AM nurses, tell me what I can do to make your shift start easier.

gninab · Sep 20, 2011

Please make sure saline locked IVs are patent. I can handle messy rooms, near-empty IV bags, and patients c/o pain and/or nausea. However, if I've got staggered administration times of 2 or 3 IV piggybacks beginning at 0800 am, only to have a difficult stick with an IV site that isn't patent, it can throw off my entire morning. What's worse, it delays treatment for the patient.

It would also be nice if you could check a patient's dressing. On far too many occasions, I've started my shift with 1 or 2 patients lying in bed with dressings saturated with either bloody or purulent drainage. Many of our doctors come in just after shift change, before I've had a chance to clean the patient up. More than once, I've taken the brunt of a physician's irritation over a patient lying in bed with a soiled dressing. I realize there are some heavily draining wounds where this isn't really anyone's fault - it happens. But when the dressing is loose, soiled and has obviously been there for days (sometimes verified by the date on the dressing, if visible), it sucks to be the oncoming nurse receiving this patient for the very first time only to have the doctor scowl and think I'm responsible.

Like the previous poster said, these tips go both ways. I realize night shift does not want to come to work and be met with these exact same problems. These are just my pet peeves. I would rather have three patients need zofran and a pain pill than be met with the IV and bandage problems I've mentioned.

Oh! I wanted to address the poster who said they can't understand why a patient would say they have been in pain all night, followed by wondering if nurses were doing their rounding. Just let me say, I have had many patients try to get pain medication before it is due by telling me the night shift didn't give them anything all night. They don't always know we can see when a med was pulled and administered! I'm sure there are times when they can't remember having received meds they actually did receive, due to being ill, post-op, on narcotic pain meds, etc.

Meriwhen, ASN, BSN, MSN, RN · Sep 20, 2011

In addition to all of the above, be ready to give report on time. Nothing is more annoying than getting onto the floor late because the report was late or ran late...especially when you know doctors, secretaries, administrators, housekeeping, etc. are all going to swoop down on us in the next 30 minutes or less.

Likewise, let us on day shift know what we can do to make YOUR shift start easier! This is a 24/7 job, you know...so we should all be working to help each other out :)

turnforthenurse, MSN, NP · Sep 20, 2011

I work night shift, and our labs always come back in the AM - usually between 0500-0600, but sometimes not as late as 0700 or after. If labs are out of whack (especially electrolytes), it is the night shift nurse's responsibility to initiate the replacement. Of course, if you've already reported off and labs don't come back until later (say 0730) then the day shift nurse will have to assume the responsibility. In cases like that, I tell the day shift nurse that labs did not come back and I will chart it as well - that way it doesn't look like I'm just dumping work on the next shift.

I always call the doctor in the AM if labs or something else is out of whack. Most of the time they will tell me to have the AM nurse call the AM docs (and I document that!), but other times they will give me orders and I will be able to initiate something. On my floor, patients are usually on replacement protocols (K, Phos & Mg) which are written and do not require calling the doc for orders - the orders are already stated based on what the electrolyte level is and what the patient's creatinine level is. If creatinine is out of whack, then of course we have to call (our protocols only allow us to initiate replacement if creatinine is

I always try to take care of pain issues before day shift comes on. Honestly, it annoys me when I come on and ALL of my patients are asking for pain medicine. If they're due, just give it to them! Sometimes I'm not always available to medicate patients right away for pain - as much as I would like to be. I find this really helps the oncoming shift out. I just wish our day shift nurses did it more for us night shifters :uhoh3: Oh, and night shifters are responsible for giving meds due at 0730, so I pass them. Sometimes they can't be given (I had a patient who wore BiPAP at night and had a trach, and therefore cannot take anything PO while they are on the BiPAP, and they were still on at shift change...or if for some reason meds aren't available at that time...or maybe the patient refuses, etc...)

If the IV bag is nearly empty, hang a new one. If you can't hang it before day shift comes, at least hang it before you leave.

Make sure the patient's room is clean...take out the trash and soiled linen bags, etc. Supplies are nice, such as extra chux at the bedside or extra dressing supplies, etc.

At my facility (and I'm sure everywhere else, too), our IV's can stay in place for 3 days. If the patient is a very hard stick, we can get a doctor's order to keep the IV in for an additional 24 hours. If the IV has "expired" on my shift, I will do my best to try to and start a new one, even though sometimes that isn't always possible. I always ask how long the IV has been in and day shift always asks me the same thing.

And as other users have mentioned (and I agree), this goes both ways.

Isabelle49 · Sep 20, 2011

Good Question, I find it helpful when supplies are stocked. Also helpful is when, if the unit is slammed at shift change, the PM nurse is willing to stay a few extra minutes to help with the small stuff that can add up for one nurse! Getting water, starting an IV ect.

You would not want me starting and IV with my eyes crossed, as that is how they were at the end of night shift.

RNperdiem, RN · Sep 20, 2011

This happens rarely, but please, if a patient takes a major turn for the worse during report please stay long enough to answer the many questions the doctors are going to have.

I did not have the patient last night, so I don't know their baseline mental status, I have not assessed anyone at 0700.

I don't need you to stay for hours, just long enough to get me through until the charge nurse can assist me.

I had a nurse do this for me years ago when my patient developed seizures at change of shift and the he stayed to help.

CoffeeRTC, BSN, RN · Sep 20, 2011

What setting are you in..LTC?

If so...make sure that the med carts are stocked and ready. If you can..get the water set up and the drinks on ice etc. Don't forget the lancets, accucheck stuff and syringes.

Make sure that the treatments supplies are stocked too.

You'd be surprised on the things you can call for at night. Ask around. I never knew that I could call the lab or order certain supplies at night.

Make a list of things you are running low on (meds, tx supplies, forms etc)

Have the vitals list written down for the next shift. (update the list so that those that don't need it can come off)

Make sure the tube feeding and IVs are running and full.

Let days know who is going out for appts and when. Make sure a chart is copied and ready for them to take.

Same goes with discharges..get the stuff ready...have CNAs pack up the resident if they can.

Most of the above is already the 11-7 nurse's duties.