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.
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 hall.....you 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.