Can you describe your 12hr 7a-7p shift?what goes on and tips

[lvloverRN]

hi, ill be starting in august in a med/surg floor, can you describe what goes on,

what you usually do once you punch in, and describe your daily tasks, and

time management, and organization skills until you leave at 7pm? I have about 10mos of experience under my belt, i am currently

working at a sub-acute unit/rehab floor at one of the long term care facilities

in nj. also, do you think my experience working there will somehow be helpful?

thank you very much!! any tips, suggestions and advice will be greatly appreciated.

[gcupid]

why would you want to check your sickest pt last? you need to see them FIRST

Each pt assignment is different. You must utilize both time management as well as prioritization. Ideally in a world somewhere over the rainbow where the skies are blue and the things that you dare to dream...blah, blah, you would see the sickest first. But I only have a few years of experience in med-surg, so here is my rationale for seeing the sickest patient last at times......Tell me EXPERTS if you agree:

Everyone needs everything done ASAP in the hospital setting but its only one nurse to however many patients and in order to avoid sinking and not get pulled in so many directions, unless its critical it can wait. Time management is priority over prioritizing based upon acuity unless it's life or death.

The patients that are walkie talkie and can swallow pills whole...Im going to hurry up & throw them da*! pills down their throat to get them out of the way bc you never know whats going to happen next. You can take your time with the sickest and not be worried about what all you have to do for the others bc its taking you so long.......Reducing anxiety..

[gcupid]

wrong thread

[tokmom, BSN, RN]

Each pt assignment is different. You must utilize both time management as well as prioritization. Ideally in a world somewhere over the rainbow where the skies are blue and the things that you dare to dream...blah, blah, you would see the sickest first. But I only have a few years of experience in med-surg, so here is my rationale for seeing the sickest patient last at times......Tell me EXPERTS if you agree:

Everyone needs everything done ASAP in the hospital setting but its only one nurse to however many patients and in order to avoid sinking and not get pulled in so many directions, unless its critical it can wait. Time management is priority over prioritizing based upon acuity unless it's life or death.

The patients that are walkie talkie and can swallow pills whole...Im going to hurry up & throw them da*! pills down their throat to get them out of the way bc you never know whats going to happen next. You can take your time with the sickest and not be worried about what all you have to do for the others bc its taking you so long.......Reducing anxiety..[/quote

Well said.

[sophBSN15]

HI,

I am in the same boat as you just got hired in med-surg unit 7a-7p. (Im in florida) The ratio is gonna be 5-7 patients. I have been a LPN for 3 years but have never worked in a hospital. I am so nervous for so many different reason. Just to let you know I will be working as an RN , just graduated and passed my boards in April. So now I am in charge of staff...and I am completely freaking out...but I am so excited about what is ahead.

[Aeterna, BSN, RN]

A bit of background info: I work on a busy medical/oncology floor. On day shift, nurses have 4-5 patients. We have a few PSWs on the floor, but because the floor is so big, maybe one patient of a nurse's assignment gets taken care of by a PSW (but only for bathing and, perhaps, feeding; they don't answer call bells or anything, unless they are finished their other duties).

My day goes a bit like this:

1) Look at my assignment, get report, and start getting a rough mental image of how my day can be organized.

2) Go and see all my patients. Do vitals if they're due, do whatever physical assessments that are important, check blood sugars for the diabetics, "put out fires" on the go, as they say ^^;

3) Start pouring everyone's morning meds. By this time, it's past 0800 and our morning meds are scheduled for 0900, so I'm within the proper timeframe. I help out patients with breakfast for those who need the assistance.

4) First break is generally around this time. Depending on which break I'm scheduled for and the condition of my patients, I might go check on the lab work results, do some charting, or help a patient get bathed. If there are a lot of fires to put out, though, I'm usually still running around and wishing for a cup of coffee I know I'll never get!

5) Late morning, I usually try to get my baths done. Also, depending on the lab work results, I may have to transfuse blood or platelets or address any other wonky lab numbers. I address these ASAP. Doctors are usually rounding on patients by now and I have to process any orders they leave.

6) Lunch. I do any blood sugars that need to be done, help patients with their lunches (including getting them up to their chairs, if needed), and pass noon time meds, all the while trying to make it to my own lunch break! I also check vitals that are due.

7) In the afternoon, things usually slow down a little. I try to do dressings in my assignment earlier in the day, but most of the time they get done after lunchtime. I finish anyone who still needs to get bathed and I try to catch up on my charting. If I have any patients wearing incontinence briefs, I check to see if they need changing. If I helped a patient up to a chair for lunch, I help them back to bed if they'd like a rest. If I have blood products, chemo, or other afternoon meds to do, I've gotta keep up with those, too. Doctors are often still rounding on patients so I keep checking for new orders and process them.

8) Dinner: again, more blood sugars for the diabetics in my assignment, more passing of meds, and helping patients with their dinners (and again, if they need to get up to their chairs, then I do that too). And again, I try to get it all done so I can make it to my dinner break!

9) Things are starting to wrap up. I help anyone who needs it back to bed. I take vitals signs if they're due. I empty Foleys, clear PCA pumps, freshen up anyone who is wearing a brief, calculate total fluid balances, and do anything else that needs to be done prior to night shift. I re-check my orders to make sure a doctor hasn't wandered onto the floor late in the day to leave orders (a couple of doctors are notorious for this). I write up my final charting and make sure my patients are comfortable.

10) End of the day. I report off to night shift and leave.

As the others said, you've gotta put out fires as they come. For example, keep checking on the patient who has chronic pain. Some patients need help with toileting (and there's always that little old lady with the tiny bladder....) Some family members or patients have a lot of questions that you need to answer or at least direct them to someone with the answer. Sometimes, you may have a confused and agitated patient. Sometimes, a patient takes a turn for the worse. Or, what if a patient is upset that they didn't get the food they requested and you have to call down to the kitchens and get it sorted out. And of course, there's answering phone calls, getting patients ready and transported for procedures and tests, talking with doctors, talking with the charge nurse, trying to start a difficult IV, cleaning up the incontinent patient who is having diarrhea, handling discharges and admissions, etc.

It's difficult, crazy, and stressful, but we manage...somehow...usually...

Just know that it is an unpredictable and fast-paced environment. I organize my day in my head but with the full knowledge that something is probably going to happen to throw it off and I'll have to re-organize myself on the fly (if I can - there are days where this is impossible and I fly by the seat of my pants). Don't get too stressed if something throws a wrench into your plans. Do your best, prioritize, and grab a co-worker or two if they look a bit bored to help you out.

[Hay, RN]

I start at 6:55am.

Hide my vital machine in the bathroom and put my name on a med-cart.

Round up them night nurses and get report.

(After all - why WANT a day nurse who drags in 10 after 7 and come get report 20 after? You want to go home and I want to go home when you come on - have some courtesy).

Go get vitals and do system assessments/make sure everyone is alive. I usually do the easist/low acuity first. I save the sickest for last becuase they take the most time.

Update the boards while I'm in there - my name, date, phone number etc (I actually erase the whole board and re-write it because half the nurses here don't have ligible handwriting).

Sit down at 0800 and put in all my assessments.

Answer any call lights/needs/pain meds. I go to breakfast at 0830.

I start med pass at 0900. Breakfast for the PTs is served around 0800 so if I have any feeders, I'll feed them before I go to breakfast.

Med pass lalalala, more thorough assessments, med pass lalalala.

I like to start baths on totals at 1000. Anyone else I cover their IV and put them in the shower. I change their linens while in shower or during bed bath.

At 1130 I get my 1200 vitals and do meds lalalala med pass.

I go to lunch around 1200-1230. Come back half an hour later and round on my patients.

I do 1400 meds at 1300. Med pass lalalala.

In the mean time all the lalalas are talking with the patients, assisting the patients with whatever they need, talking to families, etc.

1500 I do 1600 meds and obtain vitals. Med pass. Lalalala

I sit down and play on the computer ... in the meantime. Waiting for things to pop up to do - my patients to need me.

An admission here or there ... gotta plan them in. Hope for a walky talky ;-)

All in the mean time while in the rooms make sure they don't need help to the bathroom, clean them if they are soiled (I cannot leave a patient in pee or poop, no way)!

Start some nursing notes on what I did - bathed them and whatnot.

Do 1800 meds at 1700. Chat with the patients ... discharges. You know.

And I just wait on the night nurses to come on in and take over! (:

I rarely leave anything to do for the nightnurses other than what they are required to do on their shift.

Of course, all my days don't go this well but it's the PLAN I like to stick to.

I've been a nurse a little over two years on a Med-Surg unit so it'll take some time to work into a schedule/habit.

Oh, I forgot to mention our hospital does hourly rounding on EVERY patient on our floor. Meaning all the nurses have to sign up for a slot (one hour) and then do rounds that hour. I usually go around 1600 - this seems to be the calmest time. Good luck!!

Edit: We usually have 4-5 patients. No PCT on our floor. Usually four though. If we're full one nurse has to have 5 patients. Usually the LPN.

[tokmom, BSN, RN]

I start at 6:55am.

Hide my vital machine in the bathroom and put my name on a med-cart.

Round up them night nurses and get report.

(After all - why WANT a day nurse who drags in 10 after 7 and come get report 20 after? You want to go home and I want to go home when you come on - have some courtesy).

Go get vitals and do system assessments/make sure everyone is alive. I usually do the easist/low acuity first. I save the sickest for last becuase they take the most time.

Update the boards while I'm in there - my name, date, phone number etc (I actually erase the whole board and re-write it because half the nurses here don't have ligible handwriting).

Sit down at 0800 and put in all my assessments.

Answer any call lights/needs/pain meds. I go to breakfast at 0830.

I start med pass at 0900. Breakfast for the PTs is served around 0800 so if I have any feeders, I'll feed them before I go to breakfast.

Med pass lalalala, more thorough assessments, med pass lalalala.

I like to start baths on totals at 1000. Anyone else I cover their IV and put them in the shower. I change their linens while in shower or during bed bath.

At 1130 I get my 1200 vitals and do meds lalalala med pass.

I go to lunch around 1200-1230. Come back half an hour later and round on my patients.

I do 1400 meds at 1300. Med pass lalalala.

In the mean time all the lalalas are talking with the patients, assisting the patients with whatever they need, talking to families, etc.

1500 I do 1600 meds and obtain vitals. Med pass. Lalalala

I sit down and play on the computer ... in the meantime. Waiting for things to pop up to do - my patients to need me.

An admission here or there ... gotta plan them in. Hope for a walky talky ;-)

All in the mean time while in the rooms make sure they don't need help to the bathroom, clean them if they are soiled (I cannot leave a patient in pee or poop, no way)!

Start some nursing notes on what I did - bathed them and whatnot.

Do 1800 meds at 1700. Chat with the patients ... discharges. You know.

And I just wait on the night nurses to come on in and take over! (:

I rarely leave anything to do for the nightnurses other than what they are required to do on their shift.

Of course, all my days don't go this well but it's the PLAN I like to stick to.

I've been a nurse a little over two years on a Med-Surg unit so it'll take some time to work into a schedule/habit.

Oh, I forgot to mention our hospital does hourly rounding on EVERY patient on our floor. Meaning all the nurses have to sign up for a slot (one hour) and then do rounds that hour. I usually go around 1600 - this seems to be the calmest time. Good luck!!

Edit: We usually have 4-5 patients. No PCT on our floor. Usually four though. If we're full one nurse has to have 5 patients. Usually the LPN.[/quote

Question: You say you sign up for a time. Does that mean that you round on ALL the pt's on the floor? If so, how do you learn their history? Do you get a group report?

I'm wondering if this would work at my facility...

[registerednutrn, BSN, RN]

Day starts at 0650 get patient assignment. 0700 getting report on 6 patients (ratio 1:6 for nurses and 1:12-18 for nurse techs.). Depending on nurse getting report from report can take 20-50 minutes. Make walking rounds with night nurse sign hourly rounding sheet (every nurse is responsible for hourly rounding on their patients). Start med assessment pass( I assess chart and give meds at the same time I never give a patient a med prior to assessing. I also chart the assessment there is the patients room.). If things go well I am done with morning meds and assessments by 0930 to 1000. Then check for any orders received and complete those as appropriate. Usually by this time I have discharge number 1. Work up paper work gather supplies if needed (send lots home with foleys) and teaching materials. Give appropriate teaching and supplies. Call transport to transport to front lobby( thank heavens for them). Check orders. Get notification of new patient coming. Discharge patient number 2. Call dr about uncontrolled post op pain receive orders. Tele calls advises one of your patients o2 sat has dropped into low 80's go to patients rooms where patient has removed o2 sat monitor correct situation and verify o2 sat. New patients arrives meanwhile your charge nurse hasn't got to tell you you have another coming and they just arrived also and need to be ready for surgery in 15 min. And discharge number three is getting upset because they feel their discharge is taking too long. Get report on new patient and 2nd new patient ready for surgery just as surgery transport shows up. Get patient 3 discharged.Pass noon meds walk patient in hallway. Get orders for discharge on patient number 4.Get notification of new patient coming from surgery with Murphy drip. Quickly get patient 4 discharged. Try to get any dressing changes done that need to be done. Surgery patient here receive report Murphy drip ran dry on way up and will have to hand irrigate foley to remove clots. Get Murphy running. Patient you sent to surgery will be coming back shortly. Make sure all afternoon meds are passed. Deal with family as needed. Go start IV for nurse on patient that is a hard stick and needs pain med. Patient returns from surgery receive report. Hopefully some where in all of this I have found 5 or 10 min to chow down some lunch. Go start an IV for another nurse(I generally do this at least twice a day). Try to get some charting done before doing 12 hour chart check. Make sure everything is done and now hopefully it is not 7p yet so I have a min to catch my breath. Give report and find a place to hide and complete any charting not already done. Keep in mind that I am also answering phone calls and call bells, and giving PRN meds during the day as well. Needless to say my floor can be very busy. Hope this isn't too confusing. It is common to discharge most if not all of my patients in a day and admit one for every one I discharge.

[Hay, RN]

I start at 6:55am.

Hide my vital machine in the bathroom and put my name on a med-cart.

Round up them night nurses and get report.

(After all - why WANT a day nurse who drags in 10 after 7 and come get report 20 after? You want to go home and I want to go home when you come on - have some courtesy).

Go get vitals and do system assessments/make sure everyone is alive. I usually do the easist/low acuity first. I save the sickest for last becuase they take the most time.

Update the boards while I'm in there - my name, date, phone number etc (I actually erase the whole board and re-write it because half the nurses here don't have ligible handwriting).

Sit down at 0800 and put in all my assessments.

Answer any call lights/needs/pain meds. I go to breakfast at 0830.

I start med pass at 0900. Breakfast for the PTs is served around 0800 so if I have any feeders, I'll feed them before I go to breakfast.

Med pass lalalala, more thorough assessments, med pass lalalala.

I like to start baths on totals at 1000. Anyone else I cover their IV and put them in the shower. I change their linens while in shower or during bed bath.

At 1130 I get my 1200 vitals and do meds lalalala med pass.

I go to lunch around 1200-1230. Come back half an hour later and round on my patients.

I do 1400 meds at 1300. Med pass lalalala.

In the mean time all the lalalas are talking with the patients, assisting the patients with whatever they need, talking to families, etc.

1500 I do 1600 meds and obtain vitals. Med pass. Lalalala

I sit down and play on the computer ... in the meantime. Waiting for things to pop up to do - my patients to need me.

An admission here or there ... gotta plan them in. Hope for a walky talky ;-)

All in the mean time while in the rooms make sure they don't need help to the bathroom, clean them if they are soiled (I cannot leave a patient in pee or poop, no way)!

Start some nursing notes on what I did - bathed them and whatnot.

Do 1800 meds at 1700. Chat with the patients ... discharges. You know.

And I just wait on the night nurses to come on in and take over! (:

I rarely leave anything to do for the nightnurses other than what they are required to do on their shift.

Of course, all my days don't go this well but it's the PLAN I like to stick to.

I've been a nurse a little over two years on a Med-Surg unit so it'll take some time to work into a schedule/habit.

Oh, I forgot to mention our hospital does hourly rounding on EVERY patient on our floor. Meaning all the nurses have to sign up for a slot (one hour) and then do rounds that hour. I usually go around 1600 - this seems to be the calmest time. Good luck!!

Edit: We usually have 4-5 patients. No PCT on our floor. Usually four though. If we're full one nurse has to have 5 patients. Usually the LPN.[/quote

Question: You say you sign up for a time. Does that mean that you round on ALL the pt's on the floor? If so, how do you learn their history? Do you get a group report?

I'm wondering if this would work at my facility...

The purpose of the TLC round is to have a member of staff to go into every patient room on our floor/unit and ask them if they need help to the bathroom, if they need pain medication, if they need their belongings, etc. Our facility started it to help boost are HCAP scores. And it's just to talk with the patient - communicate with them - let them know someone will be in their room everyhour to help them if they need it. (In addition to all the nursing things their nurse does). Our scores are going up, too. We don't get report on the patients/we don't know that sort of thing. it isn't required really. (:

[anotherone, BSN, RN]

I don't mean pts that are ready to code or even an RRT. I mean those with a zillion tubes, higher acuity, max assist etc..Some nurses see the lesser acuity first to get them out of the way so they can spend time with the higher acuity.

Yes, In med surg if you have an unstable pt, see that pt first no matter what the other pts, drug seekers, visitors or others demand. 8AM or 8pm colace and scheudled ms-ER CAN WAIT. BUt..................... if they are all "stable" for now, i like to start with the ones that will take THE LEAST amount of time to asess/give meds to.

[anotherone, BSN, RN]

Each pt assignment is different. You must utilize both time management as well as prioritization. Ideally in a world somewhere over the rainbow where the skies are blue and the things that you dare to dream...blah, blah, you would see the sickest first. But I only have a few years of experience in med-surg, so here is my rationale for seeing the sickest patient last at times......Tell me EXPERTS if you agree:

Everyone needs everything done ASAP in the hospital setting but its only one nurse to however many patients and in order to avoid sinking and not get pulled in so many directions, unless its critical it can wait. Time management is priority over prioritizing based upon acuity unless it's life or death.

The patients that are walkie talkie and can swallow pills whole...Im going to hurry up & throw them da*! pills down their throat to get them out of the way bc you never know whats going to happen next. You can take your time with the sickest and not be worried about what all you have to do for the others bc its taking you so long.......Reducing anxiety..

Exactly. I see those pts first also. And might even chart on them before seeing the next patients. Especially if it is a 100% walkie talkie who I do not anticipate needing/wanting anything ( we do get a rare one of these). If i start with all the tubes/draines/ ostomies/turn repos etc, it may be 9 30pm before my walkie talkie is EVER SEEN.

[SweetRNJ]

I work 7a-7p on a Med/surg floor.

ONE WORD to describe it: B U S Y!!!!!

You do everything this shift, every one else probably said it already, but yah here's a list:

-pass meds

-assess patients

-maybe work with nursing students

-precept an orientee

-admit a patient

-discharge a patient

-transfer a patient to SAR or different floor or NH

-talk to visiting families

-talk to families on the phone

-prepare patient for surgery

-work with PT, OT, ST, respiratory therapists

-work with Social Workers and Care Managers

-Talk to doctors on the floor (can be 10 of em at one time sometimes LOL), talk to doctors on the phone

-help feed or assist patient with all 3 meals..

I might have left out other stuff, or plenty of stuff..but all of these dont really happen in one day, but it CAN...i think the reason i was able to list these down is coz every single on of these a few times...

Don't get it wrong, the list can go on and on, but when you're actually on the floor its not so bad. There will be days when you'll be boredm days when you're running around like crazy and there's days when it's just "steady busy".