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Feeding the Beast

December 1, 2011

I realize that the title, Feeding the Beast is a little bizarre, but I think it best describes the process of always making sure there is enough time to prepare and make healthy food. I was going to include this in Keeping the Sanity, but it would have been even longer than it already was.

Most people who know me are aware that I eat a lot. I was blessed with a fast metabolism, but also lead a very active lifestyle. Now that I am working as a nurse I need to eat even more to stay energetic and make it through the day. When I moved here I joined the local Co-op. The Co-op is a little more expensive than stores like Shaws and Price Chopper. Though when you’re eating healthy, local, organic foods, I find the prices in the Co-op are very comparable to big grocery stores’ organic/healthy sections. I will spend more on healthy foods because it is a health investment. I don’t skimp on food, and when I spend more on food at the Co-op, I subsequently spend less on take-out or at restaurants, feel healthier, have more energy, and am supporting a local business, which to me is priceless.

On the day before my marathon of shifts, I made a trip to the Co-op and bought enough healthy, organic foods that could double as easy-to-cook (without a microwave) dinners, and as packable lunches. For my four 12s, I knew that I would need at least three nights of dinners and four days of lunches. See below for a sample of what I purchased before the long work-week (varies week to week):

Amy’s frozen macaroni and cheese

Amy’s margeurita pizza

1 dozen Nellie’s eggs

1 block of Cabot Cheddar cheese (to my boyfriend, the cheese monger’s dismay—he prefers I buy ripe cheese, but that’s a story for another time)

4- Stonyfield yogurts in assorted flavors

The biggest bag of Organic, locally grown Spinach possible

1 bag of Organic Peas

1 Cucumber

1-bunch of Organic, locally grown Garlic

2-Small Organic, locally grown yellow onions

1 large bunch of semi-ripe (so they last the week) Organic Bananas

1 bag of Garden of Eatin’ Chili Lime tortilla chips

A bunch of fruit leathers in assorted flavors

1 bag of Organic, whole-wheat linguini

Basmati Rice

2-lbs of Organic, Misty Knowles Chicken breast

1-lb of Grass-Fed ground beef

1 Jar of Organic Newman’s Own Tomato Sauce

1 Can of Garbanzo beans.

1 Jar of  Organic Unsweetened Applesauce

Assorted Indian spices found in the “do-it-yourself” bulk section at the Co-op

1-Pound of Organic, Local Coffee beans

Now, some of you may be thinking, “what is she, the carbohydrate queen?” I’d like to answer, YES! I love carbohydrates. They make me so happy, but it’s all about balance. Also, I don’t really eat 2-lbs of chicken in four days, but I buy a lot of it and freeze individual chicken breasts for use on a later day, same with the ground beef. For breakfast I usually have fruit and cereal with skim milk.

Cooking and preparing the dinners listed below takes some degree of multi-tasking. I don’t get home from work until 8pm and need to be in bed no later than 10pm if I’m working the next morning as well. In two hours I have to shower, cook dinner, pack lunch, pack my bag, have some down time and get ready for bed. The dinners below are thought-up to be made while multitasking.

Examples of dinners/lunches for four days of working 12s are as follows:

Lunch Day One: Leftover linguini with meat sauce from night before, yogurt, fruit leather, banana, tortilla chips.

Dinner Night One: ¼-1/2 of Amy’s Frozen Pizza, side of Spinach and peas, small cup of applesauce, side of Garbanzo beans. Note: I always cook a dinner than allows me to bring leftovers as my lunch for the next day!  Total Cook/prep time: 35 minutes. (While pizza cooks in oven, shower and prep sides, pack lunch).

Lunch Day Two: Remainder of Amy’s Pizza, baggie of tortilla chips, a fruit leather, banana, yogurt.

Dinner Night Two: Scrambled eggs with cheddar cheese, spinach, peas, cut-up cold cucumber, and whole-wheat toast with soy butter. Total cook/prep time: 20 minutes.

Lunch Day Three: Bring Frozen Amy’s Macaroni and cheese for lunch, yogurt, cut-up cucumber leftovers, fruit leather, tortilla chips, and a banana.

Dinner Night Three: Exhaustion has set in, but need to cook. Made Indian food-Basmati rice with a chicken curry sauce, and side of spinach. Total cook/prep time: 30 minutes (most of which is the rice cooking…shower while food cooking, pack bag for the next day)

Lunch Day Four: Leftover Indian food, yogurt, banana, fruit leather, tortilla chips.

I’m not sure how many calories I’m eating, I don’t count calories, I don’t add points, I don’t own a scale. I realize this may not work for many people, but for me this method of eating and cooking paired with weekly exercise works for me. The one thing I do is look at on my food labels and consider the following things:

Where my food comes from. Is it local? Always a preference, but sometimes to buy bananas in the middle of winter, you gotta make an exception!

Is it Organic? Will buy non-organic foods if they meet the below categories:

How much Sugar, Sodium, Cholesterol is in the product? I aim for as low as possible.

How many processed ingredients are in the product? I aim for as little as possible.

Is there High Fructose Corn Syrup in it? If yes, put it back on the shelf.

Stay tuned for more entries from Tales of an RN coming soon!

 

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Keeping the Sanity

December 1, 2011

Alas! This entry is here. Funny how I finally post this while on the brink of losing my own sanity after working four 12-hour day shifts (7am-7pm) and an 8-hour evening shift (3pm-11pm) in a row, or commonly referred to in nurse lingo, “I just worked four 12s and an 8.”  And no, those shifts are not spent sitting. They are spent literally power walking up and down a hallway, back and forth, side to side, up and down. I’m not trying to single nursing out as being a harder profession than most or by any means discount any other profession, but since I’m always trying to make others understand what nurses do, it’s necessary to explain it this way.

After a lot of time spent reflecting on how I managed to get through the many shifts in a row (I know, dramatic) it quickly became apparent that the food I bought at the Co-op and the meals I cooked during consecutive 12-hour shifts compromised a lot of what did keep “my sanity.” That said a story about food could make up an entire entry alone. So refer to Feeding the Beast to be posted after this entry.

Keeping the Sanity:

Good Music: Creating a good mix for my ipod is essential. As soon as the alarm sounds at 530am, I head strait for my ipod and speakers in the kitchen and put on my mix titled, “inspiritual” which I realize is not a word, but it’s an inside joke with myself.  Listening to the music while making coffee in the French Press, showering and getting ready starts my day off right.

Coffee: I love coffee. I love making coffee in my French Press. The simplicity of it is so satisfying. That said, I can only drink 1 cup per day before feeling all jittery and nutty. I make a really good cup in the morning, put it in my pretty blue ceramic to-go mug and enjoy every sip of that coffee because I know it’s the only one I’m getting for the day.

Good Socks and Shoes: This may seem like a no-brainer, but until I worked as a nurse, I didn’t fully understand. From a lot of trial and error, I’ve found that SmartWool socks have just the right amount of cushion and anti-sweat materials to keep my feet feeling cozy all day long. For shoes, the best I’ve found are Dansko clogs. They allow your feet to arch and bend independently of the shoe and distribute the weight of your feet equally. The only downside to Dansko clogs is walking on grass outside and almost rolling your ankle. People who wear Danskos know exactly what I’m talking about.

Walking to work: I’m really lucky to live close enough to work. I have a 15-minute walk up a big hill in the mornings. I bring my ipod and continue to listen to the “inspiritual” mix, while enjoying the fresh air. This also gives me a chance to wake up fully before arriving at work. There have been a few days when I drove to work and it really affected my day negatively.  Interestingly, it takes me longer to drive to work than walk, so it’s really a win, win situation.

Lunch: Ok, this may sound like an obvious one, but some days I’m so busy at work that I don’t sit down for my lunch break until 2, 2:30. The time that I decide to take my lunch is completely up to me, so really I can go anytime I want, and it’s just a matter of planning my day right. On the days I take lunch by 1pm, I find I work much more efficiently and maintain my energy.

Water and Milk: I drink a ton of water and milk. I always have my Camelback water bottle filled and accessible not only at home, but at the nurse’s station as well. I probably drink about 2.5-3L of water per day. I don’t have juice or soda in my fridge at home because they’re loaded with sugar and always make me crash after drinking them. The only other thing I drink at home or work is milk. I go through almost gallon per week just for me.

Exercise:  I know now that I need to exercise year-round to maintain my well-being. With a busy schedule it can be hard to find the time. Friends of mine have said, “I’m just too tired to exercise, I don’t have time.” I completely understand, but if you can build it into your schedule little by little, the benefits will be worth it. There were a couple weeks when I didn’t exercise while working as a nurse. I noticed I felt more anxious after work, had trouble sleeping and had a hard time settling down for the night. Just going for a light jog 2x per week reduced those unwanted feelings and made me feel like a happier person mentally, physically and spiritually.

Hot Showers: Immediately upon returning home from work, after leaving my germy clogs outside my apartment, and removing my germy scrubs, I take the hottest shower possible. This is not only to wash off the germs I encounter at work all day, but it helps to transition into “home mode.” There have been nights I’ve skipped the shower and therefore have had a hard time settling down into being home. I’ve talked to other nurses about this feeling and they all have similar rituals upon returning home at night.

Good Bedding: I sleep with 3 quilts and mini blankets all around me. There are nights you just want to fall into bed and it’s worth it to have a soft, cozy, and warm bed to come home to at night.

Funny TV shows/Good Book: After work, you need to have a way to unwind and completely distract yourself from the day. I tend to reach for either one of the few books I’m in the middle of, or watch shows like Friends, Seinfeld, Curb Your Enthusiasm, and Modern Family that are always guaranteed to make me burst out laughing.

Foam Roller:  My dad, a personal trainer gave me a foam roller. A foam roller is used to stretch out tight back muscles or anything else you can think of. It looks exactly how it sounds. It is a long, cylindrical piece of foam that you can lie on and roll your sore back muscles across. Doing this nightly loosens up the tight back muscles that come from moving and lifting patients in bed all day.

Eating in Bed: Ok, this may sound weird. The nights I’ve eaten my dinner in bed while watching tv has been a wonderful treat after spending 12-13 hours on my feet. I’ll eat extremely slow, over an hour and enjoy the feeling of my legs elevated on pillows in my soft, warm bed.

Writing: Writing has always been one of my outlets for stress. Finding an inspirational place to write is the tricky part. I do my best writing in cafés or libraries. Today for instance is my day off so I headed out to my favorite café to write. Because I slept in, I ended up arriving around lunchtime…not a good idea. The café was packed and finding a small table with a computer outlet (since my laptop won’t work if it’s not plugged in) was a challenge. I had to get all vulture-like and prey on customers sitting at tables that appeared to be done, but were still sitting. I’m quite good at this and actually very subtle. In a matter of minutes I managed to snag a table without being pushy or rude. This is a skill and I will teach anyone who wants to learn.

The things that most certainly didn’t Keep the Sanity were:

 Letting my dishes pile up because I was too tired to do them. This only added more work for me in the long run, is gross and definitely made me want to pull my hair out.

Forgetting to wash my French Press in the evening before bed. This may sound silly, but there is nothing grosser than scooping out old, wet coffee grinds out of a French Press (Ok, actually I can think of a few things). But I’ve woken up so many mornings to the previous day’s coffee grinds still in the French Press, which only adds more things to do in the morning before work.

The biggest thing that made me want to run into a wall was letting various mistakes made at work, or difficult patient scenarios get to me. I’ve touched on this before in other entries, but it’s the most important thing to improve upon. The answer should never be to put oneself down for making mistakes or encountering tough situations. Hopefully during my next stint of working four 12s in a row, I will be able to remember this and focus on the things that Kept the Sanity.

A Wonderful Day

November 23, 2011

It’s interesting how you can have a really emotionally exhausting and draining day which is then followed by an inspiring one. I find myself getting down on myself when things don’t go the right way, especially in nursing. I don’t understand why this happens. It’s upsetting to me that people, myself included usually have a hard time patting ourselves on the back for a job well done.

In case you haven’t read my previous entry, I’ll fill you in. My last entry talks about a particularly difficult day I experienced at work. I had a very discouraging, upsetting discussion with family members of a patient over the phone. Due to HIPAA, I’m limited to how much I can divulge, but it was a very upsetting situation that made me question my abilities as a nurse. On a more positive note, the next day following my difficult day, I had a wonderful day (hence the title), which you may read about below.

The other day I cared for 3 patients. At 10 weeks into my new graduate RN residency program I have already made many mistakes, and learned many invaluable lessons. Somehow, on that wonderful day my stars were alligned and I was able to put together everything I had learned: time management techniques, patient education, pain management techniques, and documenting everything “real time” into the computer.

I administered medications on time, completed thorough physical assessments and more! Still, I found myself thinking, “I must be forgetting something, I must be missing important tasks. I really surprised myself when I wasn’t running up and down the hallways looking like a chicken with my head cut off, or acting like a squirrel which one of my coworkers jokingly told me I look like when I’m stressed. Fortunately for my coworker I have tough skin and found this to be hilariously ironic, as anybody close to me knows that squirrels terrify me. Anyway, back to my point..I couldn’t see that I was doing a good job, my mind automatically wanted to point out things I was forgetting. It wasn’t until my shift was almost over that I realized “maybe I didn’t forget stuff, just maybe I am getting it!” This revelation came to me because while two of my patients complimented me on my hard work, my third patient handed me a thank you card from themself and their family.  Receiving positive reinforcement from my patients as opposed to the negative reinforcement from the tough day before forced me to focus on the positive and move forward from that difficult day I had, for real.

I should be able to recognize when I am doing well and pat myself on the back when necessary rather than wait until a patient does, because that isn’t their job and it may not and does not always happen. This is a learned skill and I know it will come in time as I gain more self-reliance and confidence with my nursing practice. If a patient does in fact compliment their nurse, it is simply an added bonus. If a patient doesn’t compliment their nurse it doesn’t mean the nurse wasn’t doing a good job.

There are good days and bad days in nursing. We can learn from the bad days, but as I mentioned previously, you must leave those days behind and focus on the good ones, otherwise you’ll doubt your skills and capabilities as a nurse. The wonderful day mentioned above was a great day and it will continue to stick with me as an example of my good work and I will try repeating that to myself, “my good work.”  That card from a patient hangs on my fridge and it is a huge reminder as to why I became a nurse.

Stay tuned for my next entry, Keeping the Sanity.

A Not So Nice Day

November 18, 2011

I know I said that my next post would be about keeping the sanity, but in between writing my last post and the upcoming post, Keeping the Sanity I had two extremely monumental days of work that I must talk about before I forget.

If you’ve read my previous posts, you may have noticed that I haven’t mentioned anything about what to do when you encounter a patient’s  family who is, how do I put this…giving you a hard time.

Recently I experienced working with difficult family members of a patient. I received a phone call in which the family members were yelling accusatory things to me. During the conversation I started to feel my heart beat faster, the redness burn my face, and the heat take over my body. This was the first time I had experienced a patient/family situation like this and my initial gut reaction was to defend myself since my nursing judgment was being questioned. I immediately assumed that I, the new graduate RN must have made a mistake. As I began to defend myself, I realized that I owed no explanation to the family, afterall when someone is over age 18, they are no longer a minor. 

Suddenly my heart slowed down, my face no longer burned and I wasn’t hot. As I began to think more clearly I also realized that I did exactly what I was supposed to do,  provide excellent nursing care to my patient. I calmly told the family members, “I understand you’re concerned. Your loved one was medically cleared for discharge and if you have further concerns I can connect you to the physician who will be able to answer more of your questions.”  As I hung up the phone my preceptor told me I handled the difficult family members very well, and truly, there was nothing more I could do for the situation aside from documenting the conversation.

As a new graduate RN it feels as though we are being watched under a microscope. This makes moments when a patient’s family member starts interrogating you all the more difficult. I knew when I became a nurse that working with a patient’s family was part of the deal. In fact, I love educating and reassuring family members about their loved one. That being said, there is a fine line between a family that is working with the nurse, asking questions, trying to understand the situation than simply throwing around false accusations at the nurse.

When I got home, and could fully digest the things those family members had said to me, I felt horrible. Even though I was reassured by my coworkers, friends and family that I did what I was supposed to, I couldn’t shake the feeling that I had failed.  That night, as I lay in bed I had to practice the skill of leaving the day behind, pushing it far out of my mind. Being able to leave work at the hospital each day is imperative to a nurse’s well being. After watching an episode of Seinfeld and having a few good laughs while eating scrambled eggs for dinner, I drifted off to sleep as the upsetting conversation floated further and further out of my mind. I awoke the next morning ready for a new day, and didn’t let myself think about the evening before, and guess what? It worked! I only hope that next time, with practice I’ll be able to let those difficult scenarios float far, far away as I leave the hospital.

To hear about monumental day #2, read my next entry which is (conversely) called, A Wonderful Day and I promise, Keeping the Sanity will be posted shortly after.

Jack of All Trades

November 14, 2011

If I had to find a phrase that best sums up good nurses in their entirety, Jack of All Trades would be at the top of my list.  One of my closest friends from nursing school first used this phrase to describe the nursing profession back in the days of 2nd-year Health Assessment class. I remember our professor had just finished teaching a particularly difficult lecture on assessing the cardiovascular system and he ends with, “I know these concepts are challenging to grasp, but in addition to the cardiac physical exam, you need to also still remember the other less exciting aspects of nursing.”

The so called, “other aspects of nursing” to which my professor was referring include, but are not limited to the following:  bathing patients, toileting patients and wipin’ butts, brushing teeth, walking (also known as ambulating), dressing, changing bed linens, measuring urine/feces, feeding patients, measuring the amount of food/ fluids consumed, and let us not forget the troubleshooting of hearing aids, glasses, dentures, canes, crutches, walkers and wheelchairs. It was after this comment my close friend turns to me and goes, “so really, nurses are just Jacks of All Trades?” We had a good laugh over this, but gradually realized over the remainder of nursing school how true her statement really was.

In the world of nursing we can so easily get carried away with whichever difficult skill we need to accomplish (i.e. removing central lines), that we can forget about the more seemingly “simple” tasks such as, getting our patients out of bed and into the shower down the hall.

Recently I had a patient recovering from a Coronary Artery Bypass Graft and they desperately wanted to take a shower. At first I thought, “Oh a shower, that’s easy, I can do that.” Then I discovered that my patient’s SpO2 would decrease to 89% on room air, and the BP would drop to 90/50 when standing. Those questionable vitals paired with my inexperience as a nurse did not make me feel comfortable. I’m going to confess something. Somehow I managed to get through nursing school without EVER having to ambulate a patient to the shower. I know…absurd. Truth is, the patients I cared for in clinicals either required bed baths because they were very critical from neuro disorders/trauma, or they had showers in their room and the LNAs always assisted my patients to their shower, 8 feet from the bed… So you can imagine that the last thing I wanted to do was walk my patient with low blood pressure 150 ft down the hallway to take a shower. But, my patient had a specific order to take a shower, and I had already checked with the doctor that, yes, my patient could go off the tele monitor for the shower. So truth of the matter was my patient needed a shower, and also, there is evidence supporting the taking of showers after cardiac surgery to improve patient outcomes. Really, my hands were tied. I had no choice but to bring my patient to the shower.

After staring at my patient’s tele-monitor and assessing blood pressure for a few minutes, I disconnected the telemetry leads, taped up the IVs and central line dressing, put plastic wrap around the IV pump because my patient was on a continuous Insulin infusion, which I embarrassingly learned can NOT be discontinued for a shower. Once this was complete which seemed like 30 minutes later (really only a few minutes later), I tested my patient’s O2 levels and with an “OK” from the charge nurse and MD, decided that with a SpO2 of 89-90% RA, could ambulate my patient to the bathroom without the O2 tank (thankfully), as bringing the O2 tank into the shower would have been even trickier. At this point, I was sweaty and nervous because I was scared my patient would drop down in the hallway on the way to the shower and I would somehow be responsible and look like an idiot. After pushing that fear back down, I handed my patient the heart-shaped pillow that all of our post-cardiac patients receive to hold tightly against those painful sternal incisions–this offsets the pressure to the chest when a patient stands up, and we were good to go…

Turns out, everything went great. My patient walked with great ease down the hallway (despite my internal panicking), and kept saying “wow, I feel great moving around!” I learned not to assume something will be easy or difficult before I try it, and getting my patient up and moving that morning improved their oxygenation status for the remainder of the shift.

In closing, I still say “yes, nurses are Jacks of All Trades,” we do so many different things to help our patients. Amidst all of the many aspects of nursing, like my professor said, we have to remember and practice the basic skills too. Want to know how to balance the stress of working as nurse with having a life outside of work? Stay tuned for my next entry, Keeping the Sanity to be posted soon.

What Makes Nursing Worth It

November 13, 2011

Now that I’ve shared the nitty gritty details of the so-called, “typical day” in nursing, I think it’s important to share why we actually do what we do. During the day-to-day duties and responsibilities it’s so easy to forget the route of nursing care is always the patient.

Some days I find myself stressed beyond belief, pushing my COW (Computer on Wheels) up and down the hallways of the unit wondering how I will ever get my tasks complete for the day. It is at these times that I force myself to stop, take a deep breath and remind myself that what my patients need isn’t for me to be a stressed, abrupt nurse, but generally, they need for me to take the time and listen to their concerns and stories regardless of the medication that needs to be administered in 10 minutes, or the documentation from the morning that hasn’t been completed yet.

It can be hard to find a balance of meeting my patient’s psychosocial needs and their medical needs. That being said I don’t believe one can occur without the other. If a patient’s psychosocial needs aren’t met, how can we as healthcare professionals expect them to focus on their medical diagnosis or on getting better? When my patients or their family members are stressed about who is going to feed the dog while they’re in the hospital it’s all they can think about. If I try and give my patient their meds and they have something to say…well guess what, they won’t take those meds until they get a chance to say what they need to say.

Before I had any “real-world”  nursing experience, if I’d been in a hurry I used to try and get my patients to take their meds even if they were trying to tell me a story. Usually those patients would say to me, “hold on, I need another minute, just listen.” From such experiences I’ve learned that it’s actually quicker if I just muster all of the patience I can bear to hold onto and put on one of my biggest smiles until they’re done telling me their story. This generally works, and patients often thank me for taking the time to listen to their stories, concerns and anecdotes. In the end it turns out I didn’t have to force myself to listen because I usually walked away from conversations having learned something new, valuable and applicable to my patient’s care. It almost felt like I had unlocked a key to taking care of my patient. For example, from talking to my patient for 5 minutes, I now know that they love Joni Mitchell more than anything. Knowing this tidbit is useful for when my patient is in extreme pain, or is ridden with anxiety because the simple mention of Joni Mitchell’s name when my patient is faced with something difficult can distract them if only for a moment.

Despite the difficult tasks and time consuming documentation in which there never seems to be enough time to finish during a shift, it’s the little moments with patients, listening to their stories, answering their questions, teaching them ways to improve their health that make my job meaningful.

I’ve talked with patients about Jesus, their children, spouses, pets, houses, favorite music, the Vietnam War, George Bush, President Obama, Self-Defense classes for women and many more topics one could not imagine. I don’t always know everything about a certain topic of conversation, but I can usually get by with the knowledge I do have. If these little moments ceased to exist, I’m not sure I would have become a nurse and I’m not sure working as a nurse would be worth it in the long run. So listen to your patients, give them a squeeze on the shoulder and talk about their interests, because not only will it make your job easier, it can at minimum make your patients feel better for those 5 minutes.

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.