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A Day In The Life Of A NurseNurses put the Care in heatlhcare. As such, they play a wide and varying role in the healthcare industry. Nursing is a profession of caring. It is a profession that challenges every emotion that a human being can experience. Traditionally, there are three levels of nurses provided to patients, RNs, LPNs and CNAs. Today, however, you will find a new type of nursing care giver in the hospital setting. These new care givers have different titles in different hospitals. Registered Nurses (RNs) are the top educated nurses. They are the “professional” level nurse. The nursing education of an RN can vary from an Associates Degree in Science (ASN) to a doctoral degree in Nursing Science (DNSc). RNs are the nurses you see most frequently in the acute care or hospital setting. You will also find RNs that were educated in what were called diploma schools. This later program is almost non-existent today in the U.S., but these are highly skilled technically prepared professionals. Nurse-Practitioners are RNs that have completed at least a masters degree program and obtain additional state licensure to practice at this level of nursing. Licensed Practical Nurses (LPNs) have one to two years of education at an approved post-secondary school. They are technically skilled but less well educated in the sciences than RNs. They are seen less and less in the acute care setting. They are the most common nurses seen in the Long-Term Care setting. Certified Nursing Assistants (CNAs) are usually trained in a two- to six-week program and are skilled at providing assistance to their patients in meeting the “Activities of Daily Living,” (bathing, grooming, toileting, walking, eating, etc.). These are the least paid and probably hardest working nurses you will find. You will find CNAs serving in hospitals, nursing homes, clinics and home care settings. They are in integral part of team nursing. Nursing Techs. These are nursing extenders trained by the hospital where they are employed. Unlike RNs, LPNs and CNAs, there is no formal education for Techs and no state licensure that assures minimum competency of the practitioner. They usually serve in capacity somewhere between the CNA and the LPN. In some settings they start IVs, hang IV solutions, change wound dressings, provide bedside care and more. These practitioners are usually only seen in the hospital setting. Regardless of the educational preparation, the best nurses are the ones that have a “never stop learning” attitude. All nursing programs are designed to provide the student with the minimum competencies needed to begin their practice. Medical knowledge doubles every five years and so nurses, like all health care professionals, must continue to learn and expand their practice capabilities. The two most common nursing delivery systems utilized in healthcare settings are “primary care” and “team nursing.” In “primary nursing” an RN or LPN is assigned to a specific group of patients. They work that assignment everyday and they provide for all the needs of that patient. That means they do all the charting and assessments, give the medications, provide the ADLs, and communicate with the physician and other members of the healthcare team to assure all needs of the patient are met. In a primary care setting, nurses generally have a smaller assignment. Team nursing utilizes an RN as the “team leader.” The team is usually made up of LPNs, CNAs and/or Nursing Techs. Together, they provide for the patient’s needs. The RN is usually responsible for coordinating care provided by the team members, doing the assessments, documenting and communicating with the physician and other healthcare team members. The LPN usually gives the medications, cares for any wounds, and provide other needed treatments. The CNAs usually provide for the ADLs. Remember that Nursing Techs are somewhat a combination of CNAs and LPNs; therefore they provide some of the services offered by both CNAs and LPNs. Hence their popularity in most hospital settings today. Generally speaking, nurses are amongst the lowest paid professionals; salaries are quite comparable to teachers. However, unlike teachers, nurses don’t get the summers off, they don’t get two weeks off for Christmas, or a week off for Easter. They are required to work 24 hours per day, seven days per week, 365 days per year. RNs generally make between the mid- to upper-twenty thousand range as a new graduate, to upper 60s-70s for top level management positions. Of course these vary greatly depending on the area where the nurse practices. LPNs generally make one-third less then an RN in any given market. CNAs range from $6 to $12 per hour, again just depending on the area where they live an how much experience they may have. Nursing Techs fall somewhere between CNAs and LPNs in the salary range.
Type of work Nurses doThe typical day of an emergency room (E.R.) nurse and a nurse that works on a general surgical floor are quite different. Then of course there are the nurse managers within the hospital setting as well. Medical-Surgical Units: Known to insiders as med/surg, covers a wide variety of units within a hospital setting. Some examples would be: obstetrics, gynecology, nursery, orthopedics, oncology, general medicine, general surgery and the like. A typical day for a nurse on one of these units looks something like this: Reporting to Duty. Nurses usually punch a time clock and then begin receiving report from the off going shift. They do, of course, work 24 hours per day, seven days per week. Rounds are usually, and should always be made between the two nurses. Then depending on the shift, patients are prepared for meals, bathing, procedures, medications are given, teaching is done, patients are admitted, discharged. Wounds need to be dressed, patients need to be fed, reports for the hospital must be filled out, and medical records must be documented so as to promote continuity of care, and prevent the ever present fear of litigation. Patients need to be walked, tracheotomies need to be cared for, the patient in 3B is complaining about pain, IVs need to be started and some restarted, and the next shift nurse has called in sick so they need to work 12 hours today. Now all this may seem like much, but it barely touches the tip of the iceberg. Nurses take care of anywhere from six (and they must do everything, including emptying the trash) to fifteen patients. Now of course the nurse with fifteen has an Unlicensed Assitive Person or two to help. While these aren't nurses, they may be doing the dressing, hanging simple IV fluids and even starting IVs. This allows the nurse time to document on so many charts. Intensive Care Units are quite a bit different. Here they care for far fewer patients, but they literally hang on to life by a thread. These nurses must be highly skilled in assessment and protocols for a variety of emergencies. Protocols are used because in a life threatening emergency, there is no time for a doctor to be paged and return the call. Protocols are orders given with a range that instructs a nurse under these circumstances do this and under those circumstances do that, based of course, on the nurses assessment. And these very special care givers must be ready to meet the challenge. Often, E.R.s are used for inappropriate needs that should have been handled by a doctor's office or urgent care center. Things like a strained back and other muscle pulls, the flu and common colds. Auto accidents, gun shots, stabbings, broken bones, acute abdomens (something in the stomach area that requires surgery), heart attacks, strokes, show up in E.R.s and the nurse must be prepared to handle any emergency. Nursing managers in a hospital serve in many capacities. The Director of Nurses (the chief executive for nursing) is responsible for all aspects of nursing care provided by the facility. He/she is responsible for policy and financial administration of what is usually the largest division of any health care center. Middle managers such as nursing supervisors, staff educators, unit mangers, and clinical specialists all support the Director of Nursing to meet the needs of the patients and the goals of the division. These nurses usually work on a salary and put in very long days. The pay increase for middle managers is fairly unremarkable but upper management staff can double their income in large facilities. Emergency Room Nurses' days can go from sheer boredom to absolute pandemonium on a moment's notice. The profession of nursing is in trouble. The average age of a nurse is said to be 44 and getting older. Enrollment in nursing programs is down and experienced nurses (those with five or more years experience) are leaving the industry.
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