RN.

I am a registered nurse. I went to college for four years to do a job people associate with a caring personality and being able to deal with needles, blood and poop.

I am a new nurse but these 9 months have affected me profoundly. People sometimes ask me about a typical day at work. That question is hard to answer because there is no typical day- my days are as unique as the patients I care for. This is my attempt…

The unit I work on is hematology/bone marrow transplant. The patients have some form of blood cancer and are being treated with chemotherapy or having a bone marrow transplant.

34 patients, 12 floor nurses, charge nurse, physicians, nurse practioners, clinical nurse specialist, pharmacists, physical therapists, patient care assistants, unit secretary, dieticians, administration, chaplain, family members. The environment during the day is… lively.

0600
Get up, shower, pack lunch, eat breakfast, walk 4 blocks to the Medical Center
0645
Receive my patient assignment for the day
0700
Group report given and then report from the night shift nurse for my 3 patients
Take over responsibility for my patients
0730
Review chart for any new physician orders
Review the bedside chart for medications and treatments that will need to be done this shift
Organize my day on my paper brain
My real brain is going a mile a minute organizing

0800
Visit each patient- do they have nausea or pain?
Begin assessing: environment/safety, vital signs, brain, heart, lungs, GI tract, urinary tract, skin, muscles, IV lines…
Use the interpreter phone to communicate with patients who speak only Cantonese, only Spanish, only Russian…
0830
Administer medications to patient- know why and potential side effects
Check, double check and triple check the 5 “rights”- right drug, right dose, right route, right time and right patient
0900
Check chart for any new orders
Administer electrolyte replacements pharmacy orders daily
0930
Patient reports having pain (8 out of 10) Administer narcotic through the IV line and reassess pain every 30 minutes, re-administer drugs as needed
Check blood sugar of diabetic patients before breakfast and administer insulin per sliding scale

Call lights on: could be anything from breakfast is not what they ordered to they have severe pain or nausea
0945
Check lab results on each patient from blood drawn daily, if hematocrit is below 27% transfuse 2 units of packed red blood cells per standing order. If platelets are below 10k transfuse a pack of platelets per standing order.
1000
Get patients into shower and change linens
Grab a drink of water in the break room
1100
Document EVERYTHING

Chart check for physician orders
1200
Check each patient’s pain level, temperature, heart rate, respiratory rate, blood pressure and blood oxygen level
Check diabetic patients’ blood sugar
Administer medications scheduled or as needed
1300
Eat lunch or grab something from the supply of junk food permanently found in the break room
Answer patient call lights
Administer medications
Send patients off unit for procedures
Report abnormal assessments to physicians if found
1400
Patient asks me about their diagnosis/ treatment timeline which is beyond my scope of practice. I have no answers.
Patient tells me he needs a miracle because he has to survive for his daughter. I feel powerless.

Patient grabs my hand and tells me she is scared to die. I feel helpless.
1500
Change dressings that cover our patient’s central lines
Administer more medications
1600
Assess vital signs again
Patient spikes a fever: draw blood cultures, start new regime of antibiotics, monitor closely
Document EVERYTHING up to this point
Know the milliliters of fluid that have been taken in and put out of the patient since 0700
1700
Educate patient about their medications, procedures, treatments, diet, needs after discharge...
Educate family members
Assist patients to walk in the hallway when they are weak

1800
Hang a bag of nutrition to go through patients IV- the chemo has caused the skin cells lining his mouth and throat to slough off and the pain is so excruciating he cannot eat or drink
Apply skin cream to a patient whose entire body has blistered and is peeling from the chemo reacting with the skin
1900
Final chart check for any new orders
Give report to night shift nurse
1930
Leave medical center and go home
Mind is mush
8:00pm
Pour a glass of wine
Eat dinner
Watch an episode of FNL with Heather
11:00pm
Sleep.