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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!
I dont work nights anymore. When I did it was the 23-07 shift. I usually waited an hour for them to call me, for their baby to cry, or hope that a medication was due...after an hour I would just go in; most people that just had a baby don't get much sleep and I could usually get to them (i.e they called me, their baby cried so I knew they were awake, or a med was due) before I had to go in on my own.
When I worked 2300-0700, it was a rush to get through everybody (I had 20-27 that needed RN assessments- but I didn't do meds)- so just got them done as fast as possible. I charted later (EMR). For 1900-0700, I got started ASAP after 1900 report, and aimed to get everyone seen by 2300. After that, it was seeing after changes.
But if they had to be awakened, so be it. If they don't want to be assessed, they can go to the house with their spouse or SO. I wasn't there as their 'convenience'- I was there to be sure they were ok- if something went wrong in the middle of the shift, I had NO way to defend myself about why I didn't know what they were like hours earlier.
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.
Pedal pulses, heel decubs, s/s DVTs, abdominal distension, bowel sounds, heart/lung sounds, IV sites, pressure point redness, etc. Even walkie talkies can develop complications- they are the ones who drop to the floor on the way to the bathroom.
"I didn't want to be invasive" will make a lawyer's dreams come true.
I worked nights on an IMCU. We were required to do an assessment every 4 hours unless otherwise noted (ie if they just came back from a procedure or were on hospice). I did mine between 2000-2100, 0000-0100, and 0400-0500. Most patients were still up at midnight, and if they were asleep I'd wait until they called and needed a medicaiton or something. The vampires (lab) came to do blood draws between 0400-0500 so I'd follow them with my vs and assessment. Around 0500 all the patients were gotten up for their weight and first ambulation of the day. On my unit I always ended up with several insulin gtts which had to be checked and titrated hourly so those poor patients never got to sleep.
I work 1900-700 so I'm able get to know my patients very well within the 1st 2 hours of my shift since they're up; however, if I do come in at 2300 & they were already sleeping here's what I do:
knock politely, lights on and speaking softly "Hi Mr/Mrs So&So, I'm Ashley_RN and I'll be here with you til the morning; I know its late and you're trying to sleep so I'll try to make this as quick as I can, but I do need to get a good look & listen about everything that's going on with you so I can ensure I'm watching you safely overnight."
I am also on a acute surgical stepdown floor so I'm constantly saying "I'll be keeping an eye on you and checking in periodically throughout the night; I want you to get your sleep but if I feel I need to wake you, I am going to."
For the most part, people are usually receptive. There will be the occasionally cranky ones but who cares, I don't let them bother me cause knowing they're safe is more important. And as far as family members as concerned, I'm not worried about them, it's my patient who I'm there for.
Pedal pulses, heel decubs, s/s DVTs, abdominal distension, bowel sounds, heart/lung sounds, IV sites, pressure point redness, etc. Even walkie talkies can develop complications- they are the ones who drop to the floor on the way to the bathroom."I didn't want to be invasive" will make a lawyer's dreams come true.
That makes sense. Didn't think about that.
I am curious about recommendations on penlights and flashlights. First, many of the penlights are not neutral light or 'day light', but actually change the natural color of the clts skin, thus not making for an accurate assessment. Second, it is very difficult to find a quality penlight that is durable.
As for flashlights, I do believe a halogen-based flashlight produces minimal skin color changes, but again would like recommendations on a small, durable, flashlight that does not interfere with an accurate skin assessment.
thanks
p.s. An assessment should be done as soon as feasible, as there is no legal defense otherwise, ntm other factors. I would try to assess all patients at least to some degree, as soon as possible--some nurses first go to room to room immediately making sure all are breathing without apparent distress, from a simple visual inspection. Then, they check the charts for new orders. Then, as soon as possible, they go back in and do a focused head-toe assessment to include feeling the patient, pulse quality, lungs, heart, abdomen, visual inspection of the skin, etc.
It's a little different for LTC though. If I need to wake them, I will. However, I try to let them sleep where I can, and do things when they are most awake. Dementia patients do much better with sleep. Otherwise, many of them are more agitated and disoriented during the day. Depends where you work.
I am curious about recommendations on penlights and flashlights. First, many of the penlights are not neutral light or 'day light', but actually change the natural color of the clts skin, thus not making for an accurate assessment. Second, it is very difficult to find a quality penlight that is durable.As for flashlights, I do believe a halogen-based flashlight produces minimal skin color changes, but again would like recommendations on a small, durable, flashlight that does not interfere with an accurate skin assessment.
thanks
p.s. An assessment should be done as soon as feasible, as there is no legal defense otherwise, ntm other factors. I would try to assess all patients at least to some degree, as soon as possible--some nurses first go to room to room immediately making sure all are breathing without apparent distress, from a simple visual inspection. Then, they check the charts for new orders. Then, as soon as possible, they go back in and do a focused head-toe assessment to include feeling the patient, pulse quality, lungs, heart, abdomen, visual inspection of the skin, etc.
If Idid an assessment (first one of the shift) the lights went on- period. Later, if I needed to go see them, it depended on the situation; if it's a change, the lights went on. If they don't like lights, they can go to a bat cave next time
I came from a floor where assessments were done q4 around the clock. I woke my patients up at 12 and 4 to do assessments. I felt bad, but they're in the hospital for a reason, and I could never justify not waking them to a court of law if something happened because I didn't and my only defense would be "I felt bad because they were sleeping." Several times, i was able to catch subtle changes that were different from my previous assessment, and was always glad I had woken them up for those few minutes each time.
P.S. I still work per diem on this floor and patient rounds are conducted q2h from 8p-7a and hourly from 7a-8p. Strictly enforced and always done.
I work 2300-0700, and I try to get all my assessments done by 0030, unless hell breaks loose on a patinet--and it certainly has! I wake them if need be, and then I make the room as conducive to sleep as possible and leave. You betcha that I've had some patients not too happy with being awakened, but I explain to them that I must do a complete assessment, and I will get out and let them sleep. I also give them times of their meds, etc. (abx, neuro checks, mid-shift vitals) and why I'm doing it, so they know what to expect. Some are grumpy, but an explanation goes a long way to helping them understand why I'm doing what I'm doing. They usually acquiesce and let me do my thing.
I use my penlight to check on them AFTER the first head-to-toe. We also have smaller, spotlight-type lights in the rooms that I use to hang meds.
Bruce_Wayne, ASN, RN
340 Posts
Surprised at the number of people that use flashlights for assessments. Flashlights in lieu of turning on the light is a big no no in my facility. We always say, "let's shine some light on the situation!"
I'm kind of insensitive to issues about not wanting to wake people up. I wake people up and turn lights on and while I'm sorry about the inconvenience I'm unapologetic about doing my job safely and accurately.
You can catch up on sleep when you're discharged, or catch a few cat naps later. Frankly I don't care about that nearly 1/10th as much as I care about safely and accurately doing my job.