Hello all! I wanted to talk about my experience and get your words of wisdom:
I work on a busy Ortho/Neuro floor (12hr dayshift, new grad), with:
- High pt turnover rate (pts stay ~1-2 days)
- Frequent pain meds, in addition to normal†meds (meds pts take at home) administration. Every 3-4hrs each pt will be requesting more pain meds, in addition to break-through pain meds (ex: IV Dilaudid). Completely understandable, but these pain meds usually aren't due when their normal†meds are
The ratio is good on paper (1:4, sometimes 1:5), but, again, there is so much turnover/meds. If I have a D/C, then I WILL be getting a new pt around the same time without fail. It's frustrating to try to balance all the other tasks, then work on D/C'ing a pt with all that comes with it (D/C charting, going over the paperwork with the pt/answering D/C questions). THEN, getting a new admit immediately or a little before the first one is D/C'ed with all the admit charting, assessment, medications, new orders, etc, that comes with the pt. Often, we get pts at or right before shift change (which is not nice, but bearable.) One day, I D/C'd 3 pts and got 3 new pts O_O
It feels as though I'm SO busy with daily tasks that I can't take the time to place an NGT (which I have yet to do since we get so few on our floor) on someone else's pt because I have 20 other things that need to be AND I always stay late charting anyway.
Add'l info: We have 5 full-time RN positions open, 1 part-time. I've seen a lot of RNs leave in my 5 months here, but the ANM tells me the RN turnover rate is not above the national turnover rate.
Do you (or anyone else here) think you learn less during nights? Perhaps, you can learn more during nights being that you can, in theory, sit down more? I've had another new grad say that she has more time to sit down to read the patient's charts and understand the WHY (ex: they had past procedures done) vs. all the task-y things on dayshift.
I think I have similar learning opportunities on nights as on days - with more time at night for looking up something that I want to know more about, often the same shift rather than doing it at home later (e.g. what's this condition noted in my patient's history of which I've never heard or reviewing the finer details of a policy after getting a quick verbal primer from the off-going RN on a seldom used skill) and, as you mentioned, I usually also have more time to read a bit more into my patient's backgrounds to get a bigger picture of what's going on with them.
On the other hand, my time management isn't getting honed to a fine point as is require to be able to manage the hustle & bustle of days: all the patients being admitted (post-procedure), being discharged, and those being sent off the unit for tests that aren't (generally) done at night. It's not that my time management hasn't improved while working nights, it definitely has, but it seems like maybe mine is improving a little more slowly without the crucible of the time crunch that busy days put on a nurse.
I'm sure that someday I will move on to days, but for now, I enjoy the (usually) slower pace of nights where there's often at least a couple hour break for charting in the middle of the night.
Another benefit of working nights as a newer nurse interested in changing units every couple of years for a broader experience is that it's easier for me to find posts for open positions on units that interest me. Often the open positions that are posted (even internally) are on nights because any open day positions were snatched up by night nurses on that unit moving to days. I know a surprising number of day RNs who want to change units, but don't want to go to nights, so they are waiting and waiting (and waiting!) for a unit that interests them to post a full-time, day position. (In some facilities, it may be easier to change units and keep a day position, but in the two facilities that I work in, it's a lot easier to change units if you're willing to work nights... at least for a while.)
If you decide to try nights, I hope you enjoy it as much as I do. Either way, day or nights, be patient with yourself. You're probably doing better than you think!
One other tip that I didn't notice anyone else suggesting: If you have computerized charting, find out if your system supports "smart phrases." What these phrases are called varies by EHR system, but they're short-cuts to writing your "standard" progress note. For example, you can save a phrase like this:
Pt A&Ox3. VSS on 2L O2 via NC and IV fluids infusing as ordered. PNI dressing CDI. [R knee] dressing CDI. Incision approximated with skin glue, no drainage or s/s of infection. Pt reports [knee] pain [X]/10. Medicated with Norco per eMAR. Neurovascular assessment WNL with the following exceptions: (1) generalized edema to surgical site, (2) decreased ROM to RLE s/p R TKA and (3) B/L numbness & tingling to feet which patient reports is not new. Foley catheter to dependent drainage of clear, yellow urine. Pt up with max 2 person assist, immobilizer and RW. Abdomen soft, non-tender, BSx4, last BM prior to sx. SCDs on while in bed. Medications reviewed and given. POC reviewed with patient. All questions answered, pt verbalized understanding. Incentive spirometer observed and encouraged. Pt able to recall knee precautions. Fall and PUP precautions in place. Care plan reviewed, hourly rounding continues.
By just typing something like .KNEE, your saved phrase for knee patient's initial assessment narrative note pops up. You just tweak it to reflect the current circumstances (foley, DTV, voiding without difficulty only able to pivot to BSC or walking all the way to the bathroom? Is the PNI still in so the immobilizer is in use or are they past the 24-hr window and are just using a walker and 1-p standby assist? Constipated and on bowel protocol, etc.). Some nurses I work with have a mini-summary of their assessment like above and some are more bare-bones, but still in a "dot phrase" or "smart phrase" that lets them quickly toss in the start of their narrative note.
If you're required to have PIE formatted charting, you can also create specific "smart phrases" for the common problems of particular type of patient. a .KNEEPIE would include problems of pain, skin integrity (both for the incision and for PU), altered mobility, elimination (if foley in or DTV), and neurovascular (as most have q4h neurovascular assessments ordered). Most of the interventions for my knee patients were the same across the board. Yes, there were minor tweaks that needed to be made to customize for a specific patient. But having a .KNEEPIE note makes is so that I don't have to type up the problem or the interventions and just have to jot down a one sentence evaluation. What a time saver!
SarahRN2013 - Thank you so, so much for your detailed response and the time you took to write it. I appreciate that!
All the things you mentioned, such as having MORE time (usually) to read and research patient's PMH, are great to hear. For days, I need to come pretty early before my dayshift to read into each of my patient's backgrounds, plus later try to find the time to read up on the backgrounds of new admits. I find that I'm often doing a few things on breaks too, which I know I shouldn't do, but there's never enough time. Regarding time management, I'm sure your skills are fine! You can hone/learn different skills so you know how to do them more quickly when you move to days and that part won't slow you down :)
I did attempt to switch to nights, but it looks like they are hurting more on days because so many dayshift nurses have left (oh, I wonder why...), so I won't be able to switch at this time. I'm sure the next unit I move to will put me on nights because I'm so new and that wouldn't be so awful. I have at least another 6 months on my unit until that time though. *just keep swimming*
We don't have those smart phrases that I'm aware of. We don't use that charting system unfortunately, though I've heard it's a good one! Thank you for that tip! I'll remember that if I ever do have a job that uses that system. I do like all your notes though mentioned above--helps me in thinking more about what to write in my prog. note at the end of my shift.
Thank you again for your kind input and time. Thank you everyone!!
SarahRN2013
32 Posts
I think I have similar learning opportunities on nights as on days - with more time at night for looking up something that I want to know more about, often the same shift rather than doing it at home later (e.g. what's this condition noted in my patient's history of which I've never heard or reviewing the finer details of a policy after getting a quick verbal primer from the off-going RN on a seldom used skill) and, as you mentioned, I usually also have more time to read a bit more into my patient's backgrounds to get a bigger picture of what's going on with them.
On the other hand, my time management isn't getting honed to a fine point as is require to be able to manage the hustle & bustle of days: all the patients being admitted (post-procedure), being discharged, and those being sent off the unit for tests that aren't (generally) done at night. It's not that my time management hasn't improved while working nights, it definitely has, but it seems like maybe mine is improving a little more slowly without the crucible of the time crunch that busy days put on a nurse.
I'm sure that someday I will move on to days, but for now, I enjoy the (usually) slower pace of nights where there's often at least a couple hour break for charting in the middle of the night.
Another benefit of working nights as a newer nurse interested in changing units every couple of years for a broader experience is that it's easier for me to find posts for open positions on units that interest me. Often the open positions that are posted (even internally) are on nights because any open day positions were snatched up by night nurses on that unit moving to days. I know a surprising number of day RNs who want to change units, but don't want to go to nights, so they are waiting and waiting (and waiting!) for a unit that interests them to post a full-time, day position. (In some facilities, it may be easier to change units and keep a day position, but in the two facilities that I work in, it's a lot easier to change units if you're willing to work nights... at least for a while.)
If you decide to try nights, I hope you enjoy it as much as I do. Either way, day or nights, be patient with yourself. You're probably doing better than you think!