How many people do you have to wake up at night?

CoffeeRTC, BSN, RN · May 2, 2005

The only dressings done on nights are g tube's and IVs. Maybe an occasional TID dressing,but rarely. If the resident requests we will do these ones on 3-11. Maybe 4 or 5? Skin checks or body audits are done with baths/ showers, so they do these during the days.

Big no no to wake folks for dressings and audits, but don't get me started on the med pass and blood draws. Some nurses are starting at 4 or 5 am!

violetrose · May 2, 2005

I agree don't wake resident up at night except for repostioning and incont care which are essential. Treatments a NO,NO!! If I have a TID treatment we do the night treatment at the time of repositioning. ***I have a concern related to starting med pass at 6:00am, our pharm mandated that we give everyone on Prilosec or Thyroid medications before meals and on empty stomach. Our bkft meal is served at 7:00AM. In order to comply we felt it better to start at 6:00am and TRY to administer just these meds. We looked at other times but most of our resident don't have an *empty stomach because of the supplements and snacks given throughout the day and evening. WE HAVE GIVEN THESE MEDICATIONS FOR YEARS AT MEALTIMES WITH OUR GENERAL MED PASSES, WHAT IS THIS!! ARE WE GOING TO HAVE TO PASS MEDICATION ALL DAY LONG, WHAT ABOUT TREATMENTS, CHARTING ETC. THIS IS GETTING CRAZY!!

Blackcat99 · May 2, 2005

Thanks all. I forgot the pill pass that I have to start at 4:30am. We have one lady who is scheduled to be awakened at 2am for normal saline eye gtts. We have to start shift report at 6am so we all start around 4:30am. It takes a long time to give meds sometimes to persons with stubborn G-tubes that want to clog up all the time. :angryfire I think it is great to hear that some LTC's are doing the skin checks at shower time. That sounds like a perfect time to me.

CapeCodMermaid, RN · May 2, 2005

No treatments are done 11-7 unless it's a new skin tear that needs to be steri-striped. All our skin checks are done weekly on shower days which are 7-3 or 3-11. Have to agree about the times for Synthroid. Our local hospital still gives Synthroid at 8 or 9, but our consultant is a fanatic about empty stomach. Do y'all think these people are going to set their alarm clocks at home to take their meds?!?

night owl · May 2, 2005

We had orders for crazy things like, saline nasal spray, oral lubricant, Liquid tears, all at 0100. Unbelievable. Of course we usually mark the med as "held," reason being, "He's sleeping!" I used to have to wake a pt up at 0400 for a fleet enema every morning except Wednesdays and Saturdays. If someone came near me with an enema at 4am, they'd be literally getting it themselves!!! We still have a few tx's to do, but I wait until 6 or so when they're AWAKE.

donmomofnine · May 3, 2005

Our skin checks are done by our spa tech on their bath day. Treatments are not done on nights. Only wake up for incont care and most sleep through it! Meds start at five, but I am hoping that will change when we do a little "culture change" magic and let people actually get up when they are ready and eat breakfast when they want to!

DG5 · May 3, 2005

When I came onto the night shift 9 months ago, I didn't want to make waves right away, but the first thing I did with my nursing manager supporting me was to change all the eye gtts from the night med pass to the day shift. We also changed all the times of the meds that weren't necessary to give. The only ones we give are antibiotics on an empty stomach (like Cipro), and early am pain medications for those residents who need it before they get up. That is it. All the other meds that require meds on an empty stomach are given at 0730 prior to breakfast at 0830. It sounds as if you are going to have to collaborate with your nursing manager/ DOC to change breakfast to a later time or to end your shift later. Our shifts usually run 2300-0700, 0700-1500 and 1500-2300. The skin checks are done at bath/shower days. We need to PROMOTE sleep with these residents, not interrupt it.

Blackcat99 · May 4, 2005

Yes it would be nice if we didn't have to wake up so many residents at night. Unfortunately, it's our nurse managers here who keep adding treatments and meds and specifically put it on the MAR for the night shift.

dbsn00 · May 5, 2005

When I worked nights (11-7) I had to start my med pass at 5AM - there were so many eye gtts, over a dozen finger sticks w/ coverage & plenty of other meds to give. Also had to change all the GT tubing, plus bolus feedings too. There was sometimes wound care but that would be done with either incont. care or during turning & positioning. There were a couple of patients with orders for neb tx's at midnight or 2AM (usually got those D/C'd on most people for refusals, go figure :rolleyes: ) & a couple of 2AM or 4AM pain meds. I think there is overkill on the amount of meds these patients are prescribed - I have one resident who takes 22 meds at 9AM - not to mention all the other meds during the course of the day. I used to hate having to wake up those poor people who usually didn't sleep well anyway.

emeraldjay · May 9, 2005

As a CNA, one of my biggest gripes is having to wake up residents between 2300 and 0000 to offer fluids. All I can say is if someone ever woke me up two hours after I got to bed just to offer a drink, they would be wearing it.

Blackcat99, I would have serious issues with my superiors if they required weekly skin checks at night. I must be spoiled by my facility, skin checks are done with weekly baths.

When I become a nurse, I intend to advocate for a resident's sleep. The thing that bothers me most is that almost every "Intro to Psychology" class emphasizes the need for sleep and dreaming, without them, psychological problems can ensue. Yet we are required by state or facility mandates to pester our residents before they can get to REM stage sleep. It's no wonder I see residents nodding off in the halls within 20 minutes of getting their AM cares.

rebel_red · May 9, 2005

Wake em up in the middle of the night for skin checks???? This is insanity. We do ours on 7-3 or 3-11 when they are in the shower. And it is spread over the entire week, so there are only a few to do on a daily basis. Makes it mucho easy. Plus are aides are really great about reminding the nurses of skin checks and reporting any changes in skin condition they notice while giving care.

Tres