For all you non-nurses/medical readers, here is a day in my night:
6:35 pm Race into building, up elevator, and onto floor only to discover I still have 4 minutes before I'm allowed to clock in.
6:36 pm Wander leisurely into nurses station/break room area like I haven't just rushed around for the last 45 minutes to get to work on time. I'm confident I'm fooling everyone, heavy breathing or not.
6:37-6:40 pm Load up pockets. This is a thing, people. I have a pen, a red pen, a highlighter, a dry erase marker, a Sharpie, my stethoscope, alcohol pads, tape, and my scissors. And I have a just so way of putting my pens into my pocket so I can effortlessly grab the one I need when I need it in the patient's room without pulling all the other ones out of my pocket. (As cool as this system sounds, it inevitably fails me at least once a night. Sometime I should invent a better way to keep pens organized for nurses. I should have added this to my poll as a way to spend my free time. Oh, wait, it's already happened they have a 4-color pen. That's going on the Christmas list.)
6:41 pm Walk into conference room for mini-staff meeting. This is where the charge nurse tells us things we probably already know from email, but it's the important stuff he or she doesn't want us to forget. They also remind us to; you guessed it, check our email. Also, they tell which patient's are causing trouble--always a fun part of the meeting. We have a code for this, it’s “PIA.” (Pain in the a$$)
6:58 Report starts. For all you non-medical people, this is where the day nurse gives you the low down on what happened with your patient's, what needs to happen with your patient's, and oh by the way, I didn't get it all done, so here's your "to do" list. (Not really, but sometimes.)
7:14 pm Whenever report finishes; I look up my patient's and set up my computerized list for the night. By look up, I mean check the doctor's orders, look at the last couple days of lab results, read the most recent progress notes, and check out their medications. This gives me a pretty good idea of what's happening and also helps make sure stuff isn't forgotten from shift to shift.
Side note: the older nurses love to tell me how things "used to be" before computer charting. My mother would probably appreciate these stories. I think they are strange. The computer is wonderful. It makes my life easier, and it's so much faster to click through one's assessment instead of actually writing it down. Then again, I'm writing a ridiculously long blog post about all this, so I might have liked paper charting...
7:30 pm Acutal patient care begins. I start out with checking vital signs, asking pertinent questions like "do you have pain?" and do my assessment. What's an assessment you ask? I will tell you. It goes from head to toe, and checks out all the major body systems. This is always where I look like I know something because I use my stethoscope, and patient's automatically assume you know what you're listening for/to and then clearly, you know what you're talking about.
So, I start by checking pupil reaction, move down to listen to heart and lung sounds, then bowel sounds, then I check the pulses in the wrists, capillary refill in the finger tips, palpate the abdomen, ask embarrassing questions like "are you passing gas," check the pulses in the feet, look at the heels and toes, and ask a few more questions about their various medical conditions.
Small tangent: Question asking can get me into trouble because I don't always know the answers or know what I'm looking for. I hope to figure all this out someday. But in the mean time, I'm going to keep asking and "fake it until I make it." Comforting, isn't it.
8:00 pm Charting time. Because I only have 2 patients (I'm waiting for the 3rd to arrive), I finish a little earlier then normal. This is good since I will have an admit at anytime, and I have to start handing out meds in about 30 minutes. In nursing school they taught us "if it's not charted, it didn't happen." So true, so true. Ironically, I find a lot of what they taught us actually happens. (I say ironically, because how many people get a degree and never use a thing they learned?)
8:17 pm A patient asks for help going to the bathroom. I run down the hall to help.
8:26 pm I decide to start passing meds so I don't run late. Plus my charting is almost finished, and it will just take a few minutes more. (I am fast at charting. I am slow at giving meds. You know, meds can kill people. I like to triple check.)
8:27 pm "This is easy," I think to myself. One of my patient's only has 1 medication, and the other only has four.
8:31 pm New lab results pop in for a patient. This means I pause to look up the protocol so I can make the appropriate adjustments to the IV fluid in the room. I, of course, triple check because this medication is strong and I don't want to mess it up. All these protocols still confuse me a little bit, so I'm super careful.
8:38 pm On my way with my meds to patient #1. Meds are given, IV infusion adjusted.
8:45 pm Off to patient number 2 with meds. As I'm about to walk down the hall, the phone rings with report for my new patient. I pause to take report.
8:58 pm Finally get meds to patient #2. It's a sad story, so it takes a while even though it's only 1 medication because the family has lots of questions about the patient's medications. For the whole day. I am not well versed in the patient's medications throughout the day, but I explain them anyway.
Side note: There's this super handy thing I discovered on like the 2nd day I worked here. If you right click on the medication in our computer program, it pulls up the reference material for that med and tells you everything you need to know. I love technology. Paper charting couldn't do that for you. And, apparently, neither does two semesters of pharmacology.
9:07 pm Finish charting.
9:15 pm Third patient arrives.
9:17 pm I head into the room of my new patient and do my assessment, check vitals, etc. This patient comes with a sitter to watch over him/her, so I chat with the sitter briefly.
9:23 pm Check new patient's meds
9:25 pm Give new patient's meds
9:35-9:58 pm Give a patient Jell-O, help another patient go to the bathroom, give the same patient pudding, give the new patient more blood pressure medication, answer a sitter's question.
9:58 pm Go to McDonald's.
Long tangent: Yes, you read that correctly. There is a McDonald's. In the hospital. It seems counter productive, but I view it as a good business model. Eat too much McDonald's, go to the hospital for your heart, or intestines, or liver. And it's convenient because it's IN THE HOSPITAL. I like Diet Coke. I drink one almost every shift. The caffeine helps propel me through those crucial hours from 3-5 am. Tonight's not that busy at McDonald's. There are only 2 people in front of me. And, there are 3 people working...again a shocker. Normally, there are 7 people in line, and 2 people working and it takes FOR-EV-ER. Actually, the McDonald's experience should be its own post. Noted.
10:07-10:35 Eat lunch/dinner—whatever meal this is. I'm starving, who cares.
10:36 Catch up on the drama that is letting a family member visit after visiting hours are concluded. Talk to security about family member visiting.
10:39 Sitter comes to complain about family member visiting.
10:40 Go talk to family member
10:42 Begin charting again
10:44 A patient needs pain medication. Go get it and give it
10:53 Back to charting
10:54 Ooops. Go check a patient's blood pressure to follow-up. While I'm at the end of the hall, reassess the other person's pain so I can chart on that too.
10:58 Patient blood pressure still too high. Can't give more BP meds for an hour. This must be one of those "gray areas" they talk about in nursing school all the time.
11:00 Go ask a more experienced nurse what I should do about the high blood pressure.
11:02 Do what that nurse tells me.
11:05 Chart some more
**At some point while I was writing this, I got distracted, and then I couldn’t remember what else happened that night, and since my shift doesn’t have a DVR (thank the Lord!) you guys are stuck with only a half shift. At some point in the future maybe I will do a running diary of the 2nd half of the shift. Prepare yourself, there will probably be an “Ode to the 3 o’clock hour” in there, because it is rapidly becoming my favorite hour of the day.
