This is my Life, now that I'm a neurology nurse.
5:00 AM: ALARM! (oh my gosh, seriously?!) I'm exhausted! Always!
5:04: Get ready for the day, shower, scrubs, coffee, oatmeal.
5:45: Think to myself....Hmmm....dry my hair or lay back in bed??????
5:46 Lay back in bed with Alex til' about 6:13
6:13: Gather my RN things: stethoscope, pager, name badge, penlight, hemostats, etc etc etc. Fill my pockets of my scrubs.
6:30: Go wait for the bus
6:35: Get on the bus (either the 18 or 60), whichever comes first.
6:36 Try to read the paper while sipping on my coffee
6:46: Transfer to a different bus on Michigan avenue
7:00: Arrive at work! (nice short commute!) gotta love that!
7:05: Finish my coffee and organize myself for the day.
7:15: Print out medication sheets for each of my patients so I can see their medication schedule for the day. On each piece of paper I write body systems...so when I take report I can write about how each individual body system is doing:
Example: John Doe:
c/c:
hx:
neuro:
resp:
cardio:
Gastric:
G/U:
Skin:
Pain:
Plan:
Lines:
7:30: Safety Huddle. The night charge nurse comes in and tells us all about the "red alerts" Patients who are at risk for falls, skin breakdown, or something of that nature.
7:35: Go to my part of the unit that I'm assigned to that day. Today? Stepdown-ICU.
7:40: Find the night nurse who has my patients and get report on how they are doing and what they need that day. (Fill out my body system page)
Example of what it would look like filled out:
c/c: 48 YOM c/o dizziness, SOB, weakness in BUE. MR shows acute infarct in left pons.
Hx: hyperlipidemia, HTN,
Neuro: A0x3, pupils 3mm and brisk, nystagmus, BUE: 4/5 BLE: 5/5. Sensation intact.
Cardio: NSR w/ 3 PVC's. SOB/chx pain. PRN Nitro STAT EKG ordered.
Resp: diminished resp sounds. trach collar shiley 6 5L at 28%H.
G: BLM: 10/6/10. Normal sounds.
GU: Foley, amber output
SKIN: LD/ staple cranio
Pain: NORCO Q2H PRN
PLAN: TTE with bubble study, hormone labs at 8AM, Troponin levels.
LINES: 60 NS RPIV 20G inserted yesterday
So then I have to take that information for each patient and priortize my day.
8:00 I look up all the recent notes Physicans have ordered/written. I want to get a good understanding of who my patient's are, why they are here now, and what I can do to make them better. I spend from 8:00-8:45 (most days) looking through charts (all online) to get a good idea of how I want to organize my day. This is so important!!!!!!
Without organization, any new RN can FAIL!
8:45-10:00: I start visiting my patients. I write on their whiteboard, my name, the plan, etc. I do my first BIG assessment on each of them. Because this is a NEURO floor I focus on a neuro assessment. But I also assess many other things about them. Whatever is important to their care. I also give all morning meds at this time, which can take a lot of time and effort. I also look at each patient's rhythm strip and interpret it. I write down the rhythm, PR interval and QRS interval then put it in their chart.
I get on the computer and chart after I see each patient, I fill out large assessments, how they are moving around, how their IV lines look, and what sort of education I provide.
10:00 MY patient in my last room has a Lumbar drain to drain CSF from their spinal cord. I have to manually drain teh fluid every hour. 20cc's. I take vital signs and carefully monitor the patient at this time. He also a PEG tube, tube feedings, a wound vac, a prafo boot, a trachostomy, and is immobile and nonverbal. He is my big care patient for the day. I DO EVERYTHING for him. And I will be in the room every hour on the hour. No matter what. I need to drain him on the hour. I notice that his oxygen sats are falling while doing my assessment. I stop my assessment, put his HOB up and trach and oral suction him while using the ambu bag to hyperventilate. His stats go back up to 99-100. I feel great about that.
11:00: Drain. The DR's round and i try to go to with them to see what decisons they are making so I can have input too. Nice Docs will ask me for my input, mean ones don't ask but I give it anyway. I consider myself a patient advocate. I go around to all my patients again for a second neuro assessment. I turn my patient with the trach. turn him every two hours with my PCT Mary.
12:00 Drain, take vital signs, make sure the patient's get lunch. Get a transfer patient from the ICU. Call down to NICU to get report. Stay on hold for too long. A DR asks me where MRI results are. Not my job ,but i'll find them. After report I call MRI and stay on hold with them too. Meanwhile, finish some charting.
1:00: Drain, Another assessment, put in orders. Make sure patients are seen by therapies. Record I and O's. Admit my new patient. Set him up in the room with his family. Do a lot of education. Do a good initiual assessment. The DR. orders dozens of labs, all of which I will collect.
2:00 Drain. Get blood samples from my new patient, also urine specimens. Send those down to lab. Give my pager to another nurse and go in the other room to eat my lunch. I get half an hour. Just enough time to check my phone and realize Alex has been locked out of the house all morning! :( Go back to the floor, read new notes. Realize another patients glucose level is too high. Look for his insulin. Pharmacy never brought it up. Order his insulin. Call and complain they never brought it up. Steal someone else's insulin to give to him. (he needed it!)
3:00: Drain. Neuro assessments again! More tests, flushing Peg tubes, increasing tube feedings, suctioning again. call dietary for a consult for a patient with bad eating habits.
4:00: Drain. Call the patient education line and tell them I want a video shown to my patient about stroke risk factors. Get that set up and set up a question and answer session with a family about stroke. CHART.
5:00: Drain. Assessment again! Start giving evening medications. Pt complains of chest pain and doesn't have PRN meds for that. Page a resident. resident visists. Orders stat EKG and lab levels. I perform those labs, take those blood tests and assist in the EKG.
6:00 Drain. Patient has a TTE and I'm at the bedside doing the "bubble test" with the tech. Give medication if parameters allow. Finalize the report I need to write to give to the night nurse.
7:00 Last neuro assessment. VS/ recheck all orders. Update my SBARS. Tie up any loose ends.
7:30 Give report to night nurses. decide to change the draining system last minute. Realize we are all out on the floor and go down to ICU to borrow it. IT takes a while to do it.
8:30: Alex texts me, he's here to pick me up. Where am I?
8:31: Just getting done. Clean up everything, say goodnight, swipe out!
9:00 Get home, eat some delicious dinner Alex made.
9:15: We take dexter out together.
After that,,, I usually fall asleep! That's a short summary of my day, in reality we do a lot more. But I thought this would give a good idea to those who ask me what we do!
Being an RN is a lot of work, and working with life and death is stressful! But who else gets to experience mankind at their most delicate moments?
Now, I'm off to sleep. TO do it again tomorrow.
Goodnight!
