Hi, AprilD~LPN, and welcome to allnurses!
After getting report, getting the CNAs assigned, making rounds on the patients to see that they were all OK, I did any med pass that needed to be done. Around midnight we had to make sure the facility was locked down which meant checking to see that all doors were closed and locked. I also checked to see if there were any new doctor's orders that affected the night shift. If there were any treatments I needed to know when the last treatment was done. It makes no sense to change a dressing at midnight if it was just done at 9pm by the 3-11 nurse.
The rest of the night was exactly what you suspected, behind the scene work. We had to go through the med carts and reorder any meds that were low. I also used to clean and straighten up the med carts. I used to take a few of the individual patient drawers out each night and soak them in warm water and get them cleaned. I also went through the treatment cart and made sure we had the medications for any of the treatments that were ordered for patients and that any D/C'd treatment medications were discarded. Usually, our pharmacy delivery came late on the 3-11 shift and was left for the night shift to put away, so we did that too. We checked to make sure that there weren't any fax messages sitting around at the fax machine. If there were, we followed through on them as best we could, particularly if there were any doctor's orders on them. I also used to go through each patient chart checking for any new doctor's orders that hadn't been signed off--only took about 10 minutes to do this. It's an old habit I developed from working in the hospital.
The other two shift charge nurses I worked with and I had a really good working relationship and we long ago put our heads together and worked out a way to spread the meds and treatments out over the three shifts. One of the things I was doing on the night shift was changing dressings and tubings on the patients getting tube feedings. I also was giving these patients their daily medications (because they had to be crushed) at around 4 or 5am which took a BIG load off the day shift nurse. Some dressing changes were done on patients who were confused and known to always be awake at night. Our CNAS also had some baths and showers at night--again, on specific patients who were known to always be awake at night. We never woke anyone up for things if they were sleeping if we could avoid it. I was doing any dressing changes and passing any 6am medications. By 6:30 and as close to 7am as possible I was doing fingerstick blood sugars. I was also giving some insulin at 7am, but not all. Some of the insulin was being given by the day shift charge nurse.
As I said, I had a really good raport with the other shift charge nurses. We helped each other out as best we could to spread the work out. I was more than willing to take on certain meds and treatments at night. I like to keep busy.
A BIG job of the night shift was the monthly reconciliation of the MARs and TARs. It started as soon as the newly printed batch came in about a week before the end of the month. Every MAR and TAR was compared to both the patient's chart and the current month's MAR and TAR to make sure all orders had been transcribed over onto the new sheets. If we had a busy night doing things with patients we would get a little behind on these and we would have to get help from the assistant DON and supervisor(s). Those new sheets had to be ready to go on midnight of the 1st on the month and we couldn't afford to have any missing orders left off of them. The most complex ones to do were any newly admitted patients in the few days prior to the change over night because they had to all be done by hand unless we could coax someone at the computer center to take pity and print us one set of sheets.
If there were any nurses or CNAs who called off for the day shift, depending on how many, we sometimes had to get on the phone and call the staff who were off that day to see if anyone would come in and work--or we called the registries. That can take up a lot of valuable time. You panic if the cook AND their staff all call off! We unlocked the facility doors at 6am.
No one, and I mean no one, on the night shift should ever be sitting around doing nothing. There is always something that can be cleaned or straightened up--ALWAYS--if there isn't something that can be done for a patient! For our "special" patients that we were showering at night, I set up a special little basket of toiletries just for the night shift CNAs. Many of these patients were very demented and some had no families that we knew of who visited. I had the CNAs putting nice lotions or perfumes on them, using nice shampoos and soaps and doing their hair. It helped give the CNAs some pride in their work. I would also occassionally go out on the floor and join the CNAs in their rounds. You can't know what they are doing if you're not out on the floor to see them at work.