New Nurse Advice: How to Start Your Shift
Being a new grad nurse is rough the first year, and many times overwhelming. Just knowing you work tonight can be enough to start the panic wheels spinning. Here are some tips to starting your shift that helped me settle in to work on the floor.
1. Try to arrive at least 10 minutes early. Nothing is worse than rushing to work and starting the shift frazzled–well except maybe getting report from a very tired nurse that you made wait because you are late. Coming early has additional perks in that it allows you to get calm and centered before the shift, you can set your intentions for the work tonight/today, and earn respect of the other nurses by being punctual. Additionally, you can finagle the assignment when you are early; for instance you see the charge gave you room 666 hellion patient the second day in a row, you can ask if she can change it. With extra time, this change is easier to accommodate than if you ask after report is already under way.
2. Be positive. Don’t get intimidated by the run you have. When you see your list–totals, 1:1, whatever–don’t let your mind already start a negative plot against you. YOU are an awesome nurse. YOU can do this. Focus on what skills you can learn this shift, what you can learn from your patients, how you can help. Remember why you became a nurse and vibrate on that.
3. Report is a wonderful opportunity to get the shift started right. If your institution doesn’t have a policy to do bedside shift report, take it upon yourself to either try to get this implemented or just insist you get report at the bedside. This serves several purposes: 1) you and the nurse get to confirm, together, the patient’s identity which we all know is so important, 2) you get to assess your patient while you get report–how sick do they look? Is what you are hearing in report matching up with what you are seeing? Has that dressing/wound/his breathing/skin always looked like that? Based on this assessment, you can better prioritize your patients later on in the shift. You know which ones can wait for your assessment till last, and which ones need to be seen ASAP. 3) You start a trusting relationship right away. You introduce yourself, explain how the night is going to go, answer any questions, and explain what time you expect to be back. It’s hard to begin the shift with every patient buzzing the call light because they haven’t seen a nurse in hours and want to know when they get their meds. You can address this all now. 4) Tying up loose ends. You see that NS about to run dry, surely the nurse didn’t mean to leave you an empty bag? Usually when they see this they will go and get a new bag for you before they end the day. If not, at least you know you need to grab that here pretty soon.
4. Check the charts. I understand that not all nurses are lucky enough to have patient ratios, and between report and chart checks this could take upwards of an hour of your shift. But charts have to get checked, even the EHR. Make sure orders are signed, breeze through the meds/orders so you can anticipate what you will be doing this shift, make sure nothing is missed. I find its helpful at this time to then make sure you have an idea that most of the meds are accounted for in the med room, so if not you can call the pharmacy ASAP to avoid a delay.
5. Keep your ears open for who is calling the doctor. Beginning of shift is always a big time for doctor calls–vital sign changes, things missed during the previous shift, new labs, order clarifications, etc. Doctors get A TON of calls at shift change and if you are the 6th caller at 9, you are going to get an earful. Listen up for who is calling and try to chat to the doctor at the same time as the other nurses. Additionally, if you are calling the doc, make sure you ask the other nurses who else needs him or her.
6. Vital Signs. Get these done as soon as possible. If you have an aide, awesome, if not–just do what you can. This can again reinforce that mental prioritization list you have going and again, nurses are calling the doctor so you need to know the VS.
7. Prioritize care. Everyone does this a little differently. Obviously unstable patients come first; notice how I didn’t say sickest. Sometimes the sickest patients are not the most unstable, but they are the most time consuming. I personally like to save those patients–who have 400 meds, wound care, trach care, GT feedings/meds, etc–for last because I know I am going to be in the room an hour, and I want to make sure my other patients are settled first so that they don’t call.
Make sure you include YOURSELF in this prioritization. Get a sip of water, PEE, eat a granola bar. In the early days of nursing I would find myself fussy and fuzzy at 4 AM and then realize it was because I hadn’t eaten/peed/had any water the whole shift. Once you get that bad it’s hard to concentrate and chart. Take care of you so you can take care of everyone else.
8. Figure out a charting system that works best for you. Some nurses chart as they go, some chart all at once. It really depends on your run of patients. If I had a CRAZY cluster expletive of patients, I charted as I went because I knew I would never get time later. But usually, I would take notes on my brain and then chart later once everything was done. Only hazard to this is if you lose your brain *shudders*. If you can, when you are orienting to the floor as a new nurse, try to follow several different nurses so you can see how they chart. I took what I liked from several nurses and merged it into my own process.
9. If possible, when you are with your patients in the room, SIT with them. Lots of patients feel like nurses are too busy (we are) and have no time for them (it’s hard to have enough time for everyone). If you are going to spend 5 minutes in the room either way, sit if you can. This makes the patient feel like you have time for them, are listening, are more present, are on the same level as they are. Sure you also get to rest your feet, but really the point is to build that trusting bond. Patients who trust that you are going to be there for them are more patient when it comes to waiting for meds/food. They trust you, so they know you will be back. Patients who think you are super busy and forgot about them will buzz the call light every 5 mins to remind you. I like to take this time also to explain to them my plan for the night. If I have a really really sick patient that I know will rob me of a lot of time, I tell them. This way they know that I am not ignoring them, and if I can’t come right away it is only because I am with that other patient but I will be there as quickly as I can. You would be surprised how much this simple open communication helps your shift. These are people, just like you and I, who just want to know what’s going on and trust that someone cares about them. I can vouch for this as someone who was once a patient myself.
10. Be forgiving of yourself. Nursing is a 24 hour job and sometimes things don’t get done. Sometimes patients go bad right at shift change and there wasn’t anything you could do about it. Sometimes we simply forget to do things. No, your patient didn’t get a bath last night and it does suck both for the patient and the oncoming nurse, but what can you do? You only have so much time and so many resources. Trust that one day you will be fast enough to get it all done. I remember in the beginning of my career no one got baths–I was so frazzled that I frequently didn’t eat until 6 and stayed over much to the displeasure of my boss. One day, I just suddenly had time for it all. It happens insidiously–one day you just can do it all and have enough time for those things.
You are a great nurse, and you will get better and stronger every day. Be kind to yourself and treat each member of the team as you would want them to treat you. Help others whenever you can, spread good vibes, and keep your head up!
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