TurboNurse

I think the title says it all.

I just finished my second full week of being off of orientation. I learned a lot.

My first week I had two stable flip and feed kids.  That was nice.  Boring but nice.

This week I had one stable ventilated kid (these are my favorite kind!) and one that was still in the incubator and on Optiflow.   Needless to say, I went up in acuity, but not by too much.

Day one was OK.  No major changes in my kids.  Day two was a roller coaster.  My intubated patient got extubated and my one on the optiflow bought itself CPAP/Hudsons.

The fellow that had my intubated kid asked me a couple of times if I thought it was ready for extubation.  I answered very honestly, I don't know.  I really don't know.  That's not a good feeling.  I'm not a fan of not knowing.

So I asked the RT that was there that day what she thought and she felt the same way as I did.  I was leaning toward not ready.

Then toward the end of the shift, my other kiddo started to retract.  Did I catch it?  No!  I felt so terrible for not catching on to that.  The docs ordered a chest xray and blood gas.  I was looking at the kid thinking that they were going overboard with her.  CXR, OK but a blood gas on someone who is not intubated and not showing major signs of respiratory distress?  So I blew it off thinking it would be nothing.

I never heard back from the resident about the results of the CXR.  In our unit when we don't hear back, we assume no changes and go on as such.  Come to find out the next day, that the CXR was pretty whited out and the kid got a dose of Lasix because of it.  They were also put on Hudsons.  Finally, something I can understand and rationalize!

Day three I have the same assignment and was also first admit.  Now that is scary because you NEVER know what you are going to get.  You could get the baby(ies) everyone has been talking about for a few days or you could get the walk in crash c-section.  You just never know.

Luckily I got a transfer from another unit so it was a best case scenario rather than a worst case. 

This was a term kid who came to us because of an ABO incompatibility.  Basically this baby's body was attacking it's own blood cells and rupturing them which was causing the bilirubin levels to increase very rapidly.  If not treated, this is deadly

When I find out what I am getting, I start warming up my bed and getting things together such as supplies to start an IV, a bag of D10 just in case they want to hang fluids, and whatnot.  The kid gets there, the bed is warm, and I'm ready.

The admission goes really well since it's a transfer.  An hour later, after the kid is settled in, another nurse comes over to me and says that we probably don't need to have the radiant warmer on.  This was a term kid under a TON of bili lights.  As soon as she said it, it made total sense.  Did I think of that before?  Of course not!

I had to hang a med I've never given as well so I went to read up on that.  When the med came up, it looked like some had been shaking it the whole way here.  There were lots of tiny tiny bubbles in it.  So I put the syringe on end to get the bubbles to the top.  Apparently I missed some.  I went to luch after the infustion started and luckily another nurse caught a pretty big bubble in the tubing before it got to the baby.

I've just had so many "moments" lately.  I'm amazed that they keep letting me come back.

One of my saving graces is that I have a charge nurse who I work with very frequently, who has a lot of confidence in my skill and tells me this frequently.  I don't know how I would go on without her support and the support of the person who precepted me the last half of my orientation.  They are people put into my life by God.  That's the only way I can describe them.

I also try to remind myself that all of these wonderful and knowledgable nurses I'm surrounded by didn't start out this way.  They all started out in the same place that I am now.  They are wonderful resources and I love being surrounded by them because it's a constant reminder that if they can, so can I.