A new night nurse on the cusp. Tips appreciated.

[dudette10, MSN, RN]

I’m about four months into my career, and I feel like I’m climbing a steep hill that just got a little less steep. It’s still a pretty big hill, though.

I have encountered potentially critical situations, and I’ve handled them with minimal guidance. The P&Ps and protocols have been invaluable, i.e. I feel like I have a guidebook to handling these situations. I have had the opportunity to develop new skills with my patient assignments, such as trach care and suctioning, vent patient management, drips, etc.

My coworkers have been FANTASTIC. On nights where everything is goin’ good, and then all hell breaks loose as the patients wake up, and they get their morning vitals and blood sugars, we all chip in to help each other. There have been a couple nights where I’ve been the one to be able to help so everyone can get outta there in a reasonable time frame, but some nights, I’m the one being helped.

I want to improve in that regard, and I’m working on ways to do so, including morning time management with the acuity of patients I might have on any given shift. I’m not good at giving myself some morning “wiggle room” with things that should be dealt with by me before am handoff. I’m wondering if my anticipation of potential problems based on patient trends needs a kick start.

I'm getting better at anticipating the mini morning med pass I'm responsible for by collecting all necessary equipment and minimizing the running back and forth, but I still need to work on that.

Any experienced or new night nurses out there who can give tips on handling the morning rush?

[Do-over, ASN, RN]

No, but I'll be interested to read any replies. I always seem to be the last one in my rooms in the morning... I am thinking I am just slow =)

[ProgressiveActivist, BSN, RN]

0500: or as soon as you labels print, draw am labs, hang am abx, get fs, give SSI coverage, Make sure your pressors and sedation won't run dry or mix new bags, place pt on his back for PCXR. Change suction canisters and Yankauer, label a new irrigation set. Get daily weight and clear pumps.

0600 XR folks have messed up your pt. Time for one last oral care, suction, booty check, change pads if needed, turn patient.

0630: finish up documentation, put totals in I&O.

That's a lot of nurse work and you might want to make yourself a checklist until you get a routine down.

Sounds like you need to just start a little earlier so that you don't get bogged down.

[tcvnurse, BSN, RN]

When I was a night nurse, one of the most important things I learned to do is this: Do the hardest thing first. If one of your patients is way more work than the others, more IV antbx, meds, whatever, always start with that task first.

You get it over with sooner, and best of all, you no longer have to dread going in there.

Also, bring extra IVF bag in when you do your med pass. If the liter bag is a quarter full, I hang a new one. If not, I hang the second bag off the pole and it is there when you (or the day nurse) needs it.

Your unit sounds like a good one!