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

clemmm78, RN · Dec 25, 2006

2330 to 0730 Palliative care here, 9 patients.

Get to the residence about 2315 if I've been off a few nights, five or ten minutes later if I'm on a stretch. If it's been a quiet evening, I chat with the evening nurses as we wait for my partner to come in. If it's been quiet, they've done the narcotic count already, other wise I do it with one of them.

Other nurse comes in, we get a quick report which often turns into a chatting session. :) That's the fun part of working in an environment like that.

We chase off the evening nurses (two of them) by 2345 and start our rounds. We don't do patient assignments on nights because we work together on the 9 patients. Starting at the end of the hall, we check patient status, syringe drivers, which beds are on rotation, if O2 prongs are where they should be (on the patient's face), turn out lights, check outside doors, etc.

Occasionally, we'll find a patient who has been incontinent or who is very uncomfortable and needs cleaning and positioningm or is in pain and needs a breakthrough. Otherwise we do our darndest not to waken anyone. I round every hour or so, other nurses have other schedules.

Back to the desk and then it really depends on the night. We can have a very quiet night, like last night, when all patients slept (rare), we can have a constant night when we are not running, but there is something to do at all times: giving prn breakthroughs, managing respiratory crisis or pain crisis, calling family because a pt's status has changed and we feel that they shoudl come in, calling family because a patient has passed, or we are called to a room by a family member because their loved one has passed, and on and on.

If it's a crazy night, we run until we can't any more and by then, the day staff has arrived (three of them).

We don't have treatments or anything like that, it's supportive and comfort care. But we do often sit and talk with a patient who can't sleep, or a family member who is overwhelmed by the whole dying process.

We are responsible for the chart paperwork, reordering of patient meds on Sundays and Thursdays. Charting is usually quick as we have flow charts for the most stable patients.

If a patient dies in the middle of the night, we clean up him or her, but we don't call the dr for pronouncement until day time. We do make exceptions for religions or cultures that require immediate pronouncement, otherwise, there's no rush. Families are welcome to stay as long as they want.

For breaks, we don't technically get one since there are only two of us and if we are busy, we can't leave one person alone. But, most nights, we manage to squeeze in an hour nap on the couch at the end of the hall. When it's really quiet, we treat ourselves to longer. I always let my RNA go first because I feel if all heck breaks loose and one of us doesn't get a break, I'd rather it be me since I get paid a bit of a differntial because of the missed break, but she doesn't.

And then we go home only to return 18 hours later to start all over again.

MIA-RN1, RN · Dec 25, 2006

Postpartum mother/baby nurse here; 11am - 1130pm:

Get to work at 10:35, drive around parking garage for 10 minutes trying to find a spot. Get to the floor by 10:45 or 10:50. Look at the assignement, get a general feel for the day. Say hi, get an assignment sheet, punch in, find Kardexes and get report on my patients for the day (usually 4 couplets, sometimes 5). Check charts for new orders, sign charts, pathways etc. Check printer to see if any new orders have come over.

Organize assignment sheet. Its broken down into hours. Plug in assesments, vital signs, when meds are due, and anything else.

Make first rounds: See the most recently delivered or most acute pt first, do physical assessments on mom and baby, and vs on baby. Continue thru the list of pts and their babies.

Recheck charts and printer for new orders. Read thru most recent MD notes. Look up any necessary labs, call docs if appropriate.

Second rounds are at 1600.

Third rounds are at 2000.

It sounds easy. BUT....

In between....give meds, hang IV's, monitor those w/ bp issues (pts on mag get HOURLY vs, assessments, and reflex checks) A/P pts get fetal heart tones q4h (where's the doppler?), d/c saline locks, measure voids, ambulate pts. Monitor babies for jaunidce, feeds, diaper changes, answer LOTS of questions, teach LOTS of stuff. Give baby first baths as needed. Pain meds, colace, simethicone.....Lunch break before 1830 when the cafeteria closes, wolf food down between call lights. Deal with residents, measure I/O...take new admissions:

Vag admission: Vs and assessments on mom and baby. Teach unit safety protocols, obtain self-medicaitons, teach self-medication protocol, give paperwork, check baby's band to mom's, help mom ambulate first time after epidural. Then Q4 assements and vs for mom and baby.

C-sect admission: VS q 30min X2, q1h X2, q2h X2, and then Q4hX 48. And respirations HOURLY until 12h past the time the duramorph was given in the spinal. Assessments, teaching and paperwork as above, minus the self-medications. Medicate prn, usually at least one time of phenergan, two times of nubain. Ambulate within 6h of surgery, monitor and empty foley. etc etc. Watch baby carefully, prone to temp drops after spending the day in OR with mom. VS and assessment q4h on babies.

Oh yeah, and take off the orders since there is not always a secretary. Or when there is a secretary sometimes it is one who is not as careful as they could be and its easier and safer if I just do them. (I did try the option of educating the secretary once. Once.)

When I am lucky there is a tech that wants to help out more than just the standard q4 vs on moms. Sometimes I can get one to help out with some of the many many vitals on c-sects. But they don't do anything else clinical for the most part.

So its busy. Where there are five couplets, or when there is an antepartum or a pt on mag...yeah it gets REALLY busy. Or when you have a c-sect on hourly respirs, a new vag, and a pt who is either high risk or a surgical patient that landed on the floor since they are too filled up on the normal surgical floors. Or an a/p who is in for something totally not related to her pregnancy and no one on our floor remembers how to put an NG tube in anymore, and its a non-issue since we don'thave suction anyway.

By 2300, on an ideal night, my kardexes are updated and ready to give report for the next shift. In reality, its sometimes 2315 and I am giving report without updating.