What is your work routine?

Shagce1 · Sep 19, 2016

During my initial assessment I talk to the patient and find out things out that way. Later on, as I am charting or if I have a question I will review notes, labs etc. Sometimes I might check labs quickly prior to med pass if I am verifying a potassium or dig level or inr or whatever before giving those meds. It's definitely not like in school where you have the luxury to poor through every aspect of the chart. Of course I am also not having to write a ten page care plan with outcomes and interventions either. You will find your own routine. I am still a new nurse and fine tuning my routine every shift I work.

2ndB · Sep 19, 2016

I like to know my pt's history before report so I come in a little early and look up as much as I can. Sometimes their history pertains to their current stay, sometimes not. But I like to know because anything can happen. I'm on a non-monitored M/S unit and I want to know if my pt has a heart history. Usually I'll skim the most recent notes first. Later in the day I may go back and look at earlier notes.

NewMurse1014 · Sep 19, 2016

I usually come in 20 min early before shift starts to look up the chart. It might seem a long time but given 4-5 pt I only have 4-5 min per pt. The stuff I go through for each pt:

1. Doctor's short notes of brief history and reason for admission

2. PER (we're using epic system and it's basically a list of orders from general nursing orders to diet order and labs and any planned procedures)

3. Lab results and note any important abnormalities (Na, K,Mg,Ca,elevated troponin,abnormal imaging results,EKG, etc.)

4.meds for the shift (scheduled,PRN,maintenance fluids)

5.flowsheet of what the previous nurse documented (Skin issues/wounds,mentation,rhythm on the monitor since I work in a tele unit)

6.vital signs and note any abnormalities

7.any lines/drains/tubes

I only read the complete H&P and dig through the notes later when I'm writing progress notes/care plans. Some nurses will give more complete reports but some don't so I'll just go with the flow. I also ask the pt to confirm anything I read when I do my assessment. Personally I feel anxious if I don't read the chart before getting report and I don't know what to ask/pay attention to from the offgoing nurse.

bluebirdflyx · Sep 19, 2016

^^ I do the same thing as Peihan - come in a little early and get ready. If for some reason I can't come in early that day I'll still take at least a minute or two to look through the chart for some key things I'll need to know for report such as labs or vitals that are out of whack, overdue meds, or STAT orders. I try to catch anything I'll need to address right away or clarify with the off-going nurse. I've gotten pretty fast at clicking through those few screens with the pertinent info.

When (and if) I have time to look through the chart I will read the H&P, the consultation notes, and then skip ahead to that days notes. You can get a picture of where the patient started and where they are now. If they've been in for several days I don't normally read through each days note unless I'm looking for something specific.

raptorfem, BSN, RN · Sep 19, 2016

I have a system and it helps me feel a lot calmer when the shift is starting. I will look up allergies, continuous IV fluids, lines and drains, when their labs are ordered to be drawn and if it's lab or clinician collect, what their diet order is, and if they're on tele. Then I look at their most recent set of vital signs, to see if anything is off and what their trends are. That's when I figure out if they're Q4 or Q shift vitals. THEN I look in their intake and output to see if they have been making adequate urine, if they are having bowel movements/if their ostomy is functioning, etc. After all that is written on my sheets, I go into the MAR and write downthe meds I'll have to give that night. I put any PCA or epidural checks on my med sheet to, as well as any labs that I will have to draw. Since we get a fairly detailed history in nursing report, I don't really go into that part of things, but it sounds like for you it might be worthwhile to read the most recent doctors note, they are usually fairly brief and give you a good overview. Coming in early has really helped me as a new grad and if I did not have the time to do my little before shift writing down routine, I would definitely feel very frazzled starting the day. Best of luck to you! :-)

Tomrn2128 · Sep 20, 2016

Wow, thanks for all the replies everyone. I really appreciate it.

I have been trying to figure out what to look up as far as history, clinical notes,consults, dr's notes that the off going nurse most likely wont tell me....

If anyone else would like to tell me what they gather in the morning as far as information have at it :)

caffeinatednurse, BSN, RN · Sep 20, 2016

When I worked med surg, my routine went a little like this:

- come in about 6:30 for 7-7 shift. We weren't allowed to clock in or sign into EMR until 6:38, so I would usually: use the bathroom, unpack what I needed for the day, drink some water, and put my stuff in my locker.

- find a computer on wheels (or COW) at 6:38. Login to EMR and MAR.

- briefly glance at labs to see if there's new critical labs that need to be reported or old labs that the reporting off RN may have forgotten or not seen. If there are, I jot them down so I can mention them during report or to DR.

- glance at orders: who has BG checks, I&O counts, mobility restrictions, precautions, foleys, O2, if VS are Q4/Q8/Q6/Q12, isolation, specific diets so I could give report to CNAs ASAP.

- jot down other pertinent data: neuro checks, wound care, dressing changes, upcoming labs (that I need to pull), specimens to be collected, procedures scheduled during my shift, etc.

- hopefully, by then, the reporting RNs have found me & given me report. If not, I'll do a walk around the unit to see if they're free. This takes, at most, 1-2 minutes.

- if they're busy, I go ahead and stock my med cart (cups, straws, spoons, saline syringes, alcohol pads, 1 mL syringes, filter needles, IV tubing, insulin needles, etc.)

- if no one has come to find me after stocking my med cart (which happens when the previous shift has been crazy & they're still playing catch up) I go ahead & pull the scheduled meds for as many of my 6-7 patients as I can. If there's a weird med or IV solution not stocked in our unit but there's an order for it, I'll go ahead & call pharmacy to ask them to send them up, so that by the time I get to that patient, it will have arrived.

- get bedside report, check tubes, lines, drains, IV pumps, and wounds during report. Find out who needs PRN meds.

- after report, start assessing patients and giving morning meds. I usually went in order of who had meds due first, which was almost always the diabetics needing insulin.

- during assessment, I would ask questions and talk to them about why they were there. That would provide additional info.

- work my way through as many of my patients as I could until grand rounds started (around 9 or 9:30). Find out which orders are going to be DCed, any new orders, etc. Attending would also provide a briefing on patient & just wanted the RN to read our hand off reports (the sheets RNs would pass off from one shift to the another). I could usually learn a lot from grand rounds if I just listen to the attending.

- go back to assessing & passing meds to the rest of my patients.

- after I made it through the morning med pass, I would usually have some time to read H&Ps and most recent progress notes from the attending.

- I would also frequently encounter specialists during my morning routine & if I was in the room while they talked to the patient, that would clue me in on important information about ther dx & why they were there.

All of that being said, there were times when I didn't get to look at the H&P at all because of the nature of the shift. On those days, I relied on the report from the reporting off RN and did the very best that I could.

dec2007 · Sep 20, 2016

I am just starting after being out of school for 3 months looking for a job. I noticed in school that it's tough or impossible to know too much about your patients history before you start your shift. Most of my preceptor ship involved me only knowing one sentence as to why they're here and the shift begins!!!!!!!
I mean sure I would know their bp, meds, last bowel movement, achs, lines, rr, labs etc, but do most nurses start off the shift the same? I find that I go through most of my shift only knowing that the patient had a heart attack and you do your assessment from there. How far into the doctor notes do you really have time to read into to know your patient if you have 5-6 patients? lol?

The report you receive from the off-going nurse at the beginning of your shift should include a basic systems review including neuro, cardiac, respiratory, GI, GU, skin and wounds, musculoskeletal. You should also be told what IV access you have, how much oxygen is in use, basic I & O trends, and psych-social-family info. Find a worksheet or report sheet that covers the above so you can fill it in as you get report. It will save you from having to look up all that information. If the off-going nurse leaves out any of that info, ask them! They should be able to provide at least that much info to you. After report and a quick check on the patients, I review/write down pertinent labs and then look at meds so I can pace my cares. Hope this helps!

PS: Report should also include a cursory medical history and any upcoming labs or treatments that need to be done.

AtLeastMyDogLovesMe · Sep 20, 2016

You'll get your routine down. When I was a new grad I would pay close attention to how the nurses that I admired went about their day and I would try to mimic what they did. Sometimes it worked for me, sometimes I found myself thinking, "How the hell do they do it this way???" Just always remember start with what is most acute then work your way from there. Who cares if they haven't pooped in 2 days if the patient is blue when you walk by the room?? Eye ball everyone, attack what's most acute/important first, then drink your coffee and review the notes from the 1998 cardiac catheterization. Also realize, you WILL be the slowest nurse on the floor and that is OKAY. The more you do the job the more you can categorize things in your mind without thinking. It just takes time to get there.

martymoose, BSN, RN · Sep 20, 2016

my report sheet:

name.age,DR name. allergies. PMH

DX

IV access

tele rhythm, meds related to specific.

activity, falls

other pertinent info Bg's 06_________

12_________

17_________

see pt, pass meds, try to chart.pass more meds( sometimes people on q 1-2 hour meds)

JerseyTomatoMDCrab, BSN · Sep 20, 2016

I always go in a few minutes early (15-20) to look up meds, review labs and go over H&P. If there is something unclear from the chart, I ask the nurse giving me report. It's nice to have a bit of an idea as to what I am walking into, it helps me ask more pertinent questions and I find it calming to have a few minutes to settle into the day instead of just jumping right into report.

It takes time. Things like giving and taking report and figuring out a routine are skills that you can really only develop by doing them and figuring out what works for you.