My first day of frustration as a RN/CCU/CVICU

[nrsgnerd]

So, just to give a little background, I'm a very type B personality EXCEPT when it comes to work. There I thrive on being the best, very Type A and for the past 12 years I have worked as a CNA/TECH. I got the name Super Tech several years back from Peers and I am 100% about patient care. I graduated nursing school where I also excelled and so when it comes to nursing I hold high expectations for myself. OMGOODNESS, I am sooo a novice and had no idea what the world of being a nurse really was. I work in CCU/CVICU and I run like a chicken wiht my head cut off. I'm still developing a routine, and I forget things because of my lack of experience in the RN role. From a techs perspective it always looked like RN's had down time and for me, I've yet to have any. I don't even recognize my bladder calling me until my shift is over or if I'm at lunch....I don't drink anything practically all day and all I can think about is "What do I have to do now....what am I forgetting....oh crap I had meds due an hour ago.....theres the doctor, what was my K+ this morning...can I run this gtt with whatever other drip...did I remember to do this or that. Basically, my brain is in overdrive and I feel like I'm swimming against the tide all day long. And then today, I had my first interaction with a difficult situation in which I had a patient that came in 12 days ago after v-fib arrest and had emergent open heart surgery. The patient is ventillated, having myoclonic jerks, no purposeful movement but alas had brainstem function so his HR, BP are fairly stable. We had a doc tell the family to not let anyone tell them that their loved one was brain dead....and then another doc tell them the prognosis was poor. So ofcourse the family only wants to talk to the first Doc who was basically shooting psuedo-rainbows out of his butt. The pt has had two EEG's, with no changes and its undetermined how long the pt was down in vfib. Because the pt had a 100% blockage to the Left main, he was rushed emergently that first night to open heart surgery, no hypothermia treatment was given. So heres this pt, jerking....lungs coorifice/rhonchi and the children do not know who to believe about the prognosis. One grown child is having anxiety attacks and has visited our ER 3 times now for anxiety and the other is just annoyed and ******. There are 2 other children who we are told don't agree with how to proceed with care and the pt has a sister that the daughters want us to withhold information from. They want no one coming to visit except for them and it seems that in all their grief they are just not seeing the ramifications of letting this saga drag out. So far, no skin breakdown (but were getting close) but there is fever of an unknown origin, WBC's 12.1 which could just be neuro but we drew blood cultures today. Anemia ofcourse, so we infuse a unit of PRBC's and the anxious daughter makes another trip to the ER. We finally get rainbow doctor to come back and talk to the two sisters and he skirts telling them what we see as healthcare professionals (perhaps fear of a lawsuit...who knows) and it takes about 20 mins for him to finally say it...."poor prognosis....1% chance of a "meaningful" recovery. In the meantime, we are waiting on Insurance to clear him to go to a longterm vent facility (limited resources) and it seems that everyone except for the patient is being thought of. We have our intensivist doc, cardiothoracic surgeon, cardiologist, neurologists all either saying something different or just not rounding on the patient. We tried CPAP and the pt had long apneic periods. His muscles are atrophied, his EF before surgery was 10% and I feel like we are just sitting and waiting for his kidneys to shut down,nephrology to get involved and start dialysis. I suppose today was the beginning of me growing a new skin but I get so broken hearted for the pt because I know how this could progress. I love being a nurse, I guess I just have to get used to and learn how to deal with this situation. How do I let this not keep me awake at night? Do I just need time or will I become another jaded RN? I don't cry outwardly very often at all, but inside I weep for this pt.? Why is it that I have a hard time feeling for the family? I know its their parent, I know they just aren't ready to let go but it is so sad watching and just waiting. For all I know, the patient is in pain......or maybe he doesn't feel a thing. I hope its the latter. Any profound wisdom from experienced RN's in this field would be much appreciated. Thanks for reading my rant!

[meandragonbrett]

Welcome to critical care. My only advice is to take it one day at a time. It WILL get better. You've got to learn the way the unit works, the work flow, your routine/rhythm. It takes time. You've got to learn how that particular hospital works too! On top of it, you have critically ill and unstable patients to keep alive for the 12 hours. I always find it helpful to make a sheet with times 1900,2000,2100, etc. and then what meds I have due, labs due, what needs to be charted that hour. I write it on the back of my patient's report sheet so that I don't get confused which is for which. Create your own work list. Keep it in your pock it. Mark the times off as you give the meds, labs, etc. You will invariably have things come up in the night such as serial labs (troponins), serial 12 leads, traveling, new medications to start, etc. Add that to your work list so you don't forget. You can also use your work list to assist you in giving report. Hang in there. You're in a difficult unit to work as a new grad.

[NickiLaughs, ADN, BSN, RN]

I understand how you feel. I'm a new grad in an ICU that's mostly CVICU and think I've had too many terminal weans and too many patients just in this situation that has no signs of improvement.

I have stayed awake a lot of nights unable to sleep. I am told it gets better/easier with time, but then I have other people tell me I should get out of nursing if it gets easier. I don't know which to believe. I know that no one can go through life with too many sleepless nights.

I'm giving myself a year, and if I still don't like it after a year (because it really takes a year to feel comfortable in your nursing shoes anyway) then I'm going to try something else.

I don't really have any advice, I just wanted to let you know your not alone. :icon_hug: