doing physical assessment and passing any 0700 meds that weren't given (iron, metformin usually).
During my assessments, I try to tell the patient our plan for the day...and if things are up in the air, I tell them that. I feel they need to know if we're waiting for labs, tests, or simply an MD to round. Usually, the more info I give my patients at that time, the easier my day goes because they know what to expect. I'm generally ready to chart at least one assessment before my am med pass starts (815-830).
After my morning med pass (sometimes during, if able), I chart, chart, chart...as much as I can. Then, as my patient's are cleaned up, I do my dressing changes (sometimes done during the am med pass, if able). Then, chart, chart, chart...
My goal is to get as much scheduled stuff complete early on so that any surgical admissions or unexpected direct admits can go more smoothly. I'm also the charge RN, so I really want to make myself available to the other RNs (and we have a LOT of new nurses) and review their patient's labs. So, the more I get done early, the better
But, a previous poster was right...you'll get a system that works for you! Mine has changed quite a bit since I started two years ago...
- 1Aug 28, '11 by dadfirstGreat information there. Very good idea to get to the unit as early as 0630 to get your data organized for report. I think staying ahead of the day is the best bet. No matter how you roll, you are going to get your ass handed to you on either shift. The reason its called "nursing" is because "stressed out and ready to have a stroke" was already taken.