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jbeaves BSN, RN

Content by jbeaves

  1. 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. Stay Vigilant. 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.
  2. jbeaves

    Simple Ways to Turn Career Failures Into Something Useful

    Great article! I know way to many people, myself included, who beat themselves up when they make a mistake and it feels awful to spend that time tearing yourself down mentally. On the other hand, some of our greatest mistakes double as our greatest lessons if we only dwell long enough to learn from them. I think the hardest part is letting go once the lesson is learned :)
  3. jbeaves

    SHHHHH, dont tell anyone I'm a RN

    Yes, I believe we are making the same argument though my statement was certainly lacking some eloquence that may have caused the confusion. Scope of practice does not equal job description does not equal responsibilities afforded by license.
  4. jbeaves

    SHHHHH, dont tell anyone I'm a RN

    I have to disagree. At least according to the Texas BON there are several rules to delegation including "the nursing task must not require the unlicensed person to exercise professional nursing judgment." Everything within a CNAs scope of practice may fall under a Nurse's scope, but it does not go both ways. Of course this may vary state to state, but it's a bit far to call my education wrong with that little information. Edit: after more closely reviewing your comment, I believe we may be arguing the same side. I was referring to a CNA's scope of practice being less than an RNs and how that would impact your ability to act as might be required by an RN if you were working as a CNA. I did not mean there is something he cannot do as an RN that a CNA could do as this is obviously false.
  5. jbeaves

    SHHHHH, dont tell anyone I'm a RN

    dilemma noun a situation in which a difficult choice has to be made between two or more alternatives, especially equally undesirable ones. "the people often face the dilemma of feeding themselves or their cattle" synonyms: quandary, predicament, Catch-22, vicious circle, plight, mess, muddle; I mean, it seems like a dilemma to me. I threw in the ethical part as if you ignore the ethics, there would in fact be no dilemma. That said, I agree about coming forward.
  6. jbeaves

    SHHHHH, dont tell anyone I'm a RN

    This is kind of a tricky ethical dilemma. If you are a licensed RN and one of the patients for whom you are working as a tech suddenly require your nursing expertise, you could be required to act as an RN which I assume is outside of your current job description. Our nursing program taught us that as RNs, working as a tech was below our scope of practice and recommended that if we continued to work outside of nursing while licensed, that it be outside of the medical field completely. I can't say 100% what the right thing is to do, but it seems reasonable to come forward to your boss with your current situation. Do you have a good enough relationship with him where he might be understanding that you cannot afford to be unemployed for a month while waiting for your new job to start? Wish I could help more, best of luck in whatever you decide to do.
  7. jbeaves

    Cardiac Step Down: 6 week orientation for new grad

    I'm working on a cardiac step-down unit in a moderately large city. The orientation on our unit is typically 6 to 12 weeks with 8 being the average. Our unit's educator, who oversees the orientation process of all of our new-hires, decides when she believes you are ready to fly on your own. It may sound intimidating but I think it really depends on the kind of support system available on your unit after you start on your own. Our hospital has charge nurses who don't take patients and who are made fully aware of who is newly off orientation. As a result they know to kind of hover over you for your first weeks on your own. A majority of new nurses also begin on nights. This is good for a couple of reasons. First, there is typically less going on so the atmosphere is less overwhelming (no doctor's rounding, meals, physical therapists, case managers, etc.) so they can focus on improving their practice before moving to days. Second, less going on frees up more experienced nurses to be available to help a new nurse in need. In any case, I wish you the best of luck and welcome to the profession! :)
  8. jbeaves

    How difficult is nursing school?

    I have always considered myself to be relatively good at school and I felt that it was certainly a challenge, but sciences were my Achilles' heel long before college and proved to still be when choosing to go into nursing. The program I applied for was known for being difficult and my lack of a natural affinity for a lot of the material did me no favors. That said, I truly believe the stress and anxiety of nursing school, while difficult at the time, helped to prepare me for the real world of nursing and life in general. Imagine that the stress is water and you spend every day being thrown into it. Eventually, you either sink or swim. It will feel overwhelming at first but if you stick with it, over time you will become acclimated to it and at some point, you learn how to think and act rationally and clearly in a situation where you might have previously panicked, crashed, and burned. If you graduate from nursing school without ever having felt truly stressed or at wit's end as a result of the work required, I would think that you were done a great disservice as your first job will make up for it tenfold. My trick for managing to go on when everything felt like it was falling apart was to step back and think of all of my classmates and those who came before me and to realize that it was possible. It just takes a little patience and perseverance sometimes. TL;DR You got this!
  9. Both times it looked flat. Our monitor system has a habit of reading asystole occasionally while you can still clearly see a completely normal rhythm (this normally happens with errors in lead placement or sometimes just bigger patients) but I'm both instances all I could see was a flat line. Of note, the cause was determined to be hypoxic cardiac arrest (she had been refusing to wear her CPAP) so I suspect it was real, albeit brief, the first time as well. After 7 minutes of resuscitation the patient became completely responsive. While we prepared to go to the ICU she asked me if she was going home.
  10. My first use of the word "shield" is referring to more subtle tasks he would perform throughout the day either out of boredom or to ensure I did not become overwhelmed. Keeping track of medications pharmacy might need to send before they are due, monitoring I&O's throughout the day, reading up on patient's notes to make sure there was nothing I did not have to watch out for or expect. I guess more of a set of training wheels in this case. The second instance is more referring to how my preceptor would be there to react in a code. He would know more of the patient's background to answer the barrage of questions, maybe have a better idea of what might have caused the sudden change whereas I was frozen and speechless. I knew why the patient was there, but I did not know how to state it as concisely and effectively as the situation called for, nor did I know how it could be tied to a change in cardiac function.

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