I love when I love my job

I've been sooo happy at work yesterday and today, because finally, FINALLY, I have a sick patient! I'm not a total weirdo... that's just what I came here to do, take care of patients who are in a life or death situation. Not patients who are ready to go home! This poor gentleman aspirated his own stomach contents during a GI procedure, which got him tubed. Good reason to take that pre-procedure NPO rule seriously folks! But now everything else is going downhill. He's on pressors, unable to tolerate tube feeds, and making no urine. I feel like I'm learning again and enjoying myself immensely. I feel like a real ICU nurse!

Today is my last day shift. I will go to nights on Tuesday. I feel kinda sad, because I feel that I've really built some good working relationships with the day nurses, the interns, and residents.

can I go back on orientation please?

It's not that I feel I need more orientation. I don't need special help or more time adjusting. What I need is: INTERESTING PATIENTS. Since I've been off orientation, I have been bored stiff. Things that once excited me, like vented patients, art lines, blood gases... they do not excite me on the patients I have been given, easy patients, failure to weans or patients ready to be extubated. These patients are not sedated, they write on paper or mouth words to me (I am terrible at reading lips). Or they bang on their side rails with whatever they can find. Or press the call light 20 million times. Medically they aren't on the verge of coding or needing pressors or anything at all interesting. I've run out of things to google, people to call, appointments to make, things to eat, because I'm so damn bored. On the floor I had patients like this, but I had three of them. Now I have one of them, maybe two, and don't know what to do with myself.

Everyone keeps saying "oh be careful what you wish for" but I'm seriously trying to temp fate. Give me a learning opportunity! A juicy hit! A patient on pressors, paralytics, sedation! Something, anything. I'm in one of the most critical ICUs in the whole country, how can I possibly be this bored???

on my own

I started out on Monday without a preceptor for the first time. I had a really easy assignment, a guy that we extubated and a sweet lady who was tubed but totally with it. The next day I had the easiest patient ever, who could've gone home. Finally at 3 I picked up a very sick patient, who immediately started desatting on me. We started turning up the peep and then cranking up the 02. She was too awake so I had to put her down farther, starting with fentanyl boluses and then I was thinking about hanging up the propofol again. When I double checked with another nurse, that's exactly what he would do! Yay, I was so excited! I was thinking the right way!

We'll just have to see what tomorrow brings.

the graveyard shift

The last three nights have been midnight shifts for me. Talk about slow, and boring. I have been reading a book, surfing the web, trying to keep myself awake. Nothing happening. Nights are totally different from days, where I was so busy that 12 hours felt like 5 minutes. After a long night of just sitting around, I can barely drive home, my eyes are closing and my car is swerving. I feel like these can't possibly be the same patients that we have during the day! Everyone assures me that usually nights are very busy, but I've yet to see that. At about 6am docs and administration starts to arrive, the lights switch on, suddenly the place is hopping. But until that moment, it's dark and quiet, nurses sitting around with blankets wrapped around their shoulders, reading novels, eating, chatting on facebook. Doobey doobey doo.

Finishing up orientation

I've been in a lot of classes, some interesting, some not. I've also had some very interesting patients. Like the patient who was brain dead but whom we couldn't 'pronounce' braindead because he was on 'innercool', a hose that brings his body temperature down to 33.0 celcius. I had a patient that we withdrew care on, and I got to watch her cardiac rhythm go from sinus to all sorts of arrhythmias to asystole. I do feel that for the most part I'm independent, and I have learned a million things and gotten SO much smarter in this short time. I'm going to nights for a week and then hopefully I'll be let loose to be on my own.

4th week ICU

I'm definitely getting more comfortable on my new floor. There is still SO much I don't know, but it will be that way even when I'm off of orientation. I find myself now getting a bit annoyed with having a preceptor. I don't like anyone else adding things to "my" flowsheets, or I sometimes disagree with the way we are titrating the insulin, etc. I guess I'm a bit anal, and fit right in with the rest of the ICU nurses!

Last week I had classes, some interesting, some not. Most of what I got out of it was a sense of comeraderie with other ICU nurses, new and old, and a profound respect for the nurses who have been in it for decades. They are so amazing.

I have been having a lot of difficult discussions with family members about their dying loved ones. It's hard to know what to say to a family that is faced with the most difficult decision of their lives: when to pull the plug, or just stop life support. But as hard as it is, I find myself jumping right in and being willing to have that conversation with the family if they want to. They seem eager to talk to the nurse, to know our opinions, to share their feelings. I don't have the right way of explaining things down pat yet, but my preceptors are good at helping me out with ideas. I didn't realize what a huge part of ICU nursing it would be, dealing with grief and decision making with the family members.

This weekend I tried to relax, sleep in, and work on the yard. I do feel very proud of myself for advancing in my career and being willing to take the plunge into a totally new area in order to learn and grow in my profession. I feel like I am becoming a better nurse, even when it's hard. Add that to the small gardening projects around the house (I'm not a gardening person) and I feel more proud of myself than ever. It's nice to be able to give myself a pat on the back, when I feel so emotionally down.

2nd week ICU

This week I felt pretty independent. Not that there wasn't a lot to learn, but for the most part I felt like I could've done a lot of it without a preceptor. I have to admit- I thought it would be harder than this. The vent and ABGs and pressors and paralytics are really the newest things... for the most part though, it's business as usual. I draw labs myself, and get bladder and central venous pressures, and bag people occasionally. But I had a CF patient that made me feel at home- always on the call light, and in pain. We ambulated her and I bagged her the whole time!

Today my patient had a 1 in 2 million rare lung disease called alveolar proteinosis. It can only be fixed with whole lung lavage. Only trouble is, he can't oxygenate well enough to undergo the procedure- so he is going to placed on ECMO and then they're going to try. This is a ground-breaking surgery, that's never been done on someone this sick, and that could only be performed in a very small handful of hospitals by only a few pulmonologists in the world. I got to listen in on the meeting with the family, and I felt like I was part of a discovery health special.

Of course, this lavage on ECMO crazy revolutionary procedure can't be done tomorrow, because the president is coming, and specialists are prohibited from performing intense procedures that may tie up precious resources... just in case Obama develops a chronic lung condition in a matter of hours!