Routine assessment on night shift - how thorough?

Tweety, BSN, RN · May 18, 2005

I work with nurses that won't wake a sleeping patient. They come in at 10:30 and by 11:00 8 patients are "assessed". (Funny how they can do their charting....) If they have to be awake for vital signs I assessed them then. Usually only focusing on the reason they are there. If they are there for a lap chole, I may not assess their pedal pulses or their pupils.

However, I'm on day shift now.

HONEYBEAR · May 19, 2005

Providing your patient is stable and sleeping... How thorough is your qshift assessment?

When I was working in the hospital It would take me at least 45 minutes to assess my 6 pt's.

RNinSoCal · May 19, 2005

I worked night shift for a year and a half on a general medical unit and I know the problem of whether to wake a sleeping pt for assessment or not. The truth is that you have to use your judgment. For example I would not always wake a pt with cellulitis/wound infection and stable vitals but I would wake a pt with pneumonia, gross hematuria, fresh surgical site, altered level of consciousness...Any condition that could quickly go from bad to worse. We also wake our detox patients every 2 hours for the first day of detox for vitals and medication so a baseline at the beginning of the shift is necessary. It is no fun waking a person who is still drunk so that they can close their eyes and hold out their arms so I can assess for tremors.

If you are a new nurse you should always wake your pts for an assessment. It takes time for good nusing judgment to develop. As annoyed as people get when woken up you have to remember that you are helping them and your assessment might be the one that prevents a serious problem from occuring. If they didn't need your professional judgment and care they would be at home.

barefootlady, ADN, RN · May 20, 2005

RNinSoCal,

Great post. I don't find that many patients asleep at 23:00 or even later, so waking them is not usually a problem. I do as complete of an assessment as possible when checking a patient initially. Most of my patients have always seemed glad for the attention and usually have appreciated the time I spent with them.

mommatrauma, RN · May 20, 2005

My personal opinion, and having worked night shift for at least 4 years out of the last 10...You have a professional responsibility to wake that patient up if need be and do a full assessment. Because in the end...you are still responsible for that patient and the care you give...and I don't think the I felt bad and wanted to let them sleep" will fly as a defense in court... Although, I always tried to group my treatment with my assessment...like if I needed to give them medication at a certain time through the night, I may assess my ABC's initially and when I have to go in to give their meds or whatever, then I would wake them up then...that way you aren't going in 5 times per night ...

midnightRN · May 21, 2005

I'm on night shift, and wake up my patients do an assessment. The question is when. I work 12 hr. shifts and if I have not seen them at 7pm, then I wake them at 2330-0000, to make sure everything is as it should be. I do a an assessment focused on the admitting problem, but assess everything. We team up with the techs and get VS at the same time, so we don't have to wake them more often then needed. If they're stable, I'll wait until lab or the morning med pass to assess them again. If needed, if there are changes from an earlier assessment, or if they are unstable, they get woken up. If they get cranky, I try to explain that this is the service they pay for in the hospital, and yes it stinks to be woken up, but it's necessary. Most are okay with that. On nights we usually have 8-10 pts per RN. Neuro checks and detox pts. are woken more frequently. Of course, we let them know they will be woken frequently and why before bedtime, so it's not a surprise. Sincerely, Anna

Littlewonder · May 22, 2005

I think one of the biggest issues here is number of patients. When I just have three moms and babies postpartum, I never wake them up - because I have plenty of opportunities to see them awake. I can generally assess them on their own sleep-wake cycle. I also used this technique in ICU - wait until they are awake (within reason). Of course, there will always be times when concern for your patient requires that you wake them up, just try to "cluster" care so they can get the most sleep possible. It is hard to heal on a lack of sleep! (Don't we know that to be a fact, with the little sleep night nurses get!!!) This is just another one of those "nursing judgement" issues where we have to individualize care for our patients.

melzan · May 22, 2005

I work 7p-7a and asess my patients with the first med pass, that way I spend more time with them and they don't feel like I am throwing pills at them. If I do not have my asessments done by 12a then I do them when the aids get vitals. I can't just not do my asessments like some nurses, I am to much of a spaz, if I sit down to chart and realize I missed just one thing on a patient I will go and look, even if it is just to make sure they have o2 on.

pricklypear · May 22, 2005

The nurses on the floors at my hospital are allowed 1 sleeping assessment. I'm not sure if this only applies to nights, probably. Vitals may only be ordered bid or tid on some patients, so there is no need to wake them a MN. Obviously judgement needs to be used. And IMHO, some patients acutally need the undisturbed sleep more than they need to be assessed. Sleep deprivation is a big problem for patients who are hospitalized more than a few days. That can lead to confusion, non-compliance, falls, etc...

PMHNP10 · May 22, 2005

The nurses on the floors at my hospital are allowed 1 sleeping assessment.

I'm not sure I understand what a sleeping assessment is, and why only 1 (no more, no less) would be allowed. Could you please explain?

pricklypear · May 22, 2005

I'm not sure I understand what a sleeping assessment is, and why only 1 (no more, no less) would be allowed. Could you please explain?

A sleeping assessment is just what it is! A stable patient is assessed while they sleep. If it's a normal sleep pattern, pt resting in bed with eyes closed. Resps even and non-labored. IV NS infusing at 75cc/h to LBH. Site without redness or edema.

In an 8hshift, you do 2 assessments - 1 can be a sleeping assessment. MN or 4am. You might choose to allow someone to sleep thru the MN assessment, knowing that they will be awakened by lab at 4am.

Not every patient should be allowed to sleep without an assessment. That's where judgement comes in.