Tell me about your day

[southwest]

i watch the nurses at my place of employment and i am always left with the same question. what do they do with their day? i see the calamity at the nurse's station during the hand off . after that, all is quiet. on average, i work with about three nurses and each nurse has about five patients. me, the cna, assists with all of their patients. i see them introduce themselves and leave. they come back a second time with morning medication. they show up again just before lunch to check blood sugar levels and maybe a third time to tie up any loose ends before the end of the day. often there are nurses that actually have time between five and seven o' clock to talk and laugh. they are not on the floor with me, changing diapers, linen and gowns; getting ice and water, ambulating patients that have been in bed all day, but should have been up at least twice through out the day. instead they wait until the last minute to give the assignment to me just so they can document that it was done.

i want to be a nurse, but so many of them are unhappy with life or whatever and they discourage me by watching the shabby job they do.

so i ask in all sincerity--what does a registered nurse do all day in a hospital with five patients to care for? what is the biggest challenge of your day. and finally, what must i look out for to not become complacent and indifferent to my patients.

thanks for your input

[RNinSoCal]

Hello Southwest,

When I worked 12 hour days on med/surg even with only 5 pts I was passing meds from 0730 to 1000 usually -especially if I had student RNs or LVNs to watch like a hawk. Many pts had to have pills fed to them with applesauce one at time, or crushed. Then I passed prn meds for high BP or detox protocols or pain as well. I forgot getting pts to OR for surgery with all paperwork filled out by 0700 (Shift was 0630 to 1900) During med pass I always tried to make sure pts knew why they were in the hospital and what the plan of treatment was. After med pass I had to review labs and report all abnormals to MD and get orders and enter vitals into the computer for MD rounds. Assist pts in and out of bed and saline locking IVs for CT, MRI, US, hyperbaric or wherever else they were going. Next call in consults to specialty MDs for the attending(why can't they do this themselves??) Next is fixing the IVs that have gone bad and were never mentioned in report. I tried to do wound dressing by 1100 (but sometimes did not make it until 1400). Then run around trying to assist pts to BR because the NA is busy with her other 12 pts. By then it was time for lunch time insulin (Notice I still have not mentioned charting) I tried hard to get pts up in chair by noon for lunch. Then back to pill pass during lunch. Then discharge 1-2 pts and admit 1-2 ER or transfer pts. Then try to eat something. Then try to chart. Then deal with MD (Ugh residents!), case management, social services and family questions/issues. More helping people to BR. By that time it is dinner time insulin and pill pass. Some nice nurse or secretary would make coffee around 5 or 6 pm and save my brain from shut down. After 6 I would chart like the wind and hope to pass my last prns and IV meds before report. I know I just left out a lot of things. You can't define what a med/surg RN does, you have to live it to understand.

As much as I am tired of working 8 hour nights (Boredom) my feet do not miss 12 hour days.

Have some sympathy for the nurses who try to do their job well, they are the ones who respect you for all of the help you give them and their pts.

[sassrn06]

It has often been said that you have to walk a mile in someone else's shoes to truly understand what they go through. I say the same is true in your case. There is so much more to it than you can see from where you are, and I can say this with certainty, having been a CNA for four + years BEFORE I became a med-surg RN. I have said many times that I would've stayed a CNA forever, if the pay matched the work. I think we can both agree that it does not even come close. I wonder sometimes if that isn't part of the whole CNA vs. RN struggle...

Anyway, you asked what we do all day... and I must say that we, like you, probably do a lot of things that you never see us doing. Passing meds involves making sure that the pt. isn't allergic to the meds, that the meds have actually been ordered properly, and that we are giving the right meds to the right pt. at the right time. Multiple that times 5-10 meds per pt. times 5-6 pts., times multiple med passes during the day, and you can see that this could get quite time consuming. We have to call doctors-and wait for them to call back, and call back when they don't. We have to try to decipher their impossible handwriting and endure their condescending remarks when we politely attempt to clarify their hastily written orders.

We are taking pts. to the bathroom, cleaning them up, and bringing them new gowns. We are trying to prevent respiratory failure, heart attacks, and other complications, by being in tune with thorough assessments, and any subtle changes that we pick up. We are bringing our pts. water, snacks, and checking their blood sugars so they don't bottom out. Did you know that any blood sugar below 60 means that the pt. brain isn't getting energy to function on. (And why it is so important that you tell us these kinds of numbers.) We are monitoring low blood pressures, high blood pressures and dealing with unreasonable family members.

The list goes on and on and on and...Believe me. The level of responsibility that an RN carries on his or her shoulders is unbelievable. And I think what you most need to hear, rather than an accounting of minute by minute of our day, is how much we appreciate the care that you provide to our pts. Hopefully, we do that as a team, as the design was intended. Your job was created out of necessity. We need you to be the eyes and ears for us, and we appreciate your notifying us of changes that you see. The pts. trust you more than they trust the RN, or even (especially) their own doctors. That should be something very meaningful to you. You have one of the most important jobs in the whole hospital. I am sorry that your compensation may not match that fact, but it is still true, and something to be proud of.

I cannot say that all nurses work as hard as others. This job is like any other, you have the good, and you will always have those who look for ways to get out of doing their fair share. I believe that life works that all out in the end. And you will find that the only thing that matters is kindness. And hopefully, that is what you have provided to your pts. each time that you work.:nurse::nurse:

[Bonny619]

wow, you're really serious?

I think like others have said, you aren't seeing the half of it.

[nursekatie22, RN]

I thought the same thing until I was in nursing school. When I got my intern job, I wasn't able to enroll in a workstudy class mid semester, so the nurse manager wanted me to orient with the CNAs to get a feel for what they do because I would soon be delegating tasks to them, etc. It was the best thing I've ever done because I'd (unlike many of my classmates) never worked in a hospital before. It gave me the chance to find out where stuff was on the unit and get to know the CNAs I'd be working with.

I realized that when I graduated I'd no longer be able to spend all that quatity time with my patients and it made me really sad. CNAs and RNs all have different priorities and different jobs to do, but it's all done for the well-being of the patients. Granted, like a poster said before me, you probably have those RNs who don't excel in the teamwork department, but I've also encountered CNAs who do the same thing. Don't put all us nurses in the same basket; it's like saying all doctors are jerks. The few that are just give the rest of us a bad name.