TurboNurse

Wow!  This week has been crazy for me! 

Yesterday at work I got to help with an admission and then we got several other admissions that I helped out with when I could.  I got to see umbilical lines being placed as well.  I was just all over the place.

Today I took care of my first two vented kiddos.  It was interesting.  Just when I thought I was getting better with my time management, something changes.  Which is good because this is how I will grow as a nurse.  It's just hard because every time a change comes about like this, I take a huge dip in my confidence.  So needless to say, I'm not feeling so good right now.

I always wonder when and if I will get to the point of being able to take care of my patients confidently.  It just seems so insurmountable (sp?) at this time.  I can't imagine it.

The one thing with adults is that I was so comfortable there.  I knew what needed to be done for the common situations and had no problem going in and doing what I needed to do.  It's just so different with the newborns.  Please don't take this the wrong way,  I LOVE what I do with the little ones.  It's much more satisfying than working with adults.  It's just different.  The things you do to adults you just can't do with the little ones. 

I think I'm just going through my adjustment period which means I'm typically uncomfortable in about every situation right now.

I did have a totally awesome moment today.  When the docs were rounding on my babies, the head resident person came and got me because I didn't see them walk in.  I really like the docs, NP's, and PA's that work there.  I have yet to run into one that reminds me of some of the docs I worked with in the adult area.

The whole feel is just so much more inviting and relaxed with the little ones.  The people are just amazing overall.

I got to see my first ever bedside surgery.  I thought that was pretty amazing.  It was like they basically took the OR to the pod where the little one was at.  It all happened in the same pod that I was in.  Unfortunately I missed it when they opened the kid up and all the good stuff happened but I was there for the end when they were sewing it up and then decided that the surgery was fruitless and the parents had to make a hard decision.

This leads into my first death.  I got to experience the death of an infant for the first time today.  I'm so thankful that it wasn't one I was taking care of because I think I would have totally lost it in a bad way.  I was there when they pulled support and I was there when they brought the baby out to a special room and then back in.  After that, I was there for almost all of the postmortem care.  I'm also very thankful that I am having this experience while on orientation and not when I am out on my own.  I know I would have the support of my coworkers but it's just nice to know I have someone to fall back on and discuss things with.  

I think I'm finally getting a handle on report and how that will go.  I think it's getting a little bit better and I'm feeling more comfortable with all the calculations involved.

I just feel like I've been running around like a chicken with its head cut off these past two days there has been so much happening.  I feel like I'm getting to experience a lot while on orientation which is such a good thing.

I was a little down on myself at the end of the shift today because I felt like I didn't do much.  My preceptor reassured me that I actually did do a lot today.  We did have parents that are absolutely fantastic with their kids.  I love seeing parents so involved in the care of their children and that are as loving as these parents are.  But it's twofold.  This mom was so on top of the care that I felt like I couldn't do anything else.  She totally exhausted me when I really shouldn't have been that exhausted with the status of these two kiddos.

All in all it's been a super busy two days filled with new experiences.  I just hope I survive the last 6 weeks of my orientation.

I had a lot of firsts today.  Three, just to put a number to it.

First, I got to drop my first OG tube on a baby.  It was so much easier than trying to do that on an adult!  I got it on my first try with no problems!  Yay!!!

Second, I got to bag a baby for the first time as well.  It wasn't for a bad reason.  Baby was on CPAP/Hudson's and RT came to change the tape and while they were changing the tape, I was holding the bag to the baby to make sure they were getting enough PEEP and hence, enough oxygen.

The third, and most exciting first was going to a delivery as a NICU nurse.  It was a c-section.  NICU nurses where I work attend all sections so I hit up the flex nurse this morning and asked her if I could go to a deliver with her since she had the pager and we got one at about 4 this afternoon.

It was hard in the sense that I wanted to watch the section since I had never gotten to see one before and at the same time, I wanted to be involved in my half of it.

It all happened really fast but I felt like I had a good handle on what was going on.  Luckily the baby was just fine.  It was HUGE!  A 41 weeker who had had brady's during labor.

I couldn't believe the size of this kid!  I'm so used to looking at anywhere from 28-34 weekers who are a lot more tiny than term babies.  This kid looked like the jolly green giant of babies to me since my view on babies is only slightly skewed.  :)

All in all it was a good day.

I was a complete dingbat in some things thanks to having taken the NCLEX yesterday and still being nervous about it but other than that, it was awesome!

Next week I will take care of a baby on the ventilator.  I say...........bring it!  I'm ready!

So the evil test from hell is over.  Now I'm just praying to God that I pass.  I truly don't know.  It stopped at 76 questions and I feel very confident in saying I got the answer right.

I cannot believe all the "pick all that apply" questions that I got!  That and prioritization!  If anything, those questions made up a good 75% of my test.  Every time I got one I would say to myself "Oh man!  Again?!?!?!?!?!  Why me?!?!?!?!"

What happened to the select one answer questions?

I didn't get any picture or sound questions but that's not to say they aren't out there.

When I got out I just wanted to cry and I still do!  I'm not the type of person to get test anxiety.  Either I know it by then or I don't and there's nothing else I can do so I just do it.  This test on the other hand, killed me!

When the first question popped up I freaked.  I didn't know the answer and had to start using the strategies that I was taught.  After that first question, I had to stop and make myself take 6 very deep belly breaths before I even read the second question.

It seemed that about ever 25 questions I had to put my eyes down and take some nice deep cleansing breaths.  It worked.  I was able to focus a little better after that.

Then in the middle of the test, the lady who was proctoring us, started to talk to the secretary person and could be heard through the glass.  Needless to say, the ear plugs I used didn't work so I put on the headphones that were there for us to use to try and drown out the noise.  It was like that for the rest of the test.  I thought my blood pressure was high and my pulse was racing before but that got it going even more!  I was hoping when I took the survey at the end of the test that i would have the opportunity to express my annoyance.  It got so bad at one point that I turned around and looked the proctor straight in the eyes with my annoyed SERIOUSLY SHUT UP look.

Then I hit question 75 and totally held my breath just waiting for the screen to shut off and it didn't.  Freak out moment number-i-forgot-already-because-there-have-been-so-many-already.  Argh!

So I had to put my eyes down and take a lot of deep breaths before I went on.  It took me a couple of minutes before I would even look at the screen to read the question.

Not to mention that I was messing with my ear plugs during the whole test because they fit in one ear but not in the other so I was alternating covering my ears with my hands while reading the question and then wash, rinse, repeat for the next question.

At that point, with the talking and the ear plugs just not cutting it, I started to get antsy and shifting positions in my seat every 5 or so questions.  If I thought I could have gotten away with it, I would have stood up for a few questions.  I didn't want to get kicked out of the test though.

On the upside the testing center was not this dank, dark dungeon that I had expected based off of other's reports.  It was very nice and actually quite comfortable.  The desks were definately big enough so I had space to move and not worry about running into my neighbor.

I also scored probably the most awesome desk possible!  I was in a corner with only one person to my left and a wall to my right and the next desk starting to my back so, other than talking (which is a big pet peeve of mine...i need quite to concentrate), my next biggest pet peeve, which is people moving next to me where I can see them, wasn't an issue.  That will get me more than people talking.  I've gotten to the point where I can drown out other voices (thank you nursing school!!!) but if someone starts moving, I can't help but watch them and get distracted by them getting up or moving around.  The ADD totally kicks in and suddenly I'm much more interested in them than the task at hand. 

That is one of the reasons that I always sat near the front of class as well.  To reduce distractions since I know how I am.

Well I know sleep will probably not happen tonight but I at least need to relax so I'm going to start doing that now and then pray to God that I pass and get some sleep since I'm working the next two days (which is also a blessing.)

I survived my first day in the NICU.  I took on a full assignment on my first day which is 2 little kiddos.

It all started out great.  I learned a lot and still have a TON to learn but I'll get there someday.

So about 2 hours into the shift my preceptor goes on break and I hang out to chart my assessments.  Maybe 5 minutes after she steps off the floor for her break, a code alarm goes off.  Not on either of our babies, thank goodness.  It still really scared me a lot.  Luckily it was a false alarm and the nurse who called it had it under control before I even got to the room she was in (it was that fast).  It still really freaked me out though.  That is my biggest fear, a code and not knowing what to do.  Luckily my preceptor really eased some of my fears by telling me what I already know.  When a code happens, since I'm the new kid on the block, people aren't going to expect me to know what to do.  Then we went over bagging and she said that would be a good job for me to do if it comes up as well as being a recorder (not both at the same time though!).

Now that I was really awake after that, the day went pretty good.  I felt like I did pretty OK with these two considering I have never taken care of a baby on TPN and on high flow oxygen.

One thing that kept coming up in the morning is that I forgot to weigh the diapers!  I did it twice before it finally stuck in my mind.  I also kept forgeting to put the cotton balls in the diaper.  That is how we get a urine sample to do a urinalysis which is done once a shift.  I kept laughing at myself for forgetting to do that.  Hopefully now I have it down as routine.

I got to give report as well.  I feel like I totally fell on my face on that one but I made it through and learned how it all goes down.

All in all I'd say it was a very successful day.

Don't you think? 

I, for the life of me, cannot figure out why we subject ourselves to the things we do and then keep coming back, day after day, with a smile on our faces and ready to go again.

I've see things that most normal people would never dream of seeing, I've been involved in some of the saddest cases.  I've been there when lifesaving measures are being stopped to let a person pass from this world to the next.  I've been there to see a baby taken away from mom by CYFD because she is incompetent to take care of the child.  I've sat and watched someone bleed out and die because they refused a blood transfusion and not shed a tear.  I've watched a young mother die 4 months after giving birth due to a freak abnormality.  I've watched our old generation be coded again and again because the family "just can't let go yet" even though the only thing keeping the patient alive is the medicine we're giving him and the breathing we're doing for them. 

I've also been there to see the miracle of a new life being brought into the world.  I've been there to see people come back from near death to walking the halls with therapy, ready to go home.  I have seen someone code and then at the end of the shift be alert, oriented and cracking jokes.  I also have had the privalege to watch parents take their baby home who was born way too early and is now a healthy, happy, baby.  I've been there to see the will to live pull someone through the worst of situations.

This is why I think it is a mental disorder.  If you noticed, the paragraph on the bizzare and bad things I've seen is a lot bigger than than the positive and I haven't even scratched the surface of everything I've been exposed to so far.

I wonder every day I go into work, why I do this.  What draws me to this job that, from the outside, can seem so horrible and inhumane?

For one, it's the support of my fellow nurses.  I work with the greatest bunch of people you could ever meet.  When something is going wrong or someone is involved in a situation that is not good, even if we all don't get along we still all come together to support each other through these rough times.

Another reason I keep coming to work is that every day I come in is a new day for a new miracle.  It's a new opportunity to advocate for my patients and to do what is right by them even in the face of adversity.  No one day is the same and there is always something new to learn either about your patient, the nursing profession, or about yourself.

I can understand why a lot of new nurses with no other health care experience drop out in their first year but if you have the resiliance and the ability to see the good in all things you do even in the face of evil, I believe you can be one very successful nurse.

I can't stress enough the importance of building up your support system either.  Your support system is a network of people that you know you can rely on in tough times.  They can be your fellow nurses, family, friends, whomever you want it to be.  For me it is my family, friends, coworkers, and my faith in God who help me out more than they realize.

Another thing to keep in mind is that in the begining, the rough stuff is hard.  It sucks and you just want to go home and cry.  We all do and it's totally normal.  After a while, you get used to seeing some of the rough stuff and you just put on the big nurse panties and do your job because you know you have to do it and even if it seems insignificant and menial, you really do have an impact on your patients care and more importantly, their lives.

We as nurses have our patients lives in our hands and that is nothing to take lightly. 

We carry the burden on our shoulders but yet still manage to smile and walk lightly and brightly.  We are the light in a dark dark world.

There are only a select few in this world who are equipped to do this job.  For some, like me, it's a calling from above that can't be ignored.  Others are filled with a curiosity and wonderment that can only be satisfied by learning about the miracle of the human body that is taught in nursing.  There is also the adrenaline junky who likes the high stress stuff like being invovled in trauma.

It really narrows down to this though.  You know you are one of the chosen if your medical record says "Mental dx:  Nurse who loves her job".

That pretty much sums up the day. 

Today was my first day with 3 patients, one of whom we had to transfer back to the NBICU for a blood transfusion.

If you would have asked me at 10 this morning which way was up, down, right, or left, I could not have answered.  I was so lost it was unbelieveable.

What's funny is that I was talking to my preceptor about today and she was surprised that I was feeling the way I was.  She told me that from the outside it seemed that I had it all together.  Boy did I have her fooled!!!!!!!!!!!!!!!

I still managed to get the job done in a somewhat timely manner but I was still all over the place.  I literally went from one baby, to the next, to the next, and then back to the start for a med I missed (the ABX were about an hour late....oops!)

I was busy enough I didn't get a chance to go eat lunch until almost 3 in the afternoon.  Luckily I took a late early break and had a decent snack to tide me over but even still!  My tummy was rumbling like mad!

Today was also the day for poo and pee. 

This is funny, at the end of my shift I'm checking on one of my little kiddos because he started to desat on me so I went to stimulate him.  He made a funny face at me and I looked at him and asked him point blank if he was working on a "surprise" for me and as soon as I say it, the kid farts a nice juicy one.  This is also the same kiddo who tried his hardest to pee on me during a set of cares.

Then my other one was having bowel movements that were bigger than her head every half hour it seemed like.  She was another noisy one as well.  There was no guessing about what was going on in her diaper when she was doing her business!

Then there was the one who went back to ICU for a blood transfusion.  It wasn't a bad transfer because we normally could have done it ourselves but we were so swamped we couldn't do it safely so we sent the kiddo to ICU where we knew it would be done safely with the proper supervision.

Also had my first CYFD case today.  What a mess!  This poor kid is already behind the 8 ball and it's not even a month old!  Got phone calls from family about this little one and all I can say is WOW!  Just wow.  These people are certifiable.

So all of this on about 4.5-5 hours of sleep and I'm back at it for the next two days.  Then I am off a day and go back and start in the NBICU.

While I feel ready, I'm still a little (Ok, a lot) scared.  I have so much to learn and I wonder if I will ever be a competent nurse.

Please keep the prayers coming!  I could really use them right now.

So I'm a few days late in posting about my first week but I needed the time to decompress and store everything I've learned.

I'm amazed at how much I do actually know about what I'm doing.  I'm nowhere near proficient because there is still a lot I don't know but as far as the basics go, it seems that I am there.

It's true what they tell you in nursing school......that you don't know what you know.  I thought it was crap when they kept telling us but now I realize that it's the complete truth.

Dealing with the itty-bitties was always my weakest area in school but now it's all coming together.  I'm slowly learning about positioning and different aids that we have to help normal development.  I've learned about breast pumps and a little about breastfeeding and pumping.

Every day I'm getting more and more comfortable dealing with the little guys. For the most part my confidence is increasing every day although I did have one day, it was super busy and it seemed that the kiddos just cried and cried all day.  I was ready to pull my hair out because there was so much going on and I felt like I didn't know a whole lot at all but luckily the next day was much much better and I learned a lot from the previous day.

So day one starts out with me just shadowing and getting a feel for the unit and then I take on one little bugger all by myself.  On day two, the hectic crazy day, I was going to take two little ones but it was so crazy that I had my one little dude and helped everyone else out.

Day three was when I had my own two patient assignment and I thought it went very well.  The morning was a little rough because one little one was hungry, crying, and just overall crabby so I got as much of an assessment done on him as I could, fed him, and then finished my assessment when his tummy was full and he was sleepy.  :)  Then it was on to baby #2, assess, cares, feed.

I was finally able to chart everything at about 9:30 that morning.  Later than I would have preferred but it seems to be the norm so I am going to have to get used to it.

I'm also getting more comfortable talking to the parents.  I still have to ask for help when things come up that I don't know the answer to but the more I do it, the sooner I will learn.  I think next week my goal is to take on 3 babies by the end of the week.  I'm hoping to take only 2 when I come back and then maybe 3 the last two days.

I can't believe I only have 3 more shifts in the step down unit until I go to ICU!  While I'm very very excited to be moving on, I'm quite sad because I really like me preceptor and coworkers a lot.  I really want to keep in touch so I'm going to do my best to make it a point to say hi to them whenever I can.  I hope the people in the ICU part are as awesome as in the ICN!  If so, I'm totally going to love this!

I worked three days in a row and usually when I did that, on the 4th day, it was all I could do to pick myself up off the couch and eat or whatever but this wasn't the case.  Yes, I slept a lot on Saturday night, almost 11 hours!  I was completely exhausted but it was more mental than physical.

Looking back, it's no wonder I had such a hard time on my fist day off after 3 in a row as a tech.  I was mentally and (more often than not) physically tired.

I really like where I work.  I like to say it's the best kept secret in the hospital!!!  The patients are itty bitty and it's fairly easy to calm them down.  Just cluster your cares so you change them, feed them, and then put them back down to sleep and let them be for 3 hours before you do it all over again.  Every once in a while you'll get  a gassy kid who will cry and cry no matter what.  Most of the time, if you put them on their tummies, rub their backs or tummies, or just reposition or hold them, they are OK.  Every once in a while we need to give some simethicone or some Prevacid but not that often.

Most of these little guys have very few meds.  Most common are multi vitamins, folic acid (for anemia), vitamin E (also for anemia), iron, simethicone, and maybe some Desitin ordered PRN.

I like that and think that this experience in the step down unit has been so valuable and will definately carry over to the NBICU part.

I can't believe I survived my first day as a nurse!  It's crazy!  I was really nervous when I came in today because I had no clue what to expect but everything went better than I could have imagined!

My original preceptor got floated over to NBICU so I got a different person today and she was WONDERFUL!!!  I couldn't have asked for a better person to work with!  She made me feel instantly comfortable and welcome.  She was so open and willing to answer my questions.  I wish she would precept me for the rest of my time.

I started off just observing today to try to get a feel for how things go.  We had 3 babies in the ICN (intermediate care nursery) which didn't sound too bad and it really wasn't.  One went home so we were left with two and ended up splitting the assignment so I actually took care of one baby by myself on my first day!  I can't believe it!  I guess I really am the nurse now!

The baby I took care of was having some temperature regulation problems.  It is only 31 weeks old and had just come out of an incubator the day before.  We came in and did our morning assessment and got the baby's temp and it was pretty low.  We watched the baby for a few hours, until the next feed when vitals were due (we did vitals on this baby q3h with the bolus feeds).  When the temp dropped a further at the second assessment, we transfered him from an open crib to an incubator.  I have never delt with an incubator before but really, it was quite easy.  A lot less scary than I thought it would be.

So I watched the baby's temp closely for the next few hours, adjusting the temp of the incubator as needed (I'm so proud that I did this on my own and used my own judgement!) and finally, after about 4 hours of being in the incubator, the little kiddo warmed up and I could turn the temp down a little.  Yay!

The only med that the baby had wasn't due until 9 tonight so I didn't have to worry about that so much.  I just fed, did vitals, and assessed every 3 hours.  It was a great kiddo to start out with and I really learned a lot.

I also helped out with the other babies in my pod when I could (there are 4 pods, with four babies to each pod).

I'm amazed at how much of my preceptor experience in the MICU (adults) carried over to where I was.  I was much more comfortable with charting and the little things like filling out the MPOC (its basically a nursing diagnosis type deal, hard to explain without seeing it).  I felt like I was able to get right on in and just do it.

Tomorrow, depending on our assignment, I may take two babies and do all care on them!  I feel that I can do that and am ready.  These kiddo's are really pretty stable and are in the ICN to feed and grow and be monitored for things like apnea and bradycardia.

I still can't fully believe that I am the nurse but I'm getting there.  I'd say I'm at about 50% right now which is better than where I started out this morning.

Time to go eat some dinner and gear up for day 2.  They have me working 3 in a row.  I have a feeling I am going to be exhausted on Saturday but it's all good since I have 4 days in a row off to recover.

The trip ended up going very well.  I'm exhausted but that is expected.  What sucks is that I have to go grocery shopping today and then, if I feel up to it, tae kwon do tonight.  We'll see.  I'm still sore from boating on the lake.

The trip started off with a really nice plane ride.  I really enjoy flying Americn Airlines.  It sucks that you have to buy snacks and pay to check your bags but it's definately one step up from flying Southwest.

Saturday was spent in Chicago.  We weren't able to check into our hotel right away so we dropped our bags and walked to the Navy Pier and ate lunch at Bubba Gump Shrimp Co  (Finally!).  It was everything I thought it would be.  I'm so glad I got to go there.

We didn't hang out at the peir that much longer though.  It was packed, shoulder to shoulder people so we couldn't see everything we wanted to.  We gave up and walked to Michigan Ave to do some shopping.

While I really enjoyed Michicgan Ave, it wasn't everything I thought it would be.  There were a lot of expensive stores there like Cole Han and Armani but the other stores were just like what you would see back home.  I know I may be shot for this but I really like the shopping at Uptown better than the shopping there.  Maybe I just need to go back and see it more, it's worth another trip, but that was my first impression anyway.

We stayed at a super nice hotel called the Swissotel (no, it's not a misspelling) off of Wacker Drive so we could walk anywhere we wanted to go.  We had a nice lake view where we could see the Chicago river, Lake Michigan, Lakeshore Drive, and the Navy Pier.  I have to say that I really dont't think that the hotel was worth what we paid for it though.  It was super super expensive, bill came out to $500 for one night!!!!  Luckily it was split 4 ways but even still!  I would have been much happier staying in a cheaper hotel like the Embassy Suites, where the breakfast rocks!

The room we got was supposed to have two queen beds and we ended up with two full size beds.  I was super disappointed about that.  The beds were way comfy and the bathroom totally rocked!  It has a seperate shower which was really nice.  The bad part about the shower though is that no matter where you pointed the showerhead, it would spray on the floor and the floor was marble tile.  It seemed very dangerous to me.

We got our breakfast comped and I happy for that because their breakfast menu totally sucked!  We did the breakfast buffet and if we had to pay for it, it would have been 26 per person!  Totally NOT worth that kind of money.

I was happy to say that I did get the experience of staying in a very very nice hotel but I also wouldn't do that again unless it's on someone else's tab or if it were just my husband and me and we had time and space to relax in the room.

I need to go get some grocery shopping done before I go back to work tomorrow.  I will write about the rest, and the best, part of the trip when I have time again.