An overview of my workplace:
I work in a trauma and orthopaedic ward in one of the NHS hospitals in Southwest of England. Our ward has 29 single beds, divided into 5 bays and 6 isolation (side) rooms. We provide service to patients with all sorts of fractures (traumatic & pathologic), joint dislocations and infections, spinal problems, and some local infections like cellulitis.
On this entry, I will outline my normal day shift (12.5 hours).
07:30 | Safety Briefing + Patient Handover
Our shift starts with a safety briefing, it is where all the registered nurses from outgoing and incoming shifts huddle-up in the treatment room to talk about the patients and the ward as a whole. We start by deciding who will be the nurse-in-charge and the admission nurse. We then highlight important considerations like: (1) If there are patients who our currently unwell needing attention. (2) Which patients are not for active resuscitation. (3) Which patients are for NPO / NBM for surgical interventions. (3) Patients with existing or likely to develop and vulnerable to pressure damage. (4) Any infection control concerns. (5) Patients who are on high-risk medications. (6) Special dressings and contraptions like VAC therapy, PICC line, blood transfusions, or NGT. (7) Staffing levels and other concerns that the incoming shift needs to address.
It is then followed by a patient hand-over from the outgoing nurse to the incoming nurse and healthcare assistant. Here, the nurse will provide an overview about the patient assigned to you, including histories, diagnosis, mobility status, ongoing treatment regimen, and the discharge plan.
08:00 | Morning drug rounds
While the HCA is making sure that all the patients are served with breakfast and is helping those who require assistance, the registered nurse will start the morning drug rounds, going from patient to patient, giving extra attention to pain levels and administration of analgesia.
09:00 | Multi-disciplinary team board rounds
The nurse provides an overview about his assigned patients to the MDT that includes the ward consultant, junior doctors, physiotherapists, occupational therapists, and discharge officer. Here the whole team decides what is the best plan for the patients, especially the appropriate discharge plan and destination and what support the patients will require.
09:15 | Washing, skin checks, and mobilising patients, and reading through notes
After breakfast and morning tablets, the nursing staff then will assist the patients for morning wash or shower and dressing. It is the perfect time to do the first skin check of the shift as well. We check areas vulnerable to pressure damage and surgical wounds / dressing for post-operative patients. After that, we usually encourage patients to mobilise and stay out of bed most of the morning.
After all the patients have had their wash or shower, the nurse then starts to read through the notes from the team and starts making plans for the rest of the day. If there is enough time, nurses can start carrying out orders from the doctors.
12:00 | Serving of food and lunchtime drug rounds
The staff will start serving lunches and the nurse will commence on the drug rounds again. Lunchtime drug rounds is generally the fastest as it is normally just for painkillers. After lunch is also the usual time for the next dose of IV antibiotics if you have any.
13:00 | Vital signs taking + skin checks
The HCA and the nurse will start taking patient’s observations including blood pressure, heart rate, respirations, oxygen saturations, levels of consciousness, and pain scores. Any abnormalities will then be addressed by the nurse or escalated to doctors if needed. The staff will also do another skin check and will assist patients back to bed for those who want to have a nap.
14:00 | Carrying out of doctors’ orders and MDT plans and addressing other nursing needs
By this time, the doctor should have seen the patients already and the nurse will start to read through the notes again and carrying out the doctors’ orders and doing the MDT plans. This is also the perfect time to address the needs of your patients, like doing referrals if needed, preparing discharges if you have any, redressing of wounds, completing the required documentations like cannula and catheter assessments, and all other matters that need addressing.
17:00 | Serving of food
The staff will start serving supper, assisting patients back to the chair if they wish to and checking their pressure areas if there is an opportunity. This is also a good time to assists some patients to change into their bedtime clothing to lessen the workload later on. The nurse will then start preparing the next dose of IV antibiotics if needed.
18:00 | Tea time drug rounds + skin check
The nurse will start doing the last drug rounds for the day shift. This usually takes time as the next dose for twice daily tablets, next dose of IV antibiotics, and VTE prophylactic injections are given during this time. After drug rounds, the staff will do the last skin check of the shift and will make patients comfortable in bed if they want to.
19:00 | Nursing documentation
Although nursing documentations can be started whenever you have spare time, this is usually when the nurses finish and update everything. Here we document on patients progress and all the nursing care we have provided for each of our patients.
19:30 – 20:00 | Safety Briefing + Patient Handover
This is exactly the same as the morning one. It is when the day staff handover to the night nurses.
Although this is how my normal shift takes place, nursing is not something that we can perfectly plan on as patients have varying needs and situations needing urgent attention and action frequently arise in the hospital. Sometimes, you will just juggle your time to finish whatever needs doing. All throughout the day, you will also be admitting and discharging patients, answering their needs, and doing urgent interventions.
This is the normal practice in my ward and my personal preference. Nurses have their own ways to manage their shift and it is perfectly fine to do what works for you. At the end of the day, patient’s safety, answering their needs, providing effective and efficient nursing care, and making them comfortable as much as possible are all that matter.
Do I get break times?
Yes! I am entitled to have a 30minute breakfast break and 45minute lunch break.
If you have any question about this, don’t hesitate to get in touch!
tyronedelrio 