Duties of a Registered Nurse in a hospital or nursing home entail many things. Registered Nurses (RNs) are responsible for a wide variety of care provided to patients. Not only are they responsible for taking care of patients but they must delegate to CNAs and supervise Licensed Practical Nurses (LPNs). This article will talk about the wide variety of duties a Registered Nurse (RN) performs. This will include things you probably already knew but it will also include things you probably did not know………the glamorous and not-so glamorous duties of a RN. So let us begin!
Responsibilities of a Registered Nurse (RN)
1.) Assessments of patients! This includes listening to heart, lungs, and bowel sounds, Assessing pupils, mental status, pulses, skin, last bowel moment, urine color (if patient has foley), wounds, any type of tubes (PEG tubes, NG tubes, Chest tubes…etc) mobility, fall risk. Assessing the IV site for infiltration or if a new one needs to be started (at my hospital IV sites are only good for 4 days). Also vital signs are important. If your patient is on a bedside cardiac monitor you will need to assess their heart rhythm and rate and oxygen level. In addition to this you not only need to assess your patient physically but you need to assess the patients lab work and diagnostic testing results and call any critical lab values or abnormal diagnostic results to the doctors.
2.) Documentation! This is the fun part of nursing! Documenting may be different depending on where you work. For example, on a Progressive Care Unit (PCU) which is where I work. I have to document every 4 hours on my patients. I usually have about 3-4 patients at a time which is a pretty good ratio. However, ICU nurses have to document every hour and medical surgical nurses document at the beginning of their shift and by exception which means they document if something note worthy happens. Note this probably varies among hospitals. My documentation includes the following: updating the care plan for the day, charting my assessment, writing a nursing progress note every 4 hours and as needed, updating the 24 hour hourly flow sheet, daily education sheet, telemetry strips.
3.) Supervising LPNs! Note this may be different on where you live because each state has their own laws. Where I live LPNs can not given any type of IV medications or titrate IV Cardiac, Insulin or Heparin drips. In addition, they must have a RN co-sign all of their assessments, updates to their care plans, and if a patient must go off the floor for testing with a nurse an RN must accompany the patient. The cons of having to supervise the LPN is that most RNs already have their own patient load that they are responsible for and if they are having to supervise a LPN who has a lot of IV medications that must be given it can decrease the amount of time that RN has for his/her own patients.
4.) Collecting specimens! This includes any type of urine, stool, sputum, wound, skin, hair, and emesis specimens.
5.) Educating patients and their family members! As a nurse, you are also a teacher! You are with the patient the most during their hospitalization. If you are already a nurse you have probably already noticed that most doctors do not do a great job of educating their patients….noticed I said most (some doctors are great!)….and it is up to you as the nurse to answer and educate your patient on their new medications, newly ordered tests, diets, activity, wound care…etc. Also educating needs to start on admission and not at discharge.
6.) Giving Medications! Some days I feel like this is all I do….give medications. Depending on how sick your patient is….it is really all you do. The biggest medication passes for me during day shift are at 1000, 1200, and 1800. However, you do have patients who get medications at 0730,1000,1200,1500,1600,1800. When this happens I try to group them together because at my hospital I have an hour before and an hour after to give the medications on time.
7.) Drawing blood and starting IVs! Some hospitals have phlebotomist who draw blood and an IV team who starts IVs but other do not. I think having an IV team takes away the nurse’s skill of starting IVs. Think about it…..if you need an IV fast and the IV team is not available you will need to start it and if you haven’t been doing it because you rely on the IV team your IV skills are going to be really rusty.
Great video on how to find a vein before drawing blood and starting IV:
8.) Inserting Foley catheters and Nasogastric tubes!
9.) Providing daily wound care!
10.) Making sure your patients are given baths, provided mouth care, and turned every two hours if unable to turn themselves! Yes, you can delegate this to your CNAs but sometimes you are short handed and must provide a bath to your patient. Some RNs think that giving a patient a bath is not their job but the CNAs. Sorry but they are wrong! Granted that the RN may be too busy to give a bath due to everything else they have to do but if your patient is in a dire need of a bath the RN must provide one to them.
11.) Making phone calls to doctors! The nurse is responsible to report anything abnormal to the doctor. In addition, if a patient is vomiting and does not have a medication ordered to help with this the nurse must call the doctor to get an order for the medication.
12.) Increasing your patients activity level! Once again, nurses are with the patient the most during their hospitalization. Some nurses solely depend on physical therapy to work with patients on increasing their activity level which is a huge mistake. Most Physical Therapists see a lot of patients and can only spend about 30-45 minutes (if that) with patients. It is your responsibility as the nurse to make sure your patient is getting out of bed and moving. I have seen patients who came into the hospital able to walk but once it was time for their discharge they were unable to barely move because they became so weak from lying in bed the whole time. Increasing you patients activity level is so important and is very much overlooked by nurses.
So there you have it! It may not be the whole list of duties a registered nurse (RN) performs but are the basic ones. The duties of a registered nurse (RN) can be different depending on where you work. Most of these duties are the duties of floor nurse in a hospital or nursing home.
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