My first 100 days on the job: Week 3

[BeatsPerMinute, BSN, RN]

There is very little growth and reward in life without taking risks - Henry Cloud

Background: In June 2015 I relocated 1,000 miles from home to the East Coast after accepting a New Grad Nurse Resident position in the ICU. I want to post my story here as I begin this journey to get some feedback, share what I've learned, ask for support, and to help me reflect and grow as a new nurse.

Day 6

Minutes after I get on to the unit I am greeted by a 50-something man in RN scrubs I hadn't met yet. "You're following me today," he says. Preceptor #4. I love Preceptor #4. He's so smart and funny. He talks in a consistent calm affect no matter what is going on, is full of dry humor, and makes sarcastic, witty comments to everybody about everything. I feel at ease with him right away.

Preceptor#4 pushes me more than the other preceptors. I finally have access to the med cart, so he has me pull all of the meds. He has me do all of the assessments, attempt and fail blood draws, and chart on everything. I get stuck and struggle many times. Preceptor #4 also gives me the phone. I panic when it rings. I don't let Preceptor #4 get very far from me when it rings.

A crew of doctors approach me and Preceptor #4 for rounds. They ask us how our patients are doing. The attending learns that I am new, introduces himself, introduces me to the interns and residents, and invites me to watch the computer screen and he pulls up images of our patients: one with pneumonia and one with Takotsubo cardiomyopathy.

Around noon, we're behind, but Preceptor #4 offers his help next door, to Nurse A. Nurse A - the very type A personality/ intense nurse I met last week - received a recent code patient from another floor. The pt is intubated. Nurse A suctions the pt. I can see bloody mucous in the catheter. The pt is fighting intubation. The pt needs more Versed and Nurse A runs to get it. Now the pt needs lines. The attending explains what he is doing when he places a central line. The resident wants to place the Arterial line. He says that he has done one before.

Preceptor #4 leaves to check on our patients. He asks that I help Nurse A. Nurse A doesn't ask me to do anything. I stay quiet at first, then force myself to say something. "Let me know how I can help." Nurse A doesn't respond. I'm afraid of annoying her but I want her to know that I can be useful. I go to the patient, stand tall, take a breath in, and ask Nurse A what Preceptor #4 was watching for, monitoring, and helping out with. "He was watching the blood pressure," she says. When the new blood pressure reading appears on the monitor I tell her the numbers. "Good," she says. She is running back and forth between charting, getting medications, helping the doctors, and speaking to the family.

The resident isn't able to get the A-line in on the first time. There's blood on the bed and floor. We have to turn off the BP machine b/c he is placing the A-line on the same arm (the other arm had the graft for dialysis). Nurse A looks stressed out. She has other patients. The resident needs supplies and an extra hand. Nurse A offers advice to the resident (in a sarcastic, harsh, unfiltered and funny way). She is running circles around him. The resident is taking it all with grace though. He and I smile at each other. We're both learning, we're both new, and it's one of those "we just gotta smile and laugh about it" situations. I go and get supplies - a new kit, sterile gloves, a biopatch. I open the kit. Nurse A watches me. I follow the resident's direction with how he wants things placed. I am very careful. "Good, perfect," Nurse A says.

The pt begins fighting intubation again. Nurse A leaves to get more Versed. I take the patient's hand. I tell her that we're getting more medication. I tell her to squeeze my hand. Sometimes she does. "You're okay, we're taking care of you, I know it hurts, you can do this" I say. The resident gets the A-line in. We see consistent, pointy waves on the monitor. The resident thanks me for my help. I secretly want to high five the resident but I am pulled out of the room quickly to do some things for our other patients.

At 4pm we are very behind. I haven't finished charting and the next round of meds and head to toe assessments are due. My preceptor tells me to take a break. "Seriously, take a break. Go eat." I wonder how awful I look.

I head towards the break room, but when I reach the nurses' station I hear a strange, gaspy, weak voice behind me. I spin around, peer into the nearest room, and see an elderly patient sitting up in bed, clenching her side rails, shaking. I rush in. She points to her chest, unable to get a word out. She can't breathe. An alarm starts going off. I look at the monitor. Her sats drop to the 80s. Oh ****. "I need help in here!!" I shout. "It's okay, we'll take care of you" I tell her, and auscultate her back. Three other nurses run in. "She's wheezy" I say. The nurses get out an ambu bag, raise the HOB, get oxygen ready. Suddenly, the pt snaps out of it. She's okay.

Oh man, what a day. It was a good day.

I'm a little stressed at the end of the day because I have an EKG test in the morning and we do not get out on time. Preceptor #4 takes the folder I had been carrying around with me all day, finds my study guide, and quizzes me.

Preceptor #2 was also working. She finds me and hands me a packet. It's information on pacemakers. She remembered that I was struggling with pacemakers last week and thought the packet would be helpful for me to read.

These people are so wonderful.

Things I Learned:

Takotsubo cardiomyopathy is also called "broken heart syndrome"

Arterial lines give more accurate BP measurements & changes (useful if your patient is on vasoactive drugs), and allows ABGs to be drawn more easily and repeatedly.

Sepsis! Please check out this video:

Ya'll familiar with the song "Sexy Back?"

The DC metrorail isn't as scary as I thought it would be. (We don't have metro systems in the little town I grew up in!)

Needs Improvement:

I hate having the nurse phone. I don't want it. Ever.

I need to force myself to drink more water during my shift even when I don't think I have the time, don't feel thirsty, or don't want to because it'll make me pee more. At 4pm without a sip since 7am, I feel horrible.

Victories:

I think Nurse A trusts me a little bit more. She intimidates me still but I admire her.

I made my subdued, easy to anger, bipolar, alcohol and crack addicted patient smile and laugh today (kinda random, but I never did well with addicts or psych patients in nursing school)

Preceptor #4 says: "You did very well today, especially for somebody only on their 6th shift."

Accepting this job and moving to the East Coast was the most difficult decision I ever made and I have zero regrets. Things were too comfortable, familiar, and stagnant back home. I needed change, to move forward, push myself, and take risks. I've never felt so strong and independent.

Question This Week:

I'm really big into quotes this week. What are some of your favorite quotes, phrases, words of encouragement, or sources of inspiration and motivation?

Previous Posts:

The Beginning: https://allnurses.com/general-nursing-discussion/my-first-100-1000287.html

Week 2: https://allnurses.com/general-nursing-discussion/my-first-100-1002031.html

[calivianya, BSN, RN]

I like reading about your experiences. :)

My favorite quotes are not motivational. I love just about everything on despair.com and even have a poster of one of their demotivators in my room, so you don't want to hear my favorite quotes!

[BeatsPerMinute, BSN, RN]

Hahaha I love demotivator posters!! Nurses need humor!

[2k15NurseExtern4u, BSN, RN]

I look forward to your posts. I graduate in December and I'd like to work in the ICU as well. You are my spirit animal.

[loveSBK]

I love your posts. Sounds like you're getting more comfortable which is great. And sounds like you have a great support system at work as well, congrats!!!u

PS. We had "I'm bringing sepsy back" as part of education class, it was awesome. Great way to learn.

[AspiringNurseMW]

Please don't ever stop. You must now chronicle your experiences for at least 5 years! Lol

[xxdiscoxxheaven]

Wow kudos! Icu is so intriguing but terrifying! I'm a new grad as well...I start on a PP floor Monday officially. If I thought it would be more interesting, I'd totally write a blog like this!

[ambr46]

Love this! So well written. Can't wait to hear more!

[valpak]

I LOVE THIS! Please keep'm coming (if you have time haha)

....I graduate in December!

[happyinmyheart]

Please keep writing these!! We all love hearing about your experiences. You are a great writer :)

[2bnursebeckky]

I love the way you write! You express these stories so well :) I graduate in May and am interested in ICU or ED. I know its a steep learning curve, but I'm willing! Keep up the good work !!

[NursesRmofun, ASN, RN]

I like this blog. Will read more. I hate the nurse phones too!

Oh...and adding words of encouragement re: codes. '...You can't hurt someone in this situation. They are dead if you don't help them.'....paraphrasing on that.