A day in the life of a Registered Nurse....

slou! · Oct 18, 2006

Yes, nurses please post this! I would love to learn about what each of you does every day as an RN! I know it depends on the specialty too, and I'm sure every nurses' day is SO much different from each day and other nurses' days!

Jo Dirt · Oct 19, 2006

At my home health job, I get up around 7:30 or 8AM, take the family to get breakfast at Mcdonald's, stick around until 11am or so, then leave for my home visits. I've been doing a lot of blood draws and lab work, lately. I drive to different homes and do supervisory visits on the CNAs/LPNs. These usually don't take more than about 15 minutes. I also do the paperwork for recertifications to continue getting nursing services (note any changes in condition, update med lists...etc). If I'm not out until late in the evening I will go into the office. I always try to go in at least three days a week to catch up on paperwork and doctor's orders.

I don't mind the paperwork, and I like the patients (most, anyway). My favorite part of this job is the autonomy. After doing this job I don't think I could bear punching in on a time clock again.

If I ever lose this job I will either stop working or just do private duty nursing a couple of days a week. No more nursing home for me.

mariedoreen · Oct 19, 2006

1) Gather info on my patients

2) Receive report

3) Clarify any abiguous orders that may exist

4) Round to do a quick patient safety check (correct IV hanging, oxygen in use, all ordered equipment in place, etc...) and check on pain levels and/or main concerns

5) Discuss with CNAs key aspects of care on each patient (turn q2h, VS q2h, fall levels etc...)

6) Re-round on my own to complete full patient assessments

7) Chart

8) Perform treatments

And...

Administer meds as scheduled, take care of prn pain/nausea etc.. needs, check & implement new orders as they come in, assist CNAs with anything they may need, assist other RNs with anything they may need, assist physicians with anything they may need. And of course run to others with anything I may need. Monitor patients for complications, review charts for additional information, interact with family and answer questions, call doctors for med orders I may need or to report new developments etc...

Some nights in the middle of all this I take report from the ED and then admit a new patient which can be time intensive. Some nights I discharge a patient which can involve a lot of teaching etc...

I finish up by giving report to the oncoming RNs about the patients I've had, their condition and how they're doing.

Some nights things are well controlled and some nights are full-moon experiences.

Cherish · Oct 19, 2006

Really think this should become a sticky. A lot of people come here deciding if this is what they really want to do, this could shed some light on there way to there path.

GregCP, RN · Oct 19, 2006

My Job: Pediatric Med Surg, 12 hr shift, 7pm - 7 am.

I get report, draft all my information on my patients, see my patients, assess, tx, VS, parent education....then chart. CHeck the fridges, glucometer check, stock kitchen amneties, then do my rounds for another quick assessment, VS, meds. During the night, I feed the babies, change diapers, and collaborate with physicians and other departments to assure that diagnostic tests and treatments are completed. In between all that....i browse the internet. Near the end of shift, obtain any labs, wts, meds, and a final set of VS. THen, draft a final report. The day shift nurses arrive, i give report, count narcotics...go home, get drunk and play my playstation 2.

bearsnurse · Oct 19, 2006

I work in the OR still on Orientation but i have been a surgical nurse for more than 10 years now not in this country though... anyway to start my day I usually look at the board to check what assignment s i have got for the day then go and get the drugs check my OR room for equipment and most especially the OR bed for position work on my computer stuff usually chart as much as i can possible check with my surg tech what else she needs help her open our case once everything is set up run and get my patient do my pre assessment interview check with day surg nurse or holding nurse for any significant changes or info if all else is ok then we're ready to go back to the OR. patient safety..patient safety... always assist anesthesia in induction check with the surgeon for positioning then prep...the rest the sterile people handles back to my computer stuff with my eyes and ears open for anything the team might ask and need. I get to be one step ahead if i have any case following make sure to ask one member of my team to go ahead check it check the room and etc... after that dressing is on. get patient ready for transport to PACU or ICU make sure my documentation is sorted charges complete go back to OR room for after care then proceed to do next case...now this is typical of a good day but you get bad days too where i run like a headless chicken... i usually end up re count my day list stuff in my little notebook and try and learn from what i missed during the day and swear never to do it again.... hmmm.. sometimes i do think of ahnging field and career prospects... but on good days i feel the satisfaction from doing my job and being a part of that team....being a nurse advocate in taking good care of my patient making sure of their safety while they are asleep.....

GregCP, RN · Oct 19, 2006

^^ wow, I'm impressed! God forbid I'd ever need surgery..but if i did, I'd be happy to have you as my nurse, ANYDAY!

perfectbluebuildings, BSN, RN · Oct 19, 2006

Peds Medical/Infectious Disease/Chronic&Multiple Issues floor, 7p-7a.

Get report on my patients, then initial rounds: assessments, safety/equipment checks, any 8pm meds. Do rounds every 2hrs at least, sometimes more often if I'm concerned about a patient- doing assessments specific to the patient's diagnosis/hospital course and not a full assessment each time, and assessing for needs. Explain the plan of care to the patient and parents if applicable. Control patients' pain and nausea and cough and and and... Give LOTS of IV antibiotics especially, and other meds. In the wintertime: lots of suctioning, pulse ox machines and O2, and getting pts their neb tx. In the spring: keep those IVs at all costs and clean up LOTS of "stuff" from Rota. Don't forget to chart and chart again, everything that ever happens. Keep patients fed and comfy and dry. Monitor lab results and draw any central line labs in the mornings. Do pre-op records if needed. Usually admit at least 1 patient during the night- can be easy or completely crazy depending on the kid. Call the doctor as needed. Answer call lights and the occasional "emergency cord" that puts some adrenalin into your night. Oh yeah don't forget to double-check the next-day's MARs and time them. As well as check the chart for the past 24 hours for orders to all have been done or on the right track. Give report and make sure the oncoming RN knows everything so I don't have to go back and say "Oh yeah I forgot to tell you.." which I do all too often.

Dang it's hard to sum up or explain it well isn't it. Sorry this is so long. I'm interested to read other specialties' days.

UM Review RN, ASN, RN · Oct 19, 2006

Great idea for a thread! Agree with the idea to sticky this one too!

I work for night shift for a Tele unit that also takes Med-Surg and Stroke patients, so I'm certified to read EKGs, give certain cardiac meds, and also to do the NIHSS (stroke scale) on appropriate patients.

I come in, get my assignment, check labs and orders from the computer, and briefly check the monitors at the desk to make sure my patients' rhythms and rates are OK. I make a note of all those with positive trops, high BNPs, low electrolytes or hemoglobins, or high D-dimers with a positive CT angio, those who are NPO or in prep for a procedure.

I read report and prioritize by doing a quick peek at all the patients and what's hanging on their IV. Patients receiving blood or drips, or who have dyspnea, pain or who have had problems with heart rate/rhythm, and especially chest pain patients, are dealt with first.

I introduce myself, chat with the patient, get vital signs and as I roll people around in the bed to assess lung sounds and skin, I straighten their beds out and get them repositioned. I warn them if I have to come back for more vitals or if they have labs due in the wee hours--not good to frighten a heart patient.

I get the midnight meds passed and put out fires from the last shift.

As I go, I document my vitals and my initial assessment. I do a quick check through the day's orders on each patient and make sure that the correct orders have been entered into the computer.

When everyone seems to be settled down, I can take the chart and go through it more closely. Is all the paperwork complete that needs to be? Have all the meds been given as ordered? Are all the results in the appropriate places in the chart?

Critical thinking is big on night shift: Why is this patient still on Tele, why are we still doing accuchecks after 48 hours of no rise in blood glucose for that stroke patient, why is this new stroke patient getting dextrose in his IV fluids? Why is this patient with a 3rd degree heart block not getting a pacer (because he's a 102-year-old still fighting with his family about honoring his DNR status?--yes, it's happened), who stopped the heparin drip on my PE patient an hour ago and forgot to turn the pump back on, why was the stat blood ordered for a hemoglobin of 7.3 not given (because the patient refused it, being a Jehovah's). Were blood cultures done on the patient whose temp shot up? Oh crud, yes, but the doc never ordered the tylenol and it's 0300.

Stroke patients get neuro checks every 2, 4 or per shift, depending on where they are in their course of treatment. They can't have any Dextrose in IV fluids, and a temp of 99 needs to be treated.

Cardiac patients get q4h vitals. EKGs are done by us along with standing chest pain orders, as appropriate. Drips need to be maintained and timed blood draws need to be checked for follow-up.

In between all that, I'm giving meds, reassessing patients, changing them, helping them to use the bathroom, monitoring changes in the patient's baseline and interpreting them for significance--and helping anyone else who has a problem patient. We all help one another on night shift.

By 0600, I'd better have finished my chart checks and my written report and started to pass my 0600 meds and get everyone straightened out for day shift. The early docs are here and already writing new orders. If I have time, I'll start them, but if I don't and the orders are not stat, I can leave it for day shift (with a heads-up that they're there.)

If I'm lucky, I clock out at 0715.

miko014 · Oct 19, 2006

Heme/Onc, Palliative Care, Inpatient Hospice (with Med/Surg overflow) 3p - 1130p

It's really hard to do this because every shift is different, even if you have the same pts. I really have no set routine...

Check assignment, listen to report (we tape), check computer for med admin times for each pt, check computer or chase tech for VS...after that, it's just kind of "do whatever needs to be done". Critical thinking plays a huge role in this, and so does organization and PRIORITIZATION, but it might go something like: assess each patient, med admin (inc. chemo) at scheduled times, check orders, implement orders, call docs, pain meds (we do LOTS of pain meds), help techs/RNs/MDs/pt escort/whoever else needs help and/or get help myself, charting, calling MDs, calling family members, doing whatever people need, doing procedures/other misc stuff (hanging blood products, assisting with sterile procedures e.g., chest tube insertion, concious sedation, IV stuff, tube feeds, etc).

There is a lot of non-routine stuff that happens...like end of life care for pts and families, discharges, admissions, transfers...we get a lot of direct admissions, which means that they don't come in through ER, so when they get there, they have nothing (no IV access, no orders, etc.). It can take several hours for a doc to come and see those pts and write their orders, which means that we basically have someone sitting there and no idea what we are supposed to do with them. The other night I stareted with 5 pts, d/c'd 2 of them, got another one, d/c'd another one, and then got 2 admissions at the same time. Yikes! Sometimes it's insane, and other times, it's not too bad. It all depends on the pts, what they need, what is going on with them, their families, and the moon (I'm serious, when the moon is full, look out!)

snowfreeze, BSN, RN · Oct 19, 2006

RN telemetry daylight and evenings 12's and 8's. 32 bed unit cardiac monitored, charge nurse does not take an assignment. Find the daily assignment list(4 on daylight 5 evenings and nights), print rounding report sheets on my patients, take a deep breath and see if we have 1,2 or no nurse aids today. Look at my patients computer chart, current orders, tests and procedures and surgeries scheduled for today. Check diet and running IVs. Run EKG strips for each patient and compare with what was charted for the last 12 hours. Usually about this time the secretary is handing me my portable phone for the day. Listen to taped report and get any last minute updates from prior shift. Do a quick check on patients, are they in bed, fall risks with bed alarm on, proper IVs running and not ready to run dry, put my name and proper date on the dry erase boards in the rooms. If there are no nurse aids or just one for the unit I have to do vital signs on my patients every 4 hours, the nurse aid does the glucose checks unless of course we have no aid. Find the aid assigned to my hall and make sure he/she knows which patients need glucose checks and when they are ordered, AC&HS or q6, Look at computer chart for new orders as docs round early and start putting orders in the computer right about now and sometimes order tests that make the patient NPO (usually this is ordered the day before but changes during the night are common) so I have to intercept the hostess before she hands out breakfast trays. (this is a teaching hospital so I have to be leary of orders put in by residents) I have usually one or two assessments charted by now and I help with breakfast and of course everyone has to go to the bathroom now too. If any of my patients need to be fed their meals I check with the aid to see if she has any other feeders today and if so I will feed one of my own patients. At least one family member has called for an update on their loved one by now and usually CT, Echo, x-ray and MRI are calling for patients. I put patients on gurneys or in wheelchairs, if they have an off-monitor order for tests I call for transport to take them. If they need an off-monitor order I find the Nurse practitioner for that order. If they need to stay on the monitor I call bed-flow to see if we have a nurse today to transport those patients, if not I have to find someone to watch my other 3 patients while I take the patient. By 10:00am I usually have all 4 assessments charted and have given all meds up to 9am. Discharges start now so I need to make sure docs have written the discharge orders, I write my discharge instructions, assure patient has a ride home. I try to figure a time between 11 and 1 when I will have time to take lunch and discuss with the nurse who will be watching my patients as to her schedule and planned lunch half-hour. Lunch glucoses need coverage, patients are in their rooms around noon for the next assessment (every 4 hours complete head to toe assessment) and vital signs, nurses do the noon set of vitals the aids do a lot of the baths and minor dressing changes. Admissions are starting to come from ICU and IMC along with some ER patients PACU is calling about patients who had morning surgeries and are now in recovery. Afternoon meds, explain tests and results to patients and families, call pharmacy for the meds that the docs ordered today. At 2pm I tape report if I am working 8 hours, if I am working 12 I look to see what 5th patient I am picking up at 3pm. Of course vital signs are more often for a post-cath patient or fresh OR and patients who are on IV cardiac meds that are being titrated. 3pm to 7pm is usually crazy, the ER dumps all its patients from daylight on the units, we usually get 5 to 8 patients in this 4 hour period plus a few ICU patients so the ER or units can put very sick patients in the ICU. For new admissions we have an admission team, nurses who do the admission charting, we just have to get the patient settled in bed, on the monitor, take a set of vitals, height and weight and notify the admission team. I can start carrying out orders without having to do a 20 to 25 minute admission assessment.

Nurses have to co-sign sub-q insulins and heparin drips, all other meds are charted by one nurse. During the last half hour of my shift I watch for call-lights while the oncoming shift listens to taped report and looks up all the things I did in the morning.