I am a future LVN nursing student & will be going for full RN and trying to get a feel of what it will be like when i am an official nurse. LVN or RN as well as SPECIALTY nurses can you help me out?
Please be honest and tell me about your typical day as a nurse is like? Pros & cons? What you do or specialize in? Are you happy with your job as a nurse? And any other topics you would like to include :-)
Get report on five patients, make sure everyone is stable.
Review labs and vitals for trends.
Assessments.
Charting.
Determine who has 0700 or 0800 meds that need to be given right away.
Review any results from imaging studies CXR, Echo, CT etc.
Charting.
But it really goes like this:
Get report on five patients, make sure everyone is stable.
502 is on bipap and needs to go to the bathroom. Transport is on the way to take 503 to the cath lab, but where are the consents? Where's the preprocedure checklist?! Their heparin is to be stopped on call to cath lab AND they need their aspirin before leaving the floor. ED is on hold to give report on Afib RVR going into 504. 505 has discharge orders and is on the call bell. Charge nurse reminds you to discharge ASAP because we need to step-down a patient from CVICU into that room. Family member on hold for 506. Still getting report…..Wait, 506 is on a dopamine drip….drop everything get over there and verify that drip NOW. etc. etc.
Review labs and vitals for trends
There are no lab results for 502. Oh, 502 has a PICC and apparently nobody drew the 0500 labs…..grab supplies and get to 502 ASAP. There was a 0700 PTT for 506 who is on heparin, phlebotomy is running behind, draw PTT…..confirm with phlebotomy that they will be on time for the 1300 draw. See if anyone on my team can help with the draw because 504 just rolled up from the ED.
Determine who has 0700 or 0800 meds that need to be given right away
0800 Vanco needed for 502, but where is it? Call pharmacy. (Also, make sure Vanco trough is on order) I need metformin for 506, pyxis is out……call pharmacy. Three patients are on sliding scale and breakfast is on the way. 506 dopamine drip is running out, no replacement bag from pharmacy….call pharmacy!
Assessments
Afib RVR arrives into 504, orders for heparin and amiodarone, hang drips, order follow up PTT, talk to family. I hear the bipap beeping in 502, get over there and troubleshoot. RT is busy. Lab is on hold with a critical value for 506. Try and recruit someone to help with the 505 discharge. Apologize. Overhead page It is now time for your hourly rounding with your buddy!†Transport delayed for 503…..an extra minute to give the aspirin, heparin stopped, consents signed, woohoo!
Review any results from imaging studies CXR, Echo, CT etc.
504 is about to puke because the Amio is making her nauseous, grab the Zofran, see how they tolerate…maybe need to call MD and see if we need to switch to Cardizem. Still trying to discharge 505, but where are the prescriptions? They're not in the chart! We haven't met the core measure for an ACE or ARB on this patient either….see if it is documented in a progress note anywhere….NOPE!
506 had an echo ordered yesterday afternoon, but it hasn't been done yet. Call echo. Hey echo, this patient is pretty disoriented, this needs to be done bedside. (Oh, you want that bedside? Wait in line buddy!) Family member waiting in the hall wanting to know why the echo hasn't been done, it was ordered yesterday!
Charting
Adjust 506 heparin, get another RN to confirm rate change, order follow up PTT. Overhead page It is now time for your hourly rounding with your buddy!†Hey, wasn't I on the 0900 turn-team?
Docs are rounding, new orders coming in….place foley for this patient….loading dose of Cardizem P.O. for that patient…..potassium high on this patient, no electrolyte protocol in place, get orders….give Kayexalate (oh boy). Morning meds need to be given for everyone. Bipap beeping again in 502. 504's pressure isn't tolerating the amio....
I work in a childrens hospital in a cardiac surgical ICU. My hospital is a large teaching facility.
I work 3 days a week, 12 hour shifts. I take report from the previous shift at 7am, and that usually takes 20-30 minutes on average. Then I go through the chart so that I know my patients and my plan for the day before going into their rooms for my 0800 assessment. Our patient ratio is 1 nurse: 1-2 patients.
Vitals and assessments in my unit are q1 or q2 hours. At 0800 we also do room safety checks - making sure our rooms have suction, ambu-bags, etc.
Surgical rounds happen around 7-8am and all the MDs from surgery, cardiology, and the ICU docs round quickly together...I listen in if able but the nurses dont really participate in this. Then between 9-10am is regular rounds for the ICU team. This includes the attending, fellow/NP, the RN, dietician, respiratory therapist, pharmacy, and sometimes others. I briefly present some info on my patient: What sedation they are on and what PRNs have been needed, if I feel their sedation and comfort is adequate. IV access and if it is adequate. Their diet and if they are tolerating it. Things like that. Then the follow/NP presents the patient more thoroughly. I dont really like how rounds are done because I feel like they just let the nurse go first and talk to make us feel included but everything we say is repeated by the fellow anyway so its kind of silly. After they finish and orders/a plan is laid out for the day, the attending asks the RN is anything else needs to be addressed and I do appreciate that.
Then I carry out the orders, continue my assessments or med giving. I usually get lunch around 1 or so, sometimes a bit later, but I RARELY dont get to eat. If I need orders or a doc at bedside, I call the fellow or NP.....the attendings are wandering around but they only get involved if the fellow needs extra help really.
We have patient techs on the floor but they mostly restock supplies and help transport or do tasks when admitting a patient from the OR. The nurses pretty much do all personal care/ADLs for the patients. Often the techs seem annoyed if you bother them with a request, really, because they have a lot of stuff to do already. We do our own lab draws, we have to be at bedside to help CXRs be done, most bedside procedures require the nurse to be bedside, so there are a lot of interruptions.
Night shift comes at 7pm and I give report and then usually have a bit of charting to finish because hourly charting with assessments is tedious, and if anything happens that requires extra intervention you can get behind quickly.
Families also can cause you to get behind in your work. Families are a HUGE part of working in pediatrics because they are always there and its just a given that you are the nurse for not just the patient but for the parents too. They have tons of questions and often we have neonates so the moms are just days out from giving birth. We work hard to help facilitate them taking care of themselves after giving birth, and also to facilitate them pumping if they want to give their baby breastmilk (rarely do our babies nurse because we need accurate I/O measurements, and most cant eat by mouth at all). Parents have a TON of questions and they also just talk to the nurses to process everything that is going on. You have to learn to be a good listener and also how to excuse yourself from the conversation without seeming rude or cold....because you have a lot to get done!
It can be busy and it gets frustrating a lot because I often feel like "why do I even bother trying to have a brain when nobody wants to know what I think anyway? I dont want to just be a task machine." I think the nurses are treated like they "arent paid to think" in a lot of areas of nursing and this definitely isnt the worst area for that, but it still happens. But I do love what I do and I love seeing the miracle of these kids getting better. Its a great job if you can handle the emotional piece of seeing really sick kids, and you want to work in a high risk, high intensity environment.
I work in a rehab unit at a LTC. I have a love hate for my job. In LTC you have a large patient to nurse ratio. It is nice when all the patients aren't having any issues but it can be difficult to handle when there is an emergency but you also have 20+ other people to take care of as well. The LTC place I work at has the 8 hour shifts (7am-3:30pm, 3:30-11pm, 11pm-7am) which is nice.
I do med pass for 20+ patients, do trach care, PEGs/tube feeders, wound care, consult with doctors, put orders in the system, restock medications, and do typical services (answer phone, support families, make appointments, etc). I'm a RN so usually I'm deamed supervisor when there are issues in the building. When you work with a large group of people there is drama to handle too.
I do plan on getting a job at the hospital to further my nursing skills. I feel my current place/LTC doesn't train employees very well or help with education which is a bummer. Also sometimes I have to figure things out on my own when everyone else is too busy to help.
0645-0700 grab vitals on a few residents so I can update md
0700-0845 breakfast med pass
0845-0930 finish my charting from the morning and troubleshoot small issues with residents
0930-1000 morning break
10-1145 do any wounds, update md, book appts, call specialist offices, assess residents
1145-1230 lunch med pass
1230-1300 chart
1300-1345 lunch break
1345-1600 work on charting, care plans, any wound care I didn't do in the am, clarify orders with pharmacy and/or md, replace sick calls if needed
1600-1630 dinner break
1630-1745 dinner med pass
1745-1830 finish charting, get narcotic count ready, tape report
Acute care with 4-5 pts
0700-0715 get report
0715-0800 vitals and initial assessment
0800-0900 meds and help feed
0900-0915 interdisciplinary rounds with nurse, physio, discharge planner, manager
0915-1130 process md orders (they come between 0730-0900), am care and baths if time, start charting, get pts ready for tests
1130-1215 meds and help feed
1215-1630 chart, give baths if needed, follow up on lab work, more charting
1630-1730 meds and help feed
1730-1830 chart
1830-1900 report
Generally just take my breaks when it is slow. Sometimes it isn't till 1300 till I stop to eat. Vitals are usually q shift or q4h. We usually have a few people on IVs, occasionally being sent out to other hospital for tests (small rural hospital). We are directly connected to emerg and will get orders from the emerg doc if needed. Pts doctors are the general practioniers who have office hours next door at the medical center. They come in the morning before their office hours and then can be reached by phone and will sometimes stop by at the end of their work day to reassess pt. We also have people waiting for long term care as well as acute care pts who often get sent to a bigger hospital. On nights, we often draw our own blood work, especially on weekends when the lab tech isn't there. During the week she is there most days in the morning.
0645-0700 grab vitals on a few residents so I can update md
0700-0845 breakfast med pass
0845-0930 finish my charting from the morning and troubleshoot small issues with residents
0930-1000 morning break
10-1145 do any wounds, update md, book appts, call specialist offices, assess residents
1145-1230 lunch med pass
1230-1300 chart
1300-1345 lunch break
1345-1600 work on charting, care plans, any wound care I didn't do in the am, clarify orders with pharmacy and/or md, replace sick calls if needed
1600-1630 dinner break
1630-1745 dinner med pass
1745-1830 finish charting, get narcotic count ready, tape report
Acute care with 4-5 pts
0700-0715 get report
0715-0800 vitals and initial assessment
0800-0900 meds and help feed
0900-0915 interdisciplinary rounds with nurse, physio, discharge planner, manager
0915-1130 process md orders (they come between 0730-0900), am care and baths if time, start charting, get pts ready for tests
1130-1215 meds and help feed
1215-1630 chart, give baths if needed, follow up on lab work, more charting
1630-1730 meds and help feed
1730-1830 chart
1830-1900 report
Generally just take my breaks when it is slow. Sometimes it isn't till 1300 till I stop to eat. Vitals are usually q shift or q4h. We usually have a few people on IVs, occasionally being sent out to other hospital for tests (small rural hospital). We are directly connected to emerg and will get orders from the emerg doc if needed. Pts doctors are the general practioniers who have office hours next door at the medical center. They come in the morning before their office hours and then can be reached by phone and will sometimes stop by at the end of their work day to reassess pt. We also have people waiting for long term care as well as acute care pts who often get sent to a bigger hospital. On nights, we often draw our own blood work, especially on weekends when the lab tech isn't there. During the week she is there most days in the morning.
This was REALLY helpful for me. I just now wrote my own version for 3-11 shift. I'm not that new to rehab/skilled nursing but don't finish on time for med pass with an average of 16 patients. I've tried many time management techniques, but I'm not consistent. I've been getting advice on here about it, and the 2 hour window for med-pass, I'm going to tell my patients that I'm in the middle of med pass, and that they need to use the call light for a CNA, and simply leave the room when they try to trap me in there. I'm going to be polite but firm.
t981
4 Posts
It is supposed to go something like this:
Get report on five patients, make sure everyone is stable.
Review labs and vitals for trends.
Assessments.
Charting.
Determine who has 0700 or 0800 meds that need to be given right away.
Review any results from imaging studies CXR, Echo, CT etc.
Charting.
But it really goes like this:
Get report on five patients, make sure everyone is stable.
502 is on bipap and needs to go to the bathroom. Transport is on the way to take 503 to the cath lab, but where are the consents? Where's the preprocedure checklist?! Their heparin is to be stopped on call to cath lab AND they need their aspirin before leaving the floor. ED is on hold to give report on Afib RVR going into 504. 505 has discharge orders and is on the call bell. Charge nurse reminds you to discharge ASAP because we need to step-down a patient from CVICU into that room. Family member on hold for 506. Still getting report…..Wait, 506 is on a dopamine drip….drop everything get over there and verify that drip NOW. etc. etc.
Review labs and vitals for trends
There are no lab results for 502. Oh, 502 has a PICC and apparently nobody drew the 0500 labs…..grab supplies and get to 502 ASAP. There was a 0700 PTT for 506 who is on heparin, phlebotomy is running behind, draw PTT…..confirm with phlebotomy that they will be on time for the 1300 draw. See if anyone on my team can help with the draw because 504 just rolled up from the ED.
Determine who has 0700 or 0800 meds that need to be given right away
0800 Vanco needed for 502, but where is it? Call pharmacy. (Also, make sure Vanco trough is on order) I need metformin for 506, pyxis is out……call pharmacy. Three patients are on sliding scale and breakfast is on the way. 506 dopamine drip is running out, no replacement bag from pharmacy….call pharmacy!
Assessments
Afib RVR arrives into 504, orders for heparin and amiodarone, hang drips, order follow up PTT, talk to family. I hear the bipap beeping in 502, get over there and troubleshoot. RT is busy. Lab is on hold with a critical value for 506. Try and recruit someone to help with the 505 discharge. Apologize. Overhead page It is now time for your hourly rounding with your buddy!†Transport delayed for 503…..an extra minute to give the aspirin, heparin stopped, consents signed, woohoo!
Review any results from imaging studies CXR, Echo, CT etc.
504 is about to puke because the Amio is making her nauseous, grab the Zofran, see how they tolerate…maybe need to call MD and see if we need to switch to Cardizem. Still trying to discharge 505, but where are the prescriptions? They're not in the chart! We haven't met the core measure for an ACE or ARB on this patient either….see if it is documented in a progress note anywhere….NOPE!
506 had an echo ordered yesterday afternoon, but it hasn't been done yet. Call echo. Hey echo, this patient is pretty disoriented, this needs to be done bedside. (Oh, you want that bedside? Wait in line buddy!) Family member waiting in the hall wanting to know why the echo hasn't been done, it was ordered yesterday!
Charting
Adjust 506 heparin, get another RN to confirm rate change, order follow up PTT. Overhead page It is now time for your hourly rounding with your buddy!†Hey, wasn't I on the 0900 turn-team?
Docs are rounding, new orders coming in….place foley for this patient….loading dose of Cardizem P.O. for that patient…..potassium high on this patient, no electrolyte protocol in place, get orders….give Kayexalate (oh boy). Morning meds need to be given for everyone. Bipap beeping again in 502. 504's pressure isn't tolerating the amio....
Ad infinitum!