How would be a typical 12 hour night shift in med/surg in a hospital?

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Hello everyone,

I would like to know how would 12 hour night shift goes in med/surg unit in a hospital with a 6-7 patient. Currently I am working in a nursing home, which I hate because of high patient ratio 1:47 and also hate the management system. Today I did the interview with the hospital and they told me I will be given training for 4 weeks. I am in desperately need of job because I need to pay my debt. But I don't want to regret for switching the jobs. I am scared it won't turn as a wrong decision because I don't know how the hospital med/surg job would be since I am foreign educated nurse and working here just for 2 months. I appreciate any inputs.

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I come in a bit early (6:30) to write all my patient's names down, along with pertinent orders about their care before I take report at 7 pm. i check the daily notes, lab values, make a note of IV fluids and the times their meds will be due. I note any patients on sliding scale insulin, neuro check or treatments to be done and write those down too. A lot of nurses come in at the last minute and go straight to report, but I like being organized so I can hit the floor running. It helps too, in two years at my current job I think I have used about 15 minutes of overtime, I am ready to work as soon as report is through and I don't have trouble getting my work done because I am organized and know what needs doing from the get go.

I can start passing meds at 8 pm for the 9 pms that are due, so I do my first head to toe assessment before 8, giving the meds last so it will be right after the acceptable time of 8-10 parameters for a 9 pm medication. Then I do the same thing for all my others 5 or 6 patients, finishing up everything by 10 pm. When I pass meds I take a bag of fluids into the room for anyone with a rate above KVO, it saves me a trip later and if I don't use the bag I can just pass that on in report and save the day nurse a trip.

At 10 pm I do my electronic charting on each patient, we are supposed to do this at the bedside but I am not going to do that with visitors and patients staring at me while I work, it would also mean I would have to turn on the overhead lights to chart in the room and many patients have their lights out and are asleep already when report is done.

at 12:01 am I can pass the midnight and 1 am meds together.

We have work lists to go off of to be sure that all our pain reassessments are done within one hour and that neuro checks etc get done, I do this and get it up to date after the 1 am meds. We have to reassess certain things on our assessments again within 8 hours and I do these between 3:30- 4:00. I can do all of these in about 10 minutes.

4-5 am I do any line draws and send to lab. Do any line dressing changes that are needed or due by protocol.

5:01 am pass all 5 and 6 am meds, prepare for report @ 7 am, double check for procedures to be done on patients and that check lists are up to date. Check new lab values, call critical and low results as needed. Gather and record IV intake making sure the IV bags have lots of fluid left and that special fluids from pharmacy are ordered for day shift to have on hand. If fluids are getting low I will scan the next fluid bag as being hung and leave it for the next nurse to hang when the alarm beeps, I ONLY do this with plain IV fluids, no Protonix, heparin, med drips or TPN. Saves the day nurse a few moments and they appreciate the gesture.

In between these things, I answer lights as needed, take admission (our charge does the actually admission itself) and deal with prns and whatever else comes up.

Many nights I have from 3-5 hours of downtime. We usually have 6 patients with never more than 7 on a general med/surg floor. The aides usually have 12 patients.

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Currenty Im doing 8 hour nights but for the last 2 years I did 12 hour nights and my night went as follows:

I would come in at about 6:30 to get my patients and look up information. Then get report bt 7-730, then I would assess all my patients and try to at least chart on 3/6 or more depending on how many meds I had to pass. Then b/t 8:15 -8:30 I would start with pts who had 8:00 med and give them their 8's and 10's together and then after everyone with 8:00 were finished I would pass out meds for pts with just 10:00 meds. Usually after the 10:00's are finished you have some time to get organized and do a couple more assessments before 12:00 meds.(usually only a few pts have these) Give 1200 meds, then sit down and finish assessments and do 24 hour chart checks. The chart checks are basically going through the orders for the last 24 hours and making sure they were put in the computer and were followed through.

Ofcourse during this time you have call lights going off and telemetry monitors beeping ect.

After 24 hour chart checks are done I go and check on everyone and then go take my break. We had phones on us so if anyone need us during our break the secretary would call to let us know if there was no one else that could do it at that time.

Then...get back from break, check on everyone again. Hang 2:00 abx, and if your on schedule then you should have some down time to help other nurses that are really busy or clean the nurses station, whatever. Maybe dressing changes, although I would try and do all my dsg changes with 10:00 meds so I didnt have to wake them up for it in the middle of the night.

At the hospital I worked at we had to draw all of our own blood, so at 3:00 I would get all my supplies together for drawing blood and I would draw blood b/t 3:30-5:30. Again drawing 6-7 pts blood doesnt always take the full 2 hours, but pts end up asking you for other things so usually it takes almost the whole time.

Then 5:30 comes and its time for 6:00 meds and blood sugars. The nurses had to check their own blood sugars and we also had to give 7:30 meds. I would do all of this together. Then check my labs, call mds if necessary.

Then the day nurse is waiting for report and your done by 7:30!!

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Thank you DeeAngel and Leah20c. That was helpful.

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I don't have a lot of time to respond so I'll answer quick and to the point. I work 6p-6:30a.

6p-get report til 6:30

7-8: do all of my assessments on my 5 patients and then go chart everything

8-9: Pass all 9pm meds

10pm-get report on add'l 2 pt's (from the ppl that work 10a-10p)

11pm-get caught up on anything

MN-do midnight rounds and chart

1-3am: finish any charting and get all of my 24 hour chart checks done

4am-4am rounds on all 7 patients and charting

5am-get in all of my electronic shift reports

6:20am-go give any add'l updates in report to oncoming nurses

**Generally I stay very busy as there are always patients calling throughout all of these times needing something. We have 1 CNA per 12-16 patients btw.

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@DeeAngel....where do you work that you have a charge nurse that takes care of PRN's and your techs get 12 pts @ night...I want to go there!!! I am having such a rough time where I am; hosp owned by HMA, horrible staffing, low supplies and our poor techs will usually have over 15 pts a piece, sometimes one tech for 30+ pts. I am a fairly new nurse and had no preceptorship, been there for 3 mos and have had 6-7 pts on my own since about 4 weeks in.

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@DeeAngel....where do you work that you have a charge nurse that takes care of PRN's and your techs get 12 pts @ night...I want to go there!!! I am having such a rough time where I am; hosp owned by HMA, horrible staffing, low supplies and our poor techs will usually have over 15 pts a piece, sometimes one tech for 30+ pts. I am a fairly new nurse and had no preceptorship, been there for 3 mos and have had 6-7 pts on my own since about 4 weeks in.

Charge nurse doesn't take care of our PRNs but she does do the actual admission of new patients to the floor and the charges will help you with anything you need help with or are unsure about. It's a 120 bed Catholic hospital in an Arkansas city of around 40,000.

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