Night shift in LTC/Skilled Nursing

kRN0512 · Nov 30, 2012

Darn! sorry about the emoticons...I'm not really sure why they decided to pop up.

CapeCodMermaid, RN · Nov 30, 2012

That is a pretty standard nurse to patient ratio on an 11-7 shift unless you have a true subacute unit.

Mostly the night nurses are responsible to keep the residents safe if they wake up and lots of paperwork. I discourage any medications or treatments on the night shift because people are supposed to sleep.

TheCommuter, BSN, RN · Nov 30, 2012

When I worked night shift at a nursing home (10pm to 6am), I had 68 residents and cared for them with the help of three CNAs. It's not as if you're going to be doing head-to-toe assessments on them.

You'll round on them every once in a while to ensure they're breathing, respond to requests for PRN medications, change out the tubing for the feeding tube sets, restock the med carts, pass a few scheduled medications at midnight and 6:00am, file paperwork, and complete other miscellaneous tasks.

kRN0512 · Dec 1, 2012

Thank you so much for your replies! I feel like I have a better idea now of what to expect. I am actually really looking forward to getting started and "getting in the groove". I used to think during school "I'm never going to work in LTC as a nurse!" but I have to admit I've kind of missed it since I've been in the hospital the past few months :shy:

AngelRN27 · Dec 1, 2012

I have been working at my current LTC facility as an RN for 6 months. I was just moved to the 11-7 shift approx. 3 weeks ago. The nurse-patient ratio you mentioned in the OP seems standard for this shift.

Night shift "responsibilities" are pretty much as mentioned above. A few meds at 12am (usually just a couple of nebulizer treatments) and then a relatively small med pass at 6am (mostly Omeprazole and Synthroid). In between you have miscellaneous paper work as well as chart checks which require a meticulous eye and a good knowledge of your facility's protocols/procedures, which will come with time and practice. Other miscellaneous tasks include hanging new piston syringes for feeders, changing feeds as necessary, cleaning/organizing/re-stocking med carts, possibly making the morning shift's assignment (depending on your facility), checking resident appts for the following day, refilling any low meds or narcs, etc.

You'll be fine, good luck!

lcuster · Dec 1, 2012

At my facility the above is true. However the 11-7 shift also has to do upkeep on all oxygen concentrators, clean out and maintain any resident refrigerators, and lets not forget end of month turnover on MARS and TARS. Chart checks really are the most important nightly paperwork you will do. That process catches the mistakes and oversights that may occur on other shifts. Patient orders can get pretty screwed up if thats not done right. You'll be fine. Some nights the boredom is worse than the work.

Forever Sunshine, ASN, RN · Dec 2, 2012

11-7 you may very well be the only nurse on the unit. You said you had previous experience so you should be ok. I had only 5 mos part time experience before doing 11-7... I was fine.

Its a nice shift .. of course there will be nights when it all falls off the walls but for the most part.. .most patients do sleep. Theres always a couple residents up late, always residents who ask for a prn tylenol, mylanta, pain pill etc.

Theres tons of checks to do as mentioned above, plus charting. Occasionally you'll get a resident who has a change in status and needs to go to the hospital.

amoLucia · Dec 3, 2012

Y'all forgot glucometer checks, crash cart checks, refrigerator checks, etc checks. And some nite shifts do the morning fingersticks and insulin injections (it all depends on the facility).

As a CNA, you should remember how much a nuisance those residents' safety alarms were, but you need to be ever vigilant about them, esp if there's a fall to be investigated. Alarms and siderails...

You'lll start and end your shift with a narcotic count and if there's any one piece of advice that we 'seniors' can give newbies is to take your responsibility for that narc count absolutely SERIOUSLY. So many nurses get in trouble for poor counts just because of inattention or because you "trust" the other nurse. DO NOT accept the count unless you're positively sure the count is correct. If there's a discrepancy, it's all yours. NOBODY is going to listen when you say 'you didn't give any percosets'. It was your count and you're it!!! Also, never give your keys over to someone if you leave the floor and never ever just leave them laying on the cart.

Blackcat99 · Dec 3, 2012

At my LTC facility, you can always count on the pharmacy showing up at the worst time in the mornings, usually when you are trying to do your 6am meds.

kRN0512 · Dec 3, 2012

Thanks for all the replies! The way the facility is split I will be the only RN on my side which is definitely a little scary! But I'm sure I'll get into the swing of things and it will become routine. The biggest problem I have is being patient with myself when it comes to learning new things....ugh

So what about getting used to night shift in general? How long do you guys feel it takes to get into the whole night shift mentality? I'm hoping it won't be too terrible because I'll be only part time but I honestly don't know how easy/difficult the adjustment will be for me.

Blackcat99 · Dec 3, 2012

If you are the only RN, the lab will be asking you in the mornings to get the blood specimens from all of the patients who have PICC lines. Make sure you get plenty of sleep before you come to work. You may need a little benadryl 25mg when you get home to help you fall asleep. Good luck. Night shift is the best shift in LTC in my humble opinion.