Straight A Nursing: Study for nursing school exams & NCLEX · Maureen Osuna, MSN, RN - Nursing school educator, author, and nursing student enthusiast.

#446: MMM - 3 Things To Do at The Start of Your Shift

·14 min·1 clip

A new ICU nurse ignored Mo's advice and ended up run ragged by 10 AM—discover what went wrong.

This episode of Straight A Nursing offers a concise, actionable strategy for nurses and nursing students to begin their clinical shifts with greater organization and control. Host Nurse Mo shares three specific tasks to complete after receiving report to establish a "roadmap" for the day. She emphasizes that this routine is designed to create a solid foundation, making shifts less chaotic even when unexpected events occur. Nurse Mo illustrates the importance of her method by recounting a story of precepting an experienced telemetry nurse who was new to the ICU. The new nurse decided to skip preparatory steps and immediately begin patient assessments, which led to a chaotic shift by 10 a.m. and a return to Mo's recommended approach. The first recommended task is to read the most recent physician progress note or the History & Physical for a new admission to understand the patient's history and the care plan. The second task is a targeted review of key laboratory values, including white blood cell count, electrolytes like sodium and potassium, blood glucose, creatinine, coagulation studies, and hemoglobin. The third task is to review the patient's scheduled medications and their administration times to plan the day and identify any unfamiliar drugs for further study. Nurse Mo explains that this entire review should only take a few minutes and provides a "30,000-foot view" of the patient. She connects this preparatory work to developing a "high index of suspicion," using the example of a post-surgical patient with a coagulopathy where tachycardia would immediately raise concern for bleeding. This overview allows nurses to anticipate problems and steer care proactively rather than reactively. A key insight is that this routine helps nurses build mental context so they can interpret patient changes accurately and intervene in a timely manner. The episode suggests that even experienced nurses transitioning to new units can benefit from a structured start to their shift. The tone is instructive and supportive, blending personal anecdote with clear, step-by-step clinical advice. The style is conversational and direct, aimed at providing immediately usable tips without unnecessary theory. This episode is ideal for nursing students in clinical rotations and new nurses seeking to build confidence and organizational systems. Nurses feeling overwhelmed by shift unpredictability would find the concrete strategy valuable. Listeners seeking broad theoretical discussions or non-clinical career advice might find this episode too narrowly focused on bedside routine.

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