A Day in the Life of a Nurse

This post is dedicated to my cousin Janssen, who has been the voice of encouragement suggesting that this blog is being read. Thanks Janssen. :)

Sometimes as I head into the hospital for a twelve hour shift I catch a glimpse of myself in the full length windows at the front of the hospital, all decked out in my scrubs with my nametag and my stethescope, and I wonder what the next 12 hours might hold. And then I wonder if people really understand what it's like to be a nurse.

One night about two weeks ago, I came on shift at 7 pm, ready to work the night away. I had my 20 oz jamba juice with the caffeine free energy boost (I wonder what's in a caffeine free energy boost anyway) and immediately walked into my patient's room where the day shift nurse was furiously typing up reports on the computer, and trying to multi task about five different things at once. As she ran next door to answer a call light, I offered to place an NG tube (nasogastric... through the nose into the stomach to suck out stomach contents on patients who are not digesting properly) on the patient who's room we were already in. NG tube in place with no problem, I walked next door to find patient number two complaining that her chest tube dressing needed changing... again. We trouble shooted and solved that problem, and after about a half hour of solving problems, sat down for report. So, I started out the shift, a half hour behind, and with several tasks left over from the day shift nurse, who had had a hectic day. This of course did not bother me, because I know what it's like to have a day like that. Keep reading. :)

After spending a good 45 minutes settling patient number one, various problems kept arising... missing medications from pharmacy, patient's ventilator kept alarming because the patient was overbreathing the machine due to poor pain control (which we fixed with higher doses of morphine :)) etc. etc. Every time I tried to get next door, something else would alarm, or need immediate attentiong. Finally, I looked at the chest xray verifying central line placement before giving any meds through it, and realized that it was not correctly placed. The doctor then had to insert a new central line and needed assistance with set up. I had poked my head in next door several times assuring patient #2 I was coming shortly, but then one thing after another seemed to go wrong and I was already two hours behind and stress levels were rising. It was now 9 pm and I was just getting to my second, much more stable patient. She was very annoyed, made the comment that "You ought to be able to call more help in if you can't get to your patients" and then proceeded to tell me that her entire dressing would have to be changed again. I took a deep breath, smiled, and started in on the task. Within two minutes all alarms were blaring that my heart rhythm next door was dangerous and I bolted out of poor patient #2's room again. Eventually, I returned next door, and sometime around midnight, I sat down for a moment to enjoy my melted jamba juice.

Two weeks later, I was on day five of six... not completely in a row but with a turn around from night shifts to day shifts. I was exhausted from extreme lack of sleep, and my body clock was majorly messed up. I had two patients in the morning, both of which were to be transfered out, which made for a fairly calm morning. Patient number one went at 10:30 am, and patient number two was waiting on a social work consult. Early in the afternoon I was informed that I would be getting a GI bleed patient coming directly from a clinic, admitted by one of our critical care docs. I was still waiting on transfering my other patient, but was ok with the prospect of taking a second amidst the transfer process. Just as I was finishing up my 15 minute lunch (ah the luxery of a 15 minute lunch! Normally I'm lucky to get five! AND I have become extremely talented at eating a sandwitch in under a minute!) I recieved a call from the same critical care doctor, asking to speak with the charge nurse. As the charge nurse, my good friend, was downstairs getting her own fifteen minute lunch, I took the message that we were to take another admit, a bone marrow transplant patient who had a severe lung infection, and upon doing a bronchoscopy (tube down into lungs to take pictures and irrigate) in the endoscopy department, had gone into a very rapid, dangerous rhythm and would be transfered to ICU for a cardioversion. (If you've ever seen the shock paddles on TV, that's what it is... we just use half the voltage on a patient who isn't dead). I told the doctor we would take it and then ran downstairs to inform Aubrey that we were getting a patient, and I was taking her.

As luck would have it, my somewhat calm morning exploded into a horrible afternoon. As I was waiting for my cardioversion patient, in rolled the GI bleed patient... who I thought wasn't coming until much later. I scrambled to get him settled in the five minutes before cardioversion patient rolled through the door. With two brand new admits, 7 pages of new orders between the two of them, plus transfer orders on my original patient, I frantically tried to keep up all afternoon. Upon cardioverting, my little cancer lady converted beautifully back into a normal heart rhythm. I love to watch that happen, it is so miraculous. We were all happy with the result. That afternoon was one chaotic mess after another. Pharmacy missed an important medication order that I didn't notice was missing until the patient went back into the rhythm three hours later because she had not been given the proper medication. The nurse practitioner was yelling, and I was beside myself at having missed it... we depend so much on our great pharmacists that we go straight to the computer and simply give what they have told us to give based on the orders. I should have caught it, but so should he. And I was the one responsible for her having to stay another night in the ICU. Meanwhile I was frantically trying to keep up on my new admit orders next door as well, and transfer my third patient out. The last straw came towards the end of the day when the doctor ordered a very common drug that we use when someone's heart rhythm is too fast. It's called diltiazem, and it functions to slow down the rate of the heart. We normally give a bolus to begin with, and then start a drip to maintain the heart rhythm until the body can do it on it's own. Once again, scanning a vial of a medication we are only suppsed to give part of, should bring up an alert, but in this case it didn't. I had read the order, but not carefully enough, and was again, depending on the system to tell me what to do. With no alert, I gave the entire vial, which ended up being two and a half times what the patient was supposed to recieve. She was sitting on the side of her bed, and just about the time I looked up with horror at a blood pressure of 60/40, she looked up at me and said, "I feel really dizzy." Speaking much calmer than I felt I said, "Yeah, I'll bet, here let me help you lie down." As soon as she was safely horizontal, I reached up to the bag of fluid I had running in and started squeezing with both hands to get her volume levels up as quickly as possible. I called for the doctor who came in, assessed the situation and told me to keep pushing fluid until it came back up again. Her pressures came up after about a half hour of me standing there nervously watching and squeezing in fluid. That was when I realized my mistake. It was past time for shift change and now I was the nurse in the room frantically printing off reports... full well realizing I was leaving a lot for the night shift nurse. Seeing my medication error that had actually caused harm to a patient was the last straw. I walked out of the hospital that night... after 13 1/2 hours, aching literally from head to toe and emotionally defeated. The next morning the cardiology nurse practitioner said that she "could have died" with pressures of 60/40. The critical care doc just laughed at my expression. Luckily she didn't die,(as my friend DJ said, 'Just cost tax payers an awful lot of money ;)) but I still wanted to say "Please, take my licence away. I obviously don't know how to safely take care of patients."

That night as I was leaving the hospital I texted two of my closest friends and said, "I'm quitting my job, I'm a horrible nurse." One of them is a nurse and he texted back to say, "Everyone makes mistakes Em." That meant a lot to me. The other texted and said, "I'm sure you're a great nurse, you can practice on me anytime you want.:)" It gave me enough courage to go back again, anyway. That night I kept waking up throughout the night, and couldn't get back to sleep as easily as usual. The hardest part was waking up with feet still sore from the night before, and walking back into the hospital to face another 12 hours. Luckily the Lord knew I would need a break and the next day was fairly calm and though busy, not unmanageable or chaotic.

So the next time you are in the hospital, and your nurse seems preoccupied, irresponsible, inefficient, or unorganized, try to remember that she probably didn't eat any lunch that day. She probably is working a day shift after staying up working night shifts all weekend when everyone else was out playing and sleeping. That she may have only slept 10 hours in the last three days, that she probably had nightmares all night the night before about making a big mistake. That she's probably already been yelled at by doctors, hit in the face by crazy patients, cleaned up the kind of messes that you can't even dream up in your worst nightmares, and has most likely picked up several diseases, shortened her life span by several years because of long anti-circadian rhythm shifts, and ruined her back from lifting too many people.

Do I love my job? Yes. Every day is a new adventure, and it stretches me to new limits constantly. But be kind to your nurses. Chances are, they are sacrificing a lot in order to be there when you need them. And anyone who is willing to forgive us for how human we often times are, are those who make it all worth it.