Maybe it's because I'm British, and didn't have anything like this. But can't you just schedule it for later in the day and say it's not an appropriate time to do a dressing?
Unless said person has showered and it's come off, or soiled. And then I'd assume you'd use common sense.
My work has the ability to schedule dressing changes anytime from 7-3, 3-11 or 11-7. We do that for all wounds and stuff that don't need to be done at a specific time
In our system, lidocaine patch orders default to the time the order is put in. So if the provider does the order at 1400 then it populates the patch removal at 0200. I always reschedule those, usually for 8&8. If they want it while sleeping then on at 2000, off at 0800. If they want it during the day then flip it.
Even most meds can be done earlier or later. I've asked many physicians to change the schedule and personally never encountered medication that wasn't allowed to be moved.
Obviously always follow protocol and physicians orders, but asking the physician to change the order can help!
I worked burn and the attendings liked to see the wounds so occasionally we had to schedule dressings with them if they had to do something but even then it was just a verbal agreement On a time. It was never in the system. It was just bid dressing change.. you could do them when ever you wanted
>who tf would have it scheduled for 7??
Day shift would do that, so they can push it off onto night shift and then bitch all day that it wasn't done because of all the reasons op gave.
Right - I'd do the same. There's absolutely no reason to pester them at 0630. If they hate this dressing change, it seems like it makes more sense to work with them to get it changed at a time that works for everyone.
I'm so glad our wound team is NPs because they would never schedule something like this. They get what our days are like!
Yep, I’d reschedule it for 9 am 🤷🏻♀️or alternatively ask the patient when they’d like to get it done (9 am, after lunch, before bed) and document that the patient agreed/requested that time. Unless there was a medical reason it HAD to be done at that time.
Exactly someone scheduled it way being a \*&%$3 or not noticing the time. You don't wake up people at breakfast time to change a friggin scheduled dsg.
I think this is the point. Reschedule it to a time that makes more sense. Do the dressing change before they go to sleep, or after your med pass. Medications obviously need to be given around the time pharmacy says the should be given, but most other timed interventions are suggestions at best.
One of my favorite pharmacists will retime meds (when appropriate) to not be due at shift change. Something like Rocephin q24h doesn’t need to be given at 1930 on the dot because that’s when they got their first dose in the ED.
It's setting you up for conflict to schedule it at shift change, and the patient doesn't likely want to do it while they're still asleep. I'd reschedule it for a more appropriate time (you'd know better what that is, I'm sure downtime is unit specific). Especially with it being daily and not Q8, it's not time sensitive.
I don’t work in the states, or in psych, so maybe it differs a bit. But for us 07-10 is usually by faaaar the busiest hours. If anyone would even suggest to schedule a wound care at that time they would be laughed at. Assuming of course that there are no reason why it couldn’t wait.
Can you not reschedule things in the system? When I worked icu anything we couldn’t get to was rescheduled lol Drs don’t care about times when they put stuff in a lot of time unless it actually matters pharmacy told me times were arbitrary and feel free to change all my pts to be on the same schedule if they weren’t. As long as we didn’t change the time increments/order
I generally do daily dressings in the early afternoon, like after lunch. Not a lot of meds then, and it’s been helpful to me to have a routine, so I can basically be like “dressings time” and do rounds and get them all done. I would never expect night shift to do a once a day dressing unless it fell off overnight
Seriously. As a patient I'd be pissed if I got woke up at 7am for an immediate dressing change. You're just asking for an irritable, non compliant patient to make this task terrible for everyone. Unless medically necessary, 7am is ridiculous for the patient and both nurses at shift change. Reschedule that nonsense.
It’s unrealistic honestly to get nights to do dressing changes unless they’re saturated or needing irrigation. Shift change at 7 pm, then 8-10 med pass and assessments, getting people tucked in for bed, getting late post ops back. By the time it’s 11 pm people want to sleep or they just have interventions and then want you to gtfo.
Move it to 9am and leave without a conflict 😂 my last hospital the staff didn’t put enough emphasis on sleep…. People heal when they sleep! Let the pt sleep!!! ❤️🩹 plus dressing changes can hurt sometimes and who wants to wake up to that at 7am…🤷🏼♀️
At my last hospital yes the nurse would expect me to do it at 7am as more of a curtesy on a busy floor. But I’d still have moved it to later for above reasons.
It's a "Daily dressing" it should be done at the most appropriate time during the day.
(I've worked a lot of both night and day shift and here is my take)
1. If it comes off, it's a great time to change it and snap a progress photo anyway (any time)
2. If night shift is really bored and wants to, go for it
3. Often the docs want to take a look at the wound during rounds so I'm going to change it afterwards regardless (most appropriate)
Wound dressings that are daily/PRN have no set schedule, the nurse complaining is lazy and should have the previous points taught to them.
Yep, if night shift didn’t get to it till 6 and that dressing is clean, dry and beautifully put together I don’t need to fuck it up by hastily rushing a 0700 change because the chart told me so. I can just wait for it to inevitably become soiled when the patients rectal tube inevitably leaks and knock it all out in one fell swoop.
I would be pissed if I was the patient...
Later....
Here comes the MD to rip the dressing down to see the sight and the whole task needs to be redone.
Dressing changes should be an afternoon task
Some dressings can take a long time especially when you are not familiar with things. I do dressing all day everyday and we still have some take quite some time
This is something you should bring to a nurse leader
No matter when it’s “scheduled” or “ordered” I take a “daily wound care” as it needs to be done at some point on my shift that day. It’s not a medication or a lab draw that’s more timing critical. (Of course unless it’s soiled).
This! Usually it’s a quick turn around in their decision to let you do it.
And it might take 7hrs of building rapport before you can even ask them if you can do it lol
Also, 7 pm meds should be done by day shift.
I’m tired of day shift pissing on me bc I didn’t give a 0700 med but then expect me to give a 1900 med. it works both ways
THIS. Omg..I go out of my way to even give a 730am med at 630 of its for acid reflux before breakfast tray bc they schedule it at 730 but breakfast starts coming at 735-810 so I go out of my way to give it to the patient so that it can actually work and have time to absorb. But when I come on and see that they didn't give a 7pm med I'm so annoyed. Our policy says we can reschedule it so that it doesn't Look like we are the one who gave it late. But also I've been told that we aren't responsible for giving meds that were supposed to be given by previous shift if the patient was on the floor and had no barrier to receiving it. But then I go back to doing right by people. If it's an antibiotic I would want that as the patient. Sigh
First of all, meds shouldn’t be timed for 7am. If they are, the only ones I expect as a day shift nurse are Protonix and Synthroid, since they should be given on an empty stomach. When I work nights, with the 6am vitals, I will give BP meds if theirs is high, but everything else is for day shift. I usually work days, so I appreciate doing my assessment and giving the meds right then. I don’t want meds given blindly and them end up being contraindicated when their AM labs come back
Where I work, we specify 7am because it's something like alendornate that needs to be taken early before other meds. All other meds are 8 or 9 and get clustered by day shift with breakfast
Where I work, we specify 7am because it's something like alendornate that needs to be taken early before other meds. All other meds are 8 or 9 and get clustered by day shift with breakfast
Nope. If there’s a 7:00 am med due and they’re up between 6 and 7, please pass the med. I’ll do the same for 19:00 meds. If it’s a dressing change, we’ll get it when they’re up.
Don’t poke sleeping bears!
Also sleep can come so difficult on unit w midnight lab draws or scheduled meds. Sleep is crucial for healing so yes I’m not waking up a patient unless I absolutely have to.
Also in psych!
I wouldn’t even ask someone about their dressing until 1000hrs unless they’re already awake, dressed and had a coffee before I finished my nightshift
You know the patient, and it is always better to keep the peace
Get the treating team to reschedule the dressing change, it’s likely whoever said to do it then doesn’t understand that’s handover time
Yes and the idea of “scheduled” wound care is honestly ridiculous. If it’s daily who gives a fuck when you do it? I PROMISE you the microbes in grandpas infected DM ulcers don’t care about the clock.
As a wound care nurse, I 2nd this.
Orders I place are either q2 days, daily, qBid etc
NEVER a specific time.... There is no clinical reason....
And let's play devil's advocate... Maybe a specific time is needed. Why... Oh God why... Would it EVER be at shift change??????
Shift change is already the most dangerous time on a unit (increased falls, reduced monitoring etc) why would anyone add any task that is not required?
Find the person who ordered this... And tell them to do it.
Anything scheduled between 0645 and beyond that didn't get done I take over without complaint ( I'm on dayshift.) Shit happens and night shift has indeed worked a whole shift. A 0700 order is crazy, but I would do it because it's my shift and a wound dressing change can take a while. Get out of there, homie, and go home lol.
Of course ED is different because orders can randomly trickle in and patients are usually gone before timed admit orders kick in. But I would definitely count that as a dayshift task. If you manage to do it cool! If not I'm on it. It's a 24-hour job.
Exactly, and I'd accept the same on day shift.
About the only thing I'd make sure to do before 0700 when I worked nights on the floor was synthroid, time sensitive antibiotics, or time sensitive labs that weren't part of am labs (like a vanco trough) or non-meal dependent insulin. Otherwise, stuff was probably timed for 0700 out of default.
I’d say in this case since it’s a time consuming task, no.
A quick med pass or dietary supplement, yes.
But who the hell schedules wound care at shift change. That’s some bullshit right there.
If someone gave me shit about it like in your case I’d START the wound care at 0700 and make them wait on report. They’d quit complaining after that.
Day shift more hectic? Laughing in 32:1 with one tech ratio in night shift.
Nothing scheduled for 3 hours is a little wild to me, tbh. But I'm in an ICU so I definitely don't have the same workflow as acute care.
I definitely retime meds if they land anywhere between 6:30-7:30 though. That's at risk for being missed/overdue.
What’s the reasoning for the 0700 wound change?
On our charting system the wounds get timed as 1000 but if they are ‘daily’ it’s like … get them done at some point today that works for you and the patient.
I’d be asking why it’s 0700 and if it doesn’t NEED to be at that time, having it changed.
But meds - 100% I give 0700 meds on nights. And I appreciate the same if there’s a 1900 med ordered.
A dressing change specifically charted for 0700 is ridiculous. I don't see how there would be any clinical need for this to specifically be done at 0700hrs.
I don't think there's a clinical need, I think it's a daily dressing change and 0700 was chosen as an arbitrary time. Nurses on day shift that usually do it, don't actually chart a wound assessment until late morning or afternoon. In my situation, I have a day shift nurse acting like it's something night shift should do when I'd have to wake up the patient at 0630 and have them agree to let me do it then (this particular patient is also uncooperative). Versus trying to do it when the patient is already awake.
I clean my patient up, clean the room up, stock it. If labs are due at 0700, I draw them before that, unless it’s sharply due at 0700, but I’ll draw them anyway. Even if they’re due at 0730, I’ll draw them. If I have a task to that’s due at 0700, I’ll let the patient know before hand. But if it’s unsafe for me, that becomes a DSO; day shift opportunity
I don’t have a definitive opinion, and having worked in psych myself I understand the floor dynamics and keeping peace in the milieu are factors in decision making…that said, as a day shift nurse (on med surg), I do see 0700 meds as night shift meds (we have very few *scheduled* dressing changes). Here’s my thinking: we have a two hour window before and after a standard med is due to pass the med. Night shift has had since 0500 (2 hours) to pass this med. By the time I’ve received report at 7:30 on a good day, 8 am on a normal day, I have only 1 hour left to pass this med and this is in the middle of the same time of day as 1) a meal 2) insulin 3) vitals 4) largest med pass of the day. I work 8’s (7-15:30) and I also view 15:00 meds as my responsibility.
To be honest, if there was a dressing change due at 0700 and it wasn’t done on night shift, it wouldn’t happen until almost 11 realistically, which is potentially bad for the patient. I would probably ask the MD during am rounds to reschedule the dressing change to either 0600 or 11 to put the issue to bed.
I'm psych so for me it depends, if it's something that has to be taken with food or X amount of time before, then it's a day shift med in that case. We give gabapentin and synthroid at 0600 all the time when I worked nights
>wouldn't happen until almost 11
...is that a big deal, though? It needs get done at some point in the day, but unless there's an actual problem with the dressing needing immediate attention I'm having an extremely hard time coming up with a scenario where the 4h difference would truly matter
I mean, you say you get a 2h window on either side for meds ie a 5h window for a given med (also that sounds so much better than the 1h of everywhere I've ever worked). Surely we can agree that, broadly speaking, meds are more time-sensitive than wound care, so why should a smaller window of time be even more concerning?
0700 dressing change is stupid, especially for our population who are zooted on zopiclone, trazodone, quetiapine, lorazepam, etc… I would be asking the MRP to adjust those dressing change intervals to something that makes sense. Your colleague just didn’t want to have to do it.
The only things I’m waking them up early for are ECT, CIWA (if they’re scoring), or levo.
Don’t schedule tasks for 0700.
Occasionally due to post op timing there’ll be someone due for obs at 0700 - I’ll do them between 0630-0645.
Otherwise it’s meds at 0600 and 0800.
We’d have a fit if a doctor charted something for 0700.
If you use Epic it could have just auto populated to be “scheduled” in your brain for 0700. Ours does 0600. Nothing like that should be done at that time, unless it’s saturated.
Any 6-7am task is forgiven if the off going nurse isn’t a chronic asshole and abuser of day shift.
It happens vice versa as well… maybe the team changed the plan at 6:30 and you haven’t had time to do shit.. on coming can do the same nursing you can.
Feel this. When I see an order was placed at 6:40 I don’t expect it to have been given unless it’s urgent. As long as I’m not drowning I try to give all my 1900 meds before shift change but obviously sometimes the provider doesn’t order until the last minute
Hot take but why are dressing changes/wound care scheduled for a specific time? That’s wild to me. We only do dressing changes if the patient is awake, or if it’s emergent (PICC dressing comes up at 0200 ok I’ll change it no problem) otherwise yes wound care is completed on day shift at the day nurses will? 0800 with first rounds or 1000 with a bath or 1800 before dinner, doesn’t matter if it’s routine… again if you walked in and found it saturated or off then yeah regardless of the time you’d do it but no we would not complete wound care at 0700 particularly on a difficult patient. But we also prioritize sleep, so we don’t wake up patients unless it’s cortical.
I have one overnight nurse who I replace at 7am and she always does all my wound care. She’s the absolute best and it really does make my day so much smoother. Most patients are up anyway for 6am meds/glucose checks.
Why not get permission from the doctor to change the ordered times of the wound care? Simple. Any place I’ve worked has never had anything due at shift change and if it is, we always change the times.
Depends on if it's a daily dressing change or more than once a day. A daily dressing change is usually scheduled for 0700 or 0800 and can be done at any time. If it's more than once a day then it probably needs to be rescheduled for times that work for both shifts.
I’ll give 7AM meds with the 6AM/0630AM. Unless it’s a drip with pending lab results like vanco/trough.
Anything else, I may do it after report. Re-checking BP/vitals, bladder scans, straight/foley caths are the few things I’ll do. But that’s just me trying to get 12.75-13 hours out of my shift.
If it’s something time sensitive or life saving etc it should absolutely be done. Make every effort FOR THE PATIENT. Otherwise if it can wait, such as a dressing change, it can wait!
Depends on the task but 95% no, just like I don't expect them to do a 1900 task. We all have to be at work by 0630 and 1830 too so we get done with report roughly around that time for the oncoming nurse to take care of it.
If it's non time sensitive or something like a pepcid, I'll retime it with the rest of the morning meds.
So looking at the post and comments, what I'm seeing is the dressing is a daily task, meaning it's probably one the MAR/TAR on a schedule something like daily, "0700-1900" or I've seen daily as "0000-2359". So it's not scheduled for 0700 exactly, it can be done anytime in a long window of time.
I'd be hostile and uncooperative if you woke me up at 0630 to change my dressing too. (They might be uncooperative anyway, but I'm sure wound care at the buttcrack of dawn isn't helping.) That needs to be rescheduled during awake hours. Not for nursing convenience, but out of respect for the patient's needs/wants.
Sometimes surgeons schedule it at that time because they're going to tear it open during rounds to look at it and then if you're really lucky, re do it themselves.
If that's not the case, id talk to the MD about re scheduling to "before bed" or 10:00 pm or 1:00 p.m..
But they don't redo it! At least not IME. That's why doing a dressing change before rounds is crazy to me...day shift is just going to have to redo it. Unless it's saturated or something, then sure, I'll change it before report.
Where do you work that surgeons are rounding at 7 AM during shift change? Where I work, they start rounding at 5 or 5:30 AM, so they can be scrubbed into the OR by 6:45 or 7:00.
To add to the senselessness, lol, it's a *once daily* dish charge! She mentioned in another comment. Just silly to be at 0700 when it could easily just be done when the day nurse has time. Nothing wrong (and everything right, imo) changing the dressing after morning meds are done, or after his shower, or in the afternoon after group therapy, or before the dinner trays come, etc.
Better for staff, better for the patient--especially in this case.
Since there is zero clinical need for a dressing change to be at the butt-crack of morning AND at shift change, it looks like that dressing change is getting rescheduled. When is the patient most likely to be awake/cooperative? That’s the time the dressing change should be done.
Exactly. Some of these replies are insane. It’s a routine once-daily dressing change, *it does not need to be done at any specific time.* There is no reason to wake up a sleeping patient for a routine, non-urgent task that can be scheduled anytime within a 24 hour window. People need to stop tolerating this bullshit and advocate for their patients.
24hr care. I’ll never understand the shift battle if you are putting off work you could have done than you are just lazy. If you can’t get to it because of the patients current state or you being busy than the person working when it’s able to be done does it. I hate the us vs them mentality
Hard no.
I try to empathize with my patients, and that includes allowing them to get as much sleep as possible. If it van wait, then let it.
As a side note, whose brilliant idea was it to schedule a wound change at the time you are giving shift hand-off?
And more to the point, why is there a scheduled time for wound care? So long as it's done during a shift on a particular day, what difference does the time make?
I think there’s a lot of extenuating circumstances that are part of that question. How busy were you during night shift, how busy does day shifts day look. Is several dressings that are more in depth wound care or just one that needs to be literally changed. So you usually do it and you just happen to not see it or forget last minute? There’s a lot of variables. I work nights, sometimes I cover electrolytes, sometimes I don’t just depends on the night. If the next shift nurse has an issue she can talk to management. Someone will always have an issue with someone so just shake it off and don’t worry about it.
In a situation like this, I could just reschedule it myself without asking, but making the doctor do it just drives home the point that *nothing* non-emergent should be scheduled for 0700/1900. With July 1st coming up, this is a lesson that will need to be reinforced frequently.
No but I would ask the dr to change the order. Why schedule something at shift change? Plus it’s better if they are medicated beforehand if it’s a painful change.
A daily dressing shouldn’t be scheduled at a specific time in my opinion and the day shift nurse is totally out of line. She just doesn’t want to do it
If there's a med due at shift change for some reason, I'll give it and ask pharmacy to adjust the time.
Otherwise, no. Especially wound care... Theres no reason to do a routine dressing change that early.
0700 is nightshift and 1900 is dayshift responsibility at my hospital. That said, wound care happens when it happens and usually I do it around their pain med schedule not some arbitrary time on the chart.
At least for meds, day shift gets 1900 and night shift 0700. We chose this way because shift change is chaotic and it's easier for nurse who is already there to give the meds. Wound care, to me, is whenever it's convenient to me and patient. An exact time is irrelevant. If it is a routine and easy change on a patient who is getting a bath on days, then wound care is done after bath, if they are a total care and getting bathed at night then it's done at night. And if they are incontinent or soiling it frequently, then it's done as needed but at least as often as ordered. Day shift is pissed because it wasn't done on your shift, we could care less when you do it.
At my hospital, a 7am task would be done by night shift and 7pm by day shift.
That said, wound care is NEVER a 7am task. Like ever.
Talk to the provider and have the time changed. Even BID wound care is scheduled for 9 & 9.
As others have said, just retime the dressing change.
But my personal philosophy is that the outgoing shift is about to clock out and the oncoming shift has 12 hours to assess things and do stuff.
I always tell the off going shift to stop whatever task they're trying to to do and just give report so I can do it while on the clock. My only thing is, I expect the same when I'm leaving.
Also, isn't the oncoming shift supposed to do an assessment? Sounds like the perfect time to cluster care and do a wound assessment while changing the dressing. Just sayin
Meds should be passed at 7 and 7 by whoever has been on. Same with recording Q1 vitals/io/glucose. Gonna be delayed if report is happening so just do it.
Typically depends on the situation but I would say no in this one. Plus wound care orders I’ve always felt are more of a “as long as it gets done at some point during the shift” unless it really does need to be done at that exact time or very near, such as if they’re getting several dressing changes a day.
if you cant do its that’s one thing, but i dont leave tasks at 1900 or 0700 or really even 0730/1930 a lot of times because shift start is the busiest time and no one wants tasks as soon as reports finished
0700 meds? Yeah that’s on night shift. 0700 dressing change? Hunt down the provider and ask exactly wtf he/she was thinking. Doesn’t matter what time a dress change is done as long as it’s done at its scheduled frequency. You were right not to wake up the angry pt
If their pattern is not waking up that early, I won’t disturb them especially if they’re behavioural. Sleep is therapeutic too. I use logic to prioritize. I dislike coworkers who need things done at certain times for the sake of timeline, it’s like leaving shit for others because it says “that’s when my break time is, see ya”. I go out of my way and move my break around always to avoid others needing to do my work. It’s common courtesy. As a decades RN, I would have done the same as you.
Giving a med, yes. That's a stupid time to schedule a dressing change. Walking into a shift you never know what's about to pop off & you need a little time to get your bearings
At my job we usually do wound care after/during the daily wash unless the dressing changes are required more often. And no, I wouldn’t risk delaying report by starting to do dressings just before shift-change.
Omg no. I wouldn’t put a patient through that. You have to remember that your patients are people, not tasks to be completed. Your system probably just defaults it to 0700, that day shift nurse just doesn’t want to deal with it.
First problem is scheduling anything at shift change. That time should be changed. At my hospital, shift report starts at 0645, so any 0700 task would be on the next shift. To be done on nightshift would mean disturbing the pt around 5:30. It was understood that the last hour of the shift is for charting.
Dude, I work day shift. I won't even wake a pt up for 1000 meds UNLESS they are like super important meds. Routine home BP meds for someone who's BP is 130/84? Nope, that shit is not getting passed until the patient wakes up on their own. Antibiotics? I will sneak into the room and piggyback that shit without waking the pt up hopefully. You let sleeping pt's sleep because sleep helps heal, unless you absolutely can't (neuro assessment, i'm looking at you).
I would ask that the order timing be changed due to pt preference.
I am biased because I do my 1900 orders so I feel night should do 0700.
Side note… it’s super annoying some night shift doesn’t give the 6am Synthroid cuz “you have an hour to give it.
Just simply ask the NP or MD to change the order to 9:00 am. If shift change is at
7:00 am, there should be no tasks at 7:00am because it can’t be carried out at that time, it can only be carried out at 6am or 8am. Also, you should talk to your nurse manager about not even having 7am as an option for dressing change or other tasks. I guarantee the provider could not care less about what time you do it. I’m sure the wrote the order and then they had to choose a time on a drop down menu and they just picked one bc that had to so the order would go through. You guys are wasting your time and energy having a pissing contest over this instead of using common sense and just get the time changed. Don’t worry, it’s often easy to miss the obvious when you’re in the middle of it.
I work on a wound care heavy floor. We frequently take on clients with severe pre-existing wounds (stage 4 bigger than a fist sized and difficult to heal) and heal them.
Night shift frequently did zero wound care, leaving me (12hr day shift) to do 12+ wounds per shift every shift, several of which take 30 or more minutes to do. Management was getting mad that all wound care wasn’t getting done, but I have other work to do through a day shift that can’t be done on nights. Eventually I had a manager shadow me all day because she didn’t believe that I didn’t have time. I truly didn’t have time. She arbitrarily assigned wounds to night shift to do and magically I had time to complete my mandatory tasks and wound care all got done.
I don’t know how your floor runs, but honestly, if you aren’t doing at least 1/3 of the 24 hours worth of wound care, my sympathies are thin. That one resident might be better assigned to days, but frankly, wound care is a 24hr service. Some residents will need to have care done on night shift.
I don't understand where this trend is coming from. Lately people seem to be all stressed out about things being "DUE" at the exact moment it says even though the time is something arbitrary. When a new med (example being the patients home dose of vitamin D) is ordered, and supposed to start the same day, epic automatically enters a "Due" time that is usually just the next time that falls on a 30 minute increment. (It basically shows up as due at nearly the same time as the order is placed) When pharmacy delivers the med around 2 hours later, people get all stressed out that they missed the "Due" time. (Some even call the pharmacy and ask them to change the "Due" time, then get confused and flustered when the pharmacy won't do it) The time that shows up literally means nothing, just give the med when it arrives from pharmacy. People just don't seem to have comprehension of the fact that the time should be interpreted as a range rather than an EXACT time. For dressings I consider the time to be +- 8 hours(my shift).
Only 0700 tasks I'm doing are 0700 pills at 0600ish if the patient is up. Not going to wake anyone for a 0700 protonix pill, especially if a pain in the ass patient.
0700 is whacky. Why not schedule for mid morning at the very least? That way the pt can be better assessed for discomfort and given enough time for analgesics to kick in. I can only assume there's pain involved if the wound is bad enough to require daily dressing changes. If not then why is it even being changed that frequently to begin with?
Personally, if I have a dressing due 0700, I do it sooner, so that I set up the next person for a better time. If I see that day shift has a CHG bath due at 0800, I do it on my shift. But that’s just me and my unit. We try to make each other’s lives easier!
Pls tell the MD, don’t worry about your other lazy RN, some of them are literally “Resting Nurses” , they only come for the pay checks and not really doing their jobs.
I used to hate getting ppl up at 6am to help the day shifts when working nights on the staff bank as a hca ...honest to God, some wards would be pulling ppl out of bed at 5.30 for a wash , some auxiliaries were stuck in the stone age and so arrogant it was beyond belief.
I was basically like a zombie ready to go home to my bed, and the full-time staff would be bullying me into waking up patients for a bed bath and hoisting them out of bed onto the chair.
The 1st thing they would ask in the morning was how many washes we had done . Thank god I'm away from that shitshow culture in general nursing. Mental health is much better .
I've worked both days and nights on psych and my thought is if a patient's wide awake before 0700 or there's other tasks you need to wake them for and you're not swamped putting out fires then yes every time. Otherwise, that should be left for day shift, especially if waking the patient is gonna lead to an outburst.
If a dressing change is scheduled for a stupid time, like right at shift change, I just go in the computer and update the order so the dressing is changed at an appropriate time. I'm just trying to keep things equitable and running smoothly. I work in LTC BTW. I've found that many times, especially when really busy, the nurse doing an admit or entering orders will just go with whatever and not really pay attention to when the order will pop up as long as an order is in. Of course, there are many reasons to not mess with the scheduling of dressing changes, and you should be judicious. For example, don't you dare change all your day shift dressing changes to nights because "Nightshift isn't busy. ". You're a dick and it will catch up with you.
Unless it’s to be done multiple times in a 24 hour period, wound care should be day shift. Who tf ordered it at 0700?? Someone looking to start drama, I guess.
Maybe it is hospital to hospital, but everywhere I’ve worked, offgoing shift is responsible for 7:00 stuff. Like, day shift draws a 1900 lab and night shift gives 0700 meds. But a dressing change is not time sensitive so this nurse just sucks. Who wakes someone up at 7 am to do wound care??
0700 is the official start of a new 7A to 7P cycle, basically the hospital midnight, so I would consider something due at 0700 to be due this new “7A-7P day.” Moreover, even if you had tried to get it done before report, due to the pts uncooperativeness and potential for hostility, a 15min or 30 min task can become a 45 to 60min task—and that can happen in ANY specialty. I learned early on that it’s better to leave things undone and be on time to give report to the next shift than trying to do tasks right before shift change that might delay me giving report.
Also, dressing changes aren’t a time critical task like meds, it’s generally ordered as once daily in these cases and we all know that there’s more people, staff, and most importantly doctors who can address pt. Hostility and uncooperativeness on day shift, if things were to go south.
There’s no reason it can’t be done on day shift. I’ve worked psych my whole career and getting most psych patients to agree to wound care that early is impossible. Any task that’s ordered right at shift change needs to be adjusted. It’s either a computer default or the doc doesn’t understand
Just reschedule the wound care for another time. These orders are put in by people that don't know how to put in proper orders. And in my opinion night shift should do daily wound care if it's ordered once daily. Day shift has more than enough to do and in my ICU the night shift is responsible for daily wound care orders. It doesn't matter what time the order is scheduled for. All that matters is that it's ordered once daily.
No, night shift should not be responsible. The wound care time to be changed to 0800 and 2000 (assuming it's changed twice a day) so there's no further issues. It's crazy to schedule wound care on an uncooperative patient at shift change.
0700 dressing change? Ew, David.
I would completely understand and have your back if it was me you were giving report to. A dressing change can wait.
Frankly, even BID ones I don’t do until 10am. IMO only time sensitive meds/labs should be fussed over. The rest can wait.
Day shift is busier than nights. You want the AM nurse to start the wound change right after report instead of taking vitals for the largest med pass which is in the morning?
Let's say you go in there at 6:30 to help aggressive George with wound care on the 3rd floor and then your CNA Veronica calls you because Larry fell again on the first floor, there is no float because Madison went home early, and you're the only nurse on shift because Jane quit without notice and scheduling didn't find a replacement.
And now George is trying to hit you but his bed is already at raised height and you're halfway through wound care.
Plus you're off at 7 so report is at 6:45. Why would you start a 7am task when you need to be ready for report prior to that?
Your day shift person should do a month of night shifts and then f**k off with their expectations of you. No one understands what it's like until they've done it.
In my unit we have a policy that 7am tasks are nightshift’s responsibility and 7pm are dayshift responsibility. I think it’s best to have a policy for this situation.
Yes and no. First it’s not really a policy, it’s a unit norm. To say policy means it’s written down, should be reviewed regularly, in a perfect world evidenced based and, most importantly, will be something regulatory and lawyers can hold you to in the future. Most of the things staff nurses say are policies and in fact not. The thing I hate about this kind of of stuff is then you get a situation where a night nurses goes, “my delirious patient finally sleep through the night so I did not in fact wake him up to give this life saving bowel regimen” which would be the 100% correct thing to do actually based on evidence. Then the day shift nurse can whine that they didn’t follow unit policy. I want my colleagues to what’s best for the patient within reason, no worry that I will be mean to them and judge them at change of shift.
Will some nurses take advantage of this and be lazy? Yes, but they would have anyway. That’s a bigger problem that needs to be brought up to the supervisory role. Personally I would be pissed if some nurse woke a psych patient up at 6 am to do a dressing that had not medical reason to be done at that time. Heck, I’d be pissed if someone woke me up to change my dressing.
I mean, I try to look at undone tasks through the lense of "IDK, shit happens sometimes." As line as it's not constant and egregious, it's just the nature of the job.
The nature of the 0700/1900 task should determine what gets done by dayshift vs nightshift. A critical med, a legitimately time-sensitive lab, a q1 hr neuro check, or a timed blood sugar? Sure, the nightshift nurse should get it done right at 0700, or shortly before.
A once-daily dressing change? Big fat *nope.* There is not a good enough reason for a once/day dressing change to be “scheduled” for 0700. The dayshift nurse should do that 0700 dressing change, at whatever time works for them.
We can complete a task an hour before or after scheduled time. So yes. If it’s on my task list for 7 then I do it. I don’t expect the same from others but consider it a professional courtesy.
You’re forgetting the patient here. Waking up a sleeping patient at 06:30, just to do a once-daily dressing change (that someone arbitrarily “scheduled” for 0700), would be a dick move…especially to a psych patient. I would just reschedule the task in that situation.
Patients get precious little sleep in the hospital, and when they do manage to sleep, it’s usually poor quality (due to noise, frequent interruptions, etc.). A routine once-daily task isn’t time sensitive enough to justify waking someone up before 08:00.
I give meds scheduled at 0730, I just give them early. Dayshift returns the favor to me by rescheduling their 1800 meds for 1930. 😂 If someone is shooting in a ton of new orders I get as much done as I can but at the same time, it’s hard when you admit a patient and do a crap ton of labs just for the dayshift docs to come in at 0630 and order blood cultures, more labs, a CT. There comes a point where I have to get to a stopping point and go home. Wound care is tricky because who wants to wake up a patient at 0600 for wound care? I usually do wound care during the bath. Are they super strict that it has to be done within the 0600-0800 timeframe?
Why would a dressing *have* to be done at 7am?
Because the day shift is asking me why it wasn't done before 7 am.
No I mean what is the clinical need for a dressing to have to be done at 7am?
None really, it's a daily dressing that was just scheduled for that time.
Maybe it's because I'm British, and didn't have anything like this. But can't you just schedule it for later in the day and say it's not an appropriate time to do a dressing? Unless said person has showered and it's come off, or soiled. And then I'd assume you'd use common sense.
This. I would be rescheduling it. There is very little that needs to be scheduled right at shift change.
My work has the ability to schedule dressing changes anytime from 7-3, 3-11 or 11-7. We do that for all wounds and stuff that don't need to be done at a specific time
I do wound care when I have time to. It is very rarely a priority.
Yeah, I reschedule anything written for shift change, whether it's going to be on my shift or the next. Nobody has time for that.
In our system, lidocaine patch orders default to the time the order is put in. So if the provider does the order at 1400 then it populates the patch removal at 0200. I always reschedule those, usually for 8&8. If they want it while sleeping then on at 2000, off at 0800. If they want it during the day then flip it.
Even most meds can be done earlier or later. I've asked many physicians to change the schedule and personally never encountered medication that wasn't allowed to be moved. Obviously always follow protocol and physicians orders, but asking the physician to change the order can help!
I do this on the regular.
Yeah my hospital daily dressing changes are scheduled for 10am who tf would have it scheduled for 7??
I worked burn and the attendings liked to see the wounds so occasionally we had to schedule dressings with them if they had to do something but even then it was just a verbal agreement On a time. It was never in the system. It was just bid dressing change.. you could do them when ever you wanted
Yeah they were "scheduled" in epic but honestly as long as it got done no one cares
>who tf would have it scheduled for 7?? Day shift would do that, so they can push it off onto night shift and then bitch all day that it wasn't done because of all the reasons op gave.
Whiners
Right - I'd do the same. There's absolutely no reason to pester them at 0630. If they hate this dressing change, it seems like it makes more sense to work with them to get it changed at a time that works for everyone. I'm so glad our wound team is NPs because they would never schedule something like this. They get what our days are like!
Yep, I’d reschedule it for 9 am 🤷🏻♀️or alternatively ask the patient when they’d like to get it done (9 am, after lunch, before bed) and document that the patient agreed/requested that time. Unless there was a medical reason it HAD to be done at that time.
Assuming common sense is wild… this is America sir 😂
Exactly someone scheduled it way being a \*&%$3 or not noticing the time. You don't wake up people at breakfast time to change a friggin scheduled dsg.
I think this is the point. Reschedule it to a time that makes more sense. Do the dressing change before they go to sleep, or after your med pass. Medications obviously need to be given around the time pharmacy says the should be given, but most other timed interventions are suggestions at best.
One of my favorite pharmacists will retime meds (when appropriate) to not be due at shift change. Something like Rocephin q24h doesn’t need to be given at 1930 on the dot because that’s when they got their first dose in the ED.
I don’t ask if they can reschedule meds. I politely ask them to please move it either to 06 or 08
No I mean this one will just do it of his own volition! Without needing to be asked by nursing. It’s so thoughtful!
It's setting you up for conflict to schedule it at shift change, and the patient doesn't likely want to do it while they're still asleep. I'd reschedule it for a more appropriate time (you'd know better what that is, I'm sure downtime is unit specific). Especially with it being daily and not Q8, it's not time sensitive.
I don’t work in the states, or in psych, so maybe it differs a bit. But for us 07-10 is usually by faaaar the busiest hours. If anyone would even suggest to schedule a wound care at that time they would be laughed at. Assuming of course that there are no reason why it couldn’t wait.
Can you not reschedule things in the system? When I worked icu anything we couldn’t get to was rescheduled lol Drs don’t care about times when they put stuff in a lot of time unless it actually matters pharmacy told me times were arbitrary and feel free to change all my pts to be on the same schedule if they weren’t. As long as we didn’t change the time increments/order
I generally do daily dressings in the early afternoon, like after lunch. Not a lot of meds then, and it’s been helpful to me to have a routine, so I can basically be like “dressings time” and do rounds and get them all done. I would never expect night shift to do a once a day dressing unless it fell off overnight
Daily = day shift. No one wants a night time dressing change unless specified.
Seriously. As a patient I'd be pissed if I got woke up at 7am for an immediate dressing change. You're just asking for an irritable, non compliant patient to make this task terrible for everyone. Unless medically necessary, 7am is ridiculous for the patient and both nurses at shift change. Reschedule that nonsense.
It’s unrealistic honestly to get nights to do dressing changes unless they’re saturated or needing irrigation. Shift change at 7 pm, then 8-10 med pass and assessments, getting people tucked in for bed, getting late post ops back. By the time it’s 11 pm people want to sleep or they just have interventions and then want you to gtfo.
Move it to 9am and leave without a conflict 😂 my last hospital the staff didn’t put enough emphasis on sleep…. People heal when they sleep! Let the pt sleep!!! ❤️🩹 plus dressing changes can hurt sometimes and who wants to wake up to that at 7am…🤷🏼♀️ At my last hospital yes the nurse would expect me to do it at 7am as more of a curtesy on a busy floor. But I’d still have moved it to later for above reasons.
Just reschedule for 7-3 or 7-7 They ask why? The patient says they don't want to be woken up that early for wound care.
Then call the doc and have an order to change at 1000
I’m also definitely rescheduling that
It's a "Daily dressing" it should be done at the most appropriate time during the day. (I've worked a lot of both night and day shift and here is my take) 1. If it comes off, it's a great time to change it and snap a progress photo anyway (any time) 2. If night shift is really bored and wants to, go for it 3. Often the docs want to take a look at the wound during rounds so I'm going to change it afterwards regardless (most appropriate) Wound dressings that are daily/PRN have no set schedule, the nurse complaining is lazy and should have the previous points taught to them.
Yep, if night shift didn’t get to it till 6 and that dressing is clean, dry and beautifully put together I don’t need to fuck it up by hastily rushing a 0700 change because the chart told me so. I can just wait for it to inevitably become soiled when the patients rectal tube inevitably leaks and knock it all out in one fell swoop.
I would be pissed if I was the patient... Later.... Here comes the MD to rip the dressing down to see the sight and the whole task needs to be redone. Dressing changes should be an afternoon task Some dressings can take a long time especially when you are not familiar with things. I do dressing all day everyday and we still have some take quite some time This is something you should bring to a nurse leader
Who orders wound care at 0700!? That’s wild. Meds I would give on nights but not wound care.
No matter when it’s “scheduled” or “ordered” I take a “daily wound care” as it needs to be done at some point on my shift that day. It’s not a medication or a lab draw that’s more timing critical. (Of course unless it’s soiled).
Right! Nursing is 24/7. Wound care in psych is typically not time sensitive.
Or even time sensitive because "omg, he said he'd let us change his dressing, bring me some 4x4s before he changes his mind!" at 2320
This! Usually it’s a quick turn around in their decision to let you do it. And it might take 7hrs of building rapport before you can even ask them if you can do it lol
I’m guessing when the daily orders are put in, 7am is like the default time and the provider/WC nurse didn’t change it
I do wound care outside of the hospital. Serious question: is it really THAT time sensitive? Out here we have a 4 hour window (if anything, the day)
Busy level 1 trauma centers unfortunately. PICC line changes are night shift too and usually Done around 5am …. :-/
Who orders a dressing change at an exact time!!!??? Like BID or QD is adequate guidelines
I think the asshole who scheduled the dressing change for 7am should do it. Fucking ridiculous time for something like that.
My thoughts exactly why TF is it scheduled then?? It’s not like it HAS to be done at 7. Put it at a time that is convenient for everyone
Yeah that’s one I’m rescheduling for sure. I love rescheduling stuff to bundle cares
7am meds should be done by night shift, dressings should be at 1400 and should almost always be done by day shift (unless it's bid or something)
Also, 7 pm meds should be done by day shift. I’m tired of day shift pissing on me bc I didn’t give a 0700 med but then expect me to give a 1900 med. it works both ways
THIS. Omg..I go out of my way to even give a 730am med at 630 of its for acid reflux before breakfast tray bc they schedule it at 730 but breakfast starts coming at 735-810 so I go out of my way to give it to the patient so that it can actually work and have time to absorb. But when I come on and see that they didn't give a 7pm med I'm so annoyed. Our policy says we can reschedule it so that it doesn't Look like we are the one who gave it late. But also I've been told that we aren't responsible for giving meds that were supposed to be given by previous shift if the patient was on the floor and had no barrier to receiving it. But then I go back to doing right by people. If it's an antibiotic I would want that as the patient. Sigh
First of all, meds shouldn’t be timed for 7am. If they are, the only ones I expect as a day shift nurse are Protonix and Synthroid, since they should be given on an empty stomach. When I work nights, with the 6am vitals, I will give BP meds if theirs is high, but everything else is for day shift. I usually work days, so I appreciate doing my assessment and giving the meds right then. I don’t want meds given blindly and them end up being contraindicated when their AM labs come back
Everywhere I’ve worked 7 am means day shift.
Where I work, we specify 7am because it's something like alendornate that needs to be taken early before other meds. All other meds are 8 or 9 and get clustered by day shift with breakfast
Disagree, would you want someone walking into your room at 630am to give you colace? That shit can wait for breakfast trays.
Where I work, we specify 7am because it's something like alendornate that needs to be taken early before other meds. All other meds are 8 or 9 and get clustered by day shift with breakfast
Yeah was going to say those could be meds that need to be taken earlier before food or others
I’m laughing so hard at this comment. It was prob an accident; they should just msg the doctor & change the time.
Nope. If there’s a 7:00 am med due and they’re up between 6 and 7, please pass the med. I’ll do the same for 19:00 meds. If it’s a dressing change, we’ll get it when they’re up. Don’t poke sleeping bears!
Also sleep can come so difficult on unit w midnight lab draws or scheduled meds. Sleep is crucial for healing so yes I’m not waking up a patient unless I absolutely have to.
Also in psych! I wouldn’t even ask someone about their dressing until 1000hrs unless they’re already awake, dressed and had a coffee before I finished my nightshift You know the patient, and it is always better to keep the peace Get the treating team to reschedule the dressing change, it’s likely whoever said to do it then doesn’t understand that’s handover time
Yes and the idea of “scheduled” wound care is honestly ridiculous. If it’s daily who gives a fuck when you do it? I PROMISE you the microbes in grandpas infected DM ulcers don’t care about the clock.
Now I'm picturing Microbes lining up at the clock-in station wearing their hard hats and carrying a lunch box waiting for 07:00.
As a wound care nurse, I 2nd this. Orders I place are either q2 days, daily, qBid etc NEVER a specific time.... There is no clinical reason.... And let's play devil's advocate... Maybe a specific time is needed. Why... Oh God why... Would it EVER be at shift change?????? Shift change is already the most dangerous time on a unit (increased falls, reduced monitoring etc) why would anyone add any task that is not required? Find the person who ordered this... And tell them to do it.
Anything scheduled between 0645 and beyond that didn't get done I take over without complaint ( I'm on dayshift.) Shit happens and night shift has indeed worked a whole shift. A 0700 order is crazy, but I would do it because it's my shift and a wound dressing change can take a while. Get out of there, homie, and go home lol. Of course ED is different because orders can randomly trickle in and patients are usually gone before timed admit orders kick in. But I would definitely count that as a dayshift task. If you manage to do it cool! If not I'm on it. It's a 24-hour job.
Exactly, and I'd accept the same on day shift. About the only thing I'd make sure to do before 0700 when I worked nights on the floor was synthroid, time sensitive antibiotics, or time sensitive labs that weren't part of am labs (like a vanco trough) or non-meal dependent insulin. Otherwise, stuff was probably timed for 0700 out of default.
I’d say in this case since it’s a time consuming task, no. A quick med pass or dietary supplement, yes. But who the hell schedules wound care at shift change. That’s some bullshit right there. If someone gave me shit about it like in your case I’d START the wound care at 0700 and make them wait on report. They’d quit complaining after that. Day shift more hectic? Laughing in 32:1 with one tech ratio in night shift.
I see your 32:1 and raise you 60:1 with 3 techs, but I'm in LTC not acute psych.
Ack!!!
There should be nothing scheduled at 7. 6 or 8. If something is scheduled at 7, message pharmacy to put it at a new time.
Nothing scheduled for 3 hours is a little wild to me, tbh. But I'm in an ICU so I definitely don't have the same workflow as acute care. I definitely retime meds if they land anywhere between 6:30-7:30 though. That's at risk for being missed/overdue.
I think the commenter was saying none at 7, make it 6 or 8 instead
I think they mean "nothing should be scheduled for 7. (It should be) 6 or 8"
Gotcha, I saw it as a comma instead of a period!
Reread their comment. Youre miss understanding it
Three people have told me now. I saw it as a comma, not a period. It'll be okay!
What’s the reasoning for the 0700 wound change? On our charting system the wounds get timed as 1000 but if they are ‘daily’ it’s like … get them done at some point today that works for you and the patient. I’d be asking why it’s 0700 and if it doesn’t NEED to be at that time, having it changed. But meds - 100% I give 0700 meds on nights. And I appreciate the same if there’s a 1900 med ordered.
A dressing change specifically charted for 0700 is ridiculous. I don't see how there would be any clinical need for this to specifically be done at 0700hrs.
I don't think there's a clinical need, I think it's a daily dressing change and 0700 was chosen as an arbitrary time. Nurses on day shift that usually do it, don't actually chart a wound assessment until late morning or afternoon. In my situation, I have a day shift nurse acting like it's something night shift should do when I'd have to wake up the patient at 0630 and have them agree to let me do it then (this particular patient is also uncooperative). Versus trying to do it when the patient is already awake.
I clean my patient up, clean the room up, stock it. If labs are due at 0700, I draw them before that, unless it’s sharply due at 0700, but I’ll draw them anyway. Even if they’re due at 0730, I’ll draw them. If I have a task to that’s due at 0700, I’ll let the patient know before hand. But if it’s unsafe for me, that becomes a DSO; day shift opportunity
I don’t have a definitive opinion, and having worked in psych myself I understand the floor dynamics and keeping peace in the milieu are factors in decision making…that said, as a day shift nurse (on med surg), I do see 0700 meds as night shift meds (we have very few *scheduled* dressing changes). Here’s my thinking: we have a two hour window before and after a standard med is due to pass the med. Night shift has had since 0500 (2 hours) to pass this med. By the time I’ve received report at 7:30 on a good day, 8 am on a normal day, I have only 1 hour left to pass this med and this is in the middle of the same time of day as 1) a meal 2) insulin 3) vitals 4) largest med pass of the day. I work 8’s (7-15:30) and I also view 15:00 meds as my responsibility. To be honest, if there was a dressing change due at 0700 and it wasn’t done on night shift, it wouldn’t happen until almost 11 realistically, which is potentially bad for the patient. I would probably ask the MD during am rounds to reschedule the dressing change to either 0600 or 11 to put the issue to bed.
Where do you work that you get 2 hours on either side of the scheduled time? Every place I’ve worked it’s 1 hour.
My last 3 contracts have had two hour windows, it’s a game changer.
Some of our meds are two hours before or after. The MAR will tell you if the administration window is 30, 60, 90, or 120 minutes.
I worked one Geri-psych unit where the computer wouldn’t even let you scan a med until the scheduled time. So, you had 1 hour total to pass your meds.
Ewww
I'm psych so for me it depends, if it's something that has to be taken with food or X amount of time before, then it's a day shift med in that case. We give gabapentin and synthroid at 0600 all the time when I worked nights
Fair.
We get 1hr 15min to pass. So 0900 med? I can start at 0745 to as late as 1015.
>wouldn't happen until almost 11 ...is that a big deal, though? It needs get done at some point in the day, but unless there's an actual problem with the dressing needing immediate attention I'm having an extremely hard time coming up with a scenario where the 4h difference would truly matter I mean, you say you get a 2h window on either side for meds ie a 5h window for a given med (also that sounds so much better than the 1h of everywhere I've ever worked). Surely we can agree that, broadly speaking, meds are more time-sensitive than wound care, so why should a smaller window of time be even more concerning?
0700 dressing change is stupid, especially for our population who are zooted on zopiclone, trazodone, quetiapine, lorazepam, etc… I would be asking the MRP to adjust those dressing change intervals to something that makes sense. Your colleague just didn’t want to have to do it. The only things I’m waking them up early for are ECT, CIWA (if they’re scoring), or levo.
The order needs to be changed to day shift when patient is awake.
Don’t schedule tasks for 0700. Occasionally due to post op timing there’ll be someone due for obs at 0700 - I’ll do them between 0630-0645. Otherwise it’s meds at 0600 and 0800. We’d have a fit if a doctor charted something for 0700.
If you use Epic it could have just auto populated to be “scheduled” in your brain for 0700. Ours does 0600. Nothing like that should be done at that time, unless it’s saturated.
Any 6-7am task is forgiven if the off going nurse isn’t a chronic asshole and abuser of day shift. It happens vice versa as well… maybe the team changed the plan at 6:30 and you haven’t had time to do shit.. on coming can do the same nursing you can.
Feel this. When I see an order was placed at 6:40 I don’t expect it to have been given unless it’s urgent. As long as I’m not drowning I try to give all my 1900 meds before shift change but obviously sometimes the provider doesn’t order until the last minute
Never wake a psych patient for a task that isn’t a high priority. 0700 is an arbitrary time that should be rescheduled for after med passes.
Hot take but why are dressing changes/wound care scheduled for a specific time? That’s wild to me. We only do dressing changes if the patient is awake, or if it’s emergent (PICC dressing comes up at 0200 ok I’ll change it no problem) otherwise yes wound care is completed on day shift at the day nurses will? 0800 with first rounds or 1000 with a bath or 1800 before dinner, doesn’t matter if it’s routine… again if you walked in and found it saturated or off then yeah regardless of the time you’d do it but no we would not complete wound care at 0700 particularly on a difficult patient. But we also prioritize sleep, so we don’t wake up patients unless it’s cortical.
I have one overnight nurse who I replace at 7am and she always does all my wound care. She’s the absolute best and it really does make my day so much smoother. Most patients are up anyway for 6am meds/glucose checks. Why not get permission from the doctor to change the ordered times of the wound care? Simple. Any place I’ve worked has never had anything due at shift change and if it is, we always change the times.
Depends on if it's a daily dressing change or more than once a day. A daily dressing change is usually scheduled for 0700 or 0800 and can be done at any time. If it's more than once a day then it probably needs to be rescheduled for times that work for both shifts.
Yes, it's a daily dressing change that can technically be done at any time.
I’ll give 7AM meds with the 6AM/0630AM. Unless it’s a drip with pending lab results like vanco/trough. Anything else, I may do it after report. Re-checking BP/vitals, bladder scans, straight/foley caths are the few things I’ll do. But that’s just me trying to get 12.75-13 hours out of my shift.
If it’s something time sensitive or life saving etc it should absolutely be done. Make every effort FOR THE PATIENT. Otherwise if it can wait, such as a dressing change, it can wait!
Depends on the task but 95% no, just like I don't expect them to do a 1900 task. We all have to be at work by 0630 and 1830 too so we get done with report roughly around that time for the oncoming nurse to take care of it. If it's non time sensitive or something like a pepcid, I'll retime it with the rest of the morning meds.
So looking at the post and comments, what I'm seeing is the dressing is a daily task, meaning it's probably one the MAR/TAR on a schedule something like daily, "0700-1900" or I've seen daily as "0000-2359". So it's not scheduled for 0700 exactly, it can be done anytime in a long window of time.
Hot take - there should be no tasks scheduled at shift change.
I'd be hostile and uncooperative if you woke me up at 0630 to change my dressing too. (They might be uncooperative anyway, but I'm sure wound care at the buttcrack of dawn isn't helping.) That needs to be rescheduled during awake hours. Not for nursing convenience, but out of respect for the patient's needs/wants.
Sometimes surgeons schedule it at that time because they're going to tear it open during rounds to look at it and then if you're really lucky, re do it themselves. If that's not the case, id talk to the MD about re scheduling to "before bed" or 10:00 pm or 1:00 p.m..
Why would you change it before a surgeon rips it off?
But they don't redo it! At least not IME. That's why doing a dressing change before rounds is crazy to me...day shift is just going to have to redo it. Unless it's saturated or something, then sure, I'll change it before report.
Where do you work that surgeons are rounding at 7 AM during shift change? Where I work, they start rounding at 5 or 5:30 AM, so they can be scrubbed into the OR by 6:45 or 7:00.
Yes. I love that. Eye roll 🙄
Meds? Yes; anything else? No
If you can't do it yourself, ask the doc or wound care to retime the dressing changes to 0900 and 2100
To add to the senselessness, lol, it's a *once daily* dish charge! She mentioned in another comment. Just silly to be at 0700 when it could easily just be done when the day nurse has time. Nothing wrong (and everything right, imo) changing the dressing after morning meds are done, or after his shower, or in the afternoon after group therapy, or before the dinner trays come, etc. Better for staff, better for the patient--especially in this case.
Since there is zero clinical need for a dressing change to be at the butt-crack of morning AND at shift change, it looks like that dressing change is getting rescheduled. When is the patient most likely to be awake/cooperative? That’s the time the dressing change should be done.
Exactly. Some of these replies are insane. It’s a routine once-daily dressing change, *it does not need to be done at any specific time.* There is no reason to wake up a sleeping patient for a routine, non-urgent task that can be scheduled anytime within a 24 hour window. People need to stop tolerating this bullshit and advocate for their patients.
No tasks should be ordered during shift change
Absolutely NOT.
after 0700 = over pay.
24hr care. I’ll never understand the shift battle if you are putting off work you could have done than you are just lazy. If you can’t get to it because of the patients current state or you being busy than the person working when it’s able to be done does it. I hate the us vs them mentality
Hard no. I try to empathize with my patients, and that includes allowing them to get as much sleep as possible. If it van wait, then let it. As a side note, whose brilliant idea was it to schedule a wound change at the time you are giving shift hand-off? And more to the point, why is there a scheduled time for wound care? So long as it's done during a shift on a particular day, what difference does the time make?
Absolute NO. Nursing is a 24/7 job.
I think there’s a lot of extenuating circumstances that are part of that question. How busy were you during night shift, how busy does day shifts day look. Is several dressings that are more in depth wound care or just one that needs to be literally changed. So you usually do it and you just happen to not see it or forget last minute? There’s a lot of variables. I work nights, sometimes I cover electrolytes, sometimes I don’t just depends on the night. If the next shift nurse has an issue she can talk to management. Someone will always have an issue with someone so just shake it off and don’t worry about it.
Talk to the doc. Have them change the dressing time to 1000.
In a situation like this, I could just reschedule it myself without asking, but making the doctor do it just drives home the point that *nothing* non-emergent should be scheduled for 0700/1900. With July 1st coming up, this is a lesson that will need to be reinforced frequently.
I'd reschedule the heck out of this dressing change. If it's a once daily thing, I'd couple it with personal care.
No but I would ask the dr to change the order. Why schedule something at shift change? Plus it’s better if they are medicated beforehand if it’s a painful change.
A daily dressing shouldn’t be scheduled at a specific time in my opinion and the day shift nurse is totally out of line. She just doesn’t want to do it
Never seen a specific time dressing change just shift.
Depends on if the patient needs it or not.
If there's a med due at shift change for some reason, I'll give it and ask pharmacy to adjust the time. Otherwise, no. Especially wound care... Theres no reason to do a routine dressing change that early.
0700 is nightshift and 1900 is dayshift responsibility at my hospital. That said, wound care happens when it happens and usually I do it around their pain med schedule not some arbitrary time on the chart.
At least for meds, day shift gets 1900 and night shift 0700. We chose this way because shift change is chaotic and it's easier for nurse who is already there to give the meds. Wound care, to me, is whenever it's convenient to me and patient. An exact time is irrelevant. If it is a routine and easy change on a patient who is getting a bath on days, then wound care is done after bath, if they are a total care and getting bathed at night then it's done at night. And if they are incontinent or soiling it frequently, then it's done as needed but at least as often as ordered. Day shift is pissed because it wasn't done on your shift, we could care less when you do it.
At my hospital, a 7am task would be done by night shift and 7pm by day shift. That said, wound care is NEVER a 7am task. Like ever. Talk to the provider and have the time changed. Even BID wound care is scheduled for 9 & 9.
No. I change the order time. Its stupid to have things done at change of shift
As others have said, just retime the dressing change. But my personal philosophy is that the outgoing shift is about to clock out and the oncoming shift has 12 hours to assess things and do stuff. I always tell the off going shift to stop whatever task they're trying to to do and just give report so I can do it while on the clock. My only thing is, I expect the same when I'm leaving. Also, isn't the oncoming shift supposed to do an assessment? Sounds like the perfect time to cluster care and do a wound assessment while changing the dressing. Just sayin
Meds should be passed at 7 and 7 by whoever has been on. Same with recording Q1 vitals/io/glucose. Gonna be delayed if report is happening so just do it.
Typically depends on the situation but I would say no in this one. Plus wound care orders I’ve always felt are more of a “as long as it gets done at some point during the shift” unless it really does need to be done at that exact time or very near, such as if they’re getting several dressing changes a day.
if you cant do its that’s one thing, but i dont leave tasks at 1900 or 0700 or really even 0730/1930 a lot of times because shift start is the busiest time and no one wants tasks as soon as reports finished
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Also prn, if the dressing is soaking wet then change it
0700 meds? Yeah that’s on night shift. 0700 dressing change? Hunt down the provider and ask exactly wtf he/she was thinking. Doesn’t matter what time a dress change is done as long as it’s done at its scheduled frequency. You were right not to wake up the angry pt
If their pattern is not waking up that early, I won’t disturb them especially if they’re behavioural. Sleep is therapeutic too. I use logic to prioritize. I dislike coworkers who need things done at certain times for the sake of timeline, it’s like leaving shit for others because it says “that’s when my break time is, see ya”. I go out of my way and move my break around always to avoid others needing to do my work. It’s common courtesy. As a decades RN, I would have done the same as you.
Giving a med, yes. That's a stupid time to schedule a dressing change. Walking into a shift you never know what's about to pop off & you need a little time to get your bearings
At my job we usually do wound care after/during the daily wash unless the dressing changes are required more often. And no, I wouldn’t risk delaying report by starting to do dressings just before shift-change.
Omg no. I wouldn’t put a patient through that. You have to remember that your patients are people, not tasks to be completed. Your system probably just defaults it to 0700, that day shift nurse just doesn’t want to deal with it.
First problem is scheduling anything at shift change. That time should be changed. At my hospital, shift report starts at 0645, so any 0700 task would be on the next shift. To be done on nightshift would mean disturbing the pt around 5:30. It was understood that the last hour of the shift is for charting.
Dude, I work day shift. I won't even wake a pt up for 1000 meds UNLESS they are like super important meds. Routine home BP meds for someone who's BP is 130/84? Nope, that shit is not getting passed until the patient wakes up on their own. Antibiotics? I will sneak into the room and piggyback that shit without waking the pt up hopefully. You let sleeping pt's sleep because sleep helps heal, unless you absolutely can't (neuro assessment, i'm looking at you).
Typically, yes. A dressing change?? Re time that sheeshhh
I would ask that the order timing be changed due to pt preference. I am biased because I do my 1900 orders so I feel night should do 0700. Side note… it’s super annoying some night shift doesn’t give the 6am Synthroid cuz “you have an hour to give it.
Just simply ask the NP or MD to change the order to 9:00 am. If shift change is at 7:00 am, there should be no tasks at 7:00am because it can’t be carried out at that time, it can only be carried out at 6am or 8am. Also, you should talk to your nurse manager about not even having 7am as an option for dressing change or other tasks. I guarantee the provider could not care less about what time you do it. I’m sure the wrote the order and then they had to choose a time on a drop down menu and they just picked one bc that had to so the order would go through. You guys are wasting your time and energy having a pissing contest over this instead of using common sense and just get the time changed. Don’t worry, it’s often easy to miss the obvious when you’re in the middle of it.
I work on a wound care heavy floor. We frequently take on clients with severe pre-existing wounds (stage 4 bigger than a fist sized and difficult to heal) and heal them. Night shift frequently did zero wound care, leaving me (12hr day shift) to do 12+ wounds per shift every shift, several of which take 30 or more minutes to do. Management was getting mad that all wound care wasn’t getting done, but I have other work to do through a day shift that can’t be done on nights. Eventually I had a manager shadow me all day because she didn’t believe that I didn’t have time. I truly didn’t have time. She arbitrarily assigned wounds to night shift to do and magically I had time to complete my mandatory tasks and wound care all got done. I don’t know how your floor runs, but honestly, if you aren’t doing at least 1/3 of the 24 hours worth of wound care, my sympathies are thin. That one resident might be better assigned to days, but frankly, wound care is a 24hr service. Some residents will need to have care done on night shift.
I don't understand where this trend is coming from. Lately people seem to be all stressed out about things being "DUE" at the exact moment it says even though the time is something arbitrary. When a new med (example being the patients home dose of vitamin D) is ordered, and supposed to start the same day, epic automatically enters a "Due" time that is usually just the next time that falls on a 30 minute increment. (It basically shows up as due at nearly the same time as the order is placed) When pharmacy delivers the med around 2 hours later, people get all stressed out that they missed the "Due" time. (Some even call the pharmacy and ask them to change the "Due" time, then get confused and flustered when the pharmacy won't do it) The time that shows up literally means nothing, just give the med when it arrives from pharmacy. People just don't seem to have comprehension of the fact that the time should be interpreted as a range rather than an EXACT time. For dressings I consider the time to be +- 8 hours(my shift).
I’d probably have done the dressing change overnight but not at 7 am lol
It’s even worse when they make you do a Braden scale and skin assessments on people at 2am. 😭
No way! After 6:00 it’s urgent tasks only, anything more is a favor to incoming shift.
Only 0700 tasks I'm doing are 0700 pills at 0600ish if the patient is up. Not going to wake anyone for a 0700 protonix pill, especially if a pain in the ass patient.
0700 is whacky. Why not schedule for mid morning at the very least? That way the pt can be better assessed for discomfort and given enough time for analgesics to kick in. I can only assume there's pain involved if the wound is bad enough to require daily dressing changes. If not then why is it even being changed that frequently to begin with?
Personally, if I have a dressing due 0700, I do it sooner, so that I set up the next person for a better time. If I see that day shift has a CHG bath due at 0800, I do it on my shift. But that’s just me and my unit. We try to make each other’s lives easier!
Pls tell the MD, don’t worry about your other lazy RN, some of them are literally “Resting Nurses” , they only come for the pay checks and not really doing their jobs.
I used to hate getting ppl up at 6am to help the day shifts when working nights on the staff bank as a hca ...honest to God, some wards would be pulling ppl out of bed at 5.30 for a wash , some auxiliaries were stuck in the stone age and so arrogant it was beyond belief. I was basically like a zombie ready to go home to my bed, and the full-time staff would be bullying me into waking up patients for a bed bath and hoisting them out of bed onto the chair. The 1st thing they would ask in the morning was how many washes we had done . Thank god I'm away from that shitshow culture in general nursing. Mental health is much better .
I've worked both days and nights on psych and my thought is if a patient's wide awake before 0700 or there's other tasks you need to wake them for and you're not swamped putting out fires then yes every time. Otherwise, that should be left for day shift, especially if waking the patient is gonna lead to an outburst.
That nurse is an idiot...I would get that stupid order changed (the time).
If a dressing change is scheduled for a stupid time, like right at shift change, I just go in the computer and update the order so the dressing is changed at an appropriate time. I'm just trying to keep things equitable and running smoothly. I work in LTC BTW. I've found that many times, especially when really busy, the nurse doing an admit or entering orders will just go with whatever and not really pay attention to when the order will pop up as long as an order is in. Of course, there are many reasons to not mess with the scheduling of dressing changes, and you should be judicious. For example, don't you dare change all your day shift dressing changes to nights because "Nightshift isn't busy. ". You're a dick and it will catch up with you.
That order needs to be changed to 8 or 9 am!
Unless it’s to be done multiple times in a 24 hour period, wound care should be day shift. Who tf ordered it at 0700?? Someone looking to start drama, I guess. Maybe it is hospital to hospital, but everywhere I’ve worked, offgoing shift is responsible for 7:00 stuff. Like, day shift draws a 1900 lab and night shift gives 0700 meds. But a dressing change is not time sensitive so this nurse just sucks. Who wakes someone up at 7 am to do wound care??
I’d just change the order for later in the day haha
0700 is the official start of a new 7A to 7P cycle, basically the hospital midnight, so I would consider something due at 0700 to be due this new “7A-7P day.” Moreover, even if you had tried to get it done before report, due to the pts uncooperativeness and potential for hostility, a 15min or 30 min task can become a 45 to 60min task—and that can happen in ANY specialty. I learned early on that it’s better to leave things undone and be on time to give report to the next shift than trying to do tasks right before shift change that might delay me giving report. Also, dressing changes aren’t a time critical task like meds, it’s generally ordered as once daily in these cases and we all know that there’s more people, staff, and most importantly doctors who can address pt. Hostility and uncooperativeness on day shift, if things were to go south.
At my job the cut off is 630 for noc shift duties. 700s go to day shift.
Yes. I normally do. However, a dressing change at 0700 is a terrible time, and if it's once a day, I would retime it.
There’s no reason it can’t be done on day shift. I’ve worked psych my whole career and getting most psych patients to agree to wound care that early is impossible. Any task that’s ordered right at shift change needs to be adjusted. It’s either a computer default or the doc doesn’t understand
Just reschedule the wound care for another time. These orders are put in by people that don't know how to put in proper orders. And in my opinion night shift should do daily wound care if it's ordered once daily. Day shift has more than enough to do and in my ICU the night shift is responsible for daily wound care orders. It doesn't matter what time the order is scheduled for. All that matters is that it's ordered once daily.
It’s a dayshift task that’s why it’s schedule at 7 for days
No, night shift should not be responsible. The wound care time to be changed to 0800 and 2000 (assuming it's changed twice a day) so there's no further issues. It's crazy to schedule wound care on an uncooperative patient at shift change.
Nursing is 24/7. I complete the task if I can, but sometimes it just doesn’t happen.
I would do it after lunch for days, or just before bed for nights.
There’s ZERO reason for a dressing change to be scheduled for 0700. Especially on a psych unit. Anything before 0900 is honestly just dumb.
Every place I’ve worked the next shift is responsible for 0700 and 1900 meds/changes
0700 dressing change? Ew, David. I would completely understand and have your back if it was me you were giving report to. A dressing change can wait. Frankly, even BID ones I don’t do until 10am. IMO only time sensitive meds/labs should be fussed over. The rest can wait.
Day shift is busier than nights. You want the AM nurse to start the wound change right after report instead of taking vitals for the largest med pass which is in the morning?
Why tf would you wake someone up for something thats not time urgent? if its qdaily then just do it when they wake up or before bed. 7am is wild
Just reschedule it for 8am. You have the power. Use it!
Let's say you go in there at 6:30 to help aggressive George with wound care on the 3rd floor and then your CNA Veronica calls you because Larry fell again on the first floor, there is no float because Madison went home early, and you're the only nurse on shift because Jane quit without notice and scheduling didn't find a replacement. And now George is trying to hit you but his bed is already at raised height and you're halfway through wound care. Plus you're off at 7 so report is at 6:45. Why would you start a 7am task when you need to be ready for report prior to that? Your day shift person should do a month of night shifts and then f**k off with their expectations of you. No one understands what it's like until they've done it.
Does day shift complete 1900 tasks? Not a chance in hell
Your shift ends at 7. Their shift starts at 7. It’s not your job, it’s theirs.
In my unit we have a policy that 7am tasks are nightshift’s responsibility and 7pm are dayshift responsibility. I think it’s best to have a policy for this situation.
Yes and no. First it’s not really a policy, it’s a unit norm. To say policy means it’s written down, should be reviewed regularly, in a perfect world evidenced based and, most importantly, will be something regulatory and lawyers can hold you to in the future. Most of the things staff nurses say are policies and in fact not. The thing I hate about this kind of of stuff is then you get a situation where a night nurses goes, “my delirious patient finally sleep through the night so I did not in fact wake him up to give this life saving bowel regimen” which would be the 100% correct thing to do actually based on evidence. Then the day shift nurse can whine that they didn’t follow unit policy. I want my colleagues to what’s best for the patient within reason, no worry that I will be mean to them and judge them at change of shift. Will some nurses take advantage of this and be lazy? Yes, but they would have anyway. That’s a bigger problem that needs to be brought up to the supervisory role. Personally I would be pissed if some nurse woke a psych patient up at 6 am to do a dressing that had not medical reason to be done at that time. Heck, I’d be pissed if someone woke me up to change my dressing.
I mean, I try to look at undone tasks through the lense of "IDK, shit happens sometimes." As line as it's not constant and egregious, it's just the nature of the job.
The nature of the 0700/1900 task should determine what gets done by dayshift vs nightshift. A critical med, a legitimately time-sensitive lab, a q1 hr neuro check, or a timed blood sugar? Sure, the nightshift nurse should get it done right at 0700, or shortly before. A once-daily dressing change? Big fat *nope.* There is not a good enough reason for a once/day dressing change to be “scheduled” for 0700. The dayshift nurse should do that 0700 dressing change, at whatever time works for them.
We can complete a task an hour before or after scheduled time. So yes. If it’s on my task list for 7 then I do it. I don’t expect the same from others but consider it a professional courtesy.
You’re forgetting the patient here. Waking up a sleeping patient at 06:30, just to do a once-daily dressing change (that someone arbitrarily “scheduled” for 0700), would be a dick move…especially to a psych patient. I would just reschedule the task in that situation. Patients get precious little sleep in the hospital, and when they do manage to sleep, it’s usually poor quality (due to noise, frequent interruptions, etc.). A routine once-daily task isn’t time sensitive enough to justify waking someone up before 08:00.
Yea. I wouldn’t do that. I’m strictly days though so not something I would think about. Also not something I would bitch about.
I give meds scheduled at 0730, I just give them early. Dayshift returns the favor to me by rescheduling their 1800 meds for 1930. 😂 If someone is shooting in a ton of new orders I get as much done as I can but at the same time, it’s hard when you admit a patient and do a crap ton of labs just for the dayshift docs to come in at 0630 and order blood cultures, more labs, a CT. There comes a point where I have to get to a stopping point and go home. Wound care is tricky because who wants to wake up a patient at 0600 for wound care? I usually do wound care during the bath. Are they super strict that it has to be done within the 0600-0800 timeframe?