13 hours. 3o min lunch. 2 15 min breaks (if you get them). 3 assessments. 2 I&O's (intake and output). Q1 vitals (Q means every hour). Maybe Q1 glucose sticks if you get the short end of the stick. 1 CT scan. Countless meds. My life at work is measured in chaotic predictability. An oxymoron you say? Things are not what they seem...
People really have no idea what my day to day looks like. They either believe every minute is a trauma scene from ER where I'm sweaty from doing chest compressions and yelling "Get the crash cart STAT dammit!" Or they think I get paid to babysit deranged and demented neuro patients who throw their sippy cup on the floor a billion times and I have to pick it up. It's somewhere in the middle. So here's a layout for you, a night shift layout since that's what I'm currently entrenched in. Ready, set.....set....go.
I arrive at work between 6:30 pm and 6:40 pm (1830-1840). The charge nurse comes in, reads a synopsis of each patient, and then all hell breaks loose. By this time, I've learned to listen for the most pertinent information. Q1 glucose sticks= a huge pain. Contact isolation= skip that one. Wady (our term for actin a fool, trying to get out of bed and such)= guaranteed frustration by the am. Blood pressure issues= a sick patient (aka fun). At the instant the last syllable rolls off the charge nurses tongue, everyone begins screaming the pair that they want. There is a strategy to this: get there early so you get a seat next to the charge nurse and yell directly into their ear or get there late so you can stand over their shoulder for maximum proximity. Sometimes you get lucky, sometimes you panic from all the pressure and end up taking whatever is last. Sometimes it ends in hurt feelings, bitterness, and cussing. All that fun before your shift starts.
You either skip with glee or drag morosely to your side (depending on the pair you got) and get report from the off-going RN. There's also a system to this and some people get really FREAKED out if you don't follow it but that's for another day. You begin your 8pm (2000) assessments. Then you chart. The goal is to be done by 8:30-8:45. Now if your patient throws up or poops or some other calamity, the course of your night will already be altered. But you go with it. Flexibility, people.
At around 9:30 (2130), you can start doing your 10pm stuff. You go get your meds out of the pyxis, empty the foley bag, clear your pumps, give the meds, and chart. We do I&O's (intake and output, remember it- I don't want to have to define it again young lady) twice on night shift which is fine if you have one pump but sucks if you have to count about 9 JP drains, two chest tubes, an ostomy, a foley, and a flexiseal. If you don't know what some of those things are, there's a little thing called google.
Now at this point your night could go several ways. Your side could be getting a lot of new admissions so you spend all your spare time helping your cohorts. You could have an existing patient crump out of nowhere and end up coding him. You could have a habitual pooper (the worst) and spend every 30 mins cleaning up the same you know what. On a magical night, when the mice and birds sing to you and you're home by midnight with both glass slippers, everyone stays quiet. You spend some time chatting with your friends or reading a book. But sometimes you're bored and want to stay busy. So whether it's good or bad depends on how much sleep you got the day before and if you just want to go home already.
At midnight you reassess your patients, give meds and draw labs. If you patient has a great arterial line, then you can draw the blood from there and it takes two seconds. Piece of friggin cake. But let's say Pedro here doesn't get blood return from his existing peripheral IV's and has crappy veins. You spend about 30 minutes looking and poking at veins until finally you get barely enough and pray that lab doesn't cause a ruckus. I can't even get into the subject that is lab. Probably not ever, if I'm attempting to do this thing called sanctification. If you have a neuro patient, you might have to travel down to CT scan. You have to unhook your patient from all non life-sustaining drip meds, pack them up, and transfer them to a stretcher. That takes anywhere from 5-15 mins. Then you and either the respiratory therapist (if you're patient is vented) or a tech go down the elevator, push the stretcher really fast like this is vitally important (it makes it so much more dramatic and entertaining), get to CT, move your patient onto the CT table, take the CT, and do the whole thing in reverse. Reverse. reverse. Everybody clap your hands.
Everyone usually bathes their patients between 2-3 am because there's not much else you need to do during this time. Granted, if your patient is stable and sleeping, you might want to spare them the early morning embarrassment and let them do it themselves during the day shift. At 0400 you reassess again (last time) and chart.
Now around 0500 an ominous thing occurs. If you're a rookie, you get sucked in but later on you learn how to deal with it... Medical students. They come to your bedside about 0515 and want to anything and everything about your patients. If you don't know any better, you'll waste a good 15 minutes updating them because you believe they actually have some impact on patient care. Now don't get me wrong, I love myself a good med student, especially if he's cute and nice to me, but there's a time and place. When I'm tired at 0515 is not that time.
At 0530 you start again with meds, I&O's, and maybe a serial lab or two if we're gettin crazy. The doctor teams starting rounding and everything starts to wake up (except you, who are on your 3rd cup of coffee). Family members come back in and your replacement nurses make a lap or two before shift starts. Those last 30 mins (0630-7) are the longest of your shift. But they do come to an end, you give report, and assuming nothing happens and you don't have to intubate or code anyone, you clock out and go to breakfast. The sun is rising and the early morning traffic is at its best as you drive home to convince your body that yes, now is the time to sleep.
There you have it. I hope this affords more clarity to those of you who see my job as a nebulous cloud of abbreviations and big words. And if you ever want to go to breakfast when I get off, let me know :).
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