Nightlife on a surgical ward 

Sue Anderson, nurse in charge, describes her routine

 

7.30pm - 8am

The staff arrive on duty before 7.30pm and change into their uniforms, or scrubs if they are working in the Isolation unit. Handover takes place in the staff room from the previous shift, each nurse handing over their patients with instructions for the night and the next day.

Tonight I am the nurse in charge. The ward has twenty-four beds (no empty ones), and seven High Dependency Unit (HDU) patients, one in the Isolation unit. Five trained staff and one student nurse are on duty.

I receive the ward keys from the nurse handing over. The controlled-drug keys have to stay with the nurse in charge at all times. The nurses working in the HDU go directly into the unit. These are the most critically ill on the ward. All of these patients require frequent observations all night; most have drips and lines into large veins into their necks, also lines into small arteries in their arms to continuously monitor their blood pressure. The HDU is never left unattended.

The first thing I do is go out onto the ward and check all areas, making sure that the staff and patients are all right. I phone the agency to check on the shifts not filled (sometimes we may have to phone nurses at home from the ward list of permanent or agency staff to see if any one will be able to work the shift).
 

Around 8.45pm

I start to take the patients’ observations: temperatures, pulse, respirations and blood pressures. Also blood sugars tests on all diabetic patients. The ward phone keeps ringing, which I answer most of the time.

The site manager (senior nurse in charge of the hospital at night) asks if I can ‘lend’ a member of staff for another ward, I say no as it would make my ward unsafe. I also mention the unfilled shifts for tomorrow. There are several other phone calls from other wards asking to borrow medicines and other medical items. The relatives of two patients phone to enquire on their condition.

9pm

I have a phone call from the site manager of another hospital asking me if we are still transferring a patient tonight. I said that we are, but transport was unavailable earlier due to an emergency.

9.30pm

The transport arrives. I have to check all transfer letters are with the patient and say goodbye. He had been with us for a few months and is being transferred to his local hospital. Into this bed, a patient not requiring monitoring is moved from the HDU.

9.45 pm

I print blood request forms from the computer, as two patients in HDU and two patients on the main ward require blood tests tonight. I take blood from the patients on the main ward, one of whom requires six-hourly blood tests.
The porter arrives to take the bed of the patient who went to surgery earlier to the Recovery room.

10pm

I finish the observations, then commence the medicine round for six patients, after I lock the medicine trolley and secure it to the wall. Three patients require night sedation and strong painkillers (e.g. morphine). These are kept in the Controlled Drug Cupboard and require two nurses to check and sign out the medication.

Two of my patients require intravenous antibiotics. On this night, the nurse working on the main ward in the other bay cannot give intravenous antibiotics, so I have to give them for her.

The doctor on call for the night prescribes medication and intravenous fluids and also checks on the patients in HDU. I settle my patients - some have a hot drink - then turn off the main lights.

11pm

The site manager comes to the ward to check bed state. If any patients are critically ill, they need to know about it or any other problems.

12 midnight

The patients due for surgery the next day are put on ‘nil by mouth’ and commenced on intravenous fluids to keep them hydrated. Also intravenous fluids are commenced on the patients who are having special scans. Then its time to sort out the staffs’ breaks. One hour is allowed for night duty.

Blood results of the patients who had blood sent earlier are looked up on the computer, and the doctor is informed of any abnormal results. The clotting result for the patients receiving the infusion to thin their blood requires it to be altered. I make up a new infusion in a 50ml syringe and go and change it in the syringe pump.

The cardiac arrest trolley is checked and cleaned with a disinfectant spray by one of the nurses and signed in the book. The ward, sluice and nurses station is tidied. Syringes and other items are restocked at the nurse’s station. The patients’ names are written on the menu sheets and their diet for the following day for the domestic staff.

Throughout the night, on the hour all patients have their observations recorded and infusion pumps checked in HDU. A nurse checks the patients every fifteen minutes throughout the night.

1am

The doctor is called to see a patient in HDU as they have dropped their blood pressure and the urine output has decreased. After a while, the patient stabilises with treatment.
 

1.30am

Phone theatre to check names of patients on the operating list for that day.
On the computer, I start making the changes on the handover sheet, adding any information. The site manager has to collect a copy by 6am.

1.45am

I have something to eat and continue updating the handover sheet on the patients’ care, adding the admissions during the day.

2am

The nurses on the main ward start taking their breaks, one at a time. The doctor on call continues to come to the ward regularly to check on critically ill patients in HDU. Mobile chest x-rays are taken on two of the patients in HDU. One requires an ECG (tracing of heart rhythm) as there has been a deterioration in condition.

During the night, patients who are not mobile are turned regularly to change their position. Some patients require painkillers during the night and cups of tea. Some patients find it difficult to sleep in hospital and feel their pain more at night.

3am

I check the Controlled Drugs Cupboard with another nurse. The blood monitoring machines (used to check sugar levels in diabetics) are cleaned with a disinfectant spray, re-stocked and a Quality Control check is carried out. I then sign in the book.

The patients going for surgery have their notes checked for consents. ECGs, blood results are taken from the computer and attached to the notes, also a pre-operative checklist with the patients’ details and important information is attached to the front of their notes. X-rays and scans are put with the note ready for the morning.

4am

The patients in HDU have their blood taken. The results will be ready for the doctor’s morning ward round.

5am

The patient who went to theatre last night is ready to return from Recovery. One of the nurses goes to collect the patient. On return to the ward, the patient is attached to the monitor and postoperative bloods are taken and sent. The patient is in a stable condition. I finish updating the handover sheet.

5am – 6am

The site manager comes to the ward to collect a copy of the handover sheets. I write the notes on my six patients and complete all the documentation.

6am

The intravenous antibiotics are given. This is the only medication that is routinely given by the night staff. The patients who are first on the operation list are prepared, this includes giving them their 8am medication (heart and blood pressure tablets), Hibiscrub shower/bath/wash depending on the patients mobility (this cleans the skin before surgery). After that they put on a theatre gown. Their beds are made up with clean linen.

6.30am

The six-hourly blood test is due. I print another blood form and take blood from the patient on an infusion to thin their blood.

7am

Ready for the morning ward round, the patients’ fluid charts are checked.
The day staff starts to arrive any time from 7am and at 7.30am there is a big handover in the staff room. I hand over the keys to the ward.

8am

The night shift ends at 8am and we go off duty.

 

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