The day of a typical med/surg nurse.
You crack one eye open as the clock next to your bed starts blaring some song about love, loss, or riches; it's 5:15 am. You entertain the idea of rolling back over and trying to get another 5 minutes of sleep but you know if you do that you'll fall back into a dead zone and end up being late. So throw back the covers, brace yourself against the chill and get through the shower that you're hoping will help wake you up- knowing that the real energy will come from the cup of coffee you're grabbing from the Dunkin donuts down the road.
The car ride in wouldn't be so bad, now that you're semi-awake with coffee in hand; except you know where you're driving. Despite this knowledge, you talk yourself into the possibility that maybe all those patients who drove you over the edge last week and made you want to run out of the hospital screaming, all got discharged over the weekend and today won't be too bad. Fat chance, but there's always hope.
Morning report begins and yes, you have the six patient team;
Patient #1 an elderly woman who fell at home and has a change in mental status- and yes she will be trying to get out of bed. But the nursing office didn't feel like they needed to cover her with a constant observation so it's going to be up to you to make sure she doesn't fall.
Patient #2 who was found down on the street and was brought in for drug overdose and alcohol abuse a few days ago- chances are they'll be starting to withdrawal from said substances today.
Patient #3 who is homeless and suffers from "chest pain" on a weekly basis, though has amazingly never been found to have a heart attack. He's already paged the nurse's station 3 times in the past 10 minutes looking for his dilaudid- "it's the only thing that works!"
Patient #4 had a COPD exacerbation and is getting nebulizer treatments every 3 hours in addition to their 4 different inhalers, eye drops, and other medications.
Patient #5 came in with cellulitis of their leg and is being treated with 3 iv antibiotics which the doctor ordered all to go up at the same time, through their one peripheral iv site.
And finally, Patient #6 who came in with a gastrointenestinal bleed and hasn't been able to eat for the past day, but there is still no actual time for their scope- and oh yes, they haven't been prepped yet. Fantastic.
Out of report and to the nurse's station to place your charts back and you already have a critical value from the lab, blood work that needs to be drawn on two of your patients because the doctors put the orders in late and phlebotomy already came and went this morning, and there is a family member on the phone who has called twice to see the condition of your patient. Deep breath, just the start of the day. Record the lab values, call the doctors (and inevitably put the orders in yourself because they're too busy to do that and you have all the time in the world), hunt up a nursing assistant to draw the blood- which gets a scowl and a roll of the eyes seeing as they're trying to grab vital signs and get patients cleaned up at the same time. Take the call from the family member on a patient you haven't even seen yet that morning and attempt to answer the same questions the night nurse said they answered for them a few hours earlier- no, ma'am, there's no change. Call pharmacy and be sure the kayexalate will be coming on the next run for your patient's potassium level of 5.9. Oh, right. The patients.
Walk into patient #3's room and are able to greet them with "Hello, I'll be your nurse to-" before they threaten to choke you if you don't medicate them for their pain- 7:34am, only 7 and a half more hours to go (unless you're working a 12 and then god bless you). On your way out of said patient's room you walk passed patient #1s room to find her caught in her oxygen tubing, call light and iv tubing, attempting to climb over the bed rail without anyone else in sight. Scrambling to reach her before she falls- she, of course, needs to use the bathroom but your CNA is nowhere to be found so you hold her up and help her "pivot" to the commode at her bedside. Of course, while doing this you strain your back because she can't bear her own weight. Of course, you can't set her on the commode and leave her there, so it takes 10 minutes for her to finish, clean her up and get her situated back in bed. Finally you're able to pull pt #3's meds and by the time you get back in there, he's demanding to speak to your supervisor and screaming that he's in *pain* but isn't being treated. Nothing's being done for him here and it's the worst hospital he's ever been to! Attempting to assure him that you have his percocet over his screaming accusations does nothing for his temper. He demands that he needs his dilaudid and his pain is so great, 10/10 don't you know, that he knows the percocet isn't going to work so he's not even going to try it and you can tell the doctor he says so! And while he's at it, he's not going to take any of his other medications until he gets that dilaudid- which by the way he's not due for for another 3.5hours. Somwhere in the back of your mind comes the question "where is that kayexelate?" another call to pharmacy.
Onto patient #5, finally someone who greets you with a smile! You greet them and tell them you'll be right back with their medications. On your way back you pass patient #3's room and his pain seems to have subsided, miraculously, seeing as he's on the phone talking and laughing about what his plans will be for later that night. Let's let that one sit for a bit. Scanning patient #5's meds into the computer, the secretary comes over the paging system and announces that there is a doctor on the phone for you. Paging the doctor back when you're available won't work so apparently the 3 antibiotics that each take an hour to go in will be late since you only have 2hrs to hang all of your meds and this doctor *needs* to speak with you now. Excusing yourself from the patient's room and scooping up the meds on your way out, you find out from the doctor that patient #6s scope is scheduled for noon and they'll need to take the golytely as soon as possible. Right...
And so your morning continues. A battle to try and get medications in on time, fielding phone calls from doctors, finding a commode for your patient who will be sitting on it from now until their scope, taking phone calls from every member from one patient's family and dealing with one doctor who keeps putting in new orders every 10 minutes on a patient, in addition to helping clean up patients who have been incontinent or want to get washed up for the day. By the time you're finally finished giving 8:00 meds, checking labs and being sure your orders are up to date- it's 11:30... time for 12:00 meds! The day progresses. After the 11:00 hour it is impossible to find your nursing assistant and so you take on that job as well, making sure that everyone is being repositioned every 2hrs, your patients are being fed that need assistance- well sure you have time for that- and while you're at it you can split yourself into 3 different places so that you can help each of your patients who are complaining about needing to use the bathroom. Oh, and patient #3 is in agony again, demanding his dilaudid. Quick! Patient #1s bed alarm is going off...
1:00. Patients are settled. Lunch is cleared up. You only had one misshap with getting patient #6 off the floor; while calling the doctor to get a travel off telemetry order they insist the patient needs to stay on telemetry and therefore you need to travel with them. Oh, sure. Let me leave the floor and my other 5 patients in my fellow co-worker's equally busy hands. After checking with your supervisor and the nursing supervisor, neither who are able to travel with your patient- you call the physician back. You state that there is no way anyone is available to travel with the patient and the scope will have to be pushed back to a different time. Amazingly the doctor tells you that the patient- who by the way has no cardiac history and has been in normal sinus rhythm in the 70s since admission- can travel off tele.
Paperwork done, patient #6 is off the floor. I&os are done. A quick peek of everyone and no one needs the bathroom and no one is complaining of pain. A miracle! You now have 1.5hrs to chart before the orders and rounds for the next shift print out. Oh and what's that? Looks like patient #2 is starting to take swings at the staff, peed on the floor and is verbally abusing the cna who walked in to check on them. You can hear him screaming now, too... okay, ciwa - check. Get up and start the ativan.
You manage to chart on two patients when the secretary lets you know that patient #1 is being discharged- to a nursing home that they have never been to before and the case manager needs the patient to be gone by 4:00pm, so they booked the ambulance to pick the patient up at 3:30- that won't be a problem, right? Grabbing the chart you start attempting to write a discharge note. Two call bells go off and you're informed that your cellulitis patient who needs an antibiotic dose at this time had his iv infiltrate and he's a really hard stick. Place a call to the iv team. Meanwhile lab slips printed out for another patient, the doctor wants to recheck someone's blood levels- but no one told you. Suddenly you hear that doctor asking for you by name at the secretary desk and before you know it, they're demanding an explanation for why that blood work was not drawn and sent. It's important! (gee, thanks) hunt up a cna again- but wait, what cna? Because they can't help you right now, it's their lunch break. Lunch break? What's that? And speaking of breaks you've had to go to the bathroom for the past 3 hours, and you really don't want your 5th uti this year. Draw blood first, then bathroom. Walk past pt #1s room and there they go trying to get out of bed again because *they* have to go to the bathroom. Patients first. Finally they're cleaned up and back in bed, but no bathroom break for you because that doctor is watching you like a hawk. Okay, okay draw blood and send it off. It's now 2:00 and you have 30 minutes to chart on 4 patients and get as much discharge paperwork as you can done because by the time you're done giving report, the ambulance will be here to take that patient- and you still have to call report to the nursing home.
You aren't sure how, but it's 3:15. You've managed to chart on all of your patients. A wound dressing didn't get done and you're not exactly sure if that infiltrated iv was replaced with a new one- both comments earn you a roll of the eyes by the evening nurse. Most of that discharge paperwork is done and when the evening nurse gives you that evil eye glare you hear yourself saying "but i'll finish that up and call report before I leave." tack on an additional 45 minutes after you were supposed to be done. But finally you're done and are walking back to your car, ready to escape the madness. Of course you know that you forgot to report something or didn't chart or do something that will inevitably have an effect on the next shift. Forget it, you're in your car by this point and if you remember you'll call the unit. Of course the chances of you remembering anything at this point are slim to none seeing as you're delirious anyways. How did you get home...?
Nothing would make you feel better than a nice, cold glass of wine and maybe some of that emergency chocolate you're hiding in your fridge but of course that won't suffice for dinner so now you suddenly get to take care of yourself (and anyone else that may be living with you). Didn't you have to go to the bathroom earlier? Fix dinner, clean the house,make sure you have enough energy and you're paying attention to those around you because if they start complaining that you're not paying attention or you find yourself zoning out and aren't exactly sure what they were so excited to tell you about, you you're going to feel guilty. It would be so nice if someone were able to take care of you for once! But how can anyone else understand the stress you're put under and everything you have to deal with at work. You can't even grasp it each day.
What you do know is this: most days you're going to get yelled at by someone- a patient who wants their pain meds or feels neglected or a family member who is anxious about the fact they don't know what's going on or doesn't feel the plan of care is working for the patient or is demanding to see the doctor. You know you're not going to go to the bathroom at work- no matter how badly you have to go, because inevitably each time you even think about relieving your bladder- one of your patients is going to need to go. And heaven forbid if you ask someone to wait 5 minutes; either they or their family will be complaining to the supervisor about how you're neglecting them in a heartbeat, you can bet on that. You're not going to eat lunch. Period. You may get a few bites in between meds, charting, phone calls, family members, assessments and bathroom calls. Maybe. You know that people are going to assume you can take anything you unleash on them. They'll yell, scream, complain, punch, kick, spit, swear, throw items at you. They'll bleed on you, pee on you and move their bowels- not always intentionally either. One of your patients at some time or another is going to hit on you and make inappropriate comments to you and be shocked and take it out further on you when you tell them it's inappropriate. You know that maybe not today, but sometime withing probably the next week or so a doctor will be put in an order for a urine culture, call to make sure you saw the order, and then one hour later call you away from your work again and ask why the result is not showing up in the labs. (well, unless you place an order for me to straight cath the patient to get the culture, we need to let nature take its course there, doc.) you know that a family member is going to demand you telling them every little thing you're doing for the patient, and while you don't mind teaching and explaining- them demanding to know and not allowing you out of the room so you can check on a bed alarm that's going off isn't the best time.
"So why do you do it?" this is what people ask. Or people say "well every job has its bad days." or they'll try to compare their job to what you're doing. Let me say this: yes, every profession has its bad days. Yes, i'm sure that you have your fair share of troubles at your job. But from the moment someone decides to be a nurse, their life is uphill. They struggle through nursing school- the classes, the clinicals, the rough assignments and the second guessing themselves. The textbook knowledge you'll aquire that doesn't even begin to prepare you for what real nursing is like. But the system makes you go through it anyways. You'll have good teachers and bad teachers, and yes, you'll be able to tell the difference- it would be easier if you couldn't. You'll have one test that you take at the end of your education that will determine if all the hours of studying, all the late night study sessions, the missed down time, not hanging out with friends, and all the tears were worth it. Because fail it, and you have to start over. Pick a new career.
But those lucky enough to pass, you then enter a world where nurses eat their young. Which is good and it's bad. Good because it helps you build a backbone in a profession where you definitely need one, and bad because you'll feel as if you don't have support unless you're lucky. You'll want to quit every week. Doctors and families will hound you over absolutely everything and you'll have to hound those doctors who shouldn't be in their profession because they don't care for the patients. You'll have to stand up *to* the patients who try to run you over and take advantage of you and you'll have to stand up *for* those same patients as their advocate in the hospital. You'll have to be compassionate enough to understand that every patient is a person, have enough patience to know that even the one who is swearing and spitting and hitting you deserves your care for their medical problems. You'll have to understand that missing your family and bending over backwards to the extent that you're off balance and unhappy to make other people and their families happy is going to suck the energy out of you and you're not going to feel as if you have any left over for yourself or your family.
So why do you do it? Because, call me naive, i think everyone needs help that comes into the hospital. And while i could be more attentive to those nice and pleasant patients who don't ring their call bell except when they truly need something and less attentive to those who drive me crazy- the drug seekers, the confused patients, the ones who suck the energy out of you... they need good care, too. So i treat all of my patients with the same amount of attention and care i would want in the hospital because i'm hoping that at somepoint they realize they were given something they needed, deservedly or not. Because i'm human and when I'm at my worst, i want someone to give me their best. And that, is a nurse.
