A Day in the Life of a Surgical Nurse

So I am going to do my best to write what a typical 12 hour day looks like for me. My days are actually usually 16-17 hour days since I get up around 0500 AM and usually don't get to bed until 2100 or so. I leave for work around 0545-0550 and get to work at 0630-0640. And then I have about a 4 min walk from my car to the unit I work on. I always go to unit 21 first to find out which unit I will be working on for the day. At 0700 my co-nurses and I get a quick report from the charge nurse from the previous shift. This report is just the major important things we need to know about that is happening on the unit. Then I go get report from the nurse I am trading off. If it's my first day, after report my partner and I decide which patients we are taking. Then I log into the computer and check out my patient's charts- mainly looking at important notes, any orders that I need to know about, what meds I need to give, any dressing changes if there are, if I need to check blood sugars for the diabetic people, etc. Once I have that done, I do a round and pop into all my patient's rooms to say hi and get them anything they need right away such as pain meds. Then from about 0730-0900 I am busy giving medications and doing my assessments. If it's a great day, I can get everything done by 0900 without too many interruptions but sometimes, things happen such as someone is not doing too well or blood sugars/blood pressures are too low or too high and then I can get behind with everything cuz obviously I have to do something about my patients that aren't doing too well. I try to get my assessments documented by 0930 if possible but that does not always happen. Then I usually go on break anywhere between 0930 and 1030 for 35 minutes (when I go depends on whether I go on break first or my partner goes on break first). If it's a chaotic day, I sometimes don't go on my first break until at least 1100 or so. After I get back from break, I usually try to catch up on documenting and then start doing dressing changes if any need doing. And of course patients go for surgery any time of day so I have to be prepared for that as well. To prepare a patient for surgery, I have to make sure their height and weight are taken, someone has gone through to make sure we have all the meds they are taking are on file, and verify when they last had something to eat and drink because if it is not emergency surgery, no eating or drinking after midnight of the day of surgery!! I also have a checklist to complete that makes sure the important things I just mentioned are completed. The patient also has to change into a gown that we call a bair hugger (these are paper gowns that get puffed up with warm air before surgery to pre warm the patient). I also have to make sure they are not wearing any jewellry, dentures, or glasses/contacts when they go up to surgery. Hearing aids and CPAP machines they take up to the operating room (OR) because the surgeon talks to them before surgery so it is kinda essential they can hear him:):). Once all that is completed they are ready to go up for surgery. Also another very important thing is to do vital signs before heading to surgery because if their vitals are not good, then they cannot have surgery. The nice thing about ConnectCare (this is our documenting system and where we access everyone's charts) is that I can see exactly what time the surgery starts, when its completed, and when the patient goes into PACU (post anesthesia care unit). The patient has to stay in PACU for at least 1/2 hour after surgery unless they are not doing good, then they have to stay there until they are stable. Once they are stable, I get report from the PACU nurse and then the patient comes back to my unit. Depending a little bit on what kind of anesthetic they had depends on what I need to do for my patient. If they had a spinal anesthetic (this kind of anesthetic is put in your spine to numb your body usually from around lower chest area to feet), then I get to do what I call the ice test. This is basically taking ice and touching it to the patient's skin starting from their chest and going down until they can't feel it. We do this because it is very important to know when the anesthetic is out so we can get them up walking. If they had other anesthetics then I don't do any of that. But anyway, as soon as they get back to the unit, I take their vitals, ask if they are in pain or have nausea, and check their dressings to see if they are bleeding or not. I make sure they are breathing ok because believe me, sometimes patients come back very groggy so it is rather important that they are doing fine. Just FYI, we do vitals every 15 minutes for 2 times; every 30 minutes for 2 times; every 1 hour for 2 times and then every 4 hours until the 24 hour mark from when they returned to the unit. So ya that can be busy for awhile once someone gets back from surgery.

Also if I have an empty bed, then I must also be prepared for getting an admission which involves going through a very long list of questions that I feel bad asking cuz it feels stupid sometimes but I know it's important. And then if they are going to be going for surgery, then I make sure that they stay NPO (which just means they are not allowed to eat or drink anything). Also let me add that we have patients that are for OR add on which means they are on a list and once the elective, or planned, surgeries are done then they begin taking people from the add on list. So sometimes these people have to go all day without eating or drinking and then they get cancelled and get to do it all over again the next day (If they get cancelled, we do give them something to eat and then once midnight hits, no eating or drinking anymore). Also if someone is NPO, usually we have them hooked up to fluids through an IV so they do not get dehydrated.

Anyway, around 1200, I make sure meds are done and blood sugars are checked and whatever else needs to be done before dinner comes around. I try to go for break between 1230 and 1330 for 40 minutes. Once I come back from break, I do any dressing changes that didn't get done in the morning or anything else that comes up such as giving meds or doing any orders that come up. This may include giving medications that just get ordered or discontinuing NG tubes (tubes that go through the nose and down into the stomach- you never want one cuz they are terrible and very uncomfortable) or foley catheters or inserting these devices if that is what's ordered. Also another thing about surgical patients- usually we try to get them up walking within 4 hours of surgery if there are no orders restricting movement and they also have to pee within 4-8 hours of surgery. Sorry if that was too much info but I'm being honest here.

And then for discharging patients which can also happen at any time of day or night. I print off a bunch of papers called an AVS (after visit summary) which has instructions on what to do and what not to do plus when to call for help and so on. I go through all of that with the patient and family if they are there. I also make sure any prescriptions are faxed to the patient's pharmacy if they want. I then make sure any IVs are taken out, the patient has all their belongings, they have a ride, and that they feel they are ready to go home. Then once they leave the unit, I go through a quick discharge checklist and make a quick note and then discharge them from the system.

If the patient is being transferred to a different facility, I give report to EMS and give pain and or nausea meds to the patient before they leave. I make sure they have all their belongings and then help them onto the EMS stretcher and away they go. Also, EMS usually just shows up at anytime so once we know the patient is being transferred, then we prepare for EMS to show up at any given time of day or night usually without warning. Once they come, I have to drop everything else I'm doing and get my patient sent on the way.

Anyways back to my day, around 1600-1700, I make sure all supper meds and blood sugars are done and then go for my last 35 minute break. Once I get back from break, I finish up my day by ensuring everyone has pain meds that needs it, everyone is as comfortable as can be, and that there are no pressing needs when the night shift arrives. But again it is a hospital so anything can happen just before shift change which often things do come up. Honestly sometimes I think patients know shift change is coming so they call for help just before I have to give report. But anyway talking about pain meds- I do try to make sure everyone's pain is tolerable even though sometimes according to the patient they are always in a lot of pain so it does get difficult to know if they are actually in pain or if they are exaggerating a bit which I know sounds mean but truly sometimes I don't know. At 1900, I give report to the night shift coming on and then I happily pack my stuff and head home. So this is kinda a run down of what a typical day looks like. but again, it is a hospital and unpredicable so there is always little things that keep coming up that need doing and orders change so it is important to continually be watching those. But I like to tell people that even though sometimes it is chaotic and yes I do complain, I would not want to be doing anything else. Hopefully this kinda makes sense but here it is:) Have a lovely rest of your week! If you have any questions, please feel free to ask!