As a new grad it can be hard to plan out your whole shift but really it’s the beginning of the shift that requires the most planning. When I was a new grad, I got to work an hour early to print everything out and get my brain organized so that I could feel more mapped out and have a more confident plan for my shift. As you become a more experience and confident nurse, getting there an hour early may not be necessary. However, I still see experienced nurses getting there early to do this same planning! Follow along for a step by step start of shift nursing plan!
Print Out Your Brain and Organize Your Shift
At the start of shift, print out your brain and schedule your shift for each patient. Look over their scheduled medications and any PRN medications they may have. Check out the most recent nursing and doctors’ notes and look at their medical history. Doing so will give you a good idea as to why the patient is there.
See How to Organize Your 12-Hour Nursing Shift and Organizational Brain Template for New Nurses to help with this step.
Introduce Yourself and Your Role for the Shift
After going into the patient room but before you start to get report, be sure to introduce yourself and your role for the shift. Are you the nurse or nursing student? Will you be working alone or with a preceptor? It’s good to keep your patient in the loop to make them feel more comfortable. After all having three people in your room when you first wake up isn’t always fun, is it? Here’s an example of what to say…
“Hi, I’m Courtney and I’m going to be your student nurse/precepting nurse/nurse for this shift. How are you doing?”
By asking the patient how they are doing at the start of shift, you’re helping gauge how the patient is actually doing. If they’re in pain they are going to let you know.
Address Pain
At this point after introducing yourself, it is natural for the patient to let you know if they are in any type of pain or discomfort. By opening up this communication early in the shift you are offering more support and empathy to the patient than if you waited for them to call you in pain. Here’s a patient response example…
“Hi Courtney. I’m actually in a lot of pain right now, do you know when I can have my next pain medication?”
For more information on treating a patient in pain, visit Nursing Fundamentals: A Guide to Pain and Patient Education: How to Effectively Manage Acute and Chronic Pain.
Get Report
At this point you’re able to refer to the nurse giving you report. They will let you know when the last pain medication was given and when the next one is due. Now you can make a plan with the patient. Do they want to be woken up for pain medications? Do they want to call you when they’re in pain? Find a plan that works for both you and the patient and note their plan on the patients white board and on your to do list.
For example, if the nurse giving you report says,
“Oh he last had his pain medication three hours ago and it’s scheduled q4” then you can tell your patient something like this. “It looks like we can give you more pain meds in one hour. I’m going to write it on your whiteboard here so you can call me at that time and I can bring it to you. Let me just get a quick report on you and my other patients and I’ll be back to check on you and see if there isn’t something else we can do about that pain.”
Be sure to visit Essentials of a Good Bedside Handoff Report for more info.
Be Proactive
Being proactive like this helps to ease the patients’ nerves and gives them a reminder that you are in fact here to help them. Finish getting report on all your patients and then loop back to the one/ones that were in pain. See if maybe you can offer them an ice/heat pack and assess the level, location, and description of their pain.
If there isn’t an order for any PRN pain medications and you expect to need some on your shift go ahead and page/call the doctor. Especially if you are working night shift, the doctor will appreciate you calling them closer to 8pm rather than 3am. So be proactive and anticipate your patients needs for the shift.
Visit Tips for New Nurses on Calling the Doctor and Medical Abbreviations You Must Know for more information.
Follow Through
If you made a plan with your patient to wake them up at a specific time for more pain medications, then that’s what you have to do. Being on top of your pain medications and communicating a plan with your patient will lead to better patient satisfaction and an overall easier shift. Your patients will thank you.
Scheduled Med Pass
Right after you finish getting report and giving any PRN pain meds, it will likely be time for your first med pass. Make sure to collect all the patients’ medications that are due in the next hour and give them at once. Try to cluster your care as much as possible. This way you can go into your patients’ room, give them their scheduled medications, do a little patient education, and get your head-to-toe assessment done.
Be sure to visit Nursing Fundamentals: An Intro to Pharmacology and A Guide to the 10 Rights of Medication Administration for more info.
Head-to-Toe Assessment
Try to get your assessments done as early in the shift as possible but without messing up your scheduled med pass. This sometimes means that you’ll only get one or two assessments done before having to give meds. And that’s okay! Give your meds and get back to do the other two or three assessments after meds pass.
No matter how you do it, keep your patients in the loop. Let them know that you’re going to give another patient their meds but that you’ll be back to do a quick assessment in about a half hour. This gives your patient some autonomy that is often lost in the hospital. It lets them know that they can take a nap after your assessment instead of falling asleep and having to be woken up or just waiting up for when you might be back.
For a step-by-step breakdown, check out How to do a Quick yet Effective Head-to-Toe Assessment.
Chart
Set aside time for charting when you’re scheduling your shift ahead of time.
Check out Charting Tips for New Nurses.
Hourly Rounding
Continue checking in on your patients. Make sure they always have whatever it is that they need. Try to think outside the box, often times patients don’t know the resources we have available for them. Does it look like they’re having trouble sleeping? Give them ear plugs and an eye mask. Is their neighbor trying to sleep but they want to watch TV? Give them ear buds. Are they anxious? Give them a blanket and a lavender wipe. Do they just need someone to talk to? Do your charting in the room with them.
Every Shift is Different
In the end, every shift is going to be different. No matter how much you organize or schedule your shift, it will never go exactly according to plan. So be flexible. Take your plan as a rough outline and don’t get too stressed if you’re running behind. Ask a nursing buddy, or an old preceptor, or your charge nurse if you need help. And above all communicate with your patients.
If you find yourself getting nervous before your shift, visit How to Overcome Pre-Shift Anxiety for Nurses.
You Got This!
Be sure to check out these helpful posts:
- Nursing Bag Essentials for New Nurses
- Adjusting to Night Shift
- I’m a Night Shift Nurse, What Should I Do with My Days Off?
- How to Raise Awareness on Workplace Violence in the Nursing and Healthcare Field
Unsure of what nursing specialty you’re wanting to go into? Check out the Specialty Nursing Series:
- What Makes a Good Med Surg Nurse?
- What Makes a Good ICU Nurse?
- What Makes a Good Peds Nurse?
- What Makes a Good ED Nurse?
- What Makes a Good OR Nurse?
- What Makes a Good NICU Nurse?
- What Makes a Good Labor and Delivery Nurse?
- What Makes a Good Psych Nurse?
- What Makes a Good PICU Nurse?
- What Makes a Good Onc Nurse?
- What Makes a Good School Nurse?
- What Makes a Good Home Health Nurse?
- Plus be sure to head over to their matching Specialty Nurse Interview!