Waking up the crabby butts

[PeepnBiscuitsRN]

I'll admit I haven't looked anything up on AN that might have addressed this. I seem to be running a personal special on especially grouchy patients these last few shifts! I try my darnedest to get in to do assessments by 2330-2345, trailing or leading the PCA who is doing vitals. But you know I can only start as fast as the evening nurse will report off (and sometimes I end up chasing her/him all over the place for 10 minutes).

I'm not the type to make a grand entrance and flip on every light in the room and introduce myself in a booming voice. Generally I quietly enter, turn on only enough lights to do my job safely and right away apologize for waking them up. If I sense that they're good natured about it, I can joke more. I do end up having some night owls. But last week, gee whiz, you'd think I was just this monster. I had a young couple, the husband was ill with a mystery illness- I had had him the night before, and he was nice and all. But the next night, his wife was rooming in, and she had re-arranged everything so that she could push the couch next to his bed- she really gave me a snotty attitude about doing my assessment "he's FINE, he can tell you if he's not ok, the DOCTOR said we could skip all of this, just let him sleep." The patient suddenly also seemed to become kind of snotty too- "I'm with my wife, it's nice of you to check in, but I don't need it."

I had a tough time with that one. I get the impression I "interrupted something" I don't know. I've had other patients just loudly whine and complain about it.

You know...I KNOW sleep is hard to come by in the hospital! I know I don't like it either when I get woken up from a deep sleep (at least I'm not hurling myself onto your stomach from across the room like my 3 year old does!) I really do see it from their point of view, I can...really, but I can also see it from mine too. I love my license, I don't really want to lose it. I do everything in my power to not wake people up- if their telemetry alarm goes off that they're in an abnormal rhythm- you bet your life (no pun intended) I'm going to wake you up to make sure you actually DO wake up! If your lead comes off, if the nice tele tech informs me that you just desated to 67%- sorry honey, I'm waking your critically ill butt up.

So, anyway. I don't know what the point of this was other than to share.

[ktwlpn, LPN]

We will have to agree to disagree because I do believe alot of people are stoopid and inconsiderate and self -centered. This is the type of patient that expects an IV stick NOT to hurt.That's unreasonable.That's the kind of patient that expects a full night of restful sleep as if they are at The Hilton,IMHO.Isn't that who the OP is referring to? I doubt the op slammed into the room in the middle of the night with the lights blazing,speaking at the top of her voice.

I agree that education regarding expectations upon admission is important to help the patient fully participate in their plan of care and do the work required to prevent complications and get well.Unreasonable people do NOT expect to have to WORK to get better.That's the difference.

Quote Since I am being addressed directly I'll let you in on a little secret.I have been a patient a few times.Once I didn't even have insurance.Guess what happened? Nothing to report. Once I was on the high risk maternity unit.Guess what happened? Nothing to report. I had abd. surgery once .Nothing happened then ,either. I never felt discriminated against because I did not have insurance.No one ever came into the room during the night blazing all of the lights,yelling,etc. No yelling and banging in the hallways either.Except those pesky codes-they do tend to get a little loud....

[beckster_01, BSN, RN]

I can absolutely identify with my patients. On the night shift, things don't settle down until 11-12 am. The residents come in at 0430 to do pre-rounds, and that doesn't count the blood draws and vital signs that must be done at night time. When I look at my assignment I bend over backwards to "consolidate my care," because my patients will be very lucky to get 4 hours of sleep. No, the hospital is not the place to rest, but rest can certainly help the healing process.

I work 12 hour shifts, so I am not stuck with the OP's dilemma of waking people up for an assessment. If I pick up an extra patient or two at 11, then I usually do my assessment before the evening shift leaves. When I do my initial assessment I will usually tell the patient exactly when I expect to be in at night. If they have pain issues I am sure to clarify with the patient if they need me to wake them up when it is due (if so then I do my vitals/blood draws at that time), or if they want to call me when they want it. Even if I do end up having to wake them up every 2 hours, the patient is a lot more receptive if they know I am making an honest effort to let them rest. On the other hand, most of my patients are relatively sick and understand that I need to come in frequently. There aren't many that can get out of bed without assistance, and most of them have pretty severe pain issues (hey, if my sternum was cracked open, or my leg was chopped off yesterday, I would be a bit uncomfortable too).

The only thing I can offer to the OP, is there any way that you can do your assessments before getting report? I usually get to work early, and if the nurse who is handing off to me is busy then I usually go and meet the patient after I have looked up their information. It takes 5 minutes, and the nurse will either come find me and give me a bedside report, or I check to see if she is available after each patient. There is no reason for me to get behind in my day because the last shift is running late.

[cayenne06, MSN, CNM]

Wow. This is unbelievable to me! A good night's sleep is SO critical to health and well being. Very frequently, it is possible to schedule meds, assessments etc before 2200 and after 0600. Of course, very ill patients require more monitoring, but a large amount of hospitalized patients would probably fare better with less night time interruptions.

eta- and hourly rounds do not have to always necessitate waking the patient. You can round hourly and still allow your patient a full night of sleep.

[Epic_RN]

At my facility we have hourly rounding between 0700 and 2200, it's q 2 hr from 2300 to 0700. This is supposed to afford a little more time in between waking the patient up. Does it really work? I have no clue, I'm not on nights yet

[MN-Nurse, ASN, RN]

The way I look at it is I'll take a patient being a crabby butt over nonresponsive ANY day.

And if the patient's girlfriend wants to yell at me for disturbing her snookie-wookems I could give a rip.

[Vespertinas]

You're night shift? Don't worry about assessments or vitals OR meds! Just make sure the refrigerators are still running when day shift comes back.

.................juuuuust kidding!

[Been there,done that, ASN, RN]

If there was an agreement per the attending .. that the midnight nursing assessment was not necessary..

it should have been addressed on the day shift with the attending and administration.

It is your legal duty to perform an assessment... simply explain that.. do it.. and don't apologize!

[anotherone, BSN, RN]

One of the worst things about nights. I try to get report as soon as possible. sometimes even before 11 so I can try to do everythign by 1230. I always try to assess the fully oriented first. But if you have a tanking patient they get assessed first and dealing with that might take an hour. Many times people complain. If they start whining obnoxiousy I tell them they can refuse to be assessed and meds and tell them the consiquences of doing so. I DO NOT CARE one way or another but will not be blamed for a poor outcome when the pt refused assessment, meds etc. On second thought I would be blamed, it is always the nurse's fault. These are probably some of the same idiots who say we we never in thier room the whole night.

[anotherone, BSN, RN]

Wow. This is unbelievable to me! A good night's sleep is SO critical to health and well being. Very frequently, it is possible to schedule meds, assessments etc before 2200 and after 0600. Of course, very ill patients require more monitoring, but a large amount of hospitalized patients would probably fare better with less night time interruptions.

eta- and hourly rounds do not have to always necessitate waking the patient. You can round hourly and still allow your patient a full night of sleep.

NO it is not possible. When you start at 23:00 and finish getting report at 23:30 some nights. The patient is q4 vitals, has 00:00 meds, AND you have 6 patients and no aides, guess what I can't get all vitals and meds/assessments, change diapers in 300lb patients, all from 23:30-00:00. And if even one has very abnormal vitals that delays things more. i will not wait to page the dr for abnormal vitals before I assess all the other patients. nope. , lab comes at 05:00 and residents come soon after.

[NoviceRN10]

Wow. This is unbelievable to me! A good night's sleep is SO critical to health and well being. Very frequently, it is possible to schedule meds, assessments etc before 2200 and after 0600. Of course, very ill patients require more monitoring, but a large amount of hospitalized patients would probably fare better with less night time interruptions.

eta- and hourly rounds do not have to always necessitate waking the patient. You can round hourly and still allow your patient a full night of sleep.

I don't know where you work, but at my hospital there are 2200 meds, and when I start my shift at 2300 is is rare that the afternoon shift is even finished with the med pass. I am lucky to get all my reports by 2330. My goal is to get everyone assessed by 1 am, on a good night it usually only takes me an hour or so to assess and chart on 6 pts and get them situated with pain control or whatever else they require. I can't just run into people's rooms and introduce myself before report when I have no clue what they are in for, and when you walk into someone's room they always ask for something. I tried that the other night, just because a gentleman was standing in his doorway looking like he needed something. Turned out he wanted to bathe, of course. He was in pain, so I told him I'd check to see when he was due again for medication. And of course he wanted broth too. He had me playing waitress before I'd even found out why he was there. Then he was worried he was recuperating too well and we were going to send him home. Gotta love em.

As for not waking up people to check on them, if we are required to knock before we enter, how do you propose we not wake people up?

[Vespertinas]

This all brings me to what I constantly think about the hospital which is... GOD HELP ME if I become a patient. We know why we must do what we do. But it must be MADDENING to the average person who isn't asking a lot to hope for 5 hours of sleep in a time of illness.

The girlfriend in the original post sounds like she's acting as just another gatekeeper (like you) to that patient's well-being. You'll have to excuse her for considering the needs of her boyfriend before those of a stranger.

They're coming off as crabby to you but we're coming off as sometimes inconsiderate/controlling/abusive. Like someone else said, the average person doesn't know what to expect when they are admitted to a hospital and it would do both parties good to make the expectations known upfront. Personally I have always felt awful about 5am blood draws.. like it's bordering on cruel. I would be throwing a fit.