11-7 Floor Nurses a Question Please

[Tweety]

I work 7p to 7a on a med-surg trauma unit. We also have 8 hour shifts. The nurses who come in at 11pm are always done with their med pass and assessment on 7 patients by midnight. I feel like such a loser because I'm still working on round 1. Granted there are more meds and pm care takes a while.

So how long does it take to do first rounds when you work 11pm to 7am??? How can nurses possible assess 7 patients in one hour, even if they know them from the night before? I'm baffled here. If I come in at 7pm and am done by 10pm I'm ecstatic. Usually, I'm not sitting down charting until after midnight? Like tonight, I'm eating and sitting down for the first time and the 11pm nurse made it to the cafeteria and sat down charting a full hour ahead of me.

[flashpoint]

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.

[Tweety, BSN, RN]

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.

I don't know how they do it. I just felt like such a loser that the 11pm nurse was done before me who'd been there since 7pm. By 11:45 (we get there at 10:45) she gathered together her notes and sat down and started charting, by 12:00 when the cafeteria opened she was there. Funny how the day shift nurse who followed her complained to the charge nurse "I have too many total care patients in my assignment to handle it without help and I have no CNA with me today, so be aware I'm going to be asking for help." So yes, in retrospect, something must not be getting done.

But again, it's not my affair what and how others do it, just wanted some perspective on how others do it in case there was something wrong with me. Sad thing is there's a couple of others able to do the same thing. Maybe they leave sleeping patients alone and care for them later. I've never been able to do that. I have to wake them up, sorry for them, but that's just what I do. I try to coordinate it with vital signs that are being done on all patients at midnight though, I'm not a total orge waking up everyone.

[plumrn, BSN, RN]

I don't think anyone is that good that they can give meds and do thorough assessments on 7 pts in 1 hour! Checking the MARS, answering lights, medicating hurting/vomiting pts, assisting w/BSC, etc. falls in there too, right?- Unless there are hospitals existing whose pts never call with those needs while the nurse is trying to do meds and assessments.

Someone also has to help the assistants with turns, answering lights, etc. (if there ARE any assistants!) Don't feel like a loser. I think you are just a thorough nurse- the best kind!

[UM Review RN, ASN, RN]

I think you are just a thorough nurse- the best kind![/QUOTe]

Yes, you may be done later than the others, but the time you're finished has nothing to do with the quality of your work. You must be good--they wouldn't have made you Charge if not!

[leslie :-D]

and finally tweety, there ARE some nurses that just chart w/o actually doing the work.

we all know that. :stone

leslie

[jkaee]

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!

That sounds like the best thing you could do.....as long as you don't suspect neglect or false documentation, there's nothing to really do about it. I happen to be one of those nurses that can get stuff done pretty quick....I work LTC, but my fellow nurses have always "marveled" how I am always finished on time, have all my work done, and never look frazzled. It's not that I skimp on work, I just think we all have different working styles, and I just happen to be very good at time management and am very anal about the way I get things done. It's not better one way or the other (until management starts complaining about OT ), it's just the way it is. One nurse always asks me how I do it.....I don't know how, I just do. Also, I think it helps that I just work part time, so I don't usually get bogged down with all the other BS that goes on. THAT always helps!

:)

[Tweety, BSN, RN]

Thanks again. I do get done on time most of the time, but I don't skimp, and definately don't get done in one hour, and I'm quite organized and fast. I like turning and repositioning q2-4, like doing oral care, changing dirty trach ties, getting them to use their incentive spirometers, etc. I'm silly like that.

[leslie :-D]

Thanks again. I do get done on time most of the time, but I don't skimp, and definately don't get done in one hour, and I'm quite organized and fast. I like turning and repositioning q2-4, like doing oral care, changing dirty trach ties, getting them to use their incentive spirometers, etc. I'm silly like that.

sheesh tweety...you ARE silly like that.

i learned the hard way (and am still trying to learn) on when to keep my mouth shut.

just worry about yourself. and start puffin' that chest of yours because you should be proud of your devotion.

leslie

[nursemary9, BSN, RN]

Hi Tweety

From past posts you know I work 11-7.

Last nite I was quite busy ( not horrible, jusy busy!) and it just seemed to take me forever to do anything much less chart my assessments--you know silly things like passing meds & restarting IV sites that so obviously needed changing......

dah.........you think that hand that is twice it's normal size just might need to be changed!!! :angryfire

At any rate I was helping this young guy take his meds & he was having such a hard time, but so determined to do this himself--(newly diagnosed MS) & your post popped into my head!!

There is really no better way to do assessments then by actually doing the repositioning, or t he mouth care or whatever. That hands on is one of the most valuable tools we have.

Another thing that sometimes takes my time is something like an IV restart--why waste that time just restarting an IV--you can do valuable patient teaching at the same time. Also when doing the accuchecks, I always try to do diabetic teaching. i see people go in & quickly get there drop of blood & barely say word one to the patient--what a wasted opportunity!!

These things are the things that take up time, but are super important!!

When I was a patient myself, I learned the value of patient teaching.

Now I try to incorporate teaching in almost every thing I do.

Just some thoughts about how my nites are spent.

Mary Ann

[Goltzer]

I am glad, so glad for good caring nurses like yourself. Keep up the good work.

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.