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!
On a med-surge floor, where a patient is generally stable...... leave them alone if they are sleeping. Sure, go in, make sure their chest is rising, but do not wake them or pull their covers off until you have something to do that would require waking them. Do your assesment when there is a med to give or a treatment to be done. If vitals are done routinely at a certain hour, wait until then. Otherwise, don't wake the patient. They need the sleep to heal.
This is a surgical floor, with fresh post-ops. I can understand not waking someone if they are observation, or rehab or what have you, but surgical patients are generally more acute IMO, and we are required to chart q4 or q8 assessments.
During my current shift I try to get all my patients assessed within the first 1.5 hours that I'm there. I would feel uncomfortable putting assessment off much past that. I have seen people go downhill fast before...
As as far as pulling down the covers and turning the lights on, I need to see the patient's skin, and get a good look at their incision(s)/drains etc. A flashlight might be a better way so maybe I'll consider that.
I know that assessments need to be done, but I'm just looking for the most polite/effective way to go about it.
I have worked all shifts over many years. I don't like to wake people up, that's why I prefer afternoon shift, take care of their needs... and tuck them in.
However..midnight shift is no different than another other.. we need to assess the patient fully at the beginning of the shift. We are responsible for them at the get go... anything else is a moot point.
Well i go in immediately after report, half the time i ask them what they need while doing the observation and tell them i would get it for them after my complete assessment (and yes that includes pain meds). If a pt is sleeping most of the time i would let them sleep until i give them their 9pm meds (most of the pts has 9pm meds). But our assessments are onace but we do wake them up at one for VS
Specializes in Long term care, Rehab/Addiction/Recovery.
I have worked nites on both med-surg and critical care units. With the exception of the CCU, no unit is "quiet" at nite. Firstly after getting report, (even if its a walking from Pt to Pt report), I would go and eyeball all of my Pt's. Basically see if all IVs are patent, sites are fine. Check any wound sites, any drains, note amt of drainage-color, consistency. Same with urine if there is a Foley. Touch your Pt. Warm? Cold to touch? Any weeping skin? Any Edema? If they are soundly sleeping, you let them sleep! You must wake them for necessary meds, do your Vitals then. Most Pt's have (6) am meds. You can check Vitals again, if you need to. And yes..A penlight and a flashlight are necessary to have when you work nites. As someone else posted, most Pt's don't remain asleep all nite. You have your "sundowners", insomniacs, and sometimes Pt's do bottom out at nite. Its a great shift to work. I love it.
I used to be nervous to bother patients and wake them up to. But the same patients who can get rude for being waken up can be the same ones to complain that no one has been in their room all night. Or they complain that they have not seen their nurse. I look at it as, they are there for a service. Assessment is a part of that. So, I wake them up and start assessments right away. But I also cluster assignments and let them know if later I will have to wake them up for anything else, such as a 3 or 4am med.
I do a combo of what the previous posters do. It all depends on the pt. Post surgical get viewed more frequently. Frequent vs. The pt who was admitted for abx and have been with us awhile I let them call some shots. They do not need to be assessed more than once. (We get pt's who are with us up to 2 months)
Anyone who is self care or a/o x 3, I try to establish a schedule at the beginning of my shift based on the scheduled meds and acuity.
The total care pt's who are A/Ox0 usually get peaked on while I am rounding on my other pt's. That way I can do a full assessment after everyone has been tucked and another nurse can assist if needed. (of course I make sure they are being turned and cleaned regularly)
This has always worked for me and very rarely do I find myself behind in pt care.
Usually only occurs when a pt is noncompliant or someone is circling the drain.
Aside from my residents who are acutely ill that I need to monitor frequently, I do all the invasive stuff right after report and or as I'm passing my 1930 meds. Vitals, weights, glucose checks, wound care can easily be done between the hours of 1930 and 2230 when they are still reasonably awake, versus 0300 am.
Some hospitals have a policy that states that patients must be assessed within a certain amount of time from the beginning of shift. At my place it's within two hours.
I know patients don't like to be awakened if they are sleeping, but I am not willing to sacrifice my license or job should they crump after I haven't assessed them according to facility policy. I do apologize for having to wake them and I try to do a thorough but quick assessment.
This is one thing I do like about working 12-hour shifts. I meet them while they're awake and let them know what I'll need to do throughout the night, and I can get started on my nightshift assessments (for those that need them) around 2230 or so. I work mother/baby so our assessment schedules might be a bit different than, say, a med-surg unit. We do frequently have stable long-term antepartums or fresh post-op c/sections that get q4hr VS, so I have those women call me when they wake up to go to the bathroom or if they're up with the baby sometime between 0300-0430. Most of the time it works out. I do agree that patients need their rest; if I can cluster my care, I do. And if something can wait, I let it wait til a time that works for the patient.
Why take off all their covers??? WHy not use a flashlight and just pull back the covers you need to uncover to see the incision. I don't work on surg floor, but I've stayed the night with my mother, every night nurse I saw never flipped on all the lights or anything invasive as such.
I would use a flashlight, pull back just to see what I need to see, hopefully without even waking them, if you do, explain in gentle tones. Do it with the CNA's vitals times...or right at midnight...somethin.
I also forgot to add that sometimes, depending on the layout of the room, I cut the bathroom light on and crack the door, that way I get some light, but its not directly shining on the patient.
Working PCU in another state I worked 1900h-0700h. Always tried to have assessments done by 2000h. If that meant waking people up, so be it. Wake them up, turn them, look at bottoms, skin, listen to lungs, etc. I apologized for the inconvenience, but still did what needed to be done. Same for M/S.
Most patients were very understanding. Those that were not were educated as to how fast a patient could go downhill and how seriously I took my job of keeping them safe, alive, and hopefully better than when I got them.
Bottom line...you cannot accept responsibility for a patient you do not know if you have not done a proper assessment and can vouch for the condition you received him/her in at the start of your shift.
MomRN0913
1,131 Posts
What kind of floor is this?
On a med-surge floor, where a patient is generally stable...... leave them alone if they are sleeping. Sure, go in, make sure their chest is rising, but do not wake them or pull their covers off until you have something to do that would require waking them. Do your assesment when there is a med to give or a treatment to be done. If vitals are done routinely at a certain hour, wait until then. Otherwise, don't wake the patient. They need the sleep to heal.