A day in the life of a Registered Nurse.... - page 2
The purpose of this thread is to give a better understanding of the Nursing feild to those who are working towards becoming a Nurse!... Read More
Oct 19, '06stay up 24 hours on your first of a set of night shifts
miss many sunny days
miss family get-togethers eps. like xmas, easter ,thanksgiving, birthdays
run for 12 hours on sore feet and aching legs
be content helping others in time of need
Oct 20, '06I work in Neonatal ICU, 7 PM to 7 AM... A fairly typical night (if there is such a thing) goes like this...
I come in at 6:45 PM in order to check my assignment, hit the locker room to change my shoes, and do my mandatory scrub before I enter the unit. We do bedside report, so I find the nurse I am taking report from (or nurses, depending on how the assignments may have been shuffled). It usually takes 5-10 minutes to get report on each baby, depending on how recently you've cared for them, how unstable they are, etc. There are usually 2-3 babies in an assignment.
After report, I do a bedside check on each baby, looking for safety things (monitors on, IVs look good, reintubation supplies at bedside,tubing up to date, etc.) checking all my IV fluids and calculating the dosages of my drips, verifying orders for the last day and writing down exactly which meds/treatments are due at what time. I check things like when feeding tubes were last changed or if their isolette needs to be cleaned, and plan those events into my night if necessary.
Then I begin my rounds. If I have an NPO baby, (assuming they don't have some totally unstable condition requiring us to leave them alone) they get rounded on every four hours (1930, 2330, 0330), so I do them first. I do vitals, assessment, diaper change, reposition them,flush any tubes or saline locks, suction if respiratory is unavailable, give meds, and chart. If it is a big stable kid, they get weighed and their linen changed at this time, if days didn't do them. Smaller babies get weighed every other day, so I've got a 50/50 shot at not having to weigh them. Technically, our bath policy is Tuesday/Saturday, so if it's one of those days or the baby is smelly I do a quick bath at this time as well.
By 2030-2100, I should be onto my last baby, which includes doing all the things above plus feeding them (by feeding tube or bottle) if they eat. I make sure all my charting is up to date, lines are still good (we check IVs every half hour), etc. I'm sure to have 2200 or 2300 meds, so I need to know now if I need new access.
This is where about anything can happen. I may have parents in, wanting to hold or Kangaroo, or needing support and information. I may have a kid that desaturates frequently, needing me to adjust their oxygen or stimulate them. My IV may come out, and I need to start a new one. I may have a big fussy term kid or neuro baby who needs to be held or rocked... or rarely , I may have peace, and am able to sneak out and drink a diet Coke before 2245.
At 2245, it's time to start rounds again- my eaters get rounds at 2030, 2330, 0230 and 0530- so they need to be vitaled, assessed, diapered, meds and fed again. By 2330 my NPO baby will need the same. By midnight, I'm probably done for a while...
But inevitably, something will happen- delivery will call, I'll need to move my most healthy kid and give report to another nurse/stepdown and set up a warmer for an admission, NOW! Or my seemingly stable little guy will suddenly decide to turn blue and need bagging or drop his temperature or something else ominous, and I'll have to wake up the resident or nurse practitoner:uhoh21:. They, of course, will write orders for something fun like blood cultures and x-rays and a urine cath. Blood gasses may be done on my ventilated kids and vent settings changed, or I may have drips that need titrating- like serial blood sugars to adjust insulin, etc.
I get a break around either 0130 or 0300, depending on the night. For the rest of the night, I do my scheduled rounds (which only require a temp, diaper change, and feeding), as well as put out any fires that come up. We constantly assess, respond to alarms, comfort babies and parents alike, give meds, consult doctors, etc. Sometimes we get called to go to other floors to try a tough IV, or go up to attend deliveries if our regular transport nurse is unavailable. It's a general zoo most of the time, which is good. If I have a slow night, I tend to end up dozing off in a rocking chair, in which case I have to go and run up and down a couple flights of stairs!
Around 0500, I get my babies ready for morning labs, if they have any (most do). I wrap their heels with a warmer and get sucrose (a sugar solution that has a pain relief effect) for each one. When my PCT comes around, I hold the baby and give them sucrose during the stick. I also draw any venous labs, or arterial blood gasses if they have an umbilical arterial line.
By 0600, I am getting wound down. I calculate my I & O, as well as urine output per kilo per hour, and make sure all my charting is complete. I update my report sheet for the oncoming nurse and ensure that all my orders have been processed and checked off in the computer. I setup a station to give report to the day nurse, and by 0700, she should be there, ready to start her turn at the organized chaos of the NICU!:roll
I'm sorry this is so long... reading back over it makes me realize how much I really do everynight!! I love my job, though, so I don't care...
Oct 20, '06our days as an rn are always different.but buttomline is,we are here for our patients, as an advocate, as a teacher, etc. little things i do to my patients wherein i would see them happy makes me even happier. i can see the true essence of nursing ----CARE.
Oct 20, '06Telemetry, nights, and Angie's post makes me tired just reading it!
I show up at 1830ish to scope out my unit and grab some coffee, if I'm awake enough already I might count narcs before report. We listen to taped report at 1845, make assignments and off we go! Ask questions of dayshift, count drugs if not already done. I label my brain for who my patients are, take a look again at report to see who's got what procedure in the AM, is there anything that takes priority... then grab a pulse ox and thermometer, brain and steth, and down the hall to do VS and assessments. That time is used also to ask about snack preferences, discuss procedures, let the patient know what times (ballpark) that I expect to be in their room for VS, etc. Echo Angie's sentiment that it's not nice to frighten a heart patient.
I try to start passing evening meds at 2000 but that gets pushed back as far as is necessary to straighten out whatever mess I may have walked into. If all's good I have passed meds by 2130 and given snacks as well, checked blood sugars, etc. Then I'd like to have charting done by 2300 to begin rounds again, for MN vitals, pass any late sleeping meds that weren't requested earlier. If all goes well, grab dinner around midnight-ish, do chart checks in detail and have charting caught up before 3 am. At two, stick my head in people's doors to make sure they are breathing and/or asleep, and not laid out in the floor from a fall or getting nekkid and ready to wander! At 3:30, finish charting hopefully, do 4 am vitals, weigh people. TRY to get that done in a timely manner... dress the nekkid folks and empty any foleys / urinals/ hats in toilets/bedside commodes that didn't already get done.
At 0430, fix the paper MAR's for dayshift and that can take 30 mins. if pharmacy has their usual problem actually acknowledging orders and putting them in the computer. Fix strong coffee after that, have coffee and any form of chocolate that I can lay my hands on. Make sure 4 am notes/charting was done. Do one last check to make sure AM labs got put in the computer and I didn't miss something. Tape report at 0500-ish, anytime before 0600 really.
Run around like a chicken with my head cut off stocking supplies, QC the glucometer, make report sheet things for dayshift. Pacify doctors if they show up an hour early. Act like I know something... anything. At 0600, make a last round on each patient: alive? 6 or 7 am meds, give 'em, 7 am blood sugars, do 'em. Chat for a minute and then run back to desk, make closing note! Race to see if I can do this before they go INto report, so when the docs do show up I do not look like some wild woman who doesn't know my own name.
That's a night with no admissions, no late discharges, no codes, no late sheath pulls, no ridiculous 4 am cardiac caths that are back post procedure by 0630 (happened once), no cardiac drips other than heparin, no flaming med errors from another shift or department to try to fix, no "sudden ambien psychosis", nobody pooping in the floor, and nobody pulling out any tubes from anyplace in their bodies that results in any type of cleanup.
Oct 20, '06Oh wow this will be fun to try (just got off work)... here's a relatively smooth night in the ER...
1855 - clock in, check board for which zone I'm in (yay, not triage tonite). Note which nurse I'll be getting report from.
1900 - See Fire Rescue come in, day shift busy running around finishing up stuff, go and triage the rescue and find them a bed. Help place monitor, IV, 02, etc, write up med recon sheet (assuming patient can talk, family remembers meds they're on, or (yay) the list from the nursing home.
1915 - Go find my day nurse - get report on 3 patients and one empty bed. Quick looksee, hello, vitals on those patients.
1930 - go through charts on patients - call x-ray for the bed 5 who didn't go yet, call CT to ask about CT results on the abd pain dude in 6, call Lab to see where my UA is (what do you mean you didn't get any urine?), for 7.
1935 - go to patient in 7, urine cup in hand, and beg for urine. Patient says she'll "try". Disconnect her from monitor, escort to bathroom, wait til she's done (yay pee), label and send to lab. Rehook patient to monitor.
1940 - chart for 6 in order chart - medicate patient for pain (again, 10/10), explain that he can't have a meal yet - argue with family member about bringing in take out, "what do you mean his sugar is low? he's diabetic? Get glucose monitor, check sugar, 320 - "what was your last medication/insulin?" Don't know? no problem.
1943 - chase down doc (who's giving report to oncoming doc so he can get outta here) and get order for insulin coverage. Just a tad, thanks, he's NPO after all (not the doc, the patient, although the doc's looking hungry too).
1945 - bed 5 can go to x-ray - push him, on stretcher, to x-ray. Stretcher rides like a bad shopping cart and this fellow's a tad... erm... "healthy".
1950 - grab advil from locker.
1952 - um... is that a body in bed 8? Go check chart quick...16yo lower abd pain with vag bleed x2 hours - swears she isn't pregnant. Triage did the labs/UA (she has a UTI!), so that's good (having labs, not the UTI). Go see patient, irate because she wants pain meds and hasn't been seen by doc yet. Just came out of bathroom on the way in from triage - figures. Vitals, hellos, assessment.
2000 - bed 5 back from x-ray... put him back on monitor, get him all hooked up.. he has to pee. Hand him a urinal, provide privacy, back in a minute.
2005 - oncoming ER doc, "how come nobody told me bed 7 has chest pain?" (?!?!?!?!) News to me. CP protocol initiated, EKG run and printed. Add tropo to labs, go get the meds, medicate.
2010 - check on bed 6 - where is he? Check smoking area, oh there he is. Escort pt. back to bed, explain he has to stay there while he's being tested/treated unless he'd like to sign out AMA (please?). Smell a snickers bar on his breath (sigh).
2015 - oops, nearly forgot about bed 5 - no problem, he peed, almost in the urinal? Is there a tech to help. Nope, they're taking patients upstairs to the floor. OK, get linen (great, only 5 flat sheets left, what time is delivery?), change bed, clean patient, JUST enough urine in the urinal for maybe that UA. We'll see what kind of mood lab's in.
2020 - CT back on 6 - completely negative. Tell doc, yay someone to dispo.
2022 - Fire rescue's bringing a code one! ETA 2 minutes (do they ever call ahead?). Run to code room and help set up (not my zone, but we don't let each other drown, thank God), oh good, patient is intubated. CPR in progress. NH resident with SOB, finished coding as they were wheeling her out of the home, 96 years old, full code because no one has a copy of the DNR. Family on the way.
2025 - wonder if my patients are being covered by someone. Advil still in my pocket, damn.
2028 - Code one family shows up. DNR? NOO save mama! Continue code. ACLS at it's best.
2035 - code called. Sigh.
2040 - check my patients. Bed 8's labs are back... NOT pregnant huh? Go break the news and give her lots of water. You need an US sweetie. No honey, this isn't the immaculate conception, I'm sorry.
2045 - bed 6 chart in d/c rack. Do paperwork, bring instructions to patient. Um.. he came in through ambulance, how am I going to get him home? Hellifiknow. Where's his family. They left. Were sure he was being admitted, won't come back to get him. Dig up a bus token, I'm still in a halfway decent mood. Adios.
2047 - insist on time for myself. Gulp down the advil in the bathroom.
2050 - x-ray on bed 5 is negative!
2055 - orders on bed 7!
2110 - I have a floor bed for 7 - yay! Turn in admit paperwork to admitting, fill out property forms, reconcile med sheet, explain to pt. why they're being admitted (23 hour obs for CP dear, it's protocol).
2115 - call report to floor. Get put on hold.
2120 - enjoy time on hold as I'm "doing something" but I get to sit down
2125 - actually give report to floor, feel guilty sending a patient up, know how busy they are. Take a minute to commiserate. Promise not to rush.
2130 - Give what admit meds I can (including pain) so floor doesn't have to scramble.
2140 - catch bed 8 coming out of the bathroom. You didn't PEE did you?
2145 - call from US, they're ready for bed 8. Wanna bet?
2150 - Orders for bed 5 - oh good let's do a CT now. Oh and more pain meds. Ok, why not.
2155 - Give bed 8 more water, threaten (nicely) a foley if she doesn't fill up fast.
2200 - body in bed 6. Already? This one's writhing. Can spot a KS from down the hall. Poor guy. Wife's diaphoretic just watching him. Go say hello, vital him, assess him.
2205 - go find doc - bed 6 really IS in pain (as opposed to ... well you know). 60 of Toradol IM - ok I can work with that for now.
2210 - notice that bed 7's empty - someone took her upstairs. EEP - where's the chart? Find it in the slot for bed 9, figures. Complete last note, close it out.
2215 - Bed 5 can go to CT. ok. good.
2220 - when did I last do VS on folks? go round and do them on them what need it. Get water, deny water for npo's, get blanket (always cold in here you know), explain to family that cafeteria closes at 7pm. Commiserate with lousy choice of vending machine food.
2225 - Ultrasound: where's bed 8? Swears she's full. Send her to US.
2230 - Bed 6 can go to CT. Take bed 6 (damn I hate this stretcher). Bring back bed 5 since I'm there anyway.
2235 - hook bed 5 back up to his stuff, revitalize him. Whoa, what happened to his BP? 187/114. Bah.
2240 - find doc, order BP med, give med. put BP cuff on auto Q15 for a little while.
2245 - Ultrasound calls - bed 8 bladder is NOT full. Right. Go down, attempt to place foley. Cajole, beg and (nicely) threaten. Foley in. phew.
2300 - Who the heck is yelling in bed 7? oh. psych with med clearance.
2305 - glance at 7's chart - no labs drawn yet, patient irrate, brought by family for "aggression". Go see patient. Demands to be released, don't I know this isn't a prison? He'll kill me AND himself if I don't lay off him and leave him alone.
2310 - check chart - voluntary - consider AMA form....damn morality...grab baker act form, find doc, beg for signature, get it... but not happily.
2315 - explain baker act to patient (from a safe distance). Ok, not happy.
2316 - give security a head's up - keep an eye on things over here. Call psych.... get over here and check this guy out puleeze.
2320 - family for bed 8... excuse me, excuse me, excuse me, my daughter... just HOW did she get pregnant? erm.. don't you KNOW? Be with you in a moment ma'am, just let me finish up here. (trying not to show the restraints in my hand that are destined for bed 7). Get eyeroll, and HUFF, but she wanders off again. Thankyouverymuch.
2330 - Get bed 7 medicated finally (god bless 5/2) and restrained. HOW often do I have to assess those dang things? <sigh>
2335 - bed 5 CT negative - dispo time! Chart to doc. PLEASE don't rush!
2340 - bed 8 back from US, everything looks good, honey. Nice healthy 12.5 weeks along you are. Take the foley out before she claws my eyes out. Revitalize. Leave mom and daughter alone to "chat".
2345 - bed 5 in dispo rack - d/c home. Give script and instructions, miracle of miracles! this patient has a RIDE. Off he goes.
2350 - bed 6 back from CT - waiting for results. Still in agony. Get order, medicate, calm wife down. He is NOT dying, honest.
2355 - excuse me, excuse me, excuse me...oh, mom for bed 8. What do I do NOW? umm.. we're waiting for the midwife to come assess your daughter. Yes but what do I do with a pregnant teenager??? (sigh) no idea. Would you like a cup of coffee? you may be here a while.
2400 - is that a body in bed 5? I didn't even know that bed was CLEAN!
Only 7 more hours to go.....
Oct 20, '06Steph, your summary was great! Thanks for saving me a lot of typing - LOL - and you're definitely right on when you described it as a SMOOTH night in the ER! Let's not even discuss a BAD night.
Oct 20, '06well, today was a good day, so i'll tell you about it.
arrive at 0645, say hello to poor girl who arrived for an am shift but is rostered for pm. chat a few minutes, then say goodbye and call her a lucky cow because she's going back to bed, while i've been up for 2 hours already.
collect handover sheet and consult board for allocation, see a mix of good and bad news. only have three patients, know them all well = good, Pt 1: VRE precautions, pt 2: serious chronic pain and 'issues', pt 3: redressing and general tending to fiddliest dressing known to man= bad.
enter handover room at 0700 for ward handover, then seek out appropriate nurse for file-file handover.
sit down for a moment to check through charts and fill antibiotics, vitals, other treatments, meds etc into daily planner.
recieve promises of help with pt 3, who has to RIB for 2/52 and can't smoke for 48 hours, leaving him an unhappy man.
start hanging antibiotics in a pattern that will allow everyone to get them at approximately the right time.
take down dressing from pt 3 for ward round. listen with sympathy as pt tells you it hurts.
Don gloves, enter pt 1's room to check BSL, vitals and get out tablets. explaing that we'd like her to somehow contort herself in order to provide us with a stool-free MSU and a urine-free stool speci.
get narcotics for patient 2, listen as pt recites own number as has heard it on more than one occasion before.
oops, patient has dropped kapanol in bed, cue search party. spend 10 minutes searching while pt gives pointers such as 'it couldn't have gotten there'...
clarify whether pt 2 needs IM vitamin shot with doc. thank the lord doc ceases it, because the less needles, the better for this pt.
check in on pt 3, docs have seen her and she is patiently waiting with her hand swaddled for her dressing to be done.
Hand IV vanc and attend to pt's dressing. explaing why she needs iv fluids to KVO (awful veins).
page pharmacist to order new meds for patients, as someone before me used up the last of a few meds and didn't think to replace.
trade off with another nurse - i'll help make your beds if you help make mine. attend to her beds, then watch her forget her end of the bargain and get sidetracked. make bed alone.
grab specs from patient 1 - she's managed the number ones in a jar, and number twos are waiting patiently in a pan in the toilet for me to scoop a bit out.
go directly to morning tea.
too tired. rest of the day will be reported upon tomorrow..
Oct 20, '06Gee, reading some of these, I feel guilty for feeling rushed! I do find, though, that I'm often frazzled getting things done now that a year ago I didn't even know I should be doing. The pattern appears to be the more you know, the more there is to do, but also, hopefully, the better you are at doing it...hopefully!
Anyway, I'm a night shift nurse on neuro/neurosurg. I try to be there by 18:40 at the latest to start at 1900. Need a little time before shift to look at Kardexes and prioritize/pre-plan. Then listen to report and catch nurse leaving for updates and sometimes "unwritten report" (this one is a drug-seeking PITA, that one bites, etc.). Begin start of shift assessments by walking past medium priority patients on way to assess sickest first. This is usually a pretty full assessment, although our practice is a complete at midnight. It's a lot easier to do skin checks, etc., when patient is fully awake, if they're ever fully awake. So I may fudge a little on the stuff that won't change by midnight--i.e., if skin perfect at 2000, it will be 4 hours later. Also check fluids, and hang 2000 IV meds, if any. Rarely have 2000 PO's, but give them if I do. Chart assessments and check vitals. May have a few FSBS at 2100, cover if needed, then start 2200 meds by 2130. If I have a stroke pt, do NIHSS after meds, if close to midnight (usually is) do midnight full assessment with/after stroke scale, then on to other assessments. Chart after checking 00:00 Kardexes for noc meds, draws. Usually few or no meds between midnight and 0400, except occassional IVs and PRNs. Good time for dressing changes, trach care, new bags for tube feeds, etc. Usually catch lunch after cafetera reopens at 0200.
0400 next round neuro checks or assessments, depending on pt. status. Usually a few 0400 meds. Chart some more, catch up on anything running behind, record report. 0600 meds and catch up on anything not done (usually charting, because this list has omitted the nearly inevitable minor or major emergencies that through everything out of whack--bed exits, elopements, falls, unstable VS, bowel movements, seizures, fights...) 0700 occassional meds, make sure maintenanence IV's good, give verbal updates, handover and hope I don't have any charting left, then home.
Except for the little odds and ends in parentheses above, I see no earthly reason why people cringe when they float to our floor.
Oct 20, '06Quote from nursemikeI work neuro also, and i can't understand why people act that way about having to float there. or, you meet someone in the hospital and they ask where you work and you get the big eye roll/gag myself gesture "oh, i hate neuro!" What's the deal?I see no earthly reason why people cringe when they float to our floor.
Oct 21, '06It's amazing how much I learned about Nursing just from this one post!! Keep em' coming !!!!!!
Oct 21, '06I work on an ortho/neuro unit
I come in and listen to report on the phone, I then look in the computer and note what needs to be done for that day. I note any treatments, abnormal lab values, any tests to be done, etc., I then look on the computer and see what time my medications are due and note that as well. After all the computer work, I go find the offgoing RN and ask her any questions I may have and ask her if she has anything to add.
I then meet up with my CNA and give my report to her and what I need her to complete.
After morning report, I see what 7/8am meds are due and pull those from the pyxis and go and assess those patients first. After I assess/medicate those patients I make my way to all my patients to assess them. Before I assess each one I check the chart and read some of the notes in the chart so I get a better understanding of my patients.
After my assessments are completed, I begin on my 9am (largest) med pass. When I assess my patients in the morning, I always assess pain and if they are in need of a pain pill I administer that with breakfast.
Between all of this, the phone is constantly ringing and patients are needing to go to the bathroom and all kinds of interruptions, but you just pick up where you left off.
After am med pass, I try to chart at least my morning assessments (computer charting) and anything else I can.
After that it is just random meds here and there and new surgicals coming up, dismissals, transfers, patients going bad, new orders, IV's that infiltrate, confused patients, and everything else that goes on with our patients. We do routine assessments, such as neuro checks, neurovascular assessments, etc. every 4 hours depending on which kind of patient we are caring for.
Around 5:30pm I try to tape my report for the night shift (I can add to it at any time after that). I then check my charts and make sure I haven't missed anything throughout the day. I then report off to the night shift.