I meet so many people with the work I do, and I’m forever curious. If I had the time, I could listen for hours about my patients lives and histories. I love learning about what has shaped them into the people they are, and knowing how they got here can make the difference between understanding and frustration. One of my favorite things to ask is what they did/do for a living. If I have time, I also like to find out what a typical day is like on the job.
So, now it’s my turn. Here’s what a (mostly) normal work day looks like for me.
Job Title: RN, Cardiac Stepdown
Shift: 7pm – 7am
3:30-4:00pm – This is when my alarm goes off, I glare at it, snooze it a few times, and then grudgingly crawl out of my nice, warm bed. These blankets know me, and I am frequently loath to leave them. However, since I have an hour drive to work I need a bit of an earlier start than my coworkers that live closer in.
4:00pm – From this point onward I’m usually doing three or four things simultaneously. Right now it’s usually something along the lines of heating up breakfast, boiling water for tea, putting together the final odds and ends for lunch and getting dressed. Taking care of my face usually takes about 20 minutes (looking at you, seb-derm), and the rest of my getting ready about 5. I don’t wear makeup, and I usually just slick my hair back and twist it into a knot at the base of my skull.
5:00-5:15pm – Time to hit the road! I have no appetite when I wake up (never have, probably never will), so I try to throw together something for breakfast that I can eat while I drive. If I try to make myself eat before I leave, I tend to get nauseated. Depending on whether I’ve had time to do my Bible reading for the day, I’ll sometimes listen to that on the way. Otherwise, I vary between radio, audiobooks, and putting my iPod on shuffle depending on my mood and state of alertness. Audiobooks keep me awake better than anything else, so they’re my go-to when I’m on day 3 or 4 and ready to drop in my tracks.
6:00-6:20pm – Arrive at the hospital, and find a parking space. On the weekends, its not too bad. On the week days it can be a little ish even this late in the day, as we share parking space with another facility. I gather my gear, make sure my name badge is on (I’ve had to run back for it more than once) and hike on in. It’s a short elevator ride to the 4th floor. Once there, I get my assignment for the shift and put everything in my locker.
6:20-7:00pm – Here is usually where I take a quick scan through my patient’s charts and get a bit of an overall look at what’s been going on with them. If there’s anything that needs to be addressed or I have a question for the day shift nurse(s) I’ll write that down. At 6:36 we can start clocking in and tracking down the people we need report from.
7:00-8:00pm – The work begins! If a patient has something that needs addressed, I’ll do that as soon as possible, otherwise, I spend this time going through medications lists to see who needs what, checking telemetry (heart monitors!) for rates and rhythms and assessing my patients. We usually start out a shift with anywhere from 3-5 patients. If it’s 5, we know that unless we transfer a patient, we won’t be getting any admissions that night. If it’s 3? …..well, depends on how busy the ER is. There have been nights I’ve had a transfer and two admissions.
8:00-10:00pm – Wherein I run in circles like a chicken with its head cut off. Things aren’t aways that bad, but this is our busiest time. We’re trying to get medications passed, bedtime blood glucose checked, shift assessments done, and any pressing problems taken care of. This is when patient family members will be calling for an update on their loved one, and the doctors are putting in their final orders before the night on-call takes over. It is also one of the times that we more frequently move patients between units.
10:00-12:00pm – Charting time! Depending on where we are in our care, most of my coworkers and I can be found parked in various corners or at the nurse’s desk charting. And charting. And charting. Thankfully, our whole system is computerized, so once you learn it it’s fairly easy to navigate. Still, depending on the acuity of the patients, I’d say a good 1/3-1/2 a shift is spent staring at a screen clicking and typing.
12:00-4:00am – This is……time. I’d say free time, but that is wholly inaccurate. If our patients are going to sleep, they usually do that here. If anything is going to go spectacularly south, it’s going to happen here. 2:00am is the bane of my existence if I have a patient that is even a little bit unstable. Codes (respiratory/cardiac arrest), deaths, and abrupt and dangerous changes in condition tend to happen in the middle of the night or at shift change – personally I’ve seen more in the middle of the night. Throughout the night we are also going around hourly to check on all our people. We maintain drips, IV fluids, give pain medications, reposition people, and far, far more than that. Somewhere in there, if nothing is going too crazy, we take 30 minutes to stop and inhale a bit of lunch.
4:00-5:00am – Finish any remaining charting, because crunch time is coming, people! I’ll make sure that everything that needs to be done IS done, I have my necessary notes and know all the pertinent information about my patients, and gather any morning medications that weren’t brought up from pharmacy the evening before.
5:00-6:30am – Go time! This is when we finish prepping anyone that is going for a procedure or surgery later in the day, pass early morning medications, check morning blood glucose and do a final run through to make sure that nothing was missed in the last 12 hours. If a patient is going for surgery, Pre-op will often call for report around 5:45 if they’re the first case, and come get the patient between 6:00 and 6:15.
6:30-7:??am – Day shift starts straggling in, looking about as awake and alert as we feel; which is to say, usually not at all. I’ve had report to the oncoming shift take anywhere from 10 minutes to almost an hour. It all depends on the nurse, the complexity of the patient(s), and whether or not I’ve had time to actually finish everything that should be done (or if I’m still working on it =/ ). After report, I’ll take one last look through my charts to make sure I’m not missing anything, and then I’ll go clock out. On a good, streamlined morning with no hiccups, I can be gathering my things and be ready to go by 7:00. On OTHER mornings, it can be closer to 8:00 before I’m done punching out and scurrying for my car.
8:00-8:30am – This is when I usually get home, traffic permitting. There have been a few mornings with accidents that backed things up for up to 30 minutes, and the highway I take is rural enough that there really aren’t any good detours. Winding through the gravel roads would take longer than waiting.
8:30-9:00am – Bed time! After breathing a sigh of relief (another night done!) the first and only thing I do before collapsing is go take a long, hot shower.
9:00am-4:00pm – Think twice before trying to wake me. If you’re not family, work, or my alarm and the issue is not life-or-death you run the risk of traumatic dismemberment (see: telemarketers). That risk rises exponentially with each consecutive day I work.
SO! A very generalized work night, on which there are always variations. Some nights, I all but run my feet off. Other nights I twiddle my thumbs for several hours. Still other nights are one emergency after another until the on-call has given up on any kind of sleep, and all but sets up camp on our floor.
With the 12 hour shifts, thankfully we only have to work 3 days a week. There are times when it turns into 4 or 5 though, when someone is sick and one or two other nurses are on vacation – but these are the exception rather than the rule.