Does your DON want you to do skin checks on night shift?

[Blackcat99]

We got a new DON. The residents are mad because they are now being awakened on night shift to have skin checks done. I am tired of the residents always getting upset and angry with me for waking them up at night. I know if I were a resident and a nurse awakened me at night for a skin check I would be angry too.

[geriatricRNBSN, BSN, RN]

Yes, we do. The nurses usually wait till around 6 am when the residents are 'rousing and some meds are being given. It is easier to assess the resident in bed. We do NOT have them do more than 2 skin assessments per day for any nurse.

[Blackcat99]

Our IV antibiotics are usually ordered for 6am and we have many people getting meds at 6am. And of course, our pharmacy always makes their biggest pharmacy delivery at 6am too. They are trying to get us to do 8-10 skin checks a night. And they want us to leave on time-they do not want us to do overtime for any reason.

[CapeCodMermaid, RN]

They used to do skin checks and routine vitals on the 11-7 shift. I stopped this practice. IF and only if a resident requests to get up early, they may do a skin check in the shower. Otherwise, the skin checks are done on the day and evening shifts. I've also told the CNAs not to interrupt an activity to get routine vitals. If you read any of the latest studies, we are doing way more vital sign checks than we need to. Even in the hospital (with the exception of the ICU), there is very little benefit to getting vital signs every 4 hours. I'm working on changing routine vital signs to monthly and changing weights to monthly as well.

[vampiregirl, BSN, RN]

The facility I work at used to do routine skin checks on noc shift too. Now only post-incident skin checks (q shift x 3 days) are on noc shift, with just a few exceptions. The routine skin checks are scheduled for each resident's first shower of the week. So if the resident has requested an early morning shower, and we do have a couple whom this is care planned for, then this would be one of the exceptions.

Not only does it interrupt the resident's sleep (and a roommate's sometimes too), but the lighting isn't the greatest either.

[vampiregirl, BSN, RN]

If you read any of the latest studies, we are doing way more vital sign checks than we need to. Even in the hospital (with the exception of the ICU), there is very little benefit to getting vital signs every 4 hours. I'm working on changing routine vital signs to monthly and changing weights to monthly as well.

We also do just monthly weights, unless someone is being monitored for weight gain, weight loss, or CHF.

As for vitals, we check monthly unless someone is on an anti-hypertensive or psychotropic med, then it goes to q week (orthostatics for psychotropic med use). New admits get vitals assessed q shift x 3 days so we have a working baseline. We also have a protocol for unwitnessed falls/ head injuries. Occasionally we also get a doctor's order to monitor more frequently, but this isn't really common and usually for a specified period of time.

[Rose2013]

We do them on night shift. The resident's get upset and have attempted to hit us because of it.

[BuckyBadgerRN, ASN, RN]

Ours are split up, some days, some NOC's. I try to do as many treatments as I can when I do my 8pm med pass, along with weekly assessments, alert charting, skin checks, etc. BUT clearly I can't get everything done in that allotted time. I'll make a list of people of need to see and give it to my CNA's so that when a resident on "the list" gets up in the night, I can slip in and get what I need then. If someone is very opposed to a skin check at night, we can usually get it changed to days, not a big deal, our DON works with us on things like that

[glycine45]

you may not force upon a resident against their consent, especially if a & o x 4,it may be legally demeaned "assault"

[chrisrn24]

We do. Fortunately most of the people are people who tend to be awake at night.

[mind_body_soul RN]

I have to do skin checks on nights sometimes if days pushes it off onto me or if someone fell on evening shift. We also have qshift charting and vitals on 10-12 residents, so if they call in the middle of the night for something I'll try to do my assessment then, or when the aides are changing/turning people for rounds. I hate waking people up One day when I am in a nursing home, I will be the combative crazy one hitting everyone and yelling if people wake me up at night

[NurseDirtyBird]

I worked in a facility once where the DON ordered skin checks on NOCs. That ended pretty quickly when there was a lot of charting along the lines of "Resident refused skin assessment, stated "I'm sleeping! What's wrong with you?" Then it was changed to all skin checks during showers. Which makes more sense anyway. They're already naked and the shower room is better lighted.