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?!

[linearthinker, DNP, RN]

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]

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]

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.

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.