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Let me guess: you just got hired as a patient care technician and are so excited to work with patients, but the thought of your first shift is filling your stomach with butterflies.
You try to imagine what your first shift will be like to ease your mind, but it just ends up causing you more anxiety.
I get it; the nerves are real! I felt the same before my first shift as a patient care technician.
In this post, I will explain step by step what my shift looks like as a patient care technician and everything I do to prepare and ensure the safety of my patients.
I worked night shifts as a patient care technician on the oncology floor for two years, which eventually became a COVID-19 step-down unit during the pandemic.
Some patients I cared for declined in the blink of an eye, and I’ve had to call many codes.
I felt so many emotions during my first code, but I especially felt useless.
No one trained me on what to do in a code, so I’ll also talk about that.
By the end of this post, you’ll have a better idea of your first shift and feel more confident as a new patient care technician.
*Please note that every patient and situation differs, and the following post will not apply to every person or circumstance.*
First Shift as a Patient Care Technician
The night huddle starts at exactly 19:00, where the charge nurse will lead the team in a brief meeting before the shift begins.
First, I grab an assignment sheet and print my “patient list,” which has the patient’s name and what they’ve been admitted for.
Then, I’ll find the patient care technician who worked the day shift and get a report on my patients.
After receiving report, I’ll sanitize my vitals machine and workstation.
There’s a small basket attached to the vitals machine, which I stock up with any essential items I may need throughout my shift, such as:
- purple wipes
- thermometer probes
- grey top container
- yellow socks
- a bp cuff
A call light is probably going off by this time, so we need to get to this patient’s room promptly!
I always check my report sheet before entering a patient’s room and follow these steps:
1. Introduce yourself
Before entering a patient’s room, you need to do two things:
1) knock before entering
2) sanitize/wash your hands
I enter the room with my vitals machine as I make eye contact with the patient and introduce myself.
“Hi, my name is Tara, and I’ll be your Patient Care Technician tonight. How are you?”
As I make small talk, I’ll update the whiteboard with my and the nurse’s names.
Here are a few questions you can ask the patient as you update the whiteboard:
How are you doing?
How are you feeling?
How was your day?
This task takes approximately 1-2 minutes.
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2. Ensure a safe patient environment
While introducing yourself and making small talk with the patient, scan the room, observe the environment, and note if the bed alarm is on/off.
Be sure to look for anything hazardous or trash that needs to be thrown out.
Patient environment checklist:
Clean —patient’s bedside table is organized, bed linens appear clean and wrinkle-free, the countertop is clean of unnecessary items (place unnecessary items/supplies in cabinets or drawers), and check to see that the trash isn’t overflowing.
Hazard-free —no EKG wires sticking out of patient’s gown, no noticeable spills on the floor, the bed is locked, and in the lowest position, one side rail is up, and the bed alarm is on (the bed alarm applies to patient’s who are on fall precautions).
Patient’s Possessions —call light, water, cell phone, and any other necessities are within the patient’s reach.
Remember to maintain eye contact and engage in conversation while multitasking.
(P.S.- some patients love to talk, and others may be grumpy or not in a talking mood, so don’t take it personally! Patients have good and bad days, too.)
After making small talk, writing my name on the whiteboard, and tidying up, I will take the patient’s vitals.
This task takes approximately 2 minutes.
3. Take vital signs on appropriate extremities
I work with oncology patients who often have a PICC line or lymphedema, so I always observe what wristband(s) are on the patient’s wrist.
This is super important because it can determine what arm you can and can’t take the blood pressure on.
At my hospital, a pink wristband indicates “restricted extremity,” which means no I.V.s, injections, or blood pressure to the affected extremity.
Therefore, I would not put the blood pressure cuff on the arm with the pink wristband.
I also try to avoid the arm that has the IV in it.
Here’s a scenario:
A patient has a pink wristband on the left arm (restricted extremity) and a PICC line in the right bicep area.
What arm will you take the blood pressure on?
In this case, I would put the blood pressure cuff on the forearm of the arm with the PICC line.
You can also put the blood pressure cuff slightly above the ankle on the leg, but attempt to take it on the arm first.
Always tell the patient what you will do as you go through each motion.
When taking a patient’s blood pressure, ensure their legs are uncrossed and ask them not to talk while doing their vitals.
When a patient’s legs are crossed, or they’re talking, it could cause their blood pressure reading to be inaccurate.
Ultimate hack: if you have a really talkative patient who you can’t get a good blood pressure reading on because they won’t stop talking, take their oral temperature while doing their blood pressure!
If a patient’s blood pressure is elevated (150+ systolic and 90+ diastolic) or low (<95 systolic and <50 diastolic), then take the blood pressure a second time.
*Immediately notify the nurse or charge nurse of abnormal vital signs or critical blood sugar and if a patient’s behavior/orientation changes from baseline.*
This task takes approximately 2 minutes.
4. Visually assess the patient
Do a visual assessment of the patient while you wait for the blood pressure machine to finish.
Ask yourself these questions:
(some of these questions you’ll ask yourself when you first enter the patient’s room, too.)
- Is the patient AOx3 or at baseline?
- What is the patient’s respiration rate?
- Is the patient wearing a nasal cannula (N.C.)? If so, how many liters of oxygen are they on?
- Are they wearing PAS (pneumatic anti-embolism stockings)?
- Does the skin appear intact (no active bleeding, new scratches, or fresh wounds)?
- What is the patient’s position?
- Does the patient appear comfortable?
- Can you see any visible drains that need to be emptied (foley, J.P. drain, etc.)?
- Is the IV tubing touching the ground or tangled in or around the bed?
This task takes approximately 1 minute.
5. Measure urine input/output
You may hear the term “strict I/O’s” while working your first few shifts as a patient care technician.
Monitoring and documenting the input and output (I/O’s) is essential because this tells the physician the patient isn’t over-hydrated or dehydrated.
These strict measures are crucial for managing various medical conditions.
However, as a patient care technician, you are responsible for tracking what goes in the patient (input – i.e., water) and what comes out of the patient (output – i.e., urine).
Once you’ve taken the patient’s vitals, your next objective is to empty any drains the patient has and check the urinal or urine hat in the bathroom.
If you notice no urine, ask the patient the last time he/she/they used the bathroom.
If they haven’t gone to the bathroom recently, offer to assist them to the restroom if they need to go.
Pro tip: if I know a patient has multiple drains, I will double-glove when entering the room. That way, I can remove the dirty gloves after emptying a drain. It can get a little messy sometimes!
Case scenario: two patients just pressed their call button simultaneously…
Patient 1 needs to use the restroom.
Patient 2 needs more water.
You are currently closer to patient 2.
What patient do you go to first?
The restroom is ALWAYS the first priority for activities of daily living (ADLs).
You can always ask a fellow PCT or the nurse if they have time to get your other patient water.
This task takes approximately 2-5 minutes.
6. Closing Tasks: Is There Anything Else?
Before leaving the patient’s room, ask them if they’re comfortable and if they need anything else.
Questions to ask yourself before leaving the room:
- Is the bed alarm on?
- Is the environment safe?
- Is the bed in the lowest position?
- Does the patient have their call light?
- Does the patient have water?
- Is the bedside table next to them?
As you leave the room, remind your patients to call if they need anything and that you’ll check on them again during hourly rounding.
Don’t forget to wash or sanitize your hands before leaving the room.
This task takes approximately 1-2 minutes.
Your First Rapid Response
Your first rapid response will be an absolute adrenaline rush, especially if you call it yourself!
Call a code and start CPR immediately if you find a patient unconscious and not breathing.
You can call a code by dialing the specific number on the hospital’s Nokia phone (you’ll have this phone on you the entire shift).
You can also call a code by pressing the ‘code blue’ button in the patient’s room.
If you notice a patient is rapidly declining, call the nurse for help.
If you are uncomfortable calling a code, immediately contact the patient’s nurse or charge nurse.
Stay with the patient until help comes.
Once the nurse comes, grab your vitals machine if you don’t have it and take the patient’s vitals as soon as possible.
If the patient’s O2 is low, put a nasal cannula on or tell someone in the room to grab it from the supply room while you stay with the patient.
Sometimes, the code team takes a while to show up, so it may just be you and a couple of nurses in the room for a good 15 minutes.
While the machine takes the patient’s vitals, start placing the electrodes for an EKG.
If you’re not responsible for doing EKGs, then don’t worry about this part.
As a night shift PCT, I was responsible for EKGs, so I had to do this in critical situations.
After doing vitals and an EKG, I’ll check the patient’s blood sugar.
Once you do vitals, an EKG, and blood sugar, there’s probably a ton of people in the room, and you can check on your other patients now.
Congrats, you just survived your first code!
If you need to take a moment to collect yourself, please do so. It’s definitely a shocking experience.
So, to recap… here’s what to do when a patient’s status declines:
- notify the nurse
- take the patient’s vitals
- do an EKG
- check blood sugar
Again, every patient is unique, and every situation is different.
Hopefully, now you feel better prepared for your first shift.
But wait, I forgot to tell you what to bring!
What to Bring to Your First Shift
PCT shifts are typically 12 hours, and I pack my hospital bag like I’m going away for a mini vacation, lol.
These are my MUST haves for night shifts:
- dinner + snacks (PB&J, nuts, yogurt, fruit, protein bar, etc.)
- energy drink (my go-to is Reign)
- water bottle
- a jacket
- black expo marker
- Tylenol (you’ll get a headache at some point)
- a tiny notebook (like this one)
Most nights, I’ll have anywhere between 8-13 patients.
Make sure you prioritize your tasks and don’t hesitate to ask for help!
What really helped me stay on top of my tasks was writing down everything I needed to do by the hour (your preceptor will help you with this).
Remember to breathe. You’re going to make mistakes, and it’s okay. Learn and grow from them.
I believe in you! You’re going to do great 🙂
If you need to refresh your CNA skills, I recommend this YouTube Channel.
Let me know if this blog post helped you on your first shift!