Would trying nights help?

[JBMmom, MSN, NP]

I have worked part time in long term care for about four and a half years, the past two as a supervisor, not on floor shifts. I recently lost my full time job of 17 years (not in nursing) and I applied for a med-surg position at the local hospital on third shift. I decided to apply to third shift because I thought it would give me a better chance to transition without things like lab results, consult results, providers on the floor, and the hustle and bustle of days. I figured I could get the rhythm of assessments, meds and treatments with potentially fewer interruptions.

In orientation I found out that I would be trained on day shifts before my third shift position started. I have faltered a little. Admittedly I was focused on med times- because that's the key nursing endpoint in LTC- and my speed with charting was behind. I would complete the assessments early in the shift, but I was trying to chart all together when I had a quiet moment, so it looked like I didn't assess my patient until 1pm or so. On my 10th shift I was given an action plan with targets for charting and told we would reconvene in two weeks to review. I have had five shifts since then, and four have gone reasonably well. One did not, and I'm not chocking it all up to excuses, but I was on a new floor, didn't get my assignment and report until almost 8am and I had two patient with Q3 pain meds that needed 30 minute pain/vitals reassessments. I fell behind again that day and was told that I missed some things I should have followed up on, and I agreed that it was not a great day.

My last shift, though, I had three discharges, one admission and one patient throughout. I had all my assessments in by 9:30 and by 10:30 two discharges were gone with education and care plans complete. I felt like a rock star and thought I had finally turned the corner. My coordinator said it was a great day and she would let my boss know. Then last night I got a voicemail message that I'll be meeting my boss in HR on Monday. I checked my schedule for next week and it's been deleted. So my assumption is that after 15 shifts they've decided I'm just not going to work out. I know in my heart that I can do this, and be an asset to the organization. My patients seemed to really like me, but I think I spent a little too much time talking when I should have been real time charting. The reassessments I was told I missed were blood pressures. Two people not had their lisinopril lately (one held for surgery, the other noncompliant) and their bps were running in the 150-160/90-100 range. This had been consistent for the past couple days. I was finally able to give the lisinopril- doses they had taken in the past, and I was told that I didn't reassess an hour later and that was wrong. I thought lisinopril would not reach peak effectiveness for about 6 hours, why would I reassess in an hour? I also admit I spent most of the day running around trying to fund supplies and do small task things so maybe I looked disorganized- but I did admit that readily. I obviously can't give the whole story, and I'm not even sure I know the whole story.

I'm not going to the meeting on the defensive or coming across as negative. I would, however, like them to consider the investment they made in my orientation and 15 shifts thus far, and consider giving me 3-6 more shifts. Would it be unreasonable to suggest that? I spent the other night redesigning myself a new sheet for keeping track of things, I've been going in 45 minutes early to get my assignment and take down all the information I can before my shifts starts. I'm really committed to this and I've had a successful career in the past. I was also wondering whether asking for a few night shifts would be appropriate? I've had 5 patients on days, and the census lately has been giving nurses 4-6 patients on nights, so I think I could do it. Any thoughts? I'd appreciate any feedback, even if it's that I'm just not going to make it. Thank you.

[Isakolistic]

Nights have worked out great for me. I had never worked nights before I started at the hospital that I currently work at. I started on evenings and nights, and I also got trained on days/evenings and nights. The hustle and bustle of the day shifts has never really appealed to me; I'd much rather work a busy night than a crazy day. I would say you should ask to orient a few shifts at night, especially if that's what you'll be working off of orientation, to get a feel for them. Nights are generally a little less hectic, as you don't really have discharges/rounding physicians/therapy to worry about, but you may feel like you have less resources available to you. I feel like nights would be good for you to get a feel for the hospital environment as well. Good luck, hope everything goes well!

[JBMmom, MSN, NP]

Thank you for your input, I'm hoping that my boss will agree that a few more shifts would be reasonable to get me up to speed. Switching to nights would give me a better feel for what will be expected, and get me some experience. I hope they agree to give me a little more time. Thank you.