Organising shifts - please help me graduate! (long)

htrn · Oct 16, 2006

Hi, all you wonderful O&G nurses!
I have an assignment to do (the last one before I graduate!) and we have specifically been advised to use diverse resources, including getting feedback from other nurses. As it's specific to your specialty, I've posted here instead of the student forum.
I am really asking those of you who deal with post-partum mum and bub couplets. In the ward I am on, midwives take 4-6 patients/couplets each, and carry out the mother and baby checks and give medications. Other things, such as education, assisting with showers for new Caesars or changing beds, is done if needed, and not if not.
Different places do things differently, so I have a few questions:
How do you organise your time/shift?
Do you have certain tasks you must complete each shift?
Do co-workers mind if you have not completed tasks (e.g., mother visiting baby in NICU for whole shift, so could not do mother check)?
Do you have any recommendations for new nurses/midwives trying to organise their shifts?
Thanks so much to any of you who have a few minutes to help me out!
:monkeydance:

I don't know how much I can help, but I'll do my best. I usually work nights, 11p-7a, with another nurse and a nursing assistant. One nurse is 'assigned' to the nursery and the other nurse does post-partum, outpatients, labor and delivery, basically everything other than the babies.

I organize my time/shift depending on what is going on. If I have an active labor patient, I stop in and introduce myself and look at the strip. Same thing for a premature labor pt., I will do a lengthy assessment if she is on mag. Our post-partum moms are generally very stable, so they are lower on my priority list.

If all I have are my postpartum moms, I go to my freshest c-sections or those needing pain meds ASAP. I try to get to the ones still awake right away and if possible time my assessments on the rest of the moms to coincide with baby coming out to nurse or their 0200 scheduled Ibuprofen. If we are busy though, I start at one end and move to the other end until I am done.

Each patient has to be assessed once a shift, and c-sections are vital signs every 4 hours - so 2X a shift. Very rarely will we not see a mom on our shift, but that is usually someone who is quite stable, exhausted, was assessed late on the previous shift and probably on their last night in hosptial. Rarely happens though. I had one patient down right refuse to allow me to assess her, so I just charted her refusal. We do not have a very big unit and no NICU, so would not have to worry about a mom being gone all shift.

Other things I need to do on my shift: narcotic count with previous shift, check all l&d rooms for supplies, document temperatures on med and placenta refrigerators, controls for blood glucose machine, finish a couple of paperwork chores for the end of the 24 hr. period. Alot of these things can be and are delegated to my CNA - all except the narc count.

As far as shifts mad for not getting something done - there is always going to be some sort of 'the last shift didn't do......' and shift to shift nit picking. The things that really frost my butt are when I walk in and they are all sitting around reading the paper or doing crosswords and work has been left for us. The biggest butt froster for me is when l&d rooms are not restocked. We never know what is going to walk in the door when and what we are going to need. We don't have the extra staff on the noc shift to run and grab X,Y,Z for an emergency situation.

My advice for a new nurse is to figure out what the priorities are - who needs you now or first. Don't be afraid to ask for help. DON'T LET DOCTORS INTIMIDATE YOU!! My other tidbit of advice is asked to be scheduled with a really good and experienced CNA - I learned sooooo much from my first CNA I was paired with, and most of it was how to organize my shift and how to prioritize my load. This gal had been an aide for 45+ years and really knew her stuff.

I hope this helps. I should tell you my unit is fairly small 40-50+ deliveries a month. I'm sure things are very different in larger facilities.

Good luck

bethem · Oct 25, 2006

I don't know how much I can help, but I'll do my best. I usually work nights, 11p-7a, with another nurse and a nursing assistant. One nurse is 'assigned' to the nursery and the other nurse does post-partum, outpatients, labor and delivery, basically everything other than the babies.
I organize my time/shift depending on what is going on. If I have an active labor patient, I stop in and introduce myself and look at the strip. Same thing for a premature labor pt., I will do a lengthy assessment if she is on mag. Our post-partum moms are generally very stable, so they are lower on my priority list.
If all I have are my postpartum moms, I go to my freshest c-sections or those needing pain meds ASAP. I try to get to the ones still awake right away and if possible time my assessments on the rest of the moms to coincide with baby coming out to nurse or their 0200 scheduled Ibuprofen. If we are busy though, I start at one end and move to the other end until I am done.
Each patient has to be assessed once a shift, and c-sections are vital signs every 4 hours - so 2X a shift. Very rarely will we not see a mom on our shift, but that is usually someone who is quite stable, exhausted, was assessed late on the previous shift and probably on their last night in hosptial. Rarely happens though. I had one patient down right refuse to allow me to assess her, so I just charted her refusal. We do not have a very big unit and no NICU, so would not have to worry about a mom being gone all shift.
Other things I need to do on my shift: narcotic count with previous shift, check all l&d rooms for supplies, document temperatures on med and placenta refrigerators, controls for blood glucose machine, finish a couple of paperwork chores for the end of the 24 hr. period. Alot of these things can be and are delegated to my CNA - all except the narc count.
As far as shifts mad for not getting something done - there is always going to be some sort of 'the last shift didn't do......' and shift to shift nit picking. The things that really frost my butt are when I walk in and they are all sitting around reading the paper or doing crosswords and work has been left for us. The biggest butt froster for me is when l&d rooms are not restocked. We never know what is going to walk in the door when and what we are going to need. We don't have the extra staff on the noc shift to run and grab X,Y,Z for an emergency situation.
My advice for a new nurse is to figure out what the priorities are - who needs you now or first. Don't be afraid to ask for help. DON'T LET DOCTORS INTIMIDATE YOU!! My other tidbit of advice is asked to be scheduled with a really good and experienced CNA - I learned sooooo much from my first CNA I was paired with, and most of it was how to organize my shift and how to prioritize my load. This gal had been an aide for 45+ years and really knew her stuff.
I hope this helps. I should tell you my unit is fairly small 40-50+ deliveries a month. I'm sure things are very different in larger facilities.
Good luck

Thanks, Heather! There are some great tips in there. I appreciate you taking the time to reply - sorry I took so long to get back to you!

flytern · Oct 27, 2006

First, prioritize!

I work midnight shift. Usual load is 5moms/5 babies.

Fresh c/sections, those with IV's, foleys... should be seen first

(nothing worse than going into a room w/a dry IV, after being told there was 500cc left).

Second, are there any scheduled meds to be given. Will it matter if I assess my NSVD at 2am when I give her that antibiotic needed or wake her up at 11 and then again at 2PM.

Did mom send the bottle fed baby to the nursery so she can get rest? I try to get to all my moms before midnight, but it always doesn't happen. If I peak in, see that she's asleep, baby's in the nursery and she's on the second day, do I really need to wake her? Sometimes I'll leave a little note on the bathroom mirror to call for her nurse when she wakes up. Most of these moms are very grateful for letting them sleep. Now granted I'm talking about our healthy patients. If there's any reason, temp/ elevated BP's, excessive bleeding that was reported, yeah they get woken up.

Then I go to the nursery to assess babies, trying to get the hearing screen, pulse ox, PKU's done if possible.

We don't do discharges at night, so anything that I can get ready for the day girls to make the discharge faster is greatly appreciated. Even telling the patient when check out time is so they can start calling for their rides at breakfast time.

I think post partum nurses are the most organzied people (and I've done NICU/Labor/PP) You have to be. Somedays it all goes smoothly and you can get teaching done, every breastfeeder doesn't require your assistance,

and you even got your break! Other days, you're just treading water.

I figure if at the end of the shift, if you truly feel you gave good patient care, you left your patient's comfortable, you should be proud. Trust me,

the next shift will figure out if you are a slacker or a hard worker.