I started to put my application in for another job yesterday. While we are not struggling financially (anymore than the next guy?) we could always do with more income. And it would be so simple to pick up another 24h a week worth of work. Come on, I only work 36h right? Plenty of people work way longer hours. I stopped myself today and closed out all the tabs of possible jobs I could take.
For any who didn’t know, I am a nurse. Yes sir, Masters prepared RN right here. I think that means I am supposed to be smart, and I guess I can be, but wouldn’t you know that in the things I should just know, I made the dumbest move, but I don’t have to keep at it.
I am a nurse, and I am good at my job. For 36h (erm 38h) I work directly with people, looking at critical results, or just abnormal results, and decide what to do. Most people think nurse… well, I don’t know what most people think nurses do, but it isn’t much. Pass medications I suppose. And bug the crap out of you through out the night when all you want to do is sleep.
Here is a rough breakdown of what a nurse does.
6:45pm-8pm: Coming on shift we get report from the previous shift. Nurse-nurse interaction right here. We are told what brought the patient into the hospital to begin with and what kept them there. A list of code status, diet, allergies, and medical history is relayed, as well as what team is primary on the patient’s case and if there are any consults. After this there is a run down of tests and procedures already completed and their results, followed by future tests and procedures to do. Abnormal results are discussed with the plan of care for each problem. A general rundown of current patient status follows, with discussion of any new medications added, pain medications, symptoms worth noting to be treated and when those treatments (medications) will next be available or if current interventions have been working. Finally there is discussion of the future plan for the patient. Are they going home? Do they need additional services? What is keeping them here? Basically is there anything that needs to be done that is not being done and needs to be addressed?
x5 and, ideally, done in the patients room. We have half an hour and multiple nurses to get report from. Anyone believe this takes less than half an hour to complete? How about more?
8pm-10p, Round 1: Welcome to hourly rounding.Ideally, from 7p-10p I will be in your room every hour. Between 7 and 8 I have already stopped in your room to say hello and fill out that infernal white board. This is the second most irritating part of my day by the way, these boards. As a night shift nurse trying to get the date and time correct without disturbing you if I don’t have to can be a ninja task. Now that I have introduced myself to all five of my patients (or three or four while I wait on another admission to come up) I have a second to do my assessment. I am not doing this to aggravate you and my questions, while they seem redundant, are actually kind of important. I am listening for changes from the report I got from the previous nurse. Yes, we need to get your vitals. Yes, I have to listen to your heart, lungs, and bowels. Yes, I have to ask mentation questions, plus a list of questions about your perception of how your body is functioning. Yes, I am going to touch and squeeze some spots. I am not trying to purposely hurt you or cause you discomfort and we nurses try to minimize this as much as possible, but occasionally it cannot be avoided.
We are actively trying to avoid embarrassing you. We know that nakedness and bodily functions are not your norm. Outside of work, it is not our norm either. The good news is, there is nothing you have that we likely haven’t seen. I was about to get graphic.
We only have to do this assessment once. After that, hourly rounding is for better HCAHPS scores. I am only partially serious about this. There is a pervading theory that hospitals should be more like hotels and it is all about the patient experience. Ever wondered why all of your nurses say the same thing? “Hi, my name is Julie. I am going to be your night nurse. Here we do hourly rounding until 10pm, so I will be in every hour to see to your needs. Are you in any pain right now? On a scale of 0-10 how bad is it? Let me help you to the bathroom while I am here. There, are you comfortable? Is there anything else I can do for you right now? I have the time. If that is all you need I will be back within the hour. After 10pm I will be in every two hours to see to your needs.” We have script that we loosely follow. There is more theory behind why we say what we do. Either way, I say this to every patient I work with right off the bat, usually when introducing myself, then something similar every time I go into the room.
After our assessments, hopefully completed before 9pm, we pass evening medications. I don’t order medications, but you can be sure I am making some serious decisions about some of them. Blood pressure medications and insulin are two such meds. It’s me, the nurse, who has to determine if the medication is appropriate at the time of administration. Yes, I know you might not take it like this at home. But you aren’t at home and this isn’t normal, everyday life. If you can trust one thing, trust that we are not trying to kill you by messing up your medications.
After the 9pm med pass we make another sweep to see if anyone needs anything. At 10 we might finally get to sit down and chart. Ah, the bane of nursing existence. I doff my hat to paper charters but now we have our lovely electronic system. This can be both a blessing and a curse. Please understand, I don’t want to spend two-four hours of my night on this work. I would rather be ready in case something bad happens, a new admission comes, or feisty patients decide they don’t want to stay in bed even though they can’t walk.
If we are lucky we get our charting done before midnight.
12-4am, Round Two: More than a few admissions happen in this time frame. On top, we have vitals to do at midnight and four, and morning labs to draw. This is also the ideal time to do any bed baths. Yes, we do clean up our immobile patients in the middle of the night. Why? Because we don’t change shift at midnight and noon, which means night, when half the population would prefer to get cleaned up, is busy with shift change, assessments, and med-passing. The morning, when the other half is ready, is also busy with shift change, assessments, and med-passing. We will scrubby bubble you at 2am. There just isn’t a better time to do it.
4am-6:45am, Home stretch: This is likely the time we can get our second round of charting done. We also clean up orders, clean up medication lists and check to see if we missed anything. Ninja like, we sneak into your room and update all our white boards with appropriate times and dates, fill out any additional paperwork, including consents, and silently pray that lab doesn’t call us with a critical result.
6:45am-7:15am, Beauty: There they are, those beautiful angels. The next shift is coming on and we can go home and go to bed.
This doesn’t seem so bad right? And you are more than correct. Nurses dream of this night. This night rarely happens in most hospitals. With short staffing rampant throughout the country and hospitals still treating nurses like commodities, not necessities, these nights are the extraordinary. This is a night where everything is going right, the patients are generally self sufficient and not on the call bell every few minutes for everything under the sun. This is a night where we don’t code a patient for two hours, where critical blood levels don’t come back at 5am and you need to get a unit of blood hung before day shift starts, where vitals aren’t tanking or spiking because of illness.
But when you do code, a slew of nurses are there, working side by side with doctors, pushing medications, pumping your chest, and supplying the docs with all our knowledge of the events leading up to this. We are the ones who know your lab values, your vitals, your history on the fly. We are the ones recording the action, hooking up the machines or collecting equipment, and starting additional lines. The MD calls the shots, the nurse makes it happen. When your critical lab comes in or you have new or worsening symptoms, we are the ones on the horn with the doc, getting orders, discussing your current state and symptoms, helping to decide your plan of care. And when your vitals tank or spike, your nurse is quick to implement interventions and call the doc so you don’t find yourself in the ICU, or coding.
Then we get a complaint because we didn’t get someone to the bathroom fast enough, or their pain medication the minute it was available. We have to stay an additional two hours to finish up with our charting but still have to be back that night. We have to walk into our other patient’s room with a smile on our face right after we lost the code.
So I closed the tabs. I give my all in those 36h. My husband teases me about it. “How can you be so attentive at work and then be so oblivious at home?” I laugh, he knows the truth. Some nights are easy peasy lemon squeezy. Some nights I come home and have a very large glass of wine. I only have 36h to give normally. The rest goes to my sanity so that I can keep giving those 36h.
I hope when you read this you understand that your preconception of what a nurse is and what a nurse does is likely inaccurate. Often we are up to our elbows in bodily fluids and bad attitudes. We have to be the solid foundation for people going through some of their hardest moments. And we have to do it as humans. It effects us, even when it doesn’t seem like it. Put yourself in their shoes for a moment, just a moment, and accept them as they are, just like some nurse will accept you when you need them to.