There is no typical day for a nurse. No, really, there isn’t. Every day or shift has the potential to be exhausting, challenging, inspiring, or everything combined. On any given day, nurses often see patients (and their families) at their weakest and most vulnerable, but sometimes at their strongest.

Nurses usually spend more than 8 hours in the hospital tending to the needs of their patients. For neuroscience nurses, 8 hours might not even be enough to do everything that you want and need to do for your patients. Almost all the time, neuroscience nurses handle patients diagnosed with cerebrovascular disease or stroke. However, there are times when patients with autoimmune diseases (i.e. Guillain-Barre syndrome, multiple sclerosis, chronic inflammatory demyelinating polyneuropathy) are admitted in the hospital. These patients warrant almost the same level of care as stroke patients.

It is almost impossible to write about a typical day for a neuroscience nurse given the fact that healthcare workplaces vary and the actual work differs from shift-to-shift depending on the type and number of patients a nurse needs to care for. The following is a broad outline of what a workday might be for a neuroscience nurse in the Philippine General Hospital during an 8-hour morning shift.

Early Bird

A nurse’s day often begins even before the sun is up. Most nurses have taken a bath and / or eaten breakfast before other healthcare professionals even hit their alarm’s snooze button. Those who do not live within the vicinity of the hospital often ride a bus, jeepney, or train to get to the hospital. You are lucky if the commute only lasts an hour or less. On a usual weekday, travel time doubles and sometimes even triples.

Some nurses arrive as early as an hour before the actual shift starts. The time is spent preparing for patients’ medications. Some oral medications (tablets) need to be crushed as they will be given to patients with dysphagia (inability to swallow as a consequence of stroke) via nasogastric tube. A tray will often be filled with vials of antibiotics that are diluted at least 30 minutes before they are administered to patients. Ampules of paracetamol, dexamethasone, and furosemide are immediately broken and aspirated into a syringe one after the other.

Sometimes, a nurse will do a quick round in the ward to see how many are intubated and connected to a mechanical ventilator. He/she then proceeds to prepare materials for tracheostomy or endotracheal tube care which will commence after the handover.

Handover

A hospital isn’t like any other workplace where one shift ends before another begins. Morning, afternoon, and night nurses usually work as a team ensuring that patients receive seamless care. This is made possible through nurse-to-nurse endorsements (handoff of information) at the start of every shift. The morning shift nurses get information from night nurses about what happened overnight, as well as other pertinent patient information or needs that are essential for the next shift. Depending on the number of patients, handovers usually take 30 minutes.

It is also during the handover when nurses check for supplies and inventory to make sure they have enough for their shift. The code cart (emergency cart or e-cart) is typically used for emergency cases such as when a patient goes on cardiac arrest. The e-cart contains essential emergency drugs, including epinephrine, used during cardio-pulmonary resuscitation (CPR). Hence, in the neurology ward (where a high-stress situation could easily arise), it is a-must for nurses to check the supplies contained in the e-cart every shift as one wouldn’t want to run low on supplies during emergency situations.

Morning Rounds

Average days or routine work doesn’t happen when you’re dealing with many patients, especially those in the neurology ward. Mornings are often busy for nurses. A lot can happen during and in-between shifts. Much of the hours in the morning are spent on hourly assessing the condition of patients, taking their neurologic vital signs (blood pressure, heart rate, respiratory rate, temperature, GCS, & pupil size and reaction to light), and monitoring blood sugar of patients with diabetes.

Neurologic diseases often affect cognitive as well as motor/muscle function. As such, more than half of the patients are highly dependent on the nurses. During the morning rounds, nurses often position these patients on high back rest. This is in preparation for various morning care routine and the subsequent tube feeding.

The actual work starts by administering Salbutamol through a nebulizer followed by suctioning of secretions (i.e. sputum, saliva). The ward has only one nebulizer and three cheap portable suction machines that are used for 18 patients. Suction machines use ‘suction’ to pull out pooled secretions in the patient’s tube or mouth to remove obstruction in the airway. Unfortunately, some of these machines have worn out, unable to effectively suck thick, frothy secretions. As a result, some of the patients’ relatives often take the initiative to buy their own machine/s.

After routine morning care and bathing, both oral and intravenous medications are administered to patients. Some patients have multiple antibiotics which are run for 1-2 hours each. Others are given hypertonic saline solution ranging from 150 mL to 400 mL depending on the latest serum sodium of a patient.

Oral medications are mostly given via a nasogastric tube before or after (depends on the medication) tube feeding with osterized (blended) feeding or milk. Patients are left on moderate to high back rest positions after feeding, and observed for drug-related adverse reactions.

Noon

Patients’ vital signs are continuously monitored throughout the shift. Other explicit and implicit needs of patients (e.g. suctioning, bed turning) are also addressed throughout the shift.

Some doctors ask for blood, urine, and sputum samples from their patients to be tested at the hospital laboratory. Neurology nurses often take these samples at or before noon and are eventually collected some time after by a laboratory aide.

Other procedures such as x-ray, ultrasound, and CT scan have varying schedules and these procedures should be taken into account when planning the care of patients. Routine care can be disrupted by these procedures especially when they are ordered stat (medical abbreviation for ‘immediately’ or ‘urgent’).

Some patients who are ordered to be discharged from the hospital are assisted by nurses in accomplishing hospital billing clearance. Most patients in the charity wards go home without paying a single centavo as they are required to enroll in Philhealth (the Philippines’ national health insurance provider). When a patient’s hospital bill is beyond the case rate determined by Philhealth, he/she is automatically referred to other government institutions (e.g. DSWD, DOH, PCSO) for financial assistance.

Patients who are to be discharged are also referred to the hospital’s Dietary Department for nutrition-related lecture conducted by a nutritionist/dietician. Patients with diabetes who are already insulin-dependent are taught by nurses about diabetes and insulin administration prior discharge.

As most days are busy, nurses will often try to take some time for lunch in the middle of the day. This doesn’t always happen though. Sometimes, a ‘lunch’ would be whatever you could grab in-between nursing tasks. Nothing’s guaranteed for nurses, especially a decent mealtime (and even toilet time). Having the time to eat can be a luxury when you’re dealing with an endless list of patients who have immediate needs all day.

Afternoon Rounds

Much like the morning rounds, afternoon rounds kick off by checking if any patient’s status has changed since the last rounds. Some patients require strict hourly monitoring especially when their blood pressure readings are erratic. A patient may be given nicardipine (to decrease BP) or norepinephrine (to increase BP) which is titrated hourly to maintain a specified blood pressure.

By the afternoon, some patients could have been discharged or released but several more will have been admitted in the interim. Nurses can often find themselves managing new patients and administering any medications that need to be given at that time. And of course, during this time, most nurses catch up on charting/documenting nursing care and carrying out doctors’ orders.

The afternoon also include visiting hours. Nurses often use their ‘people skills’ during this period. Nurses are often tasked with updating family members on a patient’s condition. They also educate new patients (and their families) about their diagnosis, treatment and nursing care plans, as well as unit/hospital rules and regulations. Nurses will have to answer patient questions and ensure that both the patient and his/her family have adequately internalized what they need to know.

Handover

Despite the toxicity, one may consider it a good day if no patient went on cardiac arrest or had to be intubated.

Before going home, a neurology nurse will have to make sure that everything has been properly documented. Nurses will have to double-check patient charts and update handover notes for the next shift. Nurses need to make sure that the transition to the next shift goes as seamlessly as it was in the morning so that patients are getting consistent care.

When the afternoon shift nurses arrive, morning shift nurses (usually the charge nurse) will brief them and leave the care of their patients to these nurses with equally capable hands. After the final ward rounds, morning shift nurses go home, enjoy their hard-earned rest, and start again the cycle after 16 hours.

End Notes

There is no typical day for a nurse, especially a neurology nurse. No matter what a nurse does, or where he/she does it, there is always the unpredictability of how a day will start and end. It is an incredibly demanding field, but it can be a rewarding and fulfilling one.