TurboNurse

Just as the title says, one week down, one to go! I started my preceptorship this past week in the medical cardiac ICU at the local teaching/university/level I trauma hospital this week.

I will never forget walking onto the floor for the first time and just wanting to turn around and go back home. I had no idea what I got myself into.

I thought that I would be OK. I had done only one shift there as an extern but have worked other ICU's and tons of SAC units. I thought I had this. WRONG!

My past experience didn't mean squat with that student nurse uniform on! As soon as I put my uniform on for my first day of preceptorship, it was like everything I had learned in school left me. It's the curse of the student nurse. My preceptor asked me a very simple math question and because I was so overwhelmed, I could not answer it. I felt so terrible at that time that it took all the energy I had to not go run to the bathroom and cry my eyes out.

To top all of this off, I'm doing my preceptorship with a broken elbow. I broke my elbow in a bicycling accident on Easter Sunday. :(

Somehow I manage to survive the first day. In the ICU, nurses typically take two patients. One of ours had lice and scabies and the other had serious explosive diarrhea. Like shoot across the room diarrhea. Thank you lactulose, thank you.

So I come in for my first full 12 hour shift (the first shift was 8 hours and was supposed to be an orientation...that was a joke). I was so relieved to see that we had two patients that didn't have anything explosive coming out of them or anything creepy crawling on them. Neither of them were on the vent and come to find out, they both ended up being SAC/floor status.

That was a good day. I started charting on my own. I didn't chart a full assessment but I did the required charting that we have to do every two hours. I felt very successful because I was able to, for the most part, keep up with it all. I also starting hanging more meds. That day was just an overall good one.

Yesterday when I came in was a little rough at first. Now don't mistake me for saying I'm coming in with confidence because I"m not. I realize I don't know crap and every time I go in, on my way to work, I get scared. Very very scared.

So I come in yesterday morning to a patient being coded at the end of the hall. Great. Nerves are going exponentially more now. I just want to turn around and go home. I'm not ready for this, why did I chose this place for preceptorship (this is what I was thinking to myself).

So I walk into the break room to get a general report and meet my preceptor for the day. We take a pretty interesting set. We had an assignment change the day before so my preceptor dropped one patient and picked up a new one.

Well, while my preceptor was giving report on her patient the day before, the pt's heart rate spikes up from the low 100's to the 160's. I wasn't there to see it but when we got report on this person the next morning, they were intubated because they had crashed pretty hard last night.

I feel for the night nurse who had her. Remember me talking about the patient that was coding as I was walking in? Well, the night nurse had both of these pateints. Both super sick. That scares me as a new nurse to think that, if I get a job in the ICU, that can so easily happen to me.

Anyhow, my patient was on the vetilator with a Levophed drip going. As soon as I heard, there went the nerves again. I kept thinking to myself that I was never going to get this down. I had failed miserably the first day with a pt on the vent, how was I going to do it today?

Somehow I managed to take care of the patient and not kill them! I'm very happy.

There were a TON of morning labs that we had to draw so we spent a good amount of time in the room. We drew blood cultures looking for infection. I've done IV's before but I've never done a lab draw before so I was a little nervous about it. I tried once on one arm and totally blew the vein. I kept thinking crap, now I"m really going to look bad. So I went and tried the other arm because we needed cultures from two different spots for them to be accurate. BAM! Got this one beautifully on the first try! I felt so good!

So we get our bottles filled and I go back to the other side to try again. I kept getting a flash in my catheter but then I would move when trying to stabilize the needle and blow it. I did that two more times before I was starting to get aggravated and asked my preceptor if she would try on her again. At this point I had already tried and blown it three times on this hand. Of course she gets it on the first try! Doh!

So after we get our cultures, we had some other labs to draw and we did that through the arterial line. Thank God for arterial lines! They rock!

So I'm getting everything together for the draws out of the line. I successfully pull out my waste, get everything prepped and ready to go. I accessed the port just fine and then as I took the blunt needle out of the port, I got blood all over the place! I had my alcohol swab there and ready but I was so worried about keeping pieces together because if anything came apart, I knew I'd make a big mess so I'm stabilizing the needle with my left had with the alcohol swab in it all while trying to take the vaccutainer out with my right. Well, the needle comes out of the port when I wasn't ready and blood squirted all over. All of my fingers were covered and I got the patient and also got to take a little souvanier with me (got some on my shoe).

THe next time I go to access the line for more labs, I forget to take the vaccutainer off of the collecting device before pulling the needle out so blood leaked out of the vaccutainer all over the patient.

If I keep this up, I'm going to get a bad nickname about this. I'm thinking something along the lines of bloodbathTerie.

It's not a super huge deal that this happened, it was just aggravating because I was trying so hard! I made almost every possible mistake I could have made with drawing blood out.

To make up for it though, I started hanging and charting my own IV piggybacks. I felt good about that!

Toward the end of the day, when my preceptor was in taking care of her patient, my pt's Levo starts beeping so I go into the room to try to add more time to the pump but the pump freaks out and starts throwing wierd things at me so I had to run and get my preceptor. I told her I had a "pressing" issue and she came immediately to help.

The whole process was maybe a minute in length but my pts pressure was already starting to drop. My preceptor told me I did the right thing to come and get her so quickly.

I'm amazed every time I do something right because I still feel like I don't know anything.

I ended my day by giving report for the first time. I think I did pretty OK on it. The nurse I was giving report to was really cool. I told him I hadn't done this before so I gave him what I thought was important and pretty much covered all the bases. The only thing I forgot to tell him is that the Levo was almost out but that there was another bag in the room ready to go when he needed it.

It's amazing that I stressed over that small detail ALL NIGHT! All I kept thinking is that I hope he saw the bag of Levo in the room when it went dry. I was so worried that I had killed my patient because I didn't tell the night nurse that one detal. I probably didn't but for a good few hours that was what was going through my head.

Argh!!!!!!!