Night shift time management - new RN

  1. 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.
  2. Visit graykitty profile page

    About graykitty

    Joined: Dec '09; Posts: 14; Likes: 34
    RN Med surg, Renal, & Pacu; from US
    Specialty: 2 year(s) of experience in Med surg, Renal, & PACU

    15 Comments

  3. by   ckh23
    I don't believe in charting as you go, especially on night shift. On nights you hit the ground running and assessing someone and immediately charting seems ludicrous. I would start writing down pertinent things on a piece of paper, such as something abnormal on your assessment, what time you gave a prn med, etc. This way you can chart later and not have to remember what you did.

    Just from reading your post, it sounds like you need to get a little more comfortable and quicker at assessing patients. Now that being said, I'm not suggesting taking shortcuts, but finding a system that allows you to do your assessment efficiently in the least amount of time. For example when you walk into someone's room you can easily assess mentation and airway/breathing by having a simple short conversation. At the same time you should be looking at the patient to see if anything is out of place, ie are they pale, are the sweating, etc. Something I like to do is listen to breath sounds, heart sounds, and bowel sounds one right after another so I don't have to keep putting on my stethoscope 3 times. After you do your assessment I would just down a quick short hand note on paper of what you found, if anything.
  4. by   joanna73
    I agree. I work nights and there is no time to chart as I go. I keep notes and focus on getting my work done. Realistically, your charting can be done anytime within your shift as long as you have a report sheet. When I was on Acute Care, most of the nurses wouldn't finish their charting until 3 or 4 pm on day shift. The priority is your assessment, meds, orders.
  5. by   turnforthenurse
    I also work nights. The only time I "chart as I go" is when I'm administering meds, because it is policy on my unit to have a med COW with us in the room with the patient MAR pulled up. With this I can double check patient identifiers and my medication dosages. As for assessments and other things, I find charting as I go with that nearly impossible. I always carry a piece of paper on me and write down any pertinent information and note the time that it happened, that way I can accurately chart it later.
  6. by   ~Mi Vida Loca~RN
    We have the WOW's (formally known as COWS until a patient got offended). We also have PPID which is wonderful for night nurses. It's like a little handheld palm pilot. You scan your badge and enter your PW and it logs you into the system. You scan the Patients band and the meds. Then you click the button to sign them. So all your meds are charted then.

    Our computer program has a task tab that is a godsend. Really helps to keep you organized and on track. We do hourly rounding and we do walking rounds for report.

    So I go on shift. Get report and introduce myself to my patients and families if they are kiddos. Nurse A leaves, I go in to do my assessments and take vitals and talk to the patients. That takes probably about an hour for all patients if I have a full load. So now it's close to 8:30. I get my meds due and pass them and see if they need anything else. If not I go and do my charting. It takes me about a half hour to 45 mins. I tick all the forms I need and after each one the next one pops up. So I am usually done around 9-9:30 and free to answer call lights and do my rounding and so on. On busier nights it might not calm down until 12 to get caught up. Sometimes it never seems to get caught up but that is more the exception. Usually I have a couple hrs each night that I can do all my charting and get caught up before things pick up again.
  7. by   JRP1120, RN
    Quote from ~Mi Vida Loca~RN
    We have the WOW's (formally known as COWS until a patient got offended). We also have PPID which is wonderful for night nurses. It's like a little handheld palm pilot. You scan your badge and enter your PW and it logs you into the system. You scan the Patients band and the meds. Then you click the button to sign them. So all your meds are charted then.

    Our computer program has a task tab that is a godsend. Really helps to keep you organized and on track. We do hourly rounding and we do walking rounds for report.

    So I go on shift. Get report and introduce myself to my patients and families if they are kiddos. Nurse A leaves, I go in to do my assessments and take vitals and talk to the patients. That takes probably about an hour for all patients if I have a full load. So now it's close to 8:30. I get my meds due and pass them and see if they need anything else. If not I go and do my charting. It takes me about a half hour to 45 mins. I tick all the forms I need and after each one the next one pops up. So I am usually done around 9-9:30 and free to answer call lights and do my rounding and so on. On busier nights it might not calm down until 12 to get caught up. Sometimes it never seems to get caught up but that is more the exception. Usually I have a couple hrs each night that I can do all my charting and get caught up before things pick up again.


    Are you serious that a pt really got offended that your computer was called a COW??? Even after they were told what it stands for? It amazes me what some people will say "offends" them! LOL. So, what does WOW stand for? During clinicals, we had a nurse that called the vitals machine you take into each pt's room a "nurse on a stick" LOL Funny!

    The little palm pilot thingie you talk about sounds really cool. Wish our hospital had something like that! We take the COWs into the patients room for meds and scan the meds and pt that brings their MAR up on the screen. As technology advances, I wonder what other gadgets we'll be using to help us get the job done. Tablet PCs are just around the corner I bet!

    I hope to work noc shift and these ideas for time management are great!
  8. by   ~Mi Vida Loca~RN
    Well it did sound bad. All the pt hear is "go grab the cow by room 56" or similar. WOW is workstation on wheels.
  9. by   graykitty
    Thanks everyone for all the tips and comments on my op. My routine is, get report, meet all my patients put my name & phone # on their board, I can then assess mentation, ck if IV bags are low, if they need pain meds, etc. Then I get all my scheduled meds, any pain meds & IVF bags and my WOW. I do quick assessment (steth for lung, heart & bowel sounds) then ck radial & pedal pulses, edema, wounds, bruises etc. Pass all meds. Then go to next patient. Its difficult staying on track when you keep getting calls, "rm xxx needs something for pain" when you were just in there & they said they weren't in pain. So, you leave your current pt to go and get pain meds for that pt, and return to the room you were in. Sounds like some of you do all your assessments first, and then go back & pass sched meds. If I know from report that they're due for pain meds, I could grab it & give it when I do my quick assessment. The I shouldn' t have any of those interruptions when I go back to pass 9 pm meds, which is a huge med pass. Do any of you follow that routine?
  10. by   turnforthenurse
    Quote from JRP1120, RN
    Are you serious that a pt really got offended that your computer was called a COW???
    That happened at my previous facility. Nurses were talking about COWs and the patients overheard them and thought the nurses were calling the patients cows
  11. by   ~Mi Vida Loca~RN
    Quote from graykitty
    Thanks everyone for all the tips and comments on my op. My routine is, get report, meet all my patients put my name & phone # on their board, I can then assess mentation, ck if IV bags are low, if they need pain meds, etc. Then I get all my scheduled meds, any pain meds & IVF bags and my WOW. I do quick assessment (steth for lung, heart & bowel sounds) then ck radial & pedal pulses, edema, wounds, bruises etc. Pass all meds. Then go to next patient. Its difficult staying on track when you keep getting calls, "rm xxx needs something for pain" when you were just in there & they said they weren't in pain. So, you leave your current pt to go and get pain meds for that pt, and return to the room you were in. Sounds like some of you do all your assessments first, and then go back & pass sched meds. If I know from report that they're due for pain meds, I could grab it & give it when I do my quick assessment. The I shouldn' t have any of those interruptions when I go back to pass 9 pm meds, which is a huge med pass. Do any of you follow that routine?
    If the pain meds are due right around shift change time then the off going nurse is expected to have passed them out right before hand so that patients aren't requiring meds right at shift change. It doesn't always happen like that but they are pretty good about it. Like I had a patient that had some meds due at 7:30, I gave them out around 7:15 (we have an hr either way) so that the oncoming nurse didn't have meds that needed to be passed out right away. Technically I could have left them for her since I have to be clocked out by 7:30 and she comes on at 7 so we have that 30 mins of in between. But I didn't feel it was right to do that.
  12. by   tdupuis
    I personally do not see how anyone has the time to chart as they go. I have been an RN on my own now for about 6 months now and I must say even on day/evening shifts (we have 8 hour shifts at my hospital) I often do not have time to chart as I go. We have all electronic charting at my hospital, the only thing that is written is our MARs which we sign for in the book, and it is rediculously time consuming. We have to sign into the computer, the the electronic chart, then pick the patient then go into the charting section, then select the appropriate area/assessment you want to chart on - it takes at least 2 minutes just to get to the page you want to chart on! Also for us we also have more nurses on the floor than we do computers, and often times computers are being used by other staff members as well (doctors, discharge planning, pharmacy, etc.) so even if I do find a minute in my day to catch up on some charting I'm lucky if I find a computer to do it on.

    I carry around a sheet of paper with me with all my patient's information and I write down my vitals, assessments, IVs, etc. on there and keep it in my pocket then chart it later. However this isn't the best solution either because having all my charting to do at the end of my shift backfires (sometimes Drs go into the computer to look up vitals, etc.) and if they aren't in there when they check it they don't see it. This also backfires because leaving it til the end of my shift I have 5 patients to chart on and it takes me at least 5 minutes to chart on each, there's 25 minutes right there, plus having to record report (we still have taped report) and count our narcotics, I'm almost never out on time, however I don't see much way around it other than missing my breaks to chart which isn't fair either.
  13. by   AlisRN
    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.

    I keep a piece of paper sectioned off with 1 section for each pt & write down in abbreviations (of my own choosing) everything I need to chart so it's sort of a short-hand. Then, when all assessments are done, I go back and put it all in the computer chart.

    You can make up your own "sheet" on Excel or Word as well so you can just fill in the blanks as you go - if you know everything you need to chart.

    Alissa, RN in MA
  14. by   graykitty
    Quote from AlisRN
    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?

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