Hospital Nursing Nurses
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Hospital Nursing Nurses
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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!
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!
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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Catherine Burger, MSOL, RN, NEA-BC | Updated/Verified: Aug 29, 2022
In her 30 years as a registered nurse, Catherine Burger has worked in a myriad of patient care and leadership specialties across the continuum of healthcare, including labor and delivery, ICU, home health, ambulatory care, education, and clinical practice consulting. Upon completing an ADN from Pacific Union College, Catherine worked in various bedside roles until her career evolved into nursing leadership for a large HMO in Northern California. She then completed a BSN at the University of Phoenix and a Masters in Organizational Leadership at Colorado State University. Catherine is the founder and CEO of a consulting and freelance writing business (which includes a nurse leader mastermind forum), is an advanced board-certified nurse executive, serves as the Employee Health & Infection Control Nurse for an FQCA and is the Media Response Specialist for RegisteredNursing.org. Situated in the beautiful Idaho mountains, Catherine loves traveling and spending time with her husband, their five children, and raising service puppies for Canine Companions for Independence.
Latest posts by Catherine Burger, MSOL, RN, NEA-BC ( see all )
Home / Nursing Articles / Hospital Nursing vs. Clinical Nursing
Depending on the setting, hospital nursing and clinic nursing can be very different. One of the most significant differences is the acuity of patients. Obviously, hospitalized patients require a higher level of care than a clinic can provide. More monitoring is needed. However, occasionally a patient may present to a clinic with an acute or emergent issue, so nurses must be prepared to handle more complex patients and be able to stabilize them for transfer to an acute care setting.
Both clinic nursing and hospital nursing can be busy. However, they are different kinds of busy. While hospital nurses are busy in that they have complex patients to care for with many nursing interventions needed, clinic nurses have a higher volume/ patient turnover to manage throughout the day. Multi-tasking is crucial in clinic nursing as nurses must not only provide hands-on care, they may also have to address messages from patients and perform telephone triage and follow up calls.
In the clinic setting, nursing tasks may not be as complex as in the hospital. Again, this may vary depending on the clinic setting. But in a primary care clinic setting, for example, tasks such as tube feedings, complex wound care, trach care, etc. are not usually performed. Some tasks that may be done in the outpatient setting can include injections, IV infusions, catheter placements, and simple wound care . Again, every clinic setting is different, and required tasks may vary.
Clinic nursing is also very autonomous. Sometimes an outpatient department may only have one nurse. While more autonomy can be empowering for nurses, the absence of collegial support can present a challenge. Nurses frequently bounce ideas off one another and ask for advice on clinical concerns. Although physicians are more likely to be present in the clinic setting, nurse-to-nurse collaboration may not always be available.
The types of patients seen in outpatient surgery depend on the setting. Outpatient or ambulatory surgery centers perform minor procedures in which patients are released the same day. Duties may include those of OR/recovery room nurses . However, some surgery clinics function much like a primary care office. Patients are scheduled to come in, meet the surgeon for a consult, and discuss surgery options. From there, surgery may be inpatient or ambulatory, depending on what type of procedure is needed.
A significant job duty of surgery clinic nurses is education. Nurses assist in explaining the procedure to the patient, discuss the pre-surgery instructions, review post-operative expectations and procedures, and answer any questions the patient may have.
Surgery clinic nurses may also assist with in-office procedures such as incision and drainage or excision of a skin lesion. They may help set up instruments, assist the surgeon during the procedure, and perform wound care afterward. They also provide valuable patient education in caring for the site after leaving the clinic and set up any necessary follow-up appointments.
Another difference between hospital and clinic nursing is that in the clinic, the primary focus is generally on preventive health. Education on various topics such as a healthy diet, diabetic living, blood pressure management, etc. are things clinic nurses must educate their patients on. Education in the hospital setting also occurs but is often tailored to the acute problem a patient was admitted with.
When first starting out in the clinic, nurses are often surprised as to how much it is run like a business. For the most part, nurses have little to no business training in school, so when it comes to sending and receiving company emails, learning applications such as Excel and PowerPoint, and taking and sending patient messages, it’s an entirely new skill set that must be learned.
Nurses in both the clinic and hospital setting are critical in the patient care continuum. Both areas have different clinical focus but are crucial in comprehensive healthcare delivery.
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