Do’s and Dont’s (for residents when on nsicu nights)
Do
At the beginning of shift:
-Create a list of patients to watch more closely throughout the night, as well as
bumpable patients alongside fellow
-Night float is not just setting out fires, its continuing care, so you should read, analyze
the cases, make up plans, and give suggestions for morning team.
-Ask about IV access, make sure all are on DVT prophylaxis unless clinically not
indicated, discontinue foley caths if output is not monitored, NO PT should remain NPO
for days if not awaiting for procedure or intubation watch, make sure all are fed.
-make a list of patients that are on vasopressors, KNOW their doses, sometimes RN will
go up on the pressor without informing the team, we should know.
-Go through morning team notes make sure what has been discussed and documented
is actually done.
-KNOW Ins/Outputs for your patients especially SAHs they SHOULD NEVER BE
NEGATIVE.
-Go over (and ideally round on) shared patients with stroke resident on call, discuss
who will follow-up pending items, including any scans, repeat exams, or transfer
orders
-Examine your patients at the beginning of the shift to obtain a baseline for yourself
and ensure this is the same exam communicated at signout
-Round with fellow and charge RN: make sure patient’s primary nurse is present and
has any questions answered, necessary orders placed, including morning labs,
restraints, updated ventilator settings
Throughout the shift
-Maintain regular communication with the charge nurse (call, text designated cell #)
-Maintain regular communication with your fellow and be sure to CALL before
making decisions you are not sure about, and when you need further assistance,
clarification, or supervision
-Update patient’s primary nurse about any changes to the plan
-Update the primary teams about significant overnight events for their patients (this
includes stroke team, neurosurgery resident on call)
-if stroke or neurosurgery patient deteriorates, housestaff on call for these
teams should be notified STAT
-Involve respiratory therapist and fellow in issues with ventilator troubleshooting and
management; never make setting adjustments without first touching base with the
fellow
-Place and call any stat consults but always discuss with fellow and primary team
first
-if a patient is admitted with the NSICU as primary, but still physically in the ER,
make sure ER is aware you are not actively managing patients in the ER. If
anything is concerning, immediately bring it to the attention of the fellow or
attending to determine proper way to address the situation
-During down time, try to identify an area of weakness or interest and take time to
read an article or relevant chapter in a book
-If you need to sleep, make sure you let your fellow know so there is always
someone awake
End of your shift
-Review patient’s AM labs and replete electrolytes as necessary
-Go over any overnight events with fellow and what you may have done in response
-Ensure your notes (usually 6-8 depending on number of residents) are completed,
saved, and forwarded to the day residents, fellow, and attending for signature (do
not sign the note)
Don’ts
-hesitate to call your fellow or attending with any questions
-change the day team plan unless there is an acute change in status of patient
requiring revision of that plan without consulting with fellow and/or attending first
-call consults, activate code airway, STEMI alert, stroke alert without consulting with
fellow and/or attending first
-simply carry out orders or always trust key findings that the nurses relay to you,
especially when you are tired. Always examine the patient yourself and verify
findings before making a decision.
-at the same time, don’t discount nurses’ suggestions. They are the ones with the
patient the most and their concerns should be taken seriously
-admit non-neurological patients without first consulting with the fellow and/or
attending
-be rude to ER physicians, nurses, consulting physicians. Everybody is tired but
being rude doesn’t help or save any time
-simply copy/paste progress notes in the morning
-leave an admission H/P for a patient who comes in before 6am