Friday, June 11, 2010

what happens during HALF of my day?

Have  you ever wondered what a typical day is like for an RN in the ICU? Well, I must say, there usually is no such thing as "typical" since patients are not on any real schedule. The day follows however their condition warrants. But I have decided to record what occurs during HALF of my 12 hour shift to the best of my ability...




Timeline of my day:

415 alarm

416 shower
425 out
426 feed cat, put lunch into bag, prepare breakfast
435 eat/check computer
445 dry hair, get dressed
458 leave house
520 arrive to work
528 clock in after riding my bus, etc.
530 after putting away bag, venture into the ICU
532 check board for name, see who I have, get paper and sticker, print ekg strips from monitors
535 begin getting report on two icu patients. Info includes, name, age, allergies, code status, past medical history, dr’s/consults, history of present illness, mentation, respiration, cardiac, gi/gu, lines and drips, skin, family, labs, cultures, pending…
0600 Look through chart, write down times for meds/accuchecks, read quick progress md notes
0605 write down labs, not abnormals
0610 chart 0600 vital signs, including: blood pressure, HR, Rhythm, sats and O2 %, temperature, RASS scale, dump urine for the hour and note milliliters.
0612 Begin head to toe assessment: listen to lungs, heart, bowels, check pulses—radial and pedal. If pt alert, ask if they have pain, how they slept, follow-up with concerns. If ventilated and sedated, make note of ventilator settings, suction the patient if needed, tidy up the room (!!), check pupils. Zero any alines, cvp’s, ScVO2 monitors, check alarms on monitor, adjust to personal setting. Check room, make sure ambu bag, enough flushes in the drawers/make sure room is stocked for a code!
0620 if patient or family does not need anything, such as blanket, ice, bed pan, water, etc. then begin   to chart assessment on flow sheet (approx 3 pages). Go through chart and if not already done, update special treatment pages, education, graphics for IV access, treatment/plan of care, remove 234234 extra papers that do not belong in the nurse’s chart, reprint patient id stickers.
0630 Onto patient #2… chart 0600 vital signs, including: blood pressure, HR, Rhythm, sats and O2 %, temperature, RASS scale, dump urine for the hour and note milliliters.
0632 Begin head to toe assessment: listen to lungs, heart, bowels, check pulses—radial and pedal. If pt alert, ask if they have pain, how they slept, follow-up with concerns. If ventilated and sedated, make note of ventilator settings, suction the patient if needed, tidy up the room (!!), check pupils. Zero any alines, cvp’s, ScVO2 monitors, check alarms on monitor, adjust to personal setting. Check room, make sure ambu bag, enough flushes in the drawers/make sure room is stocked for a code!
0640 if patient or family does not need anything, such as blanket, ice, bed pan, water, etc. then begin   to chart assessment on flow sheet (approx 3 pages). Go through chart and if not already done, update special treatment pages, education, graphics for IV access, treatment/plan of care, remove 234234 extra papers that do not belong in the nurse’s chart, reprint patient id stickers.
0650 Breathe. Recheck all patient’s. Hang any meds for abnormal labs, like potassium.
0700 Patient #2 has temp 103.4. Order Tylenol, wait for Tylenol, bring patient water, call to have the room temperature turned down. Receive Tylenol, check patient name band to medication record, give Tylenol. Check blood glucose, adjust insulin drip. Tell patient to go back to sleep for now. Record 0700 vitals, dump urine and account for that hour’s output.
0720 Record VS, dump urine. Suction patient. Try to get him to open eyes. No luck. Measure serosangenous fluid in chest tube, clean bloody mouth.
0730 Recheck patient #2 temp. Still 103, continue to check.
0735 make note of patient’s increased HR
0740 MD walks by, give tiny update, nods and says ok.
0750 Orders from another doctor on patient #2..blood cultures x 2 from port and peripheral, AM labs.
0800 draw labs. Call phlebotomy for peripheral after failed attempt.  Record vitals, dump urine.
0810 record patient #1 vital signs, check blood glucose, give SQ insulin, dump urine. Record all.
0830 Rechecking patient #2 glucose, interrupted by respiratory. Want Pt #1 off sedation to do a breathing trial. Un-don gloves, wash hands, excuse self. Walk across hall, press “Stop” on Fentanyl drip, and tell them he is off. Walk back across hall and finish checking blood gluce.
0830-0900 General maintenance…talking to family, grabbing water, helping with turns, waiting on phlebotomy Give meds, hang antibiotics. Order more drips from pharm.
Pt fails breathing trial. Placed back on fentanyl drip. Speak with daughter along with ARNP regarding end of life.

0900 ROUNDS. MD with Charge RN, RT, pharmacy, nutrition stand in front of room and I give my update on the patient. We discuss care, what to do, etc. repeat at each room.
0915 Scan all new orders, write new drugs on the Medication record.
Record 0900 Vitals, dump urine.
0920-1015 Note pt #2 HR to be labile, jumping up to 160’s for a few seconds. Tell intensivist, order 12 lead ekg, find patient is now in atrial fibrillation. Order cardizem drip, give 10 mg bolus, and start the drip. Monitoring BP and keeping MAP>65. Pt tolerating well…
In the meantime, also speaking with husband about care, and talking with patient #1 daughter while giving AM meds…crushed through small bowel feeding tube, some through IV…
Recording Vitals, dumping urine, monitoring output.
Reassess both patients for the 4 hour head to toe assessment (see 0632 for what this entails), rechart in flow sheet. All the while making notes in the progress record.
1100 repeat. Suction, turn, glucose, vitals, titrating drips, discussing comfort measures only with family, drawing labs…
1145-1215 eat lunch and watch part of the World cup!
1220 Return to floor. Chart vitals, urine output, check on everybody. Retrieved ice, blankets, etc. Give meds, hang antibiotics
Echocardiogram arrives for #2. Check blood glucose, adjust insulin drip. Note that she returns to sinus rhythm. Await pending cardiology for further orders on the cardizem drip.
1225 glucose on #1. Waiting for renal to decide if pt can be diuresed..up 60lbs since admission.


And there you have it, half of my 12 hour day. The funny part is that it all seems so simple, but at every and any given moment, I am literally doing 20 things at once. Monitoring the patient, thinking about the disease process, correlating what I see in real life with what the patient is presenting on paper, talking to families,  waiting for MD’s to call back, coordinating with other disciplines like respiratory, trying to think ahead to worst case scenario...what is going on with the patient? What could happen? Monitoring tiny changes in blood pressure, heart rate, temperature, urine output, weight... Calling pharmacy for meds that aren’t loaded, giving ice to family, patient’s. Answering countless questions from patients, doctors, families. Explaining disease processes to families..Helping other RN’s with turns and clean up's…

CrAZY=the life of an RN.
If you or your family member is ever in the hospital, try to remember that the nurse is doing 2354234 things at once and is doing the best he or she possibly can. We get that you're stressed and sick and maybe scared. We do! I promise. We're right there with you. 

Questions?

13 comments:

lovelyascharged said...

Dang, woman! I hardly followed that. More power to ya for making it through the day and impacting so many lives as you do it...

Rachael said...

That's def a busy morning!
I've been watching World Cup too! <3

april said...

Ahhh I can't believe it's been a whole year since I've been in the hospital!

Kelsey said...

oh wow! i feel drained just reading this. i got up at this time this morning.. thank god for coffee. ur one though cookie! <3

Iris said...

Sounds super busy!! I remember those rounds in the MICU during clinicals. :) And I always go on the computer in the morning before work, too.

undergrad RN said...

Meow, lady... That's quite a day, and it's only halfway! Whew! lol

Susan said...

I don't think I could manage to write down what I do! It'd be way too all over the place...I should probably try though! It'd be a good comparison between an ICU nurse and a floor nurse!

The pt was up SIXTY POUNDS from admission? Oh my!!

Raspberry Stethoscope said...

Susan, it is definitely a shell of an agenda when compared with what i do. it would be absolutely impossible to encompass what we do as nurses through words, but i was just giving a general idea!

and yep, 60lbs from admission. that's what liver/renal failure will do, i guess. he was literally leaking all over the place from his tissues. it was terrible. obviously they were making him cmo. renal said there was no way he could be diuresed. he would not handle it.

Aalya said...

Hello! I just came across your blog. Im going to be starting an ICU job soon. Im pretty nervous as it's my first job out of nursing school. I've started a blog of my own. I want to share my new nurse experiences with other new nurses and would love some advice from fellow experienced nurses :) Please take a look and subscribe! thenewRN.blogspot.com

Lisa said...

Wow what a day! I sometimes feel stressed when I have 8 or 10 patients (on a rehab or acute care unit) as an LPN when we are a nurse short (RN or LPN)! Now I see I have nothing to complain about.

Tine said...

Hi! Found your blog through Bad Emma =) This was a great post that gives a little insight to your routine, thanks for sharing!

Staci said...

Hi!! I just came across your blog, and you are amazing!!I actually just got a job as a night-shift nurse in an ICU in south Florida. I'm a new grad and am excited and nervous at the same time..


Any advice?

Staci said...

I just came across your blog and you are amazing!!I just got a job as a night-shift ICU nurse in South Florida. I am a new grad, both excited and nervous.

Any advice?!