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

kythe, LPN · Jul 27, 2009

Congratulations on making it through your shift. :) You are fortunate to have a supervisor with the time and patience to help you through.

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???

Yes, I've seen this. I also once knew a nurse who made up finger sticks rather than actually doing them. This was caught when the next person double checked the machine and found that it hadn't been used that shift.

I've had times where I have really tried to give meds as close to when they are scheduled as possible. Then patients will actually ask why they are late because they are used to recieving them so early. I once tried to give a woman artificial tears that had clearly been ordered and signed off on for a long time, and she said, "What's this for, I've never had this".

In one facility where I used to temp periodically, I found myself several hours behind on a med pass. I was working a 3-11 shifts with about 35 patients. One resident (who incidentally spent most of her own career as an LPN), told me that most nurses combined the 4pm and 9pm med passes instead of trying to make two rounds. She was wondering why I wasn't doing that. That definately explained a lot, and that is also a facility I no longer go to. I had already heard stories of other temps refusing that particular floor as it was one of the most difficult.

This is part of why I'm now leary of certain environments. Not all facilities are like this, and some places will actually write people up for short cuts (as they should). But places that care enough to ensure that nurses are not using short cuts also tend to have better staffing so that short cuts are not necessary. If you are seeing people get away with or even encouraged to falsify data, sign off on meds not given, pre-pouring, etc, you are working for a facility that really doesn't care about its residents. This isn't good nursing, its a profit-based company.

morte, LPN, LVN · 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???

#1 above=illeagal

#2 above=unethical/illeagal

#3 above= unethical on the part of your employer, if you are off the clock, you shouldnt be working....you will not be covered by their Liability Insurance or WC in the case of an inj

#4 most persons dont take their BP at home....so, unless there is an ordered parameter this is not nec, unless the patient is symptomatic.

this doesnt sound like a place i would want to work.....good luck

NewestRN_OnTheBlock · Jul 27, 2009

#1 above=illeagal
#2 above=unethical/illeagal
#3 above= unethical on the part of your employer, if you are off the clock, you shouldnt be working....you will not be covered by their liability insurance or WC in the case of an inj
#4 most persons dont take their BP at home....so, unless there is an ordered parameter this is not nec, unless the patient is symptomatic.
this doesnt sound like a place i would want to work.....good luck

i realize that everything you pointed out is all wrong. that's my problem. i'm a new grad and tend to try to go more by the book than anything. but the more i try to do things right, the more the bosses pull me aside to say that i'm in the real world now and i need to take shortcuts to finish my work faster. when i was just starting out, the other nurses would come and help me give some meds. but of course i didn't have an opportunity to sign off on anything they gave until after my med pass was finished.

i had difficulty coming to terms with the idea of giving 9pm meds with 5pm meds. i've been pretty resistant to that shortcut. but when its 11pm and i'm still giving meds, my coworkers and supervisors keep telling me that i need to finish more quickly.

when i first tried combining 5pm's and 9pm's, it was hard enough. then they all told me to just start giving meds as soon as i've started my shift.

i'll get in trouble if i don't finish all the work (charting, giving all the meds, treatments, incident reports (if any), etc). but i'll also get in trouble if i go into overtime. i'm required to get everything done by the time i clock out for the day. i've already gotten in trouble with my boss for staying late (off the clock) to finish up my charting.

and as for the BP meds, i'd say 99% of the BP meds i give DO have parameters. so because of the ordered parameters, i find it unsettling to see that the other nurses aren't checking the BP. especially when i see that these meds have previously been held... i'm afraid of just giving a med when the patient's BP might actually be lower than the ordered parameters. or are they just holding the meds so they have less meds to give? i always wonder that when i see all the held meds in the MAR....

i guess i'm struggling because i'm constantly being told to take as many shortcuts as i can to get the work done... but everyone always adds in "...unless the surveyors are here. in that case, do everything right." like i said, i'm a new grad... if i can't do things the way i know is right without constantly getting in trouble with my bosses, then i won't be able to do anything right in front of the surveyors!!

Bokyo · Jul 27, 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.

You can start giving your meds at 5:30 AM, but start with those Patients you know were easy to deal with.....those Synthroid, Omeprazole.....in short those scheduled to be given at 6:30AM. Get all the FS done....then if they needed insulin shot...give it at 7AM, close to having their breakfast....or you can give them something to eat...you dont know sometimes Dietary may be delayed for some reason to deliver the meal cart.

I work 11 to 7:30AM....

4 AM i start doing my Charting....5:30 giving meds and FS...changing feeding of those with GTs, there are some with IV antibiotics...its always not easy in the beginning....but as you work more in that shift and station...that will be easy, piece of cake....be quick but accurate!!

Good Luck!!

morte, LPN, LVN · Jul 27, 2009

i realize that everything you pointed out is all wrong. that's my problem. i'm a new grad and tend to try to go more by the book than anything. but the more i try to do things right, the more the bosses pull me aside to say that i'm in the real world now and i need to take shortcuts to finish my work faster. when i was just starting out, the other nurses would come and help me give some meds. but of course i didn't have an opportunity to sign off on anything they gave until after my med pass was finished.
i had difficulty coming to terms with the idea of giving 9pm meds with 5pm meds. i've been pretty resistant to that shortcut. but when its 11pm and i'm still giving meds, my coworkers and supervisors keep telling me that i need to finish more quickly.
when i first tried combining 5pm's and 9pm's, it was hard enough. then they all told me to just start giving meds as soon as i've started my shift.
i'll get in trouble if i don't finish all the work (charting, giving all the meds, treatments, incident reports (if any), etc). but i'll also get in trouble if i go into overtime. i'm required to get everything done by the time i clock out for the day. i've already gotten in trouble with my boss for staying late (off the clock) to finish up my charting.
and as for the BP meds, i'd say 99% of the BP meds i give DO have parameters. so because of the ordered parameters, i find it unsettling to see that the other nurses aren't checking the BP. especially when i see that these meds have previously been held... i'm afraid of just giving a med when the patient's BP might actually be lower than the ordered parameters. or are they just holding the meds so they have less meds to give? i always wonder that when i see all the held meds in the MAR....
i guess i'm struggling because i'm constantly being told to take as many shortcuts as i can to get the work done... but everyone always adds in "...unless the surveyors are here. in that case, do everything right." like i said, i'm a new grad... if i can't do things the way i know is right without constantly getting in trouble with my bosses, then i won't be able to do anything right in front of the surveyors!!

this place has very bad potential.....to eat your lic for breakfast.......you need to find new employment as soon as possible.....would you like to be awakened at 4 am ? would you like you family member awakened at 4am?....etc......this place is a snake pit.....i know that the economy sucks....but you really need out of there

NewestRN_OnTheBlock · Jul 28, 2009

that's what i was afraid of

survey started today. of course i freaked out... but they didn't follow me during my med pass so i survived. they actually canceled my shift for tomorrow just so i won't be followed during the med pass. sucks for my paycheck though.

i realize its not the greatest place for employment. i'm just worried about having such a short term job on my resume.............. *shrugs*

bluegeegoo2, LPN · Jul 28, 2009

"...i realize its not the greatest place for employment. i'm just worried about having such a short term job on my resume.............. *shrugs*"

Most employers really don't care about short term jobs. I've had 4 jobs in the 18 months I've had my license, (not the best track record, I'll agree), and have had no trouble at all getting hired on somewhere. I would personally run as fast as I could from the job you have. You really have to be your own advocate when it comes to protecting your license. Please, save yourself.

Let's help out · Jul 8, 2011

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!

You are correct. That's exactly what you do! :idea:

Forever Sunshine, ASN, RN · Jul 8, 2011

You would have to start at 4am. Screw the hour before and hour after.. if you started 1 hour before the medpass was to begin.. your meds/fingersticks would be late because it would be 7:30am, 8am and you'd be just finishing up.

And that time is crucial in LTC for falls and other incidents so you need to have a lot of time for that. I've started at 5am before. Didn't finish until 7:15am because of an incident that set me back about a half hour.

arabstarRN · Jul 8, 2011

At the facility I am leaving, they start passing meds at 4 am because there are 51 psych patients and some of those people take forever to get meds into - is it right - NO, but the facility would rather do this than to hire two RNs or LPNs to do the med pass and make it easier... 51 psych patients to ONE nurse is a ridiculous assignment... especially when you have acuity on top of the psych issues and you have HIGH fall risk patients - Between second, and third yesterday/tonight and first shift this morning, there were 3 falls... two was the same resident, one was a resident that fell couple days ago... not enough staff to be one on one with these people, and these people will NOT stop trying to self transfer and get themselves to the bathroom nor will they use the call light. Unit manager wasn't happy, but what can we as staff do? My aides last night were trying their hardest to get patients changed and up as their assignments said... there were four of them - still had anywhere from 10-15 residents each (one was an orientee and couldnt have a full set so the other three had to have even more patients!) anyway, point is, when you have psych patients, and fall risks and sundowner's - TWO nurses are needed to watch over at least half those patients that are high fall risks as one nurse cannot be at one end of the hallway and watch a high fall risk resident at the complete opposite, nor can the aides change and care for someone in one room while providing privacy for that resident and watch another resident in the hall... just cannot happen... I don't have a degree in Miracle Working.

60 is a lot for one nurse as well even without the psych issues. The new job I just accepted I will have up to 52 residents, however they are not psych patients, and its a lot nicer facility - 5 star on the medicare nursing home comparison site compared to the 1 star I was working at mentioned above... The state obviously likes this place better lol.

Forever Sunshine, ASN, RN · Jul 8, 2011

At the facility I am leaving, they start passing meds at 4 am because there are 51 psych patients and some of those people take forever to get meds into - is it right - NO, but the facility would rather do this than to hire two RNs or LPNs to do the med pass and make it easier... 51 psych patients to ONE nurse is a ridiculous assignment... especially when you have acuity on top of the psych issues and you have HIGH fall risk patients - .

Its not right but when you are the lone nurse for 53 residents.. you have to start your medpass at 4am.

IdrilRN, BSN, RN · Jul 9, 2011

One suggestion for change at the facility would be to have the blood sugars done first thing by the day nurse for the ones that need sliding scale coverage with lispro. We did this at one place and it took a bit to get used to, but when the docs started ordering lispro so it was a nessasary change. I am working on getting that changed at the hospital I work at, the day nurses get their panties in a bunch when the blood sugar wasn't done by 7am. Well guess what even if it was I would (if I worked days) do it again if I am giving lispro at 8am on a blood sugar done at 6am.

but WOW 60 and all those blood sugars. and i am sure you get in trouble for the "overtime" I know too many nurses, usually the old schoolers who punch out stay 1/2 the morning to chart. Not sure what they have to chart on till ten am but I would never punch out to chart.