It is not what I thought that it would be.
It is not at all like nursing school.
But I still love it. I seem to able to become buddies with the most difficult of patients, but I have my favorites. They know who they are, because I tell them. Everyday I have a favorite, and I tell them.
I am working in a skilled rehab. That is the place where you are not sick enough for your insurance to pay for a hospital stay. But you are not safe enough yet to be at home.
At the hospital, a nurse usually has the total care of 5 very sick patients. They may be on multiply IVs, a heart monitor and multiple therapies. They need constant care. Believe me, those nurses are busy all day long juggling the medications, charting, communicating with providers, case managers and family members. A 12 hour shift is usually a 13 hour shift plus drive time.
At this rehab, a nurse is assigned 22 patients. Though it is true that they do not need the constant care and are not as sick as a hospital patient is, I think that 22 is too much.
Put on your running shoes because I am going to take you through my 12 hour day. (ahem, I am actually there anywhere between 14 and 16 hours. Yes, I have stayed til 10:00 at times.) Oh yes, and do not forget the 30 minute drive to work and home.
Here is a sample of a “12” hour day. Arrive at 5:45 to start looking at the charting of your patient load to get to know their issues. write a list of all the IVs that you will hang today, and bowel care patients. Make note of who is going out for appointments and dialysis because you want to make sure to assess them and get them their meds prior to pick up. Report is anywhere between 6:00 and 6:30. Reconcile the narcotic count on your cart with the hand off nurse. Receive your keys and put on your radio. The radio is like a walkie talkie that fits in your pocket. It has an earbud for your ear and a microphone that clips to your collar. This is how you communicate with everyone in the building all at the same time. You will hear a lot of chatter. Eventually you will learn to tune it out, until you hear “Donna, do you copy?” or a room number mentioned that is assigned to you.
Once you receive your keys-you are now responsible for the physical cart- all the charting, the patients, and the two CNAs associated with that cart.
7:00- IV’s are due at 7:00, 12:00, 2:00 and 6:00. Go hang all your 7:00 ivs.
8:00 Meds are due for 22 patients. Open up your patient’s electronic chart, find out when they got their last prn pain pill and write it on your list. This will become very import to you. When asking for their pain pill one hour early, you will know how to respond without running to your cart and checking. Prepare all medications at the cart. If the patient is on the bowel care list, be sure to add a prn bowel care medication. We want our patients to poop! Inactivity, and certain medications will block them up. I am a very vigilant bowel care nurse. Just call me “Bowel Care Donna”. Lock your computer, lock the cart and go to the patient’s room. Introduce yourself, do a focused assessment, give the meds and remind the patient about the call light. Ask if there is anything else that they need. If they have another need, use your radio to call a CNA, housekeeping or dietary.
Keep moving and get 22 patients done. You will get many interruptions. Your CNA’s will call you about patients that are requesting prn pain or anti-anxiety meds. If your patient falls, you need to respond and assess, notify the family and doctor. Doctors or family members will call on the phone and you need to take that too.
Time for a break, nope! If you have time, you need to try to get some charting done. If it is 11:oo, you need to get your accuchecks done. Most of your patients are diabetic and will need insulin with their lunch trays.
Can I have a break now? Nope, go to the bathroom; eat a protein bar (do not forget to drink lots of water with that, or you will need bowel care).
12:00 hang your ivs and start passing noon meds. You will do this over and over again until 6:00. Don’t forget the 4:00 accuchecks for the insulin with dinner. There is no time for a lunch break or 15 minute breaks. Just a quick trip to the bathroom and grab a snack from your lunch bag. If you are a smoker, shame on you anyway. You know better than that.
It sounds pretty simple, but add in there that patients will be asking you for their prn meds in between medication time. Do not forget that family members will want to ask you questions. Smile. There will be doctors rounding who need your attention. Smile. The radio earbud is squawking in your ear. Pay attention, they might be talking about room number. The patient needs your undivided attention. Darn, the night nurse forgot to order meds from the pharmacy and you just gave the last pill. Now you have to stop and call the pharmacy! There is not an enema in the whole building! The med room has no IV tubing, and we are out of flushes and caps again. How am I supposed to do my job? Adapt. That is what a nurse does.
Now, if nothing big happened to any of your patients today; you can start restocking your cart at 6:00 and give report to the night nurse. Reconcile the narcotics and hand over the keys.
Are you tired? Too bad! Now it is time to go into the nurses station. Find an open computer and do your charting for the whole day on everything that happened and what you did for your patients. Normally I get out of there by 8:00. It is not because I am new; it is common for all my co workers to work like this. I have stayed as late as 10:00 for a day that contained patient falls, or issues that I needed to notify doctors of. Do not leave without charting everything, because you will get a text and be expected to come back before 24 hour limit to update the charting system.
Wait a minute, I started out by telling you that I loved my job. I think that things should be run differently. Once I figure out how I can adapt as best I can, then I will start working on telling my employer how they can improve things.
But for now, I will just focus on what I need to do to care for my patients, keep them safe and enjoy fitting this job into my happy life.