A typical day in your nursing job...

TheCommuter, BSN, RN · Sep 8, 2009

1) I work on a long-term care unit in a nursing home. Unless a resident is having an acute change in condition, the nature of my work is very routine and task-oriented.

2) I have 35 patients.

3) The disease processes of the nursing home residents are generally stable, controlled, predictable, and of a chronic nature: diabetes mellitus, HTN, CHF, dementia, chronic renal failure, anemia, PVD, CAD, pressure ulcers, and more.

4) Report typically takes 10 minutes or less. Since the residents have lived at the nursing home for many months or years, the staff knows them and we only report on the highlights of the shift.

5) Vitals are taken once a week for the weekly assessment. If the resident is on Medicare, vitals are taken q8 hours.

6) Resident assessments are done once a week for the weekly assessment. Medicare residents get assessed q8 hours.

7) My routine involves doing CNA assignments and breaks, fingerstick blood sugars on about 10 residents (at 0630, 1130, 1630, 2000), injecting insulin, med pass and water flushes on the residents with feeding tubes, IV antibiotics, wound care, topical creams, and respiratory treatments. After my first round of patient care, I chart: behavior sheets, Medicare charting, daily charting, antibiotic therapy charting, ABT flow sheets, diet book, I&Os, and more repetitive paperwork. After charting, I will pass meal trays in the resident dining room if I am assigned there. If an unrealistic family member is complaining, I'll also try to appease the person. If the CNAs are arguing or squabbling with each other, I'll also try to handle that.

jamieslovingmom · Sep 8, 2009

I work in a family practice office with 3 providers, an MD, a PA and an ARNP. (Hopefully, we will have an OB doc on board next year!) I work with 2 other LPNs and 1 MA. After I clock in, I check the fax for patient reports, refill requests, etc. I take care of these in between doing vitals on patients, handling telephone triage and patient questions. I assist the MD with minor surgical procedures such as lesion biopsies, mole removals, etc. I also give patient injections, including immunizations. I assist patients in scheduling MRIs, CT scans and obtain prior auths for these as needed. I assist with sample medication and medical supply inventory and restock rooms PRN. I also perform simple labs such as UAs, strep tests, urine Hcgs. I assess patient charts and notify them when an appointment/and or labs are needed. I do basic patient teaching and provide learning materials when appropriate. I assist with patient referrals to specialists and coordinate the necessary testing for these referrals. We see approximately 20 patients per day per provider, so about 60 in addition to the many walkins for INR's, BP checks, TB testing, etc. Lots of :typing. I love having weekends and holidays off!!!!

CABG patch kid, BSN, RN · Sep 9, 2009

Typical night for me, in a coronary care unit. Patient population includes post open-heart surgery, post vascular surgery (carotids and fem-pops), pneumonia, ARDS, sepsis, hypotension or hypertension requiring pressors, severe CHF exacerbation, unstable angina/acute coronary syndromes, s/p PTCA, and the occasional ICU patients, including overdose and traumas.

Shift begins with a 1-2 pt assignment, report lasting about 30 minutes. I review most recent orders and labs during report, making sure abnormal labs have been or need to be addressed and what orders have been noted.

Then I go in to assess my pts and give any 2000 meds. Depending on the pts and families, this may take until 2100. If I have time, I try to chart as much of my assessment and nursing notes as possible. Often an admission or transfer may happen around this time. Then do pm meds, chart some more, then take a break. By about midnight, I try to catch up on some charting, make sure all my vital signs are on the flowsheet (we do half paper and half computer charting, vitals can be time consuming if they are Q15 minutes). After that, make sure my other paperwork is done, which includes 3-4 various unit-specific sheets that we have on all pts, hospital policy stuff. Depending on the pt, I may be giving meds every 2 hours if they have a lot of antibx (I think the most I had on one pt was 6 piggybacks, talk about balancing act!)

More charting, 24 hour chart checks, then bathe the vented/sedated pts around 0230 or 0300. Draw labs from pts with central lines between 0300 and 0400. Forgot to mention, urine output monitoring may be every hour, if not I usually empty foleys every four hours. 0500, make sure notes and vitals are as up to date as possible. 0600, more meds, accuchecks, last foley dump, daily weights, check lab results and call MD if urgent or to update on a very sick pt. Finish notes and vitals, get ready to give report.

Of course all this depends on how sick or unstable the patients are, I sometimes have to call docs 2-3 times during the night, or may end up having to get someone intubated, etc. Its never fun when both pts crump at the same time, or when the charge has a pt and can't help as much. Some nights are easier than others and there is certainly a lot of variability on how time consuming your people can be. But I love it!

CABG patch kid, BSN, RN · Sep 9, 2009

BTW, fun idea for a thread! I like to hear what other ppl do all day!

miss81, BSN, RN · Sep 9, 2009

Unit: Float - typical day includes Labour Room for 4 hrs (until the baby is delivered), ER for several hours while they are flooded with patients (could be trauma room, observation room or triage box), then probably end on surgery unit because they are getting a lot of post-op pt's (or a few sickies).

# of patient: surgery unit= 8-10 to myself, L&D= 1:1 in labour room and can't count in the floor, ER=who knows

Report: Taped for surgery and L&D, verbal for ER

Routine: L&D- teaching with pt (e.g. breathing and pushing teaching), comfort measures, pain control (nubain or epidural), monitor FH strips and contractions, PV exams, IV for Abx, and often delivery baby 'cause doc is not in the hospital and is on call. He doesn't always make it!

Surgery: Morning showers and bed baths, meds, assessments, dressings, ambulation, feed pt's, pre op teaching, post op assessments, more meds, ++ iv insertions, cvp/picc dressing changes, change TPN lines, check labs and call docs to report abnormal labs, I&O's, tape report

ER: Run around like a chicken with my head cut off

KeechieSan · Sep 9, 2009

Well, there isn't really a typical day where I work, but here is a good summation..

I'm done report by 7:15pm... or 7:45 if I'm stuck following one of the really slow nurses, haha. I like to go around and pulse ox my 4-6 patients first and say hi. We have a thing about getting shift change admits where I work so I probably get a new patient around 8pm or so. I like to have my assessments done by 9pm, if possible. Troubleshoot a few things, get new orders (sleeping pills, pain meds, ect). Blood sugars at 9-9:15pm, do my 8 and 9 oclock meds together at around 9. If I have IV's to change I do them now too. Aides to VS at 9pm, I do I+O's with my med pass. Chart for 30 minutes or so at 10pm or 11pm. Troubleshoot stuff here and there until around midnight, then I start chart checks. I can usually bang them out in about 20 minutes if I'm not interupted, but I probably will be :). Fart around from 1am-4am doing various things... I have to assess every four hours, which is difficult on sleeping patients..so I also go around helping with baths, helping to the BSC, hanging new bags of fluid, midnight meds, charting, changing dressings if needed and the patient is awake. VS at 2am (CRUEL!! hah) interventions if needed. At 5am I give my morning meds, help the aide with VS, dressing changes for the patients who weren't awake, assist other nurses with their IV changes (I seem to be the go-to girl these days), chart, I+O's, daily weights, baths if there are any left, report at 6:45am.

This doesn't include all the beds and briefs I change, all the rapid responses I have to attend, all the calls to the doctor I have to make for random things, and abnormal lab values that have to be followed up on....or the many units of blood/ffp/cryo ect. that are given by me in any given week.

I love my job, haha.:heartbeat

locolorenzo22, BSN, RN · Sep 9, 2009

I work on a surgical/medical/orthopedic/neurologic floor.

Patients:4-7 usually.

Typical presenations: knee, hip replacements/ back pain/ back surgeries/ ICU post 2-3 day brain surgeries/ seizures/ stokes/ altered mental status/ detoxes.

Report: oral, takes 30-45 minutes

Vitals: q4hrs for each patient...2-3AM vitals are depending on pt status and needs.

Assessments: start of shift, and if something changes

Routine: See all patients, admit fresh patients, assess and give 6pm meds with first rounds, check charts, do new tasks and bid/nite shift tasks. meds usually at 6.8.10, midnight...usually.

print discharge papers, put out fires as needed.....

SaraO'Hara · Sep 9, 2009

Short-term rehab...

Patients: Up to 12, 14 if our census is really low and I'm the only nurse.

Typical cases: Lots of ortho (hip / knee replacements, fractures), some post CVA, some post other medical issue.

Report: Verbal - 10 to 30 minutes depending on if I've had the same assignment for a while or how busy the night shift was (patients are here for anywhere from one week to 2 months).

Vitals: Every day for every patient, q 8 hours for antibiotics, q 8 or more often for unstable patients.

Assessments: Start of shift and prn.

Routine: Take report, count narcs, assess patients and help pass breakfast, do AM meds, do some charting, do treatments, call docs, deal with administrative crap... admissions are usually in the afternoon, often we don't have a clerk so I transcribe orders as well... do lunch and dinner med passes... report and count off to night shift (we're on 12s, with CNAs on 8s).

imaRN08 · Sep 9, 2009

i work PCU/tele/stepdown.

typical pt load: 5-6, sometimes 7... we are always short staffed!

types of pts: mostly CP r/o MI, ACS, severe HTN, COPD, CHF, CVA, cardiac cath and pacemaker pts, dysrythmias.

length of report: depends on who you are getting it from.. sometimes 30min, sometimes an hr at night and usually half hr in the AM, after a 15 min unit "huddle"

VS: q4+prn, more often for pts with cardiac gtts. assessments are q4 also

typical routine: get VS from CNA's (if they decide to do them in the first place), usually end up repeating them; see pts, pass meds, check BG's before HS. check pts with gtts between times as well. usually i will go ahead and get my caths for the next day all marked and ready to go at HS too. round with Dr's if they need us to. fill out our careplans. all this, if its a good night, takes usually from 2000-2230 (and thats if ER is not dumping admits on us!). during the middle of the night, we do paper and computer chart checks, pass whatever meds need to be done during this time, help the CNA do wts and VS, help answer call lights, do chart reviews on discharged pts (bc even tho we have people who do that for a job, now all the sudden we have to do it for them!) towards the AM, call critical labs to Dr's admit AM caths, pass AM meds, etc, report off.

this is very abbreviated... usually we hit the floor running every single night, and every single day. we are always short; we are scheduled short and they never care to try to find some help for us. most of the nurses never get a break, and we dont get paid for it either since our boss says that we are just trying to get paid alittle more than usual. the morale on my unit absolutely sucks to put it nicely, and our manager don't care what we all have to say either.

Ihoplover · Sep 9, 2009

Christy RN2009

My unit similar to yours - CVIMCU - usually each nurse has 5 pts (they're trying to push 6 on us almost regularly now). Duties same as yours and many times 1 (or more) of my patients belongs in ICU but they're full so I'm handling an ICU patient (or 2) along with my other 3 or 4 patients. We get fresh open hearts after they're stable and still have to juggle the other very ill patients. It's very demanding and problem is since our facility will not say the hospital is full we are taking any and all patients on our floor. So what this means is......I have an ICU patient needing more 1:1 care in 1 room, 3 other patients (say a post angio in 1 rm, new onset chest pain in other rm and COPDer in last rm) along with an elderly alzheimer yelling and trying to fall out of bed or in wrist restraints or a trach pt with sacral wounds as big as my fist on a wound vac. In other words I sure wish I worked on an ACTUAL cardiac unit instead of a "come one come all" unit - it's rough........

Purple_Scrubs, BSN, RN · Sep 9, 2009

This is a really fun thread! Here is my typical day (if there is such a thing!) as a school nurse!

7:30-7:40 Arrive at work and try to get my purse put away before being cornered by kids, parents, or teachers.

7:40-8:00 Talk to parents who have brought shot records I requested, or who want to know if their kid is too sick to be in school, or who need me to check their child for nits. I am also seeing kids during this time frame who come in feeling ill. Often they are sent to school sick so I have to track down the parents to come get them. This is also the time of day I get a lot of questions from teachers, for instance they need to know when a certain child's last vision/hearing screening was done and what the results are, or they have a concern about a child with a chronic illness, or they want me to do a lice check of the classroom.

8-9 I try and get my desk organized for the day and if I have a minute to breathe I pop on AN to see what is happening :)

9 AM - diabetic student comes in for snack and BG monitoring if symptomatic

9:30-10 - see whatever students trickle in, or stampede in as the case may be. If it is quiet, I will enter shot records into the computer and make health cards.

10:15 lunch periods start for the littlest kids. I see lots of kids during their lunch (eat too much, vomiting, etc.)

11 AM - diabetic student comes in for daily before lunch BG check. If she is high, we check ketones and monitor. If she is low, she gets a small snack and sent to lunch. If she is within her target range, we look at the menu and count carbs to see what she can have for lunch.

11AM - straight cath of a student without bladder function. (either she or the diabetic student has to wait while I deal with the other one)

11:30-12:30 continue seeing students who come in at lunch, at 12:30 I administer scheduled meds.

1:00 - student lunches are over, so I try and sneak into the break room to have my lunch. Sometimes this works, sometimes not!

1:30 - try to get some paperwork done, or make the phone calls I need to make.

2:00 - straight cath again, and another diabetic snack and check BG if she is symptomatic.

2:30 - Right now I am using my afternoons to do some staff training, but once that is done I usually try and catch up on paperwork, make the phone calls I need to make to parents, physicians, etc., and get my desk organized.

2:45 - Go to classrooms to deliver notices I need sent home, or do a classroom lice check.

3:00 - School is out! I usually stay around my office because parents will come to ask questions or bring me shot records, but sometimes I try and get outside to help with dismissal and talk to parents picking their kids up.

3:10 - This is the time I technically can leave. I usually leave at this time 2 or so days of the week after a busy day when I am just spent. Other days I stay late to get shots entered and paperwork done, or for staff/faculty meetings, or for my wellness committee to meet. I am usually out between 3:30 and 4 and I almost never stay past 4:30.