What is your beginning of shift "routine"

Ilithya · Oct 19, 2008

Firstly let me just say that I'm a day shift nurse so Im not exactly sure on what all of your duties are but I hope this helps anyways

I show up at work at 6:30 (Im supposed to be in report at 6:45) This gives me time to organize my papers and my binder as well as read over my Kardexes and MARs, I have a chart where I highlight when my various patients have meds due. It also helps me to be a little bit familiar with the patient when I go into report, then I get report and while Im in the room where I get report (which has our charting computers in it) I check my labs, then do patient rounding.

Be sure to lump things that can be done together. Like if you have a blood pressure machine than do your assessment while its reading her blood pressure. If you need to do a bath than do your skin assessment then. I don't know what your hospital policy is but we have an hour window for meds so I lump together like 7:00 and 8:00 meds and 9:00 and 10:00 meds.

Think about why you are running in circles, are you not notcing your IV bags are empty until they need to be changed? Make a note to check how much is in your IV bag everytime you walk into the room. That way you can hang a new bag when youre going in with a med, instead of walking in to give a med, realizing the bag is empty going back to get it and heading back into the room to hang the bag. Also if you have an extra 5 seconds use that 5 seconds to chart SOMETHING. It adds up at the end of the day.

If none of that helps keep a diary of what you do in the day and how long it took you, you'll learn fast whats eating all your time and what can be changed. Also organize your tasks into Gotta, Should, and Coulds do your gotta tasks first.

NorthTexasNurse · Oct 19, 2008

Thanks for the feedback! The IV thing I will definitely incorporate. I've never even thought about that. I would love to be able to use the time before report to get organized, but I have no idea who my patients are until I get to report, or after report depending on who is working. I don't know how report goes everywhere else, but at the hospital I'm at I have to find a computer that's unoccupied, log in, clock in, and log out. Then all of night shift goes into the report room. If ppl worked the previous night they will normally get the same ppl and then we will split up the rest. I'm really not sure what takes up most of my time other than charting. CPSI is our system, and it seems like I spend most of my time on it arrowing up or down on a spreadsheet to find what I need to click on to chart what I need to chart.

lavender rose · Oct 20, 2008

Hello, well my day starts at 0630, I take report then I go around with my CNA and we get people up in a w/c or situated in bed to eat like if they haven't been evaled by therapy and we are not sure of there transfer. Then depending on how many people are out there passing out trays I then compare my meds to the Kardex. I am not sure on your floor who passes out the meal trays. I imagine most everyone eats in bed but a boost up in bed always helps before trays come. When I am comparing my meds I can always look back at the chart in the doctors orders or the other mars sheets such as an antibiotic if they are taking it for 7 days and don't specify how many days I will look back on the order and then look back on the other mars and specify on my med sheet what day it is. Then can pass the meds according to the schedualed times. You have a hour window from the time it is schedualed. With me when it comes to seizure or parkinson meds I always give it the schedualed time exactly. When doing my mid morning pass I just carry around the V/S machine and take them so I have then on hand. I have a blank sheet of paper to write who has pain when what number and where so I can chart it when I do pick up a book. I ask everyone if they are having pain so I can give the med before it might get worse. I chart every chance I get I pick up the book. Do all you can while you are in the room with that patient so you won't have to keep coming back and it saves time. Always check your labs in the morning so you know where they are at. Like if they ask why am I taking these Pottassium pills all of a sudden. You have the answer after looking at the lab sheet. Just a few things that might help, some info

crunchymomx3 · Oct 20, 2008

Night shift (7p to 7a) on a med/surg floor, here. I'll give you the basic run down of what I do on my shift.

7-730: get report

730-8: print up MARs and worklists(we're half computer, half paper at this point) and go over who gets what when.

Starting at 8 I go see my patients, pass 8pm meds if needed, and do my assessments. I chart as I go. I know some people chart everything at once but that just doesn't work for me. So if I pass a med, I log it into the computer. When I assess, I immediately write my assessment in their nurses notes. I also chart as I go throughout the night. Our nurses notes are in the wallaroos.

10-11: do 9/10/11 pm meds

11: pick up patients from the 3-11 people.

1130-130: reassess picked up patientss and do a second assessment on previous patients (we do 2 assessments on 12 hours shifts)

Now anytime between 11 and 5 I can get 1-2 admissions from the ED. That takes about 2 hours to do between the admission assessment, paperwork, charting, etc. We don't have a secretary on at night so we do all of it ourselves.

In the AM (between 5 and 7) we have morning insulin, meds, and bloodwork to do.

NurseBrittney · Oct 21, 2008

We have to be at work at 645. we do phone report. Its a dream! Take your time with it. I sit with my cardexs, print a worksheet from the coputer with alot of my patient info already listed on it and then add to it from the report. After listening to report, and making my brain for the day, I check the cardexs with my EMARs and fix any med discrepancies.

We keep the same patients and I work friday, sat, sun, so by the 2nd and 3rd day I am ready to see pts by 715 or so.

Go greet patients, write my name and number on the board, do a quick assessment. Comback vitals are done and pass meds from 8-930ish. chart... and do my other tasks.

A_Simp · Oct 21, 2008

Here is my schedule and I primarily work 3 -11:30.

1430 I check out my assignment. Our charge RN posts it.

1430-1500 I print out tele strips, look up labs and copy the kardex info onto my report sheet 1 per pt. (If you would like a copy Email me and I can send it to you. Unable to attach it here)

1500-1530 I get report from the day shift as well as look up the MAR and cirlce med times on my report sheet.

1530-1730 I do my assessments, etc until it's time for insulin and med passes.

1750+ I doing teaching, d/cs, admissions, meds, f/u's and any charting, etc.

Hope this helps!

A_Simp · Oct 21, 2008

Oh thought of a few other things...

When getting report from the day shift, we do walking rounds. So I introduce myself and ID the pt during the rounds and this gives me the opportunity to eye ball the pt (aox3?), cosign high alert meds and get an idea of who I will need to assess 1st (prioritizing). I also look to see what lines, IVs they have or don't have, foleys, etc.

NurseKatie08, MSN · Oct 22, 2008

I work TCU/Rehab within a LTC Facility (3p-11p). Our average length of stay is approx 2-3 weeks depending on admission diagnosis, and I always have the same rooms, so I get to know my patients well after their first few days.

I have to be there at 2:45, but I always get in a little before so I can check out the Kardexes, and make out information on my report sheet and make out the task sheet for the nursing techs.

Then I take report & count narcs, find out whether I have any admits from the hospital that have just arrived or are expected & see how far the day nurse may or may not have gotten with their admission paperwork & confirming orders.

Next, I make rounds, just to lay eyes on everyone, ask how their day was and what they did in therapy that day, etc. Also I use this time to check if anyone needs pain med, because typically some of my pts will be sore after therapy.

After that, I give report to the nursing techs (who is incontinent, who needs FS, turning/repositioning, who should be walking with supervision, etc), stock up my med cart & start the 4pm med pass.

If I have an admission that came in right at the start of shift, I typically will go in, eyeball the patient & introduce myself, grab a set of VS to make sure they are stable, and then tell them that I am putting a call out to the doc/NP to confirm orders. If the admission comes in later (like in the middle of the med pass), I wait to start it till after 4pm meds are done.