AM SCHEDULE: 7 AM – 3:30 PM
¨ 7 – 7:30 AM: Report. Take notes – suicide,
assault, AWOL precautions; safety / medical concerns; pending discharges and
admissions; think “what are this patient’s concerns and needs”
¨ 7:30 AM: Breakfast:
Be aware of NPO
patients. Coffee, monitor, encourage record food/fluids intake, clean
tables and counters. No sharing food; all food/fluids in dining room; monitor
special diets; get meals for patients unable to attend; disruptive clients may
eat in the SALLI port; monitor silverware.
Vital Signs – after breakfast: weights MWF; make three copies of TPR – one for each nurse,
one for doctor
Do a round, introduce your self to patients who are awake.
Note that rounds are every hour; every 30 min for S/P I, every 15 min for S/P
II. Safety – unsafe objects, patient’s doors open, locked doors locked;
seclusion and restraints; spills etc.
¨ 7:30 – 8 AM: Check your assignments = your patients and tasks [letters A – P.]
Responsibilities include:
Check with you team nurse to review special concerns for the shift
Review your patient's charts for problems, behaviors, goals, interventions in
the treatment plan […one of
the most important documents in the chart. Thoroughly familiarize yourself with
the structure of the plans and the planning process.] Read progress notes -
doctor/social worker/nursing. All shifts chart on at least one problem; plan
to chart to all problems for which information becomes available, especially
the main psychiatric problems such as danger to self, depression, psychosis –
these are the problems that are the focus of treatment and show medical
necessity. Due to frequent unavailability of charts it may be useful to make a
copy of the treatment plans for your assigned patients
Introduce your self to your patients; tell them that you are
available to assist with needs, to talk to them… Occasionally a patient is on
an hourly request protocol: this is discussed and determined by all staff as a
team. It is important to respect all patients at all times… especially while setting
limits; it is usually more effective to state why something is or is not done
rather than enforcing a rule as a rule. Except medical and safety concerns it
is good to be flexible but always check with the CN. Be aware that patients see
you as being in a position of power, that many patients are intimidated and
scared… be reassuring
Observe patients behaviors, activities and speech and take notes for
charting and safety during your rounds and throughout the shift, report
anything unsafe or dangerous to the charge nurse immediately. The treatment
plan tells you what behaviors to look for
1:1 for communication, assessment, and charting with your patients
between 9 AM and
¨ 8:30
AM Community group: run by assigned staff; encourage all patients to attend. Also
invite staff who may be available. Community group is a chance to explain the therapeutic
process, introduce and reassure new patients and for patients who ‘have been
through it before’ to reassure first time patients. Serve decaffeinated coffee,
read lunch and dinner menus. Explain functions of staff person and different
staff functions; tell patients who their staff persons are; explain
‘medications nurse,’ ‘assignment board,’ ‘sharing phones and TV.’ Chart
attendance and performance in the community group log
¨ 9 AM: Vital Signs: Phones
on; linen cart out; encourage patients out of bed, attend groups
¨ 10 AM – 11 AM: Snack: Check which patients have
money for snacks; ask those patients what they want from the vending machines and get their requests;
observe dietary restrictions and two item per patient limit. Caffeine OK in
mornings; there is a limit of two caffeinated beverages per patient per day
¨ Staff Lunch 11:30 – inform charge nurse
whenever you plan to leave the unit
¨ Lunch at
¨ Visiting: No regular visiting hours
this shift. Off hour visits per MD order and at CN discretion. It is important
to be courteous to all visitors at all times. Ask all visitors whether they
have cigarettes, matches, lighters, sharp objects, keys, anything unsafe – explain why first and ask them to leave
them including women’s handbags at the nursing station during the visit;
visitors sign in; anything brought in for the patients must be assessed for
safety and logged in before giving it to the patients
¨ 1 - 3 PM: chart on your patients; it is a
good idea for new staff to practice charting on scratch paper and have it
reviewed by the team nurse and other staff. Have the team nurse cosign your
notes