I'm a Monkey...

[Merrie82, RN]

So, I had a meeting with my Unit Based Educator and Manager as a follow up to my meeting the other day with the UBE/it was supposed to be my last mtg bf end of orientation. 

I told them that while I felt ready on days, I did not on nights. That I am disorganized, and have no routine, and haven't been assigned 5 pts yet on nights. That was definitely, clearly, Absolutely ? % NOT what they wanted me to say, and I had a very hard time saying it as such. I was rebuffed. Basically told that since I am doing so well on days, nights should be just the same... and why isn't it?? I told them I wished I knew, but I suspected rotating shifts and only having worked 2 weeks of nights, intermittently, was likely at least partly the issue.

Their solution is to put me on 1 extra orientation night shift with a different preceptor (for a total of 3 shifts next week) and reevaluate after this. But they clearly intend to put me out on my own following next week regardlessof what I say. 

I feel...disgruntled, and stupid for feeling disgruntled and somewhat surprised by their reaction. Obviously I am putting a monkey in the scheduling wrench. But saying I feel ready when I don't think I am would be wrong, so there's that. Not sure how I'm feeling about my floor after all this drama and discombobulation. Maybe a bit sad that I picked the wrong floor. 

If anyone has any organization tips, or even feels like giving me a snapshot of what your routine is on nights, I would really appreciate it.

[SmilingBluEyes]

What unit/specialty do you work?

[PsychNurse24, BSN, RN]

You might ask if you can start with four patients per shift.  I did and they allowed me three weeks with four patients before I went up to five or six.  Those extra shifts with 4 patients did help me a lot.  

Our shift started at 7 PM and went until 7 AM. I got to the floor at 6:30 PM, grabbed a census sheet, and ate my dinner in the break room while I reviewed the census sheet for 15 minutes. Then I clocked in and met the dayshift nurses for shift to shift pass down from 6:45 PM until 7:15 PM.

I came up with an Excel legal-sized information sheet for my own use.  On it there was room for the patient label.  Then I typed in surgical floor specific information that I needed to check. I did these spreadsheets at home and printed them out on blue or green paper so the sheet stuck out. Then I stapled it to the census sheet once I got to work.  You can type in whatever you need to check or remember. For example I would type in IV site: central, left a/c, right a/c, left hand, right hand etc.  You can type in whatever you want. I did the same for wounds so I knew location, drains, etc.  So I typed in all the possibilities and copied that in 6 different columns of the spreadsheet.  Then I would circle the specific information for each patient.  I hope this makes sense. Anyway, those sheets were a lifesaver for me. I referred to them when I could not chart real time and it was a great reminder of what I needed to do. You can personalize it however you want to help you organize.

I was on night shift on the surgical floor.  We had shift pass downs in the patients rooms. We were expected to chart every two hours on patient safety issues. One thing that really helped was asking the dayshift nurse that was passing off to me if I could log onto the computer. Half the nurses said yes, half said no.  I could do my initial charting right at the beginning of shift while I put eyes on the patient for the first time and checked IV sites and all other pertinent information required by the floor. Then I would do the same for the nurse in the morning when he or she came back on. 

After meeting each patient in the shift pass down, I reviewed vital signs and labs and doctors orders for the last 24 hours.
Next I started on the head-to-toe assessments.  If I could, I would also chart this in each room real time.  

Then I was pretty busy until around midnight when we had to hang midnight meds and new tubing.  From 1 am to 5 am I completed all my charting as I responded to call lights and other duties. At 5:30 AM I went into the med room and started preparing the morning I V’s and other meds to be passed at six or 7 AM.  I also did my last charting and tried to get out of there soon after shift to shift pass down.

So that was my plan for every night. Keep in mind that plan only worked maybe one in five shifts because there was always some thing that came up. My best advice is to try to keep up with charting as much as possible!  Also be nice To the staff of all the other departments you will be interfacing with. I made cookies for the pharmacy folks, the phlebotomists,  and the blood folks.  Then when I needed a med last minute or for the lab people to come up and do my labs first in the morning they always did.  

Good luck!

[Davey Do]

I'm leaning more toward focusing on giving you moral support, Merrie.

I applaud your honesty, straightforwardness and candor in your meeting. I mean like, that's what these evaluations are for--- they're NOT so we can tell others what they want to hear, they're for a true perspective on the status, so we can deal accordingly.

However, it seems as though they want to work with you, giving you an extra shift or orientation. Good sign and good for them!

And I want to encourage you not to beat yourself up. Even a new pair of good quality shoes requires a breaking-in period.

I use that last analogy because I have a new pair of quality boots, but also to discuss yours: Off the top of my head, It's not a "monkey in the wrench"

It's a wrench in the works, like a fly in the ointment.

You right brained, abstract malaphrofic people are so entertaining!

My medical nurse wife often makes malaphor phrases them and I call them "Belindaisms". One of my favs is "biting at the chomp" instead of chomping at the bit.

You're both so cute.

Edit: I believe a monkey refers to a problem, like an addiction, I.e. "monkey on the back".

However, in the Chinese horoscope, those born under the sign of the monkey are believed to be intelligent and playful, so let's leave it at that.

 

 

 

[Merrie82, RN]

10 hours ago, SmilingBluEyes said:

What unit/specialty do you work?

Neuro + Ortho trauma...we have a lot of lami, crani, and stroke patients, but mixed in there are some traumatic hip fracture patients too, bc we staff the straight ortho unit occasionally.  

[Merrie82, RN]

On 3/20/2021 at 1:37 AM, PsychNurse24 said:

You might ask if you can start with four patients per shift.  I did and they allowed me three weeks with four patients before I went up to five or six.  Those extra shifts with 4 patients did help me a lot.  

Our shift started at 7 PM and went until 7 AM. I got to the floor at 6:30 PM, grabbed a census sheet, and ate my dinner in the break room while I reviewed the census sheet for 15 minutes. Then I clocked in and met the dayshift nurses for shift to shift pass down from 6:45 PM until 7:15 PM.

I came up with an Excel legal-sized information sheet for my own use.  On it there was room for the patient label.  Then I typed in surgical floor specific information that I needed to check. I did these spreadsheets at home and printed them out on blue or green paper so the sheet stuck out. Then I stapled it to the census sheet once I got to work.  You can type in whatever you need to check or remember. For example I would type in IV site: central, left a/c, right a/c, left hand, right hand etc.  You can type in whatever you want. I did the same for wounds so I knew location, drains, etc.  So I typed in all the possibilities and copied that in 6 different columns of the spreadsheet.  Then I would circle the specific information for each patient.  I hope this makes sense. Anyway, those sheets were a lifesaver for me. I referred to them when I could not chart real time and it was a great reminder of what I needed to do. You can personalize it however you want to help you organize.

I was on night shift on the surgical floor.  We had shift pass downs in the patients rooms. We were expected to chart every two hours on patient safety issues. One thing that really helped was asking the dayshift nurse that was passing off to me if I could log onto the computer. Half the nurses said yes, half said no.  I could do my initial charting right at the beginning of shift while I put eyes on the patient for the first time and checked IV sites and all other pertinent information required by the floor. Then I would do the same for the nurse in the morning when he or she came back on. 

After meeting each patient in the shift pass down, I reviewed vital signs and labs and doctors orders for the last 24 hours.

Next I started on the head-to-toe assessments.  If I could, I would also chart this in each room real time.  

Then I was pretty busy until around midnight when we had to hang midnight meds and new tubing.  From 1 am to 5 am I completed all my charting as I responded to call lights and other duties. At 5:30 AM I went into the med room and started preparing the morning I V’s and other meds to be passed at six or 7 AM.  I also did my last charting and tried to get out of there soon after shift to shift pass down.

So that was my plan for every night. Keep in mind that plan only worked maybe one in five shifts because there was always some thing that came up. My best advice is to try to keep up with charting as much as possible!  Also be nice To the staff of all the other departments you will be interfacing with. I made cookies for the pharmacy folks, the phlebotomists,  and the blood folks.  Then when I needed a med last minute or for the lab people to come up and do my labs first in the morning they always did.  

Thanks! I do have report sheets, aka, my brain, that I use for each pt. And charting! ? There is so much charting! I'm definitely still working on how to keep up with that LOL. As far as asking to have only 4 pt at first, that's a no go, I asked. I can understand their perspective. 5 is normal,  and we can go up to 6 on nights, so they want to be sure I can handle 5. Thanks again ❤

[Merrie82, RN]

2 hours ago, Davey Do said:

I'm leaning more toward focusing on giving you moral support, Merrie.

I applaud your honesty, straightforwardness and candor in your meeting. I mean like, that's what these evaluations are for--- they're NOT so we can tell others what they want to hear, they're for a true perspective on the status, so we can deal accordingly.

However, it seems as though they want to work with you, giving you an extra shift or orientation. Good sign and good for them!

And I want to encourage you not to beat yourself up. Even a new pair of good quality shoes requires a breaking-in period.

I use that last analogy because I have a new pair of quality boots, but also to discuss yours: Off the top of my head, It's not a "monkey in the wrench"

It's a wrench in the works, like a fly in the ointment.

You right brained, abstract malaphrofic people are so entertaining!

My medical nurse wife often makes malaphor phrases them and I call them "Belindaisms". One of my favs is "biting at the chomp" instead of chomping at the bit.

You're both so cute.

Edit: I believe a monkey refers to a problem, like an addiction, I.e. "monkey on the back".

However, in the Chinese horoscope, those born under the sign of the monkey are believed to be intelligent and playful, so let's leave it at that.

 

 

 

??? Of course its not a "monkey in the wrench" but it sounds good, yeah? Editing to add I was playing on the saying "throwing a monkey wrench"...

"The monkey wrench is a type of adjustable wrench, a 19th century American refinement of 18th-century English coach wrenches. ... The largely US idiom "to throw a monkey wrench into..." means to sabotage something." From the internet encyclopedia aka Wikipedia.

I believe that the monkey on the back analogy is also appropriate in this instance. And I am the Dog sign in Chinese astrology,  or at least that's what all those placemats at the Chinese place I went to as a kid said.

As for TPTB allowing me 1 additional orientation shift....they aren't. They switched my last day orientation shift to nights is all. And switched my night preceptor to a more experienced RN. I don't know that 1 additional night shift will make a big difference,  but here's to hoping it does. ❤ Thank you for the moral encouragement  ??

[JKL33]

This is one of those times where I want to say something both supportive and therapeutic but this situation makes me pretty mad so it probably won't come off that way.

If these people are terrible enough to make a new hire rotate shifts during orientation and the immediately subsequent period, then they are simply horrible human beings.

Good for you for speaking straightforwardly during your review.

Given their responses and their refusal to consider the rotating shifts issue previously, I think what I would do would be to work hard (maybe harder than ever before) during these next few months, don't berate yourself or be self-deprecating, give yourself credit for what you are learning and the skills that are getting stronger--but don't rely on these people for much. They are neither morally nor intellectually fit to guide you properly. Keep your eyes open for a good, strong "nurse's nurse" at work who can be your informal mentor or at least a go-to person.

They had an opportunity to deal fairly with someone's honest appraisal of their own struggling, and they blew it. They have shown their cards. This is your warning to go into a different mode now....which is something like Fake It 'til You Make It.

Understand?

Get what you need to get out of this experience so that you put yourself in a stronger position for...um...anything you may want to do in the future.

Best of luck!

 

[Merrie82, RN]

6 minutes ago, JKL33 said:

This is one of those times where I want to say something both supportive and therapeutic but this situation makes me pretty mad so it probably won't come off that way.

If these people are terrible enough to make a new hire rotate shifts during orientation and the immediately subsequent period, then they are simply horrible human beings.

Good for you for speaking straightforwardly during your review.

Given their responses and their refusal to consider the rotating shifts issue previously, I think what I would do would be to work hard (maybe harder than ever before) during these next few months, don't berate yourself or be self-deprecating, give yourself credit for what you are learning and the skills that are getting stronger--but don't rely on these people for much. They are neither morally nor intellectually fit to guide you properly. Keep your eyes open for a good, strong "nurse's nurse" at work who can be your informal mentor or at least a go-to person.

They had an opportunity to deal fairly with someone's honest appraisal of their own struggling, and they blew it. They have shown their cards. This is your warning to go into a different mode now....which is something like Fake It 'til You Make It.

Understand?

Get what you need to get out of this experience so that you put yourself in a stronger position for...um...anything you may want to do in the future.

Best of luck!

 

Thank you ❤❤ I do understand,  and will work as hard as I can over the next several months to get my feet under me. I have extensive experience with "fake it til you make it" LOL. 

[JBMmom, MSN, NP]

6 hours ago, Merrie82 said:

I have extensive experience with "fake it til you make it" LOL. 

I don't mean to make light of our jobs as nurses, but it sounds like you've got at least the right attitude. I think you should try to focus on your success on days to this point. You CAN handle the assignments and the patients, maybe that's why they weren't as responsive to your feedback about the shift. 

Most people seem to find the opposite is true, nights can be easier starting out because there are less other distractions to patient care. Orders aren't being changed, doctors aren't rounding, PT/OT/ST aren't stopping in, etc. You can do this, it's just about organizing your time. I think that the rotation has made it more difficult, will you still be rotating shifts or will you be straight nights? 

I also think that the new preceptor may make all the difference for you. You may be very pleasantly surprised at what a difference a few days with him or her can make. Good luck!

[Merrie82, RN]

4 minutes ago, JBMmom said:

You can do this, it's just about organizing your time. I think that the rotation has made it more difficult, will you still be rotating shifts or will you be straight nights? 

I also think that the new preceptor may make all the difference for you. You may be very pleasantly surprised at what a difference a few days with him or her can make. Good luck!

Thank you for the kind words and encouragement. I will unfortunately be rotating until mid June, then I will be straight nights, which is what I was hired for. I do think rotating is some of the issue, and look forward to when I can stop doing this.

I can't even explain how different I feel working at night vs. during the day. It's  like my brain isn't functioning properly.  I am...confused? Foggy?

I get migraines, and afterwards I usually have what I call a migraine hangover day, where I'm just not quite right cognitively. For example, on one such migraine hangover day, I was playing scrabble with my family. I was having difficulty figuring out what to do with my blank squares (I had 2!) to make a whole word. I was getting really frustrated,  bc I just couldn't think. My husband and mother helped, and I got a great word. Once the game was over, we were looking at the board and realized no one ever got the q, or z? Can't remember now. Either way, turns out I had the z, and I put it and another letter on the board upside down, thinking it was a blank. Like that. That is the level of fogginess I am experiencing at night. I am assessing patients for neurological deficits and changes, while experiencing neurological deficits and changes. I feel like a different person, a different nurse, at night. I really, really, hope that it's from rotating, and will get better once I am straight nights.

As for a new preceptor,  I hope that it helps! I am open to any and all feedback from them, and hopefully they will have some good ideas to help me be more organized. 

[PsychNurse24, BSN, RN]

Working nights is really hard for a migraine sufferer. I have basilar type migraines, and also have the brain fog for a day or two after each headache. When I worked night shift I was able to keep the same schedule during the rest of the week. My kids were grown and gone so I was able to stay up all night and sleep during the day even on my nights off. That really helped.
 

 I think you’re exactly right about rotating shifts, it is just horrible for people. You would think as healthcare workers we would’ve figured that out and stopped rotating shifts!  I take a calcium channel blocker for migraine prevention. I don’t know what kind of migraine you have but for me it totally changed my life. I’ve been taking it for 35 years and I have had fewer headaches.

Please take extra special care of yourself while you’re getting through the next few months.  I think When you are working straight Night Shift things will get better. And as others have said, if you’re doing well on dayshift it is just a matter of getting your sleep routine down and hopefully having fewer migraines and you will shine!