My alarm was set for 0600. Usually I wake up an hour or so before and have time for coffee, reading and a liesurely bath. Not this time, I slept right till the alarm so my normally leisurely preparations were somewhat rushed. Rather than omit the coffee, I omitted the bath. Coffee is an integral part of my day; two cups for work and one for home, all mixed with soy milk, flavored cream and a spoon of sugar.
Rushing out of the nice warm house at 0645 into frigid -35 degree air is more than a little shocking to the system. To top it off, I found that the electrical outlet which was functioning when I plugged the car in, was no longer working. The car still started but it was sluggish and was only starting to warm decently by the time I reached the Tecumseh Parkade at HSC.
Its a 5-10 minute walk from the parkade to D2, dependent on whether I walk through the tunnels or brave the elements outside. Due to the bitterly cold weather lately, I've been taking the tunnels to stay warm.
When I arrived on D2, all the nurses were already in the conference room giving report. Let me tell you, when you get five night nurses and seven day nurses in one small room all talking at once, it gets quite loud. Occasionally one of us gets frustrated and yells for everyone to shut up. It quiets down for a minute or two and the volume slowly creeps right back up. This lasts for ten to fifteen minutes. The night nurses go home, and the day nurses go out on the floor.
On a normal day shift each nurse has four patients. If we're short a nurse, that goes up to five. Yesterday I had five, today I started with four and am currently down to three. That makes me first in line for an admission. Our charge nurse today has five patients and is responsible for the whole unit. Not quite a fair distribution in my opinion.
Usually the first thing I do when I leave report is gather up my medication records for my patients, staple my patient notes together and write up a worklist for myself. I've discovered that with a worklist, I leave less things undone and make fewer errors. As I complete tasks I scribble them off my list. Items on my worklists include items like vital signs, assessments, dressing changes, giving meds, changing IV bags, administering pain medications, writing notes, checking charts, and many other miscellaneous things. And, yes, that includes bed pans and bum wiping.
Next I go around and introduce myself to my patients and inquire if they need anything immediately like pain meds, or water, or anything. This doesn't take very long on most days.
Following this, the day very rarely goes according to schedule. This is when unexpected things start coming up. For example, 48-1 needs to go for an x-ray and 19-3 is being called for surgery. The list goes on. If a patient goes for x-ray, we need a minimum of two people to assist because the patient must go on a stretcher and usually requires two people to transfer the person to the stretcher. Transport personnel come up to the ward and take the patient to the x-ray department. The process is reversed when the patient is finished in x-ray, again requiring two people to get the patient back to bed. Some patients require up to five or six people to move from bed to stretcher and back again.
When a patient is called for surgery, it used to be that we sent them to the O.R. via stretcher, now we send them on their beds. Before a patient is considered ready to go for surgery, the paperwork must be done and this is the time-consuming aspect of the job. An pre-op checklist must be completed, a pre-op note documenting the patient's status must be written, all the papers pertaining to the patient must be in the patient's chart, the I.V. pumps must be attached to a pole on the bed, and a pre-op dose of antibiotics must be given. O.R. personnel come to get the patient from the ward and they don't really appreciate when they have to wait to long while the nurse scrambles around getting stuff ready. Unfortunately, this cannot be avoided in some cases.
Barring any interruptions, following vital signs and assessments, I go back to the med room and get each patient's medications. Our med delivery system is computerized and accessed it via name and fingerprint. Narcotics require counting before the computer will give us any. We carry blue trays with white cups with the patients room numbers on the cups for delivering the meds.
The first few hours of the shift are normally the busiest of the day; the afternoon is generally used for paperwork, which, as any nurse will tell you, there is always plenty.
No two days are alike, or even similar; this is just a generalization of our work day.
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