The Unexpected Reflection
I spent 12 years working on the floors of hospitals, nursing homes, jails, clinics, etc. I was an agency nurse. I went EVERYWHERE. Literally over 200 different facilities in 12 years. Most of them without a scrap of orientation or much help from anyone.
Here’s how my typical work day went in a nursing home/hospital environment (the majority of my shifts), presented in instruction form:
- Look up directions to wherever you’re working and go there.
- Walk in and quickly try to find unit that you’ve never been to before in place you’ve never even heard of before. Remember this layout, because you’ll use it all day.
- Find nurse that just wants to go home after his/her shift to get report from and TRY YOUR DAMNDEST to get all the information you need to know to be functional out of him/her before he/she passes out on you. Get any weird patient information out of them during report and this ABSOLUTELY includes *HOW* the patient takes their meds (crushed, whole, in applesauce, via G-tube, at a *very specific time, etc). This also includes any weird bowel protocol items they may have on their MARs with weird-ass facility-specific cryptic code names (trust me, it happens). Ask them if there’s a treatment nurse or not (I’ll come back to this).
- Hurriedly orient yourself to the unit, your tools (med carts, supplies, garbage, kitchen, etc) and the nearest bathroom (so you can stare longingly at it as you pass it all day).
- Frantically flip through EVERYONE’S MARs (Medication Administration Records, HOLY SHIT AM I ELATED THAT PEOPLE ARE GOING ELECTRONIC) and make notes on a census sheet: which time which patients have meds to give. Just a time, because you can get more details from the MAR when you go to prep the meds. This also includes a quick glance to see if there’s anything weird that may be refrigerated or have a privacy-required route of administration.
- Prepare for and perform the med run. This is seriously the thing that happens RIGHT when your shift starts in a new facility. You don’t know crap and you have to go almost directly into a med distribution right off the bat. This isn’t terrible in a hospital setting, because even though it’s still hellish, you don’t have 40+ patients that are used to getting their meds at a VERY SPECIFIC TIME in a VERY SPECIFIC ORDER. In a hospital, the patients and families can be demanding, but they are in a sort of…time limbo. They don’t realize what time it is for medication that isn’t related to pain or that isn’t vitally important to keeping them alive. A residential patient? On about 2-3x’s as many meds, very used to taking them at a specific time and place in a very specific way. Oh, and there’s at LEAST 40 of them. And they’re not in their rooms. And their meds are all shoved into a cart that is like trying to spelunk into the ruins of a lost civilization for the one med that really needs a note like: “family supplies this, will be in an almost indiscernible bottle in the bottom drawer of the cart, mixed in with the twenty containers of miralax.” And the residents/patients all want to hate you or manipulate you right off the bat. You gotta play this fucking mindgame with them to seem competent while you juggle and fumble through the cart or their meds like you’re not losing your damn mind at the idea that you have only a two-hour window to give 40 patients their 20 meds or that you’re probably going to be asked questions that should’ve probably been directed to their doctor (this is the hospital setting more). (Ideally, staffing wouldn’t be as high as 1 nurse to 40 patients - but, trust me. Things happen. I’ve had at least 60 patients at a new place because of situations like call-offs and whatnot. It happens, even though it isn’t supposed to.)
- Audit the MARs to make sure you didn’t miss a damn thing in the med run and then start gearing up for the next med run. No joke, it’s that close together. If you have time in here, you do some documentation here or some treatments (if there isn’t a treatment nurse - which used to typically be the case).
- Forget to pee or eat or drink. You’ve been running non-stop since you got in, sleep deprived and crazy. Just doing what you gotta because that’s what you’re there to do. You wonder around this time juuuuust how horribly you’re fucking this up compared to the regular staff members. By now you have all the med carts and door codes memorized, because you’ve had to make some unexpected med-cart departures for items that people didn’t restock or that you didn’t know you’d need.
- Do that next med run. Some sort of hell, but always less torturous than the previous. You’re a goddamned pro by now. People expect you to remember them after the first med run, because you made eye contact while confirming their identity, so you’re BFF’s now (seriously, you become a pro at remembering names/faces). The first med run is either the morning med run or the post-dinner/bedtime run. So, this one is either throwing out PRN (as needed) sleeping pills like candy or it’s about 1/3 the quantity of the morning run - but for the lunch pills. (Think of it this way, if you take it once a day: odds are good it’s in the morning. If you take it twice a day: Odds are good it’s in the morning and the evening. You see where I’m going with this….to get it happening at lunch, you usually have to be taking something at least 3x per day, which isn’t as common. Granted, there’s some things that only happen at lunch, but: outliers, people. Let’s get back to this hell.)
- Document, document, document, contemplate how easy it would be to just walk out while DEFINITELY getting talked to too long by SOMEONE about SOMETHING that you have *ZERO* influence or control over. So, basically: have your time wasted - when it is oh, so precious. Learn to be really good with ignoring people while looking like you’re listening. You can even respond robotically and they usually don’t notice. Occasionally through in a mini-speech about how jacked-up the medical system is. You’ll be fine. Shove some snacky items in while that person is complaining or while you’re documenting. It’s the only chance you’ll get - even though you’re supposed to be taking a 30 minute break at some time in your 12 hours.
- Basically, this continues and by the end of the day you realize you’ve peed once, but drank the equivalent of a 2 liter of water. You rush to the bathroom and then while sitting: run through EVERYTHING you were supposed to do. Realize you forgot someone’s treatment or to turn off their nebulizer or whatever and run out of the bathroom to resolve that.
-Relax because you realize that you’ve got it all under control and you somehow managed to get a better report prepared for the next shift amidst all that chaos than the one you were presented and await your sweet release from that hell.
- Receive compliments on your performance and a job offer to come on staff full-time. Be told at this point that SOMEONE was supposed to help you out a little, but you were fine without them, right? :P
Anyhow, this was the majority of my nursing shifts for at least a solid 10 years of my nursing career. Granted, after a day of that at one place, going back to the same place for another day or two was a CAKEWALK…and by day three, you’d seem like you’d worked there for years.
The reason that this happens is because you have to be ON POINT. On your damn game to be a self-sufficient staff member that blends in seamlessly into what happens on a daily basis without you. You are acutely aware of everything that is happening and you are amped the hell up. The nurses that work there full-time are in a routine and don’t have to blink an eye to do their job sufficiently. You wind up being a positive influence on wherever you work, because you’re giving 200%.
I thought that giving up (what had to have been) a ridiculous amount of stress by switching to a desk nursing job would make my life better. For the last three years I had convinced myself of that.
The moral of this post is that it took me three years to realize just how much I needed that stress in my life. I was active. I was mobile. I had other people’s issues to Sherlock, so I didn’t fixate on myself. I was CONTRIBUTING POSITIVELY TO PEOPLE’S HEALTH. Now, my health has suffered. I LIVED FOR THAT SHIT. I got all the “you’re awesome” affirmations I needed just by being good at my job.
So, while the thought of being a floor nurse again is the most terrifying idea I can imagine - I’m beginning to brainstorm how to incorporate it back into my life in the upcoming years.
This is my most unexpected reflection within the last year.
















