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.