Not even. If you’re contracting out for nursing, it can go over 90.

A lot of overhead would still apply. Probably not licenses

No worries, I’m happy to explain because it’s not like anyone learns in school how the medical field works (although I wish we did)

The process nurses are trained to perform and which we’re constantly doing without even thinking about it anymore is an acronym ADPIE: Assessment, Diagnosis, Planning, Implementation, Evaluation.

Assessment is physical assessment of a patient. We’re constantly assessing no matter what else we’re doing because you’d be amazed what we can tell by just looking at a person. Are they alert? Confused? Breathing normally or labored? Skin color normal, pale/ashy, blue? Moving symmetrically? Strong or weak? How much of the food on their table did they eat? How much of that water we left in here three hours ago have they drunk? Do they cough when they swallow (a sign of aspiration)? We often know within seconds what we’re worried about. And we’re obligated to report that to your doctor.

Diagnosis for us doesn’t mean medical diagnosis like what your doctor gives you. It means diagnosing what we’re seeing in the moment. Say, for example, your oxygen levels are dropping on your monitor. Just turn up the oxygen right? But not so fast. Is the person cold? Have low hemoglobin counts? Peripheral artery disease (aka poor circulation)? Mouth breathing while wearing a nasal cannula? All of those things can cause the O2 monitor to drop and turning up the oxygen isn’t the correct intervention for any of them. (Maybe for low hemoglobin in the short run, but really you’ll be looking for a blood transfusion if it’s that low.)

Planning, intervention, evaluation are just doing a thing to fix a problem and seeing if it works. If the O2 monitor is reading low because someone is cold, let’s try some different things to warm them up and see if that fixes the problem.

BEFORE we call your doctor. If the O2 monitor reads low and I just call your doc before I’ve tried anything to fix it, they’re going to be irritated and probably have a chat with my supervisor about what an idiot I am wasting their time. In fact, personally, I like to try everything in the world that I can think of before I call a doc.

Then I can call them and say “Hey there was a problem but I fixed it, here’s what I did.” And then I can write my favorite note in your chart “MD aware” lol. Or I can call them and say, “Hey I’ve tried all these things and nothing is working, do you want to order XYZ?”

Yes, we are often suggesting orders to your doctors because we’re the ones seeing the minute by minute goings on. I affectionately refer to this part of my job as “reading physicians’ minds” lol. “Anticipating what might be ordered” is actually a formal part of our training. Docs don’t just take our word for things, but often they agree with us, and we don’t do things without consulting them because often they just know more than we do. It’s a team effort.

And there’s a lot more to giving actual medications than just throwing some pills at a room as we’re running by (although it feels like that’s all we do sometimes). We have to understand the pharmacology of the medications we’re giving. What are we expecting this med to do for you, what are the usual side effects, how long before the med kicks in so we know when to recheck to see if it’s working? Some medications have very specific means of administration. If you give them too quickly through an IV, you can cause problems, or even kill someone (with some of the cardiac meds that I give regularly).

Even just giving pills is more complicated than handing them to someone and walking away. Lots of people, older folks especially, need help or accommodations taking pills such as taking them one at a time or taking them crushed up and placed on a spoonful of applesauce. We have to know these things about you.

And lastly, my favorite part of the job because apparently I like the sound of my own voice (I’m sure you’re surprised, if you’ve made it this far through the comment) is patient education, which is a particular specialty of nursing. The typical order of operations is a doctor diagnoses you, gives you the broad stroke details and answers questions, then we fill in the details and answer ongoing questions that didn’t occur to you while the doc was in your room.

For example, when you start on a blood thinner, the doc tells you why and what the med is and probably tells you “it will increase the chances of bleeding,” but what does that mean for you in particular? I’ll get into the weeds with you about “if you cut yourself shaving or in the kitchen, it’s going to bleed more than you’re used to and that’s normal” and “if XYZ happens, you should go to the emergency department” and “here’s some good resources you can use for reference at home”

In a hospital, we’re also the ones coordinating all of your care. Getting you sent off for scans, timing medications around that, advocating for more interventions when we’re concerned about your status, etc.

I hope that answers some of your questions.