A Day in the Life of a Neuro Nurse

Cello strains jerk me awake. It’s 0545. I turn my cellphone alarm off and bound out of bed. I climb into my scrubs, make myself look presentable, eat breakfast and I’m out the door by 0620 with my pre-packed lunch in hand. I always pack my lunch the night before to avoid a rush in the morning and to ensure that I actually bring somewhat healthy and nutritious food to work!

Bright and chipper - ready to start my day

When I arrive at work I check the board - I’m assigned to the ward today and will have 4 patients to look after.  After getting report and writing down all pertinent information on my cheat sheet, I head to my first patient’s room  to start my assessments. He’s a 27 year old male, admitted with a cranial arterio-venous malformation and bleed -  probably going for surgery later  today. His intravenous pump is beeping . I check the site – drat, it looks like his IV has gone interstitial (out of the vein and into the surrounding tissues). I’ll have to start a new one. I turn the pump off and perform a head-to-toe assessment on him. His vital signs are fine but he’s rating his headache as a 6/10 so I make a mental note to get him some analgesia as soon as I’m finished with my assessments.  At least he is independent – bonus! My 2^nd patient is a 67 year old male who had a craniotomy two days ago to resect a brain tumor. He will be going home this morning as long as our physiotherapist is ok with his mobility status. My 3^rd patient had a subarachnoid hemorrhage  3 weeks ago and has dense left sided hemiplegia. She has a tracheostomy and needs frequent deep suctioning through it due to copious amounts of lung secretions. She also gets tube fed so I’ll have to keep an eye on her feed bag throughout the day and make sure it doesn’t run dry.  Her blood pressure is running high so I make another mental note to hang hydralazine first thing and recheck her pressure again in an hour. My fourth patient is a 34 year old female in with a shunt malfunction due to an infection. Her shunt was removed and an external ventricular drain (EVD) was inserted until the infection clears up and a new shunt can be inserted. She is also independent but due to the EVD she has to remain in a fixed position in bed. I make sure the drain is positioned at the right level and patent; if she wants to get up to the bathroom, I’ll have to clamp the drain and then re-level it once she’s back in bed.  I’ll have to check the output of this drain every hour. 

           With my vitals and head-to-toe assessments finished, I move on to getting my patients' medications prepared. I get the narcotics out of our Acudose machine for my first patient, and mix the blood pressure medication in a mini-bag to hang through the IV of my 3^rd patient. Giving out the rest of my morning medications is pretty straightforward –  however, since my 3^rd patient is tube fed and can’t take anything by mouth, I crush her medications and mix them with water before delivering them via a syringe. I notice that she sounds quite congested, so I give her a quick suction while I’m there. With a few minutes to spare before my first break. I snag an open computer and start my charting. I try to at least get my vital signs entered before going for my first break. I’ll have to finish up  later. 

Charting on one of our WOWs - Workstation on Wheels

*3 hours later*

My first patient has gone for surgery. I managed to find 10 minutes of time this morning in-between answering call bells  and doing bed baths to start a new IV on him. My second patient got the all clear to go home so after doing some discharge health teaching with him, I sent him on his way with his follow up appointments and prescriptions. Two empty beds. Not good! That means I’ll be getting new patients. I find out from the charge nurse that I’ll be getting a patient from the Emergency Department and my other empty bed will be filled by a patient  transferred out of our stepdown unit who no longer needs cardiac monitoring. My patient from the ER is an 83 year old male who had a fall at home and is presenting with moderate right sided weakness and confusion. His fall caused a subdural hematoma and the  neurosurgical resident wants to perform a twist drill procedure on him right away. 45 minutes later and I'm finished admitting him and transcribing his orders. The resident is here and ready so we wheel him into our procedure room. I hook him up the cardiac monitor and reassure him that he’s in good hands! No sedation is needed for this procedure, only some morphine  and lidocaine to keep him comfortable. The doctor drills a small hole in the left side of his head and inserts a thin drain into the subdural layer. He removes 60 ml of blood and then attaches a bulb to the drain tubing that will provide low suction to remove the rest of the blood. The drain will stay in for another day or two. About 45 minutes later, the procedure is finished and I bring him back to his bed. My patient is already much more alert and less confused and his right sided weakness is almost gone!
Well, it’s already 1830 now and I didn’t have time for my last break, but hey, my shift is almost over. I finish up my charting and get ready to give report to the oncoming shift. 

Not so sane towards the end of my shift ;)

The challenge of bedside nursing is that no day is ever  the same and things in the neuro world can change in the blink of an eye. What was a stable patient at the start of your shift may slowly decline throughout the day as her level of consciousness decreases due to a new bleed or swelling in her brain. Or, you may have a stable patient crash in a matter of minutes due to a pulmonary embolism or myocardial infarction. You may think you have your day lined up and in order but a number of things can crop up that throw you for a loop. A new elevated temperature will have you sending off urine and sputum samples, calling for a chest xray, starting an IV and doing blood cultures. As a nurse, good time management is crucial.  In the neuro world we deal with a fair amount of nausea and vomiting, headaches, high blood pressure, catheters or drains that need to be checked hourly, diapers that need to be changed, patients that need frequent repositioning in bed, IV bags to change, IVs to start, bloodwork to perform, samples to obtain, patients who need partial or full assistance with eating their meals, family to talk to, questions to answer, health teaching to do, talking to doctors, advocating for patients, hunting for missing medications, orders to check and transcribe... and on and on!  Not exactly the romantic picture of “soothing fevered brows,” lol! If I have a shift with four stable patients that actually stay in the same beds all day – great! But more often than not, patients are being discharged or transferred out meaning new admissions , or they are quite sick meaning lots of running around and things to do.

And that was a day in the life of a ward nurse. Now if I had started my blog with this: "I look at the board – I’m in stepdown today. A nervous flutter passes through my stomach. Plus side: I’ll only have 2 patients. Downside: my patients will be more sick, unstable and require much closer monitoring" - my story would have been much different. But step-down is a whole other ball game and a blog for another day!

*all patient case scenarios were fictitious in this account, however, I have had similar experiences