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.