Anatomy of a Hospital Nurse

Which of these is your hospital nurse?

Is it Nurse Ratched

of One Flew Over the Cuckoo’s Nest?

Carol Hathaway from E.R maybe?

Or possibly Poppy Pomfrey from Harry Potter?

Sorry. The answer is none of the above.

Unfortunately for better or worse, the media shapes our perceptions of the nursing profession.

What’s the anatomy of a real nurse?

According the Center for Nursing Advocacy, this is nursing:

“Nurses save and improve lives as front line members of the health care delivery team. They independently assess and monitor patients, and taking a holistic approach, determine what patients need to attain and preserve their health. Nurses then provide care and, if needed, alert other health care professionals to assist. For instance, emergency department nurses triage all incoming patients, deciding which are the sickest and in what order they require the attention of other health care professionals. Thus, nurses coordinate care delivery by physicians, nurse practitioners, social workers, physical therapists and others. Nurses assess whether care is successful. If not, they create a different plan of action.”

Her Education:

Today’s nurse has either a certification, a three year diploma, an associate’s degree, a bachelor’s degree, master’s degree, or possibly your nurse has a doctorate of nursing.

An L.P.N. or L.V.N. is a licensed practical nurse or licensed vocational nurse. The programs are usually a year long and this nurse works under the supervision of an R.N. or a physician usually.

The R.N., registered nurse, has at minimum an associate’s Degree (ADN) from an accredited college or university or a bachelor’s degree. For a long time the ADN was considered the technical bedside R.N. while the BSN was considered the ‘professional’ R.N. or supervisory R.N. This viewpoint varies from state to state and facility to facility. The three year diploma programs are disappearing but before 1970 there were over 800 of these programs in the United States.

After passing the N.C.LEX, (National Certification Licensing Exam) an R.N. in the U.S. may elect to pursue other certifications requiring further studies and testing.

Your R.N. on an oncology unit may be O.C.N., or oncology certified.

A Day in the Life:

Shift work is the reality of hospital nursing. Whether it be 7 to 3 shift, 3 to 11 shift or 11 to 7 shift.

Innovative hospitals, like other workplaces, set up varying schedules to entice nurses and to ensure retention. The weekend option is a common feature. Perhaps two 12 hours shifts and an 8 hour shift or other varieties. Some facilities allow job sharing. The hierarchy in nursing, like most jobs, rotates around seniority and education.

Generally the day shift is the only shift that has a supervisor on the unit. So if you have complaints save it for the day shift. The swing shift and graveyards usually have an assigned R.N. in charge and a supervisor who floats through the hospital.

Shift change is a unique animal, handled differently at every facility. This is the changing of the guards. At some facilities the nurses hand off their patients and information face-to-face, while nurse aides monitor the hospital unit. At other facilities ‘report’ is done via a tape recorder and the oncoming nurses come in a little earlier for the overlap.

Word to the wise. Shift change is an important and busy time as information about your care is shared between shifts. If you have a request that only your R.N. can handle, such as pain medications, avoid asking for it at shift change time.

Why She Is Your BFF:

The physicians of Grey’s Anatomy would have you believe the doctor, intern or resident is there at bedside monitoring the patient’s every need. Give me a break. They might also suggest by the clever scripts and witty repartee that nurses are merely handmaidens to those oh so smart and handsome doctors. A sad commentary isn’t it?

The reality is nurses and physicians together are a partnership of professionals each bringing their own skills and expertise to the table. The goal is the most effective plan of care for the patient.

Your nurse is your BFF. Your best friend forever, whether you like her or not. She is the one who will notice during her frequent rounds those imperceptible changes in your condition–that your skin has become pale, your breathing is shallow or your catheter is kinked. While you sleep she is checking your lab results, reading the doctor’s notes and verifying that every area of your care has been carried out and she is evaluating that plan of care.

She is your first line of defense. When the resident doesn’t answer his in-house pager at one a.m., your nurse will harass him until he wakes up. When the doctor on-call says nothing is wrong, she will pressure him, if she is believes there is an issue to address. And when that newbie intern doesn’t know which medication to order for your nausea, your nurse will tactfully suggest one.

Nurses are professionals and nursing is a profession and a calling.

The next time your nurse wakes you at midnight for vital signs, at two a.m for medications and at four a.m. for lab work and you want to throw your water pitcher at her, instead, remember she came to work at ten p.m. because she wants to be part of the team that provides you with the best care possible as you battle cancer.