Overview

1. The start of your shift- getting report from the off-going nurse
   1. Get ALL the details
      1. Who are the caregivers with the child (parents, grandparents, foster parents)?
      2. What is the child’s general mood/anxiety level?
      3. Timeline of full hospital admission- not just the past 12 hours.
   2. Do a bedside check with the off-going nurse.
      1. Things to check
         1. That the child is stable
         2. That the room and bed are safe for the child
         3. That the monitors are set to the correct parameters.
         4. That the IV is patent.
         5. That the fluids and medications infusing are correct.
         6. Are appropriate signs posted (infection control, special notices above the bed).
   3. Get organized- plan your day
      1. Look at medications times, procedures, doctors orders
      2. Check medication room to make sure meds are available
      3. Talk to caregivers ASAP.
         1. Introduce yourself
         2. Let them know what the expect during your shift.
2. Assess your patients get a set of vital signs
   1. Don’t delay with this even if the child is sleeping.
   2. Be sensitive to tired families but always prioritize getting your eyes on your patients ASAP.
3. Medication administration
   1. Med schedules are less predictable on pediatric units
      1. Fewer long-term prescriptions and home medications
      2. Stick to caregivers home routine
4. Patient care/ADLS
   1. Parents usually provide this care to their child.
   2. Nurses provide support and assistance
      1. Offer linens
      2. Help with baths/showers as needed.
5. Meal time
   1. It’s always meal time on a peds unit!
   2. Snacks always available
   3. Formula and bottles are provided
   4. Breastfeeding moms have access to breast pump and special refrigerator for milk
6. Procedures
   1. Common
      1. Blood draw (usually done AM and as needed)
      2. IV’s (placed as needed, keep a close eye on these and reinforce dressings often!)
      3. NG tubes
      4. Catheterization
      5. Urine dip
   2. Involve Child Life Specialist with all procedures
7. The end of your shift- handover to oncoming shift.
   1. Prior to handover, one last final check on the patient and chat with caregivers
      1. Let them know you are going off shift. Also, tell them if you’ll be back the next day!
      2. Double check room, equipment.
      3. Check med room for meds for next shift
   2. During handover
      1. Summary of day and patient status
      2. Highlight the care plan and any changes/updates to orders.
      3. Don’t forget to include the small details as well.
         1. Who is with the child
         2. What particular things seem to upset the child/family

Nursing Points

General

A typical day

1. 0645 – arrive and find patient assignments for the day
   1. Patient assignments
      1. Maria
         1. 3 yo female
         2. Admitted for Tonsillectomy & Adenoidectomy, post op day 1
      2. Jacob
         1. 9 yo male with cerebral palsy
         2. Admitted due to chronic constipation and fecal impaction, needs GI cleanout
      3. Vincent
         1. 2-week old male
         2. Admitted due to fever, undergoing septic work up to rule out meningitis and UTI
      4. Alex
         1. 16-year-old female with Cystic Fibrosis
         2. Admitted for antibiotics and “tune-up”
2. 0700-0800
   1. Get report from off-going nurse
   2. Do bedside check
   3. Check charts, get organized (if patients were stable at bedside check)
      1. Note medication times, lab results, procedures, order
   4. Start assessments, get vital signs on all patients
   5. Administer PRN acetaminophen to Maria
3. 0800-0900
   1. Administer scheduled IV antibiotics to Vincent
   2. Talk with Alex about plan for the day
      1. Arrange for her to get a hospital pass to spend time with friends later
      2. Administer pancreatic enzymes
      3. Check PICC line dressing, flush PICC line
      4. Administer scheduled IV antibiotics
   3. Document all assessments and vital signs.
   4. Help Jacob’s mom with linen change and bed bath
4. 0900-1000
   1. Administer second scheduled IV antibiotic to Vincent
   2. Chat with Vincent mom who is feeling anxious about breastfeeding
      1. Contact Lactation Consultant for support.
   3. Total I’s & O’s for patients and prepare for morning rounds.
   4. Call pharmacy requestion IV antibiotics for Alex and meds for GI clean out for Jacob.
   5. Prepare for rounds with the providers.
   6. Flush Vincent IV when antibiotics are complete.
5. 1000-1100
   1. Attend rounds with provider.
      1. Maria- discharge orders in place if she eats lunch
      2. Jacob- continue with GI clean out protocol
      3. Vincent- culture results will be back tomorrow at 2100 continue with antibiotics until then.
      4. Alex- has 7 more days left for Tune-Up. Provider aggrees to allow hospital pass for the afternoon.
   2. Jacob pulled NG tube out. Speak to Child Life Specialist about plans to reinsert it.
   3. Chat with RT while they administer Alex chest physiotherapy.
   4. Flush Alex PICC line when antibiotics are complete.
6. 1100-1200
   1. Chat with Lactate Consultant about your conversation with Vincent’s mom this morning.
   2. Spend time documenting.
   3. Administer pancreatic enzymes to Alex.
   4. Help give out lunches. Ring dietary to request high calorie diet for Alex.
   5. Talk with Maria’s mom and dad, confirming that she can be discharged if she tolerates lunch.
   6. Re-insert NG tube for Jacob with Child Life Specliast and another nurse. Confirm placement. Begin GI Clean out. Talk with mom about plan and importance of strict I’s & O’s. Bring extra linens, towels and supplies.
7. 1200-1300
   1. Start working on discharge paper work for Maria.
   2. Check 1200 vital signs.
   3. Notify provider that Vincent’s temp is elevated.
   4. Administer acetaminophen to Vincent.
   5. Check email and schedule some annual training.
   6. Get handover from other nurse so they can go to lunch.
      1. Check on their patients
8. 1300-1400
   1. Discharge Maria
      1. Discontinue IV
      2. Provide discharge teaching
      3. Complete paperwork
      4. Escourt them out of hospital
   2. Check on Vincent and Jacob.
      1. Help Jacob’s mom with linen change and diaper change.
   3. Re-check Vincent temperature.
   4. Give handover to other nurse and go to lunch.
9. 1400-1500
   1. Work on documentation
   2. Administer scheduled IV antibiotics to Vincent.
   3. Get report from ER nurse for new admission
      1. Tyler- 9 year old boy admitted with appendicitis. Going to surgery this evening.
   4. Administer scheduled meds to Alex and discuss hospital pass.
10. 1500-1600
    1. Admit new patient (assessment, vitals, new admission paperwork, documentation)
    2. Start pre-op check list.
    3. Administer pain medicine to Tyler.
    4. Administer scheduled IV antibiotics to Vincent.
    5. Alex currently on hospital pass.
11. 1600-1700
    1. Check 1600 vital signs.
    2. Call the OR nurse to give handover on Tyler.
    3. Work on documentation
    4. Administer scheduled medications to Jacob
12. 1700-1800
    1. Give handover to nurse, run to the lobby for a coffee.
    2. Complete relevant items on pre-op checklist.
    3. Give bedside handover to OR team collecting Tyler.
    4. Help other nurse with IV placement in a 3 year old.
13. 1800-1900
    1. Alex completes chest physiotherapy and is ready to eat.
       1. Administer pancreatic enzymes.
    2. Check medication room for meds for night shift.
    3. Talk with Vincent’s mom about how she’s feeling. How is breastfeeding going?
    4. Help Jacob’s mom with linen change.
    5. Calculate I’s &O’s for patients.
    6. Complete documentation for the shift.
14. 1900-1920
    1. Handover with oncoming nurse
    2. Bedside checks.