Like many nurses, I believe in creating good work karma...that is, we have a concept of what goes around comes around. I find it best to try to leave a trail of good whenever possible, especially for the nurse that’s going to take over for you when you leave. It’s less of a religious belief or superstition and more of a law of nature on a hospital unit. I prefer to be known as the nurse that generally leaves things in good shape. I find that people try to do the same for me in return. I’ve even been complimented for it by the day shift nurses I work opposite.

Now, we all know there are those shifts that are so wild that you’re just glad everyone is alive, patients and staff included. The things I’m about to list may just not be feasible at all times (although I argue many of them are safety issues so they should be getting done). But overall, leaving a disaster for your relief should be the exception and not the rule.

So let’s review 10 things I do to help the oncoming nurse get a good start to their shift and to protect our patients.

Room Reset:

This refers specifically to medical supplies and tools at the bedside. If I have a patient with a tracheostomy, I also replace a few drain sponges and a couple of inner cannulas. I replace out of date or gross graduated cylinders and syringes for flushing NG tubes. If they stool a lot I make sure we have pads, butt wipes, and creams ready to go at the bedside. On my unit, we have small baskets with med cups, alcohol pads, and IV hub caps to refill. I often forget this little basket, but I’m working on it.

This is something nurses have told me they love about following me. They say it saves them time and makes insane shifts less chaotic and dangerous. I mean think about it, if your patient develops a mucus plug in their trach, having extras at the bedside is lifesaving (the inner cannula is required to attach the tracheostomy to a ventilator). I’ve had the favor paid back to me by nurses whom I follow. I’ve set a good example and created a cycle of collaboration and professional courtesy. Try it where you work and see if people start to notice. Oh, and don’t just do it for the nurses, do it for the patients, too.

My standard is this: if I had to code this patient right now and 15 people were about to show up - is this room functional? Would I be embarrassed if my boss or the DON came into this room? Would I be able to get this bed out of this room in a hurry without untangling for 10 minutes?

Room clean:

Didn’t we just talk about this? Nope. This is different from a room reset - this is more environmental. The room should not look like a bomb went off (unless you coded your patient at shift change). My standard is this: if I had to code this patient right now and 15 people were about to show up - is this room functional? Would I be embarrassed if my boss or the DON came into this room? Would I be able to get this bed out of this room in a hurry without untangling for 10 minutes?

Minutes save lives, so it’s best to clean up the first available minute you have. I micro-clean every time I go into the room. I make mental note of the thing I’m going to organize next time the patient needs something. I work nights, so I’m not trying to keep them up all night while I fold blankets and clean commodes. I do try to accomplish some basics. Remove clutter from surfaces and chairs (extra linens, supplies thrown about, things no longer needed for care), empty any super stinky trash cans (even if you have EVS, don’t make the patient breathe that in as they lay in bed waiting for EVS), empty mostly full suction canisters or other drains, and do a quick wipe off of surfaces. I mean, we’re in a pandemic that’s not going anywhere for the United States, so you might as well Sani-wipe your patient rooms.

Tubing change: While some night shifts are just as crazy as day shift, usually I have a bit more time to work with during the wee hours of the morning. If the IV tubing or enteral feed tubing bags are going to expire during that day shift, I’ll go ahead and just change them out for clean, dated tubing. Some medications or sugars build-up in the lumen of the tubing, making bacteria growth possible or adversely affecting drug level testing, so it’s good to not let them hang longer than required.

Pull relevant info from EMR: In a similar spirit to the point above, sometimes I have a bit more time on my hands if and when my patients finally sleep. In this downtime, I like to read through chart notes with a few specific disciplines on my radar. For example, I seek notes from social workers who are discharge planning, wound nurses who have left recommendations, and any other relevant history that may have been diluted during weeks of handoff report. This way, when I give report, I am passing on clear, concise info, and not the H&P that’s been passed through many hands in a hurry. This information is important to guiding nursing care so accuracy is always the goal.

Stock the medication room/carts. I think this should be a shared responsibility, but if I’m working and I have a second, I’m restocking. We keep NS flushes, IV and lab draw supplies among other things in drawers in the med room for easy access. Nothing is more aggravating than having to chase after supplies at the beginning of your shift. It’s a huge time saver for the whole unit if those items are replenished periodically and before shift change. This is my charge nurse’s responsibility, but they always appreciate the hand.

While letting some drips run dry can be annoying, some can be life-threatening. Make sure you have ordered any missing or new meds from the pharmacy. Make sure you’re familiar with the medication and how much lead time they need to prepare it. If you’re unsure, ask your charge or call the pharmacy at your institution and ask them.

Do shift change cares/meds: If your handoff report is from 0700-0730 like mine is, please go ahead and give any medications due during that time. If not, it’s inevitable that report will run long and then someone else will need something and before you know it that medication is an hour late. For some things, this may be no big deal, but for patients with time-sensitive medications and packed infusion schedules, this can throw an entire shift off and affect the patient depending on the medication.

Reorder critical medications. While letting some drips run dry can be annoying, some can be life-threatening. Make sure you have ordered any missing or new meds from the pharmacy. Make sure you’re familiar with the medication and how much lead time they need to prepare it. If you’re unsure, ask your charge or call the pharmacy at your institution and ask them. Also, reorder any PRNs you used up during your shift. It’s frustrating to go get your post-surgical patient’s pain med from lockup to discover it was all administered and not replaced. The patient won’t be too happy either.

Never poison the well. As a nurse who battles anxiety on the regular, nothing makes me want to do a ‘180’ and walk away faster than nurses who say to me “God, this day has been awful. Good luck with THIS group.” or something equally as poisoning. I’ve said to people “you know that makes me want to just clock out and leave, so shall we try again?” They usually apologize realizing what a mind fuck it is to start report that way. Don’t be that poison. Be honest in report, but maybe have some tact. “I had a really busy day, this group is challenging”. Don’t drag your teammate down before they’ve even met their patients. Hold back the venting during report unless it’s relevant to the nurse providing care for the next shift.

Ensure other nurses aren’t drowning in the end. Often on my unit, if nurses are about to leave their shift, they check in with their co-workers to be sure they’re going to get out soon, too. If not, take an extra few minutes before you jet to help them finish up. You may say “eh it ain’t my problem” - but someday, my friend, you may be the one struggling to finish up and a helping hand would get you home to bed sooner. Also helps when you’re working with a team doing back-to-back-shifts - if they get out really late, it cuts into their sleep time and that cuts into their performance when they’re back on shift with you in 12 hours. We’re a team, govern yourself as such.

Show up on time for report. Technically this is more for the shift before you, but that may be the same nurse coming back in 12 hours. Again, help them get out on time so they can get back to relieve you on time.

Often on my unit, if nurses are about to leave their shift, they check in with their co-workers to be sure they’re going to get out soon, too. If not, take an extra few minutes before you jet to help them finish up. You may say “eh it ain’t my problem” - but someday, my friend, you may be the one struggling to finish up and a helping hand would get you home to bed sooner.

I very much believe that what goes around comes around and nurses have very long memories. If you’re the nurse who always leaves a mess and a poopy patient, you’ll be notorious among your peers. Establish good habits and be the person on the unit known for leaving your patients and your environments in good shape. Demonstrate that you’re a team player setting your teammates up to score.

What sort of things do you do to help out the next shift?

Featured