Don't wake that patient!!

Scottishtape · Feb 16, 2017

It appears you accepted a position in a facility that has a much lower acuity than you're used to at the hospital, thus, the less frequent checks.

Now, just because they're more stable, doesn't mean you can or should do something that makes you feel uncomfortable. If you want to visually check them Q 2*, then do it. They can't stop you, and most likely won't.

Nursing judgement trumps facility suggestion in my opinion.

CoffeeRTC, BSN, RN · Feb 17, 2017

For the most part, we do not wake the residents just to check them. Sometimes there is not need to wake them to check on them. Unless they are on vital signs q shift or more frequent, there is no need. If they have a treatment or iv med timed then that would be a good time for a mini assessment. I do visuals every 1-2 hours when I work 11-7. I'm normally down the hall helping the cnas or giving a prn anyway.

loriangel14, RN · Feb 17, 2017

Why would you wake the patient?

I work on a low acuity floor. We check Q2-3h but we don't wake them.

AceOfHearts<3 · Feb 17, 2017

Vitals every 2 hours? I'm on a tele unit and we only check every 4 hours unless we think the patient needs it more often. We even omit the 3-4am vitals on stable patients that aren't new admits.

gwengil23 · Feb 17, 2017

YEs every two hours and or as soon as possible. I am experienced SNF supervisors for more than ten years and I completely understand your concern. I was actually make my self to have a routine rounds and as soon as the call light turns on. It is not only dedicated to CNA but me as a nurse who need to be there for the patient in needs and ready to provide our professional services. Thank you.

amoLucia · Feb 17, 2017

just doing our jobs

Why would you wake the patient?
I work on a low acuity floor. We check Q2-3h but we don't wake them.

Just make sure you see their chests rise & fall. At least you'll know they're still alive. Nothing worse than walking in and finding a pt 'cold', purple-y and in rigor.

But then you have to determine if they're 'normal' sleeping, or are they 'unconscious' sleeping. Light from the bathroom casts just enough soft ambient lighting to help see.

I liked to make some minor noise in the room just to see the pt stir a bit. Also just a little movement of the bed covers will usually make a pt rustle a little.

Since your pts are 'skilled' you most likely will have some reason to provide some kind of care. Coordinate your checks with that activity as others PPs have wisely suggested. Or catch them if a CNA/PCT does care.

But in the end, if I felt I needed to wake someone up, I did so. I figured pts knew that being in a healthcare facility there would be expected services to be provided (else the pt would still be home, right?). So we were just doing our jobs if we had to wake them. They'll get over it when they go home.

You'll soon learn the fine art of distinguishing who is OK to wake up or who to let sleep. Just let the whiners, complainers, call bell pushers, screamers, climbers, etc alone if you can! You'll learn!

lovingnurse1967 · Feb 17, 2017

I worked on a med/surg floor on night shift for 17 years. I agree on not waking the patients unnecessarily. I learned quickly to sneak in with my penlight and takes steps softly "like a cat walking on a cloud" especially with confused pt's who if you woke them up they would be awake screaming all night. My problem is other coworkers counting how many times I check my pt's and telling me to only check them at the beginning and end of each shift. I found out one of the pt's when I was off had two major nose bleeds and was rushed to the ER with a 5.3 hemoglobin. This is the patient they said "don't check her so often you will wake her." Pt. on 3 blood thinners, Lovenox, ASA and Warfarin.

datalore · Feb 17, 2017

I work in cardiac intermediate care (stepdown) and I'm only "ordered" to do q2-4 vitals and assessments - sick enough that they are moderately septic, bipap-requiring, titrating cardiac drips, unstable angina... etc. (Of course I do as often as clinically appropriate in addition.) At a nursing facility, these folks are definitely more higher-need than independently-living individuals but they are stable enough that they're "at home with help", so I would feel very comfortable with less frequent vitals if I walked by and they were breathing normally. :)

amoLucia · Feb 18, 2017

OP - Sorry, I missed the prior hospital experience. And I was thinking that you were talking about LTC with 'skilled services'.

There still is a MAJOR shift when the facility level of care changes. I remember when I switched from hosp to LTC. I was 'APPALLED' that the nurses weren't doing VS at least q shift. Lung sounds? What were lung sounds? Once a month charting? Horrors!

Boy, did I have a major adjustment due. As for your peers' counting, ignore them. It'll wear off. Esp when you catch something unexpectedly.

I have had that 'ESP' premonition at times and I would just awaken some of my DM pts 'just because' of my 'funny feeling'. Dang, if I wasn't

right! I know, deep down, that I saved some lives just because I followed that 'just because' hunch.

Check your unit's protocol if there's any standard requirement for routine checks. It seems the q2h is becoming more the norm at many places. They usually DO NOT require a wakeup. But if you feel there's a need, follow your instinct. Always err on the safe side.

quiltynurse56, LPN, LVN · Feb 19, 2017

I say if you want to do rounds q 2 hours, than do it. It can be a simple visual check and with that you know whether you need to check something or move on.

I work in LTC and during that calmer part of the night when most are sleeping, I will walk down the halls and stop at every door to do this.

Been there,done that, ASN, RN · Feb 19, 2017

I worked on a med/surg floor on night shift for 17 years. I agree on not waking the patients unnecessarily. I learned quickly to sneak in with my penlight and takes steps softly "like a cat walking on a cloud" especially with confused pt's who if you woke them up they would be awake screaming all night. My problem is other coworkers counting how many times I check my pt's and telling me to only check them at the beginning and end of each shift. I found out one of the pt's when I was off had two major nose bleeds and was rushed to the ER with a 5.3 hemoglobin. This is the patient they said "don't check her so often you will wake her."

Do a visual check as often as you feel necessary. This is all about YOUR practice.

Co-workers have nothing to say about it.

"Pt. on 3 blood thinners, Lovenox, ASA and Warfarin.'

is another thread. The physician, pharmacy, and attending nurses.. ALL made a huge med error .