What is your typical work day like?

  1. I know no two days, nights, eves etc are the same but what's your routine like?
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  2. 8 Comments

  3. by   micro
    routine, what is that!!!!!!!!!!!

    okay, report, taped or otherwise, unless you have to hit the floor running.........
    quick assessment of patients, dr. phone calls if needed, first round of meds and ?????, chance to breathe and chart, maybe, grab a "dew" and a salad,then start again with procedures, medications, as well as the particulars of your patients, cares, call lights, etc, etc. etc.........
    try to chart, try to chart, I/o's, help people eat, help get ready for bed.......etc.......
    try to chart, give report taped or otherwise, try to chart.........and get out to have alife outside of work

    yiikes, I am tired.........
    micro
  4. by   MitziK
    micro, you made me Try to chart, try to chart.......exactly. Right now where I am it's a rare treat to get to chart before the shift is over. Your day sounds a lot like mine except change the Dew to a Dr. Pepper.

    Thank you
  5. by   RN-PA
    Med-Surg, 3-11 shift:

    -Arrive shortly after 1430, make assignments, print worksheets between 1445-1500.
    -Receive taped or verbal report, hopefully beginning before 1500.
    -Count narcs.
    -Check charts (and if I have time, check the charts I'm covering for LPN).
    -Check meds and make a list of meds/when they're due.
    -Assess patients-- anywhere from 4 to 6 pts. (I carry the nursing flowsheet with me and try to chart while I'm in the room with the Pt; If I'm really short on time, I just jot down "abnormals" and chart the rest later. I give report off of the flowsheet so I don't have to write assessments twice.) I carry 1600 IV meds with me and hang them as I see the patients.
    -Usually there is at least one discharge, PACU, or ED patient that I'll have to deal with in the first hour or so, and also, lots of patients still coming and going from tests-- radiology, GI lab, post-arteriogram, etc.
    -Call docs for Coumadin or IV or other orders they've missed when doing rounds earlier after first checking labs.
    -PCT's get vital signs and Accuchecks between 1530-1630, so deal with abnormals.
    -Dinner arrives around 1730. Help set up pts., feed, if necessary, and give 1800 meds.
    -On an UNUSUAL night, go for 30 min. dinner between 1800 and 1900 to the cafeteria. Otherwise, eat when able in the conference room. I almost always bring my dinner from home or if no time, always carry a "Kashi" bar (meal replacement bar) to cram in at a rapid rate, sometimes standing in our med room/kitchen.
    -2000: meds, begin wound care, shave preps, etc. (Visiting hours are over at 2000), help with p.m. care, clean up rooms. (I usually tidy up earlier as time allows as I'm in and out of the rooms.) Deal with abnormal 2000 vital signs.
    -If there's time, I clean up/update profiles and care plans in the computer. If no time, I write on the profiles- lab results, new orders, labs due in a.m., etc. for 11-7.
    -Write IV credits, I&O results for PCT to collect and chart by 2200.
    -Deal with abnormal 2200 Accuchecks, give hs snacks to diabetic pts.
    -Try to tape report before 11-7 is ready to listen at 2245.
    -Put flowsheets back in the charts. Get any IV's ready (time-taped) to hang if they're due to come down near 0000 or so.
    -Updates to 11-7 nurses after report received.
    -Count narcs and leave sometime after 2315.

    This, of course, is the bare bones and leaves out all the problems and chaos and surprises inherent to our wonderful jobs, as well as answering phones, taking off orders, answering call lights, ambulating pts., teaching, talking to family members, etc. etc. etc.!
  6. by   mattsmom81
    Well, my last 2 years of practice (I'm on sabbatical now waiting for a surgery) I did a lot of stepdown charge to help out (ya, I'm a sucker) as well as my critical care nursing. ICU was easier, to be honest. Being in charge on PCU means putting on your armour and getting oneself in the proper frame of mind before your shift...something like slamming your finger in your car door works well...LOLOL!

    Start out calling your supervisor and NM to complain about being short staffed for the third time this week...they never do anything..."There just isn't anybody...do the best you can"... day shift is exhausted and I don't feel like pressuring them to stay over again...we're all on OT....gotta take a full assignment myself again PLUS be boss...I give my best quasi-motivational speech to the nervous staff, wrangle out a semi-fair assignment for all, then instruct the monitor tech to accept ZERO patients from ER til I get back and race down the hall to asess, plan, implement and eval my group and eyeball the unit's sickest patients (basically and make sure they're all alive and head off disaster.) Hopefully I can accomplish some patient care (doubtful tho) before the next dozen phone calls, pt/family problems, and administrative or doc types in suits begin demanding to speak with the nurse in charge immediately if not sooner 'or else'... <sigh>. Being in charge means you get chewed on a lot, but the ol' skin does get thick over time.

    It's pretty much breakneck speed, send a few to ICU (ICU hates me when I do that--since I'm an ICU nurse I'm sposed to keep 'em they tell me), a few code anyway cuz a stubborn doc refuses to move. The ticky tack tasks (BS paperwork, QA stuff, etc) really get to me---keeps me from my staff and patients. But my job eval requires it. I have 2 GN's who need me closer but I can't get to them enough. I give them my best. I say a prayer for them as I know they're scared. Charge is also 'super secretary' answering phones, call lights, arguing with ER and the supe again and again dodging admits we have no time for, trouble shooting, pacifying spoiled docs, angry demanding families, assembling admit charts, taking off orders, computer stuff....whew! "Hey is this vtach or not" yells the monitor tech. It's artifact. <whew> Call pharmacy for missing meds, squeeze some treatments and vitals in, do some teaching. Steal some supplies from ICU for the staff--we're always out of everything lately.(I know where ICU hides their stuff..LOL) Usually no breaks except for a desperate dash to the potty. Too much to do and I don't want to be there 15 hours again today...my monitor tech's seeing double so I relieve her for a short break and return some phone messages I've temporarily managed to dodge. Dr. Jones has a direct admit rule out MI on the way up now still having chest pain. <sigh> Call housekeeping to do 3 stat cleans--- 3 enroute from ER, no argument says my lovin' supe. GRR. I've got 10 phone calls out to docs for problems ranging from a to z.

    We finally sit down to chart after report to the oncoming shift,....while we chart we unwind, debrief, and chat a bit. I usually go home feeling like I've fought a war with my "Band of Sisters/Brothers" We all hug--we survived another shift and did our best with what we had, although we know this is not good care. We wish we'd had more time for the little things too--like holding a frightened patient's hand or comforting a family member.

    PS...I don't miss this unit although I DO dearly miss seeing my coworkers every day!! They're great nurses!
  7. by   MitziK
    RN-PA you made me too. "Kashi bar to cram in at a rapid rate" Been there and done that too with whatever's handy.

    What is a PCT?

    Here's mine: 7-3 Med- Surg (reality 7- 1800 lately)
    Arrive about 635, go to conference room for assignments and report (this can last until 0800) depending on census I stay for full report or leave as soon as my pts are done.
    Check MAR for meds and list what needs to be given.
    Check lab orders to make sure they have been ordered and verified, report any significants to RN
    Take a peak at Tele monitor if any of mine are on one
    Trays come out about 0730, if I'm out in time I help pass trays, set pts up so they can eat, help feed.
    Pass 0730 and 0800 meds while doing quick assessments, repositioning, read PCAs if any at 0800
    Check with nursing assistant for any abnormal vs and treat, report abnormals and action taken to RN
    Mix IVPBs or fluids that will be due soon.
    Docs on first rounds- check charts for new orders, get clarifications etc.
    Give 0900 meds and more thorough assessment
    Check again for any new orders
    Do treatments, dssg changes etc.
    Give 1000 meds, discharges, reposition pts, PCA flowsheet
    Give baths
    1100 get FSBS results and treat accordingly
    get pts ready for lunch
    1130 or 1215 take 30 min lunch if possible
    1200 pass trays, pass meds, read PCA, check vital sign sheet again
    maybe chart, maybe not
    After lunch discharges if any
    About 1330 start getting I&Os, do any baths that didn't get done before lunch
    1400 flush heplocks, give meds, cont I&Os
    1500 report off, give meds
    1530 to 1600 next shift comes to floor, Yaaaay potty break.
    I get to chart and go home, or chart pertinents, run errands and come back and chart.

    Also includes teaching, telephone calls, call lights, IV restarts, f/c dc or insert, tube feedings, etc. etc

    Thats if no one codes, aspirates, develops chest pain or any of those other "surprises" as mentioned above that makes it so theres never a dull moment.
  8. by   RN-PA
    Hi MitziK!

    PCT = Patient Care Tech (Nurse's Aide). What's the "PCA" you mentioned? (Our "PCA's" are "Patient Controlled Analgesia"- IV Morphine, Demerol, etc.)

    You made me laugh too, with "1530 to 1600 next shift comes to floor, Yaaaay potty break." Isn't it amazing that we're all not walking around with raging UTI's from not drinking enough during the shift (me) and not taking time to pee for sometimes nine hours??? I've found that I can drink 16 oz. of fluid before bedtime when I get home and not have to get up during the night to "go", I'm so dehydrated. There are some nights I call what we do "Aerobic Nursing" because I'm often breathless and panting from all the running and craziness!
  9. by   KRVRN
    NICU

    1900--2000 get report, check monitor parameters, ensure functional bag/mask and suction, check charts and labs, 2 min scrub to elbows.

    2000-2130-- assessments on 2-4 babies, diaper changes and either PO or NG feeding.

    2130-2300-- chart, watch monitors, and chit chat with coworkers.

    2300-0030-- assessments on 2-4 babies, diaper changes and either PO or NG feedings.

    0030-0200-- chart, watch monitors, chit chat with coworkers and take break.

    0200-0330-- assessments on 2-4 babies, diaper changes and either PO or NG feedings.

    0330-0500-- chart, watch monitors, and chit chat with coworkers.

    0500-0630-- assessments on 2-4 babies, diaper changes and either PO or NG feedings.

    0630-0700-- chart, watch monitors and chit chat with coworkers.

    All interspersed with meds, talking with parents, calling MD or NNP for problems PRN, cuddling grumpy babies PRN, bathroom, snack and coffee breaks (we snack at the bedside). Some take smoke breaks.

    If your baby is crumping on you, you have lots of back up to help you or feed your other babies. The NICU is one big area, so any visiting parents can see that you are busy at another bedside so they don't usually feel neglected if you aren't right there. Everyone is willing to silence and intervene if anyone else's baby's alarm goes off. Everyone helps everyone... teamwork at its finest.

    There are no call lights in the NICU. :-)
  10. by   MitziK
    Hi right back at you RN-PA! PCA means the same Patient Controlled Analgesia, I'm not allowed to initiate them where I work but I do have to read them q4 and assess pt for abnormals and chart on flow sheet, took in house course. I definetly had an "Aerobic Nursing Day" today, LOL!

    Potty breaks, I can go all shift without going but as soon as I get in the door at home, I gotta go!

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