This week is Nurse's Week, and May 6th was Nurse's Day. In honor of this largely ignored (well, okay - there are a few Hallmark cards and a free sundae day at work) week of appreciation, I thought I'd tap out just how many hats a typical nurse wears in a shift. Buckle up, kids - this is not for the faint of heart.
First and foremost, an RN is the eyes and ears of the MD. We carry out the orders that MD's prescribe, after assessing if the order is appropriate. Doctors are human, too, and sometimes will order a drug that a patient is allergic to, will forget to order finger sticks on diabetics, or neglects to order tube feeding on that intubated guy. RN's then implement these orders and evaluate the response. If that dose of diuretic didn't make the patient's output increase, or those 2 units of blood did nothing to raise the patient's blood count, we don't just let it go and assume that the doctor will find out tomorrow on rounds. Not only do we notify the MD of the outcome, we also learn to anticipate what the MD's orders will be. If the order differs from what we're used to, we question it and in some cases ask for justification.
We are the ones that are at the bedside the most. Other disciplines come and go - dietary, the ultrasound tech, the phlebotomist, the x-ray tech, the social worker - they drop in here and there, but your nurse is going to be the one to sense that something isn't right.... if there is actually continuity of care and your nurse has been able to take care of you multiple days in a row, this is a real asset.
A benefit of this is that a nurse will advocate for his/her patient. If their patient is at risk for skin breakdown, the nurse is the one who pushes for that special air bed. If the patient doesn't like what came on their dinner tray, the nurse calls down to find something else. I've gone to visit 4 different floors to find a can of Sprite for a patient long after the cafeteria had closed. If the patient becomes nauseated at 3:30am, we go to the phone to bug the MD for an antiemetic. Better yet, if you luck out with an experienced nurse, they will have already lined up some anti-nausea medicine long before you need it.
When the doctor has ordered a medicine to be given stat, and an hour later pharmacy hasn't gotten it to the unit, the nurse harrasses the pharmacist until it gets there. The nurse makes sure that you get medications on time, that it's the right drug for the right patient administered at the correct dose via the right route. The nurse makes sure the phlebotomist shows up on time to draw your labwork (or draws and sends it off herself), remembers to check for the result, interprets the result, and either calls the doctor for orders, or carries out orders that have already been written on condition.
When infusion pumps start beeping for no reason, the EKG monitor suddenly goes blank, or the computer freezes up, the nurse doesn't just call up biomed without first troubleshooting the problems themselves. When I worked dialysis, part of my cart included a plumber's wrench and several washers and faucet aerators. When I had to hook up the dialysis machine in the patient's room, I never knew what kind of sink I'd end up with - sometimes the hose wouldn't fit right and I'd have to change the aerator. We change the batteries in the mini-infusers, we empty the garbage, and if we've urgently transferred a patient to another floor to accomodate a "crash and burn" from ER, sometimes we even clean the room if housekeeping hasn't had a chance to clean it as fast as we need it.
We teach new doctors how to use the computer system, we show them for the 100th time where we keep the progress notes, and we put the charts back in the rack so that they're easy to find for the next person. We run controls on several types of machines... we check the crash carts every single day, and test the defibrillators. My particular unit has 6 defibrillators that are checked every night for battery power, recorder paper, and overall function.
We competently use and troubleshoot computers, infusion pumps, balloon pumps that sit in your aorta, continuous dialysis machines, ventilators, non-invasive positive pressure machines, suction equipment, defibrillators, nerve stimulators, crash carts, external pacemakers, dopplers, medication machines, and transport monitors. We calibrate and maintain the various tubes that the patient has in their bladder, rectum, nose, mouth, trachea, vein, artery, abdomen, and brain. We constantly assess, treat, evaluate, and alter the treatment plan.
We fill out and file TONS of paperwork: admission forms, blood product consents, surgical consents, pre-op checklists, nurse's notes; blood sugar, restraint, lab, and wound care flowsheets; EKG strip papers, advance directives, flu shot consents, care plans, x-ray reports, MD orders, and Internal Audit forms. Yep, we even have to write each other up for the mistakes that happen: med errors, inappropriate transfers, missing eyeglasses, and faulty equipment.
We are the ones who re-explain what the doctor told you 3 hours ago that has just now sunk in. We explain the squiggly lines, why the vent is alarming, and just what those squeezy boots are for, anyway. We teach you about what's going to happen tomorrow during your open heart surgery. We gently tell you when it's time to let go, time to keep fighting, or time to just ... wait and see.
When a complex patient goes to CAT scan, we coordinate respiratory therapy, transport, flex nurse, and accomodate the schedule of the CAT scanner. Do you have any idea how difficult it can be to make sure that 3 very busy people are in the same place at the same time? We find the old medical records, we deal with patient's meds that aren't in the hospital formulary, and gather every supply needed when the doctor suddenly needs to insert a chest tube, endotracheal tube, ventriculostomy drain, swan ganz, art line, or central line, or God forbid, open someone's chest emergently at the bedside. If we've been there awhile, we even automatically bring the right size sterile gloves and the kind of suture the MD prefers. After we've assembled the supplies, we are there to expertly assist with these procedures.
We deal with every single kind of person imaginable: those who are demanding, scared, out of control, manipulative, unappreciative, violent, combative, crying, screaming, uncompliant, chatty, mentally ill, angry, depressed, confused, disoriented, critically ill, on the mend, thankful, kind, sleepy, or dead - both expected and unexpected. Some people hate where they are and why they're there, some people are desperate to stay within the comfort zone that a hospital can provide. We must remain objective, in control, calm, competent, and kind to those who are disrespectful and rude. We must always be available to the patient at their bedside - we don't get to poke our heads in, check out some labs, write a progress note, and leave. When the patient has put on their call light for the 50th time (I am NOT exaggerating here) so that we can change the channel, find a new TV remote, put them on the bedpan, get them off the bedpan, bring them their pain medicine, put a cool cloth on their head, rearrange tubes/wires, find the phone, help them out of bed, clean them up, change the sheets, reposition, suction, fix monitor leads, or shut the blinds, we are there. We must be diplomatic with angry patients, visitors, family members, doctors, and other nurses. We interact with every single department in the hospital, and several outside: coroners, organ banks, funeral homes, ambulance services, and other hospitals.
We must ensure adequate and safe staff for our unit. If there is a sick call, we either have to rearrange patient assignments, or sit down at the phone and start calling people to come in. We arrange transfers with other units and other hospitals, we organize float nurses, give days off, and we are always at the ready to accept patients, both planned and very ... unplanned.
We are constantly exposed to every bodily fluid you can imagine, and several that you can't. We don't get to refuse to care for infectious patients - if a patient is in isolation, we don the gown, gloves, shoe covers, and mask every single time we enter the room, even if we have to enter it 30 times a shift.
There are a lot of rewards. Every so often you'll get that patient that is genuinely a joy to care for. A nurse takes care of people that are at a low point in their lives, or at an especially high point. We must display compassion, intelligence, confidence, and adaptability. We are supported by amazing coworkers consisting of other nurses, doctors, nurse aids, pharmacists, phlebotomists, nutritionists, physical therapists, managers...
It takes a lot of teamwork, personnel, and skill to run a hospital. Every department is invaluable and contributes fully to the success of the hospital. But while not every department can contribute in a nurse's capacity, a nurse can contribute in the place of almost every department. We are able to do at least a little of what everyone else can do.
Happy Nurse's Day!
