What I do at work.

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James Fred Associates 1-800-860-2818 (9am-9pm E.S.T.)

(Article from about.com)

What I Do At Work
from Laura Robusto, BSN, RN

Part 1. A Day in the Life of a Bedside Nurse - The Start of the Shift
I receive many questions about what it is like to be a nurse. I'd like to describe my day for you so that you can see for yourself what the duties of a typical bedside nurse are.
I work on a floor that takes care of patients who have had cardiac surgery, typically coronary artery bypass grafts or valve repairs/replacements. These patients usually are one to two days post-op, and have been transferred up to us from the cardiac intensive care unit, where they went after their surgery. If all goes well, they will stay on our floor until they are discharged to home. All of our patients are on cardiac monitoring, called telemetry, so that we can see their heart rhythm at all times.

Typical shifts for a nurse are "days", 7:00 am to 3:30 PM, "evenings", 3:00 PM to 11:30 PM, "nights", 11:00 PM to 7:30 AM, twelve hour day shifts, 7:00 AM to 7:30 PM, or twelve hour night shifts, 7:00 PM to 7:30 AM.

I have worked all of these shifts. Whatever my shift, I always try to get to work a few minutes early to change into my work shoes, grab the things I need for the day, and print off a copy of what the heart monitor is showing at the moment (my "telemetry strips").
The first thing that happens is shift report. I'll sit down with the nurse who has the patients I will be caring for, and together we discuss why they are in the hospital, what their recovery has been like, what the last shift was like, and what I need to do during the upcoming shift. We keep basic information on a "cheat sheet" (some places use what's called a Kardex) that we can carry in our pockets. We can write notes on it, and it's a great quick reference during an emergency. Some places tape report, but I like face-to-face better, as I can ask questions. While I am listening to report, I'll check my telemetry strips to be sure that there is no change in the patient's heart rhythm. On day shift, I'll usually care for 4-6 patients; evenings, 5-7 patients; and nights, 6-9 patients.

After I've received report, which typically takes about a half an hour, I'll take a quick peek in on my patients. I'll check to be sure they're safe, that they have their ID and allergy bands on, and that they're not having pain that needs immediate treatment. I'll also take a quick minute to discuss the patients with the nurse assistant who will be helping me, telling her about any special needs, like blood sugar checks, turning schedules or specimens we need.

When I've seen all of my patients, I'll go back to my first patient and assess them more thoroughly. I'll listen to their heart, lung and bowel sounds, check for pulses and edema, check to be sure that their oxygen is set properly, check to make sure that their IV access appears healthy, make sure any IV medications are set at the proper dosage rate and that there is enough in the bag, make sure all skin is intact, check surgical incisions, chest tubes and/or Foley catheters, if present, and review the vital signs the nurse assistant has taken.

Once in a while, I'll take care of either a ventilator patient or one with a left ventricular assist device (special heart pump), and these patients require special assessments. I review and sign the plan of care, adding to it as the patient's condition indicates, document my assessment findings, and analyze and post the telemetry strip in the chart. If I discover any dangerous changes, I contact the doctor right away. I may do a shorter assessment on the night shift, as long as the patient has been stable during the day.

Part 2: A Day in the Life of a Bedside Nurse - The Rest of the Shift
By the time the assessments are completed, it is time to pass medications. It is important to understand what each medication is for, and when it should not be given. For example, some medications are blood pressure medications, and it is part of the nurse's responsibility to make sure that the patient's blood pressure is not too low before the medication is given. Or that the patient's potassium level is not too high before the potassium supplement is given. Or that the platelet level is not too low for the aspirin to be given. After you have learned about many of the medications that are typically given for the patient conditions you see, the job becomes easier. But there are always new medications to learn about. This is one of the most frustrating things for a new nurse, but time and experience make it easier.

I always try to take the time to teach my patients about the medications they are taking as I give them.
After medications are given, I check the patient charts for new orders and to see what the doctor has written during their rounds. It is my responsibility to see that the doctor's orders are carried out - that all of the lab work and tests like X-rays, CT scans, echocardiograms, etc. are completed and that all of the medication orders are transcribed correctly into the medication record. This may mean double-checking other people and departments. I also check to see if the results of labs that were drawn on previous shifts are available and communicate abnormal results to the doctors.

How the rest of the shift is spent depends on what shift it is. On day shift, I may get the patient up to walk one or more times. Or I may encourage them to attend a patient education class in preparation for discharge. I may teach them about medications or home care. Incisions must be cleaned, and there is usually someone that requires another kind of wound care.

Perhaps someone is being discharged (going home), and I will complete their discharge education. Sometimes I help with baths and beds, depending on the nurse to assistant ratio. On evenings, I help people get comfortable at nighttime. On nights, there is special paperwork to be done during the hours that patients typically sleep. Some duties are common to all shifts.

Usually medications need to be given one or more additional times. I round on and check the telemetry monitor on every patient at least every hour, so I am performing ongoing assessments. I monitor blood sugars on our diabetic patients, usually before every meal and at bedtime, and give insulin coverage as ordered. I may need to replace an IV, insert or remove a Foley catheter, do tracheostomy care, take care of a feeding tube setup, or perform one of many other nursing procedures. I encourage our patients to be as active as their physical condition allows to prevent surgical complications. I also answer questions from both the patient and their families, helping to provide information and decrease anxiety.

Sometimes, not all goes well, and we have to recognize and respond to emergencies. All of the nurses on my floor are trained in Advanced Cardiac Life Support (ACLS) and I am fortunate to work with a great nursing team, so between us, the doctors and the other support staff, we can often stabilize the patient and get them transferred back to the intensive care unit or emergency surgery, as needed.

At the end of my day, I check the charts one more time to make sure that no orders have been missed. Then I sit down with the nurse who will be taking care of my patients on the next shift, and give report, just like I received it at the start of my shift.

When my shift is done, I put my shoes and equipment back in my locker, wave to my buddies and leave, usually feeling good about the day I've put in, the tasks I've accomplished and the care I've given.

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