Nervous About Weekends & Call

[IsseyM]

I've been on my own for about 6 months now and I am really nervous about this. I noticed that i will be the only nurse for the weekend shift along with a charge nurse and one tech. I don't think i know enough to be put in this situation. I was told its mostly general cases, vascular and some broken bones. I've done quite a few general cases and feel quite comfortable with those, but i have no clue on triple A/other vascular stuff and this scares me big time. There is still so much i haven't been exposed to. I think we have to sign up for 8 hours of call each week, not too thrilled about that either. I already come home so tired and drained, all i want to do is go to sleep.

What kind of cases do you usually do on weekends at your hospital?

IsseyM

[TakeTwoAspirin, MSN, RN, APRN]

You are right to be concerned about a triple A walking through the door. They can be overwhelming even for experienced personnel. The good news is that you at least have a charge nurse on duty with you. In some places it would just be you, the tech, and the docs. With a charge there she/he can help, they can also call for additional backup if needed (and this will probably be the case).

I have seen nurses be pulled from other services when a bad AAA comes through the door during "off hours". They act as runners for blood and supplies etc. Believe me, these cases take more than one nurse and everyone knows that. Don't think that you have to do everything on your own. Nobody should expect you to be able to run a triple A single-handed.

Another thing you can do is try to buddy up with an experienced tech when you are on call. Make friends with these people, they will help you out in a bind.

Speak to the coordinator of the vascular service and ask if they could perhaps do an inservice on AAA procedures for the newer nurses. Read everything you can about the actual procedure. If you know the procedure it will help you anticipate any potential problems.

Good luck, I am sure you will do great.

[SuesquatchRN, BSN, RN]

What's a AAA?

[huckfinn]

Abdominal Aortic Aneurysm

[TakeTwoAspirin, MSN, RN, APRN]

a triple a can take a couple of forms.

if the aneurism is in tact, the surgery can be performed in an orderly and relatively controlled manor. it's a big surgery, but a good surgeon and team can handle it pretty well. in fact, many abdominal aneurisms are now repaired percutaneously so the incisions are about 1" on both thigh. the patient can go home in a couple of days. not a bad deal.

what most or teams fear on a weekend (and rightly so) is the dissecting triple a. this surgery requires emergency surgery if the patient is to stand any chance of surviving at all. these surgeries cannot be done percutaneously. they are always done open, with a midline incision from stem to stern. the blood loss is usually massive. at the hospital i work at, we usually call in additional nurses to act as runners for lab work and blood, and an additional surgeon and anesthesiologist. these cases are a handfull even for an experienced team.

personally, i love them. but when things go bad in a aaa they go really bad really quickly.

[huckfinn]

IsseyM-

I agree with TakeTwo. The charge nurse will not let you get into trouble. Unless that person has a cowboy/girl mentality about emergencies.

Nobody wants to get overwhelmed when the case gets tough. Remember your basic knowledge and put it to practicle use. All of the most advanced surgical procedures and emergency situations are dealt by switching your basic OR nursing knowledge application on autopilot and adjusting to the situations as they change. Most of all believe in yourself! Everyone can smell your self doubt and it makes them nervous!

[GadgetRN71, ASN, RN]

Issey, I agree with what the above posters have said-you can always call people in extreme cases and they'll help out. Does the circulator run the cell saver in your OR? If they do, pull out the machine if possible when you have time and ask for a little mini inservice on how to run it. The big things in a AAA are suction, sponges, a blade to open,suture,and that big mother of all clamps that goes on the aorta. Make sure your tech has the basics like these to start and you can fine tune once you're clamped. I would often do a little refresher on the cell saver if I knew I was on call on a weekend. Now I work at a place where anesthesia runs it and I do all ortho now so I don't have to worry.

[shodobe]

We have always had a new person buddy up with another for the first two weekend calls. The new person generally does everything with the buddy only acting as a resource and extra hands if necessary. The veteran will know after the first weekend if the newbie is ready to be alone. Also, triple A's always require help no matter how long you have done this.

[Marie_LPN, RN, LPN, RN]

One thing i really, really, REALLY recommend is if your dept. allows people to take extra call, give their call to someone else, try to avoid giving away call as much as possible for awhile.

I have gotten stuck, and i know this sounds really bad, but i have gotten stuck/burned so to speak with people who have been there a decade longer than i have, who freak out in an emergency, don't know what they need to do, and SAY over and over "I don't know what to do OMG" etc., and the majority of the reason that they don't knkow what to do is that they always give their call times away to other people. So when the doo-doo hits the fan, they're lost. And bad as this sounds, i've learned in those situations who and who isn't dependable in emergencies. And that's a horrible feeling.

So, keeping call time i recommend, and i second buddying up. Express your desire to learn as much as you can. If you have time during a normal work shift (say, during a slow time or something), ask someone with experience to show you somethings. Take notes if you think that'll help. Don't hesitate to ask questions.

[zerby1470]

My first night of call we got a dissecting AAA, which I had never done or seen. While the team was fastly getting ready to cut, the house charge called in reinforcements, cell saver, notified the blood bank, etc. 13 hours later, after a repair from just below the renals to the bilateral fems, the pt lived. Bad situation, but it reinforced to a (at that time) newbie that we were a team, and that we all know more than we want to realize.

To your original question, though, we most often do a lot of trauma ortho (ORIFs, hips, roddings, etc) and general (lap appys and bowel obstructions are the most common). A little urology thrown in (no one with a symptomatic ureteral stone wants to wait 48 hours for surgery). And C-Sections - our OB unit only provides baby care for sections, so we get the sections.

There are times we all are dead tired at the end of the day, but it is manageable when you are called in, plus there is misery in company...if you are tired, it's a good bet that the rest of the team is too, so y'all can commiserate. The nerves are normal...good luck!

[LIDAN]

I was actually taking care of a AA w/ a stroke off the table and ICH. I am a LPN student and was looking for specific Nursing Diagnosis Care plan for this type of condition. Any idea would be great! Thanks.

[brewerpaul]

Our smallish community hospital doesn't do big critical cases like triple A's. Our call cases are likely to be ruptured appendices, hip and other fractures, bowel resections, acute gallbladders (open or lap),cysto-retro with stent,dislocations and other ortho. I'm a 6 month newbiel,been taking call for about 4 of those months and feel pretty comfortable with those cases as long as I have a good tech. Biggest case I did was a nephrectomy-- it was long, but not especially hard to circulate.