How to be a good day shift nurse?

Buckeye.nurse · Feb 3, 2018

I work day shift on a hematology-oncology unit. I hope I can give you a few helpful tips.

~~Being organized starts at home. Get your gear together the night before. I usually pack my lunch for the next day before going to bed too.

~~I like to get to work about 30 minutes before the shift starts, so that I can print my patients' sheets out, and then briefly look at labs, v/s trends, orders, and history before getting report.

~~The first few hours (7 am to 10 am) are usually the most hectic. Stat orders are coming in for electrolyte replacement and blood products, med orders are being revised, and imaging is being ordered/imaging areas are calling to see if patients can come down. Constantly prioritizing is a learned skill. Identify another nurse on each shift you work for the first month who is seasoned, and whose judgement you trust. They can be your sounding board. Fevers or unstable vital signs are my top priority, followed by chemo/urgent needs (like hypoglycemia)/urgent meds. I was taught in orientation to assess each of my patients, and give morning meds before starting to give blood. Otherwise mornings can quickly spiral out of control. Obviously if my patient has a platelet count of 9, and they want to do a procedure that would have a higher priority. These are just general tips :)

~~Chart whenever you can steal a few minutes. This is one of the reason most of the nurses assess patients before starting to give blood, as that is the perfect window of time to chart in.

~~Don't panic if it is 10:30 am, and you haven't charted much yet. Generally things calm down a little between 10:30 and 2 pm. Use that time to get caught up, organized, and eat.

~~Speaking of eating, make sure you do so before 3 pm. The last 4 hours of a 12 hour day shift are not called the "witching hours" for nothing Best of luck!

theRPN2b · Feb 3, 2018

Try to get your patients out of bed during day shift. Be it in a chair for meals,a walk around the ward,or simply just geeting up to use the bathroom. Mobility is very important for recovery escpecially for elderly patients. I work in med/surg where they highly encourage this, I see that you work in oncology. I've never worked in oncology so I'm not sure how weak these patients are,if they are even able to get out of bed.

Also,try your best to leave as little left over work for night shift as possible (although I understand things happen sometimes and it's not always possible)

future-peds-np · Feb 4, 2018

Thank you so much!!

NurseC,RN · Feb 4, 2018

1. Like someone mentioned prepare ahead of time for your shift. I shower the night before, lay my scrubs out, meal prep is ready in the fridge and the coffee is timed so it's a pour and go.

2. Show up a little earlier before report to get organized, get your patient assignment (if your unit assigns before report), write down vital signs, assessment, abnormal findings documented by previous shift that need to be followed up on, labs to watch for, dressing changes, intake and outputs, ambulation during the shift etc. I highlight those important aspects that are crucial for certain doctors or I call it my "hey dummy don't forget this"

3. I check on my patients as soon as report is done so I can lay eyes on my patients, check their lines, IV fluids are set right with appropriate rate, suction and oxygen are functioning at the bedside, bed alarms are on those that need them.

4. Vital signs and assessments. Addressing concerns to bring foreward to the doctor/charge nurse if any. AM med pass depending on patient:nurse ratio I have that day.

5. Ensure patients are set up for meal time and if everyone is settled and no concerns I chart, chart, chart.

6. If you get busy rely on your health care aides, other team members, your charge nurse/nurse clinician to let them know you are running behind. Worst thing you can do on day shift is try and do it all by yourself, and feeling swamped by the end.

Hope that helps. It's a change from night shift to days but you'll do just fine and figure out what works best for you!

Accolay · Feb 4, 2018

All good suggestions so far.

Don't forget all that self care stuff starts the day before your shift. Exercise, eat something healthy every once in a while, have a hobby.

Especially as I get older, getting plenty of sleep the night before a day shift is quite important. I can be up until 2am before being at work at 7am and still function...but it's just really... uncomfortable. Doable, but just no fun at all and a much less desirable a practice to trudge through my day that way.

CardiacDork, MSN, RN · Feb 10, 2018

I used to be a day shift nurse. As everyone else said, being prepared is important. So have your lunch packed, your gas tank full, and your back pack ready with snacks and nursing gear.

The first thing to do is receive your assignment. When I worked days I would get there 15 minutes early. Receive my assignment and start filling out the skeleton of my report sheet, such as name, DOB, admitting Dx, attending, code status, and isolation precatiouns.

Just having those things filled out allows me to listen more during report as to just writing. So fill out as much as possible on your own, look up your lines, IVs, drains, and wounds and write those out as well.

For me day shift was hit the floor running from the time I got report. For me it was for very different reasons that don't translate into benefit for your practice but for me it was a lot to do with the morning spontaneous breathing trails performed during dayshift.

So the patients I knew were undergoing SBT I'd ensure are awake, feeds are off, held off on non viral enteral meds, and kept them safe until we can extubate. This for ME was the hardest part of days as you have a lot going on in addition to an agitated, awake patient, that wants the tube out and you're waiting for the team to round.