15 Minutes in the Life of a Nurse

[NurseJulie31]

It's 10am, I have been here for 3 hours and "all" I have managed to accomplish is making sure everyone has their medications. In the middle of pulling a locked narcotic that a patient needs now, the phone rings informing me that a patient has a critical lab needing called to the doctor.

This particular lab can be deadly so I pick up the phone to call the doctor....wait....what are the patient's vital signs?

Because we know he will ask that.

On my way to get the patient's vitals, I am stopped by therapy letting me know that there is a patient complaining of dizziness and her oxygen is dropping. I go to the therapy room to assess the patient and she is struggling. I am now diverted outside to grab some oxygen and get her vitals. Once she is stable, I remember that I have another patient needing immediate attention based on a lab result so I grab those vitals and pick up the phone to call the doctor.

Wait.....what med is this patient on causing this abnormal lab? What disease process could be causing this?

I grab her chart to quickly get more background information because I am required to know everything on ALL patients so that the doctor can make informed decisions. As I'm on the phone, I hear a bed alarm go off and my STNA is in a room changing another patient. I can either tell the doctor to wait, or find a patient on the floor, hope they are OK and now do frequent neuro checks.

I put the doctor on hold and get this patient to the bathroom reminding him that he must call us before he gets up....he laughs, I laugh and we both know that "education" will go nowhere.

I receive new orders from the physician (who is now yelling at me because the poor thing had to wait) and as I'm working on squading this patient out, the original patient who has been in pain reminds me of how I'm not "doing my job."

This is only 15 minutes of my day....the prioritizing and re-prioritizing. Worrying that any move you make or don't make could harm another life. Having patients ask you where their breakfast is, what time is their appointment today and do they have a ride, what is the pink pill they are taking, why are they not getting their pain pill on time, etc.

I have messages from the social worker and dietician, a patient who is a full feed which takes my STNA away from all other patient care, another doctor who just walked in writing orders for a STAT lab and a patient telling me if they don't get to the bathroom NOW, they are going to poop everywhere.

This is all happening and it's up to me to keep it straight.

All of this while being reminded from someone who works in an office somewhere that you are not "documenting things in a timely manner as they happen." Being told that more paperwork is required and more thorough documentation needed is maddening because I'm meant to be on the floor, not at a computer.

My charting and initialing of everything I do isn't saving lives, my presence on the floor is. Please stop requiring nurses to spend more and more time at a computer and then getting upset when patient quality of care scores go down.

You want quality care?

Get us some help because we are drowning.

[GaleSRN, BSN, RN]

I am the manager of a dialysis unit. We have close to 90 pts. Today I have 1 RN on "bonding" leave with her baby and family, another one is off this week due to her kids being on school break. This leaves 2 RNs, and myself. We have 2 new admissions, each one taking up to 2-3 hours each, 5 coming in for medications supposedly for 15 minutes( that is a misnomer, there is always something extra), and 3 for clinic visits. I went in this morning not feeling too great. By noon I was in full fledged influenza and had to go home. I was planning on handling all the medications and 1 of the clinic visits while approving payroll, answering about 50 emails from over the holiday, a meeting with a man working on a project, and a phone conference scheduled for 1 hours. Nope. I got the flu and had to leave my nurses drowning. My amazing nurses handled it like the troopers they are. You can bet I will do something really nice for them for doing this. I just couldn't be in the room with any of our imunocompromised patients while I was sick.

Yes I got the flu shot. No, it didn't help.

Sometimes management DOES now what is going on. It is their job to know and to try to help. Our motto is Patients come first, ALWAYS. If I have to drop what I am doing to help my staff, then so be it. You know you are in the right place when your manager answers a call light, passes some medications, does some vital signs, and so forth.

[aquakenn, CNA]

I recently left the addictions field. It is very similar as far as documentation is concern. I found myself spending 75% of my time doing documentation and 25% of doing the REAL work. Administrations, States, and insurance companies need to realize that services will help clients/pateint who receive 25% face time, will not be given the excellent care we have all been trained for.

[GitanoRN, BSN, MSN, RN]

Lauraingalls said:

Great post! I wish doctors and administration could spend even 15 min in our shoes trying to manage all the things we do.

Needless to say, they wouldn't last 5 minutes performing any given scenario posted here. Having said that, this is one of several issues that I have with my providers and administration team. However, there are some exceptions, several of the administration team with whom I work with, do realize the need to revise the prioritization of offering our patients a higher caliber of care with a decent nurse/patient ratio. Lastly, I would like to thank all of you for going the extra mile, as I wish you all the very best for the coming New Year... Aloha~

[alobozzo]

Great summary of 15 minutes on the floor. With the onset of electronic records I believe for a floor nurse it has become harder. I have been a registered nurse a loooong time and have seen many a different process. I am retired now and exhausted from the career I loved. I could not do it again. My last venue was as a director continually begging for more staff. Arguing with corporate that electronic record made it more difficult for patient care because it demonstrated the need for more nurses to administer care to stay within two hour window.

[JavaJunkie RN, BSN, RN]

And this is exactly why I no longer work in hospitals. I worked Cardiac Medicine and Stepdown for over 12 years. My last year in the hospital on a Stepdown floor the doctors started putting orders in the computer so they took away our unit secretary. This left no one at the desk to answer phones or call lights except one of the 2 PCA's. It was impossible to get everything done AND "chart as you go". How in the world can I chart as I go when I barely have enough time to do nursing nursing and help the 1 overworked PCA we have on the hall. (Please don't get me wrong, I do "PCA duties" without a problem. I'm perfectly capable of changing someone, helping to the bathroom, etc. But, nursing duties need to come first.) Oh yeah and they had me doing charge nurse duties because they were to cheap to hire a night charge nurse and all the other night nurses had less than 18 months work experience and a couple were less than 9 months out of nursing school.

After I left, I spent a year doing private duty home nursing and then moved up to a Clinical Nurse Case Manger for private duty patients. I still have a ton of paperwork to do, but at least I have 24 hours to finish a routine visit and 5 days to complete an admission or recertification. And, I can do my paperwork from home if I choose.

[Joni Petersen]

After nursing for 24 years I am now retired. Accurate depiction that didn't occur as much when I began my career. Nurses required to do more and more with the average complexity of patients increasing at the same time. I wish I had a nickel every time some administrator said...."we don't need to hire someone else to do that, the nurses can do it".

When I first started, the best CNA's on the floor would eventually become RN's. Now they quit and become Baristas. Pay is better with less stress.

As an added stress, is the increase of the opioid addicted patient. And I'm sorry, the Med/Surg floor is not a Psych ward and all that goes with that. It actually put me over the edge. Had to leave nursing a lot earlier than I had intended.

Thanks for a forum to let us vent......

[Sbhayes09, ADN, RN]

This is exactly why I chose a job outside of the hospital. All clinicals have done for me, is show me why I don't want a hospital bedside job. I'm sure it will still be stressful and chaotic in ambulatory care, but at least I have the luxury of shaving 4 hours off my work day and keeping my nights, weekends, and holidays for self care. I'm praying for you guys in the hospital settings! Your jobs are so incredibly difficult. ?

[Kooky Korky, BSN, RN]

On 3/14/2017 at 5:25 PM, Janeis said:

It is unfortunate, but learn to adapt. We are nurses, this is what we do. Computers are not going away. Like it or not, it's now our reality. Our Government has mandated computer use via Meaningful Use. If you want to make a change, get involved and stop complaining.

And the ways to get involved include:

- inform the public (family, friends, wherever you might know some people - church, etc.) of things like this.

- inform your state and federal senators and congressmen/women. Get them to pass legislation about proper staffing.

- get your coworkers to form and join a union.

- get yourself and your coworkers to stop skipping breaks and lunches, stop working double shifts and overtime when your employer cries about it, demands it, or guilt trips you to work instead of taking your day off.

- If they want you to do all that charting, let alone do it timely, get them to provide a way for you to chart without having to be at the Desk.

You have to do more than write an article here, Julie, therapeutic though it might be for you and others. Action is required if you want to see change.

[Eastern RN]

BAM!!!!

[Kooky Korky, BSN, RN]

On 3/16/2017 at 8:57 AM, music42RN said:

So ... to improve pt care we should write letters to accrediting bodies that announce weeks to months in advance of coming, and risk our sole source of income and risk not being able to work in the field we spent tens of thousands of dollars in education? If the accrediting boards had ANY interest in knowing what was really going on, visits would be unannounced.

We should write congressmen and women who clearly do not care about medical care for their constituents, nor worker overload. State regulators will fine the hospital if we don't clock out for lunch, but could care less if we have to stay late by 2 hrs to chart, even when working the next day. The same government leaders that use "patient satisfaction" scores to lower reimbursement - scores based on the RN meeting the pt expectations for call light response that have NOTHING to do with medical acuity.

Congress knows full well the biggest problem in the health care system is lack of patient accountability (CHF pt stops at olive garden on the way home after being diuresed for 3 days and returns w/in 30 days for the same problem; end-stage COPDer on home O2 that won't quit smoking 1-2 packs a day and is re-admitted monthly, the repeat ETOH detox pt, the 85+, dementia pt in a memory unit and full ADL care receiving a pace-maker, ....). They will not set limits, they will not pass laws allowing EDs to direct a pt to see their PCP in the morning. God help you if you get cancer at 45 or 50 and need help with 100,000 worth of treatment.

We have to come together and get the voters to use ballot measures to force meaningful changes. But I can't see how. I wish I was smarter.

You really think that your elected legislators and all of the people you know through family, friends, religious and social and other affiliations know what is happening in their hospitals and nursing homes? You really think there is nothing you can do to bring about the needed changes?

Yes, people need to come together. That is exactly what I believe. Nurses need to find the courage to educate, inform, and strike if voting and educating alone don't do the trick.

How do you think YOU can help get voters to vote for needed change?

I agree that accrediting bodies should not announce their visits. It's kind of like Moody's, Fitch, Standard and Poor's financial ratings. Companies PAY them to be included in their reviews? Perhaps some get good ratings because they pay? Stinky business that!

[LindaGracie, ADN, BSN]

On 3/3/2017 at 6:05 PM, Here.I.Stand said:

One great thing about the hospital I am at now, is the lab staff page the MD about critical results. The RN can't exactly intervene medically without orders, so this way eliminates the RN-middle man, and gets the pt the required orders faster.

I really like this idea! Saves the nurse time which can take 5-10 minutes or more of the nurse's time just to check/obtain the patient's VS, review the chart and contact the doctor which may become an issue of phone tag. The doctor can't really get upset with the lab because they are just reporting the lab value. True the doc wouldn't get the whole picture of the patient but he/she can check with the nurse on the floor or better yet, go check on the patient him/herself.

[LindaGracie, ADN, BSN]

When I worked in the hospital, I had this scenario occurred all the time but was constantly told I had to improve my time management. I would get frustrated because I didn't know how I was suppose to handle all of these things at the same time. Someone was always not happy. The sickle cell patient in sickle cell crisis was wanting her pain medication stat, the lab kept calling with several critical lab values, I had to administer the 8pm meds, complete the assessments, attend to beeping IV pumps, do hourly roundings, had an admission waiting to be admitted to the floor, a confused patient's family requesting to talk to the nurse, as well as my preceptor wanting me to document something or had a question. Still brings back some negative memories. Now I love my job working with one patient and family. True I am giving tube bolus feedings every 30 minutes but this is achievable because that is the only patient I am attending to. Less stress!