I am a nurse. I work at a large hospital in Kansas City. I became a nurse in 2006 after returning to school to earn another degree. I needed the degree in order to work as a nurse. I really didn't want to go to school again....
Wait. Strike that. Let's be honest. I loved going to school again. If I had my druthers I'd be in college forever. I enjoy learning, I enjoy working on projects. I like the camraderie of fellow students. I like having well-defined goals. I like research. It's just not a sustainable way of life. I thrill at the rush of "living poor" successfully - finding bargains at the thrift store, clipping coupons, living without cable TV, staying home and listening to the radio for entertainment, taking advantage of student discounts.
OK, I've confessed. That's out of the way, I will continue on my topic of the day. My typical work day. I intended to do the whole day in this post, originally, but it got too big. Here is part one: early morning.
Early morning
Getting to work
I get up at about 0500, shower, dress, pack lunch and snacks, and go to work. It is a 25 minute drive - about 35 minutes door-to-clock-in. I always wear a cross necklace to work; this is because I need God's protection and guidance in my work, and because God called me to to become a nurse. I wear scrubs, support knee-hi hose, athletic socks, and comfortable shoes. I wear athletic shoes, mainly walking-style shoes.
I also need my watch. I have el-cheapo watch from walmart - digital, water resistant, lighted. It displays in Military time, which is how we chart. Then, I don't have to think about what time to write on my charting - look at watch, copy. It would be nice to have a good watch, but there are some places at work I might drop my watch from which I would not want to retrieve it.
I try to get to work about 10 minutes early so that I can do some of the set-up things I like to do before I need to start working with my patients. I also try to help the night nurses get out of work on time, by taking over care of my patients promptly. They do the same at the end of my shift. Boy, do I appreciate that!
Getting ready for the day
After I clock in, I prepare my body for the day. I have a locker in which I place my valuables and stash my supplies. Here is how I get ready.
- Gear up for the day - On my person, I have a stethoscope, locator badge, sharpie pen, black ball-point pens, alcohol pads, carpuject (a device for dispensing certain kinds of IV medicines), and bandage scissors. I usually take a jacket with me in case I get cold. I have a bottle of water. Finally, it is essential that I have a tube of lip balm in a pocket. My lips get dry.
- Go on the unit.
- Find out my patient assignments and from whom I need to get report, if any
- Stake out a claim on a computer station that will be mine during the day. Put my non-pocket stuff at this station and log in to the computer. My stuff include a 1-Liter bottle of water and a jacket.Everything else I mentioned above stays in a pocket, around my neck, or clipped on my clothing.
- Sometimes, I have time to check email before the race begins,
- Until recently I printed out specific sheets of paper that help me through the day. One is called the "brain" on which I take notes about the patients. These include name, age, room, diagnosis, medical history, parameters that a nurse needs to know, upcoming things for the day (i.e. tests, discharge, etc.) and significant lab results from last night. The other paper is a cheat sheet for a patient profile, a questionnaire for new patients.
- I don't do these things now because just this week, we switched to a computer charting system. I'm striving to live without paper!
- Pick up and log into Vocera
Vocera is a little voice-recognition walkie-talkie device worn around the neck.
Then, I can get report from the night nurses and start the day. The race is on.
The Unit
I work in a unit that supports the cath lab and the electrophysiology lab. Our patients are mostly heart patients. Most of our patients come in early in the morning and go home either that afternoon or the next morning. We do the prep and recovery for these patients. Our goals are to keep the patients safe and to supply these labs with a steady stream of patients. An idle doctor is not earning money for the hospital! Oh yeah, and the better we do our job, the more patients will get the interventions they need sooner. That, too.
The Patient Prep
Given these goals, a patient prep is our first priority. To get a patient ready, we have health related questions to ask them, consent forms to be signed, IVs to start, and we have to fill in any gaps in the preparation process that the doctor or the patient may have missed. We have to shave their hair in various areas of their bodies. We have to get a patient weight and a full set of vital signs. Sometimes we have to give pills (Aspirin, Plavix, Valium for the nervous patient). Often we have to get finger-stick blood sugar reading, draw labs and get them down to the lab ASAP. The patient can't go to procedure until the labs are reviewed. We start IV drips, sometimes more than one. I also have to assess the patient and mark their pulses on their feet. We monitor that later in the day.
In theory, we have to have this all done in 30 minutes or less. After a year at this job, I am still not that good; however, in my own defense, there are a lot of factors over which I have no control that impact my speed in a patient prep.
Unfortunately, as the nurse, I am still responsible for these things. That's one of the frustrating things about my job.
The Overnight Patient
If a patient has stayed overnight, it is most often the case that they will leave early in the morning. We are usually urged to get them out as fast as possible. My personal goal is 1000, but the unit goal is 0900. Between 0700 and 0900, somehow I need to do all of the following:
- Do a safety check - make sure the patient is who the chart says they are, she isn't going to trip on anything in the room, etc.
- Assess my patient (listen to heart, lungs, belly, assess incisions from yesterday's procedure, monitor pulses and assess pain).
- Gather vital signs.
- More often than not, get a finger-stick blood sugar. Everyone is diabetic these days.
- Run an EKG strip from the monitor and analyze it.
- Fix any equipment problems, such as adjusting heart monitor leads.
- Make sure they order breakfast.
- Administer the morning meds. Safely and accurately, of course.
- Get them to any tests/consults before they go home. For patients who get a pacemaker, they usually have to go downstairs to get a chest xray to verify the placement of the leads.
- Make sure the doctor or nurse practitioner comes by to assess the patient
- Watch for the official release from the MD or NP
- Discontinue the IV or IVs, remove heart monitor
- Complete the discharge paperwork in the computer
- Go over the discharge instructions with the patient, give them their copies of the instructions, and get a signature. Make sure the patient has any other items from their procedure (identification cards, portable monitors, etc.)
- Give the patient their prescriptions
- Take them downstairs in a wheelchair to meet their ride.
That's a hell of a lot! Then after they go, I have to complete their chart and give it to the secretary for break-down. Indeed I have assistance, but our Nursing Assistants, like us, have priorities to prep the new people coming in. I usually do most of the above things myself.
Now, you must realize that I usually have 3 patients. It will typically be either 1 new patient and 2 discharges, or 2 new patients and 1 discharge. It's loads of fun when the new patients are scheduled to arrive at the same time and the discharge patient and his family are whining to be discharged.
In my comprehensive list above, I have not accounted for some of the variations of these tasks, such as new orders on a discharge patient (e.g., his serum potassium is low, please give him extra potassium), or a medication is missing (call pharmacy!), the unit coordinator is breathing down my neck to discharge patients because we need the beds. Something is suspicious on the patient that needs to be reported to the doctor (which the patient didn't say anything about when the doctor was in the room). Special patient requests like a cup of coffee. The patient failed to mention s/he needs a new prescription for a medication. I have to finish any paperwork the previous shift did not complete.
Mornings go by very quickly on my unit. This is when the doctors are doing most of their procedures so patients are coming and going all of the time.
Coming next time: The workday, part 2: late morning and afternoon.
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