Night shift time management - new RN

[graykitty]

Hi, I've been an RN for 7 months now, and still having trouble with time management. I work nights-- either 7p-7a, or 11p- 7a. It's a med- surge/ renal floor, 1 nurse to 6-7 patients, all computerized system, with physician order entry as well. My biggest issue, especially on 11p- 7a, is charting as you go. After getting report, I hit the floor at midnight. If I chart the assessment, look at labs, do the accuchecks, chart IV and wound assessments, and pass/hang any meds & chart them with pain assessment, I am easily into a 30 min round. At this pace, I will be waking up my 7th patient at 2:30 - 3:00 am, with some of them receiving their meds late. Our charge nurses feel this is unacceptable, because patients need their sleep at night. For this reason, I try to get my tasks done, leave place markers in the electronic chart of the actual time af ea pt's assessment. I get done seeing my 7th Pt by about 1:45-2am or so, then I sit down and chart, while the Pts are sleeping. 5am starts accuchecks again, line draws for labs, 6&7 am meds, and be ready to give report at 7am. This is in a perfect world, LOL! I clock out on time about 25% of the time.

7p-7a shift is sometimes easier, because you have more time to get it all done! However, the massive med pass at 9pm sometimes cancels out the "extra time" benefit... There are times when I finish giving my 9pm meds at 11- 11:15pm (if you happen to be my last Pt to be seen). We usually have 1 CNA for the whole 30-rm floor, and when you need a set of vitals, water, an accucheck done, etc, either you can't find them or they're busy with another patient and they'll be awhile. If I need a BP in order to give a BP med, I have to do it myself.

At the risk of beating a dead horse, recent example:

I'm scheduled 7p- 7a. Regular charge nurse calls off with family emergency. Person thrown in as charge is still being trained and doesn't feel comfortable yet as a charge nurse without someone seasoned to rely on for help. So, a seasoned nurse is called in to help (I'm advised at around midnight) and arrives at 1am. I am to give my 7 pt's to her and I can go home. Problem is, I passed meds & saw my patients from 8:30 till 11:30p, and didn't do any electric charting (had planned to catch that up at midnight). So, after giving report to the oncoming nurse at about 1:30- 2am, I did all my charting and clocked out at 5am!

I never chat at work, nor do I ever take a lunch -- I'm never hungry at night and prefer to stay on track. I combine med passes and try to save steps by anticipating what my patients will need next. My teammates are wonderful and we help each other out when needed. I just wish I could speed up and get out on time 75% of the time! I won't cut corners and I don't want to leave knowing I left documentation undone. Does anyone have any constructive criticism that can help me? I had hoped that by my 1 year mark, I would have my time management skills very much improved.

[graykitty]

I work night shift as well - but our nurse to patient ratio is 4:1. On one side of the floor it is usually 3:1 and the other side is usually 5:1 but that side also has 2-3 CNA's.

AlisRN, what area of nursing are you in, with those ratios. I'm interested in hearing from others too. On my med surg/renal floor, our ratio is 1 to 5-8 patients. Also, from midnight to 7a we have only 1 CNA for our floor (30 rooms). So, I end up doing a lot of I/O's, v/s, etc. Without much help, it is so hard getting done on time.

Recently, I reported for my 7p-7a shift, and found out I had been cut to a 4 hr shift that night. The hospital is cracking down on nurses with overtime due to staying over to finish charting. I was told to "chart as I see my patients, see my last Pt by 10:30p, give report at 11p, and clock out no later than 11:30p." I was lucky to have only 4 pt's and one new transfer to our dept. My 9p med pass was LARGE. Let me tell you, I FLEW through assessments, meds, and charting ( which I still couldn't do as I went). I finished with report at 11:40p, and still had to file a risk report on my transfer Pt. I clocked out at midnight. No way I could have done anything faster.

What if I had more patients? And more meds? And a full admission (get dr's orders, etc) instead of a transfer? I have no idea how I could handle it all in 4 hrs and have ALL the required documentation done. Any nurses out there who do this regularly?

[SiennaGreen]

I am also a new grad night shift RN. Trained on days, and moved to nights three months ago. My assessments have changed radically, timing wise, because I feel that one of my patient care goals is ensuring that my patients get some uninterupted rest. So, I typically get report, do a quick hello, assess major pertinent systems (chest tube? respiratory, dressing, pain.) I write down any pertinent findings on my report sheet, and since we chart by exception it doesn't take a lot of time. If I start at 7, I usually can finish that initial rounding by 8pm. Then I prepare for nightly meds, making sure to check for any prn sleep meds. If I see a patient has taken Ambien for the past three nights on the MAR, I pull it and take it with me rather than run all the way back to the med room after I check in with the pt. I can always return it into the pyxis. I have 2 hours to pass meds to my 6 patients. Usually I will do any detailed assessment during meds, clear pumps, hang full IV bags, and generally get everything ready so as to not interupt my patient any further. The techs do vitals between 11-12, and then in an ideal world my patients can get 4 hours of solid sleep. I get most of my documenting done between 1-4, then begin prepping for mornings labs, meds, dressing changes, baths, et cet.

That's a good night. Then, most nights I end up with an admission somewhere in there and it throws me off completely...but I try!

[FairyPrincess06]

So glad I found this posting as its somewhat helpful for me. I have 6-7 patients a night on an in pt surgical floor and time mgmt when it comes to computer charting in meditech is eating up my time at the current moment. I think I may try standing and charting on the wow even if its not right after seeing the patients. I also may try using the timer on my phone to try to keep myself on task when charting in an attempt not to let time get away from me. I'm almost off orientation only 3 more shifts left, crazy.

I am also curious to know if anyone has suggestions about giving report at the end of nights to day shift. I have been told I tell too many extra details/info at times. Also bed side report/hand off, does it really make things easier for your shift? I hear a lot of nurses say it takes too much time so they don't like to do bedside report. Any suggestions would be helpful, thanks in advance, and good luck to the new night nurses out there...it does get better/easier,right?

[FairyPrincess06]

Update: my report at work, so I have been told, had been improving each shift :) My timeliness inregards to documentation gets better when I use a timer and limit myself to 10mins an assessment to document in the computer. I also find that I do better if I chart away from the main group of nurses at the front of the nurses station but close enough that I am in ear shot of my coworkers should they need me or my pts call for assistance. My new need to work on is starting my shift as timely following report as possible and starting my morning routine closer to 5am so that I finish in time to give day shift a timely report. Any suggestions as to things should I need to pass them on to the next shift are ok to pass on to next shift or go back and finish after giving report?

[SweetBabyJames]

I feel like with 30 beds you need more than 1 CNA! Do you have any other non-RN staff members to help? Plus with your high ratios, I just don't really see how you could do a quality job while getting everything done at all!

It kinda seems like you're set up to fail.

That being said, Maybe you need to reorganize your charting. 3 hours is a long time. Sometimes you just have to write a "patient handed off to next nurse stable, comfortable, VSS." And take off. For your sanity, but also so management doesn't get on you about staying longer than needed.

Good luck!! You will figure it out. ❤️