to sleep or not to sleep???

Kanani_Ikike · Apr 28, 2008

do you wake your patients on night shift to assess them, or wait until they wake up? I work on a medsurg floor, and have mixed feelings. I would rather wake them all up, but some are long termers, who live here. What do you do?

I would definitely wake them whether they are long term or not. It would be just my luck that the night I didn't wake them would be the night they were in trouble. I have grown a thick skin since I began nursing and I don't care if they get irritated. Yes, they do need to rest, but they can sleep uninterrupted at home. As long as they're my patient, they will be distrubed at least once during the night shift, if not twice.

Nurse Salt · Apr 28, 2008

Just adding this...I appreciated knowing the nurse was checking on me.

I always tell my patients "I will be checking on you periodically, but I will try not to wake you if I don't have to. Please don't hesitate to use your button or call out to me my desk is only about 10 feet away"

The response I usually get is "Thank you, I'm just so tired." :zzzzz

nrsman1 · Apr 28, 2008

If you need to perform a pertinent assessment then yes wake them up. In order to adequately take care of our patients we need to be able to understand what is going on with them. How can we know important changing data such as change in lung sounds are occuring. Lets not forget, we are there to ensure they get better, a hospital is not a hotel visist. this sounds mean, but I don't intend on it to sound that way.

leslie :-D · Apr 28, 2008

i've worked w/nurses who wouldn't do their assessments, stating the pts needed their sleep.

translated = the nurses needing their sleep.

of course not all...but enough.

to me, nsg is 24/7, atc.

and i have often found that like sharrie's experience, my pts were not sleeping but laying there w/eyes closed...

and also, many were grateful for the interruption.

leslie

Quickbeam, BSN, RN · Apr 28, 2008

This topic always brings back memories. I worked in pediatric hospitals night shift (8 hours)for many years. It was very common for parents to sleep in the room. When I'd get my assignment and do rounds, there would always be many parents who had plastered the room with signs: "Do not turn light on at night! Do not wake us up! No VS at night! No diaper changes! No nighttime cares! No Meds!" etc... you get the idea. Of course this would be the child who had a million things ordered at night including albuterol tx and wound tx...things they really needed.

In general the child would fall back to sleep quickly but the parent would be really annoyed. I'd try and explain that conditons requiring hospital care by nature mean 24/7 observation and tx. I also tried to work with the prior shift so that when they saw the parent taping up these signs they'd be an advocate for care. We'd always end up being painted as the "awful night nurses that woke me up!".

I'd generally use a headlamp or a maglite flashlight if that was enough light to do what I needed to do.

classicdame, MSN, EdD · Apr 28, 2008

sleep is beneficial to healing. I would not wake them up, unless absolutely necessary. This is why acute care facilities are required to only do a full assessment every 24 hours, in our state. The night nurse assesses when possible, but usually it is a focused assessment.

husker_rn, RN · Apr 28, 2008

I would wake up unstable, fragile, etc patients without question. For those who had been there awhile { I worked in an LTAC } I would get the assessment at the start of my 7p-7a shift and look in at them hourly or so. If they had an IV in the middle of the night I did my assessment while I was in hanging the med. But always the health status of my patient determined the call I made. Better a wide awake confused elder than a situation gone horribly bad.

queenjean · Apr 28, 2008

Hell yes I will wake them for an assessment--I work on an acute care floor. So, when my pt wakes up in the middle of the night, short of breath with crackles in one lobe, how I am supposed to know if that's what his lung sounds were like earlier? If they are sick enough to be on an acute care floor, part of the deal is that they need to be closely monitored. Part of closely monitoring someone is to regularly assess them.

Our shifts are 7-7, but occasionally we do some switching at 11. Here is what I do--if they are going home the next day and/or the report indicates that they are very stable, I'm not going to wake them immediately. I'll check to see if I am to wake them up for something like a med administration in the next couple of hours--if so, I'll assess them at that time. Or I'll wait and see if they wake up when I peek in on them, or if they call for something. If they haven't by 1:30 or so, I'll wake them up for a quick focused assessment.

Obviously if they are unstable, I will wake them up and assess them as soon as I've gotten report. If they are grumpy about it, I just apologize for having to wake them, but I explain why it's necessary. Most of the time they understand; sometimes they remain grumpy, but I don't really care. I'd rather keep on top of an unstable situation than walk in on a cold dead patient while doing 5am vital signs.

When I get a pt at 7, as I'm doing their initial assessment I tell them what the plan is for the shift. If their condition is thus that I will need to wake them in the night, I tell them that ahead of time. I always include something like "If you wake up between MN and 2, go ahead and give me a call--I can come in and grab your vitals and do a quick assessment, and then I won't have to disturb you again until right before shift change." I think the pts in general are less grumpy if they know the plan ahead of time. And most pts find it comforting that someone is keeping an eye on them.

I hate when docs write "Do not awaken pt between hours of 10 pm and 6am, do not disturb pt for any reason." We have one group that likes to write these orders. Usually case management is on their butts then, because pts who are so stable need to be discharged from our floor if that is the case. On the flip side, our hospitalists are great about straight up telling pts "If you feel you are healthy enough to not need any nursing care during the night, then I will discharge you and you can follow up with your primary practitioner or have your procedure done as an outpt. The hospital isn't a hotel, and either you need monitoring, or you need to go home. Which is it?" I really love our hospitalists.

anurseuk · Apr 28, 2008

When I worked on an elderly ward I would do whatever I could to keep the patients asleep at night, and to stop the patients from disturbing each other. As someone else mentioned a lot of elderly patients get confused in hospital and once they are up they ARE UP!
Now working in critical care I try to get my pt's into a regular sleep patern so if they're not sedated I will intervene during the night as little as possible and 'try' to keep noise to a minumum. There are some interesting articles I've read recently in relation to sleep deprivation in ICU's actually, will post the links if I can find them on line and if you're interested.
It's quite difficult at times in ICU to have control of the situation or the other patients situations and disturbances are inevitable a lot of the time; as with other specialities really.

I'll elaboate that as I work in ICU although I try not to wake the patient we never skip on assessments, and it's easier for us to monitor the patient with continuous ECG, BP, CVP (RAP), o2 Sats, PA pressures etc and there is always a nurse at the end of the bed.

Also when I worked on an acute elderly ward we would generally come in before the patients were asleep (light still on etc) and I would do a drug round as soon as I 'd taken handover which is where I would assess the patients individually and take vitals if needed; then I would know what sort of interventions were needed or if I could leave them and hopefully sleep. I'd still go into every patient at least every 1/2hour or so.

There is nothing worse than when you hear the pagers going off at 6.30am saying 'cardiac arrest blah blah blah' and 9 out of 10 times these patients hadnt been checked all night and had probably died hours before! I was always paranoid of this... which is probably a good thing.