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Night Shift Rounding...Will your pt code in the meantime?!

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I am a new grad on a Med-Surg/Tele floor. I was taken off orientation about a month ago and just started working the night shift. During the day, I found myself in patient rooms all day long (whether it be due to the patient or their family!). Now that I'm on nights, we are only required to make rounds every 2 hours while the patients are sleeping. Granted, I often get in there more than that, but other busy nights, I may not. I am set to take my ACLS class tomorrow, so I've got patients coding on my mind! This may be because I am new, but I always have this fear that one of my non-tele monitored patients will code/die in this 2 hour interval (even 1 hour interval!) and by the time I realize it, it will be too late. Am I overly paranoid?!

Orange Tree

Specializes in Medical Surgical Orthopedic.

It's definitely possible! But when you have a patient who seems less stable than most, you just have to make it a point to check on them more often. There are times when I do almost all of my charting in one patient's room.....because that patient just seems more fragile than I would like them to be.

It is good to be concerned. I agree that if your gut tells you something is wrong then go with it and check on the pt more often. Unfortunately, you can only do the best you can do and ppl are going to code and die. A nurse at my hospital the other day had a pt that just called out for pain meds. She took the pain meds. The pt asked for the bed pan, and when she was rolling her to get her off the bedpan, she coded. YIKES. It could happen in a second. We can only do what we are trained to do and let God do his work also:). Sometimes hard for us and family to understand though. Hopes this helps. I was the SAME way as a new grad. I have found though I see my pts a lot more frequently on night shift than I sometimes do on days just because of the chaos of days shift. Our pts would be totally freaked out if they knew we were opening the door every so often to make sure they are still alive. Good luck.

Thank you both! That's funny because I do that, also....stand over them watching their chest rise or listening carefully for a snore here and there! ;)

MassED, BSN, RN

Specializes in ER. Has 15 years experience.

no, you're not. It will happen too. You'll notice the signs that someone is dying, but may not be present the exact moment it happens. Hopefully they'll be a DNR, otherwise you better take some measures to prevent that decompensation (like a Rapid response). My first patient that coded (I found him dead in his bed), I don't even remember if he was a DNR, he might've been, but that wasn't my first thought when I found him. It is my first thought now.

Im a new grad working on a busy cardiology unit and quite frankly the though of working on a different floor that doesn't routinely use telemetry scares the bejeezus out of me. Each patient is on a heart monitor. We can view each ECG and HR at the central desk, plus there is a room of people whose job is to constantly monitor the patients rhythms and rates.

This doesn't alleviate the need for me to do hourly rounding, but I rest more assured knowing that if I'm tending to patient A and patient C down the hall starts going south I'm going to get a call from the monitors alerting me to the fact.

casi, ASN, RN

Specializes in LTC. Has 3 years experience.

You could round every 15 minutes and still have someone code while you're not in the room.

GooeyRN, ASN, RN

Specializes in Psych, Med/Surg, LTC. Has 12 years experience.

You generally know who you have to do frequent checks on.

Don't rely on the telemetry monitors too much...lol. I remember when I was new, I thought they were wonderful (still do), but once, they removed a monitor when a pt left the floor and telemetry called an hour later to state they weren't getting a reading (we couldn't view the monitor readings on the floor). No system is full proof. Like someone else said, anyone can code anytime. Just try to be prepared and do your best. Sometimes, it's just a matter of it's someone's time to go and nothing is going to stop it.

kymaw

Specializes in Stepdown, LTC/Rehab, Academia.. Has 4 years experience.

Our pts would be totally freaked out if they knew we were opening the door every so often to make sure they are still alive.

So true! But we all do it!

LouisVRN, RN

Specializes in Med/Surg.

I work nights and we have this policy about q2 hour rounding as well. I try to make it a priority to round q1 hour at least, but if there is a pt I am particularly concerned about I put a continuous pulse ox on their toe. Usually these patients will not be getting up, and an alarm, although you do get quite a lot of false ones will at least get attention to go check them out. While this won't stop anyone from coding, if they are a full code it will at least give me a heads- up and gives me a little piece of mind.

ETA also document document document, every time you see that patient. My documentation on a round usually is something to the effect of "Pt lying in bed, eyes closed, breathing unlabored", if the pt is not a particularly light sleeper I try to document at our bedside computers. Otherwise we wear locators at work and i make sure my locator registered I was in that patients room. Everyone thinks I'm overly paranoid but imo better safe than sorry.

OutlawNurse86, BSN, RN

Specializes in Med/Surg, LTAC, Critical Care.

To echo what some others have already said: If you got a feeling...go with it. It maybe wrong and they might be ok...but one day/night, it might not be...

General rules for nightshift:

1) Investigate odd noises (durh)

2) Investigate lack of noise (especially in case of confused patients who are usually shaking bedrails or hollering, something be amiss)

linearthinker, DNP, RN

Specializes in FNP. Has 25 years experience.

It happens. I can't tell you how many codes we've had 45 minutes after shift change, only to get up there and find the person is COLD and rigor has set in, lol.

Up2nogood RN, RN

Specializes in pulm/cardiology pcu, surgical onc.

A few yrs back another nurses pt had cont pulse ox on for what reasons I can't remember. Well it kept going off for no reason. At that time we didn't have machines that showed trends so the nurse took it off so the pt could sleep. Phlebotomy went in like 2 hrs later and the 50 some yr old pt was cold. It just makes me sick to think about it. Good nurses do make bad decisions once in awhile :(

It does happen but I think there are signs of impending doom most of the time and you'll get better over time at picking up when things just don't look right.

HollyHobby

Specializes in critical care, home health.

I work ICU, so I have the luxury of having all of my patients on monitors. When I get pulled to the medical/tele floor, I am totally freaked out by the idea that the medical patients are not on the monitor. Also, many of them are allowed to walk around independently. :eek:

Also, I'm used to the rooms being like fishbowls, so I can easily visualize my patients. Up on the medical floor, the patients are invisible behind closed doors except when you're physically in the room. In that situation, you just can't know for sure if your patient is dead or lying on the floor.

Of course, when you assess your patients you should get a pretty good idea of which patients require closer watching or which patients are a fall risk. But any patient could die at any time, and any patient can fall at any time.

I'm (almost) of the opinion that anyone who is sick enough to be in the hospital is sick enough to be on telemetry. I think patients/families believe it is safer to be in the hospital than to be sick at home, because the nurses are watching them. Well, without tele, we aren't actually watching them. (I don't mean tele is the same as actually being with the patient, and it's just a tool, but by god with tele you at least know if your patient's heart has electrical activity.)

Since I'm ICU, I'm used to having more control over my patients. If my ambulatory patient gets up to use the urinal, I know about it. If he goes into atrial fib, I know about it the minute it happens, and so on. I don't have to worry that my patient is lying dead on the floor somewhere. I'm just spoiled and/or I'm a control freak.