The twelve plus hours during a nurse’s shift, is twelve plus hours they forget about themselves. Most do not have time for a proper lunch break, some forget to urinate, and even forget to drink water. Some people will argue that this is not nurse sensitive, and many other occupations may go through similar situations, which I will not debate, but this is The Dude Nurse, and I will speak for nurses only.
As you walk into the unit before even clocking in, another nurse calls out to you, “I have ‘X’ amount of patients for you!” At that point, you have already assume the responsibilities of your duties for the shift, the ongoing nurses are tired, ready to handoff report and go home, you may not be ready or have had enough caffeine yet, but now is your shift, and those will be your patients, your responsibility.
You clock in, get your materials ready and proceed to go check out your assignment; the ongoing nurses are looking at you like vultures stalking a carcass (but you can’t blame them, in twelve hours it will be you doing the same). You start receiving report, walking to the patient’s bedside for a meet and greet and handoff report. After each report and after introducing yourself, you ask, as you’ve been programed to, “I’ll be your nurse today, I’m going to finish getting report, is there anything you need in the meanwhile?” Hoping the patients will be ok for now, and you can move on to the next patient. This continues for the “X” amount of patients you may have this shift.
After getting report, you go back and perform a head-to-toe assessment on your patients, getting to know a little more about them, and asking for specific complaints. At this time, you are 45 minutes into your shift, have received 2 phone call (if not more), one from the lab, telling you about a critical lab result, and you have already put a call out to the physician and received orders for STAT interventions, another call is from the cath lab asking for report on your patient, and asking you to make sure the patient is ready for transport. So you begin to move faster, knocking out your head-to-toes quickly, and more focused. Now your “getting to know your patient time” is cut short as well, as you’re forced to get in and out of your patients room, while not forgetting to sign your whiteboards and hourly rounding sheets.
You are pulling a COW (computer on wheels) and accessing your orders, labs, radiology reports, daily medications, and patient information on the go. An hour has gone by and you the cath lab nurse is in your patient’s room waiting to take your patient while you are completing your STAT orders. You help them out, and move on to the next patient that is on the call light for some ice water. You’re now 90 minutes and 8 phone calls into your shift, when a physician meets you in the hallway and tell you he had to undo a dressing in your patient’s wound to assess it, if you could go redress it. As you move with your COW in and out of your patient’s room, you grab the dressing supplies and dress the wound quickly, yet compassionately, thinking simultaneously about all your patients and tasks needed to be completed.
You set a time limit for yourself. By 0900 you have to have your daily medication passing started. It is now 0930 and you just finished your first med pass, you move quicker, you may get tempted to pass a call light, but stop and ask the patient what they need, and get hit with a number 2 situation. You try to delegate the task, but end up staying to help, or do it alone, I hate leaving my patients in feces or urine. Radiology is now calling you to take your patient for an ultrasound, as you pass your last medication for you’re your last patient. It is now 1020am and you have missed the cafeteria for breakfast. You sign the patient off and look at your new orders, a few STAT orders to complete but you manage to sneak in some charting in between tasks. Your phone rings again, it is the charge nurse telling you one of your patient is vomiting, you stop what you’re doing and go administer nausea medication, while another patient is calling for pain medication they do not have an order for, so you call the physician as you administer Zofran for the first nauseous patient.
1130 am and lunch trays will be coming up shortly, you have 3 patients who are diabetics and your techs are calling you with elevated blood glucose levels, you pull insulin and antibiotics together to cluster your care, by noon you have not sat down yet, but you are okay with that because your patients are receiving the care they need. 1200pm hits and you finish your insulin coverage and receive your 15th call of the day, your patient in 405 is telling you the doctor told them yesterday they will be discharged today by noon, and their ride is here, but no discharge orders is in yet. So you place another call out, and you know you won’t receive a call back anytime soon, you try to educate the patient on the discharge process, and that once the doctor makes rounds you will have them ready to go home. They are not happy about it, and a few obscene words are thrown at you, and you assure them you will have them out as soon as possible.
1330pm, you have medicated everyone for pain, and all other medications have been given, and you can now have lunch. 30 minutes never go by so quickly as when you are trying to eat lunch, and you are interrupted 4 times with phone calls about your patients, and the patient you medicated earlier is throwing up again. This is the first time you have had water to drink since 0700am. You pick yourself up and return to the unit to learn your patient now developed chest pain, the other still vomiting, and the patient’s family member is at the desk yelling at the charge nurse that he’s been here for hours waiting for the doctor to discharge his relative, you call for a STAT EKG and administer something to relieve your patient’s chest pain. EKG shows acute changes, and you MUST intervene quickly.
You use your critical thinking to breakdown the steps to treat chest pain, as you call another physician, your 2nd line is ringing, one patient is in pain, and the other still vomiting. You ask another nurse to help you out and administer pain medication while you attend to your more critical patient. You ask your tech to help the nauseous patient, and let her know you can’t give anything for nausea just yet, because it is every 6 hours.
1500pm, you finally have a little time to complete a little more charting, praying for 1900pm for shift change. Not because you hate your patients, or you hate your career, but because dealing with people in general is draining and exhausting, and these individual lives depend on you. You are mentally tired, have received countless phone calls interrupting your care. You have been cursed at, you have yell at, kicked out of a room for being “incompetent and slow” and but you continue to push through because you are a nurse. 1645pm and you remember you have not urinated all day, but have made sure to charge all your patient’s outputs precisely. All you have had was a bad lunch with multiple interruptions, but made sure your patients were happy with their food, and ate a good lunch to help with recovery. 1800pm you receive another call from the monitor tech, your patient’s heart rhythm changed and he is now in v. fib, you run to assess and no response or pulse, you begin CPR and yell out for someone to call a code blue. You work along side your peers and physicians for the next 45 minutes to finally reestablish a pulse and transfer the patient to an intensive care unit. It is now 1900pm, and night shift is rolling in, you have not urinated, you have drank water once, you’ve sat down for a total of 50 minutes perhaps, you are tired physically and drained mentally. But you have touched and saved lives, you have treated your patients to the best of your ability, regardless of the multiple obstacles thrown at you during your 12 hours shift.
You tell yourself, I am the best nurse I can be, I will make mistakes, I will have bad days, but I will learn from it, and I will make sure my patients have a good day. You make jokes, you make your patients laugh, you hold them when they cry, you console them, you dress their wounds, you treat their pain, you “jump” on their chest, you save their lives. You are a nurse, a real life superhero, battling sickness and death, treating people at their worst times, but you do it with respect, with compassion, with love.
The Dude Nurse
Klaus Campos, BSN-RN