a shift in the life of a med/surg nurse…

I typically stay away from writing about work…
But last night must be shared. No patient information or sensitive details, I promise. It was just one of those typical shifts meets comedy of errors (can I even say “error” as a nurse?) and I decided to give y’all a glimpse into life on a medical/surgical floor.
1730 (5:30pm) – Wake up from a one-hour nap. Leave for work. Way early, but the girls have already eaten and are getting fussy. Everyone is feeling the tension, and the cure for that is usually to kick Momma out of the house.
1830 (6:30pm) – Arrive on the unit after picking up a Chick Fil A sandwich and listening to a little NPR in the parking deck. Feeling physically and emotionally exhausted. Apply some bright red lipstick to try and pep things up.
1900 (7pm) – Finish receiving report from the day shift nurses. Receive multiple compliments, “You must have slept… You’ve got makeup on, and your hair is down!” I wish. Pop into each one of my patient’s rooms and say hello. Right now, I’ve got five patients and am expecting a sixth admission during the night.
1915 (7:15pm) – Patient #1 needs an additional IV site and a unit of blood transfused. If you are a nurse, you know that both of these can be tedious processes, and right after shift change is not an ideal time to do either. However, the day nurse has worked her tail end off all day and these are two things she’s not gotten to. She offers to stay and handle them, but I send her home. 24-hour care, people! Besides, I’m coming off of a five-day break and I’ve got lots of nursey energy…
1930 (7:30pm) – Attempt IV start. Why can’t I stick this patient? Veins are great. Getting blood return, but it’s not working. Better call the doctor and ask if I can hold the other IV medication until the blood finishes, and then run it through that line. Shouldn’t be a problem. Look, I’m critically thinking! Pat self on the back. Page the doctor on the way down to get the blood from the lab.
2000 (8pm) – Doctor calls. Says patient should be able to take the medication by mouth anyway. Grateful, I write down the order and stop into my other patients’ rooms to let them know I’ll be unavailable for the next half hour or so. Everyone is understanding and pleasant.
2015 (8:15pm) – Begin blood transfusion on Patient #1. As I switch out the old unit of blood for the new one, something happens with the first bag. Or the tubing. Still not sure what. Blood goes everywhere – all over me, the floor, the wall. It’s like a horror movie. Of course, I’m worried that I’ve wasted blood from the second unit, and that I’ll have to get a new one from the lab. But that bag is fine. And of course, so is the patient. The blood begins transfusing and I begin damage control. Hands and knees with alcohol wipes. Must contain. Must prepare environmental services team (whom I’ve already paged) for the job they’ve got ahead of them. When they arrive to the room, I apologize profusely and slip out to change clothes.
2100 (9pm) – I’m now wearing scrubs from the operating room. The bright green ones that doctors wear. My patients are all like, “Were you wearing that earlier?” My friends are all like, “Dr. Kincaid, can I get an order?” To make matters funnier, I’m wearing a pedometer on my waistband, to track my steps for the night. It looks like a mini pager. I finish up nighttime medications and assessments, even on that one patient who keeps putting things off and asking to be left alone in the bathroom. So sorry, Patient #2! Gotta keep you safe. After tucking the straggler in for the night, I spend some time catching up on charting.
2145 (9:45pm) – There’s always that patient… the one who waits for you to get to the room with a medication they’ve requested, only to ask you to bring another one with it. As if they forgot. But they do it. Every. Time. I’m looking at you, Patient #3. But hey, at least you were super nice! Nice chatting with you.
2230 (10:30pm) – I finish up the blood transfusion process and retrieve the patient a new IV pump and pole from downstairs. That other one was a bit…bloody. The clean supply room is in a scary part of the basement. It’s near the morgue. I don’t know why that makes a difference, but it does. Then again, I’m a scaredy-cat by nature. I have yet to find anyone at work who will be my personal assistant and go down there at night to get stuff for me. I tough it out and fetch it myself. After switching out the machines and checking on the rest of my patients, it’s time to pump. I’m about an hour later than I’d like. Worth it, apparently… 10oz in as many minutes!
0000 (12am) – Patients are peacefully sleeping like angels. Even Patient #5, who warned me about an occasional sleep-talking habit. Need to hang an IV medication for Patient #2. This requires getting a new pump, in addition to the one already in the room. No, not the basement again! Argh. Oh look! Someone brought up a clean one earlier and left it at the nurses station. Perfect! I sneak into Patient #2’s room and set up the pump and medication as quietly as possible. All of a sudden, it starts beeping to high heaven. I pop open the cartridge door and the whole thing gets jammed. All sorts of noisy racket, but #2 just keeps on snoozing. I turn it off, carry it out of the room, and let the charge nurse know it needs to go to clinical engineering for repair. But you know what this means….
0100 (1am) – Patient #2 still needs another IV pump. B-A-S-E-M-E-N-T. When I get down there, though, my heart leaps for joy. A guy from environmental services is cleaning the floors down there, so I’ve got company!
Him ::double take:: “Hey, why are you wearing OR scrubs?”
Me ::embarrassed:: “Umm… I spilled some blood.”
Him ::astonished:: “Gross! Did you scream and take off your scrubs right there?! I woulda screamed and taken off my clothes right there.”
0130 (1:30am) – I accept a new patient, #6, from the operating room. It feels funny to be wide awake and chatty in the middle of the night, educating family members on pain management and surgical details. But neat that we can provide that kind of care no matter the hour, thanks to today’s medical advances and technology! Check my pedometer. Somewhere around 7,000 steps… just over three miles.
0200 (2am) – I feel a little more caught up. I have found that as a nurse, you’re really only accountable to medication times and your own personal work ethic. I keep a tight schedule for myself, though, and I tend to get stressed if I feel like I’m getting behind. Imagine that. But I’m caught up now, and it feels good to be back in the swing of things with hours to spare. Take a few minutes to look through all of my patients’ charts and get an idea of what doctors want to do, so I can pass it along to the day nurses. As a dayshifter, I can attest that things get BUSY. I update my charge nurse on changes throughout the night, especially the details surrounding our new patient.
0330 (3:30am) – I round on everyone again. Still sleeping! Proud momma nurse here. Time for a medication for Patient #4 (thanks for being so nice & easy, by the way) and a quick run-down of my assignment to another nurse. She’s my “buddy” who will cover for me during my break. Now, off to eat lunch and pump! Baked chicken breast, blueberries, string cheese, and a tall glass of water… caffeine seems to upset my stomach in the wee hours. Another 10oz (yay!) pumped for the sisters, and I’m back on the floor.
0500 (5am) – A few more medications, checks to make sure everyone is still sleeping safely & soundly, and a really good talk with one of my coworkers. Late night chats are fun! This is usually when I start to get sleepy. But I’m also encouraged by the idea that my relief is starting to wake up and get ready for day shift. Hurry, ladies & gents!
0600 (6am) – I like to make sure pain & nausea are addressed before I hand my patient over to the next nurse. I also replenish bags of IV fluid if they’re running low, and I check to make sure everyone has pooped & peed throughout the night. If you’re a grown-up, this is the one place we’ll celebrate your bodily functions with you!
0650 (6:50am) – Shift change. Report given. A lot of raised eyebrows and, “Uh-oh. OR scrubs. Rough night?” Although she was joking, one of my managers passed along a valuable tip last year. She told me to always try to look calm and collected at shift change. “You don’t want to scare the next nurse off!” This morning is no exception. “I spilled a little something, but we’re all good now. Patient #3 had a bowel movement. Keep an eye on Patient #4’s blood sugars. Patient #5 is probably going to surgery, so be on the lookout for an order! Have a great day, SEE YA!” Of course, report is much more detailed than that, but you get the idea. Mad dash to gather my things. Boobs are throbbing. Currently experimenting with only pumping twice while I’m at work. Might have to return to three sessions per shift.
0730 (7:30am) – Leave the hospital. It’s a little later than I’d like, but that’s the nature of the beast. I step outside into a preview of fall… low 70’s, a clear sunny sky, and a few leaves rolling across the ground?! Hallelujah! Make it to the parking deck, climb into my car truck, and slap my face a few times to get ready for the short but sleepy drive home.
0750 (7:50am) – Home, sweet home. The big boys have already left for school, and the three littlest are still asleep? Bless the Lord. Peel off clothes for a quick shower. Oh! My pedometer. 12,785 steps. Somewhere around the equivalent of six miles, walked between the hours of 7pm and 7am.
0815 (8:15am) – Get dressed for bed. Ames wakes. I throw a towel over our bed and set up two granola bars. Open his door to find him standing with a smile on his face, arms outstretched. Change his diaper and satisfy his curiosity, “Yes, DaDa is here. He’s in the shower.” He whines when I take him into our room instead of downstairs (kid loves his breakfast), but when he sees the appetizer picnic I’ve set up, he’s into it. We munch while Chris showers. The girls begin to stir and I go get them, bringing them back to bed to nurse.
0835 (8:35am) – Chris stumbles out of the bathroom. Apologizes for falling asleep in the shower. Yes, for real. Takes all three babies downstairs, and I’m out! Night night!

19 thoughts on “a shift in the life of a med/surg nurse…”

  1. Totally love this Rach. Just further proof that you are super mama. You are such an incredible example for your girls and all women – work hard, play hard, love hard.

  2. Rach,
    I am a die hard Med-Surg nurse who just switched to home health a month ago. I LOVE my new job, the hours are amazing and I love the one on one interaction with my patients. But, I gotta tell ya, reading this made me LONG for the floor!!!! First of all, as a day shifter I have to give you mad props for being so considerate and replenishing fluids and getting your PRNs out, that is so amazing!! Second,I think that we would totally be nurse besties, I am so hyper aware of not getting behind, drives me nuts! I pumped 4 times during my 12 hour shift for the first 6 months and then dropped down to 3. It was so hard but everyone was really supportive. Now I’m pumping in my car between patients, HA!
    You really are awesome, truly. To work nights and then come home to 5 kids: my hat goes off to you. But it sounds like you’ve got a great support team and an effective system. LOVED this post, I think I might have to go do a PRN shift sometime this week:)

  3. Melissa – Super sweet. Very encouraged by this. Don’t always feel so super :)

    Oliva, thanks for the kind words! Just switched to nights and trying to make the best of it! Did home health when I first graduated school (bad idea, I know) and I’m interested in it again someday, I think!

  4. this makes me wanna make an ABA blog. And also wear a pedometer. though, it wont be anywhere near yours… :)
    7p-7a whew.
    you taking any adrenal/thyroid support???

  5. I think this is my favorite blog post I have ever, ever, EVER read. I’m going to school to be a nurse and it was lovely to get a little “on-line job shadow” from someone in the thick of it.

    I’ve been going back and forth about what I want to do with my life. Do I really want to go into Nursing? Is Nursing right for me? Will I be a good nurse?

    This post confirmed all of the above. A nurse is what I want to be.

    Thank you Rachael.

  6. I found this post fascinating. In the last two years my husband and I both had surgery, I delivered my girls, and my daughters had 6 1/2 weeks in the NICU, so I have many reasons to be grateful for all the wonderful nurses out there. Being well-cared for, especially at night, is a blessing when you’re a patient. You are an awesome mama!

    On an unrelated note, I love that you call your daughters “the sisters.” I think that’s really sweet.

  7. Love youramazing blog! Wow what a night :) I worked as a caregiver for a year before my baby was born and loved it. Obv not quite the same but reading this post reminded me of that time.
    The funniest thing reading this post was that everytime I read you pumped 10oz I read it as 100oz (the font makes it a little less easy to read quickly, honestly :P). I was thinking, “100oz WOW!, That must be a twin thing because I can only every express about 6oz at a time, but 100?..” Oh dear :P
    Ciara (in Ireland) x

  8. I loved this post!! I am a speech pathologist but the summer before I started grad school I was a nurses’ aid at a hospital. This totally took me back. I also enjoyed hearing about everything you do!

  9. Thanks for the nursing post, Rachael! I’m wait listed for a 2 year BSN program in Vancouver this fall and just dying to find out if I’m getting in this year or not…it’s good to get a glimpse of what I’m getting myself into! (hopefully)

  10. Totally love this post. I’m starting my new nursing job on a CV step-down unit next week, and I’ll be on three twelve-hour night shifts a week soon (just like you!). I love the tips from you and your manager with regards to taking care of the day shift nurse. I feel a little less intimidated by my new job now!

    You seem like a great nurse AND a great mom!

  11. Do you work full time? If so, you are AMAZING. I worked full time nights as a RN in CCU before my daughter was born and now only work PRN days. I liked reading your post.

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