What is your work routine?

[Tomrn2128]

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?

[adventure_rn, MSN, NP]

Do you use Epic for charting? One great feature (if you don't already have it) is the 'Last Filed Value' button. If you have it enabled, it will bring up all of the most recently filed data, so you can hover over and see when it was charted (especially useful for things like BMs).

I'm in NICU so I'm sure our report is pretty different, but I like to read over the daily MD progress note for the day I'm taking the patient. They generally have a very brief review of systems (usually abnormal assessment findings are in bold or red), plus a brief admit history, and list of the active diagnoses/problems and what's being done to address them. For me, it's like skimming the Cliff's notes. That's also the first place I look if I have a question about the plan of care. But then, I usually only have 2-3 patients, so I have the luxury of time to read notes.

[AlwaysLearning247, BSN]

I get on at 3, get report, then I'll briefly research my patients and what times their meds are due and why they're here. Then I go in to all of them and introduce myself, tell them the plan for the day (tests, procedures, IV ABX, nebs, etc.), and assess them. Then I do my documentation and go from there. That's how I ideally like to start my shift. I usually read about the patient later in the shift and write a detailed report for the next shift.

[NotYourMamasRN]

I get to work an hour early. I write down my assignment, go through the charts and read the H&P. It stinks because I am not allowed to clock in early but I know I will be behind in my work and stuck charting late if I don't get a head start. I also get my computer all set and ready to roll and assign my patients in Pyxis.

[DeeAngel]

Working night shift I always came in early to write all my information down and get organized. I never knew what I was walking into and the extra time to get organized was invaluable to me. The staff that breezed in 30 second before shift started were always the ones that seemed to be drowning all shift. Taking the time to get organized like this early in your career will help make things less stressful for you. As time goes on you can decided to do things differently if you wish.

[Red398]

I'm a new nurse, also, on a tele unit. We have pre-made SBAR sheets we use in report, but the main things I make sure to know: Name, age, when/why they were admitted, allergies, diet, which MD is on them, any planned procedures, IV size/placement and fluids going (we have a lot of patients on heparin), any other lines to them, do they get accuchecks/insulin, their rhythm on the tele monitor, and as for history, I usually only ask for pertinent info according to system. Ex. Pt admitted with chest pain (very common) so I want to know their history involving that. Do they have a history of MI, previous stent placement, HTN, etc. I find simply asking the patient if your unsure is the best route to go. And most patients are very happy to talk about the reason why they're in the hospital (sometimes too much ) Multi tasking is your friend. Talk and assess at the same time. You'll learn your own routine!

[jena5111, ASN, RN]

Another tele nurse here--I'm going against the grain to suggest NOT coming in early, especially if you're not permitted to clock in during that time.

Aside from the idea that nurses (or any hourly employees) shouldn't have to work for free, think twice about adding even more time to an already-long shift--particularly if there's a commute on either end.

With time you will become proficient/efficient at gathering pertinent info during report and assessment. If your facility does bedside shift report, it's even easier to get a large portion of your assessment information in that initial patient encounter.

I take report at the bedside (so I've already met my patients, checked lines/drains/wounds, ask a few questions) then go to a computer for a quick scan of the latest progress note, labs, and orders. I don't waste time writing down meds unless they are due at "off" times or it's something I need to look up.

Deeper digging in the chart can happen later in the shift...if it's going to happen. Sometimes the shift is busy enough that the extra detective work just doesn't happen!

Good luck, OP. You'll figure out what works for you.