Why is everything the day shifts responsibility?

[JenniferSews]

Maybe it's not like this at your facility but I'm curious. I work 6a-2p and it seems like everything is on my shift. I do 80% of the meds and ALL the dressing changes, treatments, etc. The evening shift will get more admissions than me but often they do some of the admission and the rest is left for day shift (usually the skin assessment that requires a complete assessment of the pts entire body with 2 nurses. There are only 2 nurses on each shift so that is hard at any shift) Is there some reason I don't understand why it's like this? Aside from the never ending med pass just the complicated dressing changes on my pt load (all sub acute patients, most post surgery of some sort or with decubiti) takes forever. Then I have weekly skin assessments, neb treatments, picc flushes, picc line dressing changes, other sterile dressing changes, the occasional peritoneal dialysis that runs into day shift, change a catheter, straight cath for a urine sample, 2x tb tests on new admits, and a dozen other little things that eat into my day. Not to mention, for the love of Pete, the charting! The other two shifts get treatments like "monitor bruising for s/sx of complications until resolved q shift." But for me there's that plus a complicated dressing change that takes 20 minutes when we're rushing. I'm getting really good at wound care, but I still changed 1 dressing 3x today because of the location of the incision and the drainage. Things like sample collection often get left for the next shift but I feel bad! I still don't pull a bunch of meds at once in labeled cups like others so I know that's holding me back but I just can't make myself do that. It has to be possible without short cuts, right? (please???)

I love the team I work with so I'm not complaining. But I'm a new nurse so I keep wondering if I'm missing some reason it needs to be like this. Eight hours is just barely enough time. I left feeling like I was leaving what may have been a declining pt to the evening shift because I just flat out didn't have time to monitor her like she probably needed. That would be the third pt in 2 weeks that may or may not be sent out that could arguably have been sent out on my shift. Do I just need more experience?

[JoMark06]

Nights is a slower paced at my facility. Instead of 4-14 admits....they may get 1-4. Sign me up!!! ( and only 1 med pass):)

Must be nice. I work 730p to 8a and I do a full med pass at 10pm and 06 with smaller med passes at midnight, 2 and 4 on some patients. We get the admissions and transfers the day shift had put on hold. We often walk in the door to the nursing supervisor saying "I need a bed" or day shift saying "Pt X in bed 6 just got here". This often means nothing has been done, no orders acted on, no paperwork initiated. Come to find out, he's been there for over an hour with not the first set of vitals done.

Anyway, as I said before, all shifts have their pros and cons and everyone thinks the other shift has it easier which isn't always true.

[sassy_cassie]

I work evenings. I often put things on the day shift becasue they have the most staff and the most support if something goes wrong. On evenings it is often just me or if i'm lucky me and an aid. On days they have 2 nurses, and a aid, a unit secretary, a nurse manager (I have a great Nurse manager that does help on the floor) a couple of PTs, OT, and Speech Therapists.

[Finallydidit]

I work 3-11 My unit has 60 Res. 2 LPNs, 3-4 CNAs, 1 RN... RN does the Admits,(even if Res came in at 9am) Helps with TX, and will help with Incidents reports if there isn't an Admit. she makes most of the calls to pharmacy, Drs and family members..If we have to send someone out she does most of the paperwork if we need her to. She is a Godsend... She also works the dining room. I on the otherhand, the LPN. Have 30 Res. on my hall, 12 are diabetics, with qid accuchecks, (2 of which fall on my shift) 2 med passes. and right now about 8 minor treatments. 2 weekly skin assessments, one monthly assessment, MC charting, alert charting, in order to comply with my med passes in the time alloted I have around 6 mins per resident. thats pulling, giving, injecting, treating, signing. It takes me my whole shift to finish my job. Day shift on the other hand has an RN, Treatment nurse, unit sec, plus the DON, ADON, Theropy, all the other admin, to help out with passing trays, feedings, setting down the wondering resident. They also have volunteers, activities people etc. So day shift may be alot "busier" but Day shift also has alot more help and people to pull from. So if I can have days do an IM injection, I let them and don't feel bad about it.

[Hospice Nurse LPN, BSN, RN]

How right you are. I've worked nights my entire career. Mostly I stay on nights because all I do as play games on the computer between naps. The patients all sleep quietly through the night and we have all the support staff we need. If there is a crisis the "night shift doctor" is always at my beck-and-call. On top of all that, I have so much more time with my family, (I'm sleeping- but I'm still "with them"). That is why there is such a long waiting list to get onto night shift!

LMAO!!

[VivaLasViejas, ASN, RN]

I've worked every shift there is, and I have really learned to hate intershift rivalry. It's completely unproductive and does nothing to foster cooperation and continuity of care.

The truth, in short, is that we ALL have too much work, too many patients, and too little time. Every shift has things they can't get to during their eight or twelve hours, and the next shift must pick them up. That's why it's a GOOD thing that hospitals and LTCs are 24-hour facilities, yes?

Personally, I found night shift to be the most stressful physically, and day shift to be so draining mentally that I had to quit. Currently I work 3-11 in LTC, and until I decide to retire from floor nursing, I'm sticking with it. It's also the best shift for my particular circadian rhythm, which renders me deaf, dumb, blind and stupid at an hour when the world expects most folks to be competent. I'm great from 10 AM to 2 AM, though.

Where I work, eve shift does get most of the admissions, and we have only about half as much staff as days; but after all the 'suits' leave at 5 and the families go home, the pace isn't bad at all. I have 25 residents right now (my unit can hold 35), and I do two small med passes plus two rounds of FSBS/insulins. I also do a lot of care plan revisions, wound care (although day shift has more), and I schedule the skilled nursing assessments for my shift when we have the occasional SNF patient on our long-term care unit. The pace is brisk, but rarely unworkable unless I get slammed with an admission or two plus falls, fights between dementia patients, a bunch of phone calls and/or a demanding family/resident. I also assume primary responsibility for planning and implementing the care of our hospice patients, since that's a particular passion of mine and I'm fairly conversant with the palliative care philosophy.

I miss my evenings at home with home-cooked dinners and good TV, but they do let me out of there SOMETIMES so I can be with my family and catch up on "Survivor".

[Poi Dog]

How right you are. I've worked nights my entire career. Mostly I stay on nights because all I do as play games on the computer between naps. The patients all sleep quietly through the night and we have all the support staff we need. If there is a crisis the "night shift doctor" is always at my beck-and-call. On top of all that, I have so much more time with my family, (I'm sleeping- but I'm still "with them"). That is why there is such a long waiting list to get onto night shift!

You play games? We get to take smoke breaks every 5 minutes, even if we don't smoke. Our facilities ought to join forces.

:lol2:

[JenniferSews]

I wasn't playing into shift rivalry at all, I hate it too. The evening shift has the same pt load as me and hadn't been getting admissions. They have a lot less meds and I was getting tired of getting flack for leaving things like orders, etc to be taken off, apts to be made. I would have more time if some dressing changes, etc could be done on the 2-10 shift. But things have changed and we've been swamped with admissions. Now no one has time.

[CoffeeRTC, BSN, RN]

I have never known any shift in LTC not to be busy. Even our 11-7s are busy depending on how much work you do beside the basic med pass and charting. (in my facility the 11-7 med pass isn't too overwhelming and we don't do treatments) Still, when I work it, I don't sit down much. Always someone awake, or something to clean or file or restock etc.

[DizzyLizzyNurse]

I have worked all 3 shifts (we have 6a-2p, 2p-10p, and 10p-6a). I hate being at work at 6 am. I loved afternoon shift the best. I currently work midnights because of being in school during the day.

I think each shift has it's own pros and cons. Days definitely has so many meds and treatments. But they have a secretary to answer bells, get residents nonmedical stuff like water or food, and a ton of RNs running around. They get some admits. Evenings had less meds and treatments, but no secretary and no RN for the floor (just 1 RN for the building). They get the most admits and family visits. On midnights, I'm the only LPN on a floor of 43 residents. I have 2 CNAs. Each floor has this. We have one RN for the building. I don't pass much meds or do many treatments, but we have a much smaller staff. If one of my aides calls in, half of my workforce isn't coming in. I do tons of paperwork; ordering drugs, ordering labs, doing the MARs and TARs, checking everyone's work from the 2 shifts before; etc. In an emergency I'm the only licensed one on the floor. Plus working midnights disrupts my personal life. I don't have admits on this shift.

Any work that the other shifts can't do that they can legally leave for me (such as putting orders into the computer, getting urines, etc) I do.

[NC29mom, ASN, LPN, RN]

our ltc facility is the same girlee! the day shift does it all! all the night shift has to do is:

7p -7a meds (hardly any)

i&o documentation for enteral feeding residents

flow sheets for enteral feeding residents (done on days too)

make a new vital sign sheet for residents needing vitals next day

document temp of insulin fridge

and that's it! day nurses do it all without the shift diff in pay! amazing, isn't it??

[DizzyLizzyNurse]

Not to sound like a jerk, but then why don't you switch to nights if it's so easy?

[BackfromRetirement]

There is a Treatment nurse in my facility. Her schedule rotates to weekends too. The Treatment nurse also does the weekly skin checks. Our MDS coordinator does the new admissions on day shift. Pharmacy is done by fax and phone. It is one of the best staffed facilities I have ever worked. Even our Social Worker makes the transportation arrangements for appointments. Labs are contracted out 3 days a week. We do the rest of them.