7.00: Night shift handover is finished. The night nurse looks knackered, but she guides us around our pod and introduces us to each of our patients for the morning. I will work with a new graduate as well as oversee a final-year student on the busy paediatric ward. We meet our nine patients and bid the night nurse good night.
7.30: We have worked out our plan for the day, and now have 11 patients. I take the student with me to prepare the first child for surgery: vital signs, weight, pyjamas and pre-op questions. The child is anxious but we have bubbles to distract him – thank goodness for bubbles. The next child is more relaxed; she’s been here before and is very excited to have the metal plate removed from her leg.
8.00: The orderlies arrive to take both patients to theatre. My new grad buddy is doing well and he has already done morning vital signs on four of our nine remaining patients. I let him know I’m off to theatre before leading the two-bedded conga line.
8.30: I’m back from theatre and the burns team doctors have appeared to say they will be back at 09.30 to see their patient with his dressings down. Sedation will need to be given at 09.00 and I’ll start taking the dressing down at 09.20. I’ve called the play specialists to help by entertaining and distracting the child; the physiotherapist knows to pop in and assess the child’s movements; and the occupational therapist will also come in to see the wounds and plan the child’s ongoing scar management.
9.30: The dressings are down and the doctors are running late…
9.45: The doctors have given me a dressing plan. The child is ready to be bathed and then the dressings can go on after. I run the bath, bathe him and reapply the dressings. One area of the burn is not quite healed and looks a bit deeper than the rest. The doctors have left and will likely be too busy to come back so I call clinical photography and, with the parents’ permission, I get photos taken that the doctors can look at later to assess. I then dress the wound.
10.45: I’m finally out of the burns bathroom. My new-graduate buddy hasn’t had morning tea so I send him and my student off for a break. In between vital signs I go to check if the 15-year-old with a broken leg has gone to surgery yet. He hasn’t. And he’s had no food or fluid since 2 a.m. I page the doctors on his team to chart some IV fluids.
11.00: I finally get a cuppa.
11.15: The doctors call me back regarding the IV fluids and I take a verbal order over the phone. I go in to start the fluids and the mother is getting upset. “The boy next to us has been to surgery and has already come back – when will my boy go?” “I know it’s frustrating, but they prioritise younger children first. I’ll call theatre and see if they can give us a rough estimate,” I reply. The theatre coordinator can’t give me a time, someone else has come in needing more urgent surgery. I explain this to the mother but it’s little consolation.
11.45: There’s an IV antibiotic due for the little girl with a skin infection. The student mixes and draws up the antibiotic under my supervision; the mother gives my student permission to give the antibiotic while I observe. As she flushes the IV luer, the girl screams and recoils into her mother’s arms. The luer has dislodged and isn’t working anymore. I remove the luer, apply some numbing cream and explain to the girl and her mother that the doctor will be back later to put another luer in. I page the doctor about the IV luer.
12.15: There are six more sets of midday vital signs to do; we split them to do two each and set off with a blood pressure machine each.
12.45: A child has an abscess on the sole of her foot and the dressing has completely come off from walking around and playing. As my student cleans the wound, I teach her how to take a wound swab and ask her why I would do that. She answers correctly and does a great job with the dressing.
13.30: I’m about to walk off the ward for my lunch break when the ward clerk asks, “New patient, where do you want them?” I glance at the screen and look at the patient board. “I’ll have them in B17 please.” I get downstairs to the staff cafeteria; two of the three microwaves are broken. It’s cold pizza for me today.
14.00: I’m back from break and start thinking about the handover. I hear the patient lifts open, it’s our new patient, fresh from having his tonsils removed at a different surgical centre and he is here to be observed overnight. I follow them to B17 to take his vitals and get him comfortable in the room. He looks pale, I think he might be about to vomit. Carton, IV anti-nausea, new sheets, pyjamas and an iceblock.
14.45: I update the last few patients and print handover sheets for the afternoon nurses. I hand out the sheets, close the door to the nursing station and hand over all the patients on the ward. The afternoon staff look fresh and cheerful, kind of like what I looked like at 7 a.m.
15.00: I sit down with five sets of patient notes in front of me to write. The new-graduate buddy has already written three notes and is now on to his fourth note and the student has written two. I read, critique and sign the student’s notes. I get my notes down in between answering questions from the afternoon nurses. “Has B16 peed today?”; “When is B14s next dressing change?”; “Did the doctor say when they would come do the luer for this patient?”
16.00: My shift ended 30 minutes ago; finally my notes are done and I’m out the door.
Caitlin Francey is an NZNO delegate. The names of rooms are not the actual rooms used on this day to protect patient privacy.