Question for those who work the 11pm-7am shift

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this is true, but illeagal....seen it done and done the pre pour....limitedly but some.....

probably the biggest issue that i have the hardest time understanding is that so many nurses give BP meds without ever checking the BP. i always check the patients' BP before giving any BP meds... Although sometimes the patients get upset with me and say that they don't understand why i need to check it when they never had to have it checked before. I guess it's yet another shortcut taken that explains why it takes me much longer to give meds than it does for others! does this occur in your facilities as well???

WOW!! thanks for all the responses. i survived my shift... but not without the help of my supervisor. she didn't have any admissions or discharges to prepare for the day, so she helped me and the other new grad with our assignments (the other new grad had about 60 patients as well). we were instructed to start signing off the MAR early and do our charting early. all the misc tasks were done first. any meds due at odd hours were given on time... but the majority of the patients had meds at 6:30am. and YES, we were told to start at 4am. it started off well... until i remembered that i had another med cart full of meds to give HAHAHA. my supervisor did about 17 of my accuchecks for me. by the end of the shift, i was sooooo behind that my supervisor helped me with my insulin injections and with the rest of my PO meds. i had patients up at all hours of the night asking for PRN meds as well as dressing changes that needed to be done before i could do my med pass. so needless to say, i had to save most of my charting for AFTER i clocked out. i clocked out at 7:30am, but didn't leave until about 9:30am.

i'm not really sure how to manage nursing care for 60 patients in one 8 hour shift. i understand that some of them don't really require much nursing care in the first place. but others are very demanding and have a million things going on with them.

probably the biggest issue that i have the hardest time understanding is that so many nurses give BP meds without ever checking the BP. i always check the patients' BP before giving any BP meds... Although sometimes the patients get upset with me and say that they don't understand why i need to check it when they never had to have it checked before. I guess it's yet another shortcut taken that explains why it takes me much longer to give meds than it does for others! does this occur in your facilities as well???

This will be my first time working an 11-7 shift (i usually work 3-11). i know there are certain things i need to do during this shift that i need to ask about... like switching out the syringes for the gtubes, and checking the accucheck machines, etc etc etc.... my question, though, is about medications.

if everyone has meds due at 6:30am... and many of them have blood sugar checks at 6:30am... how do you get it all done?!?! i have 60 patients tonight. i'm working on my own, have only worked with these patients once before (and it was split in half the first time around), and i'm just wondering how to make it through this shift. how early can i start giving them their meds and insulin?!?! any input would be greatly appreciated... i think i'm gonna have a breakdown from the thought of having 60 somewhat-new patients all on my own. i also know that about 20 of them require accuchecks... help please? thanks.

i realize that everything you pointed out is all wrong. that's my problem. i'm a new grad and tend to try to go more by the book than anything. but the more i try to do things right, the more the bosses pull me aside to say that i'm in the real world now and i need to take shortcuts to finish my work faster. when i was just starting out, the other nurses would come and help me give some meds. but of course i didn't have an opportunity to sign off on anything they gave until after my med pass was finished.

i had difficulty coming to terms with the idea of giving 9pm meds with 5pm meds. i've been pretty resistant to that shortcut. but when its 11pm and i'm still giving meds, my coworkers and supervisors keep telling me that i need to finish more quickly.

when i first tried combining 5pm's and 9pm's, it was hard enough. then they all told me to just start giving meds as soon as i've started my shift.

i'll get in trouble if i don't finish all the work (charting, giving all the meds, treatments, incident reports (if any), etc). but i'll also get in trouble if i go into overtime. i'm required to get everything done by the time i clock out for the day. i've already gotten in trouble with my boss for staying late (off the clock) to finish up my charting.

and as for the BP meds, i'd say 99% of the BP meds i give DO have parameters. so because of the ordered parameters, i find it unsettling to see that the other nurses aren't checking the BP. especially when i see that these meds have previously been held... i'm afraid of just giving a med when the patient's BP might actually be lower than the ordered parameters. or are they just holding the meds so they have less meds to give? i always wonder that when i see all the held meds in the MAR....

i guess i'm struggling because i'm constantly being told to take as many shortcuts as i can to get the work done... but everyone always adds in "...unless the surveyors are here. in that case, do everything right." like i said, i'm a new grad... if i can't do things the way i know is right without constantly getting in trouble with my bosses, then i won't be able to do anything right in front of the surveyors!!