We're two weeks late, but well worth the wait. Today we present the final installment of our special four-part "A Day in the Life
Naomi S. is a Labor and Delivery RN in Texas who has been giving us a peek behind the curtain of her profession for the last month. If you missed any part of her story, please click the links to the right and get caught up.
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It’s 11:45 PM, and midnight vital signs are due. One of my patients talked her doctor into a do-not-disturb order as long as she’s sleeping, and she’s asleep now. I can skip her. I just peek into her room to make sure she’s not awake, cringing as the door squeaks. I can see her breathing in the dim light, and I wait for a few seconds to make sure she doesn’t raise her head. She’s fast asleep, not surprising since I gave her a medication to help her sleep, so I move on. My other two patients are wide awake, and chatty. I get vitals signs and chat for a minute, make sure the water is filled, get some juice for one of them, and sit back down to chart everything on the computer. I’m in the swing of my night, now, all caught up so I can chart just a few lines of whatever it was that I just did. By facility policy, I need to keep checking on my patients at least every 2 hours while they’re asleep, and every hour while they’re awake. I hope they’ll go to sleep soon, because in the morning, the nurses will come in at 7 am, and then comes the doctors, and dietary, and the parade of hospital folks that will keep them up all day. They need their rest.
I can catch my breath now, and check my facility email. Yep, there’s pages of emails I need to sit and delete, one by one, to make sure the outage doesn’t affect a system that I need. Three emails about the same mandatory training session dates, the first one saying only Mother/Baby unit nurses need to go, then the second and third a discussion and conclusion that no, ALL the womens’ services nurses need to go. Training emails always seem to follow the same pattern. I have another five automated emails telling me that some of my electronic courses are going to be due in two weeks, and there’s 15 of them, so hop to it! I have some time right now, so I start clicking away.
I’m interrupted by the needs of a patient. I help her out, settle her down, and make rounds again. I chart on everyone. It’s 2 am now, halfway through the shift. The world has gone quiet. No phone calls, no visitors, no doctors down the hall. All the patients have started falling asleep. I turn the lights off at the nurses’ station, to try and preserve some semblance of a circadian rhythm. The hall is as bright as ever, because it can’t ever be truly dark in a hospital. I start working on my e-courses again. Mostly stuff that I’ve already done once this year, but there was a change to one of the slides and now everyone has to redo it.
About 3 am, I start to get a little sleepy. I walk up and down the hallway, knees high, trying to get the blood moving. I see another patient come into triage, and then I know it’s about to get busy again. I answer the phone, call the pharmacy, call a doctor, coordinate. The charge nurse knows that I have five minutes right now to think, so I can do the running. I don’t need to walk up and down the hallway anymore.
4 am is time for vital signs again, but all the patients are asleep. Two of them have orders not to wake them for vitals signs, but the third still needs hers anyhow. I wake her up to take her temperature, and she falls asleep as I hit the button for her blood pressure. I pull the cuff off of her arm, and sneak back out of the room. Lab is on the phone looking for the nurse for another patient, so I have to look up the patient to find her nurse, and then I end up taking the message from the lab anyhow. I have to find the charge nurse because something is wrong. I relay the message to the charge and the patients’ nurse, and then I make a phone call to the physician to let her know what’s going on. I take down her orders, and then I go find the other nurses again. They’re dealing with something with one of the other patients, and she can’t be left alone. I enter the orders into the computer for them, and then I call pharmacy. I let the clerk know what’s going on, because now one of my patients is calling me again. She has a Charlie horse and I need to go and help her stretch it out and find a hot pack for her.
The other nurse’s patient is critical. She needs blood. The charge nurse gets on the phone with the doctor. I sit down at the desk, keeping track of all the other patients on the monitors. You can’t stop watching the monitor just for one patient in crisis. My patients are fine, but there are others. The clerk goes to get the blood, so now I’m stuck and I can’t leave the desk. The other nurses are in their patients’ rooms, and the charge nurse is now floating between the urgent patients. I answer the phone and field questions from lab, pharmacy, the blood bank, the doctor, the anesthesiologist, the NICU. They’re going to bring one of the patients back for an emergency cesarean section.
The clerk is back now, but I realize I need to get started charting on everyone I’ve talked to for these other patients. I have to be careful that I’m charting on the right one. The section is in the back, and the other patient’s blood has been verified, cross-verified with two nurses, and started. The charge nurse can sit down next to me and start charting now, too. It’s 5:30. The last hour and a half has gone by so fast, and so many things happened, that I’ll be charting until 6 am. That’s ok. I don’t have to chart on anything but phone calls, so I’m grateful. The nurse in the OR with the section will be here until at least 8 am, catching up on all the chaos that led to the emergency section, the operation itself, and the recovery period.
It’s 6 am, now, and I’ve got to make rounds one last time. All my patients are sleeping again. I’m glad. I can finish up charting on them, and then I can prepare the reports for the next nurse. I don’t know if the nurse coming after me will be familiar with my patients, so I start from scratch on the report sheet. By 6:30, I’m raring to go. All I’m doing is waiting for my relief, looking expectantly at the unit door.
Things have calmed down again, and everyone looks at the clock, anxious lest another emergent triage patient walk through the door in the next 15 minutes. The new on-call anesthesiologist comes to the station to chat. The clock ticks slowly. 6:35… 6:38… the dayshift charge nurse comes on. 6:40… Finally, it’s 6:45, and the day shift nurses are trickling in, one by one. My relief is here, and she’s never had my patients before, so I have to give her the full report, on patients that have been here for over a month. It takes a while. I’m not done giving report until 7:15, and we still have to round and see all the patients. We go into each room, but none of the patients wake up. We sign off anyhow, and I finally walk off the floor at 7:20.
I go into the locker room and change into my scrubs from home, turn in the hospital scrubs, and get a new set for the next time I’m working. I put my things away, and lock my locker. I clock out at 7:28. I sigh, and go downstairs to find my husband, who’s been waiting in the car downstairs since 7:15. He drives me home while I doze. I realize when I get home, that I never finished my lunch. I still have my leftovers that I had planned to eat at 3:30, when things went sideways. It’s OK. I’ll save it for tonight. I put it back in the fridge, put my ice pack in the freezer, take off my scrubs, and sit in my favorite recliner. I’m tired. I’ve walked 12,000+ steps last night, and my feet hurt.
They’re a little swollen because I haven’t yet resorted to compression stockings like some of the other nurses. I just raise them while I eat a bowl of cereal and watch some mindless TV so I can relax enough to go to bed.
By the time I’m sleepy enough to go to bed, the sun is high, and my room is bright. The cat’s been in the curtains again, pulling them away from the wall. I tuck the curtains back in, set my alarms, and plug in my phone so I can sleep at 9:30. I’ll do it all again tonight, and I wouldn't change it for the world. At least for another few years.