My first 100 days on the job: The Beginning

[BeatsPerMinute, BSN, RN]

I want to share my story on here as I begin my new nursing job to get some feedback, share what I've learned, ask for support, and to help me reflect and grow as a new nurse.

A little background: I recently relocated 1,000 miles from home to the East Coast after accepting a New Grad Resident position in the ICU.

Days 1 - 3

When I think of the ICU I think about the pt I met the other night (not mine). He was young and it didn't make sense what was happening to him. His dx was a mystery. He was in and out of the OR every other day. He had 10 diff lines going in him and was hooked up to a monitor. At one point his nurse was on the phone (quietly) frantic b/c a line was migrating out and another line was occluded, preventing a very crucial med from getting into the pt. Every movement caused the pt to shout out in pain even with his PCA. I was intimidated by just rolling him on and off the bed pan.

I feel pretty in over my head. My patients are sick - VERY sick - and the drips, protocols, monitors, readings, meds, diagnoses, treatment plans, wires, labs just swirl in my head, overwhelming me. I am thankful for a long orientation (4-6 months), classes, and that I have a wonderful, patient, smart pair of preceptors.

I worked nights and my first patient was an elderly man whose body was rejecting his new lung post transplant. He developed a number of problems and was put on a vent and trached. Goals that night included keeping him off the vent, and he made it through the entire shift (champ). I also had a 90+ y.o. M with pna, a-fib, stemi, infections…and he was full code. Family wanted everything done.” Sweet smiley man, could not speak for himself and looked absolutely miserable (pale, weak, SOB). My preceptor thought that he wasn't going to make it through our shift. My elderly F pt was post-cath lab (had some issues including HTN, complete heart block) and she had a pacemaker placed. Just needed to be monitored. I also had my first vent patient.

Things I learned:

• An intro to ECGs by my preceptor but I have a long way to go. I can recognize the basics (some blocks, a-fib, flutter) and am watching youtube videos to learn. I imagine that things will make a lot more sense after I take the ECG course next week.
  
• If you're giving Remodulin to your Pulm HTN pt, watch for hypotension and don't txt it with a fluid bolus. Remodulin usually just takes some time to kick in. Watch your pt. May eventually give a small amt of fluid or vasopressors
  
• Crushing pills in their package and waiting to mix them together avoids wasting in case your pt can't or won't take them.
  
• Though tempting, avoiding coffee makes for a better night since you don't crash. Drinking water, caffeine free tea, flavored drinks, V8, ect can wake you back up too and keeps you much more hydrated! (easier for me anyway since i'm not a regular coffee drinker)
  
• The little things, like making a pb&j sandwich for your initially crabby patient, really makes a difference. It's the little things the patients remember and thank you for.
  
• Changing shoes mid shift may help with sore feet, especially if you wind up staying for 14 hours.
  

Needs improvement:

• Remembering protocols: document this, check that, frequencies, do these tasks but don't if this or that, parameters…. so many
  
• Charting. So much to chart, note on, look up, navigate through. Wow.
  
• The lingo and abbreviations in report. I get lost part way through the story because I don't know what they're talking about and I can't keep up…
  
• My med knowledge… I have to look up everything.
  
• Critical thinking skills… Why we do which treatments, predicting and solving potential problems, ect. Oh man.
  
• Vents... what are all those numbers/lines/readings/sounds??? (back to youtube!!!)
  

(This list could really go on forever so I'll stop with these).

Victories:

• On my second night my patient told me that I picked the right profession and that I am a great nurse (which truly has made my week and has given me a little boost of confidence)
  
• I told my preceptor that there were many things I didn't understand, that I want to be safe and am open to criticism. She said that she won't let me do anything unsafe, that I was smart and would get it with time.
  
• So far the nurses and doctors on my unit have been very welcoming! I was told I fit right in.
  

[notnursezelda]

great post! looking forward to some more!

[mirandaaa]

I really hope you continue editing and adding on to this post (or posting new updates even). I think this is awesome. I'd like to do something similar when I get out of school.

[richardgecko]

This makes me so happy! I love seeing others happy.

Hopefully after my 1st 100 days I can post something equally refreshing. I'm still in nursing orientation and struggling to stay awake.

[AspiringNurseMW]

This is awesome. don't stop writing. I love this! As a student who will be starting next month, I love having a peek into what could be my future.

[BeatsPerMinute, BSN, RN]

Thank you everyone! I always loved hearing about new nurse's experiences: the good, the bad, the ugly. It prepared me in some way. I would learn from their mistakes, relate to their feelings and fears, so I hope this does the same for others and is helpful. Right now everything is very new. I am sure I will look back on my posts someday and think "Wow, was I really that lost?" But it'll be fun :) And if you're feeling like it, please share stories, critique, message me, anything! The summary of week #2 is up!