I've been working on the cardiac ICU step-down for 8 weeks. It's my second day off of orientation and I'm beginning to realize just how much of the job my preceptor shielded me from. Its 8-something PM and I've just finished my first round of vitals on my patients. I walk into the medication room when I hear the gentle bing-bong bing-bong of the unit-wide cardiac alarm sounding. I'm ashamed to admit that I've already began to interpret this potentially lethal melody as more of a rhythmic nuisance. It seems to go off with even the most harmlessly subtle motion by the patient or the occasional electrode that decides to play hide-and-go seek. As I walk out of the medication room into the dimly-lit hallway, I notice the words "Cardiac X33" slowly creeping across the marquis. A subtle panic overcomes me as realize this false-alarm going off is one of my patients.
As I begin my swift walk over to the monitor, my phone rings with the words "war room" flashing across the screen. I answer just as the monitor comes into view but her words seem to meld in with the message above my patient's rhythm or lack thereof, "you patient in room X33 is showing asystole."
I sprint to the patient's room, she's laying in bed on her side, her eyes closed. I call her name once, she is motionless. I move in meekly for a sternal rub. I've already played the next few moments in my head but I'm still not ready for what happens. Just as my knuckle reaches her chest, she groggily responds.
"What do you want?"
I hesitate. It's one of those situations where you hadn't expect words to be necessary so you had none prepared when they finally came due.
"I just... needed to check on your heart monitor leads real quick" I quietly managed to mutter.
The patient rolls over onto her back and I quickly assess the problem. She has 2 leads that have escaped into regions unknown. A quick tug brings them back to the surface and I replace the electrodes. Slightly embarrassed, I make my way back over to the monitor to reassess her rhythm. It's noisy, likely the patient trying to rediscover her former position after it had been so abruptly disturbed, but unmistakably normal and present.
The next hour rolls by. I'm embarrassed that I made such a scene in my head over what turned out to be nothing. The cardiac alarm is still sounding. It's not my patient, but another one across the unit that keeps reminding me of my reaction.
Finally, I'm ready to sit down and chart. The cardiac alarm sounds again, I've already decided it's not mine but, as I was taught in orientation, I turn my head towards the marquis to be safe. "Cardiac X33". I turn again to the monitor and surely enough, she is back in the empty rhythm again, the bold red word "asystole" eerily hanging above it.
I briskly, but casually, walk to the room. Now knowing the leads are the culprit, I press the button on the wall to dismiss the alarm. The patient has returned to her side-lying state. I begin to check the leads, trying to be careful not to have to wake her again, when I hear the alarm return to sounding. Slightly irritated, I walk over and dismiss it again and return to checking the leads. The third time the alarm sounds, another nurse walks in.
"Is everything alright in here?" he asks, a subtle but clear alertness making itself present in his tone and demeanor.
"Yeah, I'm just fixing her leads real quick" I respond.
"Is she responsive?" he asks.
As these words escape his mouth, every CPR instructor and class I've ever taken roll their collective eyes at me. I move to arouse the patient with the same "sternal rub" I had used earlier. She doesn't stir. Her chest is abnormally still. He moves me aside and calls her name and more forcefully attempts a sternal rub. She remains motionless. It's 9 or 10-something. He pushes the blue button on the wall and I realize just how much of the job my preceptor shielded me from.
When the dust settles, the patient is down in the ICU. I'm relieved, she could have gone somewhere much less intense. I'm scared, I haven't been on my own for a week, I feel like I barely know what I'm doing, and I realize for the first time since starting this job that I could have killed a patient but letting my guard down. I'm still shaking, eternally grateful to the nurse who came in and saved what could have been a horrible introduction to nursing.
I have 3 takeaways from that night that I like to share with new nurses.
Alarm fatigue is going to happen. Always respect the fact that the time you least expect it could very likely be the time it ends up mattering to most. Even if it isn't your patient, be the nurse who saved another nurse who had already convinced themselves it was nothing.
Don't be afraid of needing help.
No one in the history of nursing has become an experienced nurse without first having been a new nurse. This was one of the hardest lessons I had to learn as I've always been irrationally afraid of people thinking I needed help because I was afraid of coming off as inadequate or unable to thrive in any given situation. That doesn't work in nursing. I've only ever known of one nurse who hit the ground running and, while I have a lot of respect for him as my senior, the nurses who trained him were more afraid of his confidence than any level of caution or uncertainty in a new nurse.
Be a team player.
The nurse who helped me saved both my patient's life and my drive to continue nursing. I try to live up to his example every day in my practice and be available and ready to help anytime someone might need me.