Life of a Night Nurse, Part One

I am going to have to break this up because it is quite long and in depth. 

This is what a typical night shift looks like for me:

I arrive at the hospital at 6:50 to swipe in and get my nursing assignment.  Around 7:05 or so I go out to find the day nurse that has covered my patients and get report on them.  Report can vary, depending on if it is my first day in that week or not.  If not, then I do not need a full report unless a patient has been admitted during the day while I was sleeping.  A full report consists of the patient diagnosis, doctors, history, what their IV is running at, where their IV is, any complications, if they are in a lot of pain or experiencing a lot of nausea, if they have any upcoming procedures that I need to get consents for, and things of that nature.  Then, after receiving report on all six patients, together I walk around with the day shift nurse and meet them.  Then she or he leaves and I’m on my own.  

The first thing I always do is log onto the computer charting system and document that I have received report from whoever and that I am assuming care.  This covers the hospital in case something should happen.  Then, if when I was meeting one of the patients they tell me they want pain medication or nausea medication, I will go pull that out of the Pyxis.  The Pyxis is our medication system.  It is one of two big machines on the floor.  You go to it, enter your ID, scan your fingerprint, and find the patient.  Then you pull out whatever medication you need.  It pops open one of many drawers and tells you what pocked the medication is in.  Sometimes you have to provide a count of how many are in the drawer to begin with, especially with pain medications.  Then you take the medicine and log out of Pyxis.  If none of my patients specifically requested a medication, I’ll pull up all my patients on the medication system at my computer and look and see who has 8 o’clock or 9 o’clock medications.  I usually start with the patient that is the most acute or that has a procedure coming up.  I will go pull out their medications and go to their room to begin my head to toe assessment.  I listen to their lungs, heart, bowels, feel their feet for equal pulses, roll them over to look at their skin, look in their mouths, touch them, talk to them, and ask things like, “When was your last bowel movement?  Have you been coughing?”  I also check their IV site and fluids running and their dressing site, any incisions, ect. This takes me about 15 minutes.  Then I scan their medications with a barcode scanner. Every pill, every vial is bar-coded.  Then I scan their armband.  Then I can administer medication.  Some medicines are simple pills but a lot are “IV Push”.  This means that I either draw up sterile water into a syringe, inject it into a vial of powder to reconstitute it, mix it around, re-draw it up, and then push it through a port on their IV tubing over a certain amount of time, or draw up a liquid in the syringe, dilute it with sterile water if necessary, and do the same thing.  Also, some medications, specifically antibiotics, are in little bags.  I hang this “IV Piggyback”.  They have a secondary tubing that fits into a port on the IV pump and have to be separately programmed.  This is just like IV push except it takes longer so I have the pump do the work. For example, Piperacillin goes in over 4 hours.  Obviously I can’t stand there and slowly push in 100 mL over 4 hours.  Some medications, like blood pressure medications or pain medications, require me to input a vital sign.  These have been recently taken by a nurse tech and are written on a paper in the room.  If I am giving insulin or heparin or lovenox, I need another nurse to come and cosign with me.  I pull up the labs to show them that the dose I’m giving is ok, and then scan their ID badge.  Also, if I have given them a narcotic, which I usually do, I have to save the remaining medication to waste with another nurse, unless I use the full dose.  The doctor has ordered what does to give.  After medications,  I ask if they need anything, which they usually do (water, blankets, go to the bathroom), address their needs, and wash my hands and leave.  I do this for all six patients.  This takes me a while, usually a few hours.  I try and give all my medications through ten o'clock during this time.  By the time I can sit down and chart, the first patient needs to be checked on or might need something.