One year - it's a wrap!

As of this month I have been working as a nurse for a full year for the same hospital system. It has been an incredible journey that has been peppered with challenges and jubilation in varying degrees. Here are the major brush strokes that I have learned:

1. You will never stop encountering something new. I kept thinking "I can't wait until I hit my one year of nursing" like it was going to be a panacea and suddenly I was going to get rid of the anxiety that creeps up in my stomach when some new disease process or new piece of equipment walks in the door. What I have found is that I have had enough 'firsts' this year that when something strange appears in my patient or patient's room I know enough to take a deep breath and start figuring out what needs to be done next. This is what experienced nurses know to do instinctively - they can synthesize what they know and compare and seek out the differences they need to learn and account for to give patient specific care.
2. Teamwork is the solution to all challenges great and small. I am fortunate that I work with fantastic people. They are my sounding board when reasoning through treatment options. They are the arms that help me reposition my patients every 2 hours so prevent skin breakdown. They are the people I look forward to spending 12 hours with at a time even when it's a full moon and Friday the 13th and the ER is shipping us 5 patients all at the same time. 
3. There will always be a bully lurking somewhere. It might be a fellow nurse. It might be a doctor. It could be anyone really. But the sooner you learn how to deflect these personalities the better. This has been a hard lesson for me as I tend to be a people pleaser and desperately want to make everyone around me happy. I have learned to retool these skills into purposely killing every bully with kindness and becoming more direct in my communication. This technique works for me and I feel that I have become a more skillful communicator overall. My most triumphant moment was asking a team leader who was notorious for mocking people who asked for help by stating, "Are you going to make fun of me for not knowing this or are you going to  use your experience to help me become a better nurse by teaching me how to do this right?" Suddenly this particular person became incredibly helpful to me. I wish I had figured this out months earlier as I dreaded working with them.
4. Getting involved beyond the floor. A particular rewarding experience for me has been to join the Performance Improvement (PI) Committee. We work with our coworkers to generate the coming year's competencies (education required for our job). This means working with the nurse educator to find out what new piece of equipment is coming down the pipe line. For example, we chose to high light education on the Stabber of Death this year as one of the new neurosurgeons uses that particular piece of equipment regularly in his practice. And yes, it is actually called the Stabber of Death. It's used to place intraventricular drains at the bedside for patients with high intracranial pressures.
5. Learning to disconnect appropriately. The first year has been hard for me to disconnect from my work when I'm not there. Thankfully the number of work related dreams has started to decrease. Transitioning from school where there is always homework hovering on the edge of your thoughts to a job that is demanding in physical and emotional ways has taken some time to balance. I have found that seeking out new hobbies - cooking being most prominent recently- has been therapeutic and helpful. I am a better nurse when I don't think about it 24/7. That does not mean I don't take education outside of my work very seriously. It just means I am learning to manipulate the on/off switch much better so that I am 100% present when I'm with my family and friends.

And with that my friends,family, and followers- I'm closing up SageBrushRN. It's been a wonderful place to write and share my thoughts during this first year of nursing. Your comments have definitely been appreciated and should other new nurses stumble across this blog I hope they find it helpful as well. I'll leave the pages up, but don't plan on adding any more at this time.

~Have a dynamite holiday~

My mantra for nursing

"Cure sometimes, treat often, comfort always."

~Hippocrates

I have to return to this quote on a regular basis to find my footing, to regain my common ground. This is where Hippocrates' quote must be turned inwards as well. It's not just a prescription for how we care for others, but how we must care for ourselves in order to excel at our profession.

I had another miserable, no good, awful, question my existence as a nurse sort of night. In the course of seven months, I consider 2 episodes like that to be a pretty good track record. 

However, when all hell does break loose, it frustrating the lingering effects it has upon your psyche. I have had four nights off and go back tomorrow night. I even avoided a four hour immediate pay shift (easy money and easy work!) when they were short staffed earlier this week because I absolutely couldn't bring myself to step back in the hospital that soon. I'm cringing at returning tomorrow night even.

I have replayed that 12 hour shift over and over and over and over.....it doesn't matter if I'm cooking, packing, cleaning, walking the dingoes, trying to fall asleep in this horrendous heat, or rehashing it with a coworker. I imagine this is mildly what PTSD is like. Poor souls.

It's going to take awhile to lay that night to rest, as well as feel satisfied that if I encounter a similar situation that I will be able to use what I learned from that night to make it better. 

In the meantime, I'm trying to be gentle with myself and know that reflection is the key to resilience.

Announcement: Ch-ch-ch-changes!

Dear friends and family,

June is already upon us and some more changes with it! The summer heat, rattlesnakes, and tired dogs are in full swing here in the Magic Valley.

Recently my husband got a promotion indicating that he is going to be travelling more often. With this information and the fact that his company was dismayed at how far away Twin Falls is from a large airport it was decided we would be relocating to Boise!

Initially we were discussing the idea of moving to Boise and to have me commute the 2 hours to Twin Falls for work, but upon talking to my manager it actually turned out to be incredibly easy to transfer from Saint Luke’s Magic Valley to Saint Luke’s Boise (downtown). Furthermore, I will be moving from the intermediate care unit (IMCU) to a medical intensive care unit (MICU) where I will be brought on as a new nurse in a formal new nurse residency and given lots of support and education to flourish in the more critical/stressful environment. 

Although I will definitely miss my IMCU because of all the wonderful skills I built there and the BEST coworkers a new grad nurse could ever ask for – we are really excited to be moving to a place that meets our wants and needs in a community.

Additionally, this week we had an offer accepted on an adorable bungalow in downtown Boise. The location is perfect – both my husband and I will be able to bicycle or walk to work (my honey, having got a taste for having an office outside the house, will be finding a downtown office space), there is a park 2 blocks from our house, and the farmer’s market is within minutes by bicycle. 

We have been struggling since leaving our wonderful community in Portland and it seemed that Boise would offer a balance for us in terms of family, community, “bikability/walkability” all the while being both affordable and best for our careers in a way that may not have been possible in Portland (e.g. my husband can have an office outside the house due to affordability, I can be in an ICU with less than 2 years experience!!!).

To our dearest Portland friends – we still miss you dearly and we love you SO much. We missed every week without game night. We are so excited to be 2 hours closer driving and when we come back to visit we will be so much more fun to hang out with now because we will be more settled in our lives here in Idaho. Now you all have to come out and visit because we have our own set of breweries to show off and new biking trails, rivers, and ski hills to explore! ;)

To our families – thank you for bearing through the multitude of plans we kept trying to make and through our mourning period over the past 6 months. You made the hard days a little better and we love you for sticking by us in our worst moods. We are so happy to share our new home with you and even happier that we will be good company once more instead of your whiny children.

Again, thank you all for your love and support and we look forward to seeing you in Boise! I will continue my blogging adventures as my nursing career continue to unfold.

Whopper of lesson: withholding judgement

There are a lot of medical conditions that one does not have control over - genetics, environment, and life just happen. People live their lives as best they can and they get saddled with some disease process   that pose obstacles and challenges that we can't even wrap our heads around.

Then there are days when you want to holler some sort of Hippocratic quotation at your patients that seem to have gotten themselves into their predicament, such as these:

1. "Let food be thy medicine and medicine be thy food."
2. "Everything in excess is opposed to nature."
3. "Walking is man's best medicine."

The thing is though humans have a million foibles and it's actually surprising we don't make ourselves sicker or injure ourselves more often.... I am compassionate to the type 2 diabetics and the smokers - I love chocolate and coffee - who am I to point a finger on these addictions? 

These poor folks suffer enough without an additional serving of judgement. My job is to care for them and give them the best tools possible to help themselves. We all do the best we can and we are all in this together with our individual burdens to carry. If we can help each other, all the better.

As a new nurse I had this idealistic view that I would never be judgmental towards my patients. However, the idealistic view got a big whopping dose of reality recently. A handful of times now I have been the nurse for trauma patients that have been intoxicated and driving. It is harder than I imagined to to find a compassionate spot for these individuals when you know the passengers were perhaps life-flighted out of the area and that the patient you are caring for is the perpetrator of the accident and the least injured out of the bunch. 

My nursing assessment and skills are equal amongst all my patients, but these patients have challenged me to remain kind and warm without shutting them out for their behavior that landed them in a hospital bed. These experiences made me think back to some of my classmates that had done a nursing clinical in the prison system in Portland. They told me they made a point not to read deeply into their patients' charts until the end of the rotation, because they knew they could not reserve judgement otherwise if they knew the crimes their patients had committed. 

And so I have endeavored to immerse myself into the medical side of these patients and do my best to forget the trauma that brought them to my unit. I also plaster a smile onto my face because I know scientific research tells us that our body language tells our body what to feel, so by the end of my shift I have moved from a place of judgement to a place of kindness. 

Again, it's been a whopper of a lesson and probably one that will be relearned many, many more times.

Equipment malfunction and the "calm" panic voice

This week I had the most bizarre thing happen with my IV pump. I was running heparin via IV - an anticoagulant medication used to treat clots or potential clots in patients at risk for pulmonary embolisms or strokes among other things. Often heparin is a once or twice a day injection, but this patient needed it IV due to their circumstances. 

At about 0500 I heard the IV beep telling me there was "air in the line." However frightening that sounds, it's really rare there is actually air in the line. The IV pumps are incredibly sensitive and even eensy-teenie-weenie bubbles that cannot cause harm to the patient will set it off- generally to the annoyance of everyone within a 5 mile radius. I went to look at it and jiggle the line that exits the bottom of the pump and noticed that it was wet!!!

I have now adopted my "everything is okay, I deal with type of stuff every single day" voice when in fact I have most likely never ever seen what I am witnessing actually happen EVER. I have to admit I'm not really sure where that tone of voice came from, because prior to being a nurse that tone never existed for me. I have never been a confident person, but wearing the scrubs seems to give me an alternate ego of Nurse Reese who will take care of you no matter what. I cannot even imitate myself in that voice when I'm out of scrubs!

Anyway, I calmly explained to the patient that I was going to clamp her IV and check the tubing. I unlocked the pump to visualize the tubing inside - again something I do actually do all the time. Instead, when I unlocked the pump the IV tubing fell into 2 pieces - it looked like it had been sliced in half with a pair of scissors! I thankfully reacted fast enough to grab the bag of heparin and turn it upside down before I had created too big of a heparin puddle on the floor. 

I grabbed all new tubing, primed the line, and set the patient back up on the medication and then asked a more experienced nurse to look at my severed tubing. The nurse said, "Huh, I've seen children chew through their IV lines, but I have never, ever seen that happen." Awesome.

In the midst of this I had called lab for a stat PTT draw (the lab that tells us how well the heparin is working - the goal is to be within a therapeutic range), called the pharmacist to tell them what the problem was and that I would notify them as soon as I had the lab results for further orders, and talked to the doctor who happened to wander in during the middle of all this for report. My fear was that the patient had not been receiving enough medication and therefore was at risk for a repeat medical incident. However, all is well that ends well because in fact her PTT was a little too high -even with the leaking tubing- and pharmacy had me turn off the medication all together.

I don't think it was until 0730 that my heart rate came back down to normal. However, no one else was the wiser ;)

Moments of doubt and vulnerability

I knew my first year of nursing would be tough. I had a night recently where I barely kept it together until morning when I got to my car and just burst into tears and drove home through a fog of blurry red eyes feeling both overwhelmed and terrified that I wasn't cut out to be a nurse. It was a combination of adrenaline let down and having a moment to process what had just happened.

I had a very sick patient and our ICU was full so I got this patient in the IMCU. I hung more meds that I knew what to do with and I felt under supported by the charge nurse that night that was kicking back on the computer instead of coming to help me after several phone calls. My patient was a bucket full of anxiety which was not helping either of us and I felt really bad later because I told them they would have to wait to get an anti-anxiety medication while I sorted out the more pressing/life saving medications. I am tremendously grateful to 2 experienced nurses that came by and helped me sort out my med lines and prevented me from making any mistakes, as well as get blood products up and running before I had to rush my patient to the OR 40 minutes after arrival.

The worset feeling was the fear that I could have hurt my patient with all those medications and that feeling of never being fast enough or feeling compassionate enough. The MD I worked is also young and nervous and together we made a good team, but later that morning we confided in one another that is was a very rough night for both of us. I was touched that he acknowledged that he threw me into the deep end and that he was glad I didn't drown (his words, not mine! On the inside I very much felt like I had ridden the Titanic to the bottom of the ocean). I barely slept the following day just replaying the scene in my mind.

Some days just suck.

The following night though I got that patient back. Some charge nurses are wise and know when to make you get back on the horse that bucked you off, even if it's the very last thing you want to do.

The patient and I had a good conversation about the night before. They told me about how scared they were when they arrived and that they had never seen someone work so fast and efficiently (meaning me- good thing I fooled them!). I told the patient that I had felt bad about coming across as not compassionate when they arrived because I had been so worried about their well being and getting them ready for the OR where they could fix the patient up properly. It was really therapeutic for both parties and opportunity that would have been missed had I been reassigned a different set of patients.

And so it goes: this job has a steep learning curve that is unrelenting, but I wouldn't trade it for any other profession.