whats your day like?

Mississippi_RN · Aug 25, 2005

Not a dumb question.... More people should inquire more deeply into their intended careers before actually setting off to accomplish them so they will know what they are getting into. Also, I think it is great that you at least have some idea what you want to do :balloons:

Now...to the question... What is my day like?

Hell.

No, really...it is usually very steady at first getting busier by the moment, culminating in chaotic, slowing to hectic in early afternoon and finally, trickling down slightly hair-pulling until I just hand it over at report and leave about an hour after my shift is technically over.

It is me (RN) and another RN and LPN with a CNA and a FS (on a good day) We have a total of 16 beds, specializing in post-partums (really fast turn over rate). Me and the other RN take turns being charge. The other one of us is IV nurse AND we split the 16 beds with the LPN. The CNA can only be assigned VS and 8 beds to change and/or give bed baths (so that means other 8, if occupied, are up to the RN and LPN splitting beds to do in addition to all the other stuff. So, when I am IV nurse (which I actually prefer) I do up to 16 patients worth of IV fluids and meds, 8 patients worth of PO meds, treatments, bed baths, bed changes, etc. Plus, if the other nurse is busy I will make rounds with doctors or do admits also. But being charge is no walk either. For example, other day I was charge and I did 10 admits. Lot of paper work. :angryfire

Usually, if I am IV and have half of the patients, I will get report....then go down the hall and see my patients and help pass out trays (so the CNA will get all the V/S). Then, I will run back up, pull my POs and any 0800 IV meds and go back down the hall to do those. Then, I will come back up and start opening charts on my half. That is...in a perfect day when I do not have 5 patients calling on lights wanting something, someone with an outrageous BP, Dr who comes up wanting to make rounds, etc. :zzzzz

It is hectic and tiring...some days more than others. But if you like it, you like it. And you HAVE to like it to do it every day...

And I like it. :)

Hope this gave you some idea.

MS._Jen_RN, ASN, RN · Aug 25, 2005

I work on an acute rehabilitation floor on the evening shift.

We are a 40 bed unit. When our beds are full we have 8 RN's and 5 Nurses aides. Each RN has 4-5 patients, up to 6 if we are short on staff 'cause the beds are not full or something.

Here's a typical day:

1500-1530 Listening to report form off-going shift.

1530-1545 Following up on immediate issue brought to light in report.

Then check for new orders on patients that were assigned to me in report. Go touch base with patients and talk with them about expectations of what is going to happen in the shift (ie showers, dressing changes, teaching, bowel/bladder programs) and preform initial patient assessment. Chart assessments. Obtain dinner time blood sugar results and give all dinner time medications including treating high or low blood sugar results. Assist those who need help with setting up their dinner and or those who are a total assist for eating. Cover for other RN's while they are at lunch and go to lunch myself. Give PM meds (including meds for PM blood sugar checks) and help patients get ready for bed. Do more charting, care plans, I&O's, Tape report for oncoming shift. Answer Midnoc's RN's ?'s and go home.

Keeping in mind that all of this is being constantly interrupted with patients on call lights(mainly for toileting and pain medication), patient's family members with questions/concerns, MD's, PAC's.

If you are thinking of going into nursing it may be in your interet to see if you would be able to shadow an RN at a local facility for a shift or two. You could even try a couple of different ones like home care, hospital, or LTC.

If you have any ?'s just ask- no question is a dumb question.

Good luck-

~Jen

EDValerieRN, ASN, RN · Aug 25, 2005

This is going to be quite long. I work 12's.

I am an ER nurse, so what I do is probably much different from above. I work the 10am to 10pm shift, three days a week. I work in a large level I trauma center and teaching hospital. The ED has around 35 beds, and is about to double in size.

10:00am I show up onto the floor and recieve a report from the nurse who will give me her patients. My ER is divided up into three different zones. Zone I are high acuity patients (chest pain, stroke, resp. distress, codes, etc). Zone II are medium acuity, and zone three beds are not monitored, so they tend to be low acuity beds (by acuity I mean how sick the patients are).

When I work with the highest acuity patients, I have three patients at a time. When the patient first comes in, I will order certain tests (bloodwork, IV's, Ultrasounds, X-rays) according to what I believe the patient needs and what policy says I can do. On the typical patient, I will get a urine analysis, start an IV, draw blood, get the patient hooked up to the monitor and dressed, and do certain tests depending on the patient.

During this time, I am also assessing my patient using a head-to-toe format. I look at the patient and listen with my stethoscope, and I ask the patient a standard set of questions. When I'm done doing all of this, I will put the chart outside for the MD to come in and see the patient.

The MD will see the patient and then write any extra orders he/she thinks the patient should have, and I am responsible for making sure these things are done. This is where CT scans, Ultrasounds, Medicines, MRI's, and XRays come into play.

While the patient is having these tests done, I am taking their vital signs at least every two hours, monitoring their pain levels, giving them meds, and making sure their family is comfortable. When the test results come back, the MD will interpret them and decide whether the patient is to be admitted or discharged. If admitted, the ER will hold the patient until a room opens, and then I will call report to the nurse upstairs. If discharged, I am responsible for giving discharge instructions, teaching the patient about all prescriptions and instructions given, taking another set of vital signs, and walking them out.

I do all of this for three patients. My patients usually get in and out quickly unless the hospital is busy, so I probably see about 15 patients come through in 12 hours.

If a critically ill patient (stroke, heart attack, breathing problems, trauma, etc) comes in to one of my rooms, I immediately become one on one with that patient. In this case, I rarely leave the room, and stay right at the bedside. I will do CPR, assist with intubation, give life support meds, and counsel the family. I don't leave the patient until he leaves the floor or dies. The other nurses will each pick up one of my other rooms, so I don't have to worry about whether those patients are being taken care of.

If I am in Zone 3 or what we call "Sub Wait," I will take more patients because they aren't as sick. We also have a Zone 4, which is a unit our patients will go to if they are waiting on a bed upstairs. This zone doesn't take ICU patients, and it runs like a med-surg, only it's ER nurses, so we are a little (or a lot) more disorganized :smokin:

While all of this is going on, I usually get to see at least one very funny thing, one very sad thing, and one very scary thing each day. Usually I see more funny stuff than anything else, but maybe that's just my sense of humor.

I have to say that if you have just read all of this, you probably shouldn't be an ER nurse, because our attention spans aren't that long :lol2:

Best Wishes! If I can help in any way, please let me know!

chicagonurse · Aug 25, 2005

I'm a correctional nurse. It is sure not for everyone. Best nursing job I ever had though, I don't mind the clientele.

I start at 3pm getting report for about ten minutes.

From 3:15 until about 4:15 I prepare the medication for the 9pm med pass. This is a rare thing in nursing. There are only a few places that meds are prepared before hand.

At 5pm the diabetic patients come to the health care unit to check their blood sugar and get their medication.

After that if no one has any complaints I basically have no work to do until med pass. Should someone have an injury or health complain though he would come to the unit to be seen.

Then at 8:30 I take my med cart and go to the units and pass the residents their meds. That can take anywhere from 30-45 minutes depending on what units I have that day.

I return to the healthcare unit and chart the medication that I gave which can take about 45 minutes depending on how many PRNs were requested.

If no one requests to be seen then I am pretty much done for the evening.

PamRNC · Aug 25, 2005

Short version:

Get report; give report; check orders and lab/test results; assess patients; teach patients; give out drugs; reassess patients; chart assessment and drugs given; work with doctors and social workers to discharge patients safely to either home, rehabilitation facility, or nursing home; call doctors/nurse practitioners/physician assistants to get orders changed/fixed or to see the patient; teach patients/family members; send patients to the OR, receive patients from the PACU; send/receive patients from testing areas; Give report; finish charting.

There are so many little things and big things to do during the day that any nurse would be hard pressed to tell you all the details.

Long version:

Keep in mind there is a lot of repetition, and depending an who needs what when, the activities of the day are fluid. I may start giving meds and going from room to room, but have to skip rooms, or stay at one room until I fix a problem, or because there are no problems.

Hmm, let's see. I receive report starting about 7:30am from the night nurse, on 6-8 patients depending on how many nurses are working on our 32bed unit. We have computer charting which includes physician order entry, and lab/test result data. So, after I get report, I check the computer for any new orders, any lab results that are back from the early morning blood draws, and then go out and take a look at my patients. Any orders that need to be fixed or clarified means a page to the intern/resident doctors in charge in the particular patient. I need to check the computer for new orders at least every 2 hours, but the doctors do their rounds early in the morning and often make the most order changes during the morning up until about 10am or 11am, so I'll be checking the computer more frequently at this time.

By 8:30am I go to each room, say hello, introduce myself, check to make sure everyone is safe, pain free, and without any urgent problems (difficulty breathing, etc). The nursing assistant has been taking vital signs, so she'll give me the vitals while I give her report on what is expected or needs to be done for our patients. The things discussed in report are usually: who's going home; who needs help with eating/getting out of bed/getting washed up; who's expected to go to the operating room, or testing area; what diet each patient is supposed to be on; how frequent vital signs need to be done for each patient (fresh post-operative patients need to be checked more frequently); if we need to keep track of intake and output (how much the patient drinks and how much they pee); and any special considerations for each patient (drainage tubes, wound dressings, equipment, religious/cultural/language issues). I work in a teaching hospital - so if we also have nursing students I may repeat some of this report to the nursing students depending on which of my patients he/she has.

8:30-11am: I begin by giving out medications to each patient and as I go along, I check their IV sites, pain level, incision sites, listen to lung, heart and bowel sounds, feel for pulses in wrists and ankles, ask about how they slept, what concerns they have, what their doctors told them. Giving out medications means looking at the medication record (medex), taking the meds out of the draw on the medcart (each patient has a draw with only their own meds in it), doing a safety check to compare what the medex says is ordered with what I have in hand, then I take meds and medex to the patient and check the patient's ID band against the patient info on the medex. (It takes longer to write than to do). If there were any medications I didn't have I'd have to contact pharmacy for them to be sent. If there were any medications I didn't know about (new medications), then I would check my drug guide in my PDA to find out about the medication, what it does, side effects to look out for, and potential interactions with other medications. Most of my patients medications are pills, somtimes I have to give injections or medications through the IV.

I repeat the process of giving medications for each patient, and assess them as I go along. Often I get called to see a patient sooner rather than later, to answer the phone for a call related to one of my patients (family calling, testing area that's ready to see my patient, doctor looking to check on something). Medications are regularly due at 9am, 12pm, 1pm, 2pm, 5pm, and 6pm. Not everybody has meds due at all these times and most meds can be given up to an hour before or an hour after the due time.

12pm - fingerstick blood glucose checks, more meds, set patients up for lunch.

5pm - fingerstick blood glucose checks, more meds, set patients up for dinner.

As I go through the day I spend a lot of time teaching my patients, usually with each encounter. As I give medications out I tell them what each pills is, what it does and how much it is. If they have other questions about their meds I answer them. If they have pain, I ask them where, to rate it on a 0-10 scale, describe how it feels (burning, aching, etc), and then offer/give pain medication. Often patients are concerned about receiving pain meds because they worry about becoming addicts. This is when I have to do more teaching about pain, and pain medicine. Since most of my patients are surgery patients and just had some kind of surgery pain is expected and we need to treat it so that the patients will be able to get up and walk around as well as do breathing exercises. Many times I will teach the patient the safe way to get out of bed (depending on their surgery site), and how to do the breathing exercises (this includes watching them do it).

Patients who have tests scheduled get prepared (if anything special needs to be done) and taught about what to expect during the test. I spend some time providing emotional support to my patients usually by reassuring them, sometimes by joking and talking with them. I also discuss plans for the patient with the doctors and social workers so that I keep up to date with their discharge plans. Patients who are being discharged - I have to write up their discharge papers, print medication or treatment information sheets from the computer, sit down and discuss with the patient what they need to be aware of and do when they leave the hospital.

I also work with others who come and go depending on patient needs and sometimes if I call them. For instance, the patient may be ordered for physical therapy - the Physical Therapist (PT) will come to me, ask about the patient, and if it's okay to work with the patient (I have to let them know if there were any problems that might prevent them from working with PT). If when I checked their IV site it was bad/needed to be changed - then I would call the IV nurse to place a new IV site, after I removed the old one. If the doctors wrote new orders for blood work, then I would call the phlebotomist to come and draw the blood from the patient. If the patient needed to go off the floor for a test of be discharged then I or the secretary could page the escort service to come an transport the patient to where he/she needed to go.

At the end of the day, I check orders one last time and chart that I've done a 12hr check (looked at and acknowledged all orders during my shift). I give report to the night nurse who is taking over from me beginning at 7:30pm, then finish my charting and go home.

alyca · Aug 25, 2005

Well, I work both 8 and 12 hour day shifts at an extremely busy level 1 trauma center on the trauma/orthopedics unit.

My day~~~

0700-0730- get report on the 3-4 patients that I will be responsible for. We do total care, so the RN is responsible for everything for their patient. There are 1 or 2 aides for the entire floor (27 patients), and they do VS and assist with bathing, etc, but we have to share them.

0730- I always look into our computer charts for each patient and write down what times they have meds, noting any abx or really time-sensitive meds, pertinent lab values, and read over the past few nursing notes to be sure I didn't miss anything in report. Next, I go meet my patients, assess their pain, etc, make sure that they don't have any new numbness or loss of movement, etc in their injured limb(s), invariably I end up also giving out juice and morning snack stuff because no one wants to wait for breakfast

0830- start giving my 0900 medications, usually including blood thinner shots, stool softeners, long acting pain pills, and a wide variety of BP, psych, etc meds. I try to get started on these at 0830 so that I am sure to get everything done in time--if you wait until 0900 to start, something always comes up and you will end up being late with some meds.

0930 or so- give out comfort baths to patients who are able to clean themselves, discuss bathing with the patients who need to be bathed, especially those with spinal braces. I am pretty flexible, and let them tell me when a good time for bathing is. Our PT/OT are always around, and do not have set times to see each patient, so we are always flexible with what a patient wants. So, until around 1130 or so I am involved in bathing patients, charting my morning assessments for each patient, doing dressing changes, helping people get up to chaire, etc and I take my 15 minute break and have some breakfast.

at 1130, I start preparing my 1200 meds, if I have any. Lunch comes around 1230 or so, so the time until 1300 is spent getting people prepared for that--sitting up in bed or premedicated for nausea, etc. I also start getting out my 1300 meds (usually abx or iron pills or tums, things like that)

around 1300, I like to go to lunch . Sometimes I have a 'buddy' who will hold my phone and watch my patients for my break, other times I hold my own phone. It is pretty easy most days to work out when is a good time to go, when my patients will not be needing much from me. We carry cell phones so the secretary can get ahold of us when our patients call, and I don't mind interrupting my lunch to go see them (it really doesn't happen that much).

After lunch, there is usually a lull. My patients have either been seen by PT at some point in the morning, or they are being seen now. At this point, I know the patients fairly well and can sorta expect what their needs are. So until 1500 or so, during shift change for the 8 hour people, I can finish up on my charting and do any dressing changes that are left and just give out any prn meds that are needed. If I am picking up a patient at 1500, I go to get report on them and meet them, but pretty much I am not busy until around 1630, when I start getting my 1700 meds ready. The nice thing about being a 12 hour person is that you really have a good understanding of your patients towards the end of the day--which one goes through ice water quickly, which one will call at 3 hours on the dot to get their prn pain meds, etc, so you can anticipate what people need, and go in and ask about their pain just at the 3 hour mark, etc. After the 1700 meds, it is about preparing for dinner around 1730, and getting 1800 meds together. I try to write my case note on each patient after 1800, so that I can be sure to get in what happened all day with that patient. I finish up these, then give report from 1900 to 1930 and head off for the evening.

So, that is what I do in a 12 hour day. This doesn't include if a patient is going to OR or needs to be sent down for Xrays or to the cast room or if I get an admission during the day or if there is a pt with horrible pain issues or a patient on Q1 hour assessments for a reattached limb or if they are on a PCA and need syringe changes or if there is a code somewhere or lab draws are needed, etc. Lots of other little things come up, but this is basically what I end up doing.

following_faith · Aug 25, 2005

Any hospice nurses out there who would like to share?

(Sorry, not trying to interfere but I think this is a wonderful thread)

Thanks to those who are replying!

Indy, LPN, LVN · Aug 25, 2005

I would also encourage you to read the first year in nursing forum, to see what us new grads are up to.

I'm on a cardiac unit, 12 hour shifts mostly. Report at 6:45 am, usually over at 7:15 and we're ready to go. Look to see who I have that's diabetic. Get brain in order- brain being that paper thing that tells you what you did/are doing. Call telemetry and/or look at monitors to see what my patients heart rate/rythym is. Grab pulse ox and thermometer and go see my patients. Vital signs on each one, introduce myself, start I&O table on board in their room, brief cardiac assessment- it's very nearly a head to toe but my neuro checks aren't complete unless I think they had a stroke. Write down VS, any not normal assessment findings, what tubes they have (IV, foley) and where it's coming from, what's coming out of or going into it.

After seeing all mine, get diabetic meds ready and take insulin/oral meds with their trays. Then breakfast for the rest of mine and help anyone who needs help passing their trays, but only if you ask 'em first. Nurses get cranky if you pass a tray to their diabetic or NPO patient without asking. :rolleyes:

Come back to desk, take off dr's orders, (many dr.'s did rounds while I was passing trays or earlier) and then pass meds to anyone not diabetic.

Hopefully that'll put me in a chair, charting, from 9 am to 10 am or less time if it's not that complicated. That done, get up and pee, no more time to pee for a while. Then get everyone bathed. Either they can shower or you set 'em up a bedside bath or you help 'em to whatever degree. Help coworkers if they have a 2 person assist to bathe. Get help if I need it.

Chart, noon vitals, blood sugar checks if needed, pass lunch trays in same order. Diabetics first with insulin, then the rest. Possibly go to lunch.

Get back, betcha a nickel to a donut that there will be admissions after lunch, or post procedure patients. Spend all afternoon running between the same room or 2 rooms for groin checks/frequent vital signs every 15/30 minutes.

4pm, vital signs.

4pm, sugar checks on diabetics, pass meds, (there may have been 2pm meds as well) 5 pm, pass dinner trays, etc. IF there's no emergencies by this time, go sit in report room for a couple minutes and tape, and go the bathroom. Spend from then till 7 making sure I did everything I should have done and documented it all, wait for next shift to arrive and come out of listening to report, wait for count, go home.

That's a good day. Anything that can happen to make it more interesting, will happen.

stidget99 · Aug 25, 2005

Gee whiz!!!! Do we really do all of that????? Nurses just sit on their keesters all day (nite) and eat or gossip - right???? :rotfl:

In regards to your question regarding the "charting thing". We spend a lot of time charting everything that we've done for a patient whether it's giving a medication, patient teaching, personal cares....whatever. We learn to chart so that if we were ever called to testify (even 20 yrs down the road), we could read our charting and know just exactly what we did to or for that patient, why we did it, and what was the result of what we did.

fledgling · Aug 25, 2005

I appreciate all of you taking the time to write all this down. As a NS hopeful for next summer, I really have benefited from hearing how each of you spends your days.

Please, if anyone else wouldn't mind sharing their day, we haven't heard from L&D or hospice or many other areas of nursing :nurse:

ShayRN · Aug 26, 2005

I am a unit coordinator, so my day is a bit different too. As you can see, there are MANY areas of nursing, you really have to find your nitch...

I get report from 3-3:30 (I work only 3-11:30 shift.) Then from 3:30-4:00, I write out the NPO list for dietary, check on night turn staffing to see if I need to call anyone out and look at the next day's 3-11 staffing so that I know if I need to make some calls for that as well.

Then, if there are no admissions, I start going through the labs and xrays and stress results that are continously printing up, lol. It is my responsibility to call the docs with any abnormals and I also like to pass on to the nurses when they have abnormal results. Although, it is their responsibility to be looking them up as well. I also assign breaks and watch the heart monitors when the tech goes on break. I usually go to break between 6:30 and 7. After dinner, I go back to the floor, make sure everyone is ok, then go to my office and work on evaluations or the schedule for about 1/2 hour. I also have to mediate any personality conflicts or issues that may arise with familys and nurses or even between family members. (We once had family members get into a fist fight in the hallway:nono: ) I then repeat the process of going through labs and xrays. I also have to call for admitting or discharge orders. About 10pm I get the acutiy level on the patients from the nurses (how sick their people are...) and do the night turn's assignment. I expect the nurses to write on the "brain" a type of report sheet any significant changes on their patients that shift, or to come back when I am done and give updates to the oncoming shift. It doesnt' sound like much, ROFL, but it sure does keep me busy.

For what it is worth, I love my job and can't imagine doing anything else in the world.