What happens on a nursing shift? Starting when you first came in.

billyboblewis · Mar 12, 2011

I would get report first. Then I would make rounds of my patients. I would then check meds in chart. I would also check on treatments. I would inform others working with me of tasks that may require their assistance. The list goes on and it sounds long but unless everything falls to pieces you can finish your work and give report in time to leave at the end of the shift

Biffbradford · Mar 12, 2011

While every position has it's unique characteristics, I think they all could be summarized as "running around in circles, putting out fires, jumping through hoops, and bending over backwards". Endorsements? Where do I sign? :yeah:

newbiekenobe · Mar 12, 2011

How do you check meds? Can you describe this too? Thank you :)

LPNweezy · Mar 12, 2011

in long term care: Go in, drink coffee for 5 min, count the narcotics, receive report (which is usually the same old same old) start passing meds, document, do treatment cart, document, do other things, lol idk!

eyeball · Mar 12, 2011

While every position has it's unique characteristics, I think they all could be summarized as "running around in circles, putting out fires, jumping through hoops, and bending over backwards". Endorsements? Where do I sign?

Amen.

billyboblewis · Mar 12, 2011

Checking meds..basic You take your Mar and patients chart. You start from todays orders and find the order for each med listed on the Mar. After you find the order make sure you have the correct dosage, administration time on the mar. If you do this properly you will find that there are on occasion drugs transcribed incorrectly or drugs that have dc'd on the mar. You might need to write an incident report if you find that meds have been given in a manner not reflecting the order.

dinah77, ADN · Mar 12, 2011

TCU nurse on day shift, start at 6 AM:

Get report

While night nurse is wrapping up her notes, go check and see who has appointments outside the facility that day so I know who has to be ready when and let the CNA know ( in TCU, the appointments are usually checking in with surgeons, for example for those with joint replacements etc, or dialysis)

Check our "lab book"- we contract with an outside agency who does all of lab draws, so I check in to see who has what results coming in later, and what to report to PM shift if the results aren't in on my shift

Check 24 hour report board for any follow up phone calls or faxes that will need to be made

Count Narcs with night nurse

Check treatment book for treatments that need to be done, and diabetics that will need blood glucose checks/insulin

Begin med pass/assessments ( for example, we have a pt with a trach right now, so if she is assigned to me during my shift, she is my first priority for breathing/suctioning needs) that need to be done ASAP- continue until 8 AM

Begin blood glucose checks ( breakfast is not served on our floor until 8:30-8:45)

Finish up any meds

Do insulins once food is passed out- usually about 8:30

Complete any meds that were delayed due to phone calls, unforeseen things

9:15ish- begin any calls for orders that need to be made

9:45ish- do treatments/assessments

10:30- lunch break

11:00- begin noon med pass

12:00 blood sugars/insulin

12:30 begin charting- amount varies depending on what's going on-

1:00 complete any treatments unable to do during the A.M, and/or wrap up Phone calls and faxes

1:45 try to finish charting

2:00 report to PM shift

2:15-2:30 finish report count of Narcs with PM shift

2:30-2:45 finish charting then home

Obviously this is the ideal, and many times I have to push off things (usually the non-essential charting) due to emergencies that were unforeseen, hold onto my report sheet until the next day and cram in as much charting as I can the next AM as a late entry

CT Pixie, BSN, RN · Mar 12, 2011

Easier to tell you what doesn't happen during a shift for me

me sitting for any longer than 5 minutes at a time

me getting to pee

me eating

me drinking

nerdtonurse?, BSN, RN · Mar 12, 2011

In ICU --

Before I even get report, I look at everyone's telemetry....who's okay, who's not, who's a DNR, who's BP is bottoming out or "their systolic's WHAT?!" Get a feel for what's going on.

Get report on my patients; I also try to listen to the charge nurses report off. It's always good to have a baseline on everyone in case something goes bad.

"Eyeball" my pts -- sometimes you look at a pt and see something, and you want to ask the prior shift nurse before they leave... like, "gee, have they been that blue all day?" I also look at any drips they have hanging at that point -- nothing like coming in and all your cardiac meds/sedation meds run out 5 minutes into your shift. Get a basic neuro on them -- awake? oriented? Comatose, and if so, have they been all day or is this new?

Get the chart, and check the chart for orders that were missed...like stopping/starting a nitro drip or other critical med. Chart check.

Write down my mar on my notes, times for Fingersticks or critical labs (troponins), dressing changes, "call doc if...." etc. Nothing like the computer goes down and you don't remember the last time someone had a PRN med or if they get Solumedrol or Mannitol at 0200....big difference! Note if I have to restraint documentation, drip documentation, etc., and when it's due.

Pick my patient who is the most critical, and see them first. Do a through head to toe assessment, note any breakdown, kinda plan my shift. Do they need dressing changes? A bath? Are they going thru a drip so fast that I need to keep an extra bag in the room? Family staying overnight that's going to need a fold out chair?

Cluster the meds together -- nobody wants to be woke up every hour all night (what can you give together, what can't you?). Make sure you've got your meds that aren't in the Pyxis before pharmacy goes home.

I try to bathe one pt before midnight, and get everything done up front that I can. You never know if the ER's going to have a melt down and send you a flood of pts. I've had nights where we started with 3 patients (2 nurses) and ended up filling the unit (12) before dayshift came in....we were calling in everybody, and about to start backing them up into the PACU.

And every night is different; some combinations of nurses work better and the night rocks, others they don't and it's awful. You can have sick patients who do well, you can have not so sick patients who drive you nuts. You can have days where people do "rock, paper, scissors" to take the pain in the backside patient that comes in with fake chest pain every time they fight with their spouse and act like a diva all night, you can have a sweet person passing away where everyone wants to look after them because it'll be the last time they get to. You learn to be very, very flexible.

enchantmentdis, BSN, RN · Mar 13, 2011

First, get report from the surly day shift nurses who are dying to get out asap. If you actually want to get all your work done and not have to suffer catching up on your whole shift, do not ask many questions, just let them tell their story quickly-- they don't have to spoon-feed you; and do not have a casual conversation during report, or the extra "bonding" time will slow you way down, and soon all those call-lights will be blaring. Check labs. Make a list of meds, treatments, feedings, tests, etc. See if the CNA has vitals yet; or in today's hospitals, which have phased out CNA's, you have to many times do the vitals yourself. Check tele strips. Start rounds. See if the nurse's report matches your assessment findings/or tests patient's supposed to get. Oh, be sure to check those iv's for possible infiltration, check the hanging bag to make sure it is the correct bag at the correct rate, be sure the foley is unkinked, do the dreaded pain assessment, fall precaution checks, water pitcher empty?, bedside table w/in reach?, call-light within reach?--you cannot depend on the aides to get their work done, or you may not have one; and the patient will blame you, the nurse, the one with the most responsibility, even if the CNA isn't making the patient happy by doing the most mundane tasks in a timely manner. I've got a stomach ache thinking how bored i was with this type of nursing, but yet, how much responsibility i had for every last little thing, and no matter how hard i worked the CNA's would suck me dry needing my help all the bleeping time. And, never get complacent or procrastinate on night shift; staff is limited and s#$% hits the fan mighty fast just when you start to relax. Boy am i glad i'm in hospice now!

joanna73, BSN, RN · Mar 13, 2011

Are you in nursing school yet? Just wondering because I notice you've started at least 4 different threads today. Many of the things you're asking...you learn through clinicals. GL.