One Shift

I stumbled upon one nurse’s account of day in his life and thought, “Hey, I could do that too!”  Not that my days are all that interesting, but it’s good blog fodder.  The big difference is that I work nights and kind of see myself as a “clean-up batter.”  Original stories here: New Nurse Insanity.  via A Day in the Life of a Nurse.  Here goes…

1500: Wake up with a start, stare at the clock until my eyes focus enough to make out that it is on 3 o’clock.  Roll over with a sigh and try to go back to sleep, trying to ignore the bright sunlight outisde my bedroom window.

1615: wife comes in to make sure I’m awake, as she’s doing so the alarm clock goes off, again.  Crawl out of bed, last night really kicked my but, 5 admits, down 1 nurse and I’m feeling it in my back today.  Shower, find scrubs and load to-go bag.  Add a pair of Tylenol to my normal “morning” meds.  Feeling human, kind of.

1640: Downstairs to eat.  Hmmm, it’s looking pretty bare, guess we need to go shopping.  Add that to the list of things to do.  Eat, top off waterbottle, grab lunch, to-go bag and head for the garage.

1715:  Out the door with my bike.  My wife and I walk to end of the block and talk about our days.  She asks how last night was and sympathizes with my tale of woe.  Start riding my bike to the train station.

1725:  Dumbass in a hurry nearly sideswipes my off the road.

1745:  On MAX train into town.  Zone out trying to doze but I’m too wired from lack of sleep.  It’s a weird dichotomy, I sleep and feel good when I wake, but the moment I stop doing stuff, the utter exhaustion hits for a moment.

1815:  At work and change into scrubs.  Read the census board as I walk past toward the break room.  Notice how all the day shift nurses have that haunted look of exhaustion too.  Not a good sign.

1825:  Sit down with the day charge nurse and get report on all the patients.  Procedures done today, how agitated they’ve been, who’s been unstable, what family we’re going to 86 if they don’t leave and the most important part, what the census is and how many nurses that qualifies me for.  Looks like we’re at 16 (of 22), which calls for 5 including myself, I have one nurse on stand-by and an ED full to capacity.  One patient is on the way from ED and hasn’t arrived, 2 just rolled in at 1800.

1835:  Draw up the assignments for the night, trying to balance admits with heavy patients and how far they have to walk.  It’s not easy and somedays I feel like I’m not even close to being fair.  Tonight is one of those.  I briefly look at my patients.  First is 80 y/o male s/p colonoscopy, history of colon cancer and severe O2 dependent COPD.  The other is a 35 y/o male in with extensive bilateral PEs and a whopping dose of anxiety.  Today he had went to the cafeteria and nearly passed outin the stairwell, had a Code Green called (which usually is for visitors, but hey, whatever) and was getting extensively worked up.

1850:  Grab an extra locator for our resource nurse, make copies, collect the report sheets and head for the break room.  There I divy up the report sheets and make small talk with the nurses as they come it.  We’re out by 1905, which is near record time these days, but I’ve got a good crew tonight.

1910-2045:  See my patients, do vitals, assessments, help the echo tech with a bubble study to see if my PE guy has a PFO (never done that before, it is way cool!).  Update the census board, attempt to chart while fielding phone calls from our staffing office and the nursing supervisor.  The ED still looks packed.

2100:  Bed rounds, where all the charge nurses get together with the nursing supe to determine bed availability.  I come to hear if I’m going to get screwed.  Luckily there are medicien beds in-house, so I’ll only be getting tele patients tonight.  It’s always nice when we’re not the dumping ground.

2115:  Sling meds and tuck my peeps in for the night.  One of the guys on the floor on a lidocaine has flipped into rapid AFib while I was gone, even with a heart rate of 150 he, “feels fine!”  For the next 2 hours I help the nurse give amiodarone, diltiazem, PO metoprolol, but nothing seems to do the trick, only thing that happens is that his pressures start to drift.  I field the normal slew of questions, which doc to call, should I call, would you hold this medication and act a sounding board for my fellow nurses.

2330:  Get hit with 2 admits right in a row.  One’s mine for the moment and in a brief moment of calm, I manage to call the wife to wish her a good night.  Call staffing for my extra nurse, but find out she won’t be here for at least an hour.  Settle my new lady in, do the assessment, medication reconcilliation, admit history, then go to enter orders on her and the other admit, for I am the secretary at night.  Take a moment to pee.  Look over daily charges before I hand them over to the tele tech for entry.

0030:  Relieve  tele tech for his lunch.  Continue charting on all three of my peeps, get 2 new charts set up for 2 new patients waiting for our services in the ED.

0045:  Give report to stand-by nurse and shuffle assignments to make sure she doesn’t get only admits.

0100-0400: 4 more admits roll in.  In between patients and calls to the docs, I get my MARs signed, get my 24-hour chart checks done and finish off my charge nurse paperwork, all while eating my lunch.  Staffing calls for the census at 0400 and for confirmation of the names for the oncoming staff.    Do vitals and assessments again on my peeps.  Sit and chart on them while the tele tech goes and posts the shift’s strips in all the charts.  When I’m done I print out the census sheet that the charges use for report and start getting general report from the nurses.  It can be tedious, but it’s saved my tail a couple of times.  Luckily tonight the other problem children have been self-limited.  A couple of boluses here, maybe a little IV metoprolol,  some Ativan and a little Haldol for the crazies.  Not mention the boosts, the shifts, the help with clean-ups, nor wrangling the little confused gal who had managed to wrap herself up in the IV tubing of her diltiazem drip to the commode and back to bed without losing the site, no mean feat that!

0600:  Call staffing for the name of the extra nurse that we called for.  Find out they’re canceling one of ours, and giving us 2 resource nurses.  See the day charge walk by.

0630:  Give report, mention that we have multiple drips, a couple fo crazies, several discharges, 3 stress tests and a possible angio today.  But hey, we’re full and that means we get to work!

0700:  Act like ahuman Pez dipenser giving out Protonix and Levothyroxine.  Give report to the smae nurses I got report from thankfully.  It goes like this:

Them: “Any changes?”

Me:  “Nope.”

Them:  “OK, have a nice weekend!”

0730:  Outside to the bike cage and starting the ride home.

0820:  Get home, grab a snack, shower, watch a little morning TV.

0900:  Crash.  Thank God it’s Friday!

Writing it out doesn’t seem so bad, but it’s the intangibles that kill you.  The questions, the assists, the coordination with other departments and hospitals.  Not only am I a nurse, I’m a supervisor, an air traffic controller, a spare set of hands, a secretary, answerer of call lights, and a tele tech.  It wears you out.

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