My Night Shift Work Routine at the Medical ICU - Part 2

Welcome back! In my last post, I wrote about the first half of my night shift work routine. You can check out that post and others here!

Let’s jump right back in! I left off talking about passing meds after having done my initial assessments and chart review. Two blog posts ago I mentioned multidisciplinary teams consisting of various doctors at different levels of experience. I also briefly mentioned NPs, PAs, RTs, pharmacists, and a few other members of the team. Well, here I’ll get to talk about multidisciplinary rounds!

Tom McCall Governor's Park

Multidisciplinary Rounds

Multidisciplinary rounds, for those that aren’t familiar, is a collaborative approach to caring for patients that involve a team of various healthcare professionals. These would include doctors, nurses, pharmacists, therapists, respiratory therapists (RTs), and social workers to name a few. The primary focus is to improve cross-departmental communication, enhance and progress the patient’s care, and ensure that all team members are working towards achieving the best possible outcomes for the patient.

Some hospitals will only round in the day, however, the hospital that I worked at also held rounds on nights. This might be attributed to the fact that this was an academic hospital and provides learning opportunities on both days and nights. The majority of the patient’s presentation was given by medical residents and interns, followed by the nurse, RTs, and anyone else on the team present for rounds. The attending physician or fellow would usually conclude rounds by discussing overall goals and necessary interventions. Prior to concluding, we would have a chance to give any last-minute recommendations or clarifications.

How the presentation is set up is usually as follows:

Medical Resident and/or Intern

Initial presentation of the patient including demographics, medical history, history of present illness, medical diagnosis, diagnostic tests, and progress since admission.

Bedside Nurse

Clarify or add on to resident or intern’s presentation. Discuss any important events from the prior shift. Provide a review of body systems based on reports and personal assessments of the patient. Address any lab results, such as hemoglobin, electrolytes, and blood gases that might need interventions.

RT

Ventilator settings, tolerance, recommendations. Address blood gases and interventions.

Pharmacist

Medication review. Medication adjustments based on liver or renal function.

This is just a very brief breakdown of how a patient is presented during rounds, but there can be more or less depending on the complexity of the patient’s case!

Ultimately, multidisciplinary rounds are an important aspect of a patient’s care, as they help to ensure that all members of the healthcare team are working together to provide the best possible care for the patient. By promoting communication and collaboration among healthcare professionals, multidisciplinary rounds can help to improve patient outcomes, reduce hospital stays, and enhance patient satisfaction.

The Rest of the Shift

Once rounds are completed I continue my care for my patients. This can include carrying out interventions, collecting labs, giving medications, transporting for diagnostic imaging, and providing for the patient’s comfort and hygiene. To give a more structured timeline view of this routine, the rest of my shift might be structured as such:

7 PM - 715 PM: Receive report on assignments.

715 PM - 8 PM: Review charts, medications, and orders, and perform assessments.

8 PM - 9 PM: Pass due medications and complete documentation.

9 PM - 930 PM: Multidisciplinary rounds.

12 midnight: Complete another assessment.

1 AM - 2 AM: Lunch break (this hospital and management always pushed us to take our

full 1-hour break!)

4 AM: Complete the last assessment.

6 AM: Round out patient care. Ensure that the patient is comfortable and clean. Restock

rooms. Empty trash, biohazards, and soiled linens. Document final intake and

outputs.

7 AM - 715 AM: Give report to the incoming shift.

An ICU Room Prepped & Ready

That wraps up my night shift work routine! This isn’t always the way they go and some shifts are busier than others and can vary drastically from shift to shift. Next time, I’ll be talking about my experiences being floated to different units! Check back again later for more!

Thanks for reading and until next time! Salamat and si yu’us ma’ase!