Penn Nursing Diaries: A Day in the Life--Kendall Smith

7:00 P.M. My day typically starts the night before when I formulate my Care Plans for each patient that I’ll care for during clinical the following day. I review the patient’s medical history and all the prior surgeries they’ve had and start to think about how to tailor my plan for delivering anesthesia to their needs. I familiarize myself with any medications they take and preexisting conditions they may have that will affect the needs of their care. After formulating a plan that I can confidently go into the next day with, it’s time to decompress.

9:00 P.M. My Calm app reminder goes off to encourage me to start thinking about going to bed. Prioritizing sleep for me is key to feeling fresh and ready to take on the day. Before heading to bed, I set my alarm, meditate for 5-10 mins, write down one goal for the next day, and pray. ZZZZzzzzzzzz

4:00 A.M. Alarm rings. Usually, I set my alarm as a fun song that I am feeling for the week. Today it’s J Cole. My hand goes for the snooze button but I want to hear the end of the chorus so I let the song play. It’s time to jump in the shower and put my scrubs on that I laid out the night before.

4:30 A.M. While finishing up brushing my teeth, I order a Lyft to drive me to my clinical site. While in the program we rotate through a number of different hospitals based on the subspecialty of anesthesia that we are learning at the time (pediatrics, cardiac, trauma, obstetrics, etc). Today I will be in the orthopedic surgery department. :)

4:35 A.M. Hop in the Lyft and toss on my headphones with an energizing playlist as I reread my goal for the day and take notice of the Philadelphia skyline.

5:00 A.M. Walk into the hospital staff locker room and greet my fellow SRNAs. We chat about what the day has in store and wish each other luck as we walk to our respective operating rooms.

5:30 A.M. Finish setting up the OR, which includes an anesthesia machine check, evaluating patient monitoring devices, and testing airway equipment. I calculate the correct dosage amounts for the first case and start to take out the proper medications for the first patient. Lastly, I make sure I have properly functioning emergency equipment should any difficulties or complications arise. I tap the emergency bag valve mask twice in the morning for good luck so that hopefully I don’t have to use it ;)

5:45 A.M. Meet my first patient of the day and explain my role within the surgical team. I am often one of the first people that the patient meets when they get to the preoperative waiting area and it is important for me to work to quickly develop a positive rapport with the patient and their family members. Creating an open space for patients to discuss what to expect in the OR helps establish the trust. While I place the intravenous line (so that I can give medications before, during, and sometimes after the case), I interview them to make sure that I am aware of any recent changes in their health and to be aware of any medications that they might be taking or allergies that might affect their anesthesia plan. Then it’s time to head back to the OR to meet my precepting CRNA (Certified Registered Nurse Anesthetist) for the day.

6:00 A.M. Meet my precepting CRNA who serves as my mentor for the day. We typically go through each case and discuss specific aspects that might be challenging. I share anything of concern that came up during my patient interview with the patient and communicate that we have proper “access” to administer medications.

6:30 A.M. OR huddle time. During this time the surgeons, operating nurses, anesthesia staff, and other operating room personnel have a brief meeting to discuss the patients. It is during this meeting that we talk as a team about any special equipment that needs to be in the room, any expected complications the entire team needs to be aware of, and just generally foster a culture of safety and collegiality.

6:55 A.M. Roll the patient back to the operating room. I make sure that the patient is properly positioned on the operating table before placing monitoring devices. I am responsible for making sure the patient’s heart rate, blood pressure, temperature, oxygen level, and more are in a safe range so that the patient can tolerate the surgery. After all the monitors are applied, I start to “preoxygenate” the patient so that we as an anesthesia team (SRNA, CRNA, MDA) can start induction. We give patients a carefully calculated combination of medications including but not limited to sedatives, paralytics, antiemetics, and analgesics.

9:00 A.M. Time to start to wake the patient up. I begin decreasing the patient’s dependence on the anesthesia machine so that the patient’s lungs can be nice and strong when they are disconnected and the breathing tube is removed.

9:30 A.M. Emergence went smoothly and the patient is awake with no pain. I wheel the patient from the OR to the recovery room and talk with the PACU nurse about what was done during the surgery as well as a pertinent summary of the patient’s information. Post-anesthesia care unit (PACU) nurses provide care for and treat patients who have recently undergone anesthesia. After getting a thumbs up from this patient, it’s time to meet the next

9:40 A.M. Refocusing, I begin another patient interview. After placing the next patient’s IV, I head back to the OR to prepare for the next case.

10:10 A.M. Once the room is cleaned, new OR equipment is placed, and all the team members are in place, it’s time to roll the next patient back to start induction. I put the next patient to sleep and the next case has begun.

12:00 P.M. Time for lunch in the hospital cafeteria. After giving a rundown of the current patient to a CRNA who will be in the room while I am away for my lunch break, I quickly eat my usual turkey burger, fresh salad, and water. I like finding a quiet space outside to enjoy some warm sunshine because the OR is cold.

12:30 P.M. Now it’s time to head back to the OR to wake the patient up and get ready for my last case of the day :)

3:00 P.M. Clinical day ends—I head back to the locker room and get changed, then walk
to the nearby Septa station to travel back to Penn’s campus.

3:30 P.M. Head to the library to meet with my DNP project group to review research articles. We are translating the latest innovations in clinical research into a quality improvement project for our hospital setting, helping to make the OR safer and improve the quality of care that is given within the UPHS.

5:00 P.M. Stop by the Pottruck gym for some cardio before heading to dinner. I warm up by running on the treadmill before playing a quick pickup game of basketball.

6:00 P.M. Walk to Houston Market to have dinner and a group study session with freshman undergrads. I serve as a graduate associate (GA) on campus which means that I have the opportunity to serve as a resource and mentor to undergrads.

7:30 P.M. Head back to my room for a shower and some reading before looking up my patients for the next day.

8:00 P.M. Dudaduduadu (ESPN sports app reminder). Take a quick break from my work to watch some Thursday night football so that I can win in my Fantasy Football League. After watching a few series of the game, I log back in to finish up my Care Plans, then set my alarms for the last day of the week :)