Great idea for a thread! Agree with the idea to sticky this one too!
I work for night shift for a Tele unit that also takes Med-Surg and Stroke patients, so I'm certified to read EKGs, give certain cardiac meds, and also to do the NIHSS (stroke scale) on appropriate patients.
I come in, get my assignment, check labs and orders from the computer, and briefly check the monitors at the desk to make sure my patients' rhythms and rates are OK. I make a note of all those with positive trops, high BNPs, low electrolytes or hemoglobins, or high D-dimers with a positive CT angio, those who are NPO or in prep for a procedure.
I read report and prioritize by doing a quick peek at all the patients and what's hanging on their IV. Patients receiving blood or drips, or who have dyspnea, pain or who have had problems with heart rate/rhythm, and especially chest pain patients, are dealt with first.
I introduce myself, chat with the patient, get vital signs and as I roll people around in the bed to assess lung sounds and skin, I straighten their beds out and get them repositioned. I warn them if I have to come back for more vitals or if they have labs due in the wee hours--not good to frighten a heart patient.
I get the midnight meds passed and put out fires from the last shift.
As I go, I document my vitals and my initial assessment. I do a quick check through the day's orders on each patient and make sure that the correct orders have been entered into the computer.
When everyone seems to be settled down, I can take the chart and go through it more closely. Is all the paperwork complete that needs to be? Have all the meds been given as ordered? Are all the results in the appropriate places in the chart?
Critical thinking is big on night shift: Why is this patient still on Tele, why are we still doing accuchecks after 48 hours of no rise in blood glucose for that stroke patient, why is this new stroke patient getting dextrose in his IV fluids? Why is this patient with a 3rd degree heart block not getting a pacer (because he's a 102-year-old still fighting with his family about honoring his DNR status?--yes, it's happened), who stopped the heparin drip on my PE patient an hour ago and forgot to turn the pump back on, why was the stat blood ordered for a hemoglobin of 7.3 not given (because the patient refused it, being a Jehovah's). Were blood cultures done on the patient whose temp shot up? Oh crud, yes, but the doc never ordered the tylenol and it's 0300.
Stroke patients get neuro checks every 2, 4 or per shift, depending on where they are in their course of treatment. They can't have any Dextrose in IV fluids, and a temp of 99 needs to be treated.
Cardiac patients get q4h vitals. EKGs are done by us along with standing chest pain orders, as appropriate. Drips need to be maintained and timed blood draws need to be checked for follow-up.
In between all that, I'm giving meds, reassessing patients, changing them, helping them to use the bathroom, monitoring changes in the patient's baseline and interpreting them for significance--and helping anyone else who has a problem patient. We all help one another on night shift.
By 0600, I'd better have finished my chart checks and my written report and started to pass my 0600 meds and get everyone straightened out for day shift. The early docs are here and already writing new orders. If I have time, I'll start them, but if I don't and the orders are not stat, I can leave it for day shift (with a heads-up that they're there.)
If I'm lucky, I clock out at 0715.