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.

This will be one of my most random blogs so far.  I just feel like blogging since it's been a while.  Usually when I sit down to the keyboard, I already know what I'm going to write about and in which order I will put it down.  Not this time!  I know I need to write but about what, well I guess we will find out.

I don't remember if I've written on here since I've been on my own.  I have now been on my own for one week and tomorrow, Thursday, will be the start of week 2 of being on my own.  I enjoy it.  It's also very different.  I'm debating now if I want to try to take an admission yet.  The reson behind it is because I want to do an admission on my own before I forget what I learned during orientation. 

I do know for sure I would like some more acuity.  So far my assignments have been easy flip-n-feeds.  Of course now that I said that.........it will be interesting to see what I get tomorrow when I go in.

On Saturday, September 18,  I tested in Tae Kwon Do for my green belt.  It was a really awesome day!  I didn't sleep well the night before thanks to caffiene.  I was so exhausted when I woke up Saturday morning.  It was a miracle I remembered to bring everything with me that I needed to!

There were three people testing for green belt.  John, myself, and a kid from another class.

It started with Mike asking all of us (there were about 15 of us total from white belt up to where we were, yellow belt-green tip) if we were nervous.  I think all of us raised our hands.  He then told us to try to relax.  He said that if he thought that we weren't ready, we wouldn't be there.  Very true.

We started off with our forms/patterns starting from the most basic up to Do San.  As everyone completed the pattern of their level, the were able to go sit off to the side.  The same thing was done for our required kicks.

Our required kicks were a leading leg hook kick, vertical kick (I like this one!  It's like a front snap kick, same chamber, except your target is at a 45 degree angle from you), and a jumping back piercing kick.  This is the one that was causing me the most distress.  I feel like I'm getting better and more confident in my jumping skills but know there is still room to improve.

I messed up a little bit on the required knowledge.  I knew everything I needed to know, I just put it in the wrong order.

Another of our requirements was to reach 120 degrees on the split machine/stretcher.  He wanted us to go as far as we could and I was able to go to 173 degrees!  Next testing my goal is to be at 180 which is not the full splits but very close.

We also had to do the dreaded pushups, squats, and crunch test.  This was the hardest part for me.  We had two minutes to do each individual exercise.  I rocked the squats with 74 in 2 minutes.  I managed 44 full situps in 2 minutes.  It's the pushups that killed me.  He gave us a small dixie cup that is about 2 inches tall and we had to touch our chest down to the cup every time.  Needless to say, I managed 32 or 33 pushups in the 2 minutes.  My required number for all of them was 30.

So now my goals are to do 100 squats in 2 minutes, 50 situps in 2 minutes, and 40 pushups in 2 minutes.  The idea is to be able to do this at the next testing time which is usually every 2-3 months.

My break kick was a jump side piercing kick and I'm so proud of how well I did on this one!  Mike came up to me while I was getting tested for knowledge and told me if I wanted to try breaking 2 boards I could.  My requirement was 1 board.  I hadn't really thought about it before then but decided to go for it!  The worst that would happen is I would go down to one board which was my requirement anyway.  I figured it was worth a shot!

Mr T sets me up on the breaker and helps measure me.  I got myself all set up and BAM! went for it!  I ended up breaking the two boards on my first try!  I was so excited about that!  That was the best part of the whole testing experience for me!

During practice, I always used one board.  We have rebreakable boards and I was using the brown board which I would only break about half the time.  That's why I was so surprised that I broke two real wood boards with my first try!

As we finished up, we all lined up to shake all of the judges hands.  The judges for our testing (colored belt testing) are all black belts in our school.  Mike's was the first hand I shook and what he said to me is still in my mind.  He told me that I was looking very good out there.  That combined with how he said it just totally made my day!  I've been working very hard, giving everything in class and still practicing at home, and to be recognized for improvement like that means a lot to me.

I'm not trying to sound egotistical here but I feel I've finally found a sport that I enjoy from the bottom of my heart and that I am successful at.  It's like finally finding that perfect shoe!  You know, the one that makes your legs look great, feels good on your feet, and just looks really good.  It's perfect.

I know I still have a lot of work to do and lots of room to improve.  I'm looking forward to seeing how far I can take this.

Cross your fingers for me.  I am hopefully going to a tournament in Portales, NM the first weekend in October.  I sureh hope there is competition there for me.  This will be my first tournament since I was a white belt with a broken elbow!

Ki-yap!

I just completed working 5 days in a row.  That's about 60 hours.  I'm exhausted.  Don't know how I did it but I don't EVER want to do it again!

Anyhow, Sunday and Monday were my first days off of orientation.  Sunday was really ackward.  I'm sure my podner didn't help the situation out much but either way it sucked and I had convinced myself that I failed.  I didn't break the kids and got everything done but I just felt like I didn't do as well as I could have.

I felt very lost not having my preceptor there.  I felt very lonely as well.  I normally work the end of the week and the begining of the week has a whole different set of regulars.  I only knew a few people that were working.

When I got home that night I couldn't decide if I wanted to throw in the towel or not.  I didn't feel good about what I did and how I did it.  Even though nothing went wrong, I felt like everything went wrong.  I can't really explain it well in words.  Wish I could.

Monday went much much better.  I felt more comfortable standing on my own two feet.  I had a pretty good podmate who was much more friendly than the person I was with on Sunday.  It was just better overall.  I was even comfortable helping out my podmate with her kids when she got an admit.

Between both days though I would have to say it was successful.  I'm scared to get an admission on my own but I'm getting there.  I'll never know how it will go until it happens.

Yikes.  Just yikes.

This is the official start of my last week on orientation.  I can't believe how fast the time has gone!  It feels like I just started yesterday.  I still have so much to learn!  My favorite quote is still "The more I learn, the less I know."  I wish I could remember where I saw this at and credit the person.

Anyway, my time off these past few days has been quite productive.  On Saturday I went to a yoga class.  I hadn't been in quite a few years.  Unfortunately it wasn't the same instructor as before but it was still a good class.

Sunday I did Body Pump at 10am followed by a 25 mile bike ride for which I felt horrible on.  We stopped about halfway so I could refuel.  Guess if I do that again, I'm going to bring some real food with me.  Sport beans just didn't cut it that day.

Today I rested.  I was supposed to go up to Santa Fe and ride with the new riding group but after yesterday's fiasco, I opted out.  After yesterday's ride, my lungs felt like sandpaper and it continued until after I fell asleep.  Thank you asthma.

I'm still sore today and am walking like I'm 80.

I did some stretching this morning while watching Sherlock Holmes.  After the movie we went out and did errands.  I got the car cleaned, we got ice cream, then went to Sam's Club and Sunflower.

Here it is at 8:30 tonight and I'm still working on dinner.  I'm making spaghetti squash and ratattouie (or however you spell it).  Either way it's taking FOREVER so it must taste good.

My week coming up at work is going to be insane!  I take a STABLE certification on Thursday which is 10 hours and then I work Friday and Saturday, my last two days with my preceptor, and am then on my own on Sunday and Monday.

Scared doesn't even begin to describe how I'm feeling right now.  I am actually quite beside myself about the whole deal.  For one, working 5 days in a row is just insane when you work 12hr shifts, and two, I can't believe they are going to put me out there on my own!  Me!  I'm a brand spanking new nurse who has only been there 4 months and they trust me enough to put me out there on my own!  The thought just makes my heart race!

A part of me knows I can do it but the other part of me doesn't want to let go of what I'm used to.  It's really nice to have someone available to help you out when you back yourself into a corner.  It's also super nice to have someone there who is willing and has the time to answer your questions.

Just the other day at work, I had to change out fluids which can be quite the partaking in our little world.  After that, I had to re-zero the arterial line to make sure I was getting a good waveform and proper pulse and b/p readings.  I knew I had to hook up a syringe without the plunger in it but for the life of me could not remember which way to turn the stopcock to get it to read right!  I asked my pod partner and she told me to turn it off to baby.  Well as soon as she said it, I was like "duh!  that makes sense!  I KNEW that!  If I did it any other way, the baby would bleed to death!"  I felt like such a dummy.

Then I had another dumb moment as I was changing the fluids. I had all of my lines primed up to my transducer for the art line and then I got stuck.  We have these connectors that are like male/female connectors and when I got to my stuck point, I had two female connectors in my hand so I grabbed my preceptor and asked her what I did wrong in prepping the tubing.  Come to find out, everything was done correctly, I was just holding the end that was supposed to go to the baby!  Doh!  No wonder it wasn't fitting!  I had the wrong end of the transducer in my hand!!!  I laughed so hard at myself!!!

I have to note that these two situations were after my preceptor was already speaking good of me.  Then I go and do somethng brainless like that!  Gooooooooooooo me!!!!!!!!!!!

and they think I'm ready to be on my own.  ha!

I can't believe I only have two weeks left of orientation!   T W O W E E K S.  Even when you spread it out, it's not that long.   hahahahahaha!

Had a little mini-meeting yesterday with the unit educator about my orientation.  My preceptor thinks I'm ready.  I told her I'm scared out of my mind.  They gave me the option to come off orientation early if I wanted to.  I don't think I'm ready mentally. 

I mean if they had just told me they were ending my orientation right then and there, I COULD do it.  I have found that I am putting a lot of mental preparation into being on my own.  I am having to totally psych myself up and tell myself I can do it and the resist the urge to run the other way, toward my preceptor/security blanket.

I wonder if this is what some people go through when getting married.  Would this be like getting cold feet?  I'm asking because I never got that feeling about my wedding.

With all of this, I have found a riding group called Women Riding Well.  I went out with them last Saturday and made my first attempt at riding my bike to the crest of the Sandias.  We started at the triangle which is right at the turnoff to the crest road off of 14.  There is a gas station and that is where we parked.

I was a little hesitant at first because there was another lady there that seemed absolutely fixated on what kind of bikes everyone was riding, what kind of shoes everyone had, where they bought thier gear, etc.  I'm not so into that.  I ride for enjoyment, stress relief, and pure joy.  Not for status or for showing off what gear I have or how much money I (don't) have.  Later on I found out that she was a guest as well (there were about 4 or 5 of us who rode as guests that day).

I made it up just past the ski area, a little over 7 miles up.  The lady who was worried about what bikes everyone was riding didn't make it up that far (I don't know where/when she turned around and I don't really care).  When I got to the stop, there were two or three people already there and when I got there, it was nothing but great support, high fives, and great women.  I talked to them about the group and this seems to be more the norm than the other lady.

So I think I will take the plunge and join them today.  The group is not meeting because a lot of them are riding the MS 150.  Next week the group is going to Santa Fe on Labor Day and doing a ride down 14 to the Madrid area.  I'm excited to join them.

I am still torn though.  I really miss my friends from Albuquerque Fit.  Right now I feel like I'm damned if I do, damned if I don't.

Either way, even though I am going through a huge transition in my life, I feel like things are starting to even out and fall where they need to be.  I just have to remind myself to constantly listen to what God is telling me.  That's hard too.

It's so easy to neglect God for me in times like this.  I feel like I haven't been talking to Him as much as I used to.  I really have to make myself stop and listen to Him whereas before, it was as easy as breathing.  I didn't have to think about it at all.  I'm also wondering if I should join a small group from my church now that life is begining to even out.  I know I could really use the spiritual support.  I'm going to have to look into that.  I need a good solid church family.  I'm sure they could have totally helped me though this rough time.

I could ramble all day but I'm going to stop here.  I'm so excited at the thought of seeing my friends tonight!  I can't wait!  It's going to be so much fun!  I'm going to see some people that I haven't seen in several months that I absolutely love like family!

So I just finished up my continuing ed classes today and I'm happy for that!  On the flip side it means I only have two more weeks on orientation before they cut the cord and let me go.  I'm scared out of my mind!  But this blog really isn't about that.

This blog is to get off my chest the transition from (professional) student to professional nurse.

I have so much now that I didn't have before.  I also have so much less than I had before.  It's give and take and so far the take part sucks ass.

My whole life is changing before my eyes and I don't know what to do.  The easy answer is to roll with the waves but sometimes these waves are so huge that they take you under and you have to fight your way back to the air just to breathe.

Nursing school doesn't prepare you for this.  Yes you graduate but they don't mention how your whole life can change along with it.

For me the change has been slow and then it was like I've hit a brick wall.  BAM! Change is staring me right in the face just daring me to move forward.  It's taunting me.  It's saying to me "you know you want it.  Come and get it chicken!"

I like change but at the same time I don't like it.  I'm facing many scary life transitions right now and it sucks.  Change just a little bit at a time is good but a lot of change all at once is destroying me.

Add on to that the fact that I will very soon be trying to swim with my head above the waves at work with being on my own.

Sometimes I just don't know what to do.

So yesterday at work, I had the (not so) pleasure of being involved in my first ever code in the neonatal world.

I have to start from the beginning of my week.  Thursday when I worked was my first time being first admit.  What that means is that my preceptor and I were up to get the first baby admitted to our unit.  We ended up getting a 24 weeker (micropreemie).  While it was a critical admission, it all went very smoothly.  We were super busy but that is to be expected on an admit.

Yesterday, Friday, we get this transfer from another part of the state to do a proceedure that only the hospital I work at does in our state.

This was a messy transfer.  If I hadn't seen the EKG tracing on our monitor and if the baby had not been intubated, I would have thought the baby already dead.  As soon as the baby came out of the transport incubator, I had to stop myself from gasping.  It was just terrible.  Baby was blue all over.  I've seen cyanosis before but NEVER this profound.

As soon as we got the baby hooked up to the monitor, we all knew it was just a matter of time before we start coding.

We went on with our admission assessment and did what we had to do until it was time to start the code.

Even though we never wish to have this happen to us, I was at the same time amazed at how adrenaline-free the whole thing was.  My preceptor put it beautifully.  In the adult ICU world (where I came from) it seems that everyone is just waiting for a code to happen.  People get excited and let the adrenaline take over.  It's the complete opposite in the neonatal world.

We, yes myself included, were calm the whole time.  There was no yelling, no running.  Everyone just kept very cool and calm and collected.  I knew there was a reason I was called to the neonatal world.

When the code started for the first time, I didn't even realize they had officially started.  Just a few minutes before it happened, we opened the crash cart and got our meds ready.  It definately wasn't what I expected.  It was much better.

Since this was my first time experiencing this, my role the first two times was recorder.  It was the perfect place for me to be because my job as a recorder was to watch and record everything that hapened, when it happened.  The third time we coded the baby, I got to push the meds while me preceptor recorded for me.

The attending called it during our last code so we stopped, much to everyone's relief.

This was such a messy, ugly situation.  When my preceptor and I were talking about it after, she told me that they haven't had a code that bad/messy in 4-5 years.  I guess when it's Friday the 13th, it's really Friday the 13th!

I now also understand why we allow people at the bedside when this happens.  It seems that when the family can see that we really are doing everything we can for their baby or loved one, they begin to understand really what is going on.

When I was in school and even when I was a tech, I used to cringe when the family was at the bedside when we coded a patient but now, as a nurse, I totally appreciate and encourage family to be at the bedside.

On the emotional side of things, I was devastated.  Not as devastated as the family of the child was, by any means.  It was very difficult for me.  Even before we started to code the baby, I was having to hold back tears and just concentrate on the job at hand.

When it was finally over, I had to step out of the pod while they handed the baby to family and just let a little bit of it out.  I just put myself up against the wall and let some tears start to flow.

While that whole sitation was hard, what was even harder than that was having to go back to my other two patients, whom I haven't seen in almost 4 hours at this point, and carry on like nothing happened.  I had a lot of work to catch up on as far as charting goes because I had to chart on my two patients I started the day out with and then chart on my third one, the transport.

Once I finally made it out of work (only 30 minutes after shift end.....not too bad!) I got to my car and just allowed myself time to cry.  I let it all out and just put my head on my steering wheel and bawled my eyes out for a good 10 minutes.  Then I decided that I needed to go home so I gathered myself up again to make it home safely.

I got home and was OK until I saw my husband.  He asked me what was wrong and all I could do was bawl again, in his arms.  Bless his heart.  I don't know what I would do without him.  I have my own way of dealing with things and he let me deal how I needed to all while being available for me to talk to but not in my way.

I can also now see why so many new nurses quit the job within the first year.  If you go into nursing thinking it's all going to be passing meds and wiping butts, you are wrong!  Nursing is so much more than that.  Immensely more than that.  Nursing is treating the whole person, and in more cases than not, the whole family.

The thought did cross my mind about throwing in the towel.  It crossed only briefly before I told myself that is the wrong answer.  I got into this job because of my love of people, medicine, and (w)holistic healing. 

This was the dirty side of nursing.  We deal with life and death all day every day we are at work, especially in the critical care areas.  We are the eyes and ears for the doctors since we are at the bedside a lot more than they are.  We are NOT the doctors handmaidens.  We ARE the doctors TEAMMATES. 

I've said this many times.  As nurses, we have the ability to see humanity in it's lowest and hardest times.  It's worst.  But we all love what we do and come back for more.

It's amazing the impact we can have on a human life.  I absolutely LOVE what I do and couldn't imagine doing anything different.  My heart is in nursing and that is where I am going to stay.

While I'm ever so thankful to have this day off, if I did have to work today, I would have gone in with a smile because today is a new day.  It's a new opportunity to help these young lives go on.  Today will never be yesterday or tomorrow.  It's all about now and being the best we can be in this exact moment.  Nobody knows what the future will bring and the past is the past.  We learn as we go but our focus really needs to be on the NOW.  For if we focus our energy on the present, this is when we are our best and ready to do our best work ever.