While one would think that the answer to this is simple, I think a lot of common perception and understanding of what a nurse does is mired in poor movie portrayals and a 50 year old sterotype. There was a time when nurses fluffed pillows and gave foot rubs, but that is no longer the case. Nurse are now responsible for highly technical tasks that were once only entrusted to physicians. In the last ten years, the acuity of patients that we care for has increased dramatically. They are sicker, get more treatments, more medications, and have more co-morbid conditions that make them that much more complex. It is not that people are just getting sicker, it is that they are living longer and acquiring new illnesses and conditions and requesting or expecting more advanced lifesaving efforts. Along with the sicker patient comes hospital budgets that are being trimmed on a quarterly basis, which means each nurse takes more patients, even though the patients are more difficult to care for. Add to this the drive to use electronic medical records, which requires about five times the amount of time that paper charting took, and you have one gnarly recipe for a burned out nurse.
Here is my typical day on a typical medical/surgical floor: I go to work at 6:45am. I get my patient assignment that has been made by the charge nurse from the previous shift. I get their demographic data (name, age), hospital data (attending physician, diagnosis) and orders (diet, activity, IV, tubes/drains). I get report from the off-going nurse at 7:00am. This is when I find out what brought the patient into the hospital, what has happened while they have been there, and what occurred during the previous shift. Then I take that information, write down the medications that are due when, then go off to meet my patients. Now it is 7:30. I go into each patients room, introduce myself, review the plan of care, assess my patient, evaluate their pain, offer to assist with ADL's (activities of daily living i.e. toileting, teeth brushing, etc), and arrange for breakfast. I leave the room and log in to a computer where I proceed to chart everything I just did in that patients room. The time? Now almost 8:00am. I do this for all five of my patients, and I am lucky if I am done seeing everyone by 10:00am. This does not take into account the multiple phone calls put through to my hospital issued cell phone, fielding calls from patients needing things, family members calling to check in and physicians calling with new orders. 10:00 is medication administration time for all routine daily medications. Patients can have 20 or more medications at this time, and many times the medications need to be crushed or individually fed to the patients. I am done with medications, hopefully, around 11:30. Giving medications is not just going to a medicine cabinet and pulling them out. No, you log into a machine called "Pyxis", move through the screens selecting your patient, then individually select each med, and once you have selected the medications, various drawers pop open and dispense the medications. I take the medications to patient rooms, log in to the computer in the room, take my scanner and scan the barcode on the patient's wristband, enter the correct screen for medication administration, scan in each individual med, and then and only then can I give the patient the medications. There is a new rule just being instituted that all meds be administered within 30 minutes of their scheduled administration time. It is just not possible. So by now it is after 11:00, I go briefly into interdisciplinary rounds where each specialty in the hospital, including the physicians, give a brief summary of the patients and how they are progressing. Once I am done in rounds it is 11:30. We start to rotate out nurses at about this time, hoping everyone can get a 30 minute break in before the cafeteria closes at 2:00pm. I go around and see my patients again, help them get lunch, and take out their trays. The afternoon is coming fast, and by now I have probably discharged at least one of my patients, so here come the emergency department admissions. I put all my other patients on hold to admit a new patient, which takes about 90 minutes. If I am lucky I get a post operative patient from recovery that is not too painful, too sedated, too unstable or too demanding. By now it is 5:00. Time to get everyone their dinners, fill in all the last minute charting (every drop of water or pee, every morsel of food, every time the patient was repositioned in bed, sat on the edge, or took a walk has to be recorded). Now it is 6:00. Final medications for the day, go to each patients room and address any final needs, remove all the dinner trays and get ready for report to the next shift. Darn it! I forgot to note off all the orders in the charts! Every order that is written by a physician during the course of the day has to be reviewed, completed and signed off my the nurse. Now I am done and night shift is on the floor. I hunt them down, give them the same report they gave me, shred my "brain" sheet for the day and head for the locker room. It is 7:45 pm. I am heading home, ready to return the next morning at 6:45am and do it all again.
This is a day that goes smoothly, where none of the patients get sicker, need any extra help, no families have melt downs or demand your immediate attention, no one dies, or you don't discharge your entire group only to get another one. Did I forget to write above when I take my breaks? Nope. One thirty minute break for lunch, if we're lucky, and that is it.
You know, there are days when I wish I could fluff that pillow, rub those feet and call it a day. But I don't think that is going to happen any time soon.
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