ICU Nurse working on floor- trouble with organization

Ivanna_Nurse, BSN, RN · Apr 28, 2010

Squirtle, I dont have a whole lot of advice, but I wanted to say that I feel for you! :) Its a different mind set when they arent ICU. I am sure that you will get some great words of wisdom. Hang in there. ~Ivanna

L8RRN · Apr 28, 2010

I am new and working on organization, but I generally go in and check on my patients (usually 6) after writing all my med pass times down. Most of the time, the labs are not posted yet. We can't pull meds out of the Pyxis until 8 for 9am meds, so I use the time between report and 8am to introduce myself, do insulin, and assess pain and check everyone to see how their night went. I keep it very brief (HI, I'll be your nurse, I wanted to introduce myself and see how you are doing this morning. Are you in any pain this morning? I'll be back a little later with your morning medications. In the mean time, if you need anything, please push the call light) and try to start my 9am med pass at 8 starting with anyone that needs PRN pain meds. I found that if I just go in with their morning meds, someone ALWAYS wants a pain pill and I would have to go back and pull it, so I like checking BEFORE I start. I TRY to assess while they are taking meds and have a spot on my "brain sheet" for assessment results (like - or + and why). I usually don't document the first 3 patients when I do the assessment. I wait and see how I am running on time. IF I have done 3 or 4 by 9am, then I will start documenting in the computer as I go on the remaining assessments when I am in the room. As soon as I am done with med pass, I check for labs that would have posted during med pass (we are called for critical values and anything pertaining to meds pop up during the med pass) and finish documenting my morning assessments. USUALLY if my morning starts out good and I can get all this done by 11, then I am good to go most of the rest of the day. :) This is depending on if I have a lot of discharges and admissions, though.

Best of luck to you!

mustlovepoodles, RN · Apr 28, 2010

I feel the same way. I hated med/surg because I felt like I was spread so thin. I'd rather know 35 things about my 2 patients than 3 things about my 6 patients. I agree, your approach has to change. I used to go in and introduce myself first thing, check IVs, listen to lungs/hearts/tummies, foleys, whatever equipment, answer questions, give them an idea of how the day might go(labs, tests, Xrays, meds.) It sounds like a lot, but takes less than 10 minutes if you keep it moving. Good luck!

LouisVRN, RN · Apr 28, 2010

Having only worked med/surg, I'll throw in my :twocents: . We do bedside report which means its a chance to write my name and spectralink number on the board, introduce myself, ask about their pain, ask if there's anything else I can bring them when I come back, make sure they are still breathing, make sure they don't need another bag of fluids, check if lines need to be changed, etc. Also check to make sure there is nothing that I need to clarify with the day nurse before she leaves. (This takes about 30 minutes for 5 patients). Working nights, rather than checking labs (our standard draw time is in the am). I briefly assess all the charts looking for any STAT orders, making sure they've been completed and the doctors called with any results. (It only takes one time calling a doctor at 0300 to report the 1800 labs he wanted called to him to make that a priority). At 2000 I will start passing 8-9 o'clock meds doing accuchecks, assessments and vitals. I will start with anyone requiring pain medication and leave any people with scheduled 2100-2200 meds for last, at 2100 I will include passing the 2200 meds to those patients as well. At 2200 hopefully I have finished passing all 2100 meds and doing all assessments. I will then reassess everyone's pain and call any doctors. At 2300 I will hang all midnight antibiotics. 2300-0000 document. I can usually document a shift assessment, ADLs and focused assessment (I try to do something on each patient every 2 hours) in 5 minutes per patient, thank goodness I am a fast typer. At 0000 I will make rounds do any midnight vitals and do my chart checks, at 0100 go to lunch. DO NOT RETURN until 0130 when I will do rounds again. At 0200 I try to complete discharge planning and any education the patient might need for the following days procedures. 0300 do more documenting and change dressings. 0400 do vital signs and hang antibiotics. 0500 Start passing 0600 meds with the simplest ones first (flushes, protonix), update the patients on the plan of care for the day. 0600 pass meds to patients requiring additional care (foley's removed, dressings taken down for the first time, pumps cleared, etc). 0645 Try to be finished and compile thoughts and double check everything has been documented. 0700 Give report. 0730 Go home (I've left past 0730 maybe a handful of times in two years)

solneeshka, BSN, RN · Apr 29, 2010

Having only worked med/surg, I'll throw in my . We do bedside report which means its a chance to write my name and spectralink number on the board, introduce myself, ask about their pain, ask if there's anything else I can bring them when I come back, make sure they are still breathing, make sure they don't need another bag of fluids, check if lines need to be changed, etc. Also check to make sure there is nothing that I need to clarify with the day nurse before she leaves. (This takes about 30 minutes for 5 patients). Working nights, rather than checking labs (our standard draw time is in the am). I briefly assess all the charts looking for any STAT orders, making sure they've been completed and the doctors called with any results. (It only takes one time calling a doctor at 0300 to report the 1800 labs he wanted called to him to make that a priority). At 2000 I will start passing 8-9 o'clock meds doing accuchecks, assessments and vitals. I will start with anyone requiring pain medication and leave any people with scheduled 2100-2200 meds for last, at 2100 I will include passing the 2200 meds to those patients as well. At 2200 hopefully I have finished passing all 2100 meds and doing all assessments. I will then reassess everyone's pain and call any doctors. At 2300 I will hang all midnight antibiotics. 2300-0000 document. I can usually document a shift assessment, ADLs and focused assessment (I try to do something on each patient every 2 hours) in 5 minutes per patient, thank goodness I am a fast typer. At 0000 I will make rounds do any midnight vitals and do my chart checks, at 0100 go to lunch. DO NOT RETURN until 0130 when I will do rounds again. At 0200 I try to complete discharge planning and any education the patient might need for the following days procedures. 0300 do more documenting and change dressings. 0400 do vital signs and hang antibiotics. 0500 Start passing 0600 meds with the simplest ones first (flushes, protonix), update the patients on the plan of care for the day. 0600 pass meds to patients requiring additional care (foley's removed, dressings taken down for the first time, pumps cleared, etc). 0645 Try to be finished and compile thoughts and double check everything has been documented. 0700 Give report. 0730 Go home (I've left past 0730 maybe a handful of times in two years)

Wow, I'd love to know where you work that your night is so predictable! Most of our nights, we're shipping pts off to the ICU or getting new admits at the worst possible time or our phones are burning up with call-lights or have half-coherent fall-risk patients crawling onto the floor and setting off the bed alarms. Maybe it's because I work a primary nursing floor where we have 5-6 patients a night.

To the OP: Yes, round on your patients first thing, make sure everyone is still alive, keep it brief. I try to look over orders before even getting report because so many nurses leave so much out of report, that way I can ask questions while they day nurse is still there. After my initial quick-round, unless there is a pressing need with a patient, I chart as much as I can of an assessment. There's a lot you can tell from a quick visit. Don't give into the temptation to pull out your stethoscope during that initial round, though, that can lead to too much that keeps you in the room too long. I do that part of the assessment when I pass meds. Every I have to take the time to log on to the computer, I try to get another piece of the assessment charted, or bring the I/Os up to speed, *something* to reduce the overall number of times i have to log onto the computer during the night. At 2300 I start MN VS. Depending on how many of my patients need labs, I'll do labs at the same time (means I'm interrupting a patient only once instead of twice). If all of my patients need labs, though, I'll do all VS first, then circle back to do all labs (our VS have to be within an hour of MN; general labs just need to be at some point during the night). I always think it should be wide open once labs are done, but that's when I'll get the unstable new admit or a patient's family will show up and start fighting or two roommates will start fighting or someone getting blood will rip their IV out. With 4 patients, it all works out. But without techs and given that we do our own labs, 5-6 is tough. And our charting requirements are insane. So for us, it's all about chart-chart-chart, every chance you get. You really do have to scale back your expectations as far as knowing what's going on with each patient. It's a tough switch to make, between med-surg and ICU. Couldn't you get a PRN ICU position instead of med-surg? That way, if it's only a problem when you float, well I assume you don't float too often.