What is your daily routine? - page 2

When you come to work for your shift, what is your routine from the time you walk in to the time you leave? :monkeydance:... Read More

  1. by   crb613
    The only thing that goes the same everyday is getting report. This takes place from 1845-1900....sometimes a little longer. If nothing crazy is going on I assess my pt's (take care of immediate needs)....anywhere from 7-9 of them. We still hand chart so I also do that as I go. After this I take care of bad iv's, empty fluids, ect. Do chart checks before med pass if possible. At 2100 I pass meds for 2000,2100, & 2200. Of course this is just a rough outline ten thousand things (it seems) can happen from report to med pass. I always pray before I enter the building.
  2. by   AliRae
    PICU here. I get one or 2 kiddos, sometimes 3 or 4 if the floor is full and we have a lot of overflow. I get report from the night nurse, and peek into my rooms. If they're really sick kids, assess and check all my lines and drips right away. If not so sick and fast asleep, do some computer stuff first. Try to chart right after assessing. If I have a nursing student, this gets shoved off since I'm probably explaining things for a while. Start the wheels turning with meds and such. There's not so much a "typical" day for me, since it totally depends on the acuity of my kids ... if I have a bad RSV baby getting weaned off the vent, I can expect to spend 12 hours not leaving her side. If I have a couple kids getting ready to go to the floor, I have more down time. Vitals are Q1 or Q2, and in between there's lots of meds and dressing changes and turning and suctioning and bathing to be done. Admissions come usually when I'm least ready. Every now and again, since I'm still training for transports, I get luck and get to go out on a transport somewhere in there. Lunch is anywhere from 1130 to 1630 (if I get lunch at all.) I spend most of my day praying that I do'nt have to take field trips, and, if I do, please God, just CT and not MRI. I chart as I go and try not to get more than an hour or 2 behind on I/Os. If I have a student, we'll find some down time to wander the unit and check out all the other kiddos. Try and find a 15 minute block somewhere to go hold my favourite babe. Hand off my kids at 7, head home and crash.
  3. by   adrienurse
    :spin: I think I love you
    Quote from purplekath
    Hmmm...I don't think one day is ever like the next in psych, but I'll give you my last shift, which is a pretty "average" one.

    Arrived at 7am for handover - got 8 patients and allocated one nursing student.

    Rounds and environmental check - greet my patients, check their environments for any sources of danger. Remove plastic bags, glass, fire dangers etc. As I go, patients approach me, distressed about this and that.
    Talk to my nursing student about what she would like to learn today and allocate her two patients that I feel best meets those needs. Do meds with my nursing student.

    THEN...the chaos starts. My aim is to have about 1/2 hour with each of my patients. I spend all day trying to do this. Expecting a baby to come in with child protection for a supervised visit with a patient at 10 -- I must be present for this, visit is one hour, so must plan my day around that. Have pt#2 that needs to go to x-ray to establish where the 6 razorblades he swallowed yesterday were in his GI tract. So must plan for that also as I must escort him. Pt #3 has florid psychosis and is most unhappy about being on the ward. She spits at me and declares me "unregistered as a nurse, and places a voodoo curse on me". She secrets medications as she fears I am poisoning her, so spend maybe 30 minutes sitting with her reassuring her of her safety, explaining what occurs in a person during psychosis and why they may feel that someone is aiming to harm them. She takes the Zyprexa wafer then rushes to the bathroom and scrapes it from her tongue. As she is on an order (as all my patients are), I must then call wardsmen to give her an injection against her will ... she cries and cries, and inside, so do I.

    Pt#4 is a new admission - he is awaiting a place in a prison forensic unit, but my job is to work out whether he really is "crazy". Read his history and find that he nearly killed a woman a week ago. Decide to tread very carefully with this patient. He needs obs and bloods done. I sit across the table from him to discuss how he is feeling. I watch for signs that might indicate feelings of aggression...clenched fists, tight jaw, wanting to get up and pace. I see none of these, but sit across the table in case, knowing that if he becomes aggressive I have the table between he and I. When I feel that the coast is clear, take obs and bloods, explaining what I am doing at all times. I assess him as I go, he is telling me that he is hearing voices telling him that someone is going to die. I ask, "who is going to die? You, or someone else". He replies..."I am not sure, I can't hear them properly". I ask him if can dismiss the voices by asking them to go away. He tells me he can. I observe him from afar as I go about my work. He is not responding to internal stimuli, although he has told me that he sees things that he wants to pick up but they are not there. I add to my notes that as yet, he appears "not psychotic".

    Pt#5 is a BPD patient and before I get to see her she lights a fire under the sensor which causes the doors to the unit to get thrown open and all the fire doors to close. She absconds out the front door. I press my duress and proceed on foot. Security is coming towards me and I signal to them who the patient is, but signal with my hand to "hold off". I catch up with her and she threatens to hit me if I come closer. I walk with her and tell her that she must come back to the unit and discuss discharge if that is what she desires. She states, "I am just going for a walk". Talk, talk, talk. Sit with her while she smokes. Eventually she returns to the ward with me. Deal with the fire brigade who have arrived for the 4th time this week.

    Complete an ARC round.

    My break has passed, and now it is 10am -- baby arrives. I help the young mum with breastfeeding and discuss some of the delusions she has had about wanting to hurt her child. The visit does not go well, and must end sooner than anticipated, as she is beginning to talk about "saving her baby by ending its life" ... she becomes upset and I cannot offer medication to her as she is still breastfeeding. Consult a couple of doctors about what might be safe for breastfeeding...awaiting response as yet. But run her a warm bath and encourage her into it. Post my student at the door to watch her in case she attempts to harm herself.

    X-ray is calling -- escort my patient to x-ray and back. The razors are in the lower GI. I talk with him about what he needs to watch for in terms of pain and BM if they occur. Talk about the situation that led to his suicidality - depression and how it acts inside us. Discuss the side effects he is experiencing with his medication. Hold his hand while he cries.

    Pt #6 is a long-term patient who I am trying to prepare for eventual discharge by planning leave for him with his mother. Make 4 attempts at discussing it with him. He wants leave but he cannot hold a conversation without becoming angry. End the conversation each time with, "I'm sorry, if you become abusive we must try again later." Final conversation ends with a fist smashing a wall next to my head. Give up on the idea of leave for today.

    Lunchtime - I need a break, and I go. 30 minutes.

    On return, medicate those who are unsettled. Deal with patients at the nurse's window who have run out of cigarettes, who want to give me a letter they want posted to the prime minister stating that he is "being kept prisoner here", hear from the police who are complaining that an unknown patient has been calling the emergency number repeatedly requesting to be rescued. Attend to UDS's, more bloods, more medication, more obs. Answer questions from my poor neglected student. Organise drug and alcohol consults. Field phone calls from distressed family members and members of the public who need psych services and want admission - re-route those to the crisis team.

    1.20pm -- handover is in 10 minutes. Hurridly writes notes with which to handover my patients. Lament that precious little time has been spent with my patients. Resolve to find more time tomorrow. Handover.

    Spend the last hour or so trying to get around and see my patients and tidy up loose ends. More phone calls. Chasing doctors for med chart rewrites. Check in with my student about her patients, check her notes etc.

    2.45pm - short inservice on restraints and seclusion. I have been before so I cover the floor on my own. Do another ARC round. Encourage some of the boys to tidy up their messy rooms. A pt returns from leave intoxicated - breath and drug test. Do a search, find cannibis in his pocket which gets locked in our drug safe. Deal with a patient who is in tears because she is unsure if 12 packets of cigarettes is quite enough to get through the weekend. Get handed a complaint form from a pt who wants to lodge a formal complaint about his maltreatment on the unit. Receive a small silver balloon from a patient to say "thankyou" for helping her through a dark time. Attempt to clean a sink drain blocked with vomit from a man withdrawing from heroin who couldn't make it to the toilet ... unsuccessful. Give him some doloxene and call maintenence. Assist a distressed pt who has lost his "chime balls" worn around his neck that he believes protect him from winding up buried alive. He accuses me of stealing them. I find them, he is happy. Spend 10 minutes listening to him decipher codes in magazines and tell me what the birds have been saying to him.

    3.30pm - time to go home!!
  4. by   adrienurse
    deleted
    Last edit by adrienurse on Sep 17, '08
  5. by   AirforceRN
    Purplekath...WOW! you must be supernurse! I did 6 weeks psych for a clinical rotation and decided it wasn't for me but developed a deep deep respect for those that do it. Cudos to you and yours, IMO you have one of the toughest jobs in our profession.
  6. by   purplekath
    Haha...supernurse? Nooooo...put me into a clinical setting and I'd probably kill someone in the first hour!! lol
  7. by   Cobweb
    I was a VA hospital nurse most of my career, so I find my new routine pretty amusing

    I work night shift on the rehab unit in a rich people's nursing home. It's not unlike the Marriott hotel. I come in at 11pm, get report, and do rounds about every 2 hours. I pass out pain pills, and icepacks, and do a lot of handholding for people with broken hips, knee surgery, etc, who've hardly ever had anything bad or any kind of illness before. I check all the charts to make sure no orders were missed, and of course they were, so I catch all that up, and also take care of the lab lists for the day. I chart routine stuff about 2am, and any out-of-the-way occurrences as they happen. How busy we are depends on patient acuity--one time I had 5 bolus tube feeders, 3 half-hour dressings, and 2 IVs running, with a ton of 6am meds. At the moment, I have 2 pills and 2 accuchecks at 6 am and..that's it! I have 16 patients, and if the nurse on the nursing home end calls in, I may have up to 42.

    The funny thing about this place is that, even though the patients have elk steaks flown in from Montana and stuff like that, our staffing is no better than a regular nursing home, we run out of linen on the weekend just like every other place, and we actually get paid less than most places in town. This place is touted as being so great but for the staff it's just another nursing home. The work is easy on night shift though because the patient committee decides on med times here and they don't like to be awakened at night unless it's vitally necessary, muahaha
  8. by   TigerGalLE
    I work on a renal/respiratory floor... Day shift

    0645-0715: All the nurses from my shift listen to report for the whole floor. The previous shift tapes and they cover the floor while we get report. This way we all kind of know what is going on on the floor just incase something crazy happens. So this is when I drink coffee and eat breakfast.
    0720: Meet with the nurse handing off my patients for any updates.
    0725: Check charts and old orders briefly to make sure nothing is being missed.
    0745: Walk down the hall to meet my patients. AKA make sure everyone is breathing.
    0800: If I have a patient going to dialysis or surgery I go ahead and give them any meds they need before they go and get their paperwork done. If no procedures then I pull meds.
    0830-1000: Check labs, pass meds and do assessments. I'm also usually interupted 100 times to answer phone calls from lab, xray, family, docs, whoever. I also may discover bad IVs which will need changing. I usually have at least 1 or 2 critical labs values called. Now I must find the doc within 30 minutes to notify them of this.
    1000-1100: Check charts and chart.
    1100-1230: Give noon meds and cover blood sugars. Also covering for nurses who already got to go to lunch.
    1300-1330: Maybe I'll get to go to lunch now
    1330-1500: Check charts, do dsg changes, restart the IV, give pain meds, call resp. for breathing treatments.. Receive my patients back from dialysis. Check their BPs and give any meds. Tend to families.
    1500-1600: Do 1500 assessments.
    1600-1800: Give meds, cover sugars, fluff pillows, spend time with my patients (haha on a good day). Find time to tape my report. I usually have to call a doc for something.
    1800-1900: Tie up loose ends, make sure I am not leaving anything undone for the oncoming shift. Check through my charts and MARS to be sure nothing was forgotten. Chart.
    1900-1945: wait for the oncoming shift to come out of report, give any updates, tell my patients goodbye.

    PS: I usually have some random discharges and admits thrown in the mix. Usually the admits are only during shift change however...

    Some days are good and some days are bad. Depending on the acuity of my patients. I have from 5-7 patients and sometimes it just gets so crazy. This weekend was nice though and I was actually able to have a coffee break or two.
  9. by   mom2michael
    I work in a 8 bed ED.

    1045 - get to work - and clock in, go put up my lunch, pick up my narc keys from the floor.
    1055 - find out what's up in the ED right now - make sure all orders have been taken off for whatever patients are there, make sure everyone has been puffed and fluffed in their room, everyone is happy. Talk to the doc working, see what's up. Check the triage log to make sure we don't have people to triage.
    1200 - day shift RN takes lunch - see patients
    1300 - tech takes lunch - see patients
    1500 - I take lunch - I don't see patients
    1900 - night RN comes in - continue to see patients - count narcs with them if day RN is busy. Say hi to the new 7p-7a doc, say good bye to the day shift doc.
    2000 - eat a quick dinner in the med room.
    2200 - tech leaves - makes sure all their work has been completed, help them finish up so they can go home on time
    2315 - take my narc keys back to the floor and clock out and run if there aren't any patients. I've been known to leave as late as 0200 though.....
  10. by   BJLynn
    1425 to 1445 Arrive in nursing office and get report. Check for any new orders. See if any residents are out on doctors visits. Check the neuro, seizure, atb, and outstanding specimen board.

    1445 (Hopefully) go to my assigned floor and quickly scan the medroom to make sure supplies are there for medpass.

    1500 Feed my one bolus G-tube feeder.

    1510 Go back to medroom, get 40+ cups of water poured, get my applesauce poured up, and make sure I have all needed reinforcers such as candy or ciggarettes. (some residents get these if they answer questions about their meds or if they just plain take them)

    1530 (if nothing has happened) open door and do med pass for 40+ people. Run med programs for those that are on them.

    1615 My four diabetics start coming up. Do accuchecks, give insulin when nessecary, call for orders if needed. By this time my helper has arrived, and he/she goes and takes care of my two residents that need catheterized.

    1645 Hopefully medpass is over. I run to the fax room and fax the pharmacy before they close for any meds that I may need delivered that night. If medpass is not over, ask for backup if avaliable, or shut door temporarily and resume medpass when I return.

    1700 Go over MAR to double check no ATB got missed in the controlled chaos that is medpass. Get any treatments done that can be done.

    1800 Do second bolus feeding on bolus guy.

    1815 Take break.....maybe

    1845 Get one of my pump feeders her meds and hook her up. Do accucheck on second pump feeder.

    1900 Get ready for second medpass.

    1930 Do second medpass. Smaller than the first one.

    2000 Do accuchecks and insulin.

    2015 Hook up second pump feeder.

    2030-2230 Do treatments, charting and any other things that need to be done.

    2100 Do third bolus feeding on bolus guy

    2245 Give report to oncoming shift, count narcs.

    2300 If everything has gone according to plan, clock out.

    This schedule subject to any injuries, illnesses, in house doctor's clinics, new orders, unccoperative blood sugars, residents having difficulties with emotional outbursts or physical aggression, fist fights, injuries to the nurse, stubbed toes, pyscotic breaks in medline, etc.....

    The last time I was able to follow this schedule as written.............I really can't remember. There is usually two or three of the above incidences to help spice up my day.
  11. by   RNDreamer



    Quote from purplekath
    Hmmm...I don't think one day is ever like the next in psych, but I'll give you my last shift, which is a pretty "average" one.

    Arrived at 7am for handover - got 8 patients and allocated one nursing student.

    Rounds and environmental check - greet my patients, check their environments for any sources of danger. Remove plastic bags, glass, fire dangers etc. As I go, patients approach me, distressed about this and that.
    Talk to my nursing student about what she would like to learn today and allocate her two patients that I feel best meets those needs. Do meds with my nursing student.

    THEN...the chaos starts. My aim is to have about 1/2 hour with each of my patients. I spend all day trying to do this. Expecting a baby to come in with child protection for a supervised visit with a patient at 10 -- I must be present for this, visit is one hour, so must plan my day around that. Have pt#2 that needs to go to x-ray to establish where the 6 razorblades he swallowed yesterday were in his GI tract. So must plan for that also as I must escort him. Pt #3 has florid psychosis and is most unhappy about being on the ward. She spits at me and declares me "unregistered as a nurse, and places a voodoo curse on me". She secrets medications as she fears I am poisoning her, so spend maybe 30 minutes sitting with her reassuring her of her safety, explaining what occurs in a person during psychosis and why they may feel that someone is aiming to harm them. She takes the Zyprexa wafer then rushes to the bathroom and scrapes it from her tongue. As she is on an order (as all my patients are), I must then call wardsmen to give her an injection against her will ... she cries and cries, and inside, so do I.

    Pt#4 is a new admission - he is awaiting a place in a prison forensic unit, but my job is to work out whether he really is "crazy". Read his history and find that he nearly killed a woman a week ago. Decide to tread very carefully with this patient. He needs obs and bloods done. I sit across the table from him to discuss how he is feeling. I watch for signs that might indicate feelings of aggression...clenched fists, tight jaw, wanting to get up and pace. I see none of these, but sit across the table in case, knowing that if he becomes aggressive I have the table between he and I. When I feel that the coast is clear, take obs and bloods, explaining what I am doing at all times. I assess him as I go, he is telling me that he is hearing voices telling him that someone is going to die. I ask, "who is going to die? You, or someone else". He replies..."I am not sure, I can't hear them properly". I ask him if can dismiss the voices by asking them to go away. He tells me he can. I observe him from afar as I go about my work. He is not responding to internal stimuli, although he has told me that he sees things that he wants to pick up but they are not there. I add to my notes that as yet, he appears "not psychotic".

    Pt#5 is a BPD patient and before I get to see her she lights a fire under the sensor which causes the doors to the unit to get thrown open and all the fire doors to close. She absconds out the front door. I press my duress and proceed on foot. Security is coming towards me and I signal to them who the patient is, but signal with my hand to "hold off". I catch up with her and she threatens to hit me if I come closer. I walk with her and tell her that she must come back to the unit and discuss discharge if that is what she desires. She states, "I am just going for a walk". Talk, talk, talk. Sit with her while she smokes. Eventually she returns to the ward with me. Deal with the fire brigade who have arrived for the 4th time this week.

    Complete an ARC round.

    My break has passed, and now it is 10am -- baby arrives. I help the young mum with breastfeeding and discuss some of the delusions she has had about wanting to hurt her child. The visit does not go well, and must end sooner than anticipated, as she is beginning to talk about "saving her baby by ending its life" ... she becomes upset and I cannot offer medication to her as she is still breastfeeding. Consult a couple of doctors about what might be safe for breastfeeding...awaiting response as yet. But run her a warm bath and encourage her into it. Post my student at the door to watch her in case she attempts to harm herself.

    X-ray is calling -- escort my patient to x-ray and back. The razors are in the lower GI. I talk with him about what he needs to watch for in terms of pain and BM if they occur. Talk about the situation that led to his suicidality - depression and how it acts inside us. Discuss the side effects he is experiencing with his medication. Hold his hand while he cries.

    Pt #6 is a long-term patient who I am trying to prepare for eventual discharge by planning leave for him with his mother. Make 4 attempts at discussing it with him. He wants leave but he cannot hold a conversation without becoming angry. End the conversation each time with, "I'm sorry, if you become abusive we must try again later." Final conversation ends with a fist smashing a wall next to my head. Give up on the idea of leave for today.

    Lunchtime - I need a break, and I go. 30 minutes.

    On return, medicate those who are unsettled. Deal with patients at the nurse's window who have run out of cigarettes, who want to give me a letter they want posted to the prime minister stating that he is "being kept prisoner here", hear from the police who are complaining that an unknown patient has been calling the emergency number repeatedly requesting to be rescued. Attend to UDS's, more bloods, more medication, more obs. Answer questions from my poor neglected student. Organise drug and alcohol consults. Field phone calls from distressed family members and members of the public who need psych services and want admission - re-route those to the crisis team.

    1.20pm -- handover is in 10 minutes. Hurridly writes notes with which to handover my patients. Lament that precious little time has been spent with my patients. Resolve to find more time tomorrow. Handover.

    Spend the last hour or so trying to get around and see my patients and tidy up loose ends. More phone calls. Chasing doctors for med chart rewrites. Check in with my student about her patients, check her notes etc.

    2.45pm - short inservice on restraints and seclusion. I have been before so I cover the floor on my own. Do another ARC round. Encourage some of the boys to tidy up their messy rooms. A pt returns from leave intoxicated - breath and drug test. Do a search, find cannibis in his pocket which gets locked in our drug safe. Deal with a patient who is in tears because she is unsure if 12 packets of cigarettes is quite enough to get through the weekend. Get handed a complaint form from a pt who wants to lodge a formal complaint about his maltreatment on the unit. Receive a small silver balloon from a patient to say "thankyou" for helping her through a dark time. Attempt to clean a sink drain blocked with vomit from a man withdrawing from heroin who couldn't make it to the toilet ... unsuccessful. Give him some doloxene and call maintenence. Assist a distressed pt who has lost his "chime balls" worn around his neck that he believes protect him from winding up buried alive. He accuses me of stealing them. I find them, he is happy. Spend 10 minutes listening to him decipher codes in magazines and tell me what the birds have been saying to him.

    3.30pm - time to go home!!
  12. by   AGUIMAN3MM
    :icon_wink:Having been working for 8 yrs in California,I discovered few effective ways to have nursing routines in my field of work in an acute hospital setting-Actually,not all the times you have the control as nursing is always unpredictable in an acute hospital setting, but at least you can have a structured routine to enable us do effective and satisfying nursing tasks to our patients and into ourselves for peace and sanity! That's what nursing vocation is all about! Well, when I first arrived in the station-I will first check my assignment-----(the ratio/the name alerts/to cover LVN (if any))/the dnr/the isolations/the possibility of admission ),then I go right away to the pts' hard chart--------(the md's orders in that day!(stat orders/standard orders)-this way I will have an ideas what the md's is going to do!---check the latest lab values! esp the SERUM K,H&H,LYTES,CHEM-7!----these will guide you allow the way!------------Then, I will get reports from previous shift(bedside report-see iv's/foley's,tubings,feedings,shunts,call lights,side rails,restraints,name badge,dressing stuffs,room flags-fall risk/npo's/pt's needsain meds!water!blankets!etc!)------then, I go to my pts' MAR's--(IV'S/TPN/ANTIBIOTICS)---jot down there time of adm! the need to have pharmacy assist you!--------then,give all the prn meds for pts who are asking if time is permitted-all the pts request for there comfort like water/ice/blanket and all special request that you can help your pts stabilize there comfort/stay------ then,check your pts v/s from your aides! check the abnormal ones!medicate if necessary! prioritize the unstable pt------do quick assessment/medicate and call md if needed-------then start from there! ------medicate each patient as ordered/applicable! and do assessment as you go along the medication! /accuchecks as well! ------before mid night!follow up pharmacy for your needs/pass diabetic snacks as ordered/feeding tubes- renew/dressing change/pre-op patients flags/orders! -----------then do charting30-60 min! by then you are ready for your midnight med runs! -------make sure you have v/s from aids possible! visual check your hard chart of your pts once again! THEN-----after the midnight run! do quick charting 15-30 min,then go for quick snacks! then make nsg rounds after you take your quick break! then do your M.A.R 24-HR CHECKING!--against the pts hard chart! focus one at a time to MAR/ LABS/PROCEDURES! Avoid distractions when doing these! do not talk and socialize! then---do nsg rounds again! then take your long 30-min break!------then do nsg rounds again! THEN DO CHARTING MORE! (V/S,I&O'S)--------After that ready for AM NSG CARE assistance /MEDs&PRN MED rans! / CHARTING! AND last round before you give report to the incoming shift! THEN,finalize all you documentation then.Thank yous to you CNA'S and Charge would be refreshing too!
  13. by   nckdl
    I work in a nh dementia unit, here is my day 5:30a to 6p---

    5:30-6a give report
    6a-6:30 grab mar and head to common area with med cart and everything else i might need. Then I watch over the 1:1 pts to make sure they don't fall while straightening up the living room, ordering stuff we need from kitchen, talking with wandering pts.
    6:30-9a pass meds, pass trays, help feed people, watch over 1:1 still trying to fall, answer phone and doors multiple times.
    9a-11:30a care confrences, charting, faxing Drs on various items, tx's if i have time, occasionally watch 1:1 pts if cnas need break or to do something else.
    11:30a-1pm pass noon meds, pass lunch trays, feed people
    1pm-2pm chart, tx's if i have time
    2p-2:30p lunch if i'm not behind, if i am i eat at my desk while working.
    2:30-4p write up any orders from previous faxes, finish my tx's for the day, order meds we might run out of, chart, call families, sit with 1:1s if needed
    4p-5:30p pass supper pills and pass trays and feed.
    5:30p-6p give report to oncoming shift.

    Note that this schedule does not call for any extra time for breaks, dr rounds, unscheduled meetings, falls, skin issues, fights, activities, if we are an aide short, if someone dies, or for family members to complain.:spin:

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