Walking through the unit towards the lounge, I hear the familiar monitor dings, pumps beeping, oxygen swishing, babies crying and ready myself with pen, sharpie and stethoscope in hand.
First Things First
I receive my assignment for the evening and search out the off-going nurse for report. During report, she will explain to me my patient’s diagnosis, history and plan of care; making sure to include medications, labs, diet and psychosocial status. After reviewing the last 24 hours orders, I organize my night on paper and set off to conquer the world.
During the first round, I introduce myself and greet any family members that may be present. Next I check the room’s safety equipment, should I need it for an emergency, I want to know that it is available and in working order. I begin with my patient by obtaining a set of vital signs.
Next is a complete physical assessment, and I address any current needs. After double checking my Kardex, I administer the night’s first set of medications and feedings. Then I stock my room with any items that might come in handy throughout the shift, and move on to the next patient to repeat the same process. Typically, my assignment will consist of 2-4 patients, depending on their acuity and the unit’s available staffing.
After making my way back to the lounge for a quick drink, I find myself at the nurse’s station to begin the tedious process of charting. Vital signs, check. Assessment, check. Input and output, check. Medications, check. Age appropriate psychosocial assessment, check. Parent teaching, check. Repeat process 2-4 times.
On to the Second Round
Usually by the time I have completed charting, it is time to start again for the next round. If everything has gone smoothly, I may end up with a few extra minutes to check my email or chat with my fellow co-worker before heading back for more.
There are certainly many shifts where chaos is busting at the seams, and you are coding or admitting a patient, starting a new IV that you didn’t pencil into your evening schedule or some other unforeseen emergency, and the process is delayed. If you are in a teamwork atmosphere, it can make these hiccups much more tolerable and sometimes even humorous.
On the second and third round, I get another set of vitals and address hygiene issues. This usually includes weighing each patient prior to a bath and linen change. After tidying up, I administer medications and feedings, make sure my patient is comfortable, and head back to the lounge for a much needed break.
Most night nurses will pack a lunch, unless you are lucky enough to be in a facility where the cafeteria is open late. Occasionally, we get together and order take away or delivery. A fresh hot meal can certainly help recharge your batteries on difficult nights. And then of course, back to the nurse’s station to catch up on charting again; hopefully you have managed to fit a rest room break in somewhere!
During the final round, you get your second wind. The night is coming to a close and you can see the light at the end of the tunnel. These days, that tunnel is usually twelve hours long plus report. Repeating the same steps: vitals, medications and feeds; you follow up with any ordered labwork.
The Finish Line
Next you head back to your friendly computer to power chart, update the Kardex, and prepare for the oncoming shift and report. When you finally see their smiling faces, and the smell of freshly laundered scrubs fills the air; you know that you have made it!
Another shift completed, and the satisfaction of knowing that you have made a difference in a life helps to propel your feet out of the unit and to your car for the drive home.
About the Author
Cynthia MacDonald has been a registered nurse for 17, with most of her clinical background focused in pediatric and neonatal intensive care. She has worked in hospitals and also extensively as an agency nurse traveling locally to hospitals in order to fulfill staffing needs, both per diem and on a contract basis. This provides her with a wide base of knowledge and experience on how area hospitals operate their units, and also how different doctors practice. She enjoys working with children and babies on a daily basis, and also interacting with their families during a time of crisis, making their stay as pleasant as possible.