A Day in the Life of a Registered Nurse

What does a registered nurse’s 12-hour shift really look like?

Well, a nurse’s day never, ever looks the same. There’s really no such thing as a typical day in the nursing profession. Every unit in the hospital has their own routines. And every patient has their own medical issues and individual personality.

But I’ll try to give you an idea of a single day in my life as a registered nurse.

Follow me through my day working as a staff nurse in the hospital on a cardiac telemetry and ICU unit.

A nurse in scrubs in patient room.

5:15 Get up and get ready.

I’m not a morning person, not even a tiny little bit, and this is the hardest part of my day. I take a shower, get dressed, and apply minimal makeup. I plan to let my hair air dry on my way to the hospital, and I’ll gather it all up into a hair clip when I get there.

I want to be clean and pretty and well-groomed, but I’m not going to the prom or tea with the queen. I’m going to work in a critical care unit at a hospital.

I mix up my morning energy drink (I don’t drink coffee) and a big iced tea for the day. I grab my lunch that I packed last night and a pre-packaged protein drink for breakfast.

6:15 Drive to work.

It’s about a 35-minute commute to my hospital 16 miles away. I drink my beverage and listen to a podcast while I fully wake up and prepare for my 12-hour day shift.

7:00 Clock in and get my assignment.

The day shift nursing staff gathers in the conference room before our shift. I sip my protein drink and we all visit for a few minutes while the whole team filters in.

We have 12-15 nurses on a shift for our 30-bed cardiac unit, which is a combination intermediate care and intensive care unit. Our staff includes fairly new nurses and some with many years of experience.

The charge nurse makes a few announcements about things we need to know about what’s going on today. Sometimes the nurse manager is there to make an announcement.

The charge nurse then tells us who our patients will be for the day. Nurses with ICU level patients will have 1-2 patients and nurses with IMCU level (also called step-down) will have 3 patients.

The ICU patients require closer and more frequent monitoring. They often have complex medication IV drips, and complicated equipment such as ventilators, or intra-aortic balloon pumps.

We are also each assigned a “buddy”, a nurse we will partner with during the day to watch our patients to cover our breaks and other times we have to leave the floor.

We each pick up a cell phone and tell the charge nurse our number. We will use those phones countless times during the shift, both receiving and making calls, and paging physicians.

Nurses giving report on a patient.

7:05 Shift report.

I have 3 IMCU patients today. I head toward the rooms of my patient assignment and look for the night nurses. We sit at the desk outside the patient rooms so we can still keep an eye on the patients while the night shift nurse gives me report. Our CNAs (certified nursing assistants) try to answer all the call lights so we can get our report done uninterrupted by patient issues.

Most of the time, it works.

We run through a discussion about each patient, with the computer patient charts open. We review the morning lab values together and look at any new doctors’ orders. I take notes on my paper report sheet that I will carry with me all day. Some nurses call this paper their “brain.”

We have developed a standardized report sheet for our unit, so report flows the same way every time. The off-going nurse gives a quick background of the patient, why they’re here, and what we’re doing to help the patient get better.

Next, we visit each patient for “bedside report.” The night shift nurse introduces me to each patient, and we check IVs sites, IV fluids and medications running, supplemental oxygen and any equipment we’re using. We take a look together at wounds, incisions and anything of interest the nurse has noted, such as a rash or potential skin breakdown that could lead to bedsores.

Often, I have to get report from more than one nurse. We try to all stay brief, succinct and organized so the off-going shift can get out of here on time. They’re tired. Whatever comes up with the patients is now my responsibility.

7:30 Review charts, look at medications due, review rhythm strips, and make a plan.

I take another, longer look at my patients’ charts, reviewing physician notes and orders, and noting lab results from blood work they may have had done this morning.

Every patient is on a heart monitor, so I review their current heart rhythms, and look at what their rhythms have looked like overnight. I will be glancing at the monitors all day and I need to know what is “normal” for them so I can notice any changes.

Almost every patient will have morning medications due. I don’t write that down. But I do make a note on my paper report sheet who is on insulin (that they’ll need with meals) and who has other meds due throughout the day.

I plan my day’s activities around any procedures my patients have scheduled. For example, one patient is going to dialysis first thing in the morning. The next patient has to go to xray, so I’ll take them after the other patient goes to the dialysis unit, so my buddy only has to watch one patient for me.

The cardiologist was just here on his way to the cath lab to visit a patient. He tells me he will be back after lunch, about 12:45, to perform a bedside procedure on my patient. He asks me to have consent signed, equipment ready, and medications ready for sedation. I tell the resource nurse and my buddy about the plan.

I talk to my CNA about the day’s activities too. She has 10 patients including mine, so I can’t expect her to do everything for me. But she’ll help me with baths; walking patients; getting them up to their chairs to eat; vital signs; blood sugars; making sure they’ve ordered meals; answer their call lights; help them to the bathroom (coordinating IVs, tubes, wires, etc.); recording intakes and outputs; and restocking supplies. Just like everything else we do, these activities need to be charted.

I don’t know how my rockstar CNAs do it all, but I’m grateful to have them!

Interdisciplinary team. Nurse discusses patient with surgeons rounding.

7:30 Round with interdisciplinary team.

Interdisciplinary rounds start around this time too. Many of our patients are open-heart surgery patients and the team rounds on them on a daily basis. The heart surgeon, surgical physician assistants (PAs), pharmacist, respiratory therapist, charge nurse, resource nurse, dietician, care manager, social worker and sometimes pulmonologist all gather for rounds. If family members are present, we include them too. All team members of healthcare professionals have their own important roles in developing the patient treatment plans.

Each patient’s nurse presents to the group from a rounding sheet filled out by the night shift nurse.

It sounds intimidating, and it can be, especially when you haven’t had the patient before, and you’re reporting about a patient you just met minutes ago. But night shift has provided me with all the information I need.

This is actually a very productive time of the day. The whole team brainstorms about what is going on with the patient, and what our next plans for nurisng and medical care need to be. I can bring up any concerns I have about the patient and make requests for doctors’ orders I think the patient needs.

During rounds, I make plans with the PAs for today’s procedures such as removing chest tubes. He asks me to hold a patient’s blood thinner injection until this afternoon. I write that on my paper and the pharmacist cancels the medication in the computer orders so the medication isn’t given by someone else by accident.

8:00 Vital signs, assessments, and morning medications.

The first few hours of the shift are the busiest. Between 8 and 10 I spend a concentrated block of time in each patient’s room. The first patient I see is whoever is sickest or I’m most concerned about. If all my patients are stable, I start with whoever wakes up first and let the others sleep if they can.

Today I start with the patient who is going to dialysis. The nurse from the dialysis department has already called and they’re coming to get him in 15 minutes.

I take the patients’ vital signs such as blood pressure, heart rate, respiratory rate, temperature, and oxygen saturation. I perform a head-to-toe assessment which includes listening to patient’s heart and lung sounds, palpating pulses and checking tubes, dressings and incisions. I check a finger-stick for blood sugar.

While I assess and observe, I also gather information about my patient’s concerns and mental status. I ask the patient about any pain and we make a plan to relieve it. I ask them about their night, their concerns, and what questions they have. I fill them in on the plan of care for the day and what nursing care I will provide.

The first assessment of the day is the most thorough and the most important. It is during this time I get a snapshot of how my patient is doing. The rest of the day, I’ll continue to observe and monitor for any changes in the patient’s condition, for the better or worse.

Nurse discussing patient's plan of care with cardiologist.
Nurse discussing patient’s plan of care with cardiologist.

9:00 Orders and procedures.

While I’m performing my assessments, physicians are often seeing my patients and entering orders. I’m already making changes to how I planned for the day to go. Of course, our plans have to change as the patient situation changes, whether they’re improving or declining.

A nurse’s routine varies from day to day and from unit to unit. For a longer list of things nurses do, read my article: What Do Registered Nurses Do?

9:20 Road trip to imaging.

The dialysis patient has left for the dialysis unit. I tell my buddy about the patient I need him to look after, and my other patient and I head off for an x-ray.

A transporter pushes the patient’s bed and I accompany them to the imaging department. The patient has to stay on the heart monitor at all times, so I go with him to watch over the portable monitor. We spend more time traveling through the maze of hallways in the imaging department than the actual x-ray which only takes a couple of minutes.

10:00 A break, when I can squeeze it in.

My buddy and I plan early on for when we can watch each other’s patients and take our breaks. As with everything else in the day, this plan is fluid, but my morning break is usually around 10 or 11.

I go into our break room and eat my blueberries with plain Greek yogurt. I have the same thing every day. Sometimes I crumble up a graham cracker and sprinkle it in the yogurt. The frozen blueberries have mostly thawed and made a sweet syrup in my yogurt. It’s like a dessert.

Ok, enough bliss. Back to work.

10:26 Code Blue.

I see the resource nurse run by my room. Running is usually a bad sign around here.

I hear the heart monitor at the desk alarming frantically and see the erratic pattern on the screen. A patient a few rooms down from me has gone into a lethal heart rhythm and suffered a cardiac arrest.

The patient hasn’t been doing well all day, and the team has been preparing for the worst. The crash cart has been parked outside this room all morning, and the resource quickly wheels it inside while the primary nurse begins chest compressions, CPR.

The resource nurse calmly asks for me to “call a code.” I call the emergency switchboard and they immediately announce overhead “Code Blue, 5th floor, Room7.” I page the cardiologist.

An intensive care doctor comes running down the hall. The charge nurse, rapid response team, respiratory therapist, pharmacist, lab phlebotomist, chaplain and EKG tech appear in minutes. Nurses and CNAs from nearby rooms come to see if they can help.

The chaplain sits with the frightened family while doctors and nurses rush around, doing everything they can to save this patient’s life.

Codes are stressful and frightening, but it’s always heartening to see the quick and coordinated response that arrives when your patient is in danger and you call for help. We have all learned to work together efficiently when these high-stress situations arise.

There are more people than needed in the code blue room, so I get out of the way. I hear someone say, “Clear” as I am walking away. They are using the defibrillator to shock the patient’s heart back into an appropriate rhythm.

Nurse and doctor in scrubs discussing patient chart.
Nurse and doctor in scrubs discussing patient chart.

11:10 Discharge orders and procedure time.

I check the computer and see that my patient’s hospitalist doctor saw him in dialysis and has written a note that the patient can go home after he returns from dialysis.

The doctor has entered discharge orders, written prescriptions, and updated the patient’s medication list. I will take this information and type up an informative packet for the patient to take home. When I have time to sit down and do it.

But right now, I have to assist the PA while he removes a patient’s chest tubes and some temporary pacemaker wires that were placed during open-heart surgery. The patient will be on bedrest for an hour. I call the CNA to tell her about the bedrest.

I’ll be taking vital signs and listening to this patient’s heart every 15 minutes for an hour.

I look down the hall and see that the ruckus has died down. I glance at the monitor and see a heart rhythm for Room 7. They have gotten him back.

12:00 Another assessment, more meds, lunchtime for the patients.

My CNA does vitals this time of day, takes blood sugars, and helps patients order lunch. I check the vitals she’s recorded in the computer, assess the patients again, and administer any noon meds.

My patient who has been in dialysis all morning has returned to his room. I catch up on the medications he missed this morning because he was off the unit.

Rhythm strip from cardiac monitor shows atrial fibrillation.
Cardiac rhythm strip showing atrial fibrillation.

12:25 Conscious sedation.

Before I can get my assessments charted in the computer, the cardiologist arrives early for the procedure we discussed this morning. The plan is to sedate the patient, then use the defibrillator to shock her heart out of an inefficient rhythm.

I page the ECHO (heart ultrasound) tech and ask if she can come immediately. Thankfully, she can. If she had been in another procedure, the eager (and early) cardiologist would just have to wait.

I ask my buddy and the resource nurse to keep an eye on my other patients as I’ll be tied up for an hour or so with this procedure. The patient requires some strong sedation medication to tolerate her procedure, so I have to be in the room to carefully monitor her until she fully wakes up after the procedure.

I call the RT (respiratory therapist) and tell him my patient will be undergoing conscious sedation. A side effect of the sedation can be breathing difficulties and I like the RT to be aware I might be calling him for help. He has some patients to see in my area, so he plans his rounds to be working nearby if I need him.

The procedure goes as planned. While I sit in the room monitoring the still-sedated patient, I have the chance to do a little charting on the bedside computer. I also start typing up the discharge instructions for that other patient who is going home.

13:25 Discharge complete.

My patient who is being discharged is eager to get out of here. I print out the discharge orders and head into his room for some discharge teaching. When I am satisfied the patient and family understand the discharge orders and new medications, I remove the patient’s IV and heart monitor. When he gets dressed, the CNA takes him down to the patient pick-up area in a wheelchair.

13:40 Lunch.

AH, lunch time.

My buddy will be responsible for my patients while I’m at lunch, so I give him a brief report about what’s going on with each of them. Fortunately, since one of my patients just left, he only has my 2 patients to monitor.

I rarely go to the cafeteria, mostly because it takes up so much time from my 30-minute lunch break. When I know I’ll be working, I cook extra on the days before, so I’ll have delicious leftovers for my lunches. That gives me a little something to look forward to in my busy day. Today I have chicken tikka masala. It reheats nicely.

After I eat, I return to the floor and ask my partner what I missed. He says, “I gave 12 some pain meds, 13 is still sleeping, and housekeeping is cleaning 11. Jill (the charge nurse) called and you’re getting an admit from cath lab who came in through the emergency room.” He gives me a quick report on his patients, hands me his phone, and heads to lunch.

On any given day, I’d say I discharge one patient and admit one. It’s never the same though. Sometimes you might discharge every patient and replace them all with new patients in a single day.

Nurses in scrubs giving bedside report looking at clipboard.
Taking bedside report from the cath lab nurse.

14:15 Admission.

I get a call from the cardiac catheterization lab (cath lab) that the nurse is on the way up with my patient. They arrive a few minutes later and the cath lab nurse gives me report at the bedside.

This patient had come to the emergency department with chest pain. He was diagnosed with a heart attack and taken to cath lab where the cardiologist was able to perform a stent procedure to open up the patient’s blocked coronary arteries. This involves inserting tubes and wires through an entrance site in the patient’s femoral artery.

The nurse shows me the sheath (like a big IV tube) that remains in the patient’s femoral artery. She says, “Doctor says to pull the sheath in 2 hours.” I do the math and plan to pull the sheath (which is a serious endeavor) about 16:15. Until then, I must check the femoral sheath site and vital signs every 15 minutes. Because it’s a large, main artery, it’s a big deal if it bleeds.

We hook up the patient to the heart monitor and I program the blood pressure machine to go off every 15 minutes. I perform a head-to-toe assessment. The patient is still groggy from the medication he had in cath lab, so I decide to do his formal admission interview a little later. He’s going to have along day of bedrest, and if he can sleep through it, it will go more quickly for him

15:25 IV antibiotics and afternoon assessments.

It’s time for another set of vital signs and assessments. I usually start this at 16:00 but I need to get my assessments done before I pull that sheath. One of my patients has IV antibiotics due, so I grab the bag of fluid from the medication fridge and get that infusing.

15:55 Afternoon break.

I want to squeeze in a quick break before I pull my patient’s femoral sheath. I know if I don’t go now, I might not get another chance. I check on the patient with the sheath so my buddy doesn’t have to while I’m gone for 15 minutes.

15:59 Atrial fibrillation.

My buddy pokes his head in the break room door and says, “I’m so sorry, but your patient in 12 just went into afib. Vitals are ok and I called the CCT to do an EKG but I don’t have time to help him.” I rush back to the floor to see what’s up.

The patient and his wife are both staring at the clanging heart monitor.

I explain to the patient (and his frightened wife) that he is in rapid atrial fibrillation. This is a serious but common heart dysrhythmia we see in patients after heart surgery. It’s a really inefficient way for your heart to beat, but I assure them I know what to do.

I page the cardiologist, tell him what’s going on, and ask for an order for medication that should treat the rhythm. I then call the pharmacist and ask her to expedite my order so I can get the first dose out of the Omnicell and give it right away.

While I’m on the phone, the tech is obtaining an EKG for the chart. We always get an EKG when there is a serious heart rhythm change.

I grab the med, program the IV pump, and start infusing the drug, taking frequent vital signs and keeping an eye on the patient and the cardiac monitor. The afib continues, but the heart rate is slowing down. The patient feels ok and I assure him I’ll be watching his rhythm from the remote monitors.

Nurse hanging IV medication.
A front view of nurse with IV drip and patient in bed in hospital room.

16:35 Sheath pull.

After dealing with the afib emergency, I’m running late pulling that femoral sheath. I call the resource nurse to come help me because it requires 2 nurses. I ask my buddy to keep an eye on my patients, especially the one in afib.

I assemble the supplies I need and explain to the patient what I’m going to do. He’s uncomfortable after having to lie flat for hours, but he’s in good spirits and grateful the heart attack didn’t kill him.

I pull the sheath out and have to apply manual pressure to the groin area over the artery for about 20 minutes. I can’t let go or the patient will bleed all over. Or internally. The resource nurse charts the vitals and the procedure, and basically is in the room with me in case I need help. You never know when you’ll literally need another set of hands.

Seriously, I can NOT let go.

Since the patient is awake, and to distract him from the pain and pressure I’m exerting on his groin, the resource nurse asks him some admission questions. Multitasking.

16:50 Sheath pull complete.

It’s always a relief when I finally pull my hands from the sheath site and there’s no bleeding at the insertion site. I apply a bandaid and instruct the patient to lie flat and stay in bed for 6 more hours. I have a lot of stuff to do in the last 2 hours of my shift, so I’m pleased that he seems comfortable and cooperative.

The resource nurse offers to complete this patient’s admission paperwork for me. That will help a lot! She’s just starting to record the patient’s medical history when we hear an overhead announcement. “Code Blue, Room 7.”

Crap, not again! The resource nurse runs down the hall to help with the code. That poor patient is having a much worse day than anyone else. That always puts things into perspective for me.

17:00 Five o’clock alarm.

When my daughter was 2 years old, she somehow set a daily alarm on my digital watch to go off at 5 p.m. every day. It actually worked out well for me. So well that when I got an Apple watch, I set a 17:00 alarm on it too.

All day long, I’m scurrying around the unit, glancing at the clock, but it doesn’t really register to me what time it is.

When that 5 o’clock alarms on my watch goes off, I know my day is coming to an end. At this point I need to have all my meds given, and all blood sugars taken before dinner.

If I have any calls I’ve been meaning to make to the doctor, I need to get this done now before they sign off to the night shift or on-call doctor in their group. It’s a lot easier to talk to the doctor who already saw the patient today and knows their story, than to call the night doctor who just got report on the patient.

17:25 Calming a frightened family.

I check on my patient with the atrial fibrillation. The irregular rhythm persists, but his heart rate is in the 70s. That’s good. He’s dozing after an eventful day. His wife sits at the bedside, fearfully glancing between the patient and his bedside heart monitor.

I ask her how she’s dealing with her husband’s hospitalization.

“I was really, really scared for this open heart surgery. And then the surgery went ok, and he seemed to be recovering, and I relaxed a little. But then today, there was this afib thing…” Tears well up in her eyes. “And then that man down the hall, with the code blue, and I saw his wife crying with the chaplain, and it’s all so sad and scary. Is he going to die? That could be my Walter.”

I pull up a chair and talk to the wife for a while. I show her how Walter’s heart rate is doing much better. I explain that his recovery is going very well and that the afib is a common and treatable complication of heart surgery.

Walter’s wife starts to relax. Sometimes the patients (or their families) just need to vent their fears, and to hear the nurse say we are aware and have a plan.

I never assure them that “everything will be all right.” Because sometimes it won’t be. But I do always tell them we’ll do everything we can. And that we know what we’re doing. And that we’re very good at it.

17:42 “I’m bleeding!”

My phone rings and the tech at the front desk tells me my new patient turned on his call light and said. “I’m bleeding!” I rush to his room, pull back the sheet, and sure enough, blood is oozing from under the band aid on the sheath site. This happens sometimes. I apply firm pressure to the site again, for another 20 minutes. The bleeding stops and there doesn’t seem to be any swelling. I tell the patient his 6 hours of bedrest has to start all over.

18:05 Wrapping up the day and preparing for report.

On a calm day, by this time the patients are having their dinners, they’ve all walked and bathed, and this is a peaceful time. This is sure no calm day, but things are falling into place.

I sit at the nurses’ station and catch up on any charting I still have to do. I review my report sheet and update it with information I need to pass on to night shift. I make sure all the I&Os are entered. I update the care plans in the computer. I update my patients’ information in the charge nurse report so the charge nurses can have a synopsis of what is going on with every patient on the unit.

18:20 Sinus Rhythm.

The cardiac monitor tech calls me to tell me that the patient in 12 is now out of of afib and showing a normal sinus rhythm. I head down the hall and share the good news with Walter and his wife. I explain it could happen again, but we’ll leave him on the IV medication overnight, and keep a close eye on his heart monitor.

Nurse in scrubs helping an elderly woman get up out of hospital bed.
Helping a patient get up.

18:22 A near fall.

My buddy calls out for help in the next room. When I get there, I find him holding up a patient, barely keeping her from falling. Apparently, the patient had tried to get up unassisted and was too weak to stand. The nurse just happened to come in at the right time to assist her as she staggered across the room. A CNA comes in to help us, and the 3 of us get the patient safely back to bed. We set an alarm on her bed that will alert us if she forgets to call for help and gets up again.

18:45 The next shift starts to arrive.

It’s a welcome sight to see the night shift nurses start streaming in. They all look clean and fresh and ready to start their “day”. Kind of like how I looked 12 hours ago. My shift is almost over and it’s time to pass the baton to the next shift.

Tonight, night shift is coming in and observing the equipment and personnel crowded around room 7. The patients are uneasy and worried. The day shift nurses are tired and stressed out. Night shift is wondering what kind of crazy situation they’re walking in to.

19:00 Shift report.

Sometimes I’m reporting off to the same nurse who had my patients last night. Those reports are easiest as I’m just updating on what has happened or changed with the patient during the day.

If it’s a different nurse, I have to start from the beginning, telling the patient’s backstory, the day’s events, and the plan going forward. The same is true if I’m reporting off about a newly admitted patient.

I tell the night nurse about the chest tube and wire removal, and the cardioversion, and the afib, and the sheath pull. I tell her the patient with sheath can sit up or get out of bed at 23:20. And I ask her to check that all the parts of his admission are complete, explaining how I had been doing it bits at a time all afternoon.

I introduce (or reintroduce) the night nurse to the patients, and my shift is done. It’s been a good day.

19:37 Clock out.

We try to avoid overtime, and the last minute we can clock out is 19:37 because the timeclock rounds your hours down to 19:30. Yes, the hospital gets 7 “free” minutes out of me.

But the truth is, sometimes you just can’t get out of there in time.

Sometimes you don’t have that peaceful last hour to catch up on charting because the patients are really busy or sick (or coding!) and require your undivided attention.

Or you get a patient admission in the last hour.

In those cases, you can’t get away to chart until the night nurse is there to take over for the hands-on patient care. Then you still have to complete the charting.

As they say, “if it isn’t charted, it isn’t done.”

19:45 Drive home.

I usually get home a little after 8 p.m. I kick off my shoes by the front door and place my badge and car keys in their designated bowl on the front table. (This is important so they’re easy to find in the morning).

I’ve been gone from my house for 14 hours. I’m exhausted: physically, mentally and emotionally. I eat a quick dinner and visit with my husband and daughter. When Hannah was younger, she would sometimes be in bed before I got home.

If my husband worked today (he’s a nurse too, but he works 6 a.m. to 6:30 p.m. so he gets home before I do) we have something easy for dinner like leftovers. If he’s off, he cooks.

9:00 Bath or shower.

(I’m back in the real world, and off of military time.)

Sometimes (ok, every night) I think I’m too tired to take a bath. It sounds so hard! And I want to get to bed. But it’s a great relief to sink into my jacuzzi bathtub spiked with epsom salts to soothe my aching muscles. Being relaxed and comfortable helps me get to sleep and stay asleep.

I hang out my uniform for the morning.

10:00 Bedtime.

When you work 12-hour shifts, it sounds like you should have plenty of time to sleep, right? But you spend time getting ready in the morning, time commuting, and time for dinner, family, and bath or shower after work. I’m lucky to get to sleep by 10 and get about 7 hours of sleep. These are long days of hard work.

I need to be rested and invigorated when that alarm goes off again tomorrow at 5:15 so I can do this all over again the next day.

Another day in the life of a nurse.

A note about the photos.

The photos in this article are stock photos. Because of patient confidentiality, there are no pictures of me, my patients or my hospital. It’s difficult to find stock photos that convey what nursing looks like. I have tried my best to find appropriate pictures to accompany this article.

Leave a Comment