What is a 12-hour shift like for a registered nurse on a medical-surgical floor? I’ll break it down for you.
Imagine you’re working at a restaurant and you are the cook, the server, the host, and the cashier—all at the same time. Your assistants help with serving and cleaning tables, but if they’re busy and miss a table, it’s still up to you to make sure everything gets done.
Once you clock in, you hit the ground running. At shift change, you hunt down the nurses who have been taking care of your future patients for the past 12 hours. You hurriedly scribble notes onto your paper “brain” during report: details about diet, medications, ambulation orders, and upcoming plans for each of your patients. Most of this information is in the computer but there are times you must have it all accessible at a moment’s notice.
“I’m sorry I didn’t change the dressing in 31. It was a crazy shift, we had a code blue,” one nurse says. “No problem, I’ll change it,” you say. Because you know that “crazy shift” is nurse code for ran-around-all-night-didn’t-have-time-even-to-drink-water.
You’re also given helpful tidbits that aren’t in the chart:
- “Watch out for 4, he gets up without calling. Better run if you hear the bed alarm.”
- “Room 8 Q2 turns, sacrum is red but still blanchable.”
- “19’s family sneaks in food even though he’s NPO.”
Then, the previous shift goes home and it’s all up to you. You’re up to bat for the next 12 hours. You try to get in all your assessments before meds are due. Today all of your patients’ rooms are at opposite corners of the unit so you’ll get a lot of steps in. And while you’re listening to lung sounds, there’s a 50/50 chance your patient will ask you to help them to the restroom. By the time you’ve unplugged the IV, disconnected the NG tube from suction, and unhooked the sequential compression device, you’re already behind.
At 9:00 a.m., every patient has medications. So how is it humanly possible for one nurse to safely and efficiently manage multiple patients’ pills, blood sugar checks, sliding-scale insulin, and I.V. antibiotics in a timely manner? Strategy. From 8:00 to 10:00 you work with precision, no-nonsense, and skill that takes years to develop.
You might look too busy for your patient to muster the courage to tell you they have pain 8/10 at their surgical site. But then your nurse spidey-sense kicks in after you see them grimace. You hold their hand for a moment, ask them about their pain, and tell them you’ll be right back with their pain pill. “Don’t chase the pain,” you admonish, even as you chase your own tail from room 12 to the med room, back to room 12, then to room 31, then to the med room, around and round in circles until med pass is complete. While you strategically pass out meds, you simultaneously answer calls from doctors, case managers, nursing assistants, physical therapists, family members—all of whom probably don’t realize you met each of your patients less than 3 hours ago but you’re expected to answer questions like you’ve been their nurse for days. Your secret to keeping it all together is the wrinkled brain in your pocket, which you pull out frequently when answering phone calls.
At 10:00 you finish passing morning meds but realize you still need to chart morning assessments. You’re halfway done charting your detailed assessment of room 31’s 10 wounds when you hear a bed alarm go off. You don’t see anybody around, so you run, getting there just in time. The patient in room 4 is teetering towards the bathroom without his walker and with his urinary catheter wrapped around his foot. You steady him with an arm around his waist just as he almost loses his balance. You untangle the catheter, help him to the bathroom, and turn off the alarm.
You can’t ignore your bladder any more, even though you really need to finish charting. You drank too much coffee before you clocked in and now your bladder is threatening to explode. As soon as you sit down on the toilet your work phone starts to ring. You hurry as fast as you can and wash your hands, all while it keeps ringing. You answer, and your charge nurse says “You’re getting an admit in 2 from PACU. They’ll be here in 10 minutes. Emergency lap appy, vitals every 15 to rule-out sepsis.”
You still haven’t finished charting, but you put that on the backburner. Priorities. You call your assistant, “can you get the room ready?” you ask. “I’m helping so and so to the restroom,” she says. “No worries, I’ll get it ready. They need vitals every 15 for the first hour. I’ll put the times on the board.”
You answer another call as you’re writing on room 2’s care board. “Room 8 is calling for pain meds,” your assistant says. You told the patient in room 8 that their next prn dose would be available after 11 and it’s 10:55. You hurry to room 8 to ask about the pain, learning it’s 10/10. The hydromorphonedose is 0.4 mg and you need another nurse to waste with you. The med room and surrounding area is a dead zone: no RNs for miles. You call the relief nurse, “Can I get a waste?” “Sorry I’m on break,” she says. “Can you ask the charge?” You call the charge nurse. “I’m in a meeting,” he says. “I can be there in a few minutes.”
You try to look up your new patient while you’re waiting in the med room but the computer is too slow. The charge nurse rushes in, “Sorry, I’m here. Oh and your admit just got here.” Medication in hand, you intercept your new patient being wheeled into room 2. “Hi, you must be Jack. I’m Christina, I’ll be your nurse today.” First impressions are important so you shake his hand with the hand not carrying the hydromorphone. Jack’s wife lags behind. You introduce yourself to her and tell them you’ll be back in a few minutes. You can feel Jack’s wife’s eyes on your back as you rush away. “Will she be too busy for my husband?” she’s thinking. The patient in room 8 starts to yell as you rush in, “IT’S 11:15 I AM IN SO MUCH PAIN WHERE WERE YOU?!”
It goes like this for hours. Meds. Phone calls. Blood sugar checks before lunch. Calling doctors. New orders. Complicated discharges. Before you know it, it’s past 3:00 p.m. and the grumbling in your stomach reminds you that you haven’t had a break. You call the relief nurse. “Sure, now’s good,” she says. You free your lunch from the crammed refrigerator, plop down in the break room, and get in line for the single microwave. There are two people ahead of you, and one has a frozen meal. Someone is watching Kardashians on TV. You prefer peace and quiet but break room etiquette dictates first come, first serve.
Your lunch ticks by as you try not to think of all the things you still have to do. If you’re lucky, you’ll get the “nothing happened” from the relief nurse when you come back from lunch. If you’re not, you’ll get “bladder scan in 31 was 600 mL. Didn’t have a chance to call the doctor. 8 was nauseous so I gave ondansetron.”
The next few hours are the same: running around, multi-tasking, giving meds, admitting a new patient 30 minutes after discharging another. Before you know it it’s 6:30. You have to finish your notes before the next shift arrives. You type as fast as you can, your fingers clacking away at the keyboard, a sense of urgency spurring them on. You don’t want to get called into the management office for a discussion about incidental overtime. The nurse next to you is quietly scrolling through Instagram on her personal cell. Part of you feels jealous and part of you thinks “good for her and her time management skills.” Maybe she’s just better with computers than you are.
The next shift seeks you out. You admire their fresh faces, perfect hair, and clean scrubs, but know that in 12 hours they’ll probably look like you. You finish giving report and clock out. As you walk out of the hospital, you worry about whether one patient’s ileus will resolve, if a second patient will be here another 2 weeks, and if another will go back home or be discharged to a skilled nursing facility. You think about the rapport you earned with Jack’s wife after you sat down for a half hour and not only completed the admission charting but took the time to really connect.
Every muscle in your body aches, but you smile as you drive home because there’s no other job in the world that could give you this same feeling of accomplishment.
Christina McDaniels is a staff nurse at Scripps Healthcare La Jolla and Green Hospitals in San Diego, California.