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I am a cardiac acute care nurse in a large Northeast suburban trauma hospital. I arrive at work twenty minutes early so that I can get to know my patients. I then check the chart for admitting diagnosis, pending labs, exams, point-of-care testing needs, etc. I do this because no matter how much I trust the nurse giving me the report, I recognize that any human is more liable to make mistakes and oversights after working at this level of intensity for thirteen hours.
After receiving the report, I introduce myself to my patients. The nursing ratio on my unit is 3:1 and at times up to 5:1. If the patient is awake, I assess them right away after introductions. I bring a computer-on-wheels (COW) in the room with me to document everything. The COW minimizes distractions and allows me to assess anything I forgot if needed. Next, I administer scheduled medications.
I find it most effective to complete tasks while in the room with the patient. The hallway is an obstacle course of distractions. For example, it may seem reasonable to step out while your patient is on a nebulizer treatment knowing the treatment takes five to eight minutes to complete. In a high-acuity unit, eight minutes is an eternity. Therefore, no matter how much I plan, I can almost guarantee I will be sidetracked by a new task in that short time. On good days, my charting is done by 10 a.m., which happens about 60% of the time. This allows me to have my afternoons free to address anything that comes up. Afternoons are less predictable because usually the night shift has set up and stabilized the patient for the mornings.
The hospital I work in is not unionized, so taking breaks is not enforced. We are entitled to one 30-minute and one one-hour break during a twelve-hour shift. Some nurses follow that timing fastidiously on each shift, while some nurses don’t take a break at all. I strongly discourage that. I perform better when I take a few 15-20 minute breaks throughout the day when my patients are settled. Otherwise, I use the extra time to prepare for later tasks, such as setting up and labeling IV medications. This ensures I leave on time, and I always do.
I have the opportunity today to precept new nurses and I always encourage them to find their own rhythm. In the beginning, I used to follow my preceptor and make an index card with a table of all the medications and point-of-care testing for each patient. Once I found my stride, I realized this card was actually wasting more time than it was saving, and I relied on the EMR instead anyway. Who knows? That may change again.
Evolving and learning are constant features of acute care nursing. A day in the life of an acute care nurse may be a misnomer as, lucky for me, no two patients are the same and no two days are the same.
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