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

[RockinNurse]

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]

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.

[nursing6207]

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.

[RockinNurse]

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]

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.

[AZO49008]

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]

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

[GooeyRN, ADN, BSN, CNA, LPN, RN]

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

[socks341968]

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]

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]

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]

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)