Wednesday, August 27, 2008

battling headaches, battle on!

I continue to try to find my niche on my unit and among my peers. I also continue to learn and grow with every patient I take. Today I had two Trans-hiatal esophagectomy (THE) patients. They are a specialty on our floor as well as in our hospital. They kept me hopping today, along with a post-op CABG admit from the ICU.

I battled a migraine all day, and I was happy to be only 8 hours.

Thursday, August 21, 2008

sooner or later

I had had too many good days, and my confidence was too high. Last night, with not much reason for it, I felt incompetent. I guess it might have had something to do with the code.

An older man recovering from an aortic dissection repair suddenly became bradycardic, and then went into asystole. The code was called. It lasted a half hour before they called it. Then the nurse came out, looked right at one of us who was standing there, burst into tears and said "it's all my fault". Then she ran off.

I felt like crying, too. That could've been me. That can be me anytime. I wanted to go check on my patients, assure myself that they were alive.

My report to the night shift was disorganized and incomplete. It made me feel like a failure, incompetent, a poser. And deep down, it was the code and the tears, and the knowledge that when or if it is me, I would have nothing to offer, and no way to help.

Wednesday, August 20, 2008

training the residents

It's been pretty calm at work the last few days- with the exception of some chest pain from a rule out MI patient, which resolved itself with one nitro. I had this nightmare the night before, about a patient who went into v-tach, I pressed the code button, and only a few students came to help me and they had no idea what to do. That was the dream. At work, my R/O MI patient says he's having chest pressure and left arm pain, and suddenly throwing PVCs every which way. I got a bit panicky, but soon I was focused and fine.

Yesterday I had a patient who choked on some chicken, went sky-high tachy, desatted, and who was on an off service who came and said if his BP drops, we're going to shock him. We're going to what??? Sure, his tachy rhythm might be mistaken for Afib, from a distance, but after showing the strip to a few more experienced nurses, the concensus was just tachy. Not to mention, the patient already has a pacemaker and AICD! I was like, uh, excuse me boys? Let's not shock the patient, ok? He's going to be just fine. They looked up at me and said 'ok... well, we're still going to do an EKG and troponins'. Cool, go for it. Then the real physician came over later, and cancelled all that crap. What a day!

The balance beam final came on RIGHT at 11, when I had to give report. I beelined it back to the break room and everyone said "You missed Shawn Johnson!" Shit. But when she won, I was jumping up and down, and everyone was laughing and saying 'get her an ativan!'

Another fun fact- there are blue pads all the way across my couch at home now, just in case my cat pees on it again.

Sunday, August 17, 2008

psych nursing 101

I had three mentally ill patients yesterday. One of them had a trach, which she managed to pull out, and kept biting me and the sitter. That was a scary moment, when I came in the room and that trach was sitting in her lap. I couldn't figure out the obturator, so I put it back in without it. Luckily, it went back in easily. I spent the majority of the day giving the patient lectures about biting and trying not to threaten her with restraints.

My other crazy patient escaped from the hospital in the morning. She had a sitter, who was let go right after, and took off. She was located later outside of the ER.

My third patient I have had for a while. He refuses to move. Refuses to get out of bed, turn, reposition himself, etc. So I enlisted the help of PT for that particular lecture, and it worked. He sat up in a chair for about 45 minutes out of the 12 hours.

I never felt overwhelmed though, I always felt I was on top of things. And we had NO techs. I feel pretty good about it all, although I'm hoping for a better lineup next time.

Friday, August 15, 2008

a gold medal day

If nursing was an olympic sport, I think I would've given one of my best performances yesterday. I took four patients, something we rarely do on our unit. With my eye on the clock (I didn't want to miss women's gymnastics), I had everything done by 10. Everything being- meds, patient walks, insulin, care plans, SOAP notes, charting, dressing changes, etc.

It felt like I just stuck a difficult landing.

Thursday, August 14, 2008

learning on the spot

Yesterday was another good learning day. I got to hang blood by myself, for the first time. I was busy, busy, busy. No one can say that nurses don't earn every penny we get, it just kept coming and coming. I had a discharge and an admit. Admits are way easier with the MAR online, though.

Tonight is the women's all-around final on the olympics, and I will have to find an empty room to sneak into to watch.

I have to admit that I feel a little lonely at work now. I don't really have any friends, just a couple but our schedules are hard to match up. I hope it changes but I'll just be as friendly as possible to everyone until then.

Wednesday, August 13, 2008

my many skills

Yesterday was my first day back after four days off. Actually, I was supposed to go in Monday, but when I got there, I wasn't on the schedule. Their mistake. But they sent me home, they were all set. Then, 45 minutes later, when I was already back in my pajamas, they called me back and said 'uh, can you come back?' Uh, no.

Anyway, I took on the hardest patient there was. I figured, what the hey, no better way to get back into things than to jump in head first. But she wasn't bad at all. I got trach experience, so that was good.

The highlight of my night came when one of the techs came to me and asked me to come translate for a patient down the hall who doesn't speak English. She speaks Hindi. I said no way, my Hindi is nowhere near that good! But he convinced me, and I managed it, and I was sooooo freakin' high! That rocked.

Friday, August 8, 2008

growing up and out

My first day off of orientation was Sunday. It was a strange feeling, but also such a feeling of pride in myself. My first two days on my own were uneventful. I felt as if my head was held high, as if something inside of me was standing taller every day. I have never felt such a sense of accomplishment, such satisfaction with myself.

My third day brought all the learning experiences I could ask for, including a plugged J-tube, a THE leak, and a patient returning fresh from cath lab. I learned to use hot water, coke, and above all, muscle for the J-tube. I learned to wash it off and jam it back into the hole when it falls out. I learned how to do dressing changes for the leak, by having the patient swallow water while I use a Yaunker to suction it out. I learned how to hold the leak closed while the patient eats. I learned the standard orders for a patient post-cath lab, to take vitals every 30 minutes x2, then every hour x4, checking the pedal and tibial pulses, ambulating the patient 4 hours after sheath removal, and checking the groin site. I overheard a patient's wife saying, as if just realizing, 'Edith is a good nurse!' and felt my heart swell.

The next day, I was called at 11:30 and asked to come in and be assistant charge. What a sense of self-importance I had as I changed out of my pajamas and into my compression stockings! How I walked into that building, as if I alone could do the job, as if I had not just happened to be the only RN they could find to do it!

I was given the A/B side pager (it alerts us to dysrhthmias from the monitors) and instructed to take our brand new Dura Heart patient down to X-ray. This is the first patient to receive a Dura Heart, the fourth and newest LVAD, implanted for the first time by our very own cardiac surgeon. It's magnetic pump reduces damage to red blood cells, reducing the need for anti-coagulation. It has the potential to replace heart transplants, it lasts so long. Our first patient is doing fine, and we're all feeling a sense of pride at having him on our floor.

I took patients at 3. I had two aortic dissection patients, one pre-op, one post-op, and in my spare time I educated myself on the diagnosis and the surgical repairs. I also went up to 5 to visit my friend D, on her first day off of orientation on the ortho-trauma unit. We talk excitedly about our successes and our 'learning experiences', the ups and downs of our floors, our co-workers, our hours. We have been together through nursing school, through every step of our new careers.

The other orientees that started with me did not get off of orientation early. Last night was supposed to be their last night, but one orientee has not done so well. I feel bad for him, but the secret smugness I feel inside at having done better than someone else shames me. I feel like he has not had all of the learning opportunities that I had during my orientation, either, and this has only hurt him more. I wish him every success.