Inside the Nursing Department: A Day in the Life of Patient Care

Today I was able to shadow the Nursing department, which was day 2 of my work experience.

Understanding the Drug Chart and Controlled Substances

One of the first things I observed was the drug chart and how medicines were signed out. The chart has the patient’s name at the top, with the medicine name repeated down the left hand column, along with time stamps in the column next to it, and the date in the subsequent columns. There is also a key on the front of the chart, which refers to different reasons of why a patient is refusing a certain piece of medication, because there is not enough space to write it in the drug chart itself, so a number is just placed instead. I learnt that in certain circumstances it requires two people (a doctor and a nurse) to sign out one piece of medication. This circumstance is when signing out control drugs, which are drugs that can cause addition. Hence it requires 2 people to sign this out so that the second person can recheck the dosage. Just to name a few control drugs: Morphine, Gabapentin, Oxybutinin. The medicine/pharmacy room was also ventilated with a 24/7 AC unit running the temperatures down to at least 16 degrees celsius.

Witnessing the Complexity of Patient Cases

One patient suffered from a drug overdose, and cannot see, move, or eat anything orally. Hence they require a PEG tube to be able to eat, and drink. This PEG tube needs to be cleaned and washed out everyday. I also was able to observe the Nurse and Doctor collecting a blood sample from the patient. They wore white aprons and blue gloves. the NHS hospital requested a blood sample to be taken of this patient. This patient was placed at this private hospital by the CCG, who finds places for patients who do not have a place to stay. CCG funds the patient’s place at the private hospital, however since they are not a private hospital patient, the blood sample must be done at a NHS hospital lab. The blood sample is taken by using a vacutainer. This has different sizes of needles, where a smaller number refers to a bigger needle.

Urodynamics: Investigating Bladder Function

During my observation I was able to learn about a Urodynamics test, which essentially translates to “how much can the bladder hold”. For example for a normal functioning bladder, at around 300 ml of urine, the brain will start to feel an “urge” to go to the toilet, but even if you choose not to go, it will not be an issue. At around 600 ml of urine, that is when you may start to feel pain, and you become desperate to go, and anything past 650 ml, the sphincter muscle will not be able to control the opening of the urinary tract. The way a urodynamics test is done is a catheter is passed up the urinary tract, and then a pump will push fluid up the urinary tract into the bladder. The machine will keep reading how much ml of fluid it has pumped thus far into the bladder, and the observer will keep an eye on the patient to see when they have their first urge, second urge, and when the sphincter muscle is no longer able to control the opening, which is called an urgency on the medical test report. Interpreting the graph is very objective, as was mentioned to me by the doctor.

In the urodynamics test result:

• Rate of bladder fill is recorded: 50 ml per minute
• When there was the “first sensation”, so could be at 84 ml
• When there was a strong desire to go to the toilet: could be at 114 ml
• When there was an “urgency”, which means the sphincter muscle released urine without direct permission or intent from the brain.

Exploring Medication Management and Emergency Drugs

There were some names of medicines that the hospital was ordering that I also wanted to take a note of:

• Midarolem
• Lidocaine 1% and 2%
• Levibupiuicaine sterile
• Depomedrone
• N/saline
• Posiflush
• Clinidine
• Contrast Omnipaque
• Naloxine
• Flumanazil
• Intralipid
• Usually emergency drugs:
• Propofol 1%

Patient Records: Timeliness and Detail Matter

I also saw the crucial role nurses have in managing patient records and keeping them up to date. When any healthcare professionals write notes about a patient’s session, they must write it within 24 hours of that session, otherwise it is outside of guidelines time scope. Some things that they may record are:

• How the patient was feeling (subjective)
• Goals reporting/changing
• How the patient was coping with the goals, and how do they respond to them

The purpose for the notes about each patient is so that every therapist/healthcare professional can understand and see the progress made with the patient prior.

From Hospital to Home: The Role of Handover

Another interesting observation I was able to see was how the Nurses have a lot of role and responsibility in the handover of a patient from the hospital to a care home. Things that were discussed between the Nurse and the Care home representative were:

1. How many showers a week
2. Any wounds on the skin
3. Any special equipment that is used to carry/transport the patient
4. Does the patient require any special assistance from staff to turn in bed.
5. Medical background, or any diabetes?
6. Asking about any fluids that are taken by the patient.
7. Any problems with teeth and eating orally.

Some patients are considered an outpatient, which means that they stay elsewhere during the night, and only come into the hospital for their sessions of therapy and rehab.

The nurses can also fill in a Pharmacy Order for medication that has either run out, will run out, or any new medication that they feel will be beneficial to the patients. This form includes sections for the drug name, strength, form, dose, frequency, and unit quantity. It also has a sentence mentioning “For controlled drug orders, please ensure all the columns above are completed and the “unit quantity” is written in both words and figures.

Today’s experience highlighted just how vital nurses are in ensuring continuity, safety, and quality of care. Their role goes far beyond bedside support—they are administrators, communicators, and clinical decision-makers. I saw firsthand how they interact with other healthcare professionals, interpret clinical data, and advocate for patient needs, whether it’s through managing medication, supporting diagnostic procedures, or facilitating safe handovers. This deepened my appreciation of nursing as a discipline built on knowledge, compassion, and precision.