I've been working at a LTC for about a month now 7-3 & today I was offered my desired position on 11p-7a!!! I'm super excited! & there is like a $3 shift diff!!! Any 11-7 nurses have any advice for me??
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In a nutshell? Top tips: be meticulous with paper work, follow up on anything and everything you can from previous shifts, be proactive, and make sure CNA's are doing rounds as often as they should be! Good luck!
I work NOC and like it for the most part. I spend a lot of time following up on paperwork and labs. I try to update care plans when needed (new skin issue, new infection, etc). I make sure admit paperwork is done. I spend a lot of time making sure the med carts are stocked and organized. I go through the MAR and TAR with a fine toothed comb looking for ways to streamline things or get rid of old orders/treatments.
I try to view myself as a helper to days, looking at what I can do to make things run smoother when it's busy...
But, there are days (actually nights!) where someone falls or I have to send someone out, and then all the above gets thrown out the window! lol
Wow how do you find the time? I have been on Nights for 8 years now and we are just as busy as the day and evening shift tell me please what I am doing wrong. Typical night in my facility with 75-82 residents split between 2 nurses. Come on shift at Ten take report. Count three med carts for your three halls. Make out your V/S list for the residents in follow up including your Medicare patients Last shift I had 8 on Medicare + 10 on medical follow-up (falls,antibiotics,readmits, new admits, etc, etc). Lets get around and see those 18 folks before it gets to late. Make your notes to chart from as you go along. You also have 3-4 patients on Bi-Pap that need assist with their head gear and all the humidifiers on the BI-Pap machine need distilled water.Your still on the first hall of 3 you have at least 3 people see you pass by and want prns for this or that if its a pain med all the back to the unit to that cart where all the pain meds are. add your pain meds to the to do list you are making you will need that later for the charting you have to do in triplicate on pain meds. The phone rings at the desk you wait on the 4th ring you make a run to get the phone. Good Morning Its a great day at Happy Acres. The required way to answer our phones my direction of the corporate gods in New Jersey are down south in Oklahoma but don't get caught answering the wrong way or hour head will be chopped off. Can speak to my mom one of the CNAS Or the other nurse on the other side of the building cant use the intercom at night so go get them. Now back to hall one and finish there. Start hall 2 if your lucky 30 to 45 mins same with hall 3. Back to the unit. I have the unit , locked /dementia unit with 13 of the sweetest little ladies in the world but they can get on a roll even on the night shift. By now its after midnight closer to 1 a.m..
Get ready to do all your required paper work . Book 1 The Pain Book enter all the prns you gave on the 3 halls on the pain sheet be sure those are signed for in the narcotic book and charted in the nurses notes in the chart told you it was in triplicate. Book 2 The Behavior Book one page for each Psych med or sleep aid each pt is on typically 90-100 pages to initial in 3-4 places. This book also contains the Resp sheets for HHNs, Bi-paps, O2 , and inhalers. The diabetic sheets are here as well make out the FSBS list for your finger sticks later 18 right now. The Day nurse will give the insulin after six closer to breakfast. Book 3 the treatment book for your 3 halls 40-45 pages to sign no real TXs but all things you initial for not covered in the other 3 books. Don't forget the MARS for three halls. Lunch break 30 min that you punch out for but keep working. if you stop and do nothing for 30 min you are 30 min behind the rest of the shift. Now there is those 18 charts to start on 8 are Medicare so start the new MCR for the next 24 hours don't forget your required shift entry on the back of each sheet. Its 4:30 now time for last big push before shift change. Set your pills for morning med pass yes i said pre set there is no other way to get done on time there are 30 people with 6 a.m. meds ( synthroid, protonix, pepcid, various ac meds)depending on the day of the week. Now if you have had no falls or mishaps requiring the 10 page incident report, no one to send out , or no admissions to finish from 2-10 shift you might get done. Is this typical of all places? How can I do all those extras you do.
This sounds pretty much like my facility. Census is about 75, of those I take 3 carts which is 50 residents or so. I only have 8-10 medicares though, no "medical follow ups" so only about 10 notes to right/VS to obtain. I only get certain residents' VS when I arrive on shift as our shift starts at 11, not 10, so I only obtain those that I know tend to be awake so late at night. The rest I get during med pass in the morning. Oh, our shift ends at 7:30, so I give my own insulin after accu-checks.
Sounds like a lot of work, and it is, but I also do the extras I mentioned above. I make sure I give myself a 20 minute break to eat my PB&J sandwich and just take a couple deep breaths. It's possible. Maybe it's the coffee? Welcome to my nights!
Our paperwork is much more streamlined. No extra books. Just the main TAR/MAR book. All pain follow up and behavior things are charted in those books. All insulin is in that book.
I have 35 residents. Two carts to count. CNA's do vitals, unless its a bad fall then I do it. All but one sleep through the night. 11 people get 6am meds. 1 glucochek daily and 2 other that are just twice a week. We do AC checks at 7:30 just before breakfast. CNA's know not to take diabetic down before asking.
The standard on nights about the same everywhere I guess. It sure seemed easier in the past night shift way back was just keep them turned and dry. Then autoclave aseptos they were glass then with big rubber bulbs on top. I think we had like 6 meds. The old Doc didn't want his patients woke up at night for any reason. How times have changed. you could cook some great hotdogs in the
autoclave. Anybody miss the old days
I start 11p-7a shift Monday the new schedule came out today everyone on day shift was calling me a trader today lol but Im a new nurse I've only been working there for like a month...I just wanted to try something new never worked nights before plus Im single no kids might as well