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!
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
That's what I do. We only do one head to toe assessment per shift on my floor, so I do that early on and wake them up if I need to (I work 1900-0700, so usually they're awake). If it's necessary, I'll wake them up later, but usually try to coordinate with vitals, if they've gotten up to the BSC, lab's in there, whatever.
For a flashlight, I use a mini maglight. It's lightweight enough to carry in my pocket, but bright enough to show me what I need to see without turning on an overhead light. I highly recommend them!
Specializes in Long term care, Rehab/Addiction/Recovery.
unless we are talking a critical care area.. and patients are required assessing q 15-30 minutes, the most important role for the RN is to receive her Pt's and ensure that they maintain this condition thru the shift. In a non- critical area, if you receive a Pt awake then do what you need to do quickly. If the Pt is asleep your initial note would be "Pt received asleep NAD." Noting that all is ok, (that can be done quickly and quietly with a good flashlight by a skilled nurse). Again, let the Pt sleep! Rest is an important part of getting well. On one med-surg floor I worked on, an RN did hourly bed checks on all the Pt's, and an aide did half hourly checks. If anything was "off" the Rn was notified immediately. Most of your Pt's are "stable". It is the nite shifts task to keep it that way.
unless we are talking a critical care area.. and patients are required assessing q 15-30 minutes, the most important role for the RN is to receive her Pt's and ensure that they maintain this condition thru the shift. In a non- critical area, if you receive a Pt awake then do what you need to do quickly. If the Pt is asleep your initial note would be "Pt received asleep NAD." Noting that all is ok, (that can be done quickly and quietly with a good flashlight by a skilled nurse). Again, let the Pt sleep! Rest is an important part of getting well. On one med-surg floor I worked on, an RN did hourly bed checks on all the Pt's, and an aide did half hourly checks. If anything was "off" the Rn was notified immediately. Most of your Pt's are "stable". It is the nite shifts task to keep it that way.
The best way for me to keep them stable is to check them first thing....that way if something changes I can catch it at 2400, rather than coding them dead in the bed at 0300. I'd much rather cheese someone off by waking them up than risk losing them. In my line of work there are usually two patients to assess in each room - mom and baby, whether baby is intra- or extrauterine. I'm all for letting people sleep, but if I find a patient in bed asleep with a 28-week baby between her legs at 0130, I have to be able to say with absolute certainty that when I checked on her at 2400 it was not that way. That may sound far-fetched, but it has happened (though fortunately it is rare).
I don't mean to sound like I'm jumping all over you, but night nurses have licenses to keep. I just don't think "I wanted to let her sleep" will hold up in front of a med-mal attorney when he asks why I didn't assess my patient within the parameters set forth by facility policy.
Specializes in Long term care, Rehab/Addiction/Recovery.
Elvish I agree with you. You stated you work in a Mother/Baby unit. I personally have never worked in this area. I'm sure this type of unit has its own unique assessment needs as you are caring for (2) two Pt's. As I had stated in a earlier post, a wise nurse upon receiving her Pt's, will do rounds and "eyeball" all Pt's doing an initial quick assessment. Of course it is expected to return to each bedside at some time during the shift and do a more complete assessment. Some can be done in the middle of the nite. Most starting around 5:00 am. I never condone neglect. Rest and sleep is important as well.
Doing assessments at night is one of the areas you really have to use your judgement. Like everything else, it takes experience.
Some patients' conditions require two or more focused assessments. When they are in bad shape like this, they are either fully awake and in so much turmoil that your assessments at night don't bother them at all or they are so out of it they don't complain.
Example, if someone's BP, HR, respiratory status, or blood sugars look like they are going squirrelly on me I don't care how much I have to bother them to get the necessary data. Patients on various drips or continuous infusions will often fall into this category.
Other patients can get a quick focused assessment at the beginning of the shift and you don't have to bother them again all night. I still round on them about once an hour, but this could mean peeking on them through a window or sneaking in and doing a auditory "breathing check" in a dark room. Sometimes you can spot them heading to the bathroom or getting some water and boom, they've been assessed.
Still others might require one focused assessment at the beginning of the shift, then a quick BP or VS check before meds that require it.
The challenge for you is that ANY patient can inhabit any of the categories above at any time. I've had nights were the guy I thought was circling the drain stays rock steady while the 35 year old otherwise healthy patient has me in there calling rapid responses.
If you are lucky enough to get the same patient list on consecutive nights, the things you learned in previous shifts really help drive your plan for the night.
starting at 1900 is way different than starting at 2300. by the time you get out of report it might be 2330 and with 6 patients good luck getting everything done at a reasonable time. this is one of the cons of night shift. yes some patients get mad and don't want to be bothered. you can explain it and they can refuse assessments,(very rare that this happens). i don't like using a penlight to assess ivs and i don't. If i am starting at 2300 i go and see the patients without any 00:00 meds first or the "easiest" ones and get them out of the way, that way i can save the complicated tiem consuming ones and do them last all at once.
I work in med- surg and we get a good amount of post ops. so say the 3-11 nurses assess them at 4pm fresh post op. should the 11-7 am nurse not assess them untill they wake up at 5 am? i don't think so and i never operated under that mindset. i have seen the night nurse come in MANY times and pick up differences in assessments that needed MD involvement other meds etc.
Not knocking anyone and I know many of us work in different areas but no way can I see myself NOT assessing my pt until 5am when I started working at 2300 or sooner.. We assess out pts q4h period. We do vital at a minimum of q2h if not hourly or q15 minutes. I know I work critical care but even when I worked med/surg we did vitals q4 around the clock, assessments at 8p, 12a and 4a on everyone.
While sleep is important for healing, I refuse to skip this part of my job because a pt appears stable. Resting at home is way better than RIP because they are dead. Yes, I have saved many "stable" pts with my nightly assessments from coding.
Elvish I agree with you. You stated you work in a Mother/Baby unit. I personally have never worked in this area. I'm sure this type of unit has its own unique assessment needs as you are caring for (2) two Pt's. As I had stated in a earlier post, a wise nurse upon receiving her Pt's, will do rounds and "eyeball" all Pt's doing an initial quick assessment. Of course it is expected to return to each bedside at some time during the shift and do a more complete assessment. Some can be done in the middle of the nite. Most starting around 5:00 am. I never condone neglect. Rest and sleep is important as well.
I was in the hospital for 6 full weeks. Yeah- having to wake up stinks. Patients can sleep at home. When they're not under your license, and care. They don't pay for a nap...they pay for a professional (and this isn't about debating that point) to keep tabs on them.
But you don't know when someone is going to go bad- when the doc asks when they started getting funky, you have nothing to tell him/her. The doc isn't going to care that they had their eyes closed with even resps at midnight, 2, and 4 am, when you call at 5:30 to tell them they have a NEW right hemiplegia, and can no longer speak. FWIW. Patients don't put off a stroke, because they happen to be on an ortho or GYN floor.....
unless we are talking a critical care area.. and patients are required assessing q 15-30 minutes, the most important role for the RN is to receive her Pt's and ensure that they maintain this condition thru the shift. In a non- critical area, if you receive a Pt awake then do what you need to do quickly. If the Pt is asleep your initial note would be "Pt received asleep NAD." Noting that all is ok, (that can be done quickly and quietly with a good flashlight by a skilled nurse). Again, let the Pt sleep! Rest is an important part of getting well. On one med-surg floor I worked on, an RN did hourly bed checks on all the Pt's, and an aide did half hourly checks. If anything was "off" the Rn was notified immediately. Most of your Pt's are "stable". It is the nite shifts task to keep it that way.
Strokes, MIs, SUDEP, PEs..... they don't always come with enough time for someone to call for help.
Night shift is to keep them alive. Asleep and coma pretty much look the same if you don't wake them up (or try to).
I work in med- surg and we get a good amount of post ops. so say the 3-11 nurses assess them at 4pm fresh post op. should the 11-7 am nurse not assess them untill they wake up at 5 am? i don't think so and i never operated under that mindset. i have seen the night nurse come in MANY times and pick up differences in assessments that needed MD involvement other meds etc.
I don't think anyone suggested not assessing a patient until 5am during an 11-7 shift.
sapphire18
1,082 Posts
Agreed. I've never heard of "EMD." We call it PEA.