SNF rehab nurse on midnight shift here... It really depends on how your staffing looks. Our day shift rehab unit by itself has 4 nurses, 6 CNAs, a treatment nurse, 1 or 2 admission and discharge nurse(s), 3 MDS nurses, clinical coordinator, assistant cc, nurse assistant who is a cna with extra training... Usually our CNAs in nursing school. They do accused checks, manual vitals, change out O2 tubing and neb equipment, stock carts, help the floor CNAs, and a full rehab dept of pt/ot/speech and our in house np. We have 60 beds. Their days get pretty insane, with doctors, new orders, care rounds meds and Medicare charting. Our whole unit is skilled so everyone has full head to toe documentation daily. Nights we are a skeleton crew... 3 nurses 3 aides a nurse assistant we share with the building... We have about250 beds total and at night have max 7 nurses in house, one being the building super. Let's just say we are really efficient at running our codes now. Anyway, at night my schedule usually goes like this:
1900- report and count, takes an hour.
2000- start med pas... Put in vitals the CNAs got and recheck manually any that are off.
2130- accuchecks and insulin a at hs.
2200- last tid med pass. Usually cardiac meds and abt/iv meds.
2230-0000- process orders that didn't get done on days and double note orders that were already done. That's our rehab policy, not like that On long term side. Glance over late labs if they're in yet, we get labs faxed bid except stats. Page on anything concerning. Check if any creatinine clearance forms came over with med changes and new abt from pharmacy.
0000-midnight med pass. Qid meds, ivabt and cardiacs usually again.
0030-really dig in to orders, processing labs (our docs like last values written on them for reference, along with any meds that could possibly affect values that they're on, or if they're not on anything like a low hgb and no iron, or vit levels drawn but no ordered supplements etc... Check ua c+s results and decide if docs need to be paged, make sure everything's been faxed to docs offices for morning) help aides toilet And sprint for alarms, snack on something and pee. This keeps us busy along with reading up on pt history, dx on medline, checking drug books, looking over labs and X-rays and charting on abt and by exception. Pass out prns when people start waking up and asking for them. We're usually taking down our tube feed equipment once it runs out at this time to hang new sets, checking dates on iv tubing and line dressings. Med shipment comes around midnight so that gets signed in and put int he right places. We check supplies for day shift and raid the stock room.
0500- am meds pass starts.
0630- start accuchecks for days if the NA isn't available.
0700- days comes in and eats their breakfasts in front of us
and does report.
0800-usually still ther, finishing crap up. We have q6 straight caths, a few pvr bladder scan patients, and someone usually goes to hell at some point though the night, and gets shipped to hospital. I run back to the desk to clicks out theostomy appliance I changed because it magically fell off all by itself, the dressings I fixed or re did because they got covered in bm, or urine...
0830- I clock out on a normal day. If it's really bad or someone crashes right at the start of days, we stay to help ship.
i work with the most kick ass team... We are like family. It's crazy, we laugh, we cry and we have a great time no matter how ****** it gets. Our night shift rounding docs make a huge difference too, were all a slap happy team who can get **** done and make it fun.
Now with it all written out, I sound busy lol