a day in the life of a nurse

 

Angellette Griffith

Fanshawe College

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Abstract

I chose to write my essay on the work load of nurses because
it is something that seems to be over looked. From a young age, I have been
drawn to anything related to medicine and taking care of others.  From the bottom of my heart, I believe that
nurses deserve the same recognition as doctors because at the end of the day
they are a team. I recall a time when my sister, a registered nurse midwife of
15 years, saved a patient and her baby’s life and the doctor was the one
recognized.  A patient was brought in at
12:30 am at 3cm, and only moved 1cm since admission with a grade 3 meconium
(the first feces of a new born), receiving 5l oxygen via face mask as the baby
was in destress and needed additional oxygen. Upon reviewing the patient’s
notes, she spoke to her gynecologist 2nd, explaining to her that she was
preparing the patient for an emergency caesarean. Doctor Gomez said, “wait to
see if she makes any progress because I am not interested in doing a caesarean
section today.”  After speaking to the
doctor, she examined the patient to find small clots at the introitus (vagina).
My sister then bypassed the doctor’s decision, and took the patient into the
operating theatre for a caesarean section as she was noted to have placenta
abruption (when the placenta is detached from the mother). As for the infant,
he came out with Apgar score (a physical condition of a newborn), and was
placed in the nursery for close observation. 
If my sister had waited longer the infant would have died, but Doctor
Gomez got recognition for saving their lives. This particular incident my
sister experienced, drove me to highlight a day in the life of a registered
nurse, with hopes to enlighten my audience that nurses work just as hard as
doctors.

A Day in the Life of a Registered Nurse

A doctor may find the medical cause of a patient, but it is
the nurse who help the individual to overcome them. (Picoult, 2003). To say
registered nurses are busy is a bit of an understatement. They spend long hours
daily dedicating time and effort into their work. The determination is clear
within the role of a nurse which includes leadership, assessment and treatment,
for each of their patients. Nurses are doers who work physically harder than
doctors, they are not as well paid or respected as they deserve, they have less
autonomy and less credibility than they might, and they are wonderful patient
advocates.

 

Nursing leadership assures that every individual does their
part to get a job done. Evidence has shown that leadership has a positive
impact on patient outcomes. Cummings (2010) studied nursing leadership in nine
acute hospitals in Canada, collecting nurse’s perceptions of their leaders,
whose styles ranged from highly resonant to highly dissonant. They found that
the differences in leadership styles explained 5.1% of the variance in 30-day
mortality rates between hospitals. The individual that is in charge for the
entire nursing team is called the head of nursing, and that individual must
allocate each staff member to a task, they need to ensure that every patient
has received adequate care and debrief every individual on the team. According
to the American Nurses Association (ANA) Code of Ethics for Nurses with
Interpretive Statement, the nurse is responsible and accountable for individual
nursing practice and determines the appropriate delegation of tasks consistent
with the nurse’s obligation to provide optimum patient care (Kelly-Heidenthal
and Marthaler, 2005).

When the staff arrive to work, the individual that is in
charge has to assign each nurse to five-six patient and a clipboard (medical
chart containing information such as: medical history, vital signs, diagnoses,
treatment plans, laboratory and test results). Then, the nurse has to go into
every patient room during morning assessments, set up patients for breakfast,
charting (medical chart), give medications, and assist patients with following
out doctor’s orders. Lastly, at the end of the shift the nurse and the nurse in
charge must debrief the nurse on the oncoming shift. During the handover, the
nurse has to give details of every patient assigned. The handover of each patient
is generally made up of three sections: Past: historical information. The
patient’s diagnosis, any information the team needs to know about the patient
treatment plan. Present: current presentation. How the patient has been during
that time of the shift and any changes to their treatment plan. Future: what is
still to be done. For lots of reasons tasks that need to be completed at a
certain time may be handed over to the next shift, simply because the team did
not have time to complete the task. Nursing leadership is vital not only to the
long-term credibility of the nursing practice, but to achieving good patient
and client care and effective nursing leadership is very important in all
nursing role.

 

Clearly, nurse-patient encounter is the first encounter
between a nurse and patient while assessing that patient. Nurse assessments
focus upon the patient response to health problems, perceived health needs,
health practices and values. The goal of assessment is the collection and
analysis of data that are used in formatting nursing diagnoses, identifying
outcomes and planning care, and developing nursing interventions. Incomplete or
inadequate assessment may result in inaccurate conclusions and incorrect
nursing interventions. When entering a healthcare facility nurses are the first
person you will encounter asking you series of questions while checking your
vital signs, it may not seem like a lot of work to some, but nurses does
assessment from the moment you walk through the door and at the beginning of every
shift. There are three types of assessments carried out by nurses,
comprehensive, focused and an ongoing assessment.  Firstly, the nurse must perform a
comprehensive assessment which is completed upon admission to a healthcare
agency. This assessment includes assessing the physical, emotional and mental
aspects of all body system as well as the environment and social issues
affecting the patient. Next, a focused assessment, this assessment collects
data about a problem that has already been identified. This assessment has a
narrower scope and a shorter time frame than the initial assessment, the nurse determines
whether the status of the problem has change (improved, worsened, or resolved).
Finally, an ongoing assessment which is a systematic follow-up when problems
are identified during a comprehensive or focused assessment. This assessment
includes the nurse doing systematic monitoring and observing related specific
problems, it also allows nurses to broaden the database or confirm the validity
of the data obtained during the initial assessment. Assessment is the first
stage of the nursing process in which the nurse should carry out a complete and
holistic nursing assessment of every patient’s needs, regardless of the reason
for the encounter. “The most important practical lesson that can be given to
nurses is to teach them what to observe- how to observe-what symptoms indicate
improvement- what the reverse- which are of importance-which are of none-which
are the evidence of neglect- and of what kind of neglect. All this is what
ought to make part, and an essential part, of the training of every nurse”
(Nightingale, 1860/1969, p.105).

 

“Medical treatment is emergency care for symptoms that have
develop over a long period of time. The symptom is the flower on a plant.
Treating the symptom is picking the flower, while the plant remains untouched”
(Zukav, 2015). Nurses provide care based on patient needs working along with
doctors to formulate a care plan. The nurse provides psychological support to
clients with terminal illness. In addition, through the assessment process
nurses individualized priority-setting, priorities will be influenced by the
acuity of the patient’s condition and the acuity of all patients assigned to a
nurse. Priority ranking of patients are characterized into three levels: First
level is where they treat patients with immediate survival, safety and high
demand. Second level highlight concerns such as mental status change, acute
pain, acute urinary elimination, untreated medical problems requiring immediate
attention (diabetic needing insulin), abnormal pathology lab results, risk of
infection and safety or security. Third level is where those that do not fit
into the above categories. When there are no life-threatening problems, nurses
used both professional judgement and the patient to set priorities and
determine planning. “Prioritization is defined as deciding which needs or
problems require immediate action and which ones could be delayed until a later
time because they are not urgent”. (LaCharity, Kumagai, and Bartz, 2006, p.4)

Critical thinking skills is the core of being a good nurse,
in addition, they use these skills to provide effective care while coping with
the expansion in roles associated with the complexities of current health-care
systems. Nurses use critical thinking skills to prevent medication error, in
fact, they think in a systematic and logic manner with openness to questions
and reflect on reasoning to ensure safe nursing practice and quality care. Every
day, nurses make decisions through critical thinking. Critical thinking is
identified as an essential nursing competency by the National League for Nurses
(1997). Critical thinkers are people who know how to think. They possess
intellectual autonomy, in fact they refuse to accept conclusions without
evaluating the facts and reasons for themselves. Critical thinking is process
that allows nurses to see the big picture instead of focusing only on details.
Furthermore, nurses must administer numerous drugs daily in a safe and
efficient manner. They administer drugs according to the nursing standards of
practice and agency policy. Before administering any medication, the nurse must
compare the medications listed on the Medication Administration Record (MAR),
other recording forms, or computer orders with the healthcare practitioner’s
order. When administering medication, the nurse must check the label when
removing the drug container from the drawer, check the drug when removing it
from the container and before returning it to the patient’s medication drawer.
The nurse should give only medication that they prepared and checked, because
they are the responsible party should an error occur.

As a result, long hours and dedicated time spent by nurses
are their daily work routine. Everyone has a common goal, but the nurses are
not being recognize for their hard work. They deserve the same recognition as
doctors because nurse is the center of healthcare. Society think so little of
nurses, but at the same time doctors rely on them so much. Doctors will see a
patient anywhere from five to thirty minutes a day depending on how sick you
are, and the rest of the work are left to the nurses. They are the ones making
sure you get your pills, check your vital signs to ensure they do not drop,
make sure you do not fall and break something. If a patient vomit, doctors will
run out of the room while a nurse rushes in, they change your wound dressings
and start you IV line. They will clean disgusting things off even if you are
drunk, delirious or mean and through all of this they try to be friendly and
positive. People say nurses are not busy really is an understatement.

 

 

 

 

References

Cummings, G. (2010). The contribution of hospital
nursing leadership styles to 30-day patient mortality.Nursing Research, 5(1), 331-339.
Daniels, R. (2004). Nursing fundamentals: caring &
clinical decision making. New York, NY: Thomson
Delmar Learning.
Delaune, S. C. & Ladner, P.K.
(2002). Fundamentals of nursing:
Standards & practice (2nd ed.).
             Albany, NY: Thomson Delmar
Learning.
Kelly-Heidenthal, P.,
& Marthaler, M.T. (2005) Delegation
of nursing care. Clifton Park, NY:
  
           Thomson Delmar
Learning.
LaCharity, L.A., Kumagai, C.K.,
& Bartz, B. (2006) Prioritization,
delegation, and assignment:
              Practice
exercise for medical-surgical nursing. St. Louis, MO: Mosby Elsevier
National League of Nursing. (1997).
Interpretive guidelines for standards
and criteria 1997:
              Baccalaureate
& higher degree. New York: National League for Nursing Accrediting
              Commission.
Nightingale, F. (1860/1969). Notes on nursing: What it is and what it
is not. New York: Dover.
Picocult, J. (2003). My sister’s keeper. Simon & Schuster.

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