IS this norma for Med/Surg night shift...or is it just my hospital?

[raindrop]

I get to work at 7pm and I get my assignment - between 7-9 patients (Med/Surg). I work from 7pm-7 am

I get report; there are so many interruptions during report, report last from 40 minutes to an hour.

I start my assessments.

I start discharging whoever needs to get discharged.

I then find out of an admission that I am getting.

I take care of issues - ABC's

And then at around midnight - I have to file stuff from dayshift. It is mandatory.

And then I have to start getting papers ready for the next day - assessment sheets, I /O sheets). I have to stamp those with the appropriate date, put patient labels on them, and put them in the charts for the next day.

I then have chart checks to do. I have to make sure that all orders received on days (7a-7p) have been correctly entered into the computer. I have to ensure that all labs/test have been ordered right, that test have been done, etc, etc.

I have to make sure the Kardex is up to date

And then I have to check the new MAR's and ensure that there isn't anything on them that shouldn't be, like a newly dc/d drug....and that new orders are on it.

I then find out of another admission.

CNA is going to dinner, now I have to answer call lights.

Hey look, it is almost time for me to go......but first I have to add up everyone's I/O's for the past 24 hours. (hopefully the CNA has emptied everyones foley by now)......and then chart those in graphics.....and then file the I/O sheet from yesterday. Adding this stuff up, recharting it, is very time consuming.....as is filing. The CNA's aren't allowed to do this anmore because apparently there were too many mistakes in their calculations.....?

We don't have a clerk on my shift. Admission/discarge paperwork are 100% on the nurse. Once in a while the house supervisor will help enter orders, but that is rare.

A friend of mine who lives in a different state says that her job is nothing like this - no chart check, no filing, and they have a clerk. She works at a Magent hosptal and claims that is the reason why her job is easier than mine. What do you guys think?

[RainDreamer, BSN, RN]

Hey, that's discrimination. I'm a guy and I'm a unit clerk. Ah, I'm just kidding.

At our hospital there are unit clerks from 7A-11P and then there is a float clerk who goes to all of the floors, or stays on just the busiest floor, and does all of the over night admits. The filing is usually done by the day and evening clerk and doesn't take more than 10 minutes if you have a good system. But other than that, everything is the same. Chart checks ... etc.

She, as in our unit clerk Yep, she's a she.

Our unit is so busy I can't imagine NOT having a unit clerk. On the off chance that there is no unit clerk, then a nurse fills the role.

Very important job, we like ya guys! (there, ya happy now?! lol)

[JennieJenRN]

Well

I do not work at a Magnet hospital and I work night shift we have a clerk! I do not check what the previous shift did they are responsible. We have computer charting so meds are checked when they come through. I do go through the eMAR to make sure it's right. It should be every shifts jobs to keep the Kardex up to date. Is there no one to help with admits??

I give you credit I could not work in those conditions!!!

[newlywedRN]

5-6 pts for our 12 hr night shifts. rarley a CNA(sometimes 7-11p) and never a clerk, plus our CNA's have been stripped of all of thier duties(no vitals, no blood draws, no I&O) they basically clean our dirty linen carts, clean kitchens, weigh our admits and put charts together for us(but dont enter orders). We do all the chart checks. I thought this was normal but I guess not....

[JaredCNA, CNA]

Our night shift has 5-7 pts (not bad really), a ward clerk, and 1 CNA per 16 pts. They do chart checks and check the new MARS for the next day. I couldn't imagine having as many pts as the OP does AND having to put a chart together and entering all the orders. Who takes care of your new pt and all of the others while you are sitting at the desk getting the admission orders in and chart put together?

Much worse the respondent that said they have no ward clerk on Sundays at all!!

I work as a full-time night CNA on a 30-bed Med/Surg Ortho/Neuro floor. Since I started on this floor in January of 2007 there have been only a small number of nights (less than I can count on two hands) where the staffing didn't suck. 99.99% of the time our census sits at 30, either by the time I come in at 11 we are a full house or we are within an hour of me getting there. This is what our staffing looks like most nights: 4 staff nurses (including charge), 2 aides, and no Unit Clerk. The nurses takes 8 med/surg usually POD 1 patients with the charge having 6. For about three months straight I was the only full time night CNA with 4 nurses for thirty patients. We never have a clerk at night. On the weekends, there is no 3-11 CNA. Like I say we have two full time night CNAs but we do rotating weekends so on weekend nights we have one aide and the nurses usually take 9 patients...I've seen the charge nurse with 8 on the weekends before. Oh, and weekends 7-3 there is always 1 aide.

Has anyone heard of worse staffing than this? Just curious.

[leslymill]

That list of duties is very normal for the night shift. Night shift has gotten well dumped on over the years. If you had a ward clerk, you would still have to do med administration record checks, care plan updates, and 24 hour chart checks. 24 hr I and O. Pre-op check list initiations etc. A ward clerk could do much of the addrressograph stamping for the next day I and O, and the charging kardex. Not to mention making sure therre are fresh doctor order sheets and progress note sheets.

[ccfrn0806]

Sounds like most of my nights!! I actually had 5 admissions, 2 transfers and one discharge the other night - all this while maintaining an average of 9 patients - one of the admissions came rolling onto the floor with a BP of 53/35 - yeah...nice. Another came rolling in and when we transfered the pt to our bed blood was pouring out of her abd - seems that the doc decided to pull the JP and well.....that's about it - didn't feel the need to put a dressing over it or anything - grrrr. And of course I still had to do all the regular duties - 24 hr Chart checks, etc etc and to top it all off - my manager comes strolling through around 3:30 am (at this point I still haven't peed or ate/drank a thing) and is on a rant about why one of my new admissions' IV tubing isn't labeled with the date...?????!!!!!! GRRRRRRR! Yeah...like THAT was my top priority at the moment - come ON! Okay, sorry for venting there - point is... I feel your pain - it can get very aggravating at times all the responsibilities put on night nurses only to overhear day shift saying how much "slower" it is at night!!! Not that they don't do a ton but give us some credit! But..overall, it's worth it at the end of the day, right!

[Eyefish999]

sounds exactly like my floor, can have up to 8 pts, combo of ortho and neuro, and the neuro are all on telemetry, no unit clerk, understaffed, have to pick up extra patients at 11p because they send a nurse home , then a few minutes later the ER dumps off all their patients they have been holding for hours, not rapid admited,,,even though they have been in the ER since 3pm....all out of supplies,,no batteries for remote tele box,,,every patient is full assist, confused stroke patients, orhto patients in pain uncomfortable, sundowners falling out of bed

[JaredCNA, CNA]

^ EXACTLY like our floor.