5 am-The alarm goes off . I get up bleary eyed wishing I could crawl back to bed. I have put in 5 days at my regular M-F job. This is day#6. This job helps me, help my college bound kids.
6 am-I get ready, pack my lunch and am out the door. My steps have a spring just like the weather! Fitbit 500 steps!
6.45 am-I am at work ready for my shift. I listen to the controlled chaos in the Nursing office. The phones ring constantly, the outgoing Assistant Directors of Nursing(ADN) are finishing up their administrative report, attending pages and answering questions from the Staffer. Staff call from different units. Requests, demands, threats of protests of assignments.
7.20 am-I finally start getting report. The report is constantly interrupted by phone calls from charge RN/ Union rep RN asking for more staff on a weekend especially when their unit had sick calls at the last minute.The staffer is directed to take all calls so that we can finish report. Report is done and the night ADNs leave/stay to finish up their report and the day is on!
7.50am-The day ADNs go over staffing with the staffer for the day and the oncoming shift. I am covering all critical units (ED, Dialysis, Cathlab, OR, MICU, CICU, NICU, Telemetery, L&D and postpartum. I get my printout with all the names of the staff for the day and night shift.
8 am-I catch up with what's going on in the hospital (yes, some gossip!), drink my coffee as I call the operator and give her my pager number and the units I am covering. I go online, check our EMR for any issues with patients that were mentioned in report, go over the orders for the one to one observation patients and check the status of the Emergency Room admitted pts that are waiting on beds. Now I am ready for rounds.
8.30am-10.30am: My first round is a quick one to each unit as I check for hospital discharges, meet the charge RNs and eyeball all units for any potential issues.The pager goes off constantly as I move from unit to unit.
10.30am-11.30am: Discharge rounds. Meeting with social work,managed care, chief medical resident, home care etc as we go over all discharges in the house. I inform them of how many ED pts are waiting on beds.
11.30am-11.40am-Meet with patient logistics and go over bed situation and potential discharges.
11.40am-2pm-Unit to unit rounds. Check staffing(schedule book) against paper, speak to the teams, resolve issues, attend Rapid Responses and all codes.
Some of the issues:
1. -ED Patient complaints-Pt can't breathe. Family can't get help from anyone as they are busy! Get staff to help pt.
2. -Attending MD complaint-Cannot get social worker. Patient just lost his wife in a traumatic car accident. Hunt and find the social worker who is not responding to his pages!(I know where this one in particular hides!).
3. -Family complaint-Dad was wandering around ED, peed on himself, was never given food. Planning to call Dept of Health and their lawyer. Spoke to RN taking care of patient and asked her to make sure that pt is put by the nurses station or is eyeballed frequently. Spoke to logistics to expedite bed as pt has been waiting two days in the ED for an isolation bed.
4. -ED Charge RN-Floor is not taking report. Called floor who is transferring out another pt to the CICU. Compromise. Take report in 40 minutes. Called operator to page housekeeping to expedite bed cleaning. Requested ED to send pt up in 1.5 hrs after alerting floor.
Thank charge RN in the ED and ask her to call me if any issues that she cannot resolve.
5. -Dialysis-Worried charge RN, Staff cancelled. Go through staffing with her to see who can stay/come early/call in. Come up with a plan.Move on to the next unit.
6. -Cardiac cath recovery. Pt stable. Staff on Facebook. Pleasantly tell her to refrain from social media at work.
7. -OR-Pt in surgery. Post op RNs waiting.Pretend not to notice the food spread around! No issues.
8. -ICU-Pt needs one to one. No staff available. Call staffer for discuss if we can pull staff from a different unit to help. If not, ask them to put their Nursing Attendant.Staffing ratio safe.
9. -CICU-Pt being terminally extubated. Wife and children at bedside. Healthcare proxy not there. Staff not sure if the rest of the family knows. Speak to the daughter who is worried if her mom could handle this.Patient married for 64 years, wife has Alzheimer.Reassure family, answer their questions, refer to the MD for specifics, huddle with the Nursing staff to plan for any issues, alert security and ED charge RN in case wife has any issues. Stretcher on standby.
10. -NICU-Speak to the family of a baby who was terminally extubated and is in mother's arms. Comfort, listen, speak to the RN taking care of patient. Requests call back from charge RN when the baby dies.
11. -L&D- Discuss issues the nurses have with the ED nurses when pts are send in distress upstairs without stabilizing. Talk to the ED triage RN and reinforce safety first. Follow up with patient. Asthma teaching.
12. -Post Partum-Remind staff that they are up for inspection and discuss baby friendly initiatives. Ask them to get rid of the formula bottles that are hiding in plain sight! 13. 13.
-Telemetry: Speak to the charge RN who wants an extra NA to sit with a confused patient. Round on the patient, who is sitting up in bed eating lunch, answering appropriately, call bell on the floor! Requests RN to make sure that the call bell is within reach and recommends that the patient be on enhanced observation.
2.30pm-Go back to staffing office and go over staffing for 3-11pm and 7pm with staffer.
Bathroom break, hurried lunch that is constantly interrupted with pages. Call from managers on unit issues.
3.30pm-5pm- Attempt to start with administrative report,check on my family, answer pages, call supervisor of radiology, CT, Ultrasound, lab with unit issues. Page central supply, linen and pharmacy supervisors with issues.
5pm-6pm-Last rounds on problem areas.Receive calls about expiration in the NICU & CICU pt.
6pm-6.30pm-Last huddle with staffer on staffing after sick line is checked.Check EMR for unit and house census. Finish up report.
6.30pm-Code called overhead. Attend the code, expediate x-ray, stat meds from pharmacy, keep family updated, support staff, make calls to get a stat bed in the ICU.
7PM-Ready for report, pager going off, phones ringing-----! The circle of life!
I have noticed that I enjoy building teams, planning with the staff for the best outcome, encouraging staff when they have a rough day and calling them out when they are not professional. I am able to guide them to react professionally when people are in their face. Much as I love the one on one interaction with the patient, I am able to do a lot more as an administrator guiding the hospital ship through choppy and calm waters!
So... Calling all potential captain ADNs! Make a difference every day! This I say as I limp out at the end of my day! Fitbit-9270 steps! I sure could use some M&M (Massage and Motrin)!