My first 100 days on the job: Week 6

[BeatsPerMinute, BSN, RN]

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.

What a week! I worked night shifts for the first time in a month, had day class, have been studying ACLS (it's tomorrow! eep! anyone got any advice??) and finding time for fun. I've been exploring more, found a church I like, learned new weight-lifting techniques by my personal trainer, and tried Vietnamese food for the first time. I've also taken a sudden interest in learning other languages and started studying German. Oh, and I went on a date :)

Each week that passes I fall more in love with DC and the cardiac unit. I feel right at home. It's been such an adventure.

Day 12 & 13

My first night shift back was pretty rough. I am a morning person so nights can take a toll on me if I don't prepare myself. On Day 12 I was tired by midnight and tempted to curl up on one of the empty patient beds. At 3AM I was struggling to walk. It felt like there was some impairment in the connection between my brain and legs - I had to make deliberate effort to move. By 6AM I reached a whole new level of exhaustion. I was writing up my note when all of a sudden my vision doubled and I blacked out. My preceptor caught me falling out of my chair. I jolted awake and couldn't believe what just happened. "Orientation is hard on nights," my preceptor said.

I decided to force myself to the gym the next morning, exhaust my body, and get a good, solid sleep. It worked. Day 13 I was wide awake all night. I drank V8 and coffee but didn't eat any food - this kept me awake, hydrated, and curbed cravings. I had wonderful patient, too. He was a middle eastern man who loved to joke around. We also talked about travel and his family. I enjoyed hearing his stories. My favorite patients are those from other cultures and we get quite the variety on our floor: Spanish, Russian, Arab, Hindu, Muslim, Korean, ect.

Though my patient was ICU he was pretty basic (50yr old Male, presented with a STEMI, hx HTN, DM and previous MIs. Post cath. Full code and nka. Orders were simple: EKG, meds, diet, labs, blood draws, sliding scale, anticoagulation, NS at 50mL/hr, nurse communication). When I wasn't assessing or giving medications, he was sleeping.

I spent quite a bit of time helping other nurses this night. One pt became unstable so while my co-worker helped him I watched over and gave meds to her second patient. Another pt with drug-induced endocarditis became very antsy, so I moved to a computer closer to that patient to keep an eye on him. He became delirious and attempted to crawl out of bed multiple times. His nurse and respiratory therapist thanked me over and over again for keeping him safe. I felt so useful!

Things I learned:

- The more you help out your co-workers, the better things will be for you (especially as a new grad). You earn trust. The staff also become more inclined to help you when you're in a bind as well as teach you stuff. The Resp therapist taught me more about ventilators and CPAP. The nurse let me hang blood products for the first time.

- BIBS (bag irrigate bag suction) to remove mucous plugs from trachs is considered "old school" by my hospital now and is not considered good practice

- Ventilators: if your high flow alarms are going off your patient most likely needs to me suctioned. If your low flow alarms, check to ensure your tubing is fully connected.

- The process of intubating a patient: preoxygenate, sedate pt with Fentanyl (and wait 3 mins for meds to kick in), paralyze pt with succinylcholine AFTER sedating them, asses for decreased resistance to bag mask ventilations, perform trach intubation and use pulse ox as a guide, inflate balloon when ETT is in place, tx brady if occurring, perform primary confirmation and chest chest rise and fall and listen to L/S, perform secondary confirmation with capnography, secure ETT

- When giving fresh frozen plasma you don't need to worry about blood type. Anyone can receive anyone's plasma.

- There are numerous (and free!) resources and methods out there available to learn languages: Duolingo, Youtube, RWorld, WeSpeke, Livemocha, Lang-8, Reddit subgroups, Rhinospike. Plus Meet-Up & Facebook groups.

- The more you immerse yourself into a new city when you move away from home, the better. I've been too busy to get homesick. Sure it's a bummer to not be able to see your friends and family whenever you want to, but there's texting/phone calls/Skype, and home will always be there.

Needs Improvement:

- Still need to get better about studying on my days off. I still have a long way to go before I am to become an independent ICU nurse. There are still many meds, procedures, tests, orders, diagnoses I don't know or understand.

Victories:

- The praises I got from staff for helping out.

- I succeeded on caring for my own ICU patient completely independently for the first time (I wonder if this would have happened sooner if I didn't have 6 preceptors, but oh well, I did it!)

- I found an effective method to keep myself awake at night.

- Overall I'm becoming more adventurous so I'm proud of that :)

Also, for real, if anyone has any advice on succeeding in ACLS please please please share. I'm so nervous!

[DowntheRiver]

ACLS is like the N-CLEX - don't overthink it! When you break it down it is pretty simple. Just review your rhythms. I always read your posts - I have confidence that you'll do great!

[loveSBK]

I've been waiting for your post lol. I love how you are keeping a "diary". I love DC as well.

For ACLS, its really not bad. I had a great teacher and he went beyond just to teach us and to understand especially why the algorithms are the way they are. The book was useless to me as I learned everything from class. But its a fun class. Don't be nervous. Use your critical thinking for the mega code,

[BeatsPerMinute, BSN, RN]

I did it! I'm ACLS certified!!

(I don't know why the image is so big lol.... tried reducing size and then removing but am failing)

[ckarnes]

Way to go!!!!

[nasr69]

I luv reading your posts ! thank you!