How do you all like to start your shifts?

[j_tay1981]

I'm trying to get into a fairly efficient groove while starting my shifts. My shifts start at 1900, but the majority of my patients don't have meds due until 2100. At or institution, we can give meds one hour before and after the time they are due.

My first assessment is done around 2000.

I'm trying to be as efficient as I can. I was waiting until 2000, (an hour into my shift) to do both meds and initial assessments for each patient. That way, I could wrap PRN pain meds they may need into their scheduled meds when I ask about pain during assessment. Sort of a 'one stop shop' method, I suppose. The problem here is that this seems to take awhile.

Some nurses, upon arrival to the floor, see each patient briefly and ask if they need anything OR do their assessment then and return around 2100 to give meds. To me, this seems like it would be slower since patients would likely ask for pain meds (or any other PRN) at this time, thus creating a situation where the RN would need to return to give scheduled meds.

I know it is about the patient and not about me, but I'm just trying to build a certain amount of efficiency into my shift.

How do you all like to begin your shifts?

[j_tay1981]

During report we complain for about 30 minutes and then when I see the nurse going off leave I feel awful because I have no one to complain to.

Hahaha! Points for honesty!

[j_tay1981]

My shift is 7a-7p. I start out by going with the previous nurse to do bedside reporting (Of course if the patient is sleeping I do the report at the nurses station.) Then I can assess what type of fluids the patient is on, if they are on any. I can see that a bag is almost empty I need that nurse to change it, I would do the same thing at 7p if I left a bag low, (which rarely happens, I very anal when it comes to my job, no pun intended, lol.) Anyway, I basically touch base with each patient with the previous nurse. After that nurse is done, I go around and do my assessment, I check tele, etc. I then usually have all my assessments documented by 0730, we document on the computer. I then check labs, meds and anything else I feel is pertinent to my job. I start my 0900 med pass at 0800 with breakfast trays, it helps me get them done, especially if someone is on insulin I have to give that med anyway. I take all manual blood pressures, because I work on a step-down tele floor and I need to see for myself what my patients blood pressure is before giving BP meds. If I have patient's going to the cath lab and or any procedures I make sure all the paper work is filled out and the chart is ready to go, typically I do that before I do my assessments. I try to do my notes in the charts as I go. My floor can be insane, it's so incredibly busy, typically I have between 4-6 patients a shift. I am pretty organized and rarely have I ever had to stay over. I know this is a long post, but this is basically how my day goes. Not sure If I helped you but I hope I did.[/quote']

This was super helpful, thanks! Does charting on the fly (as opposed to seeing everybody then charting in bulk) go faster? I would think it would at least be more accurate since everything is fresh in your mind.

[Indy, LPN, LVN]

I start with coffee. Nothing short of a code gets in the way of the coffee. Granted, I can sip while getting report most of the time.

[TiffyRN, BSN, PhD]

I work in an NICU set up in wards with anywhere from 4-12 infants/room. We pretty much stare at our infants as we take report. When finishing report I spend about 5 minutes in the computer to assign myself to the appropriate infants and maybe check a couple of quick items there. Then I go to each infant's bedside, connect their BP cuffs, check emergency equipment such as oxygen, ambu & suction, greet the parents if they are present then draw up first feeds.

[Overland1, RN]

The very first thing that should be done in the shift is a quick check to verify all patients are breathing well; I know a nurse who did so after receiving "report" and found one of her patients had assumed room temperature... the person likely died during the past hour (30 minutes for report and other stuff plus time for previous nurse to record that report). She was rather embarrassed to find this out, as the family arrived at the same time, asking when the patient died.

[M/B-RN]

I like to start my assessments right away because I have learned that if I tell myself I will do something later then something bad happens and I get caught up doing something else and I end up doing the scheduled med and the assessment too late. I feel like I'm almost jinxing myself by saying, "it's okay I can do it later."

If you have to return to give a med later, it's not too big of a deal because it doesn't take very long, it also gives a chance to re-assess pain if you gave a PRN prior to and do anything else you may have forgotten.

I chart as soon as I leave each room, it really does help you stay on track. I don't always do it, things happen sometimes, but I try to as much as I can, especially because when I have 4+ couplets, that's 8+ assessments I'd have to keep straight in my mind!

[advsmuch08]

As soon as report is done I go to each patient room to introduce myself. I update the dry erase boards with our names, diet, activity, etc. I briefly explain the plan for the night. While I doing these I'm looking at the patient's coloring, checking over IV fluids, oxygen, making sure bed rails up, call bell close. Double check for any new orders. As soon I can start passing meds I do and complete my assessments too. Of course there's a million interruptions but that's the routine I aim for.

[cardiacrocks, BSN, RN]

"Of course there's a million interruptions but that's the routine I aim for."

I read somewhere that an RN is interrupted on average every 2 minutes. The one thing I detest is being interrupted during my med pass or if I'm getting a narcotic out of our accudose. Sometimes I will say, can you give me a minute to finish one thing before you give me another order. During the day can be crazy too with all the new orders. Of course I love when they just put orders in for a heart cath and the cath lab calls and says, "is that patient ready yet?" UMMMMM, NOOOOO, I literally just got my orders, however, I can send them and you can do the prep, consent and stuff. Of course the usual response is, "No, you call when you are ready." Ummmm, yea that's what I thought, lol. I do however, love my job!! :)

[MJB2010]

Depends who I am working after. If I am working after someone who left a mess, I spend the first hour or so answering call lights for pain meds, beeping ivs, and bathroom and checking off all the orders that got left behind. If I work after someone who has their stuff together, I start off by doing my assessments, then do my med pass. I feel like before you leave at the end of your shift, you should make a last round to make sure no one needs pain med or has an empty iv bag. Just common courtesy. But we all have crazy days or that busy shift where you get slammed and can't get to it. But there is a difference between leaving a mess once in a while and those who do it every single time. On my floor we do bedside report, so I have already had a look at everyone and said hello.

[SwansonRN]

I work both days and night shifts in the ICU. For days my ideal routine after report, peak in on my patients, check/caliper their strips, then look through their orders, meds, ins and outs that I didn't catch during report. Ideally I can actually see my first patient at 0800, do my assessment first thing, check that they have the right safety equipment, check the monitor alarms, weigh pt, zero a line, check cvp, temp, vitals blah blah. Hopefully I can have all of this documented, but by 0830 latest I leave to see my less acute patient, do the same thing. I rarely pass any meds before 9am unless it's super important. At nights it's about the same, but usually less hectic and I make a "shopping list" and "shop" for each patient. We do our baths and change lines/cannisters/supplies at night which is just tasky and time consuming so I find that if I bring everything in the room at the beginning of the shift its easiest.

[kmarie724]

I work day shift. My first priority after getting report is to get blood sugars and insulins done as well as any tx or assessments that are that are best done before people get out of bed for the day (I work in LTC and have a mix of long term and short-term rehab pts). Once everyone is to breakfast, I take some time at the desk to look at everyone's chart and make my plan for the rest of the day.

[tripsis]

I work ICU days with shift starting at 0630. Get bedside report and take that time to do a visual assessment, ABCs and safety check as well as turn my patient while I have the extra set of hands. We look at labs and go over the previous shifts orders and do a delirium assessment. After report I head to toe assess my most critical patient, check CVP, dressings, oral care, and talk to RT about the POC. Same thing with patient #2. IDEALLY I have both assessments charted by 0800. Then I go back and do meds, accu checks and pass trays if my patients are eating. Typically, docs round from 8-10 so if I have my assessments done and charted early, I can round and be completely in touch with what's going on with my patients.