Waking your patient when coming on shift?

meanmaryjean, DNP, RN · May 28, 2018

What type of unit? Is a complete neuro exam more important than restorative sleep in your patient population?

Sour Lemon · May 28, 2018

I absolutely do not routinely wake patients when I come on shift. I do check to see that their respiratory rate is WNL, their coloring looks good, there's not blood pouring out of their face, etc.

KatieMI, BSN, MSN, RN · May 28, 2018

You know, there is not a shred of evidence about a whole lot of stuff we all were "always taught" in school and after it. "Never putting an IV on the side of mastectomy", "never taking BP on the side of PICC line", "never taking blood sugar from the little finger", etc., etc., are all nothing but old wives' tales. And waking up patient just because you happen to come up to do you shift is, I am sorry, simply brutal. People lose a lot of sleep while they are in hospital and sleep is often that's what they need more than all our pills and shots put together.

I would understand if there are special circumstances like frequent neurochecks or psych observation. But otherwise there is no rationale and no clinical reasoning for doing that.

brownbook · May 28, 2018

I agree with all the above. Usually a patient gets somewhat woken when you or the CNA gets their vital signs, or the nurse checks an IV site or dressing anyway. You shouldn't hesitate to assess what needs assessing for fear of waking a patient.

It greatly depends on why the patient is admitted, how many hours or days have they been on your unit, what report did the prior shift give you.

caliotter3 · May 28, 2018

I absolutely do not routinely wake patients when I come on shift. I do check to see that their respiratory rate is WNL, their coloring looks good, there's not blood pouring out of their face, etc.

This is how I treat my extended care home health clients when I arrive for night shift. If they are asleep, I leave them that way, and hope that taking their vital signs does not disturb them. In most cases their family wouldn't allow me to disturb them anyway. There are few, if any, instances where I must awaken them.

broughden · May 28, 2018

Good Evening,
I have a new nurse following me
and I want to teach them the importance of waking your patient when you come on shift, especially if they are a high risk patient. I can't find any literature which I find is odd because when I went to nursing school, my instructors always said you can't assess your patient's loc if they are sleeping so you must arouse them when coming on shift. Does anyone have any supporting literature?

As a former patient in an ICU who was in severe pain and needed whatever few minutes of sleep he could get....do NOT do this.

I swear there was one med student who would NOT stop waking me up every single time to do his stupid assessment, I was going to strangle them with my IV or catheter tube.

mrsboots87 · May 28, 2018

I work a Neuro/PCU floor. Outside of my CVA patients needing their complete Neuro checks, I do not wake my patients if they look otherwise I'm. I get a LOC from the chart and when they wake, if they are different I go from there. Especially when half the time I get told the patient didn't sleep well that night because we wake them every 4 hours for vitals as it is. Or if get told they were up all night and just fell asleep within the last couple hours. I just let them sleep. If it's like 10 and they still haven't woken up, I'll arouse them enough to complete their assessment then leave them alone. A lot of people don't want to be woken between 7 and 8 if they aren't already awake.

Gardeninggirl · May 28, 2018

Thanks, this is the guidance I really wanted to look for. I have a specific case in mind with a patient who had a brain bleed and had a subsequent one and died. I don't work on a neuro floor but we get patients who are "stabilized" before coming to us. Sometimes they really aren't all that stable after all.

nurseandtell · May 28, 2018

I think you have to wake up the patient to fully assess their neurological status. Although it might cause problems, especially at 0400, you have to do your assessment. They are in the hospital for needing close acute care.

I do agree with some posts stating that some practices are followed due only to "it's how we've always done it."

Let me know if you find any supporting literature!

AceOfHearts<3 · May 28, 2018

The body needs sleep to heal. I bust my butt on night shift to get my patients bathed and ready for bed by 10-11pm and I also tell them I'll disturb them the least amount possible overnight so they can get as much sleep as possible. I'm in the icu and if I have a patient on hourly or every 2 hours neuro checks I always look to see how long they've had them and have they been stable- I then go straight to the residents to see if it's appropriate to change it to every 4 hours so the patient can get some better uninterrupted sleep. I once came in to a patient that had been on hourly neuro checks for THREE days!!! I'm sorry, but at that point the patient is probably delirious and those neuro checks aren't all that accurate.

I wake patients for neuro checks and if there is a question on mental status or concern in respiratory status that can lead to altered LOC. I do my midnight assessment, but the 4am I tend to wait until the patient needs something (bed pan, labs, etc.) because they always need something.

I worked some shifts starting at 3am on a tele floor before moving to the ICU. I'd sneak in and place my stethoscope on the patient, assess their breathing (equal, even, unlabored, rate WDL, etc.), review their vitals, peak at IVs, and then wait until they called for the bathroom (or needed incontinence care) or pain meds to do my full assessment that I would have done right away had I not started my shift in the middle of the night.

LovingLife123 · May 28, 2018

I think it depends. Are you in an icu? Do you do head to toe assessments? Obviously, for your case with the previous head bleed, you need to do a neuro check. That's without question. But say a surgical patient, I may wait until 8 or 8:30 depending on the amount of sleep they got the night before.

It's also important to keep them on a normal sleep/wake cycle. So I try to get my non neuro patients up and going around 8. I have to do head to toe assessments 3 times a day and I get lots of neuro patients so I have to wake most of my patients.

But I can tell you from experience, those neuro assessments are not accurate if the patient has constantly been awake.

There is lots to consider and this is where your critical thinking needs to come in as you can't treat all patients the same.