*Original post released on 08/30/2022
If you’re a nursing student or new nurse considering beginning in or transferring to the critical care setting, this article is for you! I’m sure you’d love to know just what an ICU nurse experiences in a 12 hour shift…and to be honest, that routine can be what sways you one way or the other in choosing critical care. In all honesty, night shift and day shift in the ICU setting are completely different. This is why I’ve split up this topic into two different articles. After having worked both night and day shift personally, I feel as though I can give you a fairly good idea of what to expect in a 12 hour shift. Without further ado, let’s get started with the 12 hour night shift!
Initially, my day begins around 1845. During this time, I’m settling my things into my locker, looking at my patient assignment, gathering any necessary paperwork (labs, med lists, orders, etc.), and touching base with the off-going nurse. At 1900, I attend a nurse huddle meeting for the unit and then return to get report from the current nurse. Report usually takes anywhere from 10 to 20 minutes, depending on the patient load, how acute their current status is, and whether or not I am familiar with the patient(s). Around 1930, I begin to review my patients’ meds, orders, labs, and major tasks to be completed for the shift (dressing changes, Foley insertion, line insertion(s), etc.).
Now that it’s past 2000, I’m checking on each of my patients to see their current status and perform a thorough baseline head-to-toe assessment. During this time, I’ll also check their blood glucose levels for the night prior to bedtime. Then, I begin gathering my supplies and meds to pass for the patients under my care. How I complete this task depends largely on the facility I’m working at. For instance, if I have a way to lock my meds away in a cart, I will pull all of them at one time, working patient by patient. If I do not have a way to store the meds in a secure manner, I will only pull out the medications for one patient at a time and make subsequent trips as needed. Tip: Ask your patients in advance if they have pain so you can grab those PRN meds at the same time and save yourself the trouble of an additional trip.
Once I’ve finished passing all of my meds and taking care of basic hygienic and urgent needs, I’ll begin the process of documenting all of my nursing actions, assessment data, and any follow up notes. I try to ensure that I document a quick note every 2-3 hours during the shift to provide a quick update on current vitals, disposition, MD visits, studies, labs, etc. that may have arisen throughout that time period. This helps cover yourself in the event that a shift gets busy and it becomes difficult to recall those details. Although a little difficult to adjust to at first, charting short follow ups more often can help you in the long run.
At midnight, I perform a focused assessment of the neuro, cardiac, and respiratory systems at a bare minimum, also adding in any bodily systems that may be experiencing issues at that time. I check vitals and chart them. In the ICU, vitals are typically done at a minimum of every hour depending on what medications the patient is receiving. I usually try to let the patients sleep and rest as much as possible, so from midnight until at least 0400, I limit the number of interactions I have with my patients. Of course, if they need assistance or sincere medical attention, I will prioritize that over their beauty sleep.
At 0400, I’ll perform a second focused assessment of the same systems (neuro, cardiac, respiratory) and any systems that are experiencing issues. I take vitals again and blood sugars again (if it is required for the patient) and chart them, write my follow up note, and perform any end of shift hygienic care out of consideration for the oncoming nurse. I’m used to bathing my patients on the night shift and I’ll usually do this towards the end of my shift so the patient is a clean as possible for the next nurse and the day. After this, I’ll begin tallying up my intake and output values for the full shift for recording on the charting system. Once 5am hits, I’ll typically be within the allotted time frame to administer the remaining medications on my shift. Following the administration of those remaining meds, I’ll finally chart my I&Os.
Every facility I’ve worked at has a patient flowsheet of some sort which annotates their reason and date of admission, past medical history, current lines/drains, overview of systems, and updates. I’ll finish up any charting and then update that sheet (as well as my charge nurse) before it concludes. I try to look at the day shift nurse assignment in advance to change of shift so I know who I’ll be giving report to. If I have the same nurse returning, I’ll compile a concise list of updates to provide to them about the patients. If not, I plan to make adjustments to my report where necessary for providing report to the new nurse to improve continuity of care.
Change of shift report typically begins at 7:15am or so due to beginning of shift huddles. I’ll give the oncoming nurse either updates or report, depending on the assignment. After report, I check with the nurse to see if they have any questions, concerns, or need assistance with something before I leave. If my patients are on drip medications (Ex: vasopressors, sedatives, etc.), I try to ensure that they have an extra bag of the medication either ordered or in the med room ready to be used. Finally, I can collect my belongings and head out for the night…all to come back first thing in the evening for another shift!
I hope this helped provide you with some insight into a typical nighttime ICU shift. Of course, not everything runs so smoothly and I couldn’t possibly give you multiple scenarios of how your shift may vary. My best advice? Find a routine that works best for you, perfect it, and stick to it as much as possible so that when chaos interrupts your day, you know exactly how and where to pick up and get back on track. Until next time, happy studying!