What are your duties on your Shift?

Copy med sheets, change IV tubing, give baths (although day shift is expected to do them as well, it doesn't seem to get done except at night for the most part), and change over all the NGT stuff. I'm sure there's more but I can't think of right now.

Melanie = )

Baths, weights, calorie and in and out calculations, MAR checks against actual orders, filling in the flowsheet info for days (weights, age, corrected age, diagnosis, etc)...

No differences in the ER. Certain tasks are assigned to different individuals, like checking outdates, restocking, etc., but there is no task assigned to each shift.

Tele Night shift:

We have a patient assignment. If we have a tech, we do assessments, pass medications, interpret and monitor heart rate/rhythm, enter orders, correct entries that are erroneous, give meds/treatments that may have been missed by the other shifts, complete admission assessment and paperwork, coordinate tests and/or take patients for tests (for instance I had to take a patient down to CT scan for a stat head CT, but I can call Radiology and get a stat CXR to the patient's bedside).

The other shifts have transporters for these duties; we don't.

I have to have a very broad knowledge of hospital policies and procedures, and how to report problems appropriately, how to enter/delete/change orders/information/incident reports on the computer. It also helps to know the different dr. styles--that Dr. Jerk requires an ABG if you have to call him at 0400 for a patient in resp distress or the good dr WILL hang up on you after ordering it. It helps to know ACLS--just in case we have patients who are hovering on the edge of something big. We have to know how to access the AOD, Pharmacy, Respiratory, Radiology, Lab, and Charge Nurse, to name a few. We have to know where all the supplies are kept and how to access them. For instance, you just have to know that in order to get a Latex-free cart for a patient, you have to call the Administrator, same for if a Code Cart is used.

I have to do central line draws for labs from some people, and make sure that I check lab results on patients, and follow through if treatment is needed.

(All labs are relative. Had a patient whose troponins were high, but looking over the progress notes, the doc indicated that he only wanted to be called if the trops went over a certain number, and Pt was already getting all the indicated treatments. I had to investigate all the information and make a decision about who to call and under what circumstances.)

We have to prompt docs to use preprinted orders and we have to know enough about what should be done for a patient's condition, to be able to suggest to the doc certain medications, tests, treatments, or consults. For instance, if I see that a patient is not on anticoags and suddenly the patient develops A-fib, I'm going to do a 12-lead to confirm it, then I'm going to look over the Doc's Progress notes to see if they decided against anticoags in the past if the patient's had a hx of Afib, and then if there's no reason why not, I'm going to call the doc, inform him/her of the rhythm change, and he will give some orders, and I will suggest some orders/tests.

It's incredibly intricate and unbelievably time-consuming to investigate and make the decisions that we make on a daily basis. If nursing was just "do this, do that," it would be so easy, but each patient requires intense critical thinking skills, intelligent judgments, and TIME.

Other shifts, other departments, just don't seem to get this about night shift.

I sure wish they did. Because of what we do, they can come in and do their thing with confidence that everything up to that point has been done and has been corrected.

I estimate that I spend about 1/3 of my shift actually eyeballing my patients on the monitor or in their rooms. The rest is spent poring over their charts, making sure that their care is the most appropriate, best care they can get.

ICU, nights - stocking, counting stock meds and faxing sheets to pharmacy, 24 hour fluid balance sheets, baths/linen changes (supposed to be some day and some night baths but doesn't work out that way at all), daily patient charges in our computer system, IV board, notifying doctors of admissions, early am labs and XRs, daily weights, printing out tele strips and setting up flowsheets for day shift oncoming...

That's all that comes to mind at the moment - but I'm sure there's more! I'm still new on night shift (less than a month)! :)

What is it that you do on your shift that the other shift does not do or should do? Please be sure to includethe following: type of nurse and shift.

Just curious ... is this for a school assignment?