It’s been a couple of years since I’ve done one of these, so I thought why not? I’m currently with the same unit at the same hospital, but we’ve since moved into a shiny new tower and narrowed things down to a surgical focus. We still take medical patients if we have available beds, but most of our patients are headed to or from surgery.
I mashed a few days together and held onto the notes for awhile before writing, and as usual… no patient details! Just an honest glimpse into hospital nursing. Enjoy, if you’re into this sort of thing.
0635 Obtain a small iced coffee with vanilla + half & half from Caribou Coffee in cafeteria. Sneak up the back elevators, refusing to speak until the drink is at least 50% consumed.
0638 Clock in, check my work email, look up my patients. Holding my breath on my hip and knee patients. Lord, please let their hemoglobins stay above 9.0. Today is discharge Friday and we don’t need any hold-ups. Vitals looking good. Labs looking good. Today will be a good day. It will.
0650 Get report on patients. Meet each one, making enough noise to wake them up and ensure they’re alive and well. Oh, you were sleeping? The hospital isn’t a place for you to rest, silly. It’s a place for us to get you well enough to rest at home… which will be today, if I have anything to do with it! No, hip, I will not send the pretty nursing assistant in to give you a bed bath before you go home. We will set you up to give yourself a bath. Remember, if you don’t use it, you lose it! It’s no wonder they call me Nurse Ratchet. Current assignment, five patients. Anticipate discharging two or three, and admitting at least two back.
0715 Wake up a patient to discover she speaks zero English, only Chinese. Lots of smiles and nods exchanged while I track down her son’s phone number. They only needed to keep her overnight, but her pneumonia can be managed at home now that she’s had some special breathing treatments. Please come in and help me ensure your mom knows her follow-up plan and gets her prescriptions filled. Oh, you have to open the restaurant? Of course. Just come when you can.
0830 Interrupted by a phone call during morning assessments and med passes. Dialysis nurse asks if my patient is ready for them to send for her. Patients with end-stage renal disease have started getting dialyzed after surgery now that we opened a special unit downstairs, but it’s a new process for me. Assure the dialysis nurse I’ll have her ready. Finish up with current patient and grab dialysis reference binder. Shoot into that patient’s room, letting her know they’ve sent for her. Perform quick assessment. Give the right meds. Hold other meds until after procedure. Take a set of vitals. Help her out of bed, zero out the scale and plop her back in to get an updated weight. Refer back to the checklist for the millionth time. Hope I got it right. Transport is here for her.
0930 Everyone is medicated and assessed. Eat a quick breakfast and check in with Chris. Find a quiet spot and start charting. Receive a page that someone’s ready to go. Discharge the hip replacement. Make sure he knows about his follow-up appointment with the surgeon. Remind him how to self-administer his blood thinner shots. Show him what his prescriptions look like. Quiz him on his precautions – keep legs apart, sleep with a pillow between knees, use an elevated toilet seat. Give him one more dose of pain medication and send him on his way. Thank his wife for the flowers and place them at the nurses station.
1100 Make rounds on remaining patients. Hang a few IV antibiotics. Back to charting. Must finish by the time my new admission arrives. Admit a spinal fusion patient. Check to make sure his drains are hooked up correctly and his pain meds are adequate. Not surprisingly, he’s moaning for more. Try to find a nice way of telling him that he’s got a lot on board already. Will give him more when he can have it. He curses at me. Direct his girlfriend to his room. Slip into break room to help set up for a baby shower. Coworker and his wife are en route.
1130 Make rounds on patients. Spinal fusion patient is standing up. Seriously, standing up with his eyes closed. Oh my gosh, how did he manage to get out of bed this soon after surgery? Trace his drain, catheter, and IV lines to ensure it’s all in place. Patient is tapping his own arm, threatening to leave and get some “real stuff on the street” if I don’t give him more now. Settle him back into bed. His girlfriend hugs me and whispers her apologies. Page the doctor to give him an update and ask if he wants to add anything else, but the amount of stuff this guy has in his system could knock out a horse.
1200 Discharge a medical patient, here for weakness and dehydration. Pick up the information on my new admission. Another spinal fusion. Lord, please let her be easier than the other guy. Pop into baby shower to give coworker diapers and eat a slice of pizza. Receive a page that my spinal fusion patient is trying to leave the floor. Naked.
1215 Head into disruptive patient’s room with backup, since the patient won’t cover up or get back into bed. He’s screaming obscenities at me, and he’s furious I’ve called security. My earrings are out and my gloves are on. I learned a lot working psych. Finally settles down and lets me take out his IV. Doctor’s orders, since we can’t guarantee he’ll stick around and we can’t let him out on the street with that sort of access. Administer oral pain meds and smile at his girlfriend, who’s crying and mouthing her apologies again. Make rounds on patients. Finish my lunch.
1330 Make rounds on patients. Admit new spinal patient. She’s super pleasant, but I can’t get a temperature on her. She’s shivering and asking for more blankets. Pile them on and turn up the heat in the room. Make a mental note to return asap for another try. Discharge Chinese-speaking patient with son. He’s repeated everything back to me correctly. Offer to use official interpreter line, but he says he’s good. He needs to get his mom settled at home and return to the restaurant. Check new spinal’s temperature, and the only place I can get a reading is in her groin. It’ll do for now, but she needs to warm up.
1500 Pass meds. Medicate mean spinal patient and nice spinal patient. He’s much more cooperative now, and her temperature is up. Admit a new hip repair for a nurse who’s finishing her lunch. Make rounds on patients. Catch up on charting. Call doctors about the ones who aren’t peeing enough. Discharge a knee replacement to a rehab facility. Call report to facility and answer a million questions with a chipper attitude. Break down equipment from empty room, hauling the fifty-pound leg machine to the back of the unit.
1700 Help a new grad nurse hang platelets. Make sure she’s not rushing, freaking out, or trying to infuse more than one thing in the same line. Point out the part in the policy that dictates the rate. New nurses always run blood too slowly. On the way back, call Chris to make sure he knows what he’s serving the kids for dinner. Remind him to set alarms so he’s not starting everything too late. Pass evening meds. Make rounds on everyone. Catch up on charting. Grab water and sit down for a minute in the breakroom. Admit a new patient to the back of the unit, since it’s the only room.
1830 Check my task list and new orders one last time. Ready to give report. Receive word that there’s been an accident near the hospital, and that most of the night shift crew will be late. Make rounds on patients again and medicate the ones who are hurting. The spinals, surprise surprise! One patient starts to get confused, and another’s IV site has gone bad. Always at shift change.
1930 Give report. Soothe night shifters’ nerves and shush the apologies. One nurse sat in standstill traffic for over an hour. Walk to parking deck and call husband, apologizing for being late. He passes the phone from baby to baby. Say goodnight to each one.
2015 Arrive home and sneak in the side door, changing clothes before addressing anyone. Lucas & Avery are still wet from their baths when they hug me. They don’t seem to prefer towels much. Chris sends them upstairs after a quick visit. Eat a salad with sunflower seeds and blue cheese dressing. Fall asleep watching a show on Netflix with Chris. He wakes me gently. Brush teeth. Wash face. Take nausea pill. Kiss husband. Sweet dreams.
Med-surg ’til it hurts.
Want a next time?
Maybe I’ll write a shift in the life of a charge nurse…