Angellette GriffithFanshawe College AbstractI chose to write my essay on the work load of nurses becauseit is something that seems to be over looked. From a young age, I have beendrawn to anything related to medicine and taking care of others. From the bottom of my heart, I believe thatnurses deserve the same recognition as doctors because at the end of the daythey are a team. I recall a time when my sister, a registered nurse midwife of15 years, saved a patient and her baby’s life and the doctor was the onerecognized.
A patient was brought in at12:30 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 babywas in destress and needed additional oxygen. Upon reviewing the patient’snotes, she spoke to her gynecologist 2nd, explaining to her that she waspreparing the patient for an emergency caesarean. Doctor Gomez said, “wait tosee if she makes any progress because I am not interested in doing a caesareansection today.” After speaking to thedoctor, 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 theoperating theatre for a caesarean section as she was noted to have placentaabruption (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 wasplaced in the nursery for close observation. If my sister had waited longer the infant would have died, but DoctorGomez got recognition for saving their lives. This particular incident mysister experienced, drove me to highlight a day in the life of a registerednurse, with hopes to enlighten my audience that nurses work just as hard asdoctors.
A Day in the Life of a Registered NurseA doctor may find the medical cause of a patient, but it isthe nurse who help the individual to overcome them. (Picoult, 2003). To sayregistered nurses are busy is a bit of an understatement. They spend long hoursdaily dedicating time and effort into their work. The determination is clearwithin the role of a nurse which includes leadership, assessment and treatment,for each of their patients.
Nurses are doers who work physically harder thandoctors, they are not as well paid or respected as they deserve, they have lessautonomy and less credibility than they might, and they are wonderful patientadvocates. Nursing leadership assures that every individual does theirpart to get a job done. Evidence has shown that leadership has a positiveimpact on patient outcomes. Cummings (2010) studied nursing leadership in nineacute hospitals in Canada, collecting nurse’s perceptions of their leaders,whose styles ranged from highly resonant to highly dissonant. They found thatthe differences in leadership styles explained 5.
1% of the variance in 30-daymortality rates between hospitals. The individual that is in charge for theentire nursing team is called the head of nursing, and that individual mustallocate each staff member to a task, they need to ensure that every patienthas received adequate care and debrief every individual on the team. Accordingto the American Nurses Association (ANA) Code of Ethics for Nurses withInterpretive Statement, the nurse is responsible and accountable for individualnursing practice and determines the appropriate delegation of tasks consistentwith the nurse’s obligation to provide optimum patient care (Kelly-Heidenthaland Marthaler, 2005).
When the staff arrive to work, the individual that is incharge has to assign each nurse to five-six patient and a clipboard (medicalchart containing information such as: medical history, vital signs, diagnoses,treatment plans, laboratory and test results). Then, the nurse has to go intoevery patient room during morning assessments, set up patients for breakfast,charting (medical chart), give medications, and assist patients with followingout doctor’s orders. Lastly, at the end of the shift the nurse and the nurse incharge must debrief the nurse on the oncoming shift. During the handover, thenurse has to give details of every patient assigned. The handover of each patientis generally made up of three sections: Past: historical information. Thepatient’s diagnosis, any information the team needs to know about the patienttreatment plan. Present: current presentation. How the patient has been duringthat time of the shift and any changes to their treatment plan.
Future: what isstill to be done. For lots of reasons tasks that need to be completed at acertain time may be handed over to the next shift, simply because the team didnot have time to complete the task. Nursing leadership is vital not only to thelong-term credibility of the nursing practice, but to achieving good patientand client care and effective nursing leadership is very important in allnursing role. Clearly, nurse-patient encounter is the first encounterbetween a nurse and patient while assessing that patient. Nurse assessmentsfocus upon the patient response to health problems, perceived health needs,health practices and values. The goal of assessment is the collection andanalysis of data that are used in formatting nursing diagnoses, identifyingoutcomes and planning care, and developing nursing interventions. Incomplete orinadequate assessment may result in inaccurate conclusions and incorrectnursing interventions. When entering a healthcare facility nurses are the firstperson you will encounter asking you series of questions while checking yourvital signs, it may not seem like a lot of work to some, but nurses doesassessment from the moment you walk through the door and at the beginning of everyshift.
There are three types of assessments carried out by nurses,comprehensive, focused and an ongoing assessment. Firstly, the nurse must perform acomprehensive assessment which is completed upon admission to a healthcareagency. This assessment includes assessing the physical, emotional and mentalaspects of all body system as well as the environment and social issuesaffecting the patient.
Next, a focused assessment, this assessment collectsdata about a problem that has already been identified. This assessment has anarrower scope and a shorter time frame than the initial assessment, the nurse determineswhether the status of the problem has change (improved, worsened, or resolved).Finally, an ongoing assessment which is a systematic follow-up when problemsare identified during a comprehensive or focused assessment. This assessmentincludes the nurse doing systematic monitoring and observing related specificproblems, it also allows nurses to broaden the database or confirm the validityof the data obtained during the initial assessment.
Assessment is the firststage of the nursing process in which the nurse should carry out a complete andholistic nursing assessment of every patient’s needs, regardless of the reasonfor the encounter. “The most important practical lesson that can be given tonurses is to teach them what to observe- how to observe-what symptoms indicateimprovement- what the reverse- which are of importance-which are of none-whichare the evidence of neglect- and of what kind of neglect. All this is whatought 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 havedevelop 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 withdoctors to formulate a care plan.
The nurse provides psychological support toclients with terminal illness. In addition, through the assessment processnurses individualized priority-setting, priorities will be influenced by theacuity of the patient’s condition and the acuity of all patients assigned to anurse. Priority ranking of patients are characterized into three levels: Firstlevel is where they treat patients with immediate survival, safety and highdemand. Second level highlight concerns such as mental status change, acutepain, acute urinary elimination, untreated medical problems requiring immediateattention (diabetic needing insulin), abnormal pathology lab results, risk ofinfection and safety or security. Third level is where those that do not fitinto the above categories. When there are no life-threatening problems, nursesused both professional judgement and the patient to set priorities anddetermine planning.
“Prioritization is defined as deciding which needs orproblems require immediate action and which ones could be delayed until a latertime 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 withthe expansion in roles associated with the complexities of current health-caresystems. Nurses use critical thinking skills to prevent medication error, infact, they think in a systematic and logic manner with openness to questionsand reflect on reasoning to ensure safe nursing practice and quality care. Everyday, nurses make decisions through critical thinking. Critical thinking isidentified as an essential nursing competency by the National League for Nurses(1997).
Critical thinkers are people who know how to think. They possessintellectual autonomy, in fact they refuse to accept conclusions withoutevaluating the facts and reasons for themselves. Critical thinking is processthat allows nurses to see the big picture instead of focusing only on details.Furthermore, nurses must administer numerous drugs daily in a safe andefficient manner. They administer drugs according to the nursing standards ofpractice and agency policy. Before administering any medication, the nurse mustcompare the medications listed on the Medication Administration Record (MAR),other recording forms, or computer orders with the healthcare practitioner’sorder.
When administering medication, the nurse must check the label whenremoving the drug container from the drawer, check the drug when removing itfrom the container and before returning it to the patient’s medication drawer.The nurse should give only medication that they prepared and checked, becausethey are the responsible party should an error occur.As a result, long hours and dedicated time spent by nursesare their daily work routine. Everyone has a common goal, but the nurses arenot being recognize for their hard work. They deserve the same recognition asdoctors because nurse is the center of healthcare. Society think so little ofnurses, but at the same time doctors rely on them so much. Doctors will see apatient anywhere from five to thirty minutes a day depending on how sick youare, and the rest of the work are left to the nurses. They are the ones makingsure 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 willrun out of the room while a nurse rushes in, they change your wound dressingsand start you IV line. They will clean disgusting things off even if you aredrunk, delirious or mean and through all of this they try to be friendly andpositive. People say nurses are not busy really is an understatement. References Cummings, G. (2010).
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