Friday, March 5, 2010

First twelve hour shift on the unit Part 1

       This past Tuesday I did my first shift on the unit.
        I arrived about 15 minutes prior to the beginning of my shift. I had no idea where to go to meet my preceptor. I went to the staff lounge, waited for a bit, didn't see her come in, then walked around the unit. I asked a few people if they knew where she was, nobody did. A few said she hadn't come in yet.
So I went back to the lounge and asked a few more people. Someone finally suggested I go to the Charge Nurse office upstairs and ask.
       By this time it was a minute past the beginning of my start time so I decided to clock in on my own. I had never used  the clock in system before, but I figured I could do it by myself. What I wasn't sure of was the protcol about clock in time, which machine to use, etc.
       Then I went upstairs, went to the door of the Charge Nurse office, and found 4 nurses sitting around a desk, giving/taking report. They all looked up at me, and despite my desire not to interrupt, I told them I was supposed to be orienting with &* today and asked if  they knew where she was. The Charge Nurse replied, "And she's not here today." She looked at a sheet of paper and said a name, which I only caught the last name of, and told me to go back downstairs to B Quad to find her.
       So I went back down stairs and asked if anyone knew where &* was. Someone directed me to the Unit Secretary's office. I went into the office and stood against the wall, listening to three people getting report from a tape recorder. Then another nurse came in and gave report directly. It turned out one of the people was a nursing student from PLU, I think there were about 6 of them on the floor that morning.
After report I asked one of the nurses if she her last name was &*. It was, so I introduced myself and told her I had been assigned to follow her around for the day.  I think I said something to the effect of "I've been pinned on you for the day".
        &* was very gracious. As she prepared herself to go out onto the unit ,she asked me if it was my first shift on the unit. I said that it was, and she said it would probably be a "follow her around and observe" type of day. I told her that was fine with me and I followed her out onto B Quad where she had been assigned.

Report and Patient Assignment:
    It appears that report is given via tape recorder. The out going nurses on a particular quad take turns going into a private room, an empty patient room, or an open office, and record report for each of their patients onto a tape recorder. Then the oncoming staff go into the room and listen to the report via tape recorder. Then the oncoming nurses choose which patients they want to work with and receive "live" patient updates from the outgoing nurse of that particular patient.
  I'd never encountered report given this way before. I will have to experience it some more before I have a sense of how it really works.

         Apparently it had been a "crazy" night shift. Nurses were behind on charting, patients needed lots of things done, and everyone seemed pretty frazzled and overwhelmed, understandably. I pretty much hung out to the side of things, listening and observing. A nursing student was assigned to one of my preceptor's patients, whom my preceptor had worked with the day before, and she had three other patients as well.
       We spent much of the morning preparing two patients for discharge. There was some teaching to do, some paperwork to fill out, but much of it had been done by the night shift. As I mentioned before documentation is all done via paper charting, and all doctor's orders are via paper charting as well. It is an interesting excersise to read various forms of handwritting, some of it requires a great deal of "interpretation", which I am not exactly comfortable with. It seems as if the nurses become familiar with doctors' handwriting and establish some degree of exerptise in interpreting their orders, but the room for error is still unnerving for me. We shall see how/if this changes for me over time.
That's it for now. More on my first 12 hour shift on the unit to come.......

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