Sleep. Wonderful Sleep.

A word of warning to those about to be admitted to the hospital:  we will not let you sleep.  At least we will not let you sleep much.  A couple of weeks ago I was working on our step-down unit taking care of a couple of folks who were convalescing from open heart surgery.  You would think that sleep would be an essential part of the treatment.  Sleep is the restorative, the healer and the way we escape.  But if you have had open heart surgery it is not going to happen.

My two patients the other night got at most, 2 hours of sleep at a time.  More like little naps than actual restful sleep.  Here’s how it breaks down:  2000, vitals and assessments, 2200, CBGs and meds, 2400, vitals and assessments again, 0200, CBGs, 0400, vitals, assessments and blood draw if they have a central line, 0500, lab draws, and then they’re up in the chair washing up prior to breakfast.  Any wonder that we get so often in report that, “Well, they kind of slept alot today.”

Really?  It wouldn’t have anything to do with the fact we don;t let them sleep at night, would it?  Now I understand that most of this is warranted, if at least nothing more than for us to stay busy.  Our surgeons actually write for vitals QID, but due to the way our protocols are written, if they are in the step-down unit, they get q4 hour vitals and assessments.  There is no real flexibility…unless you actually exercise your nursing judgement and decide not to do one set of vitals or such.  But the urge to cover ones ass, especially when you’re out of practice with open heart patients, is strong.  While we have the autonomy to make our own decisions, it sometimes feels like we are not encouraged to do so.  THere have bentimes where I look at my patient and go, “Hmmm.  They look pretty stable, I think I’ll skip the four-o’clock rounds.”  Other times, I’m looking in every 20 minutes.  It goes to the core of being a nurse, the ability to make an informed decision to best support your patients’ healing.

Unfortunately trying to change these protocols is a near-impossible task.  Read: it will never get done.  So in the meantime we’ll be waking you up every 2 hours, or so.



  1. This may be a silly question, as I don’t work as a nurse… but why can’t the CBG’s and meds be done at the same time as the vitals and assessments? Less disruption.

    The meds are scheduled to provide adequate plasma concentrations of the drug. For example some drugs are scheduled for every 12 hours, and unfortuntely those times don’t match…it does suck. We try to cluster care as much as possible but sometimes it just isn’t possible.


  2. Stupid question, what does CBG stand for in this context? I work with horses, not people, and I haven’t seen that term before.

    Is there a reason that CBG’s are on opposite hours from the q4h vitals? Could they be combined into the same visit? The doctors at the horsepital are pretty good about scheduling treatment times to coincide when possible to minimize the number of times we have to go into any horse’s stall.

    “Mat baby” recumbent foals with HIE don’t get much sleep, either. They often start out getting an extended set of vitals which is basically a 10 min. P.E. every hour (complete with a BP cuff on the tail), and turned every two. When they are strong enough to start standing and nursing, we have to get them up every hour. The process of getting them up and helping them teeter over the mare, nurse for a few minutes, then get back on the mat and situated comfortably leaves precious little nap time before the cycle starts all over the next hour. They get so tired from trying to stand, but they never get to rest. At least human babies get to just lie there!

    CBG is capillary blood glucose monitoring. Theoretically we could combine, but the first thing you want to do when you get on shift is look your patient over, that sets the “tone for the rest of the night, and the ensuing cascade.


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