Nov 5, 2006

Creature of Habit

I thought it would be interesting to see how my Med/surg unit routine would compare with nurses who work on other type units. Feel free to comment on the differences.

I work 8 hour shifts...from 0700-1500. I know most RNs work 7-7 12 hour shifts. I'm fortunate to have a boss who can be open minded and family friendly and allow some of us slackers to work ONLY 8 hours.

My Routine:

0430-0550~ Wake up, get coffee, shower. Pack lunch and Ari's things and leave carrying a sleeping 5 yr old to the car.

0550-0600~ Drop Ari at best friend's house (she's so awesome for making sure Ari gets on the bus in the AMs)

0600-0645~ Commute to work while drinking my breakfast, coffee and a slimfast shake

0645-0715~ Clock in, put my stuff in my locker, grab a phone (a cordless type that's run within the hospital only) and listen to the voicemail report on my patients. I pull them up on my computer. The computers are on rolling stands and you have to snag one quick and put your name on it.

0715-0800~ If the nightshift nurse is a decent one, he/she waits to see if you have any questions before leaving. Start assessing my five patients beginning with the most critical sounding ones. (Granted....most of the patients on my unit should all be stable and not critical or they have no business being there. I go by the "what's the worst that can happen " when determining which patients I see first) For example, those on telemetry monitoring with cardiac history come before those with diabetic foot wounds.

0800-0830~ Our unit should change it's name from Internal medicine to the Diabetic floor. Usually 3 to 4 out of my 5 patients have diabetes and need to have blood sugar checks and insulin coverage before breakfast comes up at 0830. I don't head for the med room to get the insulin until I see the trays coming down the never know when the trays will be late and diabetic patient's glucose can crash if they don't get something to eat with their insulin. Blood draws NOT done on the night shift and any frequents (Like cardiac enzymes and Vancomycin levels) are done about this time.

0830-1000~ Morning meds. Everyone's got them. We only pray you weren't assigned with more then 1 or 2 elderly or dialysis patients. They tend to have at least 10 daily meds a piece. Also, any ER admissions you might be getting we hope and pray wait until 1000 to come up or your whole routine and schedule is totally blown. Happens all the time, though. Also, help aides give out lunch trays, call Dietary dept. about any missing or wrong trays. Order missing meds
....everyday the pharmacy has forgotten at least 1-5 meds.....everyday.

1000-1130~ Help aides give bed baths, daily care, get my walkie-talkies in the shower. If things run smoothly with meds and baths I might have started charting my assessments at this point. Any meds that were not where they were supposed to be have been ordered by me and brought up by now...Administer those. Chart , chart, chart

11:30- 1200~ Eat my lunch while my aides are checking blood glucoses. Lunch comes between 1200 and 1230. Insulin will need to be administered.

1200-1300~ Insulin, help aides give out lunch trays, call Dietary dept. about any missing or wrong trays. Chart

1300-1415~ This is the time to finish any charting undone, do any non-routine things like dressing changes, IV tubing changes, new IV starts (they expire in 96 hours) and start any discharge paperwork for those patients going home.

1415-1430~ Leave voicemail report for new shift coming on at 1500. Finish last minute charting

1430- 1530~ Send any ambulatory discharging patients on their way after any appropriate teaching, applying dressings, and discontinuing any IVs they may have. Walk down or get the aide to walk down via wheelchair any patients who aren't so ambulatory. Ask replacing nurse if they have any questions and clock out.

1530-1630~ One hour (usually) commute home in rush hour traffic. Rush hour starts at 3 pm in this city. The price I pay for a safe community.

1630-2100~ After getting out of the parking garage, fighting traffic, & picking up Ari from her afterschool program I'm finally home by 1700. Time to make Ari dinner while checking my email. Eat dinner, get Ari in the Bath, story time and a little TV then bed by 2100....if I'm lucky.


At 22:12, Blogger BetterCell said...

You sound like a great nurse Jo.......and many thanks for being informed/intelligent regarding the administration of insulin at an appropriate/sensible time to meet the food intake of your patients with Diabetes.

At 07:14, Anonymous Anonymous said...

I am exhausted just reading this! You're my hero! Sorry I've been away.

At 16:41, Blogger Deacon Barry said...

We also have a fair number of diabetic patients. If we have them going to theatre, then the first hour of the shift is usually spent getting a GKI infusion going as well as preparing them for theatre, because the anaesthetists prefer them to go second on the list.

At 22:33, Anonymous Anonymous said...

I'm working in your house next semester (!) but don't know yet which floor. Can you take a student nurse under your wing yet? ;-)

Your patients are lucky.

At 10:17, Anonymous Anonymous said...

I'm exhausted just looking at your daily routine Jo! I didn't like the rush-rush-rush of med-surg when I was a student, and would never be able to work it now. Even though my shifts can be just as bad as yours with all of the rush-rush-rush to get everything done (I work in L&D). Time management has always been a big issue with me. I hate being thrown off my pre-set "schedule" of things to do for the shift, but it's necessary to be very flexible in L&D. Guess it also helps to love the field you're in!!

At 11:15, Blogger Kim said...

That, in a nutshell, is why I never work the dayshift!

And why I don't think I have the stamina to work on the floors anymore! LOL!

It's night shift for me. And without any little kids, I have much more free time. When I worked the day shift, even without young children, I had no life at all. Working nights, I can sleep when the family is at school/work and be up with them for dinner and at night.

Plus, I'm a night person all the way, staying up until 0400 on my nights off and sleeping until noon if given my druthers.

Add to that a 19% shift differential and I'm wide awake! : D

Trust me, the floor nurses work harder than I ever do in the ER. I may see more patients, but they are there and gone. You have to be so much more organzied AND deal with disruptions to routine. There is no routine in the ER, so there is no way to disrupt it!

At 00:10, Anonymous Anonymous said...

This is exactly why I work nights (7p-7a) and why I work ICU. I think the hardest I've ever worked is when I did Tele. I had 5 patients, sometimes 6, and half of them just came from ICU or looked liked they might need to go to ICU. I totally agree with bettercell's comment on insulin. I hate when day shift nurses want me to check and cover ac(before breakfast) blood sugars at 06:00am. I mean breakfast isn't there for a good hour after I leave. They should be thanking me for not killing their patients before breakfast.

My routine:
I get up around 15:00, eat something with my wife when she gets home(she's a PACU nurse, 7-3 M-F deal), I have to shower and get dressed around 17:00, and I'm out the door by 18:00. It's a 30 - 35 min. ride to work depending on traffic. When I have time I stop at Starbuck's for a Grande Mocha. I get report from the offgoing nurse from 18:45-19:15, assess my patients and clean any "Code Browns"(hence my name) before visitation starts(20:00 - 21:00.) Visitation is over at 21:00, Yipeee! I know that sounds bad but I'm being honest here. We can dim the lights and put a little music on(which I think is healing btw.)
I give any bedtime meds and hope that my patients aren't getting blood, aren't on drips that I have to titrate like crazy, aren't in any acute distress, don't CODE on me, and that I don't get any admissions. Give some baths between 03:00-05:00, finish I & O's, catch up on vital sign charting(sometimes it's every 15 minutes when I have people on vasopressors), and hope that the day shift doesn't get lost on the way to work. We also have to flip the lights back on and shut the music off before the day shift arrives(these are sins that we don't speak of.) The ICU I work in is fairly calm compared to one's that I've worked in before. It's not a bad deal at all. Thanks for listening.

At 02:24, Anonymous Anonymous said...

I work in a rural hospital. I work full time 12 hour swing shifts. Mostly nights but some days too.

Our hospital does emerg, cardiac, LDR, medicine, surgery, palliative, rehab, and the bed blocker LTC's as well.

There are 16 acute beds, 1 observation bed, one LDR room, and 6 rehab type beds....soon to be adding 4 more and 3 day surgery/overflow beds. We have 2 RNs on per shift, and from 7-15 we have 2 LPN's and one PCA. 15-2300 we have 2 LPN's and then 2300-0700 there is 1 LPN. Our hospital is busy. We are full or over full a lot of the time.

We don't really have a patient assignment, we all just pitch in and get the work done. LPN, RN, the designation doesn't matter, we just work together. But some days are just crazy! Our days are all so different, depending on what we have on the unit that day, I can't even give you a clear picture of what we do.

At 21:39, Anonymous Anonymous said...

i work nights 7p-7a in a level III neontal intensive are philosophy is i will only work with patients that i can restraing with one hand and who poop in diapers newborn sized and smaller.
12s are hard at first but i do like them. nights are the best for me and my family at this point in their lives. (5 kids 19, 14, 13, 10 and 4).
our boss is family friendly often changing schedules even after the permanent has been posted. she also allows for us to work half a shift and having an eqully skilled RN cover th other half.
routine in the NICU.
it all depends on the census, the acuity and how many deliveries and transports we have going on. i will tell you that a 3-4 baby grower assignment is much more kick back than a 1:1 baby weighning less than a kilo.. some nights i am skating with no potty breaks and some i am udling abbies inbewteen assessments. it all balances out i guess which is why i have been doing this for 16 years and counting.
nice to meet you!


Post a Comment

<< Home