New Nurse Night Shift Time Management HELP

Lev, MSN, RN, NP · Nov 23, 2014

My full time job is days on a busy med surg unit (for the next month) Several months ago I took a rotating shift position at a different hospital on a less busy med surg unit. I found that I was slower on nights until I got the hang of the computer (they have since switched charting systems). Also my preceptor had a different style of managing patients at the beginning of the shift which slowed me down because I was used to my way of doing things. Are you totally off orientation and now working the shift you have been hired for or are you still on orientation but now have a different preceptor on nights? I think you built a semblance of a routine on days and now you have to modify it for nights. You are a new nurse so it's not so easy. When are medications scheduled? I've found that there are less meds to give on nights but the timing may be different than what you are used to on days.

VANurse2010 · Nov 23, 2014

I've never struggled with time management, so take it for what it's worth:

If you have time to do something now, do it. Don't wait assuming you'll have time later. If you can give meds in an hour either way window, give them an hour early if appropriate, or if you have 2000, 2100, and 2200 meds - pass all of them at 2100. That saves a number of trips into the room and the chances of getting sucked into something time consuming.

Also, you need to be nice to your patients, but the shift is not the time to socialize and listen to Mary Sue talk for an hour about her daughter's wedding or whatever. Assess, pass your meds, move on. If youre able to chart your assessment at the bedside, that can help too. I found that worked well on the floor, but not so well in ICU.

firstinfamily, RN · Nov 24, 2014

I always assess my patients first, then usually start my first med run, then I will do my documentation, a little bit and the next med run before bedtime for the pts. I try to get as much done as early as I can so that if stuff happens later I will not be behind. You have to find what works for you. Night shift is a little different than days, usually less resources, but I find it is easier to get my time management down, less interruptions. You should not be staying 2 hours after the shift to document. Document as things occur, are you still getting post-op patients late at night?? That can hold things up. Look at your system and see where you may be able to improve. It is hard going from days to nights, learn what others are doing to stay on task. Good Luck!!

greenerpastures · Nov 24, 2014

Best piece of advice I ever got was from a teacher and a family member. Always try to get the important things done in the first 4 hours of your shift - assessments, HS med pass, any significant phone calls/charting that needs to be done - so that the next 8 hours can be about playing catch up/less significant charting, AND so you have some cushion if everything hits the fan! On nights, I try to have assessments charted and chart checks done by midnight. I start my HS med pass at 2000 and try to be done by 2200 with 6 patients.

SoaringOwl · Nov 26, 2014

Also, you need to be nice to your patients, but the shift is not the time to socialize and listen to Mary Sue talk for an hour about her daughter's wedding or whatever.

Not to thread-jack, but I hate bedside charting because it seems to encourage chit-chat. The patients want to talk, and ask questions while I'm trying to chart. Maybe it's just my experience, but I chart faster at the nurses' station, which I know is a big no-no these days. :angrybird12:

xNurse91 · Dec 3, 2014

Thank you guys for your advice, I'm getting out on time and it's going a lot better! I have been doing some charting at the bedside but I save my assessments for the nurses station which has helped a lot. Charting my vitals at the bedside has seemed to have a huge impact on getting things done faster (probably because as soon as I sit to chart someone needs something). I still have a more to learn but it is much better :)

crj96 · Dec 7, 2014

The first thing I do, after getting report, is to check on my patients, introduce myself, and update the information on their boards. I ask them if they need anything and promise to come back shortly to do their assessment. Once their needs are met, I have time to go over orders for the night and any medications they have scheduled. I write the medications by time on the back of my "brain sheet". I look over my report and note any gaps in their information so I can get that taken care of before the patient goes to sleep. I also write down what PRN meds they're most likely to need, with the last time given, and the amount of time needed between doses.

I do my assessments as early as possible and get them charted. The first med pass is typically at 2100. If I can go through and chart on everyone at 2200 and 0200, I'm good. At 0500 I need to start pulling foleys, IVs, anything that needs to be done to prepare day shift for a good start. I write down any important labs, anything that I've done, and the last pain med given. Worst case scenario is that I have my last rounding to chart when day shift gets here.