I wonder some days if it is possible to know just enough to be dangerous but to not know enough to know not to do something wrong or that something has gone wrong.
I had my first 1:1 baby today and at the end of my shift, this is what I was thinking. I felt very good about how things went and how I handled all of what went on. It was a very successful day. At the end though, since my confidedence was up, that's when I started thinking.
I feel like I know just enough to be dangerous. On the flip side, I don't know enough that also makes me dangerous.
I guess you could say I am teeter totering right now on the edge and I feel like I'm dangerous.
Dangerous. There. I had to use the word one more time just because I needed the laugh.
Anyway, I feel like things are going along nicely now. I was frustrated yesterday at work because we had a really easy 3 baby assignment (normal is 2). They were basically flip em over, clean em, and feed em. A girl that went to school with me (graduated at the same time) was also working and she has taken care of several very sick kiddos and I hadn't taken care of any. So yesterday I laid the hint on really hard that I felt like I was ready to take a sick kiddo because I felt, and do still feel, like I am behind in where I should be.
I've been taking care of stable vented patients for a good month now. We had one that went south on us and was super super busy/sick but it's different when it happens during a shift than when you come on. Plus this kid wasn't on any vasoactive drips, we were just busy doing workups and whatnot on him so up to this point, I had zero experience with vasoactive drips.
I got my fill today and feel good about it. While it is different from dealing with adults on Levo, at the same time there are a lot of similarities so I actually wasn't intimidated by it at all. I had taken care of several adults on levo when I was doing my preceptorship in an adult ICU.
There are so many ethical issues that come up in an ICU setting. If you let yourself start to feel emotion, I can see how someone could easily crumble and fall into pieces.
I tend to put on my "nurse face" when I go into work to prevent that from happening. I focus on what needs to be done while giving compassionate care to my families and babies but at the end of the day, it's a job.
Yes it can be disappointing to think that we go through all of this and put the baby through all of this on just a slim chance that it may survive. If you stop to really think about it at work, it's done. Game over.
I wish I could just explain it better but it's just something that we do to be able to come back day after day and take care of these kids.
Don't get me wrong, there is a TON of good that also comes out of the unit. More good than bad. At the same time you also have to realize that we have the highest mortality rate of any other unit in the hospital so it's as good as it is bad.
Either way I love my job and plan on being there for years to come.
This week didn't start out too well.
Tuesday I rode my bike to work and fell over, to the right where I broke my elbow back in April, while waiting at a stop light, on the way to work. Doh! Luckily I just came out with a little road rash and some bruises on the insides of my knees where they met with my bike. Of course I was still clipped in on the right side. Again.
Wednesday-day was not too bad. I had a real hard time staying awake during my continuum classes in the afternoon. I got home on Wednesday and it was business as usual. As I was making my dinner before my tae kwon do class, my cat Squeakers comes up to me and is not looking right. He's not moving his tail at all and is having a very hard time sitting down.
I called my husband to tell him something was wrong with the cat. He got home about 20 minutes or so before I had to leave for my TKD class and we decided we were just going to watch him to make sure everything is OK.
I got home from class and he was still the same so I took a shower and got ready for bed since I was supposed to work on Thursday. We both thought everything was OK until he jumped up on the bed for our usual nighttime ritual and he barely made the jump and once he got up there, he just stopped as if he were in shock and just growled. It wasn't directed at either of us but it definately wasn't normal.
So, at 10:30 at night, we are headed to the emergency vet. Things went OK there. We finally left at about midnight. Squeak had to stay the night for observation. We thought he may have had a blockage in his urethra which is common in male cats I learned.
Needless to say, I did not go into work on Thursday. I picked him up Thursday morning. I was up bright and early because I didn't really sleep at all Thursday morning. I like to say that I pretended to sleep. I was so worried about him I was awake every hour it felt like.
During the day Squeak was very lethargic, more than I would have expected so I called our regular vet to tell them what was going on. Back to the vet we went at about 4 that afternoon. I was so exhausted as I'm sure he was too, and when we finally got into the exam room, I put him up on the table, put my head down in front of him and started to cry. Of course that is when the doc and the vet techs came.
The doc did a real comprehensive exam on him and spend probably a good 45 minutes with us. She is awesome and I really like her a lot. She was baffled but was thinking it was one of three things. Either he was blocked as originally thought, had thrown a blood clot, or has lumbo-sacral disease (degenerative arthritis in the lower back).
Turns out, we think it was a trauma to his low back/tail becasue of the quick turn around he made. He spent the day at the vet on Friday for more tests and that is how the doc came to that result.
Even with all that, this week did turn out good. My baby is OK and I had a really good day at work yesterday.
I was walking to the med room to get meds for one of my little bitties and I see the family of a kid I took care of last week and said hi to them to see how they were. The story around them is very remarkable and really touched my heart.
The mom asked me if I could primary their baby while I was talking to them. What a compliment!! I was so honored and would have jumped on it if I weren't in orientation. I explained to her that I wasn't able to because of orientation. If they are still here when I am done, I'm seriously considering taking them on, even though they don't recomend taht as a new person, we just really have a connection between us.
It's just amazing to me that they asked me to do that for their child, even knowing that I am new. It really brings together the fact that we DO make a difference when we go to work as nurses.
Sometimes we go home and feel like we don't do anything but in reality, we make a big impact on our patients and their lives, and in my case, the familys life. It's hard for us to see this because it's just another job, another day, another patient, that we are there to take care of.
I feel like I create this disconnect with most of my babies on purpose because if I didn't, I would constantly be bringing work home with me and that is not healthy. I like my job but I also love the social life that I have and don't want to mix the two too much. Because of this, I care for my babies but I don't let myself get attached.
For that reason, it's a job. It's just a job and nothing more. Most of us don't have the time to stop and think if we are really making a difference or not because of that disconnect.
When something like this happens, it brings us back into the reality of things and how we really do imact all the lives around us when we work.
Being a nurse is really an amazing thing. I can't imagine doing anything different. My heart is here and where my heart is, I am.
I may end up going to nights sooner than expected. I was told this on Tuesday when my classes started. I'm kind of bummed by it and also very scared. I'm really wondering how I will handle it and for a while even had a bad attitude toward it.
That got straightened out sort of. Last night we had to take our oldest cat to the vet because he was acting really odd and showing us he was in pain. I first noticed the pain about 6:30 that night. My husband got home so I left for tae kwon do thinking he was going to be OK. When I got home from class he looked good. Then we go to lay down for the night and he jumps up on me which is part of our normal routine and the poor little guy almost misses and then he stopped right when he got up and just growled which is not like him at all! Needless to say that really freaked me out so we took him to the vet ER at about 10:30 last night and got home about 12:30 or so this morning.
He stayed overnight for observation. The doc thought he may have had a blockage in his urethra so we felt it was better safe than sorry and let him do an overnight. From what I hear, he was not a happy camper. The doc described him as growly. Apparently it got so bad that they had to give him a dose of diazepam (Valium) to help him calm down. After that, the doc said that he did urinate (yay!) and he also ate and drank for them.
I picked him up this morning and I could see that he was tired. They sent him home with pain meds and gave him a dose before I got there. He's not super sleepy but he's not up walking around and playing with his "sister" like normal.
I made a follow up with his regular vet on Monday. Until then, we're just going to watch him.
So how does this realte to the night thing? Well I was up until about 1am this morning and just being up like that gave me a little confidence that I can do this. I would like to try.
I am so nervous/scared though. I've worked 2nd shift before and I did't deal with it well at all and it put me into a depression. Granted that was in a completely different stage of my life but it still had quite an effect on me.
I just want to make sure that when I go to nights that I go in with a good attitude and take care of myself just as I do working days. I plan on still biking, going to the gym, doing my tae kwon do and all that. I'm hoping to add running back into the mix as well. With all the stuff going on with the cat, I've had to put off my own doctors visit. I'm still trying to get in on Tuesday though.
I just feel like I've been bounced all around during my orientation. It makes me feel like the left handed red headed stepchild in a way and I don't like it.
I LOVE my preceptor now. She's really awesome and I've learned a lot from her already.
I just don't know.
There is so much going on right now that my brain just can't quite keep it straight. Once I get settled into orientation, I start these classes and then I find out I may go to nights two weeks sooner than planned and on top of that we are planning a family.
These are all exciting and for the most part, good changes, it's just a lot at one time.
I've signed up to go to a tae kwon do tournament in Odessa TX on July 31. I'm very excited for that as well. I did some sparring in class last night and got some compliments on it from a teammate which really means a lot to me. It also helps that I was sparing someone closer to my size instead of trying to spar someone who is twice my size and a lot taller than I am. I was only able to do one round instead of two because of my ankle.
I made sure to stop at the first sign of pain because I really don't want to mess it up before the tournament. This will be my first time sparring in a tournament and I'm very excited for it and would hate to have to sit out of it because I did something dumb in the meantime. I will also be competing in patterns. I'm working on my green belt pattern now. It's called Do-San. I am not planning on competing with this pattern but I still want to start working on it.
Needless to say I called off work today. I didn't feel I would be safe on only 4 hours sleep, especially when we are going up in acuity. I feel terrible for calling off but I feel it was the best choice to make. I will be at work tomorrow.
Just an update since I haven't been here in quite a while.
This last week was filled with ups and downs. It started off with the unit educator calling me into her office to have a 'talk'. So I go in after I eat lunch and she proceeds to tell me that the reason I have not been able to get a preceptor for the second half of my orientation is because people think that I come across as a "know it all"! My initial reaction was WTF?!?!?!?!?!?!?! I told her right there that I do NOT know it all and I'm the first person to call myself on it. I've never thought nor pretended that I know it all. I then asked her if she had talked to the person who was precepting me and she never answered. Then she proceeds to tell me that she found me a preceptor and told me that this preceptor said "If she pulls that stuff with me, I'm coming straight to your office." WTF?!?!?!?!?!?!
I hate that she told me that because now I'm super leery of my new preceptor and am wondering if she will treat me badly. I'm really scared to start with my new preceptor.
I was already on the verge of tears that day because I was feeling very intimidated and also felt like I knew less when I came in than when I finished up the previous week. Then to add that on top of me already wanting to cry and the floodgates opened. I left her office and found myself promply in a bathroom on the floor crying trying to calm myself down. I was so upset!
I finally calm myself down and get some of the red out of my eyes and make it back to the unit and my preceptor noticed that something wasn't right so then I get all teary again and told her what happened and what was said. Her and I were both on the understanding that the reason they were having a hard time finding a preceptor for me was because there just wasn't enough experience on the unit. Then I told my current preceptor about what the educator said about my new preceptor and my current preceptor couldn't believe it. She precepted her and told me that she was absolutely wonderful. She tried as hard as she could to ease me and reassure me.
After this, I find out that our educator has a reputation for lacking in social skills and tact. Ugh! Too bad I had to learn that one the hard way.
That was all one day.
The next two days went really well. On my last day this week, I was basically left to my own and I feel like I did really well with my patients. I got all my cares done on time along with giving all my meds and getting all my labs done on time. A complete first for me. I was so excited! I hope I can keep up with it! I also went and helped out a couple other people as well. I felt very successful.
It's wierd how I can have the worst week possible and turn it into the best week so far. I'm just so glad that my first day didn't ruin my whole week.
On a non work related note, I got a new bike this week. I actually picked it out last week but wasn't able to pick it up until this week because the bike was going on sale and I wanted to get the sale price so my husband went an picked it up for me so I could ride it on my day off. Yay!
We rode yesterday and I really enjoyed it. I started out slow just to get used to the bike and when we finished, I was holding a much better pace than I had on the old bike. I felt really good about that. Hopefully we will go out for a ride tomorrow morning. Can't wait! I finally feel like I won't be holding the group back.
On Wednesday I tested in Tae Kwon Do. I went from white belt to yellow belt, green stripe! I skipped three belts to get to where I left off the first time and then I found out there is going to be another testing coming up "soon" which I'm taking to mean in less than three months which is the normal testing interval so I may move up to green belt before I know it! I'm so excited!
I can't wait to go to class and not be one of the lowest ranking people there! We got some brand new people last week, two I think, so there will be some white and yellow belt (no green stripe) below me. Woot!!
I have to wait a week or two to get my belt so in the meantime, I go to class without my belt which will be odd. I'm still super excite though!
So yesterday turned out to be quite interesting.
I feel like I totally messed up. There were some antibiotics due at 1 along with a dose of caffiene and then another dose of a different antibiotic due an hour later. Well here it is 2:30 in the afternoon and I have yet to hang any of the antibiotics (first one was due at 1).
So I get back from lunch and was talking to the doc about what she was going to order for the kiddo and she mentions she is going to order a vanc (anitbiotic) lab and then I have my oh crud moment and realize I have yet to hang them when they should have been finishing up at the time I was talking to the doc.
I felt so down on myself and was so mad at myself that it took me a while to figure out what to do. I can't believe I missed that!
I was so on top of it with my other kiddo! I was so proud of myself that I got a fluid change done immediately and was just totally on top of it.
So after all this happens and get my first dose of antibiotics in, it was time to retape the kiddo's ET tube (breathing tube that is used when someone is on the vent). We had mentioned to the RT that morning that it needed retaped because it was all gunky and gooey. Not really a good thing but it happens and is normal.
RT comes over to retape and my preceptor and I were both by the bedside because the main RT person was being so rough with the kiddo that he kept bradying down and desating. A brady is not a good thing because it means that the heart is slowing down. In his case it was slowing down because a reflex called the vaso-vagal response was being triggered which happens. What is not supposed to happen is to let the kid go like this for 3-4 minutes! My preceptor and I were both at the bedside telling the RT that things are not going well and we need to change something. It got so bad that we grabbed the bag to bag the baby but RT wasn't budging. The oxygen sat dropped to 45% (normal is 85-95 for our kiddos) and I saw it go even as low as 34% and RT wasn't budging. I was beyond pissed!!!!!
Luckily the kid didn't code or go too too bad during the procedure but what happened should not have happened. He obviously wasn't handling it well and needed some breaks but RT just wasn't seeing it. The care they gave was very dangerous and did cause actual patient harm.
The baseline of the FiO2 (percent of oxygen the vent delivers) for this kid was 25%. To give you an idea of how awesome that is, room air is 21%. Needless to say the kiddo was doing fantastic and was on his way to being extubated. Until this.
We had to turn the FiO2 up to 100% during the procedure just to get the sats back in the 60's. When the procedure was over and he was retaped, we were able to bring the vent down to 85% but if you remember, his baseline was 25%. This is something that is NOT normal and should not have happened.
Because we were still having problems keeping the kids sats up, we suctioned him because we figured secretions got mobilized during the tape change. When we suctioned him, we got frank blood out of his lungs due to the trauma that was caused because the RT used excessive force on this kiddo.
So there was obvious harm done to the patient.
We got a STAT chest xray to make sure the tube was still in the right place and that it hadn't slipped lower. We got the results back and the tube needed to be retaped because it was in the wrong position. So my preceptor goes to the RT who did the first retaping and told her that the tube needed to be retaped because it was not in the right position. This RT says flat out that she is not going to do it.
The docs all knew what was going on because as soon as we saw the frank blood coming out of his lungs we paged them. We also had a very difficult time calming the kid down after the procedure. We contained the kid withour hands for a good 30 mintues after the procedure and still nothing. While the doctor was there we also asked if we could give him a bolus of morphine to help him calm down because he was in obvious pain and discomfort.
It was just such a mess and I was so upset by the whole situation that I couldn't manage to write it down yesterday. I had to wait to calm down.
Other than that incident, my job is going very very well.
This was my best week overall where I felt like more things are starting to fall into place. I feel like I'm standing more on my own two feet and have started to take the initiative in the care of my patients. I'm not afraid to page doctors and ask them questions. I'm not afraid to speak up during rounds if something comes up that I think needs to be addressed. I'm talking to families and updating them with more ease and I'm giving report much better and more on my own.
I stll have so much to learn but things seemed to come along quite nicely. I'm hoping after my nice stretch off (am off for 6 days in a row!!!! yeah!!) more things will start to fall into place.
Oh yeah! I forgot to mention that I also got my first successful IV start yesterday (this is why I missed my meds when they needed to be given)! I just started trying for IV's the day before so I have not had much experience with doing this on premature babies. One came up on a baby that wasn't ours but the nurse who had this kid came over and asked us if we wanted to try. Of course I jumped right on it! I actually got it on my first stick on the kid but the catheter kinked so we pulled it out and tried the foot. I got the foot on the fist stick as well. I still need to learn how to tape but I got the hardest part down on my third stick overall (I tried twice the day before).
I'm just so glad that things are clicking and I'm feeling more comfortable standing on my own two feet.
