How to handle station 2

Being a Charge Nurse

1 How to prioritize your patients

What patient should you focus more

What you should know about your patient during rounds
Know your APs, their management style

2 How to handle charts

How to prioritize, what to carry-out first

Tips on Nurses notes
Tips on carrying Discharged Orders

3 How to handle Toxic Patients

When to refer to the Attending Physicians, or when to refer to RODs

What nursing interventions you could offer to a patient given a situation
How to Monitor patient
Proper way of assessment of your patient

4 How to handle trainees

How to delegate your work to your trainees

What you can delegate, what you cant

5 How to handle/coordinate with your Nurse Assistants

6 Tips in handling a Morning Shift, Afternoon Shift, Night Shift; with regards to Time
Management, things you should handle first in your shifts
7 Tips in making endorsements

How not to forget special procedures/due blood chemistries and other special
endorsements

8 How to handle irate clients

How to handle station 2

Being a Medication Nurse
1 How to prioritize medicines to be given
2 How to arrange your Medicines
3 How to handle Massive Medicines to be started
4 How you should give the Medicines
5 how to make a Prescription form (specially Senior Citizen patients)
6 How to handle a Morning Shift, Afternoon Shift, Night Shift with regards to time
management
7 Tips from the experts

As a Charge Nurse

1 How to Prioritize patients

The Station 2, among all areas had been seen as one of the busiest place in
the Hospital, various patients of various cases have been admitted in your care. As
a charge nurse, you have to prioritize all of them to be able to have a more
systematic duty and so you can handle your shift the easiest way as possible.
You should know your patients well, during your initial rounds, dont just dwell
on the patients IVF bottle and its remaining level, but you should assess patient
clearly, know their chief complaints, or any other unusualities verbalized or youve
noted. Sometimes, the patients chief complaints isnt the present problem that you
may encounter on your rounds.
What patient should you focus more:
Depending on patients status, and your assessments, you will know which of
all your patients should you give more attention to; the basic, ABCs will really help,
but depending on your assessments of your patients status will also matters a lot.
Some cases that you should pay more attention to:

Patients who is dyspneic or labored breathing, not tolerated present

management, like oxygenation support given by AP
Patients with Dengue, or any clients that are risk for bleeding that may lead
to shock
Patients with Cardiovascular problems, such as MI, or with Chest pains/ or any
signs or symptoms that resemble or could lead to cardiac arrest.
Patients with neurovascular problems, like CVDs, especially those that with
decreasing sensorium, or change in level of consciousness
Patients with severe pain/discomforts
Pregnant women in labor, can be depending on the number of gravidas

What you should know about your patient during rounds

Aside from their present IVFs, you should know your patients present
condition, sometimes, during your rounds, the patient or their Significant Others
would verbalize complaints or concerns with regards to the present management of
their disease/illness. As their nurse, you can give them basic information that can
atleast supplement their concerns, but be aware that there are certain information
that only the Attending Physician is allowed to give.
Sometimes, your initial assessment with the patient would give you a hint on
the possible management that their APs may give upon their rounds, or sometimes,
you may already know which patients will be discharged on the day basing on your
rounds. Or like youve encountered a new problem with your patient during your
shift, by that, you will expect that your shift would be busy or not.

Know your APs, their management style

Most important of all in station 2, or in any station, you should know your APs.
Each doctors have their own way of management of their client/patients, they also
have their own way of approach, in dealing with their patients or to us nurses. You
need to understand their different approach so that you will be able to meet their
expectations. Some doctors were very strict with their management, that updating
them from time-to-time is a must, these doctors were also a factor that why you
should prioritize their patients. Other doctors are also a bit more lax, though
depending on the cases of their clients, the need for you to update them isnt really
that necessary, and they would acknowledge more if you do nursing interventions
first before you will refer to them. Some doctors would want to be escorted during
their rounds, some would rather do their rounds by themselves. But if possible, you
should always escort your doctor so you could learn from their management,
because it is during in their rounds that they can discuss matters with regards to
their management with their patients. Knowing each one of them would be a great
advantage in your behalf because you can be able to anticipate what kind of
management will be done.

2. How to Handle Charts

Carrying-out of the APs orders, doing nurses notes takes most of your time,
so having a systematic way of handling with your charts will help a lot.

How to prioritize, what to carry-out first

After the doctors have already made their rounds, its time that their orders
will be carried out, usually, especially in the morning shift, piles of charts waiting to
be carried out would stack-up in front of you. By prioritizing them would help a lot to
maintain a stable pace in your shift. If possible, try to glance in all those orders first,
especially if the doctor is still around so you have time to clarify their orders if you
cant read it or theres something that you dont understand. Simple orders like IV
follow-ups would fall in last to be carried out, STAT orders fall in first, or if the
doctors have a lengthy order, you can try to partially carry them out, like carry out
only the STAT ones, then you can leave it a while to focus on other things first. In
the morning shift, it is advisable to carry out charts with discharge orders, they
should be given the most priority because the billing process of the hospital takes a
long one, and this could avoid the SOs to go irate waiting for their bill. Referrals,
consent for procedures, depending on the importance, could come in second to be
prioritized since you have to leave the station to go to the patient for their consent
for referrals or procedures, which could take time. Other orders can be arranged
depending on your style and can be delegated to your trainees if they are available.

Prioritizing orders like special procedures and referrals can vary depending on the
status of the patient and the importance that it should be carried out first.
Tips on Nurses notes
Like I always tell to other nurses, the nurses notes isnt really made to be
that eligible like scribe artists do but it is made to protect us nurses from possible
legal threats. And that it tells us another picture of what happened of the patient
throughout his/her hospitalization. And the reality is that it takes most of our time,
and we have to do it even if we like it or not. So here are some tips to make it a bit
easier. First, in station 2, since it isnt really an ICU setup, all you need to write are
the important points, like the usual IV fluid, number and level, the assessments
youve made upon your rounds. Then the routine things that is like a part from the
DAR notes, then comes the health teachings, or any other important happenings
that happened within your shift. You dont have to copy all what is written on your
endorsement notebook, you dont have to write who made the follow ups of the
next IVF, or you dont have to write what the medication nurse had given(though
sometimes we have to write them). All you need to write are what YOU (the charge
nurse) have done to the patient. With regards to health teachings, there are some
valid health teachings that you can use with most cases, but also you have to take
note of what health teaching you can give depending on what case does the patient
has. Further details will be done thru demo.
Tips on carrying Discharged Orders
Ive included this topic to be discussed here since making discharge summary
had been disregarded by some staff, and that sometimes we tend to forget how
important the discharge summary can be to a patient bound to go home. Always
remember that what are written on the discharge summary will be the instructions
the patient will use at home, where no more medical staff can assist them. Having a
wrong/incorrectly made discharge summary can cause a big threat to the patient.
Then how to carry out a discharge order? Well, carry it as simple as possible,
as simple that ordinary people can understand what you will give. Medical/nursing
terms are not allowed. Those are simple things that you should remember. But
doing so could take most of your time, especially, there are days that a lot of
patients are being ordered to go home, and that the watchers cant wait for their
bills to come out, and then blaming it all on us because we were carrying the orders
so slowly. Well, though there are times that you can anticipate that this would
happen, but still, it will drain most of your shift. So heres a simple tip in carrying
discharge orders faster. You can carry it on the nursing discharge summary first,
after doing so, the close your nurses notes, and give it then to your medication
nurse for countersigning and that it will be processed for billing faster. If youre
already done with the other charts, then you can make the prescription form. I

myself saw this process is much faster than the usually procedures that others had
made. DEMO will be done
3 How to handle Toxic Patients
The thing that drained us most, is to have patients that are terminally-ill, or
so we called TOXIC-patients. They alone can take a lot of our time, either we were
afraid that their breath would be ceased during on our shift or that the doctors
might get furious against us if we screw up. Toxic patients are so stressful enough
for us; the APs orders alone for these kinds of patients are stressful even. So
handling them properly can help a lot.
What nursing interventions you could offer to a patient given a
situation
Depending on the case of the patient, aside from attending to their needs,
you can offer nursing interventions to help alleviate their concerns. Like for a case
of patients, with high grade fever, by simply demonstrating the watchers the proper
TSB on the patient would help, or encouraging the patient to take in lots of fluid (if
patient can tolerate fluid intake). Or to a case of the patient with difficulty
breathing, were you reposition patient on high fowlers position and teaching them
on proper deep breathing exercise. Or to a patient with concerns on pain, depending
on the case, there are ways to help them alleviate what they feel. Building rapport
to the watchers also helps a lot, coz there are times that no more medical
interventions can help, by simply being able to listen to the watchers feeling when
they verbalized helplessness for their patient is already enough. Just remember that
in cases like this, dont just stay in your station, be at the patient and try to do
something as a nurse.
When to refer to the Attending Physicians, or when to refer to RODs
When things get worst, or that your interventions are already futile, well, its
time to refer them to your doctors. In simple cases/concerns, like the patient had
been vomiting, or the patient is in need of pain relievers of pain. But you also have
to report everything to the APs. Though there will be APs that were a bit out-ofreach at the moment, that could be the time that you look for the ROD, or times
that the ROD is busy with other patients at the ER, then it would be better to look
for your AP. Contacting them also had different ways, some would prefer being
called on phone, some prefer thru SMS, either way, the way or how you refer the
patient to your AP also matters. For toxic patients, if immediate intervention is
needed, then call the Resident physician, and at the same time, ask the ROD to let
him/her inform the Attending Physician for proper referral. Then, updating the AP
afterwards can then be your initiation. A proper referral/coordination with the nurse
and the AP is really important in handling toxic cases.
How to monitor patient

There are ways to monitor your patient, well, you could either attend to them
personally, or delegate them to your nurse assistant. But as a charge nurse, its
your primary intervention to be able to attend personally to the patient when it
comes to handling them, especially the toxic ones, since you are the captain of the
ship, your every decision is critical. Depending on the case, like with CVD patients,
where there blood pressure is being monitored carefully, though medical
interventions would be given like vasodilators, still you have to keep on monitoring
the patient, to see if the management was effective or not, so that you can update
your AP from time to time. For toxic cases, sometimes, its your decision on how
much kind of attention would you want from it, though some APs failed to give
orders to monitor the patient critically as every hourly or more often, its also your
discretion if you want to monitor them, but you also have to think the capability of
the people you have, like if the nurse assistants hand is already full to have more
monitoring with the number of patients and toxic ones he/she presently has.
Proper way of assessing your patient
Proper way of assessing a patient, either toxic or not, were all the same. Just
observing the cephalo-caudal style of assessment can be enough. But take into
consideration also the importance of ABC; Airway, Breathing, Circulation, since they
should be given priority of care. Just make sure that important assessments are
being recorded properly, or that it be written in your nurses notes, or be it in the
sidenotes after a referral to the AP.
How to handle trainees
On a busy setup like station 2, a helping hand is always what we could ever
want in a dire situation like these. And thats how where the Nurse Trainees would
come. They are an extra hand that we have, they are licensed like us, and therefore,
they are also capable of doing procedures, performing tasks competently as we do.
But since they dont have much of the experience as compared to us, they should
be guided properly in a way they will grow and gain all what is needed for a
potential staff nurse in the future. But handling them could be a bit difficult too,
since if you wont handle them properly, they would only get in your way and take
most of your time checking/supervising their work, since you are a charge nurse in
station 2, you cant afford to lose so much time just teaching/empowering them. So
here are some ways we should remember when handling them.
How to delegate your work to your trainees
Delegating/Empowering your trainees so that you can optimize their
potentials in every situation in station 2 is what matters most. Since they have
already undergone orientations on what is the set-up in the nurse station in the
hospital, its not wrong if youd expect them to know the basics, but its already a
mistake if you expect that they know a lot. As a charge nurse, their senior, you have
to give them tasks within their scope, or level of experience. The most difficult part

for a busy staff like you in handling them would be teaching them from the start.
Perhaps the easiest way to do at first is to orient them about your job. Let them
observe how you do your work. Sometimes, they themselves would offer us a help,
and thats the time you start delegating, try to give them very simple tasks for a
start, like carry-outing orders like with IVF to follow only, or simple laboratory
procedures, or simple medications. But never forget to give them feedback on their
work, so that they would know if what they were doing were right or wrong. As they
grow more and gain more experience, you can then try to give them tasks that were
more complex that before, so that as time goes by, they can be your partner in your
duties where minimal supervision is needed for them. All you need at first would be
patience, and try to give time for them, try to enhance their potential; remember
that these nurse trainees are all licensed ones, and our future partners in work.
What you can delegate, what you cant
In station 2, there are things that we can delegate or empower to our
trainees, like I said previously, procedures or things that you will delegate to your
trainees would be based on their level of experience/scope, be careful not to overdo
it, or like giving them procedures that may be beyond their potential, they might
think that youre making them do all the stuff that is supposed to be your job, in the
end, youd lead them to exhaustion and no more learning in what they do. But there
are some procedures that you cant always delegate to your trainees, its a bit
complicated to explain why, but there are instances where, only the charge nurse
on duty should perform the task, like making referrals to the attending physician if
there are some serious problems have been noted on your patient, or letting them
handle clients with a lot of concerns, or other procedures that only the charge nurse
was endorsed. These instances would, if you let them do those tasks, they could be
scolded by the APs or the patient would go irate, because they were not endorsed,
lowering their self esteem. Thats why we should be a bit careful with empowering
our trainees.
How to handle/coordinate with your Nurse Assistants
As a charge nurse, your success in your shift can also depend from the way
you coordinate with your Nurse assistants, because in a busy shift, they were the
ones who see the patients, and sees whats happening on the patient side, so
coordinating with them properly is really important. Since the charge nurse are the
captain of the ship in the station, you have the right to direct your NA on what they
should do, like asking them that they should focus more on this patient, or direct
them simple nursing interventions in dealing with a patients concern. But doing so
might be a bit difficult, since sometimes, the way you will direct your NA might hurt
their ego, so properly addressing them professionally is important. One example is
that, when you are monitoring a patients V/S, you can ask for your NA to update
you with the latest V/S they got from the patient. But you also have to see the
current capability of your NA at the present, I mean, if your NA is already very busy

with his/her duty, and youre not, then try to help them. The function of the NA is no
easy job, and for me, I take their job as physically draining since throughout your
shift, youd be taking vital signs, doing other treatment procedures to the patients,
and that you the CN would ask more of them to do can be too much for them, thats
why gaining their coordination is a bit difficult and at the same time, crucial in your
part.
Tips in handling a Morning Shift, Afternoon Shift, Night Shift; with regards
to Time Management, things you should handle first in your shifts
Simple tip, develop a self time-management/ or system on your work, and that may
vary on the different shifts that youre in.
Morning shift: since youre going to expect a busy shift, its better if you have a
headstart on your duty, try to be there as early as possible, receive the
endorsement as complete as possible, make your rounds as fast but as precise as
possible. Then after your rounds, make nurses notes, be quick as possible in making
them, coz once the doctors have made their rounds, youll be having a bad time
completing those notes. And by around 1 or 2 pm, make your endorsement, and
then continue on your present pace in your shift.
Afternoon shift: since you will be receiving a very busy shift, expect that the mood is
still very busy, so once youve made your rounds, try to finish all that is pending
from the morning shifts, like facilitating discharge of patients, follow-up APs who
havent made their rounds yet, or who havent acknowledged from a referral. Once
youre done with it, and then start making nursesnotes, then finally, your
endorsement.
Night shift: the most relax of the entire day, since you dont have to expect a
doctor to make their rounds on your shift. But still, your task will be to double check
what has happened throughout the day, its your job to check if there are some
procedures/orders that were not carried out. So you start your shift by refilling forms
on the chart, doing 24 hr checking, and nurses notes at the same time. Basically, all
systems that you could think of here can be effective.
Tips in making endorsements
Precise, and complete, and understandable, thats basically the things
needed for a good endorsement. Write what is important, what is needed for the
continuation of care, where you will endorse your shift to incoming shift.
How to receive endorsements, not to forget special procedures/
laboratories
In receiving endorsements from previous shift, sometimes it is best for you to
be a bit strict, ask if there is something you dont understand from their
endorsements, and take note on some special endorsements that may not be

written on the endorsement notebook. Receiving the endorsement is like seeing the
whole picture of the patients hospitalization and managements that he/she is
receiving.
It is pretty natural that there will be a lot of procedures, laboratories,
examinations that you will receive with the number of patients you have in station
2, it is advisable if you highlight the procedures or jot down all the procedures due
on your shift in a piece of paper for you to be reminded. It is also good that you
know the procedures very well, like blood chemistries that the APs had ordered, the
running time of the tests and what time should you be expecting for a result to be
available. You can coordinate with the laboratory dept. for the availability of the
results.
How to handle Irate clients
Having irate clients in the ward is always unavoidable, and has become a
usual challenge for most nurses in the hosp. They can be a significant other that got
frustrated with just waiting for their bill, or complaining with so many prescriptions
given to them that they should buy in the middle of the night. If possible, try not to
let them get to that point, by doing your job properly, quickly and precisely as
possible. If there are already irate clients in front of you, you can try to approach
them in a professional way, look directly on their eye, so that they would feel that
you mean business here. And talk to them in a very calm and understanding voice.
Let them verbalize their concerns, while you should always listen, after their
concerns were voiced out, if you can be able to give a solution, then offer them
solutions, or explain to them the reality in the hospital, and that dont let them
expect more. But if there are certain issues that you cant help out, then you can try
to call your supervisor for help. Just remember that these situations are a bit
complicated, you as a person should try to control your patience and ego to avoid
further progress of the situation.
Being a Medication Nurse
1 How to prioritize medicines to be given
> Always give STAT medications first
> PRN medication maybe give after (for fever and pain)
> Give medications that are unstable at room temperature first (ampicillin, Coamoxiclavs)
2 How to arrange your Medicines
> Arrange medications by patients name and room number
> allocate one medicaton tray for ward patients, the other one for private
> P.O meds maybe placed on top of IV meds to save space on the tray
3 How to handle Massive Medicines to be started
> First step is to relax and calm down

> Scan through all the tickets and prioritize

> Start STAT medications first
> Give Rx to Non med patients next
> Ask availability of medication first before requesting or going pharmacy to get it
> Ask for help whenever you can
> Do skin stesting first before giving Standing meds, you may return to the patient
after giving meds.
4 How you should give the Medicines
> Give medications accurately but briefly, IV meds can be give less than 1 minute if
you can
> Dont stay in one patient for too long, remember that have many patients to
attend to
> You can delegate P.O meds to SO if they are capable of. If not, give it yourself.
5 how to make a Prescription form (specially Senior Citizen patients)
> include generic name on prescription plus S2, PTR of prescribing physician.
> Ensure every prescription is complete and accurate.
6 How to handle a Morning Shift, Afternoon Shift, Night Shift with regards to time
management
???? no idea. case to case basis, but think and prepare ahead of time. for example
in noc shift, you can signed at the chart ahead of time to those medications that
you are so sure you will give (standard meds, no-prec meds)
7 Tips from the experts