getting assessments done

[SALLYSMG]

i have a question regarding night shift assessments? I work the night shift and after getting report, I check my medicines to see if anyone is due a sleepy pill ect, (most of the time they have allready been given a sleepy pill) and i go to each room to get my assessments done, sometimes if im really busy i go say hi to each patient and make sure they are still alive and do whatever it may be that requires my immediate attention, for instance, a critical lab value, etc. My question is, sometimes when i go into the room, i frequently find my patient fast asleep, i wake them up as gently as possible and ask permission to turn on light, some of my patients get mad and say "not this again", I tell them that I have to assess them on my shift and that if i dont then i am not doing my job. Well, it may sound silly but do i have to assess right at the beginning of my shift or can i maybe wait, i notice that some of the more experienced nurses (im a new grad) are doing their MARS and other things. I know that eventually I will have to get assessments done and Im just confused as to what i should do? Is there any suggestions, I want to do the right thing.

thanks

[RNfloatpool]

I work the night shift and always do my assessments after shift report. I don't want to sound mean, but I don't ask permission, I just introduce myself and do my assessment. I mean this is a hospital not the hilton hotel so they should not expect to be undisturbed from 11p to 7a. I would not wait until later because you never know what the last shift has left for you. I have had tons of people I shipped to icu within the first hour because they looked like crap when I went into assess them. Our evening shift does our MARs so they are ready when we get there.

[TigerGalLE, BSN, RN]

I think you can see alot by just looking at a patient. When you first get there... peak in (maybe only turn on one light, or the bathroom light). Quietly look, listen and feel. If a patient is really sick you'll know it by looking at them most of the time.

I always at least peak in and introduce myself at the beginning of my shift. Take care of really important things, then go back and pass meds and do a full assessment.

If I peak in to introduce myself and my patient has labored breathing, looks bad, or says they feel horrible I'll go ahead and assess them right then. Because that then becomes my priority.

Then I check charts and labs before passing meds... pass meds... and then chart my full assessment... I work day shift and I know our routines are different but you have to set priorities.

[allantiques4me]

I think you should try to organize your shift after you receive report and see which patients require more ,then go do assessments.You can assess many things without waking the patient.Unless you are assessing nuerologic functioning or the like.You need a baseline assessment.If you assess later there might have already been a drastic change in condition.

[Overland1, RN]

I always do a quick walk-around (no, I don't kick the tires on the bed) and make certain the patients are doing OK, then start the assessments. Do the assessment ASAP in the shift; you may find that patient who has had dyspnea now has apnea. It would be most embarrassing to find that out after it is too late.

"I was doing my chart checks!" is probably not a valid rationale in such cases.

[cappuccino]

when i worked the night shift i assessed patients soon after getting report. it makes sense because some are still awake. patients understand that you have to assess them. just get in and out pretty quickly and they're happy campers.............

[nursemary9, BSN, RN]

when i worked the night shift i assessed patients soon after getting report. it makes sense because some are still awake. patients understand that you have to assess them. just get in and out pretty quickly and they're happy campers.............

that's pretty much what i do--as soon as possible when i come on shift.

it takes about 1/2 hr. for report & then i check meds & then see everyone.

[helpinghands, BSN, RN]

Usually the techs are doing vitals at the beginning of the shift, so I just follow behind them. We also have to do a second assessment at 3am. I try to coincide this one with the 3am VS and labs draws. If they are a new admit I warn them about this so it isn't such shock when it happens. If they are expecting it, it doesn't seem to bother them quite as much.

[crb613, BSN, RN]

I also work night shift. We start report around 1845, & are usually done around 1900-1915. The very first thing I do is assess my patients, see to immediate needs, & check vitals. I chart as I go so when I am finished with my assessments, I am finished with initial charting. I work med surg, & my usual load is 7-9 patients it takes about 45-60 mins to see them & chart. I let them know I will be bringing in their night meds at 2100. I pass the 2000,2100, & 2200 meds at this time. I can usually get my chart checks done before I start to pass meds.

If I am not in the room...the CNA's are assisting with walking, pm care, snacks ect. so someone is giving attention until I can get back with meds. I let them know I will be in all night checking on them, & I will be as quiet as possible....but I will be in. I will be touching you, & looking under the covers...if you are bleeding, or something is going on I want to know.

[GooeyRN, ADN, BSN, CNA, LPN, RN]

I don't ask permission. I assess what I can while they sleep. (gently and quietly assess for pedal edema, listen to bowel sounds, observe color, check IV site, etc) I hang any IV piggy backs and change primary bags while they sleep. Then, I wake them and tell them I need to give them a quick once over and hand them their medications. I can usually get most of my needed assessments while they sleep, only bugging them for less than 5 minutes each while they are awake. It works great, except for when you trip or knock over a water pitcher and startle them. Then they usually aren't too happy about me sneaking around.

[RNperdiem, RN]

You don't really know your patients until you have assessed them. Do them first thing in the shift. The above posters have many good points. Assessment is a high priority nursing action.

In situations like yours, I imagine myself standing before the judge. Explaining that you didn't want to wake a patient or did MARs first would not sound like a good defense.