nocs on a med/surg floor

Little Panda RN, ASN, RN · Mar 18, 2013

What do you think of Med Surge so far? I recently accepted a position for flex time on a very busy med surge floor days and pm's. If I can work out getting all their general orientation stuff done then I should be starting sometime in April. The challenge is finding the time when I already work a full time job, lol.

proud nurse, BSN, RN · Mar 18, 2013

So far I love it. I'm learning and doing so much. Drawing labs, starting IV's, hanging blood...etc. As a recent grad, this is very exciting for me.

Good luck! I hope you like it as much as I do.

Born_2BRN · Mar 18, 2013

Learn as much as you can now. There will be some unpredictable tasks occur during your shift that requires flexibility--lots.

Tait, MSN, RN · Mar 18, 2013

1830: get in to prep paperwork, say hello, review charts

1900: Hand-off report

1915-2200ish: Assessment and meds, address concerns, call docs if needed (someone always seems to say "I haven't pooped all day" at like 9pm)

2300: Assess for additional pain needs and sleeping pills

2400-0200: Left over charting, pain assessment, rounding, chart checks.

0200-0500: More of the same, pt management, pain mgmt, admissions if any, rounding,stock med carts, clean up, code cart checks, narc counts (depends on the day).

0500-0630: Morning meds, record report, final notes, pain assessment, if CN prep assignment, pre paperwork for oncoming shift.

0700: Handoff

Mind you this is on an ideal night. Generally the downtime is from around 2-5 in the morning.

Best of luck!

Tait

missladyrn · Mar 18, 2013

Welcome to nights!

Here is my run down

1845- bedside report and chart check review (look for new orders written on days that may not have been addressed or faxed to pharm yet)

1915-2300 assessments, evening meds, pain assessment. I usually ask all of my questions and review their med schedule all night so they know to be expecting me in all night long. I also ask them if they want to be woken up when pain meds are due or if they want to call when they are ready. Some patients will sleep too long and wake up in horrible pain (deep sleepers) others will wake up with the first twinge. I normally recommend waking them up the first night or two after surgery, after that it is up to them. If there is anything they need or are concerned about, I want to know NOW so i can call the md before the wee hours.

2300-00 round to check for five 5 p's. Take away any food or drink for anyone npo for surgery in am. at 11pm I offer snacks to these people so they can rest without their tummy growling.

0000-200- my floor has a lot of drain removals at this time, extensive dressing changes, full chart reviews to ensure all orders were put in correctly and carried out

200-400- second round of drain removals on my floor (some docs order removal at 2, some order removal at 4) and dressing changes

400-600 morning rush, 5 p's and morning medications. I also use this time to ambulate patients who need to walk.

600- end of shift, make sure all iv fluids are full or changed and in date, make sure everyone is ok for pain med to last shift change, clean up room if necessary etc, dc foleys if ordered.

But the best laid plans don't usually work out. You need a "loose" plan like this as a general guide, but you will get admissions, have emergencies, have blood transfusions etc that will keep your schedule on edge all night.

Make a list of all your "must do's" and your "want to dos". Get the must dos done first and after you get into a good routine ( a few months or so after orientation) you will find yourself getting most of your want to dos done as well. In the beginning getting all your must dos done is trying. On my floor dressing changes are not timed but it makes sense to do them when taking out a drain. But If I cant get to it I cant get to it.

advsmuch08 · Mar 18, 2013

It seems the busiest times for me on nights are from 1900-0000 and 0430-0700. Charting and daily chart checks usually takes place around 0100.

Twinmom06, ASN, APN · Mar 18, 2013

1830: get in to prep paperwork, say hello, review charts
1900: Hand-off report
1915-2200ish: Assessment and meds, address concerns, call docs if needed (someone always seems to say "I haven't pooped all day" at like 9pm)
2300: Assess for additional pain needs and sleeping pills
2400-0200: Left over charting, pain assessment, rounding, chart checks.
0200-0500: More of the same, pt management, pain mgmt, admissions if any, rounding,stock med carts, clean up, code cart checks, narc counts (depends on the day).
0500-0630: Morning meds, record report, final notes, pain assessment, if CN prep assignment, pre paperwork for oncoming shift.
0700: Handoff
Mind you this is on an ideal night. Generally the downtime is from around 2-5 in the morning.
Best of luck!
Tait

Thank you for this! I'll be starting med/surge on 6/17 as a new grad and this helps!

ChrissyRN74 · Mar 18, 2013

Another tip for nights is find out when/if your computer systems have reboot or down time and be prepared for it. You do not want to be in the middle of charting and have your computer shut down on you. We usually get emails the week before on any lengthy down time but every night the system reboots itself at 0215 and if we are logged in we not only loose the info we were charting but we get locked out sometimes as well and calling IT at 2:00 am is never fun. Oh and make sure you get enough sleep. Good luck!

eatmysoxRN, ASN, RN · Mar 18, 2013

I'm on an ICU Cardiac Stepdown/med surg floor.

1845-1915: Get report. Bedside reporting helps me verify everyone is okay and check all my drips and fluids. I keep a post it and write down any needs for fluids/prns or any other requests. Go to the nursing station to my computer for any new or overlooked orders after doing anything time sensitive I discovered in report. Print teaching packets for patients having procedures.

1945: Pull my meds from pyxis and put them in bags. Go grab supplies like piggyback tubing, new bags of fluid, flushes, syringes.. Etc.

2000-2200: pass meds, check sugars.. Assessments. I cluster my care and try to do all meds and my assessment while in the room. I also get my consents signed for any next day procedures.

Depending on whether I have a full load (8 patients) or not the time it takes to pass meds and assess is variant.

Whenever I finish I head back to the desk and make sure there are no new orders or anything else I need to complete. Then I chart all my assessments.

Around midnight I usually start my chart checks.

I start morning meds at 530.

Of course this doesn't include the frequent admissions and discharges we do when we arrive or before we leave. Chest pain complaints. Blood transfusions. Drip titration.

~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~

proud nurse, BSN, RN · Mar 18, 2013

Thanks everybody! I worked nocs in LTC for many years, but the hospital is very different. This helps a lot.