Hospital RNs - how do you organize your shift?

[0.adamantite]

I know this is going to vary from shift to shift, facility to facility, and based on patient ratios, but I'm wondering how everyone organizes their shift?

I have been an RN for about a year. We have patient ratios of 4-6. I work rotating shifts.

I like get report and like to get on the floor within half an hour of my shift beginning. That means on a day shift, by 7:30am I am going to try and see my first patient. However, a lot of the time I will see other RN's still on the computers while I am going from room to room. I wonder if they are spending more time reading the patient's chart to learn about them.

Then, from 7:30am-9:00am/9:30am, I collect a patient's medications, visit their room to introduce myself, check or note their vitals (if the nursing assistant has already recorded them), do my initial assessment, given medications, and assess for pain/nausea medication needs. I will turn total care patients. I will talk about the plan for the day, answer questions, and make sure they have sometime ordered for breakfast. I will also address any immediate concerns or make pages to doctors.

After my first round, I will try to make a second round from 9:30-11:30am, give medications, reassess pain, do my charting, walk patients, turn patients, change dressings, and address needs.

Try to break from 11:30am-Noon (rarely happens).

Then from Noon-1pm, complete any additional charting, help with any second walks, give lunchtime medications/insulin, note vitals, turn patients.

1pm-3:30pm: Finish any afternoon medications, address any lingering concerns, turn total care patients. Walk anybody who needs it.

[lhflanurseNP, APRN]

Seems to me that you have your time well managed. From your planning, I can see you have time to handle emergencies. Good for you!!!!! I find that letting patients know when I will be coming back through helps diminish my calls to the rooms unless it is important. I have even heard them tell family to "back off" because they know I will be there within 10 minutes or so of the time I told them.

[BSNbeauty, BSN, RN]

I work on a busy Postpartum unit. Here is how I try to plan my day but ofcourse it rarely works out as such.

7a-730- Report and walking rounds

730-0830- Chart check/ Assess/medicate 2-4 patients ( we typically have 10, five moms and five babies)

0830-0850- Group report ( all staff attends this daily. We get a run down of who is on the unit, who is in LD, and go over discharges)

0850-930- Finish assessments and meds

0930-1030- Chart

1030-1300- Discharges, 2nd rounds, medicate, and do more charting

1300-1330- Lunch

1330-1700- Admissions, medicating, charting, teaching

1700-1900- Admissions, medicating, charting , teaching

1930- Report

This is just an outline of what I do but doesn't include the endless assessments, teaching, lab draws, calling mds, help with breastfeeding, and just putting out fires all day. Plus if I have any antepartums I have to add in 30 min daily NST. Every day is crazy busy, every day is different. but I love my job!!!

[ArtClassRN, ADN, RN]

1 Arrive on shift, see which fires are blazing.

2. Put as many fires out as I can.

3. Go home.

[ChristineN, BSN, RN]

I work in the ER so unlike when I worked on the floors, there isn't really an organized system to the day. The goal of the day is to stay caught up as much as possible with each pt in the event that a critical pt comes in and then I get busy and behind with my other pts.

If the morning is slow, the only predictable thing is making sure my bays are stocked and ready to go for any incoming pts

[ukjenn231]

I like to get report in a timely manner. If we do bedside report, then I will get to meet each patient briefly. If we don't do bedside report, then I like to run by each room, lay eyes on the patient, introduce myself and just see if there are any imminent needs. I like to look on the computer ASAP to write down the times of any meds, labs, dressings, etc. Then I start to go around and do assessments, pass meds, and do whatever needs to be done. Sometimes I like to chart as I go to make sure I am getting stuff done. I work nights so I also like to ask patients up front around 8:00 if there is anything they anticipate needing tonight so I can call the docs early (usually sleeping pills are the answer.)

[Beverage]

Arrive 10 mins early to get my assignment and look up labs before stand up. I get bedside report on 4 pts ( cardiac Tele) check suction during report and start my assessments. Chart my pain, IV and risk scores during assessment making notes of items to discuss with MD when they round. Pass meds and stop for breakfast at 0930. The rest of the day varies depending upon the pt, ie confused, restraints, ISO, drug seeking, pain mgmt, chest tubes, gtt mgmt, lab draws. Tele boxes on and off repeatedly for procedures (X-ray, u/s, stress tests, cath lab, Ct, MRI...) ambulating, turn q2, VS q4, neuro checks, dressing changes... I usually get lunch between 1400-1500 so I find time to chRt in EPIC as early as I can.

[That Guy, BSN, RN, EMT-B]

Load bouncy balls into cannon and FIRE! Seriously, thats why I love the ER. No rhyme or reason and once you have it all set, something changes.

[libran1984, ASN, RN]

Load bouncy balls into cannon and FIRE! Seriously, thats why I love the ER. No rhyme or reason and once you have it all set, something changes.

Agreed... Just sit back and wait for it to hit The thought of organizing my day sounds dreadful and somewhat terrifying.

[meanmaryjean, DNP, RN]

PICU here:

1900-2000: Get detailed report on 1-2 patients by body system, verify orders in computer with off-going RN, bedside 2-person verification of all IVs and drips, make out my timeline for the night.

2000-2100: Assessments, vitals, I&O, meds, get my parents settled for the night (blankets, pillows, sleep accommodations as needed)

2200- Re-assess, meds , vitals, I&O- lights out / TV off for patients (usually), change out central line fluids

0000- re-assess, meds, vitals, I&O- bathe any intubated/ sedated patients, dressing changes on intubated patients prn

0200- Re-assess, meds, vitals, I&O- 30 minute break if possible, re-stock rooms/ isolation carts

0400- Re-assess, meds, vitals, I&O- AM lab draw, call MD with POC testing results, change out feeding bag set ups prn, morning xrays

0600- Re-assess, meds, vitals, I&O- finish up my charting and update care plans, etc, empty trash and linens

0700- Welcome the day shift with open arms!Detailed report by body systems, verify orders in computer with on-coming RN, bedside 2-person verification of all IVs and drips

Lather, rinse, repeat!

Sometimes, with certain patients, the whole 'vitals/assess/I&O' is HOURLY. Those are some fun nights, esp. when both patients are hourly everything! :)

[Been there,done that, ASN, RN]

Your plan looks great.. on paper.

How are you going to delegate when the plan does not come together?

Will you delegate to peers, charge nurse, rapid response?

[FineAgain]

1915: Get report

1930-2100: Give meds, do assessments

2101: Wheels fall off wagon

2101-0730: Put out fires, give meds, put out more fires; go home