get/give report, check labs, review pt's meds for accuracy and suitability (based on tests, lab results, pt condition, vitals, safety, compatibility, etc), administer meds based on how patient takes them (crushed or whole, sometimes in applesauce, sometimes in pudding, sometimes in their meal, some before they start eating, some after they eat. Get patients and family comfortable including answering questions on their status, paperwork for pts going to OR, notifying docs of bad labs/deteriorating pt condition, coordinate care with PT/OT/tests/OR/SW/Case mgr/doc/dialysis/dietary/lab/pharmacy/family preferences, etc. Babysit other departments to ensure they followed up/completed care/tasks correctly, collaborate with tech for new orders such as specimens to be collected, review charts, do charting, tasks such as insert new IV when old one went bad, insert foley, insert NG tube, do dressing change, measure and culture wounds, obtain patient's medical history, check on allergies, initiate infection control measures on a patient such as contact isolation precautions, help pts with feeding/bathing/bathroom/positioning.
Call outside pharmacies/Aunt Sally/Uncle John to figure out what that blue pill is the patient is saying he takes at home, how many milligrams, and how often, then call the doc to ensure its ok for him to take this, then speak with pharmacy to find out they don't carry this, so call back Aunt Sally to ask her to bring in the bottle from home, then send it down to pharmacy for labeling. Do tube feeding/TPN, trach care, suctioning, monitor and treat respiratory ailments, PRN meds and calling the doc when these don't work, caring for sundowners' pts/disoriented/confused, running into the room of the patient who is trying to get out of bed when their alarm goes off over and over and over, or trying to take off their tele over and over and over. Trying to reinsert that IV the patient pulled out 3 times and attempt to avoid being scratched or smacked by the patient because management refuses to give the green light for restraints.
Dealing with rapid responses/codes. Mediating between angry patients/angry family and angry doctors/other departments. Trying to calm down the patient having an anxiety attack. Holding back anger when your detoxer is taking away precious time from your dying patient. Figuring out which prn med a patient can have next when they have been getting multiple prns throughout the day and are close to the daily max on some. Placating management. Educating patients, families, and students. Entering orders because the secretary already has a stack of charts with STAT orders. Clarifying orders the doc wrote that no one can read. Continuously assessing and evaluating patients. Applying TEDs/SCDs, or encouraging ambulation while checking O2 sat. Dealing with diabetics and meals/insulin. Answering your phone. Making suggestions to the doctor on meds/interventions. Getting ice/food/blankets/pillows/chairs/etc for your family of the dying patient. Trying to politely get out of the room of elderly Beatrice who is telling her life story because you have a billion other things to do. Remove food from the room of the man going to surgery that the family brought in, and explain again why he can't eat. Clarifying with the doc a half filled out discharge form. Compiling discharge information and educating family and coordinating discharge. Run over to another nurses station to get O2 sat/christmas tree/BP cuff because your unit only has broken or nonexistant ones, or the rest are being used. Order new equipment and call until it gets sent up. Get new battery for your phone for the third time that day.
Pee and sometimes eat. Hope that your patients are understanding that you are doing your best. Chart. Hope you didn't miss anything important. Hope no one dies. Catch a big potential problem and get it fixed before it becomes bad. Get yelled at by management for not charting enough or for staying late to chart, or for putting in that you missed your lunch. Get a smile and a genuine thanks from the family of the dying patient you helped. Get cussed at and belittled by your detoxer and your confused lady who hits everyone. See the relief on a family member of a patient who is doing better, and thanks you for listening and for catching that big thing.
I'm sure there's more, but that's just off the top of my head. We do a LOT, have to remember a LOT, and can potentially have a huge impact on the quality of care our patients get. However, working conditions in med surg are often poor, with far too many patients who are very sick and all need your attention at the same time. Count on management not backing you up and actually hindering your ability to do patient care. It is incredibly frustrating when you've got a patient who needs XYZ but you simply can't provide it because you are too overwhelmed by your patients and everything else you need to do. It is very frustrating to see staff members cry because of the overwhelming stress. We are dealing with lives here and at times feel very unsafe in our job. That is what makes it different from other professions. We have great responsibility that has real impact, but we need the time and tools to do it properly, and we don't always get that. You feel like you can't always be the nurse you want to be. And that's not a good feeling. More often than not, its a 'keep my head above water' feeling. The more experienced nurses have repeatedly echoed these thoughts as well, so I am not alone in this, and unfortunately, don't see how it gets much better. Really, if working conditions were improved, this job would lose so many less nurses.