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What a Nurse Really Does

November 13, 2011

To best describe the job description of an RN I will provide an example of a typical 12-hour day shift on an inpatient Cardiac Med-Surg unit. Assume that nothing out of the ordinary is happening and none of my patients have any xrays/tests scheduled off of the unit and that I have no admissions, discharges or transfers. Of course let it be known that there are no typical days in nursing and every hospital/facility is different.

***

6:40am-Arrive to the unit, stow belongings in the break room.

6:45am-Locate and claim my COW (Computer on Wheels) and pager for the day.

6:53am-7:10am-Clock-in, Review my (3-4) patient assignment for the day (look up medical history, hospital history, labs, meds, notes), Print out telemetry rhythm strips, analyze telemetry strips, sign and paste in the patient’s chart, find the night nurse, get report on my patients’ from the night.

7:15am-7:30am-Visual check on my patients, check IV drip rates, introduce myself to patients, check in with the LNA.

7:30am-9:00am-Complete physical assessments of the Cardiac, Respiratory, Neuro, GI, and Vascular systems. Assess IV sites, and surgical incisions.  Assess pulses, if they aren’t palpable, get the doppler. Review vital signs and fingersticks. Remind my patients to order breakfast before I administer their insulin. Remove  meds from the Pyxis machine, administer PO (by mouth) meds and hang IV meds (Insulin drips, cardiac IV meds, & IV antibiotics). Document my assessments in PRISM (the electronic health record). Review and acknowledge MD orders in PRISM. Provide and document patient/family education on meds, plan of care, etc.

9:00am-1pm- Finish any morning documentation that hasn’t been completed, complete hourly checks on my patients and document hourly checks. Work with the LNAs to get my patients washed up and sat up in the chair. Assess what my patients ate for breakfast, document what, and how much they ate and drank in the PRISM. Make sure my patients order lunch, administer insulin. Review and acknowledge MD orders in PRISM, go to lunch for 30 minutes. If patients are post-op day# 3 from cardiac surgery usually the MD will remove the chest tubes, RN will remove the IJ Cortis (Central line in the Intra-Jugular Vein), Foley Urinary catheter will be ordered to be removed, and patient’s external cardiac pacing wires will be removed by the MD. Provide and document patient/family education on meds, plan of care, etc.

1pm-4pm- Check on patients, assess pain. Medicate for pain as necessary per orders. Review any labs in the computer, call the MD for any abnormal result (i.e increased/decreased Potassium, Sodium, elevated Troponins/CKMB), intervene per orders. Review tele monitors, if patient goes from normal sinus rhythm into Afib, Heart Block, gets tachycardic or bradycardic, notify the MD and administer meds per orders. Complete afternoon physical assessments (a miniature version of the am assessment), document assessment in PRISM, Document what and how much of what my patients ate in PRISM. Document that I re-positioned my patients at least every 2 hours (bed, to chair, to bed, to lying down, to sitting). Review and acknowledge MD orders in PRISM. Provide and document patient/family education on meds, plan of care, etc.

4pm-7pm- Finish documenting PM physical assessments, always check on patients, document hourly checks on my patients, make sure patients order dinner, administer insulin. Continue to assess pain, continue to reposition patients every 2 hours and document how much patients are eating, drinking, and going to the bathroom. Review and acknowledge MD orders in PRISM. Write a nursing DAR note (Data/Assessment/Response) for each of my patients and file into the care plan in PRISM. Provide and document patient/family education on meds, plan of care, etc.

7pm-7:30pm-Give report on my patients from the day to the night nurse coming in, make sure all documentation is complete, return my COW and my pager, leave work in an exhausted state.

***

At minimum, the following must be completed during a shift regardless of the situation:

Physical Assessments in the morning/afternoon, Pain assessments, Hourly checks (at minimum) on all patients, Intake/Output assessment, medication administration throughout the shift. Patient/family education, documenting the above in PRISM, DAR notes for each patient. Communicating with the doctors (team) in charge of your patient(s) and relaying pertinent data related to your patient and most importantly ADVOCATING FOR THE PATIENT.

I hope this helps show a sense of what an RN actually does at work. Wondering what makes us nurses continue to go to work every day?  Read my next entry, What Makes Nursing Worth It.

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One Comment leave one →
  1. Leanne permalink
    November 13, 2011 4:26 pm

    I can’t believe someone told you nursing is easy, what an ill-informed person. I love your new blog, thanks for letting me know about it ! xoxo Leanne

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