How do you all like to start your shifts?

  1. I'm trying to get into a fairly efficient groove while starting my shifts. My shifts start at 1900, but the majority of my patients don't have meds due until 2100. At or institution, we can give meds one hour before and after the time they are due.

    My first assessment is done around 2000.

    I'm trying to be as efficient as I can. I was waiting until 2000, (an hour into my shift) to do both meds and initial assessments for each patient. That way, I could wrap PRN pain meds they may need into their scheduled meds when I ask about pain during assessment. Sort of a 'one stop shop' method, I suppose. The problem here is that this seems to take awhile.

    Some nurses, upon arrival to the floor, see each patient briefly and ask if they need anything OR do their assessment then and return around 2100 to give meds. To me, this seems like it would be slower since patients would likely ask for pain meds (or any other PRN) at this time, thus creating a situation where the RN would need to return to give scheduled meds.

    I know it is about the patient and not about me, but I'm just trying to build a certain amount of efficiency into my shift.

    How do you all like to begin your shifts?
  2. Visit j_tay1981 profile page

    About j_tay1981

    Joined: Sep '09; Posts: 219; Likes: 69
    RN, Neuro/Med-surg; from US
    Specialty: 1 year(s) of experience in Neuro, Med-surg.


  3. by   sweetiepeas
    I always start my shift seeing patients and doing my assessments, they only take about 5 minutes, flush any IV's, check what's running, etc. if they need pain meds I make that a priority and get it when I'm done with them. Then onto the next patient. Once I'm done, I'll start meds. Then treatments, dressing changes or whatever needs to be done. I like having hands on with each patient within the first hour. What are you doing for the first hour before giving medications?
  4. by   ChristineN
    I am a float nurse but I normally work in the ER. My shift starts by seeing if I have any stat labs/orders that need carried out and if any meds need given or if I was told in report that someone might need pain meds. After I address those things, then I will go see any pts I hadn't seen yet and do assessments.
  5. by   Marston3s
    During report we complain for about 30 minutes and then when I see the nurse going off leave I feel awful because I have no one to complain to.
  6. by   workingharder
    Quote from Marston3s
    During report we complain for about 30 minutes and then when I see the nurse going off leave I feel awful because I have no one to complain to.
    Ok, that was funny.
  7. by   alrighThen
    I get report and start assessing my patients. I only have 2-3 in the ICU/IMC so this is usually easier than on the floor. Then I do chart checks, make a list of things to address with our intensivist, look up which meds/labs are due and plan my shift. Then I give meds, chart, give baths and so on. This is an ideal situation. If nothing is going on. Kind of rare. I need to spend a few minutes with each patient and know what meds to anticipate giving before I feel ok about running off in different directions at first.
  8. by   Kyrshamarks
    I personaly like to start my shifts with a big water glass full of vodka and a couple of ecstacy pills. makes the shift go by a whole lot quicker.
  9. by   Rhi007
    Tuesday to Thursday I start my ED shifts with red bull and Friday to Monday I have 200mg of no doz, a cup of coffee and at about the end of my shift we ***** about annoying/. Painful patients and thank Jesus for the easy ones.
  10. by   ufo8micats
    I do private duty nursing and my liens is 3. So my night starts by setting up his feed and meds. Then we play, then my only responsibility besides him is staying awake at night. Which usually consists of iPad for games and Netflix, watching tv or a movie. And staying awake
  11. by   eatmysoxRN
    I start with walking rounds where I assess base needs. I typically assess any patients with a need while I take whatever they requested in the room. By 2000 when I start meds, I do assessments while I give meds. If a patient doesn't have meds I try to hit them up before my window of med times. After that I head to the nursing station and chart assessments and grab my charts to start checking them. Of course the computer tells me if there are orders that someone hasn't checked at all and I check those before I start meds to be sure there aren't cancelled meds or new ones that aren't entered into emar yet.. Truly though, that's an ideal night when staffing gives me 6:1 instead of 8:1. That also assumes no major complaints like chest pain.. No blood to start.. No emergencies to deal with. I get an ideal shift probably once every month.

    ~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~
  12. by
    Look up patients before report, done w/ report 1920-1930, assess the first patient, including lines, drains, etc, give pain meds and address immediate wants/needs (ice water, reposition, etc), repeat x3 more patients, check 20:00 VS and chart assessments, pass meds/hang TPN/Lipids, do dressing changes, cover HS chemsticks, look up the patient I'll be picking up at 2300. Ideally.

    What do you do until 20:00?
  13. by   cardiacrocks
    My shift is 7a-7p. I start out by going with the previous nurse to do bedside reporting, (Of course if the patient is sleeping I do the report at the nurses station.) Then I can assess what type of fluids the patient is on, if they are on any. I can see that a bag is almost empty I need that nurse to change it, I would do the same thing at 7p if I left a bag low, (which rarely happens, I very anal when it comes to my job, no pun intended, lol.) Anyway, I basically touch base with each patient with the previous nurse. After that nurse is done, I go around and do my assessment, I check tele, etc. I then usually have all my assessments documented by 0730, we document on the computer. I then check labs, meds and anything else I feel is pertinent to my job. I start my 0900 med pass at 0800 with breakfast trays, it helps me get them done, especially if someone is on insulin I have to give that med anyway. I take all manual blood pressures, because I work on a step-down tele floor and I need to see for myself what my patients blood pressure is before giving BP meds. If I have patient's going to the cath lab and or any procedures I make sure all the paper work is filled out and the chart is ready to go, typically I do that before I do my assessments. I try to do my notes in the charts as I go. My floor can be insane, it's so incredibly busy, typically I have between 4-6 patients a shift. I am pretty organized and rarely have I ever had to stay over. I know this is a long post, but this is basically how my day goes. Not sure If I helped you but I hope I did.
  14. by   j_tay1981
    Quote from Marston3s
    During report we complain for about 30 minutes and then when I see the nurse going off leave I feel awful because I have no one to complain to.
    Hahaha! Points for honesty!