Evenings vs Days on Med-Surg floors?

Chaya, ASN, RN · Feb 13, 2009

Our ratio is about the same (1:4-5) but the 7P-7A nite people may get an admission bringing them to 6 pts. I don't think there is less work on eves; just the workflow is a little different. The med pass on days usually takes the longest. The docs are trooping in seems like every few minutes; you just get your orders taken off and there are new orders for a one-time/ "give now" med. Or Escort appears on the floor looking for paperwork to take your pt to a procedure that was just ordered that you didn't realize they were going to...Plus PT, Docs and Case Manager running in and out to see your pts so you have to work care around them.

But then, eves is when most of the admissions come in-that's about 45 min of work per admit. They usually need to pee immediately and haven't eaten all day so you need to try to enter a diet order before the kitchen closes, and they generally want something for pain immediately and can't get it without the orders being taken off and 2 RN's signing them. You are less likely to have a Unit Coordinator on eves to take off new orders and some of our admissions come up with like 4 pages of them. And eves is when the families visit; they arrive and want to talk to the Docs-who have just left. Calls to an MD can be problematic on eves; you have to figure out which covering Doc to page and in general they can give you an order for a pain med or sleeping pill or see a patient in distress but what they can NOT do is talk to Jr about the overall plan of care for Dad from the perspective of knowing the Pt. Also a maybe a little extra paperwork on eves; Eves has to total up input/output on all their pts for the previous 24 hours.

BlueBug · Feb 26, 2009

On evenings where I am, we almost never have a CNA or any help, so that means total patient care for all patients. I have had from 4-6 patients, usually 4 patients and 2 empty beds which leaves me praying for no new admits. After 11pm we have no unit secretaty so we have to put our own orders in the computer. We are pretty much on our own, no in-house Dr or pharmacy. The kitchen is closed.

We do 24 hour chart checks and make sure that ALL orders/med changes made in the past 24 hours have been entered into the computer. We put mars, labs, and physcian rounds into the charts. We do our I&Os. We are also the lucky ones who get to call the Drs early in the AM when the 0300 labs start coming back as critical values.

One of the biggest differences that I have noticed is that we have a limited amount of time to get our meds and assessments done because people want to go to sleep. I always try to get them done asap, but when the lady in room 4 is incontinent and has c-diff, the patient in room 2 had their IV go bad and they don't have the ordered PICC in yet and you are supposed to hang IV meds(The PICC guy is only there on days), and room 3 is getting IV Morphine every hour to control cancer pain(which the day shift should have had changed to a drip...) It can be crazy to do it all yourself and get your assessments in so people can settle in and go to sleep.

One more... some patients have completely different personalities at night. That patient who was A&OX3 for days and able to get to the toilet no prob may become confused and unable to walk at night. Not fun...

Days and Nights are both crazy in their own different ways.

~BlueBug

suni, BSN, RN · Mar 1, 2009

The ratio pretty much stays the same on all three shifts for us. We may have an NA or a UA but generally not both and we only have 1 LPN a shift