Jill wakes up at 5:00 am on Wednesday, showers, gets the kids off to school, and makes a 35 minute commute to the large metropolitan hospital where she works.
By 7:00, she is reviewing her four patients’ electronic medical records for updates in their lab work, and x-rays. By 7:15, she gets report from the night nurse. Three of her four patients are stable, but the 42 year old man in room 370 began having chest pain at 7:05 and the oral Nitroglycerin and IV Morphine are not helping the pain. Jill immediately goes to the patient’s room to assess him. Blood pressure and pulse are stable and his heart monitor shows normal sinus rhythm. But Jill has many years of experience as a nurse, and intuitively knows that her patient is not “stable”. She orders a stat EKG and pages the doctor.
The doctor arrives and reads the EKG report. “The patient is having an MI (myocardial infarction or heart attack) and we need to get him to the cath lab.” Jill starts an IV and readies the patient for the cath lab. By 7:40, the patient has left and she turns her attention to her three other patients.
Mrs. M has just received word that the pain she has been having in her lower chest is pancreatic cancer. She is relatively young, just 49 years old. Jill walks in just as the doctor has left. Mrs. M. is crying and can’t believe what she has just heard. Although Jill needs to get all of her assessments done and pass the 8:00 medications, she quietly sits on Mrs. M.’s bed and holds her hand. She asks Mrs. M. if she’d like to talk with the chaplain. She calls in the chaplain and tells Mrs. M. to call her if there’s anything else she can do.
It is now 8:10 and one of her other patients, Mr. C. has his call light on. He asks her, “Where are my 8:00 pills? I always take my pills at 8:00 sharp.” She tells him she will go them now but first she needs to check him over. He then says “I need to use the commode, can you help me?” She happily obliges, and while he is on the commode, the nursing assistant comes in and tells her one of her patients has just fallen while trying to get to the bath room.
She asks the nursing assistant to sit with Mr. C. and she goes to check on the patient that has fallen. The patient insists she is fine, so Jill helps her back to bed and calls the doctor. She then readies the patient for x-ray so the doctor can see if she has broken any bones in the fall. She reminds herself that she will need to complete an incident report.
It is now 8:30, and the family members have gathered with Mrs. M. and they would like to speak with the doctor. Jill pages the doctor and asks him to come and speak with the family. The family has many questions, and Jill answers what she is able to until the MD arrives.
She then turns her attention back to Mr. C. She brings him his pills and he begins to tell her story about his life during World War II. She patiently listens and then tells him she needs to go check on her other patients.
The lady who has fallen has returned from x-ray, and thankfully, she has no broken bones. However, the doctor was just in and wrote orders for orthostatic blood pressure readings to try to determine the cause of her fall. Jill records the numbers and returns to the desk to start some charting.
At 10:05, she gets a call from the cath lab stating that the patient will need to have a coronary artery bypass tomorrow morning. He returns to the room and is quite anxious.
She stops to reassure him and talk to him briefly about the surgery, promising to come in later and do the patient teaching in preparation for the surgery.
Jill then helps the nursing assistant with bathing, oral hygiene, and ambulation of her patients. By 11:30, she is “starving” and goes to the break room to eat her lunch. At 11:35, Mr. C. goes into ventricular fibrillation, and a Code Blue is called. She rushes out to his room, knowing that this will be a “no break” day.
This story is not an exaggeration. It is part of every day life for a nurse working in a critical area.
You can see why the job description is “Patient Listener, Assessor, Medication Administrator, Defibrillator, Teacher, Critical Thinker, Vital Signs Taker, Bather, Mother, Ambulator, Documenter, and Counselor,” and all before noon on a “regular” workday!