Surviving The Nights.

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I just had my first productive shift for my new PCT position on nights. This shift was by far the WORST shift I had worked in a long time by myself. Vitals are normally done at 7, 11, and 4 and I barely finished my 7pm vitals by 11pm only to go and do the next set almost to 4am and by 4 my vitals were done at 6:30am. I was constantly told by two other very busy nurses to "let them know" if I needed help so they could help me with vitals. So I did, and one of the nurses did not chart a single thing for 3 patient's I/Os. Another nurse told me I should have vitals done between an hour before and an hour after, which I was completely aware of, but also did not assist me with anything else that night. I had two new admissions during the hours of 7 and 11 and also a pt. who insisted on talking a walk during shift change with his oxygen tank. My second admission took up the rest of the hours between 11 and 4 with 5 bowel movements and confusion. What should I do when a night like this happens? I was told to tell the TL but I don't want to look incompetent. I also don't want to look like I am trying to make other nurses pick up my work for no reason other than time management. My next shift is Monday night and I am going to try as hard as possible to get my time management down, even if it kills me. Is there anyone else that has had nights like this? Trying to keep my spirits up.

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I'm curious what type of unit this was and how many patients you ended up with?(and how many RNs). Granted the number of patients isn't always a perfect indicator of how busy you'll be. One or two bed jumpers or a couple really demanding patients can throw a monkey wrench into your night. Sometimes you just gotta do the best you can do, and prioritize. Its important to let the RNs know what the situation is. They may or may not be able to help, but at least they wont be surprised if its a couple hours later and something that was supposed to be done hasn't been.

There can be some leeway on vitals, but they are something I would make a priority. It'll be an ugly scene if you are just finishing up your first set of vitals and its 2200, and you have to tell the RN that your last patient has a temp of 103 or a BP of 198/98. Its better to start them really early than to finish them up really late. Just remember you cannot please all of the patients all of the time. Some patients are just going to have to wait to go for that walk or to take a shower.

It gets easier the longer you do this job, especially if this is your first CNA/PCT job, but you are always going to have crazy nights that you just need to get through. Sometimes you may have 2 or 3 nights in a row like this if you have some really hard patients. Sometimes you'll be walking into work praying a particular patient was discharged, only to find not only are they still there, but you got another patient you're familiar with who is even worse.

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On an average night I normally have 8 or 9 patients, on a busy night that could be up to 10 even 11 if I get a patient who wants a specific sex for their tech that night, and sometimes we switch of if that happens. Nurses are assigned only 4 patients in my hospital. I also work on the Hem/Onc/BMT/Medicine floor of my hospital. We are currently adding space for our hospital to move Medicine elsewhere so I am hoping that will decrease some of the more acutely sick patients on our floor eventually.

On a normal night, when everyone doesn't need to use the restroom at the same exact time during vitals or when they aren't calling for pitchers of ice for their 4 oz soda that we already keep cold before it is given to them, things are fine. I can start my vitals right after report, do my rounds, and also get things stocked for day shift to arrive the next morning. When I have one or two patients who have C. diff or are running 103 fevers who need vitals every 15 minutes or when a nurse needs me to run to the lab for 4 units of blood in a night, things get VERY behind. The past night I worked was fine, no one needed to vomit or use the restroom unless they called out for me. Also only one patient was running a fever which broke before I even came for 4am vitals. Others were fine with the minimal requests they asked of me.

I managed to get all my vitals finished in a timely manner, though 4am vitals run a bit slower because patients are waking up to use the bathroom. Also, one of my patients needed a shower and his leeds to his tele reattached and his entire room cleaned before his procedure at 6am. He also took a 45 minute shower so the attending nurse couldn't start his IV until he was out and dressed and his bed was cleaned. I finished it was just more of the patient not wanting to be rushed (was a younger pt.). Also on a patient who was incontinent of stool an RN changed her twice during my shift, and right at my last round I managed to change her once more. I am also told to bring fresh ice to every patient before day shift gets there so they don't have to do it.

I guess it was just overwhelming when it was my first night ever being alone to deal with my patients. I am learning to manage my time, tell people I have other patients to assist before their specified needs and that sometimes I can't toilet two patients at once so call another tech. I am not a good communicator and tend to try to take on the things that need to be done myself, even if I get to them a bit later. Now I feel like I can manage my time without having to struggle, at least that is the way I felt the last night I worked.

I just hope my spirits survive once I go on my own again.

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My guess is you just need to get faster with your tasks, which comes with time and practice. Cleaning up someone who is incontinent and repositioning them is something that can take an experienced CNA a few minutes and an inexperienced CNA(or even RN) almost half an hour, I've seen it. Doing a 12 lead used to take me way too long, now I've done so many of them I can fly through it.

Every minute or two you shave off a task adds up when you're doing it for 10-15 patients. That's the difference between sitting around waiting for the next shift to come so you can give your report, and rushing around til the last second and staying 15 minutes after to finish your charting.

This is why some hospitals only hire experienced CNAs, regardless of whether someone is a nursing student. But if you are new they obviously are willing to accept that it'll take you a while to learn. Every shift you'll get a little faster. The important thing is to be safe while you are learning the job. When you are rushing to compensate is when you can get hurt, or a patient can get hurt. So don't panic and get in a big rush and just do what you can and you'll get better as time goes on.

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I have been on my own this past week and I have improved A LOT since this post. I have learned that if I need more time that I need to start earlier, because early vitals are better than late ones. Also, if there is a needy patient who is having multiple bowel movements or getting sick every few minutes that I need to communicate with their RN because they have the ultimate responsibility for their patient that night. I have also been trying to adjust to each RN, some nurses are picky about certain things techs do and some are not. I had a pt. last night who needed ted hose and she had a stroke previously so her entire left side had nerve damage, including her legs, so she was literally not allowing the original ones the nurse had told me to put on anymore. I switched out the size without thinking to even consult with her nurse and as soon as I did this the nurse told me that switching them to a more comfortable size defeats the purpose because the hose are meant to keep their veins straight. I just commented that I was unaware and moved on. When those types of situations happen I often would like to say "if you had communicated to me that she needed a specific size I would have gladly used the ones you advised and consulted with you if she needed a change" but I am taking it all in as experience to only increase my knowledge as a tech.

Last night was probably the best shift I have worked since my time at this job. I had patients who could toilet themselves though, so it made taking vitals much faster than if I were to be changing 3-4 incontinent patients while doing my vitals. I am noticing the little things about my patients in particular that I can assess just from being in the room that will let me know how much time I will be spending with them throughout the night.

As I said in a previous post, I can take any test about health/science/CNA related and pass it with flying colors. It is more of the hands-on skill related material that I need awhile to practice, observe, and learn WHILE doing my job that takes me more time. I still find myself saying little prayers on the way to work asking that God be easy with me while I am learning on these shifts, so when there is something like a code patient or an explosive diarrhea accident all over the floor (both happened on my first shift this week) that I will be an expert.

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Glad things are getting better. They will continue to get better and occasionally you'll have nights that seem like a setback. You will also have some coworkers that will be tough to deal with. My first hospital PCT job was extremely difficult. They said it was not an entry level job and only the experienced need apply, and they werent joking. I was an experienced nursing home CNA and I still struggled some at first. 12 to 20 patients a night on a busy Med/surg/tele unit, and the vast majority of the people were very sick.

I was extremely fortunate in that I had some of the best RNs you could ever possibly hope to work with. They were extremely good at what they did, hardworking, and had lots of patience, which is a rare combination. I was so greatful for the help I got as a new PCT that I've always made a note to go the extra mile when I'm orientating a new employee myself or working with a new RN doing their first few shifts. I even try to go out of my way to help nursing students as long as they arent too snotty and it doesnt interfere with them learning to manage their time and do the job.

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I feel your pain on feeling overwhelmed. I work on a general peds floor and there are nights when i am all alone with up to 26 patients. I am also a unit secretary and am expected to do both nt and us roles. It's a lot but the kids make it worth it.

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I am averaging about 7-10 patients on a regular night. This previous night we had FOUR new admits. Which in that case, it's all hope is lost. Even the nurses were putting on their pouty faces as they had to tell me all 4 patients needed teles, SCDS, ted hose, and their paperwork finished. I handled it pretty well and didn't feel as overwhelmed, but that was also with patients who were quiet and could toilet themselves with minimal assistance. Throw in a total care or two into that mix and I would have had probably my worst night there so far. I honestly love being there for my patients and seeing how they feel or giving them that warm cozy blanket in the freezing cold hospital that they are dreaming about since they were admitted. I like talking to them and hearing about their children and their birthdays and their wonderful families who shower them with cards and balloons all over their rooms. But I just hate that as a CNA I cannot spend enough time getting to know their needs on a personal level. Patience was lost as I was passing exam after exam for my BSN courses, and especially on this new journey of taking and passing my CNA exam. Now I am finding myself reacquainted with good ole patience because there is no time to be anything else when you are around patients who are unfortunately in a hospital instead of out and about living their lives.

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I have to say that compared to other floors I have been on, yours seems tough but not horrible you could be the only tech to 40 patients or the only tech to 20 patients. This HAS HAPPENED TO ME BEFORE. It could be a whole lot worse. Time management is incredibly key. Vitals can be done in a timely manner and doesn't have to last 2 or 3 hours if you know what to do and how to do it. If your changing the bed, pad it down with multiple pads, bed jumpers, sit near the room and stay with the nurse so that she is aware that the patient may need to be medicated more often.

PCT are crucial to nurses, but you also need to know how to gain the best format to do your job trust me. I was in the same ballpark as you were once and things only get sweeter with time. Before you know it, floors will be requesting you to float to their floor. :)

Plus if you are planning on going to Nursing School, guess what, your time management skills are going to be on point when the day comes and you are an RN.

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