The day drags on; you hang in there until the job is finally complete. You are exhausted, tired, and sure something is clearly wrong. Arriving in the emergency department is never one of those moments you expect. Staff greetings are quickly followed by people taking your vital signs, pressure on various parts of your body, and placing you under X-ray machines. Symptoms come and go, and verdicts are read. Good news or bad, you have just been put through a million-dollar workup, all made possible by America’s dedicated health care workers.
Chances are one of the first faces greeting you was that of a nurse. From arrival to departure, the nurse makes it all possible. Whether it is 7 a.m. Monday morning or midnight Saturday, the nurse will be there to greet you, assist you, carry out physician orders, monitor you, cry, laugh, and heal. After 20 years of nursing, it is my pleasure to help you understand exactly what nurses do.
To keep this post from reaching ten thousand pages, I will keep this dedicated to the hospital setting, more specifically to an acute-care medical unit. To the naked eye, nurses seem to run around and act busy. Fair enough since we often do this. What else is going on as the nurse sits at the desk, is on the phone, looks at computer screens, or talks with the physician? The nurse acts in various ways to make it possible for the person sick or injured to get better.
The nurse arriving at work will follow a series of steps to obtain all the information needed to improve you. The science behind this allows for a systematic approach to learning your situation, background, assessment, and recommendations for the next few hours. This is known as a handover report and will prepare the nurse to care for you. During this time, the patient may or may not be involved, questions asked and answered, and goals discussed. Physicians prescribe a series of treatments, medications, and suggestions they feel will help you improve. The nurse follows orders of priority to carry these out throughout the course of their shift. This means fighting with intravenous lines, tubing, and pumps to carry out that Cipro order your doctor wants you to have every 12 hours. The nurse must make sure the line going into your vein is healthy and not causing you additional problems.
While doing this, the nurse helps you get in and out of bed to walk to the restroom, sit in the chair, and prepare your lunch. Blood work results are in, and the nurse looks them up in the electronic medical record that is on the computer screen at the nurse’s station. Your potassium level is very low and must be corrected. The nurse pages the physician and obtains orders to replace it. This order is entered and sent to a pharmacist who ensures it is an accurate dose. The nurse enters into the medication record into the electronic medical record and again will follow a series of events to keep you safe. Asking you your name and date of birth makes sure it really is you. The nurse then checks the five rights of medications: the right drug, the right dose, the right patients, the right route, and the right time. Your potassium is replaced, and life goes on.
The physician drops by later in the afternoon to check in on you. The nurse concurs that the day is going well and chimes in her two cents on how you are progressing. You haven’t eaten much because of your nasty cardiac diet. You mention this to the doctor, who agrees to give you the regular diet for dinner. The nurse calls the dietary department and lets the kitchen know to give you some real food tonight. During this time, you get confused about the medications and feel it is time to go home. The nurse reminds you where you are and feels you are at risk of falling or trying to leave. The turns on an alarm on the bed to notify you and anyone else in earshot if you start misbehaving. The next nurse arrives and receives the handover report, only to have you as a safety risk with closer monitoring until your confusion clears. You have kept the doctor posted along the way, who thanks you but has no solution to offer other than more labs in the morning.
The nurse makes it all possible. The nurse works with many people in the hospital to make you better and keep you safe. We train to perform the highest standards science must offer while using critical thinking and credible evidence. The next time you are sick and need the hospital, you will see first-hand how the nurse will improve you.
John Green is a nurse, health care writer, and consultant and can be reached on his self-titled site, John Green.
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