I need some advice

Altra, BSN, RN · Sep 21, 2013

Was going to send you a PM but you may not be able to get it as you're a new allnurses member.

Trust me when I say this: you're not the only one to ever experience this. If you're like me, you'll adopt some new habits learned in the unit. And in some areas you'll retain your ER sensibilities.

Adaptation is the name of the game.

daviex · Sep 21, 2013

Stick it out and suck it up! Keep your eye on the prize: Flight Nurse!! You got this. Think of those senseless sheet changes like you do the guy that game in via EMSA for dental pain. You'll be glad you did when you suit up to go on your first flight. Good luck.

TraumaSurfer · Sep 21, 2013

My question is this: It's been a few months and I find myself enjoying much of the complex pathophys and trending labs etc... But the menial tasks are already wearing on me. Technically my obligation is roughly 2 years to the ICU and I'm afraid I can't see myself hanging on for that long.
Do I run back to the ER (where I belong!)?
Do I stick it out and suck it up?
Any thoughts would be greatly appreciated.

Working flight or any type of transport is about adaptability. Flight is not all glamour and glory. It probably has more tasks which you might consider menial or even ridiculous but they all serve a purpose when it comes to safety and being prepared just like the ICU. The checking and rechecking can get tedious but your partner would easily get fed up with you with your present attitude and would have to feel like rechecking everything you were suppose to do. That defeats the purpose of a team. At this point, you don't seem to have the flexibility or the mindset to go into the different environments or scenes to pick up a critically injured or injured patients. You will have to be able to run through all those menial tasks quickly without hesitation for the safety of the aircraft, the crew and the patient.

Even 2 years of ICU experience is not near enough. For some Neo Teams it takes over 5 years of experience in just that unit to be considered. Most of the RNs I worked with when I did flight had at minimum of 10 years and that was in different ICUs. Most were proficient enough to work Neuro, CVICU, CCU, MICU, Pediatric and Neonatal. They were adaptable and did not whine about doing the menial tasks. They understood why even something like a clean sheet is important to the patient in the ICUs. All the menial tasks even if different come with patient care regardless of the setting.

You also will not have an ICU physician holding your hand on flight. If you don't know your stuff the patient and your partner suffers.

Bottom line:

What are you going to say in a Flight job interview when asked why you left the ICU after such short time? You better have a better reason than what you just gave or you will watch your application hit the trash can. Most interviewers can spot someone who is reluctant to change very easily.

MassED, BSN, RN · Sep 21, 2013

This is exactly why I'll never work in an ICU of any kind. I can't imagine having perfectly spotless sheets, tucked linens, etc. It is ridiculous. Do they count every time someone farts? LOL.

burnrn85 · Sep 21, 2013

I was the same way. I loved the acuity but disliked how particular some could be regarding things that had minimal bearing in pt. care. I never had a problem bathing, changing sheets, etc. but I would not re-change the linens if a drop of blood got on them. However, if A large amount of blood or body fluids soiled them, I would. To keep the peace, I kept extra towels in my rooms to act as a barrier for procedures. So if I was drawing blood from an art line, I'd put the towel under the draw source and any blood drops would get on the towel, not the almighty sheets.

I dislike the comparison to aircraft safety as a menial task. It's actually the top priority in HEMS. Linen changes are not.

Stick with it, learn as much as possible, be adaptable, learn assertiveness, and gain confidence in yourself and your skills. You'll do fine if you truly desire to be a flight nurse.

TraumaSurfer · Sep 22, 2013

I dislike the comparison to aircraft safety as a menial task. It's actually the top priority in HEMS. Linen changes are not.
.

What do you think safety involves?

It can include everything from weather checks with the pilot to keeping the helicopter and equipment stocked and clean. You can not page housekeeping. These tasks are repetitive and not very exciting. Flight teams may even have to assist a patient with their bodily functions on a long flight. You have to adapt and that includes some of the menial nursing tasks.

MassED, BSN, RN · Sep 22, 2013

I can understand cleanliness in the ICU, within reason. There are plenty of OCD types that thrive with perfection in those environments. Those types tend to get easily ruffled in an ER where control in the chaos can be a difficult to find and conquer. No one is comparing flight safety to linen changes in an ICU. Medicine owes itself to aviation in regards to safety, as anyone who can googe will find articles on the subject.

burnrn85 · Sep 22, 2013

@mass...trauma surfer made the comparison

@trauma... You are trying to compare two entirely different environments. The OP referred to a spot of blood and linen changes with no mention of house keeping. Just the lack of priorities in a menial task vs pt care. In HEMS, there is no way that safety checks are ever considered menial and pre-hospital is far from a tidy environment. Sure, decon happens after each flight, but pt hygiene is not addressed during flight. They are often bloody and muddy...no bed baths or linen changes for these folks.

burnrn85 · Sep 22, 2013

I'd like to add that the reason I disliked the comparison is not because it's a poor comparison, but rather because complacency with aircraft safety is the reason we hear tragic news stories of death in the industry. I've never heard of a death related to lack of clean bed sheets.

TexanTough · Sep 22, 2013

I understand the point you are trying to convey. I do not take issue with repetition of so called menial tasks *IF* there is a clear reasoning/point behind them. Do you not think I made sure my trauma bays were stocked, calibrated, all systems go every morning and every trauma thereafter? I was very meticulous on things that mattered the most. I do not think I am above a sheet change or the nit picky tasks required of me. However, I do not logically see them as an efficient use of time or improving patient outcomes. Flight checks and a culture of safety directly impact the mission and/or patient care. Checking and calibrating equipment along with ensuring you are stocked, locked, and loaded all have a direct impact on patient care.

When I say I 'think differently' than my peers, here is a classic example. A person arrives from the ED. (Most likely indigent or homeless.) Everyone is fixated on how bad they smell, contact precaution swabs, and the general uncleanliness/disorganization. I am fixated on a map of 40, poor pallor, and a heart rate in the 140s. The nurses here hone in on getting someone "situated" rather than stabilized first. It's not that they are poor clinicians, it's that they are very used to a situation where everything is in it's place before any interventions.

Not every day is a scene flight or bloody trauma. I realize those comprise a small % of actual transports. However, my practice is patient centered and to maintain a homeostasis of sorts. I enjoy many aspects of the ICU and have gained valuable exposure to the long term management of the critically ill. In many ways my post is a 'vent' of sorts and isn't meant to demean critical care nurses or 'whine.' The assertion that I cannot acclimate is false. Clearly, the heart of emergency nursing and the mastery of it is acclimation/adaptability. I have acclimated to the environment I'm in, but it is mentally draining to have a group of peers who prioritize differently.

The comment about having an ICU doctor holding my hand. I currently do not partake in hand holding nor will I ever. I am considered 'brash' by some because I am so forward and impatient with twiddling of thumbs by residents. I will have all appropriate labs ordered, gtts in hand, and say "these are our parameters, unless you vehemently oppose, want to put those(orders) in?"

In closing, I get your point. I know that not every task is fun or mentally stimulating. I'm simply reaching out to see if others have had the same experience.

You haven't crushed my career goals. I think I will stick it out and suck it up for now. (With the knowledge that my heart will always be in emergency nursing.)

Working flight or any type of transport is about adaptability. Flight is not all glamour and glory. It probably has more tasks which you might consider menial or even ridiculous but they all serve a purpose when it comes to safety and being prepared just like the ICU. The checking and rechecking can get tedious but your partner would easily get fed up with you with your present attitude and would have to feel like rechecking everything you were suppose to do. That defeats the purpose of a team. At this point, you don't seem to have the flexibility or the mindset to go into the different environments or scenes to pick up a critically injured or injured patients. You will have to be able to run through all those menial tasks quickly without hesitation for the safety of the aircraft, the crew and the patient.
Even 2 years of ICU experience is not near enough. For some Neo Teams it takes over 5 years of experience in just that unit to be considered. Most of the RNs I worked with when I did flight had at minimum of 10 years and that was in different ICUs. Most were proficient enough to work Neuro, CVICU, CCU, MICU, Pediatric and Neonatal. They were adaptable and did not whine about doing the menial tasks. They understood why even something like a clean sheet is important to the patient in the ICUs. All the menial tasks even if different come with patient care regardless of the setting.
You also will not have an ICU physician holding your hand on flight. If you don't know your stuff the patient and your partner suffers.
Bottom line:
What are you going to say in a Flight job interview when asked why you left the ICU after such short time? You better have a better reason than what you just gave or you will watch your application hit the trash can. Most interviewers can spot someone who is reluctant to change very easily.

TraumaSurfer · Sep 22, 2013

I'd like to add that the reason I disliked the comparison is not because it's a poor comparison, but rather because complacency with aircraft safety is the reason we hear tragic news stories of death in the industry. I've never heard of a death related to lack of clean bed sheets.

What exactly do you think safety means and what it involves? Ever hear of things flying into the rotor? What about leaving things behind either at the scene or the station? What about cleanliness for infection control?

It is not sheets it will be other covering. Equipment and whatever is used in patient care will still be need to be cleaned. Do your really want to keep whatever the other patient and the patient before that had hanging out in the ambulance or aircraft? We do not have housekeeping to do all those menial tasks and the aircraft does not clean itself. We also check and double check things which others might find menial and very, very repetitive. If you don't like paying attention to the little things, then you won't like flight or ICU. A sheet might seem like a little thing but in an ICU, depending on the amount, no one wants to look at blood or wonder where it came from. Also, the tricks to learning how not to make a mess should have been mastered. In the closed space of a helicopter making a mess is not so forgiving and you could easily trash equipment which is nearby.