11-7 Floor Nurses a Question Please

Tweety I work in a small rural hospital 25 beds. Some long term, some skilled pts., few acute ones..sometimes none acute. I don't wake those who are sleeping and don't need vitals. I observe them as they sleep for resp., color, foley, etc. I value the 3-11 nurses report on the patient and feel comfortable just observing at midnight if they are sleeping. Our meds are scheduled to be given for the most part no later than 10pm. The acute patients are different..they get a total assessment q 4 hrs. I have worked 3-11 and it's very busy with treatments, meds, getting people to bed etc. 11-7 at my hospital is much quicker to assess. Often times waiting for the ecf and skilled pts. to wake up and call to assess lungs, bowel sounds etc. Of course if there is a problem with anything I would assess at 11 and as often as necessary. Basically I am done in a half hour after report on 9 pts. Our hospital is different from the larger ones though. When I worked in cardiac, it took about an hour and a half to give meds, assess, etc on 8 pts. Guess it depends on what is going on with the type patients you have.

OK, this is gonna bore you to tears, but here's my SOP for the shift:

I work 11-7. I come in, get my assignment, staple and fold my Cardexes, and get my Report sheets stamped up. We use written reports from shift to shift, so we're out on the floor as soon as we want to be. I'll have 6-9 tele patients with a tech, up to 6 without.

The tech and the 3-11 staff is still on the floor finishing up. I go around all the rooms and make sure that everyone is breathing by peeking in the room, then I concentrate on looking at the chart for orders and then I write down the times & meds I'll be giving on my shift. Now I know if I help someone to the bedside commode, that we need a UA or that we need to OB stools, for instance. I also find out what meds patients already have hanging--like blood, for instance.

Then I go back around with meds in hand, and I do all my assessments. When I go in a room, if the bed pad is up around the patient's neck, I get them squared away and comfy as I do my assessment. My tech does the vitals and I/O's, so I deliberately delegate that stuff to him/her unless there's a really pressing issue there. She'll be changing the wet folks through the night, but since I have to assess them and the 3-11 shift has usually just changed everyone, I don't find many problems.

As I finish at each room, I complete the flow sheet and scribble a brief blurb on the nursing progress notes. The rest can wait.

I'm usually done with assessments and meds by 0230, and that's good because the cafeteria closes at 0300, and I must take my break now. I run down and bring my food & coffee back up to the floor and scarf it down in the break room while getting a 10-minute BayNews 9 update.

Then I come back out on the floor and start doing chart checks. This sounds simpler than it is. I catch errors in transcription from the lab, incorrect orders written by the doc or the nurses, and have to get clarification. I find order entry errors from our very busy unit secretaries, and get them corrected. I especially check over the orders for patients who are transferred from other units because I invariably find that someone didn't order the CKMB on our Cardiac Enzymes. That necessitates a call to the Lab. On rare nights, everything is perfect, but there are 5 pages of orders to check. All of it takes time--sometimes hours--to straighten out. The other shifts fail to grasp this and this misconception is why they think we're "not doing anything" all night. :stone

*PS Don't gloat over their mistakes or they'll gloat over yours. We all make 'em, yanno?

Then I look over all the consults, tests, and labs from admission on for each patient. Very briefly. As I do each patient's chart, I start at the front, check the meds, the orders, the H&P, and the tests, usually in that order. Then I'll write up a quick Report on our Report sheet--which is also basically a flow sheet.

At 0530 I pull my 0600 meds and hope to heaven that I only have a couple more chart checks to complete. I give my 0600 meds, finish up the charting, and put the phone calls out to the docs that were able to wait till the a.m.

Now that is a very basic scheme, and as you can see, it doesn't cover admissions, preceptoring new nurses, q2h neuro checks, q4h vitals, sending unstable patients to the Unit, working without a tech, Codes, transporting patients down to CT scan (we have to do it ourselves at night), replacing IVs, covering for each others' breaks, getting confused patients taken care of (which also falls into the replacing IVs repeatedly category), getting critical labs called to us at 0500 and starting stat treatments, getting pain med orders, treating chest pain (averages about an hour), consulting with one another about lousy handwriting, weird orders, & funky rhythms, and getting meds from the AOD when they're not profiled in the Pyxis.

Sorry if I bored you with all that, but frankly, until I wrote it down, I really didn't realize how much we get done. Usually it's what we didn't get done that we hear about.

I generally get out by 0730 or 0745. A rough night is after 0800.

Hi Tweety,

I work 11-7 on a 33 bed med/surg/oncology floor. We get every imaginable type of patient here. We do not get vents or tele's tho.

I can't give you a straight answer. It depends on my patients & how busy the floor is. It depends on there conditions & also on weather I might be getting an admission right off. It also depends on weather I have any chemo to give (not very often). It is very up in the air.

That said, I almost never get to leave the unit & take a break--mainly my choice. I prefer to be where I can see & hear my patients. I really don't trust others to do stuff on my patients--I've always been this way.

However, as you can see, I am at work now & not so busy at this moment. I count my time sitting at the desk, checking out all nurses as my break.

We also have 7P-7A workers. They seem pretty much like you describe.

I know that PM's is much busier here then any other shift.

Personally, I think it is abnormal to be done with one's work by 0100.

I will say that if a patient is sound asleep with stable vitals, I don't wake them, but do the assessment around 5 AM. We do check all vitals at midnight. That is hospital policy. It is very rare that we skip this.

I also have to say that since we went to computer charting, it has really sped up the charting of the assessment.

Mary Ann

PS--Also, if I am charge, that also may delay things.

Whew, Angie . . . the next time one of my fellow rural nurses with 3 patients complains I'm going to point them to your post.

:rotfl: I really love it though, busy as it is. If I had a lot of downtime, I'd probably be in danger of falling asleep or something.

But the main point I really should have made was this:

WE HELP EACH OTHER. If one person's drowning, we all pitch in. THAT's why we all get out around the time we're supposed to. Teamwork!

LOL me complain neverrrr..I love my job. Angie pointed out many things that i just take for granted. Checking orders, diets to the kitchen, calling a sleeping doc for necessary orders, getting meds ready for morning, charting, and hourly rounds to make sure all is fine. Which most times there is always someone up and not happy lol. We are spoiled with two CNA's making q2 hr rounds on all our incontinent, or comatose patients..they are wonderful. Gosh did I say I love my job..:)

Thanks for you input. I'll just mind my own business, but it seems strange that one can assess, medicate, turn, reposition, take care of 7 patients in an hour.

But that's none of my business. Thanks again! I'll just keep on keeping on, I don't know anyway to cut corners and speed up right now without making things worse on myself. So I'll just mind my business. Woot!

Angie! Whew, I'm tired. I dont' dare write my duties down, as I'm sure it's the same as yours and I would freak. LOL

Angie! Whew, I'm tired. I dont' dare write my duties down, as I'm sure it's the same as yours and I would freak. LOL

I hear it's the same all over Florida.

Oh well, guess that's the price ya pay for having no state income taxes and being able to go to the beach on our 1/2 hour off with our extra fitty cents. :rotfl:

I tend to do a pretty quick assessment on my stable patients and there is no way I could get seven done in a hour. Are your coworkers keeping up charting during that time too? Maybe I am a slacker, but it seems to me like they might be missing something.