What is your daily routine?

Pumiky · Apr 8, 2007

i'm a nursing student. At the moment i'm doing my internship on oncology palliative floor. Since this is our last semester we are expected to take up to 4 pt by the time we're done with the internship. At the moment I have 3 pt. I come to the floor at 06:30. My shift starts at 07:30. I come early so I have a full hour to go over the chart, review the last MD orders, check how my pt were doing over night and talk with the night shift nurse. We don't have report on our floor (not a verbal one) so I find this to be very useful. At around 07:00 I review my pt. care plans and medications, I prepare my meds for the day and by 07:30 if all goes well i'm down the hall to take a first look at my pt's making sure they are ok. I then go back to the pt. who's high priority with the BP machine to take vitals and then go see the rest. Once vitals are taken I give the 08:00 meds and then I do AM care. then 09:00 meds and I try to do charting by 10:00. After that the day evolves around meds, treatments, dressing etc. On our floor we have a routine of doing rounds before and after breakfast, before and after lunch and right before the day shift ends. During these rounds we reposition pt., change diapers, make sure they are comfortable etc. We have a half an hour coffee break and an hour for lunch, which we take when we can. I try to do charting throughout the day and by 15:00 I try to have everything done so I have half an hour left to go over my charting and make sure I didn't forget anything.

Usually (thank God) this works for me, however keep in mind that I also get a lot of help from the other nurses, especially when it comes to AM care. On our floor there's no such thing as "This is my pt and this is your pt" we all care for everybody together so it does make it easier to actually have a daily routine. Hope this helps you, Have a great day

pumiky

TazziRN, RN · Apr 8, 2007

I'm in ER. There is a 30-minute overlap so that the oncoming staff can check the crash carts, supplies, etc. Then we get report from the offgoing shift. We assume care for the pts that are still in the ER, or we make sure we are prepared for what might come in. We chart as we go, so most of the time we do not have to stay over to finish charting. Pts are triaged on arrival, seen by the physician, and many of them have tests and/or treatments. Somewhere in the 12-hour shift we take a half hour for lunch. There are 2 RNs on per shift, 3 on the weekends. We divide the 6 beds between us but if a pt comes in serious or critical the load shifts so that the nurse for that pt can concentrate on the one.

purplekath · Apr 8, 2007

Hmmm...I don't think one day is ever like the next in psych, but I'll give you my last shift, which is a pretty "average" one.

Arrived at 7am for handover - got 8 patients and allocated one nursing student.

Rounds and environmental check - greet my patients, check their environments for any sources of danger. Remove plastic bags, glass, fire dangers etc. As I go, patients approach me, distressed about this and that.

Talk to my nursing student about what she would like to learn today and allocate her two patients that I feel best meets those needs. Do meds with my nursing student.

THEN...the chaos starts. My aim is to have about 1/2 hour with each of my patients. I spend all day trying to do this. Expecting a baby to come in with child protection for a supervised visit with a patient at 10 -- I must be present for this, visit is one hour, so must plan my day around that. Have pt#2 that needs to go to x-ray to establish where the 6 razorblades he swallowed yesterday were in his GI tract. So must plan for that also as I must escort him. Pt #3 has florid psychosis and is most unhappy about being on the ward. She spits at me and declares me "unregistered as a nurse, and places a voodoo curse on me". She secrets medications as she fears I am poisoning her, so spend maybe 30 minutes sitting with her reassuring her of her safety, explaining what occurs in a person during psychosis and why they may feel that someone is aiming to harm them. She takes the Zyprexa wafer then rushes to the bathroom and scrapes it from her tongue. As she is on an order (as all my patients are), I must then call wardsmen to give her an injection against her will ... she cries and cries, and inside, so do I.

Pt#4 is a new admission - he is awaiting a place in a prison forensic unit, but my job is to work out whether he really is "crazy". Read his history and find that he nearly killed a woman a week ago. Decide to tread very carefully with this patient. He needs obs and bloods done. I sit across the table from him to discuss how he is feeling. I watch for signs that might indicate feelings of aggression...clenched fists, tight jaw, wanting to get up and pace. I see none of these, but sit across the table in case, knowing that if he becomes aggressive I have the table between he and I. When I feel that the coast is clear, take obs and bloods, explaining what I am doing at all times. I assess him as I go, he is telling me that he is hearing voices telling him that someone is going to die. I ask, "who is going to die? You, or someone else". He replies..."I am not sure, I can't hear them properly". I ask him if can dismiss the voices by asking them to go away. He tells me he can. I observe him from afar as I go about my work. He is not responding to internal stimuli, although he has told me that he sees things that he wants to pick up but they are not there. I add to my notes that as yet, he appears "not psychotic".

Pt#5 is a BPD patient and before I get to see her she lights a fire under the sensor which causes the doors to the unit to get thrown open and all the fire doors to close. She absconds out the front door. I press my duress and proceed on foot. Security is coming towards me and I signal to them who the patient is, but signal with my hand to "hold off". I catch up with her and she threatens to hit me if I come closer. I walk with her and tell her that she must come back to the unit and discuss discharge if that is what she desires. She states, "I am just going for a walk". Talk, talk, talk. Sit with her while she smokes. Eventually she returns to the ward with me. Deal with the fire brigade who have arrived for the 4th time this week.

Complete an ARC round.

My break has passed, and now it is 10am -- baby arrives. I help the young mum with breastfeeding and discuss some of the delusions she has had about wanting to hurt her child. The visit does not go well, and must end sooner than anticipated, as she is beginning to talk about "saving her baby by ending its life" ... she becomes upset and I cannot offer medication to her as she is still breastfeeding. Consult a couple of doctors about what might be safe for breastfeeding...awaiting response as yet. But run her a warm bath and encourage her into it. Post my student at the door to watch her in case she attempts to harm herself.

X-ray is calling -- escort my patient to x-ray and back. The razors are in the lower GI. I talk with him about what he needs to watch for in terms of pain and BM if they occur. Talk about the situation that led to his suicidality - depression and how it acts inside us. Discuss the side effects he is experiencing with his medication. Hold his hand while he cries.

Pt #6 is a long-term patient who I am trying to prepare for eventual discharge by planning leave for him with his mother. Make 4 attempts at discussing it with him. He wants leave but he cannot hold a conversation without becoming angry. End the conversation each time with, "I'm sorry, if you become abusive we must try again later." Final conversation ends with a fist smashing a wall next to my head. Give up on the idea of leave for today.

Lunchtime - I need a break, and I go. 30 minutes.

On return, medicate those who are unsettled. Deal with patients at the nurse's window who have run out of cigarettes, who want to give me a letter they want posted to the prime minister stating that he is "being kept prisoner here", hear from the police who are complaining that an unknown patient has been calling the emergency number repeatedly requesting to be rescued. Attend to UDS's, more bloods, more medication, more obs. Answer questions from my poor neglected student. Organise drug and alcohol consults. Field phone calls from distressed family members and members of the public who need psych services and want admission - re-route those to the crisis team.

1.20pm -- handover is in 10 minutes. Hurridly writes notes with which to handover my patients. Lament that precious little time has been spent with my patients. Resolve to find more time tomorrow. Handover.

Spend the last hour or so trying to get around and see my patients and tidy up loose ends. More phone calls. Chasing doctors for med chart rewrites. Check in with my student about her patients, check her notes etc.

2.45pm - short inservice on restraints and seclusion. I have been before so I cover the floor on my own. Do another ARC round. Encourage some of the boys to tidy up their messy rooms. A pt returns from leave intoxicated - breath and drug test. Do a search, find cannibis in his pocket which gets locked in our drug safe. Deal with a patient who is in tears because she is unsure if 12 packets of cigarettes is quite enough to get through the weekend. Get handed a complaint form from a pt who wants to lodge a formal complaint about his maltreatment on the unit. Receive a small silver balloon from a patient to say "thankyou" for helping her through a dark time. Attempt to clean a sink drain blocked with vomit from a man withdrawing from heroin who couldn't make it to the toilet ... unsuccessful. Give him some doloxene and call maintenence. Assist a distressed pt who has lost his "chime balls" worn around his neck that he believes protect him from winding up buried alive. He accuses me of stealing them. I find them, he is happy. Spend 10 minutes listening to him decipher codes in magazines and tell me what the birds have been saying to him.

3.30pm - time to go home!!

XYRNMN · Apr 8, 2007

Don't have the time right now to detail my at work routine, but here's my between-shift routine.

12 hour nights, 45 miles away.

Get off at 0730,

leave ramp 0735,

get home 0820,

call wife who is already at work at 0830,

eat a bit until 0840,

lights out 0900.

D*** alarm sounds at 1625.

S&S&S until 1650.

Get dinner going at 1700.

Wife gets home 1710.

Watch news while dinner cooks.

Eat around 1730-1740.

Get on scrubs at 1750.

Out the door 1755-1800.

Arrive in ramp at 1840.

Punch in on the unit at 1855.

3 on, 1 off, 3 on, 3 off, 3 on, 8 off....

Rinse and repeat as necessary.

~K

Suzy2 · Apr 8, 2007

I am a cardiac tele nurse. If everything works and doesnt go haywire, this is my schedule.

6:45-7:30- report from previous nurse & print med sheets.

7:30-8:30-pm assessments and charting of them, give tech report

8:30-9:00-pull meds out of pyxis for each pt.

Suzy2 · Apr 8, 2007

9-10: pass meds and chart

10-10:45:chart tele reports, check i/o, scan charts for any new orders

10:45-12:00: gather midnight meds, place npo signs for pt.'s going for testing,answer telephone/call lights, chart meds

12:00-3:00: chart checks, print tele strips, answer phones, call lights,prn meds, catch up on charting from new admits/discharges, or problems with pt.s

lunch sometime between 1-3 (depends on how soon everything else gets done)

3-4pull meds from pyxis, answer phones/call lights

4-5 chart am ongoing eval, check vital signs

5-6 pass 06 meds

6-6:45: chart tele strips, check i/0 wts, fill out forms for sx (preop)

6:45-715-give report and go home!

This works of course if pt.'s are stable, not experiencing pain or having other issues and their families don't mononpolize my pt. care time as well having multiple admits or discharges. We usually take 8-10 pts. hope this helps

meandragonbrett · Apr 8, 2007

Get report, do walking rounds, make initial shift assessment, meds, treatments, assessment q2h, vitals q15 (often times), do a dance to ward off the evil ICU spirits, chart, chart, chart, assess, meds, travel to CT/MRI (hopefully not, but sometimes have to). Give report, complete walking rounds, go home.

KJRN79 · Apr 8, 2007

Arrive at work 7 am, place opens (it's a daycare [~1200 kids total]) at 7:30. That means I have a half hour before ANY THING can happen. And by anything, there have been bomb threats, work strikes (from the daycare teachers), many call outs (teachers, again), no heat in the building, children who are excluded due to physical exam expired (required annually by the state, we give 6-9 week notice AND they have a 30 day grace period before exclusion.)

I try to do my paperwork, clean off my desk from yesterday's mail, check email, check appointments for the day for me and all the nurses while it's quiet.

8a-9a, do rounds of the kids' rooms, collect doctor notes, accident reports, answer questions from teacher/parents.

9:30 newest nurse arrives, is still on orientation. Go over her plan for the day, try to get a little of paperwork orientation done.

10:00 often leaving for an outside center, either to check red tape paperwork/physicals/accident reports, or because a teacher called and said "he fell when he was climbing on the bookcase and hit his head on the floor" or "this kid has a rash/bruise/unidentified mark" and a nurse has to go.

11:30 stopping for lunch. I eat breakfast around 6am, and I get hypoglycemic if I can't eat before noon.

12:00 covering lunch shifts for other nurses, meaning I get all of their calls while they actually get a lunch hour. Once in a while, they get this lunch hour.

12-1pm, answer questions, help teachers with meds...many kids on nebs. Occasional mistake with a food allergic child...child ate something he/she shouldn't have...maybe twice a month. I think agency wide we have about 20 kids with epipens and about 40 with Benedryl only. Some of the kids know what they can NOT eat, but more likely they are too young to be that responsible.

1-3pm, nap time for kids means meeting time for the rest of us. Usually this involves meeting with a specific classroom's staff and discussing all of the kids. We talk about education, getting ready for kindergarten, social issues, including family dynamics, attendance and health, how involved the parents are with the school, how the child is eating/nutritional status, and is any paperwork due.

3pm-4pm, the kids waking up with fever, possible pink eye, "I don't feel good's"...and trying to wrap up all outstanding phone calls of the day.

I try to leave by 4, two other nurses stay until 4:30-5:00 (in another building)and the new orientee stays until 5:30 while I keep the agency cell phone on until 6pm.

I'm guessing that this may be one of the more unusual routines posted on here. Maybe we should have a contest!

2bNurseNik · Apr 8, 2007

Oh my.....sounds very, um, interesting, to say the least. Do you ever have a "good" day.

Hmmm...I don't think one day is ever like the next in psych, but I'll give you my last shift, which is a pretty "average" one.
Arrived at 7am for handover - got 8 patients and allocated one nursing student.
Rounds and environmental check - greet my patients, check their environments for any sources of danger. Remove plastic bags, glass, fire dangers etc. As I go, patients approach me, distressed about this and that.
Talk to my nursing student about what she would like to learn today and allocate her two patients that I feel best meets those needs. Do meds with my nursing student.
THEN...the chaos starts. My aim is to have about 1/2 hour with each of my patients. I spend all day trying to do this. Expecting a baby to come in with child protection for a supervised visit with a patient at 10 -- I must be present for this, visit is one hour, so must plan my day around that. Have pt#2 that needs to go to x-ray to establish where the 6 razorblades he swallowed yesterday were in his GI tract. So must plan for that also as I must escort him. Pt #3 has florid psychosis and is most unhappy about being on the ward. She spits at me and declares me "unregistered as a nurse, and places a voodoo curse on me". She secrets medications as she fears I am poisoning her, so spend maybe 30 minutes sitting with her reassuring her of her safety, explaining what occurs in a person during psychosis and why they may feel that someone is aiming to harm them. She takes the Zyprexa wafer then rushes to the bathroom and scrapes it from her tongue. As she is on an order (as all my patients are), I must then call wardsmen to give her an injection against her will ... she cries and cries, and inside, so do I.
Pt#4 is a new admission - he is awaiting a place in a prison forensic unit, but my job is to work out whether he really is "crazy". Read his history and find that he nearly killed a woman a week ago. Decide to tread very carefully with this patient. He needs obs and bloods done. I sit across the table from him to discuss how he is feeling. I watch for signs that might indicate feelings of aggression...clenched fists, tight jaw, wanting to get up and pace. I see none of these, but sit across the table in case, knowing that if he becomes aggressive I have the table between he and I. When I feel that the coast is clear, take obs and bloods, explaining what I am doing at all times. I assess him as I go, he is telling me that he is hearing voices telling him that someone is going to die. I ask, "who is going to die? You, or someone else". He replies..."I am not sure, I can't hear them properly". I ask him if can dismiss the voices by asking them to go away. He tells me he can. I observe him from afar as I go about my work. He is not responding to internal stimuli, although he has told me that he sees things that he wants to pick up but they are not there. I add to my notes that as yet, he appears "not psychotic".
Pt#5 is a BPD patient and before I get to see her she lights a fire under the sensor which causes the doors to the unit to get thrown open and all the fire doors to close. She absconds out the front door. I press my duress and proceed on foot. Security is coming towards me and I signal to them who the patient is, but signal with my hand to "hold off". I catch up with her and she threatens to hit me if I come closer. I walk with her and tell her that she must come back to the unit and discuss discharge if that is what she desires. She states, "I am just going for a walk". Talk, talk, talk. Sit with her while she smokes. Eventually she returns to the ward with me. Deal with the fire brigade who have arrived for the 4th time this week.
Complete an ARC round.
My break has passed, and now it is 10am -- baby arrives. I help the young mum with breastfeeding and discuss some of the delusions she has had about wanting to hurt her child. The visit does not go well, and must end sooner than anticipated, as she is beginning to talk about "saving her baby by ending its life" ... she becomes upset and I cannot offer medication to her as she is still breastfeeding. Consult a couple of doctors about what might be safe for breastfeeding...awaiting response as yet. But run her a warm bath and encourage her into it. Post my student at the door to watch her in case she attempts to harm herself.
X-ray is calling -- escort my patient to x-ray and back. The razors are in the lower GI. I talk with him about what he needs to watch for in terms of pain and BM if they occur. Talk about the situation that led to his suicidality - depression and how it acts inside us. Discuss the side effects he is experiencing with his medication. Hold his hand while he cries.
Pt #6 is a long-term patient who I am trying to prepare for eventual discharge by planning leave for him with his mother. Make 4 attempts at discussing it with him. He wants leave but he cannot hold a conversation without becoming angry. End the conversation each time with, "I'm sorry, if you become abusive we must try again later." Final conversation ends with a fist smashing a wall next to my head. Give up on the idea of leave for today.
Lunchtime - I need a break, and I go. 30 minutes.
On return, medicate those who are unsettled. Deal with patients at the nurse's window who have run out of cigarettes, who want to give me a letter they want posted to the prime minister stating that he is "being kept prisoner here", hear from the police who are complaining that an unknown patient has been calling the emergency number repeatedly requesting to be rescued. Attend to UDS's, more bloods, more medication, more obs. Answer questions from my poor neglected student. Organise drug and alcohol consults. Field phone calls from distressed family members and members of the public who need psych services and want admission - re-route those to the crisis team.
1.20pm -- handover is in 10 minutes. Hurridly writes notes with which to handover my patients. Lament that precious little time has been spent with my patients. Resolve to find more time tomorrow. Handover.
Spend the last hour or so trying to get around and see my patients and tidy up loose ends. More phone calls. Chasing doctors for med chart rewrites. Check in with my student about her patients, check her notes etc.
2.45pm - short inservice on restraints and seclusion. I have been before so I cover the floor on my own. Do another ARC round. Encourage some of the boys to tidy up their messy rooms. A pt returns from leave intoxicated - breath and drug test. Do a search, find cannibis in his pocket which gets locked in our drug safe. Deal with a patient who is in tears because she is unsure if 12 packets of cigarettes is quite enough to get through the weekend. Get handed a complaint form from a pt who wants to lodge a formal complaint about his maltreatment on the unit. Receive a small silver balloon from a patient to say "thankyou" for helping her through a dark time. Attempt to clean a sink drain blocked with vomit from a man withdrawing from heroin who couldn't make it to the toilet ... unsuccessful. Give him some doloxene and call maintenence. Assist a distressed pt who has lost his "chime balls" worn around his neck that he believes protect him from winding up buried alive. He accuses me of stealing them. I find them, he is happy. Spend 10 minutes listening to him decipher codes in magazines and tell me what the birds have been saying to him.
3.30pm - time to go home!!

snowfreeze, BSN, RN · Apr 8, 2007

I work telemetry. My first thing to do is find what my assignment is. supposed to be 4 on daylight but sometimes I get 5, 6 in the rare occasion of late call offs. Log onto the computer and print my assignments rounding report sheets which tell me latest labs and some other basic information. Check the caredex for IV sites and fall risk plus their past medical history. Then I look at orders for the dietary order and their running IVs. Then I listen to the taped report for each patient. Once I have all the report info I look for things that were not clear in report on each patient, labs, test results, new tests to be done today, orders that were written after 6am. Most of the information for our patients charts are online so I can check this at the same time docs are rounding.

Next I go look at each patient to be sure the IVs are correct and they dont need replaced soon.

Then I start my assessment rounds, if there is only one nurse aid I have to do vital signs too.

Take a family call for update on patient

After one or two complete assessments I help set up patients for breakfast.

I don't pull up the sliders until their tray is there as they just slide back down and I need to pull twice.

Families call to ask how grandma is doing.

Breakfast is here so I cover insulins and give meds.

Families need update.

Potty time, everyone has to go to the toilet after or during breakfast

Families are here and need a new update and want to talk to a doctor.

I finish my assessments during this time along with passing meds.

Families want to know what doctors have rounded and what they said.

Many patients are called for tests now, x-ray, Echo, stress, CT, MRI, carotid dopplers, LE dopplers for those to r/o DVT, barium swallows for the stroke patients. I need to try to combine the off unit testing into one big sweep for my patients if possible. This includes calls to a couple of departments.

Families want to know test results.

I then look at new orders and retime medication change orders as I have probably already given the prior dose.

Families want to know if grandpa is coming home today.

I check the labs that were not available earlier and change heparin drips as needed and call docs with really weird lab results.

Family members need to know if grandma ate lunch.

I try to plan when I can go to lunch and still get my patients to tests and assist with procedures at bedside.

I check for discharges and transfers prior to lunch also. A discharge means an admission soon after so I plan for that also. Discharges need a ride home, some patients have family to assist, some need the social worker to coordinate with a nursing home or rehab facility.

Q4 vitals and assessments

afternoon meds, insulins at lunch

settle patients back from tests, order food for those that were NPO for those tests.

Lunch sometime in that crazy period.

Families are here and want to know how patient is doing and are angry that nurse is at lunch.

by 2pm I try to record report if I am done at 3:30.

If I work until 7:30 I look to see what patients I will get at 3pm.

Patients that need to have tests ordered this morning I get them to that department.

Admissions settled in and crying for a meal are attended to.

Take a deep breath and chart what I have not done on the run.

Give meds and insulins,

Send new acute patients to necessary tests and reschedule those not needed or patient unstable for tomorrow.

Tape report.

Answer lots of call lights, evening sundowing and potty stuff.

Families are everywhere and asking for nurse or doctor updates at desk.

answer questions if I can.

Add multiple requests to chart from families.

Go home.

relax with my cats,

SoontobeAdrienneRN · Apr 8, 2007

wow, these are great!!