Day in the life of a Deaconess nurse

It’s 6:30am on the MultiCare Deaconess Hospital medical/oncology patient floor. Sunrise streams through the large windows overlooking downtown Spokane as patients start stirring awake in their rooms.

Nurses and certified nursing assistants (CNAs) chat in the hallways as some prepare to end their 12-hour shifts and others begin their day.

As the day shift gathers for the morning huddle, Juliette Marler, RN, a nurse on the floor, joins the group.

Marler has been with Deaconess just over a year and recently finished her nurse residency program. She spent the previous decade as a hospice nurse, and this is her first time in an acute care setting. So, while caring for others is nothing new, she says this is a completely different experience.

Thirty-two patients occupy the floor today. The medical/oncology floor tends to be an overflow unit for patients, Marler explains. Outside of oncology cases, their patients generally don’t fit into any other specialty units and may face health conditions such as respiratory problems or heart failure.

Others may have memory or cognitive challenges and will remain in the hospital for extended periods while their care plan works through the court system.

The morning rush

Marler’s day starts by meeting with the night shift nurse assigned the same patients. The two walk room-by-room to review how each patient’s night went, how they’ve been responding to medications or food, and anything coming up today, such as expected visitors or procedures.

Marler takes notes on the patient sheets in her pocket, knowing she likely won’t make it to a computer to chart her notes for a few hours.

Two of her patients are meeting with Deaconess’ hospice partners today. With her background in hospice, Marler understands just how important this day is for them, so she makes a note to be there to answer any questions their families may have.

Marler says, “There’s no time for long days when it goes by so fast.”

The first two hours are the busiest of the day, Marler says as she picks up her speed down the hallway. Patient call alarms ring to her phone as patients request breakfast, their medications and assistance getting out of bed.

A handful of CNAs on the floor assist the RNs with about a dozen patients each. They’re on hand for mobility needs, clothing and linen changes, and regularly checking vitals, among other tasks.

Marler says a quick hello to each patient — some she’s cared for before, while others are new to her today — and takes care of any urgent needs. She then heads to the secure medication room to collect the morning medicine for her first patient, stopping at the nutrition room on the way back for juice and applesauce.

While a patient’s chart indicates the medication, Marler says it’s up to her to know who has a hard time swallowing pills, who needs anti-nausea medicine and who prefers which juice. Having worked in a busy Seattle restaurant for years prior to becoming an RN has been a benefit to remembering things like this now.

As she runs back and forth from the two secure medication rooms, the nutrition room and patients, Marler also takes time to talk with the families who have arrived for the day, catch up the hospice representative and monitor one patient who’s continually trying to leave their room when it’s unsafe for them to do so.

Not to mention the small nuances that add up, like navigating tight patient rooms full of bulky furniture and monitors, turning off call alarms in difficult-to-reach places, and running to an open computer when she can to message the doctor or kitchen.

It’s a lot for one person to manage. There’s no time for long days when it goes by so fast, Marler says. But she’s still glad she switched to working in a hospital. She joined as the COVID-19 pandemic was slowing down and hospitals across the country were in dire need of more staff.

While the pandemic shed a light on the challenging job of nursing, Marler says the media still has it quite wrong.

This is real life, not TV

Patients on the medical/oncology floor face long, hard battles, and some may be nearing the end of their lives, Marler says. For many, it’s easier on the patients and their loved ones to just keep them comfortable.

People have misconceptions about how patient care works, she adds. For example, the number of patients who survive or come back with the same level of cognitive function after CPR is much lower than people expect.

Even after years of caring for patients, Marler still gets anxious when a code blue is called — an urgent request for resuscitation when a patient has stopped breathing or does not have a heartbeat. She always calls for support immediately — knowing how important every second is, she’d rather overreact than underreact.

Hospital beds are equipped with heart and respiratory rate monitors, which help teams stay on top of a patient’s condition. Still, nothing beats being at the bedside. Marler unfortunately lost a patient during a code blue in her first year, something she’s observed to be rather rare, with only a few called each year on her floor.

Staying calm in the storm

While the daily routine is the same, the job never is, and it takes experience to remain calm when things get chaotic and are constantly changing, Marler says. Change fatigue is real, as is the mental and physical exhaustion of going full speed for so long.

It’s important to have a support system and take care of yourself on days off, she says. She sleeps in when she can and spends time with her son, getting outside when possible.

And of course, she has others on the floor to connect with. Five hours into her shift, Marler joins a handful of nurses for a quick snack in the break room before the next rush hits.

CNAs start their next round of vitals, lab tech preps for their next patient and the nutrition team drops off a tray of food. Leaving the floor, it’s suddenly silent. Call alarms, buzzing monitors and the sound of nurses weaving in and out of rooms fades away.