Do You Know
What Your Nurse is Doing When You're in the Hospital ?

    A.  Direct Patient Care : Assessment
    B.  Direct Patient Care : Medications
    C.  Direct Patient Care: Care & Treatment
    D.  Indirect Care : Communication with your Physician
    E.  Indirect Care: Communication and Support of Family
    F.  Preventative Patient Care
    G.  Indirect Patient Care: Documentation
    H.  Protective Care
    I.  Conclusion

A.  Direct Patient Care : Assessment

Checks your vital signs, temperature, heart rate, blood pressure and respirations.

Checks your skin color, temperature & looks for rashes, sores, and other marks.

Listens to your speech, observes for slurred speech, difficulties in speaking or understanding what is said and/or following directions.

Assesses your level of consciousness, how awake and alert you are.

Observes your ability to move and walk steadily. Checks your strength to ensure it is equal on both sides.

Checks your vision, to make sure you are not experiencing blurred or double vision, seeing spots or having any degree of blindness.

Assesses your hearing, makes sure if you have a hearing aide, it is in your ear and working.

Makes sure you are able to chew and swallow your food, keeps dentures clean and available.

Listens to your heart, to make sure it is beating with a regular rate and pattern. Some nurses are able to monitor your heart on a monitor and interpret the type of heart rhythm you are in. Nurses also check your pulses in at least your wrists and feet to ensure adequate circulation.

Listen to your lungs, to check for good air movement, listen for fluid buildup, listen for mucous buildup or possible infection. If you are on a ventilator, your nurse must also make sure the tube is in the right place, the machine is working properly and excess mucous is suctioned from your lungs.

Checks your abdomen, listens for bowel activity, feels for any lumps or tenderness. Makes sure you are moving your bowels regularly without pain or bleeding.

Makes sure you urinate at least every 8 hours. Checks the color, odor, amount and looks for any blood or debris in the urine.

Verifies that all tubes, intravenous lines, arterial lines or other monitoring equipment is in place and properly functioning.

B.  Direct Patient Care : Medications

To administer a medication, the nurse must first have obtained an order from your doctor.

The nurse must then check the order for accuracy of the dose and the manner in which it will be given, for example, pill or injection.

Your nurse must check your list of allergies to ensure you do not receive any medication which will cause you more harm than good.

Then he/ she must double check the order with another nurse to ensure no mistakes were made.

The order must be sent to the pharmacist to be checked a third time for accuracy and then filled and sent to your floor.

When it is time for your medication, the nurse must check it three times to make sure it is correct, then give it to you, and chart that it was given.

Sometimes your nurse needs to specially prepare your medication by crushing it, or mixing it with juice or food.

The nurse must be aware for side effects and watch for them in the patient.

Any problems must be called to your physician and the medication re-evaluated.

C.  Direct Patient Care: Care & Treatment

Doctors write many orders for treatments, tests, lab studies, education, etc. The nurse is responsible for making sure that everything your doctor orders is done.

Nurses communicate with the lab, x-ray department, physical & occupational therapy, nuclear medicine , heart station, and all other department involved with your care.

Your nurse makes sure all preparations for tests are followed through. This may include drinking contrast dye, receiving enemas, or simply not eating after midnight.

If you are going to surgery, your nurse must make sure the proper consents are signed, all labwork has been drawn, if necessary, that blood products are available for transfusion, that a list of your current medications is available for the OR team, that all jewelry has been removed, etc.

Nurses do dressing changes, bathe and provide skin care for their patients, and provide range of motion exercises for the immobile.

They assist patients in returning to their optimal level of health, preparing them to care for themselves again, once they go home.

All drainage systems are emptied and recorded at least once every eight hours. The odor, color, consistency, amount and anything out of the ordinary must be noted.

Your nurse keeps the patient informed of what he/she is doing, explains all procedures and answers any questions, or refers them to someone who can.

D. Indirect Care : Communication with your Physician

Your nurse has a special relationship with your doctor. Since he/she is with your 24 hrs. a day, it is the nurses responsibility, to relay all changes in your status.

Your nurse needs to know all pertinent facts about your current and past medical history, since they can play a significant part in determining how to treat your particular problems.

The nurse needs to read your doctor’s progress notes to be informed of the current plan of care and what specific things to look for in the patient.

Your nurse is a patient advocate, and must be persistent if the physician is not doing what is best for the patient, or not in agreement with the patient’s wishes. Every situation is different and there are many gray areas in medicine.

E. Indirect Care: Communication and Support of Family

Nurses need to balance hospital rules, patient’s need to rest, and the need for patients and family members to be together.

Your nurse is the coordinator of all meetings between hospital employees and your family.(Physicians, therapists, social workers etc.)

The nurse needs to communicate your progress to the family spokesperson while being cautious not to overstep her knowledge base. Doctors are responsible  for giving test results, diagnosis and prognosis.

Nurses provide educational information to you and your family so you can make informed decisions. It is not his/her place to decide for you.

Your nurse will provide emotional support to your family in stressful situations. Also providing information on private counseling if necessary.

The nurse will also protect your privacy and confidentiality, therefore, information about you may be denied to people who call to check on you.

F.  Preventative Patient Care

Your nurse is responsible to ensure you will have adequate healthcare once you are sent home from the hospital.

This may involve contacting a home care, or hospice agency for additional nursing care.

This would include teaching you to do procedures at home, self- catherterization, blood sugar monitoring, or dressing changes.

The nurse must make sure you understand discharge instructions. This would include taking and understanding your medications, what your diet and activity level should be, when to make a follow-up appointment. Also to schedule any bloodwork or further testing needed.

You must also be made aware of what signs and symptoms to look for, and what you should do if they happen. Most importantly, call for help, don’t sit home waiting for morning, or for a better time.

G.  Indirect Patient Care: Documentation

It has been said, "If you didn’t write it, you didn’t do it." With the increased legal action in our society, this statement has become a reality. Therefore, your nurse must not only perform her responsibilities, she must make sure she has written ,in detail, everything she has seen and done.

H.  Protective Care

In order to protect our patients, as well as ourselves, from the risk of contracting any disease or infection, all nurses practice universal precautions. This means wearing gloves when there is potential for contact of blood or body fluids, and frequent hand washing.

When necessary, masks, gowns, goggles, and other protective gear are worn.

Nurses are routinely checked for exposure to tuberculosis, and monitored closely, after any possible exposure to hepatitis or HIV.

I.  Conclusion

Nursing today is much more complex and time consuming than it used to be. Nurses are often overwhelmed with the demands placed upon them, and left feeling inadequate. The previous list is not all inclusive, but a general sketch of what hospital nurses are typically required to do. Your nurse is there to help you, but, if you can, you need to do for yourself. Hospitals are sometimes confused with hotels that provide medical care. This would be an ideal situation, but is simply not realistic with the current healthcare situation. I wrote this in an effort to increase public awareness and to help you understand what a stressful, potentially dangerous career being a nurse really is.

You are listening to "Angels" by Amy Grant

This page was last updated on 05/22/04.
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