Hospital RNs - how do you organize your shift?

[0.adamantite]

I know this is going to vary from shift to shift, facility to facility, and based on patient ratios, but I'm wondering how everyone organizes their shift?

I have been an RN for about a year. We have patient ratios of 4-6. I work rotating shifts.

I like get report and like to get on the floor within half an hour of my shift beginning. That means on a day shift, by 7:30am I am going to try and see my first patient. However, a lot of the time I will see other RN's still on the computers while I am going from room to room. I wonder if they are spending more time reading the patient's chart to learn about them.

Then, from 7:30am-9:00am/9:30am, I collect a patient's medications, visit their room to introduce myself, check or note their vitals (if the nursing assistant has already recorded them), do my initial assessment, given medications, and assess for pain/nausea medication needs. I will turn total care patients. I will talk about the plan for the day, answer questions, and make sure they have sometime ordered for breakfast. I will also address any immediate concerns or make pages to doctors.

After my first round, I will try to make a second round from 9:30-11:30am, give medications, reassess pain, do my charting, walk patients, turn patients, change dressings, and address needs.

Try to break from 11:30am-Noon (rarely happens).

Then from Noon-1pm, complete any additional charting, help with any second walks, give lunchtime medications/insulin, note vitals, turn patients.

1pm-3:30pm: Finish any afternoon medications, address any lingering concerns, turn total care patients. Walk anybody who needs it.

[cassie77775]

Postpartum here:

645-7-get the census and find out who my patients are(4 moms and 4 babies)

7-730-do bedside report

730-815-assess all my moms and babies

830-915-get all necessary meds one patient at a time(usually jus too meds)

930-1030-chart all of my assessments and teaching for all 8.

1030-1045-take a break

1200-1230-lunch if I didn't get a new admit or have something important to do

1200-1300-reassess all my newborns

1645-1700-another break and prepare my sbarr for the oncoming shift

The rest of the time is

Assessing pain, helping with feedings, teaching, doing discharges. If the patient is a new one, then I will be doing very frequent assessments. I try very hard to keep up with my charting and tend to chart as soon as something is done.

[hiddencatRN, BSN, RN]

Report: 7:00-7:30-45ish depending on how organized the day shift RN is.

7:45: start seeing patients for 8pm assessments, bringing along 8pm meds and 9pm meds if ordered.

9ish: chart assessments, education, chart checks, etc.

Rest of the night: give meds as ordered, any special interventions as ordered, respond to patient needs.

If there's no cna I do vitals with assessments which puts me behind at 8pm. But most of our stuff is scheduled so....I just do it then chart, lather rinse repeat.

[itsnowornever, BSN, RN]

Load bouncy balls into cannon and FIRE! Seriously thats why I love the ER. No rhyme or reason and once you have it all set, something changes.[/quote']

THIS!!!! I see the ones most critical, put out that fire transfer. Transport the ones waiting Togo to rooms. Then see the non-sick. Somewhere in all that deal with a critical that just came in, tell a non-sick pt to please be more patient, sorry I'll be there ASAP. And then go home when I'm all done.

Posting from my phone, ease forgive my fat thumbs! :)

[nursej22, MSN, RN]

I work cardiac tele, 3-11.

3 pm: team huddle and get assignment. Assignment not usually available until 310. Get report from off-going shift at the same time ED, PACU and ICU are calling report and patients are arriving and patients are standing in doorways demanding to be released. In other words, chaos. Try to lay eyeballs on sickest patients first, while fielding phone calls and pages q2 minutes. Give any pain, now, or stat meds. Focused assessments on new arrivals. Try to get discharges out so they stop paging. Patients needing fingersticks get seen last so they can be done same time as assessment. Sneak in any other assessments if time allows. Check in with aide, if I have one, about turns, ambulation, chair for meals, bed and chair alarms. Call report on any transfers off to make room for admits.

Start passing dinner meds by 430, and make sure post-ops are up in a chair for meal. Once meds are passed try to chart, re-assess any prn meds given. Break as time allows. TC to MDs about abnormal VS, rhythms, labs, ineffective pain meds.

7 pm, usually have another admit by now, or have called a rapid response. Dementia patients are starting to sundown and bed and chair alarms are everywhere. Try to chart and check charts up until 8 when its time for more pain meds and to start hs meds. This can take up to 2 hours because of interruptions and missing meds.

2200 Clear IV, PCAs,epidurals, TF, mark chest tubes. Report to charge, finish charting, sleepers prn.

[Kay28]

I work inpatient psych 1500-2330. I get on the unit a few minutes early to find out my assignment and fill out information I will need for my shift on my brain sheet (ie. meds, tx, blood sugars). Shift report is from 1500 to 1530 on a good day, sometimes it takes longer. All the RNs for evening shift are in the room listening to report on the whole floor (30 beds). 1530-1630 I go meet all my patients and get vitals signs on everyone I have, along with doing a quick assessment. I might have meds to give out at 1600 or 1700, and after 1630 we start doing our CBGs and giving sliding scale insulin. All along I try to document as I go, otherwise it tends to get overwhelming. Might have to assist with dinner for the patients depending on how many mental health workers are on that particular night, dinner comes at 1730. Then you try to put out as many fires as you can before visiting hours, which could mean calling the doctor on call or breaking up a fist fight. Visiting is supervised from 1900-2000, everyone visits in the kitchen. 2000 means start passing out meds as quickly as you can, patients will start lining up at the nursing station. Then, for the rest of the shift, catch up on documenting and give PRNs. Oh, and don't forget, you will have at least one admission thrown in somewhere, maybe two. And maybe a restraint or seclusion going on at the same time. I can have anywhere from 5-9 pts on my shift. But somehow you make it all work, and survive the shift to make it home another night.