Shift begins with bedside handover from outgoing nurse, introductions made, ID’s checked, we smile, we say hi, we scan, noting the patients skin colour, affect, facial expression, position in the bed, are they moving, scared to move?
First patient has a zip-like vertical incision in her abdomen (large ovarian cancer removed the previous day) neatly sutured closed, covered with see-through dressing.
Drip stand, four pumps attached sits alongside. Above the 1st pump hangs a bag of lethal pain killer. Is it labelled correctly, is the line labelled, pump programmed accurately, drug matching the order, IV cannula dressing secure, any sign of infection, kink in the line?✔️
2nd and 3rd pumps give a micro dose of numbing local anaesthetic into the skin near the wound, check them too, are dressings secure, no leaking✔️
The 4th pump gives an hourly volume of saline and antibiotics at the same time. Check ✔️
Drain in the wound, is it unclamped, is the squeezy chamber vacuumed, is the volume of blood/fluid in bag ok? Mark it, record, check dressing✔️
Abdominal dressing, is it intact, any bleeding, ooze, gape in the stitches?✔️
Urinary catheter, is it fixed securely to the inner thigh (stops pulling at the urethra, ouch) check volume and colour of urine draining?✔️
BP machine, is it available, ready to go?✔️
Is everything plugged in, battery loss painful at critical moments 😩✔️
Untangling as we go, thinking ahead to moving the patient out of bed when the dance begins of unhooking drains and catheters, unplugging pumps, unwinding lines, round and round, threading this way, threading that (it’s an art!)
Handover received for remaining seven patients then off we go into the fray to a chorus of alarms and call bells, to pain relief needed urgently, to someone retching into a vomit bag, to a new admission wheeling up the corridor from emergency.
Immediate fires tended we start proper, expecting to be on our feet most of the shift treading a path between bed, treatment room, nurses station, linen trolley and pan room. Feels like exercise but in reality just a lot of walking ( doesn’t that count🤔) heart rate elevated only in emergencies.
Space is limited so every inch is grabbed back, surfaces cleared, patient belongings put away, equipment returned, unused blankets folded, extra pillows removed , all making clinical care easier.
If there IS an emergency valuable time can be lost untangling lines, moving shit from the floor to let relevant teams in. Sicker the patient, tidier it needs to be
* * The aim by end of shift is for all patients to be clinically stable, pain free, clean, cocooned in fresh sheets and blankets, curtains pushed back natural light coming in. Takes a lot of work!
Observations first, blood pressure, heart rate and oxygen saturations reveal all. Temperature check too, looking for signs of infection.
Next medication administration, a huge responsibility, focused concentration needed every time, no short cuts, ever. Patience too scrutinising sometimes multiple charts.
Physios help sicker patients take the first lung expanding, leg pumping walk, brave promenades up the corridor, hospital gowns flapping, legs in compression stockings, trampoline socks gripping the floor.
Some are keen for a shower so we go for it, multiple drips, drains and catheters in tow, a major physical manoeuvre for both patient and nurse. Quick is key.
Peering at their abdomen in the mirror the sight often too much, “don’t look!” Cannulas and wounds waterproofed , then gently, sweat, blood and pink antiseptic stripes are hosed off.
Drying backs, lower legs, feet. Nurses don’t bat an eyelid at the sight of naked flesh but we scan, skin detectives looking for problems, rash, bruise, sore, a dressing undone.
Then, patient adorned in clean hospital gown, the final push, back across the floor to a freshly made bed, to opioid pain control, to sleep.
Scan again, quick recce, is everything in place before moving on. One episode of care for one patient, the two nurses responsible for seven others.
Things can and do go wrong.
Drugs often not available when needed. Equipment malfunctions. Doctors difficult to contact. Crashing BP’s. Soaring temps. Sudden rivers of blood. And the human factor, patients needing extra time and attention, a pain crisis, a heightened emotional response (crying, raging, acute anxiety) Overwrought relatives.
Nurses who need or like plans to work out in a linear way find this all frustrating. It IS frustrating!
End of shift, we look at each other, hopefully satisfied, patients exactly as planned ** or we commiserate, feel bad, stretched too thin, patients fine but our perfect, lofty goals for them not quite achieved.
We learn not to blame ourselves, it’s a 24/7 job, we work in a system, within a team so handover is given to the next shift, it’s our turn to go home, rest, re-energise, ready for the next .
Lindsey Crossan Registered Nurse/Midwife
