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 1 PM; take notes. Plan your 1:1's; use the treatment plan to decide issues to address. Discuss do’s and don’ts with the team nurse and other staff

¨      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 12:15 PM: Monitor as for breakfast. Check supplies of regular and decaf coffee, sugar, creamer, diabetic creamer and sweetener, stir-sticks, fruit, candy, diabetic snacks - pretzels, Gatorade – ask the nurses how much they need, cups… call kitchen at 311 to get supplies that are low (janitor for cups)

¨      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

Complete assignments: letters A – P on the assignment sheet; prepare coffee for next shift, clean staff lounge, TV room, table, garbage can, showers and disinfect; clean utility room, complete laundry, take dirty linen to 3rd floor; clean dining room – tables and counter; treatment and property rooms; garbage cans at nursing station and in treatment and property rooms