What Is A Shift Like?

postmortem_cowboy · Feb 17, 2007

Third shift is usually from 11-7, and there usually isn't much going on during that time. In my experience, although i've never pulled an 11-7 at a LTC facility, you'll take report, check on patients and pretty much just keep checking on them throughout the night. On a medsurg unit, there are some things that may come into play, GT flushes every so often, IV's that need new fluid, feeding bag changes etc etc. Third shift would be the easiest, however the most involved as far as paperwork is concerned. Night shift on a M/S unit takes care of all the 24 hour checks, making sure all the doctors orders have been carried out, from ordering this radiological exam the next day, to med changes/starts/stops and to prime the charts for the docs, so that they have paperwork available to consult the next time they're in. Could be different in a LTC facility. Usually on that shift it's the later hours of the shift that get busier, some meds might get ordered early morning, you have accuchecks that need to be done, possibly insulin if your facility allows for nights to dose insulin before breakfast arrives etc etc. For the most part it's usually a lot less stressful, patients are generally sleeping, all the days meds are passed and you usually just do paperwork. Just my two cents.

Wayne.

nursenikki928 · Feb 18, 2007

i worked nights for 2 years in a ltc facility 7p - 7a. i did this right out of nursing school and it was a great place to start. usually you take report, check your patients, change and hang new tube feeds, and do charting, and note the new orders that came through at the end of 2nd shift. our pharmacy delivered at night so we also had to check in the meds each night and refill the starter machine. we also checked our glucometer each night. i started med pass in the morning at 5 am. we also have a dialysis center and many of our resident went to dialysis between 5 and 7 am so they had to be medicated, fed and ready to go. then i had accuckecks to do and right before i left i gave the insulin before the breakfast trays were given. hope that helps some. good luck

cschuess · Feb 18, 2007

Night shift in a long term care facility is far from quiet! Usually people are awake all night with needs. Staffing is lower so the nurse needs to pitch in and help the CNA's. You are responsible for all the 2nd checks of new doctor orders. You are responsible for ordering stock etc...Lots of paperwork!! Pretty fair amt of medications to pass too!! Not to mention the wear and tear on your body! You can sleep 8 hrs and still feel like your exhausted!

Blackcat99 · Feb 18, 2007

When I worked in LTC on night shift is was very hectic! I was lucky if I got my 30 minute break. I had a lot of meds to give to the tube feeders in the mornings. We also had to do dressing changes and skin checks during the night. On the nights I thought I could go home on time, there was usually a fall at the end of my shift so I would always have to stay over and do all the paperwork and fill out an incident report. If a CNA reported any new skin breakdowns, there was always a lot of paperwork to fill out for that too. Of course, I was always notified by the CNA's of new skin breakdowns at the end of my shift so I always got stuck doing overtime.

marjoriemac, LPN · Feb 18, 2007

I usually work days but have picked up a few nights as overtime and for the experience. We got a report, done night meds, helped out with putting residents to bed then done any drug orders. We checked residents hourly and done a continence pad change at 12,2,4,6. If anyone buzzed, we went to see what they wanted and if anyone was awake, we talk to them. I sometimes helped the carers with the cleaning to stay awake! Late in the night or early in the morning (whichever way you look at it), we checked there was enough documents for the day shift, gave out early morning meds and filled in our notes before helping get anyone up that wanted to. get up. In between all this, I changed a PEG feed. This is a standard shift in my home but of course there are nights where people are ill and you need to call out docs or where everyone is awake and wandering too! I personally prefer days as they pass quicker, nights can drag at times.

JanWrotenRN · Feb 18, 2007

Noc shift where I work is very busy. I have 40 residents-three on cont. PEG feedings (bottle, syringe and tubing changes), and three on q2hr bolus feedings. I have 13 accuchecks, 8 Lanoxins and 2 Synthroids to give at 0600. Not counting the prn pain meds. We are responsible for all labs-catching the samples and completely filling out the slips with SS#, DOB tests ordered, pay method, etc.

The paperwork seems endless. I always have a stack of return faxes from MDs with new orders, etc left from evening shift. Each resident is on some type of psychotropic drug, so all the behavior sheets have to be initialed. It takes two-four hours JUST to initial the MARS,document the accucheck and pulse results, file the old faxes and lab results, order the labs, and chart. Then you have to write out the 24-hour report sheet and the census. We also have three residents who LOVE to wander into other resident's room and try to take a midnight stroll at night (only the front door has an alarm and we have four doors), and a couple who like to try to get OOB with their peg still attached to their tube feeding.

Most times we have three CNAs, many times two, and sometimes only one CNA for the whole building. It is crazy, and I rarely have time to pee. I run my butt off trying to make sure my residents are still in the bed, or in the building and breathing.

kiszi, RN · Feb 19, 2007

Meds, routine aerosols, prn pain meds, chart check, file, double-check new orders, accu-checks, calibrate glucometers, Skin treatments, Tube feeds and flushes, change O2 tubing and concentrators weekly, MDS charting, progress notes, Q shift pulse oxs, Temps for res. on ATB, full vitals on new admits and recent falls, Paperwork for next day's dr. appts, Check fridge temps on 4 different refrigerators throughout the unit, sign off TARs, check MARs, check in new pharm. delivery, fill out paperwork to send back returns, send back narcs(more paperwork, special bag).... get wandering residents back in to bed, stock med cart......

I'm exhausted just typing it! And please don't get me started on changeover. When that's being done, filing and other stuff just goes on hold for the duration, usually including my lunch break. Phew!

you'll take report, check on patients and pretty much just keep checking on them throughout the night.

I simply must find the wonderful place where this is all that happens!! I'll let you all know when I do.:nuke:

k

Please don't get me wrong, I love not dealing with MDs, families, meal times, dressing changes, administrators, and general BS. I'll never say my shift is the hardest, but it still ain't easy!

kmwlpn · Feb 25, 2007

I just started working night shift about 3 months ago, and it is always busy. You are the only nurse on the floor so all the decision making fall completely on you. After recieving report and counting the narcotics, you have to start your 12 mn meds. Meds at this time are not to bad, but the 6 am med pass is a load. Nightshift is anything but quiet, whoever thinks that rsdt's sleep at night has never worked night shift, we have call lights going off constantly throughout the night. I spend at least 3 to 4 hours just on paperwork. Then you have a lot less staff so you must help the CNA's with rsdt care. I start a med pass at 5 am at the latest and continue until 6:30 am when the next shift comes in. Medpass is alot harder in the AM because you have to stop for the phone, call bells, and rsdt's hollering out or climbing out of the bed, etc. It takes longer to pass to rsdt's when you have to go in wake a rsdt up, roll the bed up, make sure they are good and alert, and then give the meds, and spend the time meeting the request of the rsdt before moving to the next. Every rsdt you wake up is going to want something extra before you leave the room, and you have to help them because the CNA's are always busy, in with others. You also have to hurry around in order to be ready to give report to the 2 or 3 nurses coming in on dayshift. Every AM you can expect something to make you behind such as rsdt's falling, coming back to the hospital, a skin tear or bruise, low blood sugar and all the next shift staff calling in...I very seldom ever leave right on time....But all in all I still am less stressed most of the time on night shift, but I'm also lucky to have the CNA's that I work with, which knows what to do and does it....I could not make it through a night without them all.

gitterbug · Feb 25, 2007

Night shift is very busy. No two are alike, and when there is a full moon it seems like the demons or elfs or whoever like to stir things up.