A Day in the Life of a Nurse
What is a typical day for a Nurse like? What do they do? What do they go through? When becoming a Nurse, it's important to understand the realities of a Nursing career and to follow the Nursing code of ethics. Each day is different and can be both fulfilling and exhausting. Below, is an example of one day in the life of an ICU Nurse.
6:45am — I arrive to the unit for my daily assignment.
7:00am — I hit the floor running. We are short staffed because one of the assigned Nurses has called in sick. I have five patients on ventilators with no Respiratory Therapist. Mr. Poston keeps triggering the pressure alarm on his ventilator, because he is lonely. I don't have time to play with him. I have 45 medications and 4 tube feedings to hang before 8 o'clock. I have to run back and forth between drawing up meds and hanging tube feedings to answer the alarms in two different rooms and suction the patients' traches out. The oxygen saturations finally hold and come up. I return to drawing up meds.
8:30am — All patients have been assessed, meds have been given, and tube feedings hung; I's & O's are done for the morning. My charting hasn't been done. I am starving, but if I don't chart now, I won't have another chance until later tonight. I sit down at the computer, and it takes me nearly an hour to chart.
9:20am — The ventilator alarm begins to sound in one of the rooms. The Nurse that is assigned to that room isn't answering it. Where is the Respiratory Therapist? I have to run because the ventilator has started to sound the critical alarm. The patient has come off the vent. The pulse oximeter is alarming – low sats, which means the patient is not getting oxygen. The patient is turning an ashen color of blue, but he's conscious. The first thing I do is check his airway, and I find that his tracheostomy is resting on his chest with the balloon (otherwise known as a cuff) inflated. I grab a syringe, deflate the balloon, reinsert the trache, re-inflate the balloon and reattach the circuitry that attaches to the ventilator. I hit 100% oxygen and manually deliver breaths to the patient. His color comes back. After only about 1 minute, his saturations have risen above 92%. I stay at the beside for a minute longer to make sure that he is alright, and then I return to my charting. The computer froze up because I was away too long. All of the charting I did has somehow gotten wiped out. There's no more time for charting now, I'll have to try again later.
9:30am — Because of the computer and the trache, my 0900 meds haven't been given out. One of my colleagues - the Nurse for the patient whose trache came out - sticks her head out of a room and asks me if I need help. Yes, I think to myself…you can help me by taking care of your patients, so I don't have to. I keep this thought to myself and tell her "No, thank you. I'm fine". I tell her about her patient and I think I may sound a bit irritated because she apologizes to me. I check myself and change my tone. I tell her that it was no problem, but if she wouldn't mind filling out an incident report on her patient I would appreciate it. I will give her the details. She agrees.
10:00am — The 0900 meds are given. I turn and fluff all the patients. Mr. Poston is still setting off the ventilator alarm for attention, and I am still running in there every 3–5 minutes. I set him up with some magazines, but I still do not have time to spend the time with him that he wants. I have charting to do and trache care to perform.
10:30am — Here come the doctors. There are new orders. Oops, I almost forgot the 1000 catheter I have to place. I am speed walking. I still haven't eaten or used the bathroom since I got here.
10:45am — I am sweating and wonder how much someone with my frame and body weight can sweat before they dehydrate. I need something to drink. I tell the other Nurses that I am going to get some ice water. One of my patients begins alarming again. The other Nurses are in the hallway talking and glance at me as I walk off. Out of the corner of my eye, I look back to assure myself that one of them is getting the alarm.
11:00am — One of my patients is being extubated after about 2 1/2 weeks on the ventilator. A precarious situation at best, so I wasn't sure if she would fly. I have to coax the patient to take deep breaths and get her 02 sats out of the 80s. I finally assess her again and she seems to be fine. I go back to do more of my charting. The computer is running slowly again.
11:23am — I look up at my monitor and realize that my extubated patient is not flying. Her sats are down, pressure's up. I go in to find her very upset and agitated. She points downward. I lift up her sheet and see that she's lying in a massive pool of bloody stool. Her fecal incontinence bag has suddenly burst. She has had three massive GI bleeds in the past 3 weeks. The end product was now in her bed. I grab another Nurse to help me clean her up. We lay her flat and start to roll her and her 02 sats go down even more. She has audible wheezing. We straighten her back up again. I inform the docs, who order a chest x-ray. We then decide that if we crank up her 02 and get two additional Nurses to help us, we can get this poor woman cleaned up. We were wrong. This time she desats and bradys down to the 40s. One of the senior Nurses tells me that if this patient has a choice between breathing or lying in bloody stool, she must choose breathing…or else die.
1:50pm — By now, it's almost 2PM. The charge Nurse is telling me I must go to lunch. I am also supposed to report off to another new Nurse who is on orientation. I tell her I don't feel comfortable with this; there are too many tasks that need to be done. She tells me, "Well, the orientee has to learn, and if she can't do it then you need to delegate to someone else."
2:00pm — I find the orientee. Her patient has just returned from CT and his blood pressure is falling dangerously low. We collectively decide that I will delegate my tasks elsewhere. I find a Nurse to help me and she agrees to draw all of my labs (yes!).
3:00pm — The charge Nurse insists I get off the unit and go to lunch. I head down to the cafeteria. On the way, I realize that something is going on with another patient I have had many times in the past. She's status/post lung transplant and has been intubated/reintubated at least 3–4 times in the past year. I am sensing that she is going to die today, as I see many of her family members around. I've gotten somewhat close with them over the past couple months and it frustrates me that I don't even have a single minute to spend with them and maybe give some comfort.
3:13pm — That changes once I sit down to eat my cold pizza. The husband of this dying patient approaches the lunch table where I am sitting with a couple of other Nurses from my unit and says tearfully, "I just want to thank you for all of your caring and support." I jump up from my chair. "Has Beverly passed?" "No," he says, "but she's going to." I give him a great big hug and burst into tears myself. So much for emotional decompression.
4:00pm — I am back on the unit with renewed courage and resolve. I check on my extubated patient. She is more and more agitated. Since she tolerated laying flat for the Physician to pull one of her central lines, I decide I will risk cleaning her again. Boy – am I wrong. This time she bradys down to the 30's, and all the other Nurses are in the break room - eating cake for a baby shower.
5:30pm — I am admitting a patient being worked up for possible liver failure. She is really scared and in pain. With a PCA. As much as I consider PCAs a wonderful invention, they always tend to exasperate me. The user interface is really difficult (maybe so the patient can't figure out how to reprogram it). You also need a second RN to witness every change you make, and it involves heaps and heaps of documentation, including a computerized pain assessment form. Filling it out feels like trying to shove a square into the circle hole.
5:45pm — The patient tells me that her mother is flying in from another city, where her 30-year-old brother has just had surgery to remove his jaw. He has throat and neck cancer. So, at some point I need to intercept the Mom and make sure she's not hysterical. I am starting to tear up, myself. As a new Nurse, I have not yet developed that hardened exterior which prevents me from with over-emoting on the job.
6:15pm — I consider this patient's pain relief a priority. I had to negotiate with the Resident three separate times to increase her dosage. He keeps upping the demand dose by 0.1mg, which is ineffective. He is finally advised by the attending Physician that it is okay to implement a basal rate of 1.0mg/hr. Each time he rewrites the dose, I have to reprogram the PCA, and find an RN to witness. This whole process takes an hour.
7:15pm — I am exhausted but, before I leave, I stop in and see Mr. Poston. He asks me why his daughter doesn't come to visit him anymore. Boy, I wish these patient's families would spend some time with them. Most of them are throwaways. Their families can't deal with the illnesses and slowly, they just stop coming to the hospital. I tell him, "I don't know but, I'm here." He smiles at me. I pat his arm and talk with him a few more minutes before I head home.
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