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Many nurses start out on night shift but then transition to day shift.  While the work is technically the same, the flow of the day is quite different.  Here are some tips/tricks for the nurse transitioning from night shift to day shift.

#1 – Pay attention to meds with meals

Insulin is the major medication to take note of.  When you’re looking at what meds you have to give for the day, pay particular attention to AC/HS blood sugar checks with insulin coverage, and any other meds that need to be given with meals and manage your time accordingly.  I got burned on this at first.  I wasn’t paying attention and before I knew it, dietary delivered their tray.   They ate without getting their sugar checked first and they had sliding scale + scheduled insulin due.

Also, keep in mind meds for dialysis or pancreatitis patients that have meds that must be given with each meal and again, manage your time accordingly.

#2 – Try to chart in real time as often as possible

On nights, I’d chart a few things in real time, but once everything settled down, I’d sit down to complete all of my charting at once.  Keep in mind, you don’t always get time to be able to catch up so chart as things happen if you can!

#3 – Anticipate obstacles for discharges

If I find out in report that a patient will probably be discharged that day, I immediately ask them about transportation.  Many times family members that are their rides are only available during certain times, so find out early so you can manage your time appropriately.  Otherwise, they’ll put on their call light and say their ride is waiting downstairs and the doctor hasn’t even put in the scripts yet.  Also, make sure they can pay for their scripts.  Too many times I was giving discharge instructions and suddenly they said they couldn’t pay for their meds, but their ride was already on the way.

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#4 – Know what time the physicians begin call

And make sure you get routine needs addressed before then!  This is usually around 1700.  Nothing frustrates on-call physicians more is calling at 1730 for something routine that the attending physician or their advanced practice provider could have easily addressed.  Manage your time so that you have all of the orders you need before it switches to the on-call doctor.  You also want to make sure you do this so you don’t leave night shift hanging.

#5 – Don’t try to get absolutely everything done before you let yourself eat lunch

I would do that on night shift because it was more feasible.  There weren’t any discharges and much fewer admissions.  I would see everyone, medicate them, chart, and round again before I would eat.  This isn’t realistic on day shift because once you’re done with 0900 meds and charting, it’s time for 1130-1200 meds.  Usually you start to get discharges (and therefore admissions) around this time as well, which means you won’t be eating lunch until 1600.  Try to get your lunch whenever you can.

#6 – When family members call for an update, take a message if you’re busy

They like to call at shift change, around 0900, and 1200-1300… you know, the busiest times of the shift.

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I know, it’s frustrating, but most people don’t realize how big of a headache that is.  Simply, don’t take phone calls mid-med pass unless they’re urgent. .  That’s when you make errors.  Have whomever answered the phone get a number and call them back, or ask them to call back in an hour.

#7 – Round with the physicians

Do this to build rapport and establish a professional trusting relationship. On night shift, you’re working with on-call physicians typically, getting them to the next day and prioritizing most decisions to be made the following shift with the attending. On day shift, you’re working elbow-to-elbow with the attending physician about decisions, concerns, and plan of care.

Make your face known to them, shake their hand, and give them an update on your patient before they ask.  The nice thing about day shift is you really get to know the doctors.  Having a good relationship with them can make your job much easier.

#8 – Don’t call physicians about non-urgent/emergent issues that can easily be address during rounds

We need to be respectful of their time, as we want them to be respectful of  ours.  If we call for every little need that can be addressed during rounds, it takes them away from other patients.  If it’s something that’s not going to change your plan of care between now and then, wait until they come by for rounds if possible. Consolidation of calls/pages is appreciated by all!

#9 – Don’t linger around, chatting it up with night shift

You’re already behind! Seriously, day shift feels like you just hit the ground running immediately. If you hang back to catch up with your BFF night shift bud, you may already be late on some meds, missing the resident’s pre-rounds, or missed a pre-breakfast Synthroid dose!

Seriously, my first few weeks on days felt like –

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#10 – Take some time to touch base with your CNAs/PCTs first

After report, double check to make sure they know who needs a bath today and who has blood sugar checks and if you need to be notified for specific vital signs (for example, for a systolic blood pressure above 160).  Don’t assume the night shift tech gave communicated everything they need to know. Again, been burned here. Never assume anything – double check with your nursing staff, especially those with whom you’re sharing tasks for patients throughout the shift. This also builds rapport with them as well, which is essential because you will rely on them heavily.

If you’re struggling with some specific clinical things

If you’re a new graduate nurse, or a nurse switching to a new unit, or a nurse having trouble grasping some important patient-specific issues, you’ll want to spend some time on your days off going over some concise and helpful information.  This makes a world of difference and helps connect the dots sooner. You can focus on practical steps at the bedside, while filling in the why at home when you have a little more time to process the information.

YouTube has tons of great free videos (Khan Academy, for one), or check out your speciality nursing organization (the American Association of Critical Care Nurses has tons of great resources for critical care), or you can check out the NRSNG Academy.

NRSNG Academy is primarily an NCLEX resource, but there is a ton of information applicable for the new nurse.  The EKG, Lab Course and MedMaster Courses are specifically what I’m thinking will be particularly helpful for the new grad.

They go in depth on mechanism of action, nursing considerations, contraindications, and more within MedMaster. The EKG Course dives deep into each rhythm, nursing considerations, pathophysiologically and electrically what’s occurring, and more.  The Lab Course does a deep dive into specifically what each lab is measuring, why it’s important, and more.

    

 

You can buy each course individually, or you can try them all with a trial NRSNG Academy membership for $1 and cancel any time.

NRSNG Academy works like a monthly fee, so once you feel like you’ve extracted the value and knowledge you need to be more successful at the bedside, you simply cancel. There is a ton of information in the entire academy that would be applicable to the newbie nurse and it would take a few months of membership to equal the cost of purchasing each individually.

Click here to try the NRSNG Academy for $1

Even more resources for new nurses

           

Enjoy day shift!

Getting up early is the worst, but sleeping at night (every night) is the best!

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