how do you night nurses do your assessments?

[redredrose]

I am starting a new job soon where I will be working straight nights. Right now I work 3-11.

I've picked up a few night shifts, and one thing that I've found I dislike a lot is having to wake patients up for assessments. I have to turn on the lights, pull their warm covers off of them, ask them a bunch of questions, make them move around, make them use the incentive spirometer etc etc. Patients have gotten annoyed with me, or have fallen asleep while I was assessing them. Family members staying the night, I can imagine, are probably less than thrilled when the nurse comes in and turns on the lights and starts chatting etc. The few nights that I've worked, I found myself apologizing for waking them up, and hurrying through my assessment.

What I want to know is, how do you night nurses deal with this? I've heard some night nurses say they use a penlight instead of turning on the lights...but I think it would be harder to get a good assessment this way. Or even one nurse on my floor said that they give the patients a couple hours to wake up on their own and push the call light for something and then she'll go in and assess. I kind of like to get my assessments done asap.

I think nights will be hard because I like to get to know my patients, and not feel like I am constantly disrupting their sleep. But it's all that I could hired for right now....Some words of wisdom on how you make it work would help!

[Jenni811, RN]

i tell them ahead of time that if they get up in the middle of the night, please put on your call light. I explain why. I also tell them that if they do not get up in the middle of the night, i will have to wake them at some point.

i try to get EVERYTHING done when i wake them once. (i.e. Vitals, weights, assessments, toileting, pain meds if needed etc.)

If i tell patients ahead of time what i will be doing and why, then they understand why i am waking them up at like 4am. I usually give them till about 4am or so to awake on their own.

[sapphire18]

I am very for getting pts on a regular sleep schedule and letting them rest while in the hospital, however just by virtue of being in an acute care setting, they NEED to be assessed every (fill in the blank) hours. Even if they seem stable at 2000 or from previous nurse's report, you just never know. If someone is going to get angry at you for this, there's just nothing you can do about it but apologize and explain the rationale for the interventions. And remember that they're not angry at you, but rather the situation. You're just doing your job. You'll get used to it. Good luck:)

[Thedreamer]

Just make sure you do your assessments after youve gotten report.

[Sun0408, ASN, RN]

I tell my pts that are "awake" I will be waking them up at midnight and 4 am for assessments or meds through out the night. Most of my pts are vented and sedated so this is not an issue but the "awake" pts understand. We don't wake them to do the IS, our MDs write "while awake" for those. I also try and cluster my duties. If its 2315 and they want pain meds, I do my assessment then for an example.

They are in the hospital for a reason and it is important to remind them of this very important task.. I have worked nights for 2 years on med/surg and now ICU, most pts don't "sleep" all night or very well to begin with.

[ParvulusPuella]

I go around with the LNA for 0200 vitals and get my second assessment done then.

[Do-over, ASN, RN]

I work 1900-0700, and try to start my midnight assessments by 2245. If they are sleeping good and I am not terribly worried about them at that time I will wait a bit or save them for last. I do a focused assessment when I make my initial rounds.

My goal is to have my assessments done before midnight - want to have a fresh picture in case any one crashes.

[caliotter3]

Have not worked in settings that required more than one assessment unless there is a reason. If I come on at 2300, I do my assessments as quickly as possible so I don't have to disturb anyone after 2330, until time for morning meds, if necessary.

[realnursealso/LPN, LPN]

Things must have changed alot, when I worked nights in the hospital we used flash lights. Why would you turn all the lights on and take their covers off? There has to be a gentler way, what about the patient in the other bed, what if they aren't your patient, you wake them up too? Not picking on you, just think you should think of a different way of doing this. We looked under the side of their covers at dressings, we listened to their breath sounds, we could check for pulses in extremeties without uncovering, we'd just put our hands under the covers by their feet. We were reminded that the patients were sick and in the hospital for a reason and they needed their rest. Maybe I'm just one of those old crabby new nurse eaters? Usually some time in the night the patient is awake.

[Sun_danc3rRN]

I work 1900-0700. As soon as I get bedside report I go back in and assess all of my patients. I usually just go back in and wake them up if they are sleeping. I re-introduce myself, assess pain first, then I start my head to toe and then focused, then I offer potty, drinks, make sure their cell is close by, etc. I usually get all of my patients assessed by 2000 and then start prioritizing my tasks and my med passes. I get the patients done that just need pain meds or have one or two meds, then I work up to larger amounts of meds, or more complicated meds, and I usually save the most involved patient for last. This way I can do my meds, dressing change, drop an NG tube, etc, all in one shot and then they can rest for the next few hours. I have a co-worker who didn't get to assess a patient until 2300, and when she went in the patient who was previously stable, had passed away from a massive MI...sometime between 1900 and 2300. She was fired prior to the end of the shift for failing to assess her patient in a timely manner. I don't have a clue if this was her first time in trouble or not, but it made me glad that I follow my same order the way I do things every single shift.

[loriangel14, RN]

I do them right after report if they are up, otherwise I do them in the AM between 0530-0700.if anyone rings in the night I do it then while they are up.

[turnforthenurse, MSN, NP]

On my floor they need to be assessed every 4 hours. Sometimes I have meds due at 2300-0000 so I will cluster tasks and do assessments then. The CNA's typically do vitals at 0000 and 0400 so I will try to follow them in since the patients will have to be woken up to take their temp (or to put their BP cuff back on).