Tips wanted/needed for my 12-hr pm shift.

[mom35]

Hi all, I am on here all the darn time. I love the feedback and I dont have to withstand strange stares from my fellow rn's when I ask a stupid question-lol! This time I wish advice for the flow of my shift. I want to describe it and get feedback as to whether there maybe some places I need to change and/or tweak my night to be more efficient. Background info: Graduated one year ago, adn program in dfw, finally landed position in south texas, border town as of Nov. 2011. So, going on six months total- three in orientation, three by myself (however I work with awesome RN's/LVN's and they help me when needed). I usually have 6-7 patients and if I start with 5 I will get two admissions, we take up to 7. I have become better because I use to stay for three hours post shift to do charting! Now I am usually out by 8am depending on how acute my pt. population was. It is a medsurge/tele floor. I try to arrange my night as follows:

1845-1900 get report, usually it takes until around 1920, but I come in early in the case am rn is ready to report and get out!

Next, go do assesments - head to toe, id, iv's, skin, pulses, auscultation of chest/abdomen, ask if bm/voiding/eating/pain/positioning. I write down what pt may need such as if in pain, get med and if need iv bag so that when I come back with 2100 meds I wont have to make extra trips.

Next, after all assessments if I had pt in pain I will get the pain med then, so they dont wait until 2100 meds.

Next, I look at labs and make opening notes in computer charting.

Around 2030 I begin my 2100 meds.

Next, and maybe I am slow but it usually takes me about an hour to pass 6-7 pts meds, according to how many each one takes, I dont know how to cut this time down though.

Anyway after 2100 meds I get my new MAR, since I am night shift, and reconcile it with old mar. I mark all of my meds with the time to be given with a sticky note and put on the new mars and right down the times for each room and med as follows:

210- 3,5,6

(like this is room 210 with meds due at 0300,0500,0600).

This is the only way I can keep track, if ya'll know of a better med tracking method clue me in.

Now it is usually around 2300.

It may be later because of course there are call lights and iv pumps going off to attend to and of course I am checking on my patients during all this.

So next is chart checks (since I am night shift). This is usually done within 45 minutes because I am always going back in to make sure that all the orders are done.

Now it will be close to 0100. Now I finally start to chart my assesments, care plans, and such. Of course I have to give any prn meds like if bp is high, and all the while I go check on my patients.

Okay, so you would think that all would get done, but somehow between 0100 charting and checking on pt, running to call lights, attending to cleaning pt, I am still charting up until 0700. When I write it down I think to myself, " well why cant I seem to get everything done before end of shift". Because there have been nights when I literally wont sit for the whole night, and I have had to stay way after to do charting. But now after six months I do usually get done by 0800, so I have improved even though I am still slower than most others. Sometimes from 0100-0700 seems like a blur to me because I am running and trying to remember everything so that I chart accurately-did I mention my memory hasnt been too hot since the end of nursing school!! Now throw in an admission or two and that is when my trouble might start!! Of course it puts me behind even more.

You guys tell me. What tips can I use to be more efficient in my shifts! Thanks in advance

mom35

[mom35]

Also I would like to add, and I apologise because my post is so long, I still cant remember the results of all of my physical assesments like it seems the other rn's do. Some of them never write a thing down. When I do assesment I end up writing pretty much everything down because by the time I get to chart It I sometimes dont remember who has what . Sometimes assessments are easy to recall, but not always.

[DeadHead219]

Do you CBE?? That may help?

[mom35]

Do you CBE?? That may help?

yes, we do chart by exception. Once I sit to chart I can usually keep the ball rolling pretty well, but maybe I am too slow with everything else. One thing I could cut out is that I try to write up my reports around 0500. I do this because my report is not very good. I write better than I talk and while giving report I can cover the basics but many times the nurses are wanting more, I guess. Just a few weeks ago this nurse that just started at our facility and has been nurse for a year reamed me because I did not know whether or not the pt. from ICU had been intubated while in icu. Sometimes I guess I do not look at all that should be relevant for my patients. If I start looking up all the information on each pt. and use that in my report, it takes up more time. I just thought report is the basics and what I did and what happened on my shift. I hate giving report so much that I get nauseated before doing so.

[tigerlogic]

So, I'm currently a CNA-soon-to-be-nursing-student and also work 7p-730am and though many here complain about it, my hospital does bedside charting and I love it. I swear it cuts down on time because you don't have to write down notes and then chart later and my memory at 4am is not as sharp as I'd like either. Can you do bedside charting? Do you think that would help you?

best to you!

[Nurse Kyles, BSN, RN]

Does your floor use a standard report sheet? In nursing school, I was always very nervous about giving report, but my facility uses a standard SBAR report sheet. This makes it pretty easy, because every nurse is using the same sheet in the same order. When I get my report, I write it in a color, then when I do my assessment I write in black. If the assessment information is the same as report, I circle it. If it is different, I write the differences down in black.

I use a Grid style sheet to organize my day. There are as many columns wide as the patients I have. Then down the left side I have a box for each hour of my shift . At the beginning of my shift I write down all of the tasks/meds I will have to complete by the end of my shift at the appropriate time. If I give a PRN medication, I write it down in the patients column in the box for the time it was given. I then write down if there is a reassessment necessary. It kind of helps me keep track of the chronologic order of all the things that happened in my shift. I print off the sheets from the computer, and have things like I/O typed in at the standard time it is due. I only have 3-5 patients depending if I work in PCU or on the Med/Tele portion of our floor. When I complete a task on my grid I highlight it. If it is an assessment I write the precise time that I completed the assessment. When I have charted the task I write a line through the highlighted task. This indicates it is completely done. Not sure if this makes sense the way I am writing it, but this style of Brain sheet really works for me. I attached the sheet I use. Take a look and maybe a version of it will help you organize your day. Good Luck!

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