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Dan Bratton, RN, BSN, works rotating shifts at the medium sized (220 beds) Good Samaritan General Hospital. For two weeks, Dan works 7 a.m. to 3:30 p.m., the next two weeks will be 3 to 11:30 p.m., and the next two weeks will be 11 p.m. to 7:30 a.m. (The 30 minutes overlap between shifts gives the nurses who are leaving some time to report the important events that pertain to each patient to the nurses taking over.) Dan graduated six months ago and this is his first position in a medical-surgical unit. Today, Dan is working the day shift, 7 a.m. to 3:30 p.m. The day shift is busy because this is when physicians come in to see their patients and many diagnostic tests and therapies are scheduled.
6:45 a.m. Dan arrives a few minutes early so he can change into his hospital-supplied scrub suit and get himself organized for the day.
7:00 a.m. Dan's supervisor gives him a list of eight patients to care for. Dan knows two of the patients from his previous shift; six of the patients are new. They range in age from 25 to 85 and their diagnoses include: diabetes mellitus, congestive heart failure, two days post-stroke, and acute renal failure.
7:05 a.m. Dan listens to the report of all the nurses going off shift, paying particular attention to his eight patients. Because the report is tape recorded, any questions must be asked of the night shift leader.
7:30 a.m. Dan goes to the patients' records to check each care plan, describing tasks and schedules for the day. Each patient's physician will be coming in early to go around to see his/her patients. Dan will check on any discharges scheduled and any therapy or diagnostic testing that requires the patient to travel to another area of the hospital. Then he plans his day around these events and the medication and care schedule for each patient.
8:00 a.m. Dan accompanies the physicians to report on any changes in the past 24 hours and to gather information on what is next in the physician's plan. He discovers that the diabetic patient is to be discharged to home and he will meet with family members to reinforce the self-care needed to balance treatment for diabetes: exercise, nutrition and medication. Also, one of the post-stroke patients is going to be moved to a rehabilitation facility. Dan talks with those family members to answer questions, provide reassurance and explain the goals of rehab. He shows them a web site, www.medlineplus.gov, where they can find specific information about stroke, appropriate rehabilitation, safety and homecare, and any medications that may be prescribed later.
9:00 a.m. Dan receives and stores the single-dose medications for his patients who have been brought to the unit by a pharmacy technician. He has to check the physicians' documentation for new orders and authorize them and set them in motion for each of his eight patients. The day goes very quickly, even without any real crises arising. Medications and treatments must be given before patients go to their therapy with rehabilitation or before they go to have radiology testing or treatments.
10:00 a.m. Most of the patient discharges occur before noon. The patients who are going home need to have specific discharge instructions, as well as an escort to leave the hospital safely. As soon as one patient leaves, another is admitted, so Dan greets the new patient and completes paperwork setting up a nursing care plan.
11:00 a.m. Dan "rounds" on his patients again before lunch to check blood pressures and other vital signs and to keep an eye on everyone.
12:00 noon This is a good day, Dan gets to relax and eat lunch with a colleague. They discuss a continuing education program on diabetes that they will attend over the weekend. According to their state Board of Nursing regulations, they need 30 hours of continuing education every two years in order to renew their license to practice.
12:30 p.m. Dan and his colleague return to work. He sees that one of his patients has called for help. When he goes to the patient's room, he finds that she became dizzy and fell on her way to the toilet. He helps her back to bed and assesses her condition. Fortunately, she appears to have no broken bones and the dizziness has passed. He cautions the patient not to stand up quickly, but to give herself a couple of minutes sitting at the bedside before standing and walking. He also encourages her to seek assistance when she wants to get out of bed. After checking the patient's medication list, Dan phones the patient's physician and suggests some medication changes that may decrease the patient's tendency toward dizziness. Dan knows that the circumstances around this event are very important because his hospital is working to decrease the overall rate of falls and patient injuries.
1:30 p.m. By this time, Dan must administer another round of medications and treatments to his patient group. He checks the physician orders to find new IVs, blood tests and referrals were ordered. Dan checks with the unit secretary to see that these were ordered. Dan talks with one of the medical school students about patient falls and how to prevent them.
2:30 p.m. Dan speaks with a nursing school faculty member on the telephone. She is looking for a clinical practice site for students in the summer rotation. He agrees to work with undergraduate student nurses and to recruit fellow staff nurses to take other nurses. He does a final round to check each patient's condition before he leaves for the day.
3:00 p.m. Dan gives a report to the group of nurses coming on for the next shift. He speaks to his supervisor regarding his preference for next month's schedule that is being planned. (Some hospitals have made self-scheduling available to the nursing staff.) Then, Dan has a few moments to document the care he provided during the past eight hours. He enters data into a computerized record that contains easy templates for routine care. After that, it is time to relax for a moment!