Ricochet is the best place on the internet to discuss the issues of the day, either through commenting on posts or writing your own for our active and dynamic community in a fully moderated environment. In addition, the Ricochet Audio Network offers over 50 original podcasts with new episodes released every day.
A Typical Day in the Life of a Bedside Nurse, Part 1
5:30 a.m: Alarm buzzing. I wish it weren’t. I snooze.
5:35 a.m: Buzz, buzz. Snooze.
5:50 a.m: Buzz, buzz. Holy…how am I still in bed?! I have to be at work!
Roll out of bed as quickly as possible. Find my scrubs from the laundry basket of things that I haven’t hung up yet (thank my good judgment in buying wrinkle-free scrubs), brush teeth, pull hair back into some semblance of tidiness, throw keys, phone, etc., into pocket. Grab shoes and socks, stumble, badly, in the dark toward the bedroom door to exit into the living room.
Walk into the kitchen, pour coffee. Whatever is left of it from the day before goes into a cup and I drink it. Cold. It’s okay, I don’t like it hot anyway. I chug some of it down while I take my morning meds (the ones that make me moderately functional). I plop down into a chair and pull on my socks and nursing shoes. I examine those shoes again and wonder if I should replace them. It’s probably only been a year. Some of the cushioning is still good, but everyone else has these other shoes that look ridiculous, but they say feel amazing… I consider my shoe envy for a moment while I double-knot. I finish the rest of my coffee. I put my mug up on the counter. I run over to my work bag (lucky me, it’s only about 30 feet away) and grab my holey lunch bag, while tossing my wallet into the larger tote. I check the inside for forgotten food (there’s an emergency packet of oatmeal of indeterminate age).
I throw some yogurt in the bag along with some granola. If I’m feeling good, I’ll toss in an apple and a piece of string cheese. Before my water bottle absconded, I’d have filled that up from the fridge. But like many things left in the break room, it managed to disappear.
I grab my new fancy watch and check my heart rate, temperature, O2 saturations. I figure I’m feeling well enough.
I stumble into the dark bedroom and kiss my husband goodbye. He mumbles something; I wish I were in there with him. I try to shut the door gently.
Four feet away or so, I open my kid’s bedroom door and do a similar routine. I remind about school, alarms, homework, and all of the usual mommy worries. I pull myself away and gently shut the door. I pray the alarm goes off and that school is attended today in my absence.
I look at the time and grab my stuff just fast enough to remember that I didn’t make a cup of coffee. Oh well, it’s too late for that anyway. I secretly hope that the day is calm enough that I can take my 10 minute morning break and get to the cafeteria for a Starbucks iced coffee. It isn’t that I love Starbucks, I just love iced coffee and I don’t have any.
I get in my car and attempt to beat the traffic to work. Now that the pandemic is “over” (apparently?), everyone’s on the road again. The drive is not better and the parking situation at work is worse than ever. It takes 20 minutes to find a spot and the tracker that is supposed to say how many spots are left is wildly overestimating the number of spots, since there are exactly zero and it said 12. I loop back around and go back to the entrance to pay for visitor parking. It is already late and my badge does not work on this level. Oh well. Enjoy my $8.
I essentially run-walk nearly inducing an asthma attack through my mask. I pass by the Covid screeners, who now only screen visitors, wave, sanitize my hands, and take my mandated hospital-grade mask and put it on in front of them. They nod approvingly. Whatever.
I speed up as I get to the elevators and rush to scan my badge and push the button. Someone rolls up behind me to let me know that the usual elevator is having problems, again, so we’re back down to one. It might be a little while.
.JPG&f=1&nofb=1)
The eternal object of my ire.
This is a problem because I have exactly two minutes to get up three more levels, speed halfway through the floor, drop my stuff, and find my way to punch in before the magically appointed cutoff time. I get there, scan my badge, and the clock obligingly ticks one minute over and registers that time instead.
Great. Now I’m tardy. Half an absence.
I walk in to morning huddle.
Huddle, for those not in the know, is meant to be a brief touchpoint in the morning in order to discuss anything that all staff needs to hear. Primarily, though, it is only the nurses who are present for this, as our aides saunter in as they feel like it (if they do). We try to pay attention while writing down patient room numbers, getting labels, and securing our names on a lunch list (“psssssst….if you signed it can you send it over?!?”) at a hopefully “good” time.
So now, I will take a break from the daily routine to explain what is Good to nurses. It could be, literally, any time of the day. We begin breaking for lunches at 11:30 and end at 4:30. Everyone has their preferred time and depending on who else is scheduled that day, there could be a literal battle for the signup sheet (at least for day shift). People have been known to cross out other people’s names and write their own. Oh, the drama.
This is drama for a reason, though. The nurse has to try to plan the day around this break. Why? Because. Everything must be in place. Everything must be as settled as possible: it is considered rude to make the breaker nurse do anything during your lunch. This way she is still available to provide help for everyone else. You know when your lunch is. You should be prepared. Your patients should all be medicated, they should know you are leaving, they should want for nothing. You should be exactly ready when the appointed time comes.
Because if you are not? They might just skip over you and move on. Lunches must be completed (in CA) by an appointment time, so there’s really no waiting on you. Either you are ready or you might just get the last lunch at the end of the day.
Also known as “dinner”.
Everyone has their preferred times, but the routine is the same. Know the time you got, be ready. When they call, even if it is late, you better have everything sorted out and ready to go. So now we return to our regularly scheduled daily routine…
Huddle ends whenever the charge decides to end it. Sometimes it is a quick, “Hey! Director is on vacation for a week, the NP is on vacation. You know what that means. Susan from 5th will be checking in on us to make sure we’re okay. All concerns get directed to her. Surgeons will be doing their own orders, guys. GUYS! Hey. Let’s make this quick: the NP is out. The Surgeons are taking care of themselves. PLEASE, please, fortheloveofgod, remind them of their orders early. Call them early. Because we all know that by 3:30, they’re gonna start getting really slow to answer the phone. Ok. Have a good day! Don’t FORGET! Bedside report! Call your families to update!”
Sometimes it is not quick. “We have a mandatory survey that needs to be done. It is in your email. I will be checking you off. If we do not complete this by Friday, you will have your name added to a different list, and trust me, you don’t want to be on that list. Also, Nursing Education has determined that we have an increase in CAUTIs throughout the hospital. We’re still at zero, yay us, but that does not mean that we’re exempted from the extra education. There’s a module you have to complete by April 1st. That’s not a joke. Also, when the patients are sleeping… oh, wait, that one is for Night Shift. Um…okay, I guess that’s it? Oh! Don’t forget your Clinical Ladder project updates are also due by April 1st. We will take you off of the Ladder if you don’t comply this year. And we mean it. You’ll lose your 5% or 10% raise you’re getting. You’re getting it for all the extra work you’re doing in your clinical projects, and representing the hospital, and volunteering, and educating…. and if you aren’t able to do that, maybe you need to take a step away from those kinds of responsibilities. If you need to, let us know. But you’ll still be off the ladder, yes, with the raise. Sorry, it is what it is. If you want to complain, take it up with Management. Ok. And don’t forget your charting! We need to do better with our pain charting. It is something that we are specifically going to be auditing every shift and if we start to notice patterns, we will end up having a conversation. OK. I think that’s it. Have a good day.”
I walk out of the report room toward the hallway. Night shift nurses start calling out room names or nurse names, either advertising which patients they have or which nurse, or sometimes just trying to hand off their iPhone so that it is no longer their responsibility when someone calls at 7:15 a.m.
And so the day really begins.
Published in Healthcare
This is an amazingly written story, TRN, stark and vivid. Of course, it’s a thousand times tougher to live it than to read it.
Your alarm list looks like a mom’s with very bad time management skills…
Before I left, we had to clock out for lunch. Do you guys have to do that? And you had to use the clocks on the unit, not the ones closer to the cafeteria. Another words, if your unit was a 5 minute walk to the cafe and a 5 minute walk back, your 30 minutes for lunch is now 20. Don’t be late! The float person has other people to get out, too!
Don’t even mention the ed stuff.
I really despise this sort of minute by minute parsimony with respect to time.
Great post.
Could the lunch craze could eased at all by donations to the hospital? Could people arrange food delivery or something to ease the pressure on you? Or is it more a matter of limited time during chaotic days and there is no way of getting around it?
Retail shares that problem of too few workers and too little time, so every day is a race. I don’t miss it.
Hey now! Or someone with sleeping problems and ADHD, but you know, your judgement may vary…
Oh yeah.
So the evil KRONOS machine. We will get to that later. Oh and I’ll talk about the commute to the Cafeteria. I might even get into the break room person limit due to covid and how they took seating away so we wouldn’t congregate (during the end of the shift, when we’re waiting to clock out).
Yeah. Cafeteria and back is about 10-15 min. On a good day.
I wish it could. There are various factors at play.
Ha! I was identifying and empathizing ;) no judgement here!
… and that’s a stock image. I don’t post my own images frequently. My phone snoozes a lot, but I’m not that bad anymore.
Usually.
Thanks, Jimmy. I hope you hang out for the rest of it. I’m sure it’s going to be quite a long series as a lot generally happens during a typical day on my unit. I’m trying to average things out a bit so that you get a glimpse of the bad along with the okay, with maybe even some of the good. But it is difficult as the “average day” can be pretty bad around here, really. It isn’t all administration or micromanaging or stupid technology not working. Some of it just comes down to the patient population and the luck of the draw. Are they surgical or medical? Are they being monitored? How closely? Are they getting discharged today? Home or to a facility?
…and perhaps most importantly, which doctor will be writing the orders?
I will say this from the IT side:
KRONOS is truly evil.
No one like it, from IT to “users” to management.
There is not a single thing about it that works right.
No doubt. You hooked Me. Keep ’em coming.
You poor, sad, SOB. ;)
God bless nurses. I was in hospital for a day and a night for a hip replacement. I was treated like a queen by the nurses. Honestly, they were kind, professional and amazingly efficient.
Whatever nurses are paid, it is not enough.
OK, as someone who has had to pay nurses, some of them are overpaid. It depends on the nurse.
Nurses are vital and key. They can also be stubborn as doctors. It takes work to get a good group. You get that, and your nursing team can be amazing.
Well the group who took care of me were amazing. I have much respect for nurses and very little for teachers.
I don’t want to get into a Pink Collar battle here. So I will say this: much like nurses, there is a wide variety of good-bad teachers. Unlike nursing, they don’t really seem to have much in the way of licensing. Nurses have to requalify every 1-2 years through continuing education, etc. Teachers do not seem to have to do similarly. It appears that they have 5 years of a preliminary credential which requires graduation and an exam, then they may take teaching coursework while teaching and have the 5 years to complete it.
I do not see continuing education.
For whatever it is worth, nurses are the most trusted profession. I suspect that is for a number of reasons which do not apply to many teachers.