Question for those who work the 11pm-7am shift

LyndzBenz · Jul 26, 2009

I work a 7pm to 7am shift and my patient load is usually about 3-6 patients. In our facility we usually have an hour window, 30 min before a med is due and 30 min after a med is due. So, we can give it early if it is convienient and safe. We also give the 7am meds for day shift and day shift gives our 7pm meds. (it's just about impossible to give meds during report unless you get there early). Now with insulin, if it is a sliding scale to go with morning accuchecks I will give it. If it is Regular insulin, aka fast acting, and it says give before breakfast, I will let day shift give it. I am not around to know what time the patient is eating and I will not be responsible for their glucose bottoming out for the day shift nurse. But that is my facility. Talk to your house sup or your charge nurse. Hope this helped.

jlb_rn · Jul 26, 2009

erm, pardon my ignorance (i work in critical care so my patient load is 1-3) but where do you work that you are responsible for 60 patients? I didn't even know that was possible - how do you provide nursing care for 60 patients in 8 hours?

sincerely,

confused nurse :)

morte, LPN, LVN · Jul 26, 2009

This will be my first time working an 11-7 shift (i usually work 3-11). i know there are certain things i need to do during this shift that i need to ask about... like switching out the syringes for the gtubes, and checking the accucheck machines, etc etc etc.... my question, though, is about medications.
if everyone has meds due at 6:30am... and many of them have blood sugar checks at 6:30am... how do you get it all done?!?! i have 60 patients tonight. i'm working on my own, have only worked with these patients once before (and it was split in half the first time around), and i'm just wondering how to make it through this shift. how early can i start giving them their meds and insulin?!?! any input would be greatly appreciated... i think i'm gonna have a breakdown from the thought of having 60 somewhat-new patients all on my own. i also know that about 20 of them require accuchecks... help please? thanks.

this is not a doable assignment....that said....if you have the blister cards of meds, organize them per mar, insulins can not be given early...meds no earlier than an hour before scheduled....accuchecks shouldnt be done early either, however....., dont expect to be out before 830 or so....good luck

achot chavi · Jul 26, 2009

erm, pardon my ignorance (i work in critical care so my patient load is 1-3) but where do you work that you are responsible for 60 patients? I didn't even know that was possible - how do you provide nursing care for 60 patients in 8 hours?
sincerely,
confused nurse :)

\

for starters,LTC is not critical care, but 60 is a heavy load,

I was once pressured by my DON to be the only nurse for 90 pts!!! (with only 3 CNA's with me) I left that job.

However, I agree depending on the degree of care the patients need, 60 can be a lot and you have to be organized. You do have that one hour window obviously and sometimes you are late- someone falls and needs immediate care etc.

If you are late for a BS and the pt already ate- I just tell the doctor that the blood sugar was not fasting...

NightNurseRN · Jul 26, 2009

60 patients?!?!?! :uhoh21: itd seem to me youd have to start passing meds when ur shift started to be done by 630 in the morning!

kythe, LPN · Jul 26, 2009

Personally, I would not work a shift where I was required to do a med pass for 60 patients that included 20 finger sticks. I know that doesn't really help you though, especially as a new grad where you may not have many work opportunities.

I've worked in LTC for over 2 years now. Most of my experience is agency, so I go back and forth between a few facilities. I have worked plenty of night shifts, but have not personally had more than about 35-40 pts on a unit. Even this can make for a very stressful shift if you are not used to the patients and there are a lot of finger sticks. It is also unsafe because you cannot do it all without making med errors of some sort.

You may ask some of your co-workers how they deal with it. I have even asked aides I am assigned to how they typically see nurses doing the med pass. What you are likely to find is that as many meds as possible are pre-poured during the night, and also that the med pass may start as early as 4 am even if they are not ordered until 6 or 7.

morte, LPN, LVN · Jul 26, 2009

Personally, I would not work a shift where I was required to do a med pass for 60 patients that included 20 finger sticks. I know that doesn't really help you though, especially as a new grad where you may not have many work opportunities.
I've worked in LTC for over 2 years now. Most of my experience is agency, so I go back and forth between a few facilities. I have worked plenty of night shifts, but have not personally had more than about 35-40 pts on a unit. Even this can make for a very stressful shift if you are not used to the patients and there are a lot of finger sticks. It is also unsafe because you cannot do it all without making med errors of some sort.
You may ask some of your co-workers how they deal with it. I have even asked aides I am assigned to how they typically see nurses doing the med pass. What you are likely to find is that as many meds as possible are pre-poured during the night, and also that the med pass may start as early as 4 am even if they are not ordered until 6 or 7.

this is true, but illeagal....seen it done and done the pre pour....limitedly but some.....

NotFlo · Jul 26, 2009

You may ask some of your co-workers how they deal with it. I have even asked aides I am assigned to how they typically see nurses doing the med pass. What you are likely to find is that as many meds as possible are pre-poured during the night, and also that the med pass may start as early as 4 am even if they are not ordered until 6 or 7.

Yup, this is how people manage 60 patients. The facility would rather look the other way than make a more reasonable assignment.

Most of the PO meds will be prilosec and synthroid.

I used to work in a facility that has a 60:1 ratio on 11-7. All the nurses prepoured and started their med pass at 4.

melz34 · Jul 26, 2009

60 patients I work on a childrens pediatric ward and I work 7pm to 7am or sometimes I work 7am-7pm or half days 7am-3pm or weekends or bankholidays anyway on nights my shift starts at 7pm and me and the other nurses meet up with the nurse in charge and from here we are assigned about 6 pts sometimes more depending on how many patients are on the ward during this meeting all the patients details are handed over to us, including reson for their stay, the care they have recieved and any procedures they are due to have and many other things at about 7.30pm after I have got my patients details I go to each and every patient and ask if they need any help getting to the shower or bath or if they need help washing and then I will change any dressings that get wet and apply fresh clean ones I will also administer fleet enemas to those who require them. then at about 9.00pm I have usually finished doing all this and I will go round each of my patients and look to see if they are due any pain relief or medication and then if they do I will go and administer the required medication and/or pain relief to each patient. between 10.00pm and 12.00pm it will just be a case of going and settling young patients to sleep and getting them drinks and answering call lights and answering phone calls from worried parents and relatives. then between 1.00am-6.30pm it will be pratically the same as the 10-12 period and also I check on stock order new if needed I also do the 24hr chart audits and admit new patients from A&E we admit pts from A&E all through the night and morning. do weekly summaries and keep myself busy to stay awake. at 6.30am we give meds again and blood sugar testing but because we only have six pts or a few more it's quite easy for me to do it all in halfhour so I can't really solve your problem you shouldn't really have 60pts its far too many love melz:roll:yelclap:

kythe, LPN · Jul 26, 2009

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this is true, but illeagal....seen it done and done the pre pour....limitedly but some.....

Yes, I agree. This is part of why med errors are inevitable in this kind of work environment. Giving meds too early and pre-pouring are med errors, even if you don't do anything else wrong.

Many facilities are set up in a way that makes this "necessary". But when state comes through, or if a resident or family complains, it is the nurses' job and possibly license that is on the line. The facility will continue to get away with the staffing issue that created the situation in the first place.

I feel fortunate that the facilities I've been working in lately have more appropriate staffing levels and short cuts are not done. Sometimes it's easier said than done to just change your job, yet this may be the only way around a potentially dangerous work situation.

NewestRN_OnTheBlock · Jul 27, 2009

WOW!! thanks for all the responses. i survived my shift... but not without the help of my supervisor. she didn't have any admissions or discharges to prepare for the day, so she helped me and the other new grad with our assignments (the other new grad had about 60 patients as well). we were instructed to start signing off the MAR early and do our charting early. all the misc tasks were done first. any meds due at odd hours were given on time... but the majority of the patients had meds at 6:30am. and YES, we were told to start at 4am. it started off well... until i remembered that i had another med cart full of meds to give HAHAHA. my supervisor did about 17 of my accuchecks for me. by the end of the shift, i was sooooo behind that my supervisor helped me with my insulin injections and with the rest of my PO meds. i had patients up at all hours of the night asking for PRN meds as well as dressing changes that needed to be done before i could do my med pass. so needless to say, i had to save most of my charting for AFTER i clocked out. i clocked out at 7:30am, but didn't leave until about 9:30am.

i'm not really sure how to manage nursing care for 60 patients in one 8 hour shift. i understand that some of them don't really require much nursing care in the first place. but others are very demanding and have a million things going on with them.

probably the biggest issue that i have the hardest time understanding is that so many nurses give BP meds without ever checking the BP. i always check the patients' BP before giving any BP meds... Although sometimes the patients get upset with me and say that they don't understand why i need to check it when they never had to have it checked before. I guess it's yet another shortcut taken that explains why it takes me much longer to give meds than it does for others! does this occur in your facilities as well???