Typical day of pediatric nurse

The first rule of pediatric nursing is that there is no typical day. Your patients are so diverse they can have any number of conditions. Peds covers patients from birth to age 18. One day you might have a newborn and a toddler. The next day you might have two teenagers. It's never predictable and it constantly changing.

I work in PICU, so my day is a little different then a general floor nurse in pediatrics. Our typical patient ratio is 1:2 but at times we have three patients and if they are really sick then the patient is a 1:1. My typical schedule for the day is this:

0700:
Arrive at work
0700-0800:
Get report on my patients and organize my day. Our report typically lasts 10-15 minutes or more per patient. We are very thorough. We cover the patient's name, age, weight, and allergies. Then talk about the diagnosis, the history of the illness and any past medical history. Then we cover by system the physical assessment of the patient, including any treatments, PRN medication, or other interventions that were given in the past 24 hours to correct a problem. The systems are cardiovascular, respiratory, gastrointestinal, genitourinary, neurological, skin, and IV access. Then we discuss safety issues, social situation, the discharge plan, and any scheduled treatments, tests, procedures, etc for the shift. The leaving shift explains any concerns so that the day shift can address it in rounds. Then we review the physician orders and the MAR to ensure accuracy.

After I get report I copy my patient's MAR onto a smaller piece of paper that I carry in my pocket. I write down every hour of the shift and next to the hour I write down what medications, feedings, tests, etc are scheduled for those times. Then I start my flowsheet (our documentation system) by ensuring that the patient information is accurate and I note the time I took report and who the report was from. Then I prioritize my patients and go in to assess them in order of most critical first.

0800-0900:
Morning assessments and medications. Next I go to see each patient. If they have 8am medications I will get those from the pyxis first. Then I go in the room, introduce myself to the patient and the parents. I check the room to ensure that all of our safety equipment is available- ambu bag, mask, O2, suction, spare tracheostomy tube- if needed, code sheet (a paper that lists the dosage of emergency medications based on the patient's weight). I check the patient's name band to verify who they are and make sure that the IV fluids are correct and have the correct patient name and label. I check the expiration dates of all tubing to make sure it doesn't need to be changed. Then I do my head to toe physical assessment and vital signs. Finally, I will give any medications that are due.

I do this for all of my patients and when I am done, if I have time, I will document the assessments in the flow sheet.

0900-1800:
This part of my day is the time that is never the same. We do vital signs on our patients every 1-2 hours and focused assessments every 4 hours, at a minimum. In between I am giving medications, feeding patients or setting up enteral feedings, performing hygiene care, tracheostomy care, suctioning and doing chest physiotherapy, drawing labs, ambulating patients, changing IV tubing and fluids, repositioning, transporting patient to procedures, wound care, communicating changes with doctors and following up on new orders, as well as dealing with unexpected situations and requests from patients and family.

For documentation, we document vital signs q 1-2 hours, assessments q 4 hours, medication administration, PRN meds, strict intake and output, fluid balance, urine output per kilogram of weight, when we suction and do chest PT, hourly ventilator or O2 settings, and any important interventions, observations, or communication.

In the morning we have rounds with the doctors. At our facility, the nurse presents the patient. This means that we basically give the doctors report on the patient, the current treatment plan, any changes in the patient's condition and our concerns. Then we all discuss the patient and the treatment and make changes if needed. Then it's my responsibility to check and verify any new orders, scan the order sheet to the pharmacy, and transcribe the orders to the MAR. Of course, I also have to initiate new interventions if we are changing something with the patient, such as their O2 delivery device, the type of formula, need a lab result, etc.

I also try to ensure that my patients are getting adequate social stimulation. This could mean holding the babies that don't have parents visiting, making sure they have mobiles and toys or music playing in the background. For the toddlers and older children, it's playing with them, talking to them, getting them out of the crib, if their condition permits.

Sometimes there are special things that are taking place that I participate in, such as a family meeting where we talk about the patient's care. I also communicate with social work, case managers and child life about the needs to the patient. In addition, I do some admissions and/or discharges and help the other nurses with their patients when needed.

1800-1900:
Finishing up with my patients, making sure all meds are given, IV fluids are full, rooms are tidy and the patient doesn't need anything. Then I catch up my flowsheet, total the intake and output, ensure that I've signed off all my medications and treatments, and write my nursing note. Our nursing note is basically a concise report about the patient's diagnosis, what we did for them that day, what changes were made, their current physical condition, and the plan for the next day.

1900-1930:
Give report to the next shift, say goodbye to my patients and head home. However, this never all gets done before 1930.

I have to say that I probably spend 10-15% of my time doing documentation: my flowsheet, taking off orders, signing the MARs, etc. 10-15% communicating with healthcare team and the other 70-80% is spent with my patients and/or the families. If I have an admission or a discharge, it's probably more like 20% documentation, 10-15% communication, 65-70% patients.

Pediatrics is a very broad specialty and varies accourding to where you work, NICU, acute care floor, PICU, ER

I work in a SNF/LTC that is pediatric birth to 21 years, the youngest patient in house right now is 2 years old and we have a few 21 year olds who are looking to be moved to group or nursing homes.

My day depends on what unit I am assinged to and staffing. One unit is more skilled and there the nurses have 9 patients each with half of those being trach kids, and some respite and hospice kids as well, so these kids need a little bit more monitoring.

The other units the kids are more stable so then each nurse has 20 kids, I work at night so the night shift has 20-40 kids to do assessments on, if there is an LPN then I only have 20, but we only have one LPN who works at night and she needs days off so there are days that I have the full 40.

2230-2300
Every shift, come in and get report which takes 30 min, if I have the LPN she gets report on half of the kids and I will check with her if there is anything of concern that I should be aware of.

Based on report deterimnes who I check on 1st. The nice thing about my facility is we are well staffed with CNAs and they are all CNAII so they are able to pour the tube feedings and out of 58 kids in house 50 are tube fed, we also use med aides who pass all of our meds, if I work on the skilled unit the nurse passes their own meds, which makes sense as they have 9 compared to the 20-40 on the LTC.

After I do a walk through eye balling all my patients I begin to do assessments, each child gets a full assessment every 24 hours which are devided up among the shifts, but we need to review the full assessment each shift and depending on what is going on with the child do a review focused assessment.

Then there are treatments, I have 4 that have neurogenic bladders that need to be cathed q shift and a lot of neb treatments and vest treatments, skin treatments.

IF the kids sleep all night, which hardly ever happens there is some down time between 2-4 am, which I use that time to make sure my aides have been able to have a break and cover breaks for the med aide and LPN. If there is no LPN, I am pretty much doing assessments/paperwork all night long.
Around 4am I will round on my kiddos again and am available if needed, because these kiddos are fragile almost every night someone has a seizure and needs more monitoring, or if someone is sick more monitoring.

At 0530 one of the day shift CNAs comes on and that means it is time to start getting kiddos up and dressed and ready to go to school, more than half of the kids go to school in the public school system the rest are home schooled, so that means getting 20 plus kids ready for school for 7-8am pick up times.

Report is 0630-0700, very rarley do I have to stay over infact in the last 3 months I only stayed over once because one of my patients had a status seizure right at 0620 that lasted 10 min, did start report untill 0700 after he was stablized.

I agree with the PP. There are so many subspecialties in peds that there's no "typical" day. I'm in hem/onc and my day is never the same, even with the same assignment. This is how it would go in a perfect world, where kids don't spike temps, chemo doesn't run late, no pain crises, doctors put in orders in a timely fashion, etc etc...


This can apply to AM or PM shifts:

7:00-7:10 Get assignment and fill out hourly brain sheet. I usually just fill in my meds.
7:10-7:30 Get report.
7:30-7:45 Fill in other info on my brain like dressing/cap changes, TPN/IL times, chemo start times, etc.
7:45-9:00 VS, assessments, safety audits.
11:00-12:30 VS, assessments.
3:00-4:30 VS, assessments.
6:00 plan of care review/charting.
7:10-7:30 Give report.

We do hourly site assessments on PIVs/CVCs, daily line changes, nightly labs (sometimes q12), feed changes q4....oh, and a boatload of charting. Infusions with frequent VS (IVIG, cytogam) and titrating rates are common. Any blood products I always stay in the room for the first 15 minutes. Not only because we're supposed to, but it gives me 15 minutes where I have to stay put. I keep one eye on my patient and chart uninterrupted for 15 minutes. Meds are usually IV, anywhere from 15-120 minutes and a lot of kids have meds every 2-3 hours. We have a fair share of PO meds too so you have to come up with creative ways to get the little ones to take them. I/O tallies are at least q4, but thankfully the PCAs can handle that, along with VS other than our initial set. Our assignments are 2-3 patients. Kids that are actively dying are almost always 1:1.

Lately, we've been crazy busy and I've stayed late. The latest was 9:15 on a day shift because my patient started going downhill at about 6:30. By the time we got him stable, transferred to PICU it was 8:40. I stayed to chart on him and my other patients.

That was a really long day. I kinda got tired just thinking about it lol