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Olivia Breef, RN, BSN, OCN, is a charge nurse in the oncology department at Memorial Hermann Memorial City Medical Center. At the youthful age of 27, she has her oncology nursing certification (OCN) and manages a staff of TK nurses on her nightly shift from 11 p.m. to 7 a.m. After she awoke from a morning’s sleep at 2 p.m., she shared with Vault her daily work routine taking care of cancer patients.
10:00 p.m. I leave the house and get to work before my nurses get in at 10:45 p.m. for their shifts. Luckily, I live close to the hospital.
10:20 p.m. I get to the hospital early before the other nurses arrive because I am the charge nurse. I first find out who my staff will be for that shift. I then talk to the charge nurse from the previous shift to get an update on the patients and find out if any major developments happened during her shift. Then I take the staffing list and the patient census, and I dole out assignments based on how many nurses and patients we have.
10:45 p.m. My nurses begin to arrive and they begin the report process where they listen to tape recorded patient notes from the nurses working the previous shift.
11:15 p.m. I go out on the floor and figure out what medications my patients that I am responsible for will need for the night. I check my computer to see which patients have midnight medications. I also prioritize my patients’ needs. If I have a patient that is in pain, then I take care of that patient immediately.
11:30 p.m. I do physical assessments of my patients and administer any medications they need. I make sure they are comfortable and stable.
12:30 a.m. I chart my patient assessments on the computer. We have to chart every two hours everything about the patient including if they were awake, if we helped them to the bathroom, if they were in pain and how their IV looked. I check on my other nurses on the floor and make sure that they are doing ok and their patients are doing fine.
1:30 a.m. Every morning from 3 a.m. to 5 a.m. a phlebotomist comes and draws blood for morning lab tests that the physicians have ordered so they can be ready when they round in the morning. Many of my patients have central IV lines that we administer medications through and draw blood. Only a registered nurse can take blood from a central line. So, I figure out which patients the phlebotomist can draw blood from a periphery vein and which patients I will have to draw blood from the central line.
1:35 a.m. I check on my patients again and make sure they are still sleeping and comfortable. I then do various housekeeping things like making sure the crash cart works.
2:00 a.m. If it is not a crazy night, then I take a break and get something to eat.
2:15 a.m. After my break, I get lab tubes together to use that I will use when I draw blood. I also catch up on my charting and check up on my nurses to see if they need anything.
3:00 a.m. I draw blood from all central line patients. Some nights there are more than others and this process can take a while.
4:00 a.m. I speak with the head nursing supervisor (the head nurse for the whole hospital) about staffing for the next shift. The number of patients dictates how many nurses, nursing aids and secretaries we need. I look at who we have scheduled to come in and figure out if we need any extra nurses. The head nursing supervisor decides if we will get a nurse from a different part of the hospital.
4:30 a.m. I check on patients again and check on my nurses.
5:30 a.m. Lab results start coming in. Any lab results that are outside the normal safe levels, what we call critical levels, the lab will call me about. As a charge nurse I have to tell the nurse in charge of that particular patient about the critical level, and I have to make a decision to call the doctor about the level and get orders from him or her.
6:00 a.m. I do rounds on my patients again and give out any medications that are ordered for them. If the patient is awake, I remind them they can order breakfast in 30 minutes.
6:15 a.m. I start on some paperwork. If I had not received 100 percent confirmation about staffing when I spoke with the nursing supervisor, I give her a call to confirm everything for the next shift. If I need to call in staff or tell them not to come in, then I do it now before they start making their way to work.
6:30 a.m. One of the doctors usually calls and does rounds via telephone. I am on the phone with him, and we go through all of his patients on the floor and discuss their labs. I also tell him how they fared during the night. He then gives me orders accordingly.
6:45 a.m. The next shift of nurses start listening to the reports that my nurses tape recorded at 5:00 a.m. As the nurses finish listening to the reports, my nurses are still around for any questions the next shift of nurses might have. Sometimes my nurses have updates on something that happened to the patient after 5:00 a.m., and they give the next shift nurse those updates.
7:00 a.m. I finish entering the oncologist’s orders into the computer. I also call in any physician consults I might need on any critical lab results. All the while critical lab results are trickling in as the lab is processing blood. I still act as the charge nurse until the charge nurse for the next shift comes out of reports. When she comes out, I usually report off to her about critical lab results and doctor’s orders for patients.
7:20 a.m. I clock out and head home. Another day at the hospital is over!