Day in the Life

l.rae · Nov 21, 2002

l work in ER too....so here's a few minutes out of my shift...l clock in and get report on my patients.....l have two cardiac beds, a gyn room and a trauma bay in my assingment. Just as l am walking back into the ER after delivering my last pt to ICU, l see a squad rolling a pt into the gyn room....the only room open except for the cardiac be l just emptied. l stop the medics to question them because the pt just looks way too pale. A young 20 something male involved in a minor MVA earlier in the day, was treated and released from ER that morning....but this evening he is back with N&V and abd pain..."wait a minute, l will clean the cardiac bed for this pt" l tell them....do a quick assess, put 2 large bore IV's in the pt and get the MD to see him immediately....work furiously fast to get him ready for care flight to trauma center...he has a cracked spleen......He's gone, he will be fine, here comes another squad....psychotic pt. drunk...thinks he's superman...and on and on the shift goes....where's my ice chips?...how much longer?....l need more pain meds.....l need the bed pan.........l don't like needles......can l go smoke while l wait for the dr?(this from the alledged respiratory distress pt who arrived by squad)....l'm here for a pregnancy test(14yr old) l have always maintained that my job is like working on the Jerry Springer SHow with a few emergencies and illnesses thrown in for laughs......LR

waggy-2 · Nov 21, 2002

Hi.

I work in a small hospital-CCU 6pm-6:30am, also float quite a bit to ER. CCU- MIs, CVAs, ODs, Resp. distress-ventilators, some post-ops,....ER same as above with trauma, allergic reactions, CHFers, COPDers, Psychs, Frequent Flyers, general illnesses, Because were a small hospital, some get shipped via ambulance or chopper when stabilized. For a small place, we keep quite busy. The ones that stay go to Med/Surg, Tele, or CCU.

Have a good one,

Sue

whipping girl in 07, RN · Nov 22, 2002

I work in ICU as a staff nurse 7pm-7am.

First we get a general report on all the patients so we have an idea what's wrong with everyone in the unit.

Then I get report on my two patients. If there's anything unusual in the report, we go in the room and the offgoing nurse shows me (example: pt's neuro status, a hematoma from an arterial sheath, etc). Then I review the chart to make sure there are no new orders that we don't know about. I take a quick look at my patients and if they are stable, I usually do my 24 hour chart check at this time too, to make sure all the proper orders are being carried out (activity, diet, meds, fluids, equipment, etc) and that anything that's supposed to be d/c'd has been. Then I check my med bins to make sure I have all my meds for the night and order what I need from pharmacy. Then I assess my patients. (If they are unstable, I assess them before I do all those other things). I assess neuro status, heart, lung, and bowel sounds, abd palpation, pain, IV sites, strength, pulses, and dressings. I make sure the IV fluids and drips hanging are what's ordered. I do a set of vital signs. If the patient has a Swan-Ganz catheter, I do a set of cardiac numbers. If they have a Swan, CVP and/or arterial line, I flush, level and re-zero the line and check the presssure system to make sure the numbers are accurate. If there's an arterial line, I cycle a pressure with the cuff to make sure the arterial line is accurate. I check to see how often the cuff is cycling (if no arterial line) and adjust as needed. If the patient is stable, I usually set it for every hour; if on a vasoactive drip, every 15 minutes whether stable or not and more often if necessary.

After I finish my assessments, I usually try to get my notes open, unless something comes up (you never know). If I didn't bring anything to eat, I check around and see who wants to order food and get the ball rolling on that.

Then it's usually time for visitors. I go in and talk to them for a few minutes and answer questions as best I can. After they leave, it's time to clear the pumps and empty the foley so I can add up 3-11 shift I&O. I also do another head to toe assessment (every 2 hours).

We bathe our patients at night, so I try to get a bath done before midnight. After I bathe one patient, I eat dinner. Then it's time to do another assessment and more charting.

Things continue basically in this fashion. I do assessments and vital signs and squeeze in whatever tasks I need to do. Lab comes at 3 for AM blood draws, EKG at about 3:30, xray around 4:30 to 5. If I can't get my patients (at least one) bathed before midnight, I try to let them sleep until lab comes and wakes them up, then I bathe them. If one of my patients is "with it" and one isn't, that's the one I try to get bathed before midnight, so they can get some sleep. If an assessment changes significantly, I call a doctor to get orders as needed. I take off the orders and put them in the computer.

Our codes are called overhead, so if there's a code, whoever's caught up with the most stable patients responds to the code, bringing the emergency drug box and initiating ACLS protocol. If we save the patient and there's an empty bed in the unit, we transfer them to the unit; otherwise, they go to ER.

At six I finish up for the night; add up 11-7 I&O, finish up my charting, get the labs on the chart and compare them to the day before, look in the med bins and see if there's anything I need to order for day shift, make coffee, look at day shift assignments and see who's getting my patients, take out the trash, empty the laundry hampers, and straighten up the desk and my patient's rooms.

Of course, I have nights where things don't go well at all, where I run from crisis to crisis without ever getting into a routine, where I barely finish my work. Things happen and I've learned I just have to roll with it.

This was incredibly long and probably a little boring, but it's what I do three to four nights a week. :)