Alarm goes off. Day 3 of my back-to-back 12-hour shifts. I hear regularly from friends (none of whom are nurses) “You’re so lucky, you only have to work 3 days for a full-time job”. Hmmm, wonder if any of them are getting up this early?
Wait in bitter cold parking lot for shuttle bus to take me to hospital.
Even though I am on the floor and starting to look up my patients so that I can be prepared for the day, I can’t clock in until 0650. I am in awe of the other nurses who just “slide in” right at 0700 safety huddle and start their day.
Safety huddle with night shift and day shift. One of the RN’s called out today, each of us get an extra patient, bringing the total to 6 patients per RN.
Bedside report, an opportunity to meet the patients and discuss with outgoing RN what is happening with each patient. One of our patients needs to use the restroom, patient requires both of us to get out of bed and put on his back brace. (In my mind I’m thinking, OMG I’m going to start my day behind because we still have 5 more patients to get report on, and I know I have 8 AM meds due).
Time to actually start some nursing!! I usually do my assessment after I get my morning meds. As I wait in line with the other nurses to get to the pyxis we have an opportunity to quickly “catch up” with each other. “Julie, how are the little ones doing?” “Mary, how is your Dad, oh he’s in hospice, I’m so sorry”. Why come to work if you can’t have relationships with your co-workers? As nurses, we certainly don’t have time to discuss the day over a coffee break or at the water fountain but even in short spurts it makes such a difference knowing you’ve got others who are going through the same thing that you are.
Call light going off on my Ascom, patient just received their breakfast and until I go get their blood sugar they are not supposed to eat. It has to wait, I’m next in line at the pyxis to pull my meds. Each of my 6 patients have approximately 6-10 different medications. Call light again, patient states their breakfast is cold now and will need to be re-heated when I come in for the blood sugar.
Grab my WOW (workstation on wheels) and start rounding on my patients. Let’s be honest, some patients, in fact, most patients are nice but some are not. The patient who didn’t get her blood sugar checked before eating her breakfast which is now cold was my “not nice” patient that day. Got her problem settled (cold meal) and explained I wanted to do a quick head to toe assessment and a fresh set of vitals. “Can’t you see I’m eating now?” Well, ok, at least let me take a quick listen with my stethoscope and get your pedal pulses…..AND I’m about to start, and the doctors and residents walk in! The team discusses the patient’s care among themselves and with the patient. One of doctors removes the dressing on a wound that the patient has on her lower leg, takes the dressing completely down and then leaves the room. Remember now, I’m still on my first patient, I need to run out to the supply room to get the items necessary to re-dress the wound. (Hmmm, the night nurse must have forgotten to share with me that this patient has a wound on her leg).
I am finally getting to see my 6th patient. I walk into the room and my elderly male patient is crying to himself. “Mr. Jones, what is wrong? It looks like you’ve been crying” Mr. Jones learned earlier today that he will likely have to go to a SNF (skilled nursing facility) for further rehabilitation. “I just want to go home, my wife is in good health and she can take care of me, I don’t understand why everyone thinks I need to go to a nursing home to get better!” Even though my phone was going off continually with alerts, I sat down in the chair beside his bed and just listened to him cry while I held his hand.
I pull my WOW to a corner on the floor (maybe no one will see me and I can get some charting done) and start to chart my assessments. Call light, one of my patients needs to go down for an MRI and transport is here to get the patient. I and the care partner get my patient ready to go down for the procedure. Give a quick report to transport and then I can get back to my charting. Call light, one of my patients is ready for their pain medication. However, the patient is not due for the pain med until an hour from now. Go to the patient’s room and explain that they are not due for their pain med until 1300 (I have written the times on the patient’s whiteboard when I started the shift). “Well I am having breakthrough pain and I need the doctor to give me something.” I page the resident and explain the situation. Resident orders a one-time dose, go to pyxis to get it and it’s not available. Call the pharmacy to ask them to tube up the medication. Pharmacist states, “It’s going to be a while before we can get it up there”. Just as I head back to do some charting one of the other RN’s needs a witness to pull a narcotic, back to the med room. Oh, my goodness it’s 1400 and I know I have more meds due and have to hang an IV medication. My “not so nice” patient is due for the IV medication, however, when I arrive in her room she has pulled the IV out. I now need to start a new IV. My stress starts to rise since I am not very good at IV’s, but I at least have to try. Sticking this patient more than once is not going to go over well. “I don’t like being stuck and I want to talk to the doctor about why I even need this medication! Please page the doctor for me and get him in here.” I am able to get out the rest of my 1400 medications.
Lunch break, finally! I will never understand the logic behind only getting 30 minutes for lunch in a 12-hour shift. I sit down in the break room to gobble down my lunch, we are supposed to have other RN’s carry our phones during lunch, but that doesn’t happen, no one has asked me to hold their phone for lunch, so I certainly don’t want to ask anyone either. It’s just an “unwritten” rule I guess among nurses. Just as I sit down, phone goes off again, “pharmacy has tubed up that medication for you Susan and the patient is waiting.” So much for 30-minute lunch, it was about 10 minutes at best.
Patient’s family has arrived to pick up patient for discharge. My sweet elderly patient is being taken to the SNF by his daughter and his wife. I go into the room to review the discharge papers. My patient says to his family, “Susan has been the best the last few days, she seemed like the only person that really listened to me, everyone else just talks over me.” I am about to cry myself but I don’t. I take my patient in a wheelchair out to the entrance of the hospital after he gives me a big hug he gets in his car and leaves. It’s a gorgeous sunny day out, the fresh air feels wonderful!
Susan, you’re up for first admission the patient should be arriving soon. That’s actually a good thing at 1700, I’ll get the new admission and I should have plenty of time to get them settled before the night shift arrives. Oh, my goodness, I forgot to call the SNF with report on my patient that was just discharged, they are on the phone now. I should be in the med room starting to pull my 1800 medications for my patients, but I’ve got to give report first.
Starting to pass my 1800 medications, the nurse is on the phone with report for my admission. Patient arrives on the floor at 1830. It takes at least a half an hour to get a patient settled.
Safety huddle for both day and night shift.
Bedside report for all 6 patients. I explain to the night nurse I will finish up the admission and get the meds out for that patient (they were left over from the nurse who didn’t have time to give them on the floor he was coming from). Hand my Ascom phone over to the night nurse. FINALLY!
Complete my charting.
Wait on cold street corner to get shuttle bus back to my parking lot.
I cannot think of any job that is more satisfying than being a nurse. Six people put their trust in me to care for them at a time when they’re not feeling their best; did I do it perfectly, no I did not. It’s a privilege to do what I do and I wouldn’t have it any other way!