whats your day like?

nursemary9, BSN, RN · Aug 26, 2005

Hi

I'm a bit different from the other responders. I work the night shift.

I work 8 1/2 hrs. per nite--2300-0700. I work a 34 bed Med/Surg/Oncology unit.

I have done this for many years. The one thing with night shift is we usually have a little less staff.The Powers that Be feel there is less t o do at nite. Not usually true, tho. There is PLENTY to do.

We start with report from the previous shift at 2300. This usually goes until 2330 or 2345. we have a computer charting system, so I usually check my medications first.

Our hospital has pretty prescribed times for medications, so most of our antibiotics that are given IV get given at midnite & 0600.We usually have a LOT of Midnite meds and antibiotics, plus I get all of the IV's I'm going to need for the nite. I get them out & labeled & put them outside the patient's room. I then start my assessments. Even tho it is night time, we must do a head to toe assessment on all patients. This includes listening to there lungs & all. We have the same dressing changes to do & all that the other shifts have. We just try to do these things in the early AM so pt's can get some rest. We check all vital signs at Midnite and may or may not repeat them in the AM.

There are pain meds to give as needed.

We are assigned 6-7 pt's. we may or maynot have a CNA to help. However, if we do have one, there is one CNA for anywhere from 17-34 patients.

remeber this is an acute care floor, so we are jumping all nite. Most of our patient's sleep very little. We are sometimes getting as many as 6 admissions just on our shift. These are lots more work.

Some nite, we don't get a chance to breathe!! Tonite is a rare nite--a bit slower then normal---I have 6 pt's & so far only two are very needy.

Now since our floor is also Oncology--the Cancer floor--we get Chemotherapy at nite. I do lots of this as I am OCN certified--this means I became certified in Cancer Nursing & in Chemotherapy administration. We also give LOTS of Blood transfusions here at nite because cancer pt's sometimes need this. We give other blood products besides.

So we do lots of running here. In between we have the computer charting which has made things a bit faster.

I have done this for many years; I sometimes, don't even realize how much we do. we do everything at nite that is doner in day time except meals. We even do some baths to help the day shift or if someone has made a real mess of themselves.

I hope this helped a bit for you.

Nursing is exciting; it's also h ard work.

Good Luck!!

We need more young nurses at the bedside.

I think I may have forgotten to mention that we have to check the labs from yesterday--results & also check to see what need sto be done. We also have to prepare pt's for tests & surgery.

The night shift at our hospital draws all the AM blood from our Central lines.

During the nite, we don't have a lab person to actually draw blood, so if there is a test that need sto be done, we have to draw that to.

Mary Ann

lovinghands · Aug 26, 2005

I am a psych nurse on an inpatient acute unit. I work 8 and 12 hour shifts. Generally I am the only RN on the unit - if I need backup, I call neighboring units or the supervisor (if he/she isn't too busy). My unit is usually full, 15 pts, and we run with 3 aides depending, of course, on acuity and staff availability.

I count and get report at 2:30 and am on the floor by 3:00. The beginning of my day is usually busy - orders and finishing up tasks leftover from dayshift. The Dr and PA-C have a tendency to write orders late in the day, so I may be working on admissions, discharges, med changes, referrals, following up on abnormal labs, etc. I deal with all medical and acute psych issues - everything from a scrape to chest pain to suicidal thoughts or aggression. I am the med/treatment nurse. I am also the team leader, so I deal with delegation and personnel issues on my unit. Somedays run smoothly and other days it seems all I do is set out fires and race the clock.

We are an admission unit and most of our admits come in the evening, usually I have one but I have had up to three in an 8 hour time span. If I have an admit, I complete a nursing assessment with the patient, deal with immediate medical/psychiatric concerns, take off admission orders, contact their family, and of course document every intervention and write up an initial treatment plan. I am engulfed by paperwork my entire shift - it seems for every intervention there is triplicate paperwork to complete. I love patient care, hate the paperwork - it's a necessary evil though.

There is a high level of unpredictability when dealing with psych admissions - I deal with patients with varying diagnoses, including medical, and crises (s/p suicde attempts, mood disorders, psychosis, homicidal ideation, dementia, etoh/drug withdrawal and personality disorders). I have worked with some awe-inspiring patients over the years and a few that I'd prefer not to meet again (to put it nicely :wink2: ).

Some of our patients can't communicate their needs so assessment is critical. I don't think this can be emphasized enough with this population. It's easy to pass things off as a "psych issue" and then have it blow up in your face a few hours/days later. I follow my gut instinct if I can't pinpoint a specific problem - fortunately we have a great medical team who listen to staff concerns.

Somedays I am assigned the defib nurse if there is code in the hospital and other days I handle scheduling conerns for my department. There are many small tasks that I complete throughout my shift - I try to help the aides out as much as I can and vice versa. We work as a team and we depend on one another - I could not do my job without their help.

The last hour of my shift is usually the calmest, most of the patients are in their beds and the staff seem to unwind at this time. I finish up on my last minute tasks and try to spend a little time with staff in between doing things. It's my favorite time of the day, sort of a debriefing for us. Then the oncoming nurse shows up and I count/give report and try to let things go as I leave for the day.

Great thread OP - it's very interesting to read about everyone's day.

HappyNurse2005, RN · Aug 26, 2005

I am on a cardiac floor,as you can see by my sig line. I'm also a new nurse.

7a-7p shift

-first of all, get report on 3-4 pt's. We may have 5 occasionally, but try to keep it to 4.After report, check the labs that were drawn at 5am.

-head to toe assessments on my pt's and chart. many are surgical pt's, have incisions, dressings, chest tubes, blakes, etc to check.

-check the vs adn blood sugars the NA's took to see for any out of whack. Many will tell you abnormal values, some won't, so I check. Treat blood sugars as necessary

-check charts for new orders/new meds. note any orders, verify any newly ordered meds in the computer(make sure the pharmacy put the order in the computer the same way the doc wrote it for). Follow thru on any of those orders.

-will likely have pt going for a cath at some point. make sure pre-cath checklist is on chart, pt has 2 iv's, etc. when cath lab calls, give them pre op meds.

-when pt comes back from cath, set up the room, get ready to do frequent vital signs, must check site for oozing, hard-ness, check pedal pulse frequently.

-will also usually discharge at least one pt. this involves more paperwork, writing out of prescriptions, pt education on wound care, meds, precautions, follow ups, etcetc. If they are going to a nursing home, this is even more paperwork, and calling report to nursing home.

-will likely also admit a pt. maybe coming from the ICU, or a direct admit. head to toe assessment, more charting, etc etc.

-lunch time blood sugar checks, treat as needed.

-throw in boatloads of education. at all times throughout the day, the pt's ask you questions, like a pt who was supposed to be on a heart healthy diet at home was asking how he could eat his tomato sandwiches-are tomatoes good for him, what about the mayonnaise, what type of bread should I use? or pt's asking about meds, procedures, and so on.

-interdisciplinary team meetings three times a week

-calling docs for any bp's not staying up, pain not controlled, etc. any out of whack issues that need attention. treat as needed.

-blood transfusions occasionally.

-afternoon meds and dinner blood sugars.

stuff just always happens all at the same time. pt's want their meds, you get discharge orders on 2 pt's at same time, this pt is coming back from a cath, etc.

I love it though!

MS._Jen_RN, ASN, RN · Aug 26, 2005

I forgot to mention that I am often the "Charge Nurse" (RNC) (in addition to taking my 4-6 patients). This is a sort of overall supervisory position that is rotated, on "off shifts" between staff who are trained and willing to do it. (We get a dollar more an hour when we're in charge for our "trouble").

On our acute rehabilitation unit the RNC is responsible for handling all staffing issues for their shift and the following one. So I ensure that we have adaquate staff for my shift (eves) and mid-nocs. I handle any call-ins or people needing to "leave sick". I also need to handle any acute issues that may arrise during a shift i.e. a patient is "going bad" and their Rn is in need of assistance, problems with contacting MD's, family member or patients complaints that couldn't be resolved by their RN, disputes with other departments etc, etc, etc. I know that many facilities handle staffing the RNC position in different ways. That's how my unit does it. I thought that this part of the job should be mentioned because sometimes it greatly affects "what my day is like. . ."

Peace to all-

~Jen