Adrenaline

I knew I had an admit coming since midnight, but they did not roll in the door until 0200. That sort of delay always makes me nervous because I know a train wreck is coming my way. I assisted (by myself!) the MD to place a central line and hovered nearby as RT placed an arterial line. I hung and titrated dipervan by myself. I had lots of nurses helping me and I delegated away and took advantage of every offer while maintaining control of the situation.

I pretty much felt like this guy.



I came home humming and then promptly passed out at 0900 in a fit of adrenaline let down. What a satisfying night :)

Flying solo

It happened almost without my notice. Titrating IV drugs, handling alarming vents, and even drawing labs via needle sticks are becoming second nature. I have a long way to go before becoming comfortable in this job - actually if I ever become comfortable it will be time to change jobs.

However, the alarms and tasks that had a way of getting my adrenaline pumping are become less stressful and now I seem to have more mental focus to do what I enjoy - think about my patient and consider their disease process and how I can improve their outcomes. These last 2 weeks I took care of the same patient and having the band width to think about their situation was really great versus feeling like I was giving all my energy to complete each task as it arose.

In January I will rotate back to days and I know it will take time to construct a rhythm there as well. Nonetheless, the chance to rotate back and forth every 8 weeks or so will be welcome as a chance to stretch my skills as well as get the chance to work with all the doctors and nurses that roam our halls. Additionally, I have now floated to the Meridian ICU (in the same hospital system, 20 minutes out) and to the surgical ICU (down the hall). Although I feel like Dorothy in the Land of Oz when I leave my home unit it's nice to have those first floats out of the way!

Happy autumn.

Back to nights: the space to think and teamwork

I had mixed feelings about returning to nights 2 weeks ago, however, as my preceptor, who has the exact voice of Quagmire from Family Guy stated, "you have time to critically think on night; days you just try to survive."

The first night I was able to successfully handle 2 sick ICU patients on my own which was the boost in confidence I had been seeking. I also participated in a code on another night where I did chest compressions for only the second time in my life. It was a well orchestrated dance that I felt like at least I knew my own moves instead of being in the way.

The end of orientation is 2 weeks away, but now a definite point on the horizon. Although I'm not looking forward to flying solo the teamwork is incredible and I'm thankful to be working with such nice competent people. 

This quotation fits well with tonight's mood and is one of my little brother's heroes:

"My work is all about adventure and teamwork in some of the most inhospitable jungles, mountains, and deserts on the planet. If you aren't able to look after yourself and each other, then people die" 

- Bear Grylls

Sleep: a new found hobby and obsession

Last week I worked Tuesday night and had mandatory Wednesday morning education. I took the liberty of grabbing some blankets out of the blanket warmer at 0730 Wednesday morning and finding myself a fold out bed in a patient room in the unused medical behavioral unit that is on the IMCU/ICU floor. I snoozed deeply for one hour and then stumbled back out to grab some breakfast and coffee just before  class. The cook downstairs took pity on me because she made me extra eggs and bacon and kindly suggested I take the BIG cup for my coffee. I definitely got some weird, followed by concerned, looks from my coworkers upon still seeing me on the floor at 0900. I would like to point out I am not the first nurse to sleep in the med behavioral unit and I'm already booking my stay for a few weeks from now when I'll have a repeat of this ridiculous schedule!
The days that I don't sleep enough I end up playing catch up. When I did get to bed on Wednesday I was running on adrenaline I think because my body was compensating and didn't know what else to do! I slept for 3 hours, went to a basketball game with some family members, and then came home and was promptly in bed by 2200 and slept for 12 hours straight. Nothing was going to convince me to get out of bed otherwise.
Being on this night time schedule makes me so much more responsible when it comes to tracking my hours of slumber in an OCD sort of way ;)

The Goldilocks' shift and 2 pairs of Danskos (eeek!)

Friday night was awesome. My biggest complaint on night shift has been that it has been too slow. I realize that I sound a bit like Goldilocks- day shift was too crazy busy and night shifts have tended to be too boringly slow. Friday night was my Goldilocks night where everything was just right.

I had 3 patients. I transferred one upstairs, admitted one from the ER, and worked side by side with my favorite doctor who was admittedly looking a lot like a zombie from lack of sleep. My coworkers were a set of ladies I had not worked very much with yet and discovered that together we made a formidable team in the IMCU helping one another out all night. It was great to feel both supported and to know that I was helping my coworkers out equally.

By the time I looked at the clock it was already 0430 and I rushed to finish interpreting cardiac strips, download vital signs, finish noting orders, and be in time for my 0600 meds. By the time I finished giving report and clocked out at 0730 I was running on adrenaline that even after my drive home I was feeling great. The sunshine, that has previously missing from my life for the last 3 months (I didn't see it on day shift either), was glowing in a blue blue sky. We had pumpkin waffles at my in-law's for breakfast and then my darling suggested we drive to Boise for the day to spend our Xmas gift cards.

Much to my delight I got 2 pairs of Danskos - one orange with leaf prints and one dark cherry red (both sparkling). Interestingly enough I found them at two different farming stores. Shopping for Danskos in the middle of cowboy boots is pretty entertaining, but makes sense in the fact that they are all made of leather and last forever. My orange ones were from a little store, Flynn's Saddle Shop of Boise (gift certificate location #1 and they carry the shoes at much lower cost than anywhere else). The staff was super sweet and got me all the size 38s they had available in their small selection. Since Danskos are hand stitched even though the sizes are the same, the fit is not always equal. So after much deliberation I found my 'Cinderella slipper.' Since none of the other 38s fit quite right it was then onto D&B supply to use gift card #2 where I found the dark cherry red pair that remind me of the Wizard of Oz. Although I'll keep my black Danskos on hand, it's nice to feel like I have outgrown them for work!

We ended the delightful day of shopping (don't worry- my hubby got to do his very own shoe shopping with his REI gift card for hiking boots) with dinner with hubby's brother and sister in law and our nieces and drove back under the stars. It was so great to spend time with family, get out of the house, see some sunshine, and then sleep a well deserved 12 hours when I got home.

Prepping for tonight

Tonight I'm flying solo!

I am following one nurse's schedule (my mentor) who is my 'life line' when I need to ask questions, but chances are she will be charging or in ICU so really not that available. Which is a good thing. My "mentorship" lasts a month, but I'm determined to be as independent as within reason and to not let my butterflies get the better of me (my biggest struggle is second guessing myself, which is not the same as asking for a second opinion - patient safety always comes first).

One of my preceptors called me out for saying "I think X...." too much instead of just saying "X is happening." I have been very aware of my use of language since that reprimand in order to portray confidence when I speak - both for my patients sake as well as for avoiding being verbally abused by some of our not so nice MDs. I also happen to be one of those people that apologizes with "I'm sorry" all the time so this exercise has been challenging, but necessary. It feels like I'm faking confidence at the moment, but I suppose the saying is 'fake it until you make it.'

Someday I'll hope to be terrifyingly confident (really it's quite a sight) as the nurses in the ICU that I deeply admire and hope to be as competent as in say...50 years? :)

Today (before I take my afternoon nap) I am cramming in some more of my online ECG class. For non medical people here is a very good, short definition of what ECG is (from: Wiki: Electrocardiography).

Electrocardiography (ECG or EKG from German: Elektrokardiogramm) is a transthoracic (across the thorax or chest) interpretation of the electrical activity of the heart over a period of time, as detected by electrodes attached to the surface of the skin and recorded by a device external to the body.The recording produced by this noninvasive procedure is termed an electrocardiogram (also ECG or EKG).

An ECG is used to measure the rate and regularity of heartbeats, as well as the size and position of the chambers, the presence of any damage to the heart, and the effects of drugs or devices used to regulate the heart, such as a pacemaker.

I really am enjoying all the education that I am receiving. Each day of ECG classes gives me something new to apply at work. Our unit has large screen monitors scattered throughout the halls with all the unit's patient ECG strips on the screen in real time. So, even if my patients' hearts are normal there is usually something going on that I can practice my ECG 'reading' skills on during the night. 

Back to the books and then time for some napping. 

Also, I included a dingo picture for today because they were being silly.

Mondays are better when they are shared.

Night Shift Narrative

This was my interior monologue in my head last night:

2000: "Sweet I have all my assessments done and my first round of cardiac strips saved and interpreted. Plus my patients and their families are lovely. Boo yah!"

2200: "A family on the unit bought us pizza. One slice is heavenly! Time to get folks tucked in"

2300: "Just got an admit. Easy one at that. Why are they coming to my unit???"

0000: "Must do 2nd assessment and 2nd round of cardiac strips. Some IV antibiotics to hang. Geeze, my eyelids are twitching"

0100: "me so hungry...time for my salad. Gross... too much work to walk down stairs to get something else"

0200: "Just one cup of coffee. Please"

0215: "Omg. Adrenaline rush. That just happened. Time to fix it"

0230: "What the heck! Just gave an awesome SBAR to the hospitalist and I'm pretty sure they didn't even listen to the words coming out of my mouth. I'll follow the new orders, but I'm calling back in an hour because they WON'T work"

0300: "Here we go...."

0330: "Hi. It's me again. That thing you suggested didn't work. Now what? Sweet, thank you."

0400: "Finally....Now I'm awake enough for 3rd assessment and strips. I'll wait for lab to go draw blood and slide in right after them once the patients are awake"

0430: "Hee ha ha - my coworkers and I are hilarious at this time of the morning. We should be comedians!"

0500: "Omg, my eyelids are the weight of bricks"

0600: "Lab results are in, time to get all my electrolytes signed and acted on. A few phone calls to pharmacy should fix my potassiums...So on top of it!"

0700: "So happy to give report!!! Day nurse that arrives 5 minutes early I LOVE you. Plus you had 2 of these patients yesterday - fastest report ever!"

0730: "Time for the window frost scraping party in the parking lot with all the night nurses! And I can't even remember what was so funny at 0430. Probably something dumb."

0830: "In bed. All I can hear are IV pumps and cardiac monitor alarms ringing in my ears....yawn"

Butterflies the size of dragons: 1 week until orientation ends

In class yesterday it was brought to my attention that my orientation ends on February 8th. I am desperately clinging to the scrub ties because I don't want it to end. Even though I rarely utilize my preceptors at this point, I am very much against the idea of no longer having them at my beck and call.

My nurse educator just laughed at me when I looked at her with the signature 'panicked new nurse' eyes and she confidently stated that in fact I would be just fine without anyone hovering within hollering range.

I'm glad she is convinced and I'm thankful UP prepared me for this. But I would be lying if I said if the butterflies in the my stomach are the size of actual butterflies. They are more like the size of dragons that are terrified of fire.

I'm back on nights this Friday/Saturday/Monday. I'm going to savor it!

Last week on days!

This is my last week on days before I trade in my early morning drives to work for early morning drive to home. I'm not very excited about becoming a night owl, but it's the position I was hired for so I am trying to keep my chin up about it.

Unfortunately, I also start my weekly day classes on Wednesdays from 0900-1300. I've already had to request 3 Wednesday night shifts off in the next month because whoever is doing the scheduling keeps trying to double book me and I think it's quite unfair to work 4 hours, maybe get 2-3 hours of sleep, and come back at 1900 for a 12 hour shift. So far, those changes have been made and greatly appreciated on my part (and my patients')

On the positive side though, I did have my first class yesterday and I really enjoyed returning to a learning environment. At heart I am nerdy and cerebral and really enjoy delving into the nitty gritty details of pathophysiology. We focused primarily on the respiratory system yesterday and one of the MDs came into give a presentation on sepsis. It has been interesting comparing and contrasting my experiences as a student nurse in teaching hospitals to that of being an RN in a community hospital. The latter is about 10 years behind current, best evidence based practice (EBP). This MD is young and new to the area and is open to following EBP and was very encouraging to us to call him when we saw particular problems arising in our sepsis patients. This physician was also acutely aware that some of the senior physicians are stuck in their ways and may need to be pushed to take the appropriate measures. It was great to have that acknowledged.

Our duplex is pretty much unpacked and organized. My honey and I have had so much joy cooking together again. Breakfast consisted of fresh eggs, avocado, peppers, and local salsa. It was delicious. I ran errands yesterday and splurged on a new paleo/gluten free cookbook that I am looking forward to cooking with. The best part is the book comes with a 30 day meal plan AND shopping lists for each week. It is so handy and the meals look mouth watering!

Here is to my last week of daylight :)