Rounding on patients at night

[proud nurse, BSN, RN]

I round on my patients every 2 hours. I go the opposite hours that the CNAs go, that way my patients are being checked on every hour. Some people might think it's overkill, but it's just the way I've always done it. I've always worked nocs, so mostly I'm just eyeballing them anyway. I can slip in and out like a cat.

Sometimes I will touch them lightly to check orientation or see if they need anything, check are they comfortable, eyeball a wound or dressing...etc. Plus, the last thing I want them to do is tell the next shift that the noc nurse didn't see about them all noc. And I definitely don't chart things I didn't do or assess. No matter what shift you work, when your patients are sleeping, do you just document they are sleep and comfortable? How do you rate their pain if you don't wake them to ask?

[hopefulwhoop]

I also work at night and I peek in on my patients every 1-2 hours.

If they're sleeping, I slip in, look closely enough to make sure they're breathing and slip back out. If there's anything that needs to be addressed while I'm in there (eg, beeping IV pump), I address it. I do think it's unnecessary to wake them up. Unless there's a med. due or something along those lines, I think it's unnecessary. Some pts will have problems going back to sleep, so I let them be. If they're in NAD and are alive, I leave them alone.

[SionainnRN]

I worked breifly on a surgical floor (so wasn't for me!) and when i worked nights I would make sure to talk to my pts before the fell asleep if they wanted me to wake them up for their pain meds, or if they were sleeping to just let them sleep. I view sleeping pts like sleeping babies, don't wake them up! For the big joint replacement surgies I would wake them up ever 4 hours to keep them on their pain med schedule otherwise they wouldn't be able to do their PT/OT during the day. I would round about every 1-2 hours, peek in and make sure everything was okay, but since sleep is such an important part of healing, I wouldn't wake them up just to see how they were doing.

[loriangel14, RN]

Why would you wake a sleeping patient? We do rounds on my floor qh.I slip in, check for comfortable breathing and leave. If they are sleeping we assume they are not in pain. We would never wake a patient for a PRN med.

If I was a patient I would be furious if my nurse woke me up to "see how I was doing". LOL I don't sleep well at the best of times and I would be up for the rest of the night once I was awake.

[ayla2004, ASN, RN]

Ilwork on a ward that wakes pt every fours hours during the night. We round on them every two. Very often with poor sleepers they have just got over to sleep and they are awake.

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[proud nurse, BSN, RN]

Why would you wake a sleeping patient? We do rounds on my floor qh.I slip in, check for comfortable breathing and leave. If they are sleeping we assume they are not in pain. We would never wake a patient for a PRN med.

If I was a patient I would be furious if my nurse woke me up to "see how I was doing". LOL I don't sleep well at the best of times and I would be up for the rest of the night once I was awake.

Like I said I can slip in and out quietly. I don't necessarily wake them, but if they are turning about or taking a sip of water at the time of my round I will communicate quietly with them.

I was just asking because a co-worker does one round at the start of her shift, and will let the patient call if they want something.

Everyone has their own routine I guess.

[SwansonRN]

We have hourly rounding, q2h turns, am labs (I usually do mine around 0000-0200 so if something is off I can address it before day shift), bed baths, and line/bag changes all due at night. Sucks to be my patients. I would love to just let them sleep all night, it's just not realistic with all our tasks.

[sunnybabe]

I'm too paranoid to not do q1hr checks. I just peek in and might hover next to them to make sure they are breathing. Creepy i know, but it's only for a second.

[KelRN215, BSN, RN]

Why would you wake a sleeping patient? We do rounds on my floor qh.I slip in, check for comfortable breathing and leave. If they are sleeping we assume they are not in pain. We would never wake a patient for a PRN med.

If I was a patient I would be furious if my nurse woke me up to "see how I was doing". LOL I don't sleep well at the best of times and I would be up for the rest of the night once I was awake.

Neuro patients often have to be woken up during the night. When I worked in the hospital, the majority of patients were on neuro checks q 4hr. You need to wake a patient to do a proper neuro assessment on them.

Now, we used our judgment. If the patient was admitted for a migraine and he was ordered for q 4 hr neuros because that was part of the neuro admission orderset, there was NO WAY I was waking him up in the middle of the night. Patients with a stroke or who'd just had surgery absolutely need to be assessed at least that often.

[SionainnRN]

Neuro patients often have to be woken up during the night. When I worked in the hospital, the majority of patients were on neuro checks q 4hr. You need to wake a patient to do a proper neuro assessment on them.

Now, we used our judgment. If the patient was admitted for a migraine and he was ordered for q 4 hr neuros because that was part of the neuro admission orderset, there was NO WAY I was waking him up in the middle of the night. Patients with a stroke or who'd just had surgery absolutely need to be assessed at least that often.

Huge difference between waking someone up to do neuro checks and waking them up to see if they're doing okay! Most of my pts agreed that if they were asleep, let them sleep. The ones we did need to do neuro checks on understood. I can only imagine what I would have thrown at me if I woke up a pt and asked how they were doing and if they needed anything!!

[buytheshoes11, MSN, RN]

I check every 1-2 hours at night and don't wake the patient unless necessary. An example would be a Q2H or Q4H neuro check.

[FlorenceFrightengale]

At the beginning of the shift, I let the patient know I'm there until 730 and that although I'll physically peek in every hour, I don't wake him or her unless necessary. I'll give a little plan, "you have a heart monitor so I'll be needing to wake you around 4 AM for vital signs then at 6 AM for your Synthroid pill, otherwise I'll peek in but let me know if you need me if you don't see me. I'll make sure you have your call bell handy."

When I round I check to make sure the bed alarm is on (if warranted), call bell and personal items are within reach and the patient is breathing evenly. If the patient is incontinent or a turn, I will obviously check him or her every two hours or more often.