Having a good shift means that you are expected to complete a modicum of tasks. Not all of them can be done in order, but this is a small baseline to go off of.
- Arrive 15 minutes early: this helps give you time to walk to the other units if you’ve been floated. You also need to make sure you can access the medication pyxis
- clock in
- obtain report: no need to be snarky. Just get the basic info and prioritize what needs to be done by the end of shift
- do your assessment: if this is a neuro pt in any capacity, make sure that you do bedside neuro evaluation as part of shift exchange. Both nurses need to witness the current status of the patient before handoff is complete. If anything happens, such as a neuro change, you will be covered because the change didn’t occur on your shift
- give 1st round of meds
- take a break: you may not have time later
- check the labs
- check electrolytes, especially K, Na, Ca, Mg, Phos. An easy way to remember is “8, 4, 3, 2”: meaning that you need at least 8.0 Calcium (Ca2+), 4.0 Potassium (K), Phos you need at least 3.0, and Magnesium ~2.0 to replete electrolytes. Replete them early in the shift. Also see when you can recheck them once they’re replaced. Another tip is that giving potassium tablets 40 mEq is faster than doing 10 mEq IV potassium x3. But oral potassium tabs taste bad
- clean up your Orders. Make sure you’re doing what you’re supposed to be doing. For example, checking that your pt has any procedures upcoming and if they need to be NPO, make sure that you adhere to that so their surgery isn’t cancelled
- check if you have any continuous IV infusions. You don’t want to spend the entire shift not knowing that you had IV fluids that you had to run all shift
- draw morning labs
- give a bath: do it at 4am because these last two hours of your shift are going to go by real fast
- label your lines: not a fan of this one, but the old nurses are sticklers for it. Just slap a sticker on. Usually lines last for 3 days, so choose a sticker that reflects when to change it. Propofol lines must be changed every 12 hours and tubefeed lines every 24h
Charting
Don’t let this fall by the wayside, or it will come back to haunt you at the end of the shift. You will find yourself quite tired and at the same time struggling to complete the charting before you go home. Failure to do so will draw ire, legal issues, and calls from your manager on your day off
- Assessments: are always done at least once a shift–and no later than 2 hours after receiving a new patient
- Vitals: know how often you must incorporate readings into your charting. For ICUs, it’s usually once an hour. For other floors, every 2-4 hours. Be nice to someone and maybe they can show you how to “slave” those readings into the monitor. Because typing them one by one will rob you of precious time and lower your accuracy
- Intake & Output: this seems trivial, but actually it’s Very important. Keeping strict “I’s & O’s” is imperative w/critically ill pts that are usually bogged down w/renal or hemodynamic instability. Bowel movements are not something to be forgotten either. It’s almost as bad of an emergency if a pt hasn’t had a decent BM in over 3 days. It also keeps track of medications and continuous fluid infusion. This includes critical care meds like vasopressors and sedatives! Finally, tube feedings are taken into account, as well. CRRT and other interventions are more for advanced nurses
- Braden: is a skin/bedsore rating system that is required once a shift
- Morse: is a fall rating system also once a shift
- Pain: usually done q2-4 hours
- ADL: q2-4 hours. It describes pt’s movement. You should always chart pt is in their “left” then “right” position each time, switching between the two. Never chart pt’s on their back anymore
- Lines and IVs: usually once or twice a shift. More important if you have invasive monitoring lines such as ART or central lines (that go directly to your pt’s heart). It also keeps track of PIVs
Extras
These are tasks you can do that will make it easier for the next shift
- do MRI screening: if the pt or family can answer questions, it will allow next shift to transport the pt to imaging without delay. You can also check if pt is claustrophobic and needs orders for Ativan PRN
- prepare a consent for a procedure. If the pt is asleep or unable to give consent, at least make sure it’s there and ready for the next shift. While you’re at it, check if there’s a blood consent, a POLST, and any other relevant paperwork
- do Valuables: check to make sure there are no meds (especially controlled meds) in the pt belongings. You don’t want to be caught off guard if pt is taking them behind your back to double up
- insert an IV: if you know pt is going to lose an IV or they only have one, then be nice and insert another one for the next shift and for pt’s safety
CoroMed App:
Having a good shift means that you are expected to complete a modicum of tasks. Not all of them can be done in order, but this is a small baseline to go off of.
– Arrive 15 minutes early: this helps give you time to walk to the other units if you’ve been floated. You also need to make sure you can access the medication pyxis
– clock in
– obtain report: no need to be snarky. Just get the basic info and prioritize what needs to be
– done by the end of shift
– do your assessment: if this is a neuro pt in any capacity, make sure that you do bedside neuro evaluation as part of shift exchange. Both nurses need to witness the current status of the patient before handoff is complete. If anything happens, such as a neuro change, you will be covered because the change didn’t occur on your shift
– give 1st round of meds
– take a break: you may not have time later
– check the labs: watch for timed labs that you must draw & plan for these!
– check electrolytes, especially K, Na, Ca, Mg, Phos. An easy way to remember is “8, 4, 3, 2”: meaning that you need at least 8.0 Calcium (Ca2+), 4.0 Potassium (K), Phos you need at least 3.0, and Magnesium ~2.0 to replete electrolytes. Replete them early in the shift. Also see when you can recheck them once they’re replaced. Another tip is that giving potassium tablets 40 mEq is faster than doing 10 mEq IV potassium x3. But oral potassium tabs taste bad
– clean up your Orders. Make sure you’re doing what you’re supposed to be doing. For example, checking that your pt has any procedures upcoming and if they need to be NPO, make sure that you adhere to that so their surgery isn’t cancelled
– check if you have any continuous IV infusions. You don’t want to spend the entire shift not knowing that you had IV fluids that you had to run all shift
– draw morning labs
– give a bath: do it at 4am because these last two hours of your shift are going to go by real fast
– label your lines: not a fan of this one, but the old nurses are sticklers for it. Just slap a sticker on. Usually lines last for 3 days, so choose a sticker that reflects when to change it. Propofol lines must be changed every 12 hours and tubefeed lines every 24h
CHARTING
Don’t let this fall by the wayside, or it will come back to haunt you at the end of the shift. You will find yourself quite tired and at the same time struggling to complete the charting before you go home. Failure to do so will draw ire, legal issues, and calls from your manager on your day off
– Assessments: are always done at least once a shift–and no later than 2 hours after receiving a new patient
– Vitals: know how often you must incorporate readings into your charting. For ICUs, it’s usually once an hour. For other floors, every 2-4 hours. Be nice to someone and maybe they can show you how to “slave” those readings into the monitor. Because typing them one by one will rob you of precious time and lower your accuracy
– Intake & Output: this seems trivial, but actually it’s Very important. Keeping strict “I’s & O’s” is imperative w/critically ill pts that are usually bogged down w/renal or hemodynamic instability. Bowel movements are not something to be forgotten either. It’s almost as bad of an emergency if a pt hasn’t had a decent BM in over 3 days. It also keeps track of medications and continuous fluid infusion. This includes critical care meds like vasopressors and sedatives! Finally, tube feedings are taken into account, as well. CRRT and other interventions are more for advanced nurses
– Braden: is a skin/bedsore rating system that is required once a shift
– Morse: is a fall rating system also once a shift
– Pain: usually done q2-4 hours
– ADL: q2-4 hours. It describes pt’s movement. You should always chart pt is in their “left” then “right” position each time, switching between the two. Never chart pt’s on their back anymore
Lines and IVs: usually once or twice a shift. More important if you have invasive monitoring lines such as ART or central lines (that go directly to your pt’s heart). It also keeps track of PIVs
EXTRAS
These are tasks you can do that will make it easier for the next shift
– do MRI screening: if the pt or family can answer questions, it will allow next shift to transport the pt to imaging without delay. You can also check if pt is claustrophobic and needs orders for Ativan PRN
– prepare a consent for a procedure. If the pt is asleep or unable to give consent, at least make sure it’s there and ready for the next shift. While you’re at it, check if there’s a blood consent, a POLST, and any other relevant paperwork
– do Valuables: check to make sure there are no meds (especially controlled meds) in the pt belongings. You don’t want to be caught off guard if pt is taking them behind your back to double up
– insert an IV: if you know pt is going to lose an IV or they only have one, then be nice and insert another one for the next shift and for pt’s safety
