Can you describe your 12hr 7a-7p shift?what goes on and tips

Been there,done that, ASN, RN · Jul 9, 2012

I don't mean to scare you , but....

Hopefully you will receive a quick and thorough report. Ask questions after each patient to clarify any thoughts/questions you might have.

Eyeball your peeps , look at your vital signs and labs and start the AM med pass... ASAP.

Unless you have the luxury of a 1:4 ratio... FORGET a head to toe assessment. Concentrate on the system(s) that is the reason for admission. While briefly assessing the rest.

For here on out.. time management and organization are OUT THE WINDOW. You will be running around, putting out the biggest fires.

Don't forget to smile the entire time. It's now a job requirement.

Keep up with your meds and IV's at all costs.Delegate to your assistant . If you get flack in any way, start writing them up.

Good luck, let us know how it goes.

Please fellow posters... don't even go there with MY advice.. this is how I have successfully made it for 30 years, and considered an excellent nurse.

tokmom, BSN, RN · Jul 9, 2012

Can you give us an idea on ratio, whom is on your team? LPN, CNA?

What I have done that works for me:

Get my cheat sheet ready with my pt's names

Obtain report from Nocs.

As I'm getting my report, I'm mentally going through my pt's acuity and making a mental list on whom I'm going to see first and second, etc..

Some nurses see the sickest first, others the easiest. See what works for you.

Once of report, check your med times and labs if back.

Go round on your pts and do your assessments. Put out fires as needed.

Pass meds within the next hour prior. Remember, you have an hour before and after.

Always put in the back of your mind that you could get an admit at any time. I think 'working' ahead in your mind helps you become organized and stay that way.

Yes, your prev job can and will help you in your new position.

Congrats and welcome to Med/Surg. I hope you find it as interesting as many of us long time med/surg nurses do. :)

lvloverRN · Jul 10, 2012

thank you so much for your time and response..appreciate it!

lvloverRN · Jul 10, 2012

thank you tokmom for your time and reponse.... and for your encouragement. God bless.

suziqiluv · Jul 11, 2012

why in the world would a person check their sickest patients LAST?

suziqiluv · Jul 11, 2012

why would you want to check your sickest pt last? you need to see them FIRST

lvloverRN · Jul 12, 2012

prolly bec you know you'll get stuck with them for a while and might not get a chance to see how the others are doing / baseline upon coming to your shift..im not sure but i guess it depends how sick they are, are they in distress or not, that's the question.

Susie2310 · Jul 12, 2012

prolly bec you know you'll get stuck with them for a while and might not get a chance to see how the others are doing / baseline upon coming to your shift..im not sure but i guess it depends how sick they are, are they in distress or not, that's the question.

When my husband was admitted to a med/surg unit with acute renal failure and sepsis, I certainly hoped he was high on his nurse's (and doctor's) prioritization of patients to see. I would have been very unhappy if I had thought his nurse had given him a lower priority because he was very sick. He needed fluid boluses and antibiotics, and he needed them quickly. People die from septic shock and renal failure. The point I'm making, and that I think the above poster is making, is that acutely ill patients need prompt care and should be a nurse's first priority. The nurse needs to prioritize on the basis of the patient's needs: Who is the sickest, most unstable patient right now, what is going on with them, and what medications/IV fluids or other care does the patient need now to prevent further deterioration.

tokmom, BSN, RN · Jul 13, 2012

prolly bec you know you'll get stuck with them for a while and might not get a chance to see how the others are doing / baseline upon coming to your shift..im not sure but i guess it depends how sick they are, are they in distress or not, that's the question.

I don't mean pts that are ready to code or even an RRT. I mean those with a zillion tubes, higher acuity, max assist etc..Some nurses see the lesser acuity first to get them out of the way so they can spend time with the higher acuity.

tokmom, BSN, RN · Jul 13, 2012

When my husband was admitted to a med/surg unit with acute renal failure and sepsis, I certainly hoped he was high on his nurse's (and doctor's) prioritization of patients to see. I would have been very unhappy if I had thought his nurse had given him a lower priority because he was very sick. He needed fluid boluses and antibiotics, and he needed them quickly. People die from septic shock and renal failure. The point I'm making, and that I think the above poster is making, is that acutely ill patients need prompt care and should be a nurse's first priority. The nurse needs to prioritize on the basis of the patient's needs: Who is the sickest, most unstable patient right now, what is going on with them, and what medications/IV fluids or other care does the patient need now to prevent further deterioration.

Yes, I'm well educated on sepsis. I educate nurses on the protocol. I'm not talking about a severly sick person. (see my post above) I would like to think a nurse would use critical thinking in such a situation and see your husband first, and get him to an ICU where aggressive fluid resus can be done with ABX, pressure lines, etc..

I'm talking STABLE, but higher acuity...sheesh

tokmom, BSN, RN · Jul 13, 2012

why would you want to check your sickest pt last? you need to see them FIRST

OMG people, read the post above!

I'm NOT talking about ignoring the circling the drain pt that and seeing a simple post op etc..

Geez!

I'm not going to repeat myself.

For the OP. I have done it both ways and it depends on my acuity/load, what I do first. And for the record with over 20 yrs of nursing and certified in Med/Surg, I have never coded any of my pts or been surprised by a down turn. I must be doing something right.

The only times I have almost ran to a room to see a pt is when some dumb nurse tells me in report the pt's KCL is 7.5 and she could not figure out why the pt is 'sleepy'. Or the nurse who told me a pt's tele was showing something that looked liked gravestones. Now those situations I can tell everyone that I did of course, see those pts first. I also called an RRT and took care of that pt before seeing the lesser acuities.

This is why you have to use your brain in report to weed through the fluff they give you and prioritized who to see first. If all your pt's appear super stable, go see the lesser acuity if granny is going to take a bulk of your time.