Those that work a 6a-6p shift....

ParvulusPuella · Apr 11, 2011

We do 6-6 scheduling. On nights, we do 2 assessments per shift, one at start of shift and then one around 2 am, with vitals. Vitals are q4, and we usually have meds at 2100 and 2400, occasionally at 0200 and 0400. There are always dressing changes, and the occasional tube feed, etc. And of course, charting everything. We use computerized charting as well, but it still takes forever. Add in admissions, and some nights I never get the chance to sit. There is plenty to do at night.

GoingHome · Apr 12, 2011

There is a lot of time to clean up the computerized chart. Make sure the rooms are clean and organized (untangled and off floors), baths (have stuff in room for days if patient wants to do in am), Do those daily drsg changes, rotation of IV sites, check dates on tubings & IV bags, am lab results on the chart and address abnormals if possible. Have those early birds up and in the chair. It's all about making the whole process work smoother. You have a very special and important role. Unfortunately some take advantage of quiet time and read books. It amazes me when there is so much that can be done.

PSUStudent · Apr 12, 2011

The 4 hospitals that I have either done clinicals or worked at were 7-7 shifts. There is always something to do, yes many times night shift can be slower through the hours of midnight and 4 am, but other times like people above said, there are admissions, pt's declining, or other issues that need attention. Good luck to you guys and I am sure, like all change, it will take time to adjust.

Double-Helix, BSN, RN · Apr 12, 2011

I depends on where you work. Do you do acute care? In my hospital, it's 7-7. Night shift nurses do pm meds (a lot of q4 or q6 antibiotics, nebulizers, q 2-4 hour pain meds, sleeping pills). They do hs blood sugars and insulin. They also monitor residuals for the patients who are on continuous feeds, or do bolus feeding. Night shift is responsibly for ambulating each patient at least once, if they wish. Some things like dressing changes and trach care can be done at night. Nights also does the standard assessments: head to toe, IV patency, urinary catheters, central lines, wounds, etc. Patients can have complications just as easily on night shift.

Ashley

tokmom, BSN, RN · Apr 12, 2011

Let me clarify. I'm not saying that nights does nothing. I have worked all the shifts throughout my career, so undertand you can be slammed.

However, they will have less things to do. They have an admit and discharge nurse until 8 pm, so two hours in their shifts won't have to do the above. There is no 24 hr chart check. Meds are all on bedside verification and there are no mars for meds that need to be made.

What I'm looking for is how to make the shifts more equal task wise.

This is a med/surg floor.

Right now it's divided like this:

Day shift: Count pyxis (twice a week, 2 machines), do two meals, check crash carts, count tele boxes, check rooms for readiness, stock rooms, go to interdiscplinary rounds daily. Two accucheks. Meds at 06, 08, 10, 12, 14, 1600. Surgical returns and the bulk of discharging.

Nocs: One meal, one accucheck, meds at 18, 2200 and PRN.

When we go to 6-6, it will be like this:

Day Shift: Count pyxis, 3 meals, check crash carts, count tele boxes, check rooms for readiness, stock rooms, rounds, three accuchecks. Meds at 06, 08, 10, 12, 14, 1600, 1800. Surgical returns and discharges.

Noc shift: Discharge/Admits after 8 pm. Meds at 2200, Accucheck. Any PRNS.

See how lopsided it is?

I like the idea of tubing change and IV site rotation. I think the CNA's could restock the med rooms and also do some of the early morning baths on confused patients.

bjaeram · Apr 12, 2011

How is staffing though? Our day shift has so much more staff, extra nurses, techs, management in house, ect. Nights goes down by several people. That makes a huge difference.

Why can't nights do the pyxis checks, crash carts,tele boxes, stocking, ect.

evolvingrn, BSN, RN · Apr 12, 2011

I work 7pm to 7 am and almost all the pts have 2100 meds and many have 0200 and 0600 meds as well and i pick up a larger pt load at 2300 ( i generally go from 4 to 5 pts to 6 to 8) At our facility we still have paper mars so we have to recopy mars, do 24 hour checks, restock med rooms and we do more thourough assessments on 2 pts. (although day also has to on a couple pts) There is also less volunteer support and we take on a larger burden of adl cares with our cna partners than our day shift counterparts. I will acknowledge that the day shift has a heavier load in terms of meds , meals ect. but they also have a heavier support system. There are many days that i don't get breaks either..... For awhile we were also responsible for doing a full bed bath with our cna but that has 'disappeared' just by the fact that people quit doing them. I think our Cna's could still do this stuff but our system is setup on the night shift where they expect a nurse supporting them in 99 percent of adl cares. when i work days and pms the cnas often do more able pts on their own.

tokmom, BSN, RN · Apr 12, 2011

staffing is the same on days as it is on nights. There is no difference.

I do think nights could do some of the stocking and counting pyxis. Good idea.

Thanks everyone. It's interesting to see how it differs.

We are going to have meeting on this issue. I think if people feel like they have a voice, they will take some ownership into the tasks.

nursedeb1967 · Apr 12, 2011

My hospital in ohio is still on paper charting. i work the 7-730 night shifts. we do walking rounds, take vital signs, pass meds at 9 or so, get people ready for bed, accuchecks, midnight meds and am meds. we get our preop patients and hemodialysis patients ready for their treatments in the mornings they go and anything else that may fall in between, i would say the first 4 to 5 hours can be brutal!

BOOYARN · Apr 12, 2011

well work nights then get paid more and do less

Mommy&RN, BSN, RN · Apr 12, 2011

On nights, we do shift assessments, pass hs meds, prns, etc., pyxis is counted twice per week by nights. We hang all TPN. We draw all central line daily/am labs. Total care/disoriented pts are bathed at night. Anyone going for tests or OR has to have baths.

We try to restock the medication cups, glucometer boxes, you know all of the stuff that is super inconvient to run out of.

Then there is SUNDOWNING...