My first 100 days on the job: Week 7

[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.

Day 14 & 15

(Note: I need advice on the things under my Needs Improvement” highlight. Please and thank you.)

It was an intense week.

I watched a person die for the first time. What surprised me most was how…. undignifying and disturbing it is in real life. The movies create a dramatic but clean and instant portrayal of death. In this situation, after the team had terminated life-saving efforts, the patient didn't appear to be completely dead… She continued to breathe agonally, which seeing for the first time, sent chills down my spine. Her body would move in twitching sort of way as she spontaneously gasped. I found myself completely lost in that moment of standing just outside her room, watching signs of life leaving her body. She would gasp and twitch. Then nothing. Then there it was again, the gasping and twitching. I noticed streaks of blood running down the side of her mouth. It was awful. The husband was just a few feet behind me, facing the wall and crying. Somebody offered him a chair and words of empathy. When the code had been called I was the one who left to go find him, but I didn't know what to do or say in that moment.

The next night, I cared for an ALS patient in the advanced stages of the disease. He was trached and vented - which has been his state for almost two years now. He had minimal purposeful movements. His ability to communicate was limited to moving his eyes from side to side and smiling. His state made me very sad, but I could clean him, turn him, suction him, give medications, provide treatments, monitor him, and reduce his pain. When I did something that he wanted or needed, he'd smile, and I'd completely focus in on the moment of caring for him. You know how people can get lost in the zone” with something they love to do? I was completely in the zone” caring for this patient, and it brought me such joy and meaning. Those moments are why I love nursing.

Things I learned

- The German word for Nurse” is: Krankenschwester. I told my preceptor this and she responded with, Sounds like crack distributer or something. I guess that's about right. We DO distribute drugs. Makes sense.”

- Prepping a sedated, vented ICU patient on multiple drips and EEG for MRI is no fast or easy task. We had to disconnect our pt from the bedside monitor and put him on the transport monitor. We removed his bp cuff, pulse ox, and SCDs. We had to stop his drips but get an MRI compatible machine to bring the Fentynal with us. The unit was out of the tubing we needed for the Fentynal and so I went from unit to unit to go find some. Transport and a respiratory therapist had to come with for the trip. We had to travel from the floor to the basement, down long hallways, up the elevator to another floor, and of course the transport machine started blaring LOW BATTERY” at us halfway to our destination. The MRI itself only took 20 minutes but we were gone for two hours.

- I finally got those ACLS algorithms down. As mentioned in a comment on my last post, I am now certified! What really helped was this guy's youtube channel https://www.youtube.com/watch?v=EU_Y6x7aAX8

- If you start your shift with thoughts like I can't wait to get back home to (sleep, read, see my friends, do whatever non nursing thing you like to do)” you're setting yourself up for a bad day at work. It's better just to go in on nurse mode,” if that makes sense, and go in with the goal of just doing a good job. I was tired the other night and wound up being pretty lazy. When my shift was over I left feeling crappy about myself. The next night I wanted to redeem myself and work really hard, and I wound up having a fantastic night. Remaining focused gave me the energy to help my co-workers, learn more, be a better nurse, and I ended that shift feeling great.

- Hobbies are very important. Coping mechanisms are important. I am able to leave work at work because I have enjoyable and relaxing things to do when I get home.

Needs Improvement

- When the woman died, I didn't know how to console the husband. I was at a complete loss of words. I mean, what do you say, really?

- I'm struggling with how to tune out the negativity, especially when I've had a bad night myself. There are some nurses on the floor who love nursing, but many hate it. Exact words from staff: I hate nursing.” I cannot wait to get outta here.” I'm back tomorrow. It sucks.” I'm so tired.” Family members are so annoying.” Management always has their head up their asses.” This hospital is so cheap.”

Any have any advice on these two issues?

Victories

- I independently cared for a vented patient for the first time. Vents had always intimidated me until after my shift on Day 15.

- My preceptor told me, You did a really good job today. You pick up on things fast.”

[Stitch3296]

I'm really not one to give advice as I am just starting out myself. But wanted to say I LOVE your posts, it's great how you break your shifts down and learn from them.

As far as the tuning out the negativity, I think you answerved that already yourself. Focus on why you're there, and how you can make a positive impact on both your patients and coworkers. Just like they say bad attitudes breed...so do good ones and optimism. Not that it will always be easy, but looking for the good even when it's small. Good luck!

And thanks again for sharing your experiences and journey, they're helpful as I begin mine!