Night Shift Rehab Nurses-How do you organize?

[coopman712]

Just wondering if you wouldn't mind sharing your *rounding* routine. I was in a situation where I had 8 patients and a CNA and now will have 10. Our CNAs would do vitals and blood sugars but at the new facility, they do not. Working night shift is tough in that it is so hard to get it all in before bed time. Obviously there are treatments and middle of the night meds that warrant waking them up, but how do you get everything in?

I am not that experienced. I am wondering for those who seem to have a good rhythm, if you wouldn't mind sharing how you organize your evening rounds/ med pass/ assessment. I have always found it tough to do everything I need on those initial rounds and still be on time with med passes.

Thanks!

[PediatricRNTX]

I dont work rehab or have 10 pts..but i work nights in peds w no techs or front desk (meaning I answer call lights and phones, put charts together, do my own vitals, and some housekeeping)...I manage by arriving 15 min early...reviewing charts and organizing my "brain" ..so I walk in once and get most everything the pt may need at that time...I hit the ground running rt at 7pm...timing and planning is everything.

[coopman712]

Thanks-Yes I always arrive a good 20-30 min early. It helps but I still need a smooth routine for passing meds, assessing, treatments of 10 patients in a 2 hour window. Always sounds easier to me than when in practice. LOL

[TheCommuter, BSN, RN]

I work 12-hour night shifts at a freestanding rehab hospital. Fortunately, the CNAs still do finger stick blood sugars and vital signs, which is a huge help to the nurses. Depending on staffing, I get anywhere from 7 to 9 patients on a fully staffed night, or 10 to 12 patients on a night with short staffing.

I arrive at my regularly scheduled time, receive report, count the Pyxis, pull my meds, and hurry up and pass them while doing my first round. As I'm passing the meds I'll do a quick assessment, change any dressings, do any treatments, etc.

An overly talkative or chatty patient can throw a wrench into the routine, but overall this seems to work for me. We do hourly rounds during the night, so I'll round on even hours and the CNA will round on odd hours. If the patient is asleep we do not wake them up unless there's a specific reason to do so.

I usually start charting between 11pm and 1am, as we still use paper charting. I also try to do my 24 hour chart checks at this time.

I still need a smooth routine for passing meds, assessing, treatments of 10 patients in a 2 hour window.

If I have 10 to 12 patients, my med pass and assessments usually do not get done inside a 2-hour time frame. I'll start at about 7:15pm and not be done until 10:30 or 11:00. It takes even longer if my group of patients is overly needy or very chatty.

[coopman712]

Thanks!

I always felt like other nurses got it all done. I hate being late with meds...

[ashleyelam]

I am the night nurse on a small rehab unit, up to 12 pt max. However we take a lot of train wrecks that other facilities refuse. I have 1-2 CNAs depending on how many patients I have that are Hoyer txfer, incontinent, on bladder training, etc. When I round I take 1 CNA room to room with me. They pass ice, empty trash, and help me by writing down my vitals and other things I tell them from my assessment and then we toilet or bed check them. This way we only wake the patient one time and I am not fumbling with a clip board and pen or cross contaminating. I have help turning patient etc. It just goes faster. But another added bonus is I see how my aids handle pts and they see me handle them and I set the example for things like hip precautions and safe txfers. The other CNA is getting call lights and restocking things. I chart vitals immediately after I'm done. Then my next round is for pills but again I combine this with bed checks and toileting. Hope this helps someone.

[coopman712]

So how long does it typically take you to round?

[emptyboxcars]

Not to sabotage your thread, because I think it's a great one, but can the OP tell me what it's like working as a night nurse doing rehab? I am a new grad who will be starting on a sub-acute rehab floor soon (doing nights) with the same patient numbers you mentioned in your original post. To me, 6-8 patients, some of whom are sub-acute (vents, chemo etc) sounds like a lot of work as a night nurse....am I wrong?

[coopman712]

I think it is a lot of work, but then again, I am kind of new still. My hospital has trachs but no vents. Nights we get 8-10 patients typically, sometimes less and I think it is really hard to get thorough assessments done. At my hospital night shift starts with rounding quick to get vitals and any assessment possible. Then we round again to pass meds, Blood sugars, change dressings, suction trachs, skin checks since most are in bed at that time. I think it is a great first place to be b/c you get varying acuity levels and get experience with a lot of different things, but not as much as med surg. The pace is a little slower than med surg IMO. I do find it very hard to get thorough enough assessments to accurately fill out our charting but I do the best I can. We usually have a lot of meds to pass at night which takes time naturally!

Good luck to you!