PM SHIFT
ORIENTATION: SCHEDULE
PM SCHEDULE: 3 - 11
¨ 3 – 3:30 PM: Report. Take notes – suicide, assault, AWOL precautions; safety and
medical concerns; pending discharges and admissions; think “what are
this patient’s concerns and needs”
¨ 3:30 PM: Do a round, introduce your self to patients. 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.
¨ 3:30 – 4 PM: 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 the problems, behaviors, goals and
interventions in the treatment plan.
[The treatment plan is one of the most important documents in the chart.
Thoroughly familiarize yourself with the structure of the plans and the
planning process.] Also read progress notes - doctor/social worker/nursing.
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. PM shift also charts on
problems not addressed in the previous two shifts
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. 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 4 and
¨ 4 – 4:30 PM: Get
ready for dinner – make coffee; 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)
¨ Dinner at
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
¨ Lunch break - take this at some point
if not scheduled. Inform charge
nurse whenever you plan to leave the unit
¨ Visiting 6 - 7:30: 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 first be assessed
for safety and logged in before giving it to the patients
Get snacks. This is a good time to 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. Also a good time to prepare coffee and to distribute the snack
prepared by the kitchen for snacks for everyone – the kitchen staff prepares
the snacks but mental health workers distribute them
¨ 7:30 PM: Snack/video and coffee in the dining room; gather all patients. No caffeine;
observe dietary restrictions for individual snacks. Snacks are officially over
at
¨ 8 - 10 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.
¨ 9 – 11 PM: Complete assignments i.e. the letters A – P on
the assignment sheet, especially: clean staff lounge prepare coffee for next
shift; clean TV room, table and garbage can; clean showers and spray with
disinfectant; clean utility room, complete laundry, take dirty linen up to
third floor; clean dining room – tables and counter, take snacks out; treatment
and property rooms; garbage cans at nursing station and in treatment and
property rooms