Here we go, night nursing, part two!
Every patient must be checked on every two hours, and
charted on. It is ok to back chart in my
facility, so I typically just carry paper and pen with me to note things that I
might forget, like pain levels and IV pump numbers (Yes we have to enter these
in as well). If a patient is on a PCA,
which is a Patient Controlled Analgesic, or the “Pain button”, I have to clear
it out and see how much is left in the machine, how many times they have pushed
the button, how much has been delivered to them since the day shift nurse
cleared it, ect. These machines are all programmed specifically
for each patient per doctor order. If
they run out, I have to set a new one up, which requires going to the charge
nurse for the PCA pump keys and having another RN sign off with me. I document the things I cleared off on a PCA
flow sheet that is kept with each patient’s paperwork. If my patients are on telemetry, or heart
monitoring, I need to call down to the telemetry unit once per shift to see
what they are running. If they are
running something unsavory, the battery is low, or if a lead is off, the unit
will call up to the floor to tell me. Then
I check to see if I have any medications due at that time. If not, I can perhaps chart a little,
depending on the craziness of the night.
I might need to admit a patient if I have an empty room,
which can easily take an hour. Then
their medications have to come through pharmacy into my computer before I can
give them. If one patient is acting
crazy I have to address that. (yelling,
cussing, hitting, confused, not breathing right, chest pain, ect).
By now it is about 11pm and I have to run down
to the cafeteria if I want any food because they close now. I am usually one of the last people
there. I put my food somewhere on the
floor, usually in the break room, and see if my patients need anything. Remember, any medication I need is in one of
two machines on the floor, and needs to be scanned in, so it is a process. If any IV pumps are beeping or feeding tube
pumps, I need to trouble shoot those.
Around midnight I go grab all six of my patients charts and note my
orders with a red pen against the computer.
I do a 24-hour check since I am the night shift nurse. This means I see what is ordered for the
patient and see if it matches what is ordered in the computer, or see if I have
done it. For example, if a patient needs
labs drawn in the morning, I have to write for that order in the computer so
that lab knows to come get their blood.
Or, if they are having a procedure the next day, it is my job to get the
paperwork done. Then I check on all my patients
again and give midnight medications. You
can give a medication 30 minutes before it is due to 30 minutes after it is
due. Then I take the charts back to the
main nurse’s station, where the charge nurse is, and put them back into their
spots. Then I try and chart. I really try to have all my head to toe
assessments and 2 hour assessments charted by midnight. This may seem late to some seasoned nurses,
but remember, I am new. As long as I
have physically done the assessments on time, I feel like it’s ok.
After those things are done, I check on the patients every two hours, give medications through the night, and chart. At four, labs are drawn and chest X-rays are done. Sometimes I have to draw the labs, sometimes law workers do it. Also at 4, the intake and output records for the last 24 hours are totaled. A big graphic sheet is printed out for each patient with vitals and intake and outputs listed, included drains and IVs. I will go and physically put these in the patient's charts for the rounding doctors to look at during the day. Everything is available on the computer, but some doctors still prefer the paper charting. Hopefully at some point I've gotten to eat, but that is rare. I will check the surgery schedule if any of my patients are going to have surgery that day to see if I need to get some pre-surgical vitals on them.
Around six I usually go wake everyone up and see if they need pain or nausea medication, to go to the bathroom, or anything else. I look to make sure their IV bags are full and their IVs are still working. This way the day nurse doesn't get left in a mess. A lot of medications and insulin are due at seven so I'll check blood sugars. If something is to be done that day like a catheter pull or dressing change, I'll try and do that too. By this time, the day shift has come on and I give report. I usually leave around 8am and go home to sleep.
After those things are done, I check on the patients every two hours, give medications through the night, and chart. At four, labs are drawn and chest X-rays are done. Sometimes I have to draw the labs, sometimes law workers do it. Also at 4, the intake and output records for the last 24 hours are totaled. A big graphic sheet is printed out for each patient with vitals and intake and outputs listed, included drains and IVs. I will go and physically put these in the patient's charts for the rounding doctors to look at during the day. Everything is available on the computer, but some doctors still prefer the paper charting. Hopefully at some point I've gotten to eat, but that is rare. I will check the surgery schedule if any of my patients are going to have surgery that day to see if I need to get some pre-surgical vitals on them.
Around six I usually go wake everyone up and see if they need pain or nausea medication, to go to the bathroom, or anything else. I look to make sure their IV bags are full and their IVs are still working. This way the day nurse doesn't get left in a mess. A lot of medications and insulin are due at seven so I'll check blood sugars. If something is to be done that day like a catheter pull or dressing change, I'll try and do that too. By this time, the day shift has come on and I give report. I usually leave around 8am and go home to sleep.
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