Orientation

Welcome to ER amzyRN!!! The swing shift you will be orienting on can be a tough shift. Not a tough shift in terms of workload, but a tough shift in terms of giving/getting report. I will explain further. At 1pm in the afternoon the day shift is already halfway through their tour. You come on at 1pm as a "relief" so to speak, depending on the workload. Depending on the patient volume and acuity level at 1pm, your charge nurse may assign you to take some of the heavy patients off the other nurses workload. This is right when you walk in the door by the way. Plus you'll be added to the roster to receive patients from triage of course.

So once you get acclimated and your humming along in your shift, it will be time to go home. Now, at 1am, the night shift is halfway through THEIR tour. But since its your time to leave, now you have to sign out all your remaining patients to the nurses on the night shift who may very well be getting slammed from triage at 1am. If you received really heavy patients from triage or never admitted the heavy patients from 1pm, prepare to get resistance from the night nurses on accepting your patients willingly. Again, this is depending on patient volume at the time. It also depends on your coworkers. Some nurses understand the situation with the swing shift having to sign out to somebody and other nurses always seem to disappear when its time for the swing nurse to sign out. My ER sees over 350 patients per day, so were very busy from about 11am to about 12am the next morning. Getting report from the swing shift can be a nightmare or just a small bump in the road.

The swing shift is really no busier than the other shifts. But just remember, at 1pm you could be walking into Grand Central Station but everyone is so happy to see you. Than at 1am, if you have 3 intubated patients, people suddenly forget your name. Good luck.

Hi Amy, welcome to the ER! I'm new to it myself. I oriented on a "swing shift" (3p-3a) before asking to be moved to 7p-7a. I'm a new grad and was an even newer grad at the time. I can tell you that the best part for me was that my department starts to clear out around 11pm, so it was nice to end on a calm note and be able to catch up on any loose ends (simple documentation, email, learning modules, etc...) before leaving. Most of the 7a-7p nurses have to stay late in their shift to accomplish that. But I will say that the only down side is exactly why I switched shifts. There is only one swing shift person a day and it was me. When I would be assigned to take over another nurse's patients, they weren't accustomed to handing off their patients 4 hours before shift change and would ALWAYS try to leave me with a sloppy patient load- or dump a very unsafe one on me. I fortunately (or unfortunately?) worked in my department for years before being hired as a new grad nurse and became friends with all of the nurses before I ever was one, so when they would try to leave me hanging like that I was comfortable enough with them to use my back bone and openly state my concerns. It got tough though- people don't like to be called out on trying to dump their unsafe patient load on you or leave you with their loose ends, no matter how nice you say it. But you've got to be safe and you've got to be professional. My BIGGEST word of advice to you is DO BEDSIDE REPORT!!! Regardless of what they fail to document, 5 minutes in the room with the patient with that nurse by your side holds them accountable, keeps you both on the same page and helps you prioritize. It helps you do a quick assessment of your own, which allows you to prioritize their needs better than you would based on someone else's "story". I found that those 5 minutes in the room with the other nurse helped a few times, and I can think of one time where it would have been very valuable had I done it. Also- from one newbie to another, standing with another nurse gave me the opportunity to ask questions about the many things I was not (and am still learning about) familiar with. Some old school nurses I work with aren't big fans of bed side report, and there are certainly some situations where it isn't appropriate, but my department really pushes for it to be the standard and I do find it much safer. Good luck on 1p-1a :) If you're a busy body like me, you'll love it!

Do your best, ask questions, don't expect a "smooth ride." You will be fine.

I'm a huge proponent of just talking your way through a shift. Asking questions while you are working is an excellent way to learn. So when you're triaging a CHF pt who is hypotensive and getting 2L, you can ask why on earth someone with heart failure is getting so much fluid, for instance. If you don't have a preceptor who is ok with answering a TON of questions, request a new one.