Adam D. RN2005

Thank you for the compliment. I will say that I am humbled by what you have said because I don't think of myself as a rolemodel. I am just trying to be the best nurse that I can be. Again thank you and good luck. Adam D. RN

I kept on meaning to sit down and write this post over the past couple of weeks, but life just kept on interfering. And the fact that I have been so busy that I haven't had time to really sit down and do this. August 7, marked my one year anniversary since my first shift as an RN. I remember how nervouse I felt that morning when I woke up. I knew that I was no longer the student and the butterflies were in full beat in my stomach. Over the past year I have seen and done many things for the first time. I went from being a ball of nervous energy on that first day to being an experienced RN today. All the way through my first year, I have kept a positive attitude and have not let the stress get to me. Yeah, I did crack once during an extreme shift in December and cried at the end. I have had shift that were worse than that, but I managed to get everything done and stayed on top of everything. I coded one patient that at 98 should have been a DNR, and felt honored to be at the side of a grieving family at the lose of a loved one. At a wedding this summer, I showed my family what I do. And a funny thing happened, my mother started to give me some respect. And I do mean some. Oh well. I guess I will always be a child in her eyes. But I have also become an increadibly calm person. I use to be a very anxious person, someone that anxiety plagged left and right. But I have become very calm during emergencies. Yes, my voice does get loud and I become more talkative when a patient makes me nervous. But, I have become calm under pressure. In the past year, I have taken care of hundreds of patients. But I think the most rewarding was the patient I took care of this past weekend. The one I saw was hurting, but hide it. I finally got them to open up, and when they did, I gave them my shoulder to cry on. I was there for them. I got that patient the emotional help they needed. The night nurse had reported the next morning that they kept on asking if I was going to be back the next day. Even if I was off, I would have gone in, because it was the right thing to do. And to all of my patients, I am there for them when they need me the most. If it means that I will be leaving work at 8:30 instead of 7:30, then that is fine by me. There are somethings that are more important than what I need to do at home. When I made the decision to become a nurse, it suprised me. I honestly did not see this one coming. Funny, now that I am an RN, I look back at my life, and realize that I was always the type of person willing to help. But that is who I always have been. A compassionate person. For the Newbies who are just starting. Take a deep breath. Close your eyes and prepare. Take every day as a learning experience. Do something I do on a daily basis. I look at my performance through out the day, both the good and bad. I look at the mistakes I have made, and see how they have happened. I refer to this as my lessons learned. And then I adapt so that I don't repeat the mistake. Leave the stress of the day on the floor. Realize right now you are inexperineced. And you will feel a little bit more stressed. But realize this, in one year you will have experience to fall back on. And always smile. You will be suprised how a smile will get you through the tough times as well as the good. And always keep a sense of humor. Learn to laugh it off. And if you feel uncomfortable, ask for help. Your collegues will think more of you when you admit you don't know something. And don't be afraid to stand up to an arrogant MD. Because not only are you that patients caretaker, you are also their avicate. And trust you instinct. If you feel something is wrong with the patient, even when you can't put your finger on it, or nothing is there, then chances are, there is something wrong with the patient. I am now one year in to my profession, and today I know that I made the right decision when I chose to become a nurse. Because it is in my blood. Adam D., RN

To answer some questions: Type of nursing tha I do is Med/Surg Nursing. I work on a TOUGH, and I do mean TOUGH MED/Surg Unit. I was planning this month to start the transition to ICU nursing, but have decided to put that off for a while. I love what I am doing so much that I am going to stay and learn more. I have been an RN for exactly one year. And have loved every second of it, including the shifts that have taken to me to H**L and back. I have yet to have two shifts that have been exactly the same. I also have a very sunny disposition, I will find the positive in everything. In my nursing bag (BTW, it is the Nursemate Ultimate Nursing Bag) I just carry my stethoscope w/ flashlight, BP cuff, and my lunch, as well as a couple of files for my other duties at work when I am not at the bedside. I am in the middle of putting together a second nursing bag that will just reside in the trunk of my car. That is going to have another stethoscope, BP cuff, Flashlight, and various first aid items. And I am going to another wedding in Bean town in september, We will see what happens then (hopefully nothing) but the stethoscope and BP cuff will be in the car just in case. Adam, RN

I had attended my cousins wedding last week, it is now a three ambulance wedding. And it wasn't even an irish one. (My cousin use to be an EMT, so there were quite a few medics, a couple of nurses, a PA and one gynecologist there.) After the ceremony, during the cocktail hour, while I was shoving pigs in a blanket in my mouth, my aunt comes up and just says "Adam, we need you, someone is sick." She wouldn't elaborate beyond that. I follow her expecting to see a guest drunk, and I was going to say something to the effect of drink water for the rest of the evening. Last thing that I expected to walk into was a elderly gentleman having a full blown stroke. When I came up to now my pt, I did my standard set of questions. He complains of lightheadedness and genalized weakness. Instinct told me something neuro was going on. He's speaking normally, no sluring, and is AOx3. Go through my neuro assessment, and everything is normal. The only thing that is abnormal is the fact that his arms and hands are ice cold, and his legs are burning up. But everything is normal. Not diaphoresising. Everything is just normal. I switch gears and keep CVA as a possibility. start asking the wife calmly for a history. HTN, boarderline Diabetis, and a few sx here and there. Last meal was at 1300, it is now after 2000. DM is a possibility, and he may have some PVD going on (can't tell you how many DM pt's I witnessed this on) which explains the legs and arms bit, generalized weakness and lighthead. By this time the PA and gynacologyist comes and the PA starts doing an assessment as well, I focus on the wife and let the PA know my first instinct is CVA but maybe Hypoglycemic. 911 is called, PA is getting the same results on the neuro assessment, and then I noticed it, the PT started to slur his words. At this point, I start speaking to the wife, wanting t know everything about this afternoon. She said he c/o a severe headache that went as quickly as it came, and massive sweating this afternoon at about 1800. (Bingo, now I am thinking of some sort of headbleed event.) I am now thinking headbleed. PT is starting to show confusion and rightsided weakness. Very visable, this guy is stroking, I wish I had my stethoscope and B/P cuff, which are back at the hotel (I don't leave home without them. You never know) The Wife is getting anxious. Just in case, he is a candidate for TPA I started to ask questions on Meds he took this afternoon and evening. Did he have any ETOH. Any ASA. Every question that could possibly R/O the pt as a canidate. (PA later commented to me that she could not believe the questions I was asking. Because she would have never thought to ask those. And was very impressed by my thinking and how I was able to keep the wife calm. And how calm and cool I was (despite the tux I was wearing) during the entire ordeal to the point that the MD offered me a job if I ever decide to leave Bedside RN'ing. When the EMT arrived, the wife got very anxious. I had my fingers on her wrist worried that she was going to MI on me. At one point she states I feel SOB and am having difficulty breathing. Her pulse was very high. I turn to the EMT and motion one over to me, identify myself as an RN and say quietly not to make the wife more anxious. "She is feeling a little SOB and is having difficulty breathing..." before I could finish my sentence and ask for 02 with a NC to calm her down the EMT turns to the wife and loudly states "Ma'am. you having difficulty breathing. Do you want us to call an additional rig?" I wanted to kill the EMT because the wife got very anxious at this point. I was able to calm her down without the O2, but the EMT defeated what I was trying to do. After I the PA gave her report and I gave my report to the head paramedic, he commented to me that this is probably the most complete report he has ever gotten on the scene concerning a pt. I just smiled. After we shipped the pt off, the other 911 call was for a ETOH drunk cousin who fell and broke her wrist. She was last seen refusing to let go off the full wine glass. The final 911 was for a employee who tripped and broke her leg. The next morning my aunt comes up to me and just says that she was impressed with how I reacted during a chaotic situation and stayed calm cool and collective, and said she now knows that pts are in good hands under my care. And that the wife told her to thank me, that I was a true hero that night. My parents also commented on how many people came up to them afterwards commenting on my performance. We also found out that he had a cerebral bleed. My first instincts were completely correct I feel very humbled by all of this. I don't feel like a hero, I was doing my job, taking care of a sick patient and trying to keep everyone calm and get as much info as possible to help find a diagnosis and get the correct treatment to the patient. We also found out that he had a cerebral bleed. The family now jokes about the new rating system for wedding. For me, I just was glad that I was there to help. But next time this happens, my nursing bag will be in the trunk of the car. Adam, RN

It really wasn't that tough. There is a lot that you have to know, but they teach it to you. But they teach you how to run a code, and it really helps you anticepate what the MD is going to order depending on what the situation is. Adam, RN.

:bluecry1:I guess stunned, shocked and grief stricken is the best way to describe my feelings right now. That also is the best way to describe my unit feelings. The patient was a favorite of the units, a frequent flier. They had been on the unit multiple times and for months at a time. The pt had wounds all over their body and constantly septic. Spent all their time in a clinitron. They were admited several weeks ago, and on a weekly basis undergo surgury for I & D of the wounds and wound vac. They had been getting better. This morning they were sent down for surgery, the pt is good spirits. (Not my pt this time around) I saw them and just said goodbye. Not my customary see you later. I don't like saying goodbye because there is finality to it. About an hour later I was in the nurses station sitting next to the OR PAC when a general page came up on their blackberry and it just said "Why is **** coding in OR?" For the next fifteen minutes we didn't here anything, then we got the god awful news. Not one Nurse or Tech who had taken care of the pt had a dry eye. Our patients could just see a difference in our body language. We later got news that they had a PE on the table. We had a brief memorial service for the pt this afternoon among the staff. I remember the first time I had the pt about a year ago. My preceptor had assigned me this pt and all she said was I was going to get signed off on my wound care today. I looked at my preceptor and said no pt has that many wounds. Preceptor just said you never met ****. When I walked into the pt's room, they looked at me and said newbie nurse. I nodded. They just said that'll change today with a wry smile. That started a relationship that was both professional and personal nature. And that was the way this pt was with everyone who took care of them. One time many months later, when I was just doing wound care all day for different RN's pt's, came to them and they said I want to get to know you. I said you already know all about me. Their response was, no, let down your hair, I want to know the person underneith that you hide, the one in emotional pain. No one expect for my therapists and family knew about my deep routed emotional pain. That pt saw what I refer to as my sorrow. While I was doing their wound care,(their wound care commonly took 2 to 4 hours, just the sheer number of them) I told them about it, my adoption. Turns out, we both were adoptees, and it became a common bond between us. That day was one of the most therapeutic days for me. They understood my grief. That pt had considered me to be one of their favorite nurses. Their family was the units family. One nurse today said it perfectly, they were our baby, the units baby. They were family. When the family came up to get the pts stuff, it was hard on all of us. They just thanked us and just said they considered us all to be family and had positive things to say about the core group of RN's and techs who took care of them. The pt will be missed. They will no longer be in pain. But our baby is gone. I plan on going to the wake, and if I am not working to the funeral. It is the right this to do. They will be missed very much. Adam, RN

Past two days, I have been taking an ACLS class, today took the certification exam and can now start adding the proverbial alphabet soup after my name. The new way for BLS CPR is completely different. No longer the 2:15 ratio, but now the 2:30 ratio. Getting past confusion, and learning how to run a code, made what I refered to as organized chaos a little bit more organized, and I now see the method to the madness. I also gave me a heads up as to what meds are going to be pushed during a code. Work has been keeping me busy. My manager has contantly been giving me positive feedback, and it has been noted by many of my co-workers, that now with 11 months of experience under my belt, that I am now calm, cool and collected when a situation arises. I have really kept my sense of humor and don't let things get to me. When the nutty (whether they are an almond, cashew, or peanut) family member approaches me, I just take it in stride and keep my cool. No use getting myself angry, or upset. I just take what they say with a grain of salt. I am also not afraid to question a MD's order without hesitation. If I feel something is not right, I will question it. Two weeks ago, I had a patient in for alcoholic pancreatitis. They had been NPO for 5 days. New resident who was in their 3rd day of practice comes up to me and promptly tells me that they are going to D/C the patient. I looked at the resident as if they were crazy. (I did not know the attending was standing behind me.) I told them that the pt has been NPO, we don't know if they can tolerate a diet. And their lipase levels on the lab went up. Resident then says to me it only went up a little bit. I then said it went up 50 points from a normal number. We don't know if it is trending upward. His responce was "I'm the doctor and your the nurse, (saying it as if I am lowly and uneducated.) and I am going to d/c the patient." I simply responded with, "and how long have you been out of schoo?" 1.5 months, "And how many days have you been practicing?" 3 day. "Do you know what the purpose of an RN is?" To carry out what the MD orders. "Wrong, it is to cover your gluteous Maximus." At this point the attending stepped in, and just said to the resident, follow me, went into the stair well where they were chewed out. Resident came out with a dejected look, said sorry followed by lets keep the patient atleast 24 more hours. Fortunately the pt tolerated their meal and the numbers were just an abnomally. And the resident last time I saw them was trying to get on my good side now on the last pt that I had. They asked me what did I think was the best course of action. I guess they learned their lesson, never insult the nurse. The latest class is going to be so much fun. Got to head to sleep for tomorrows shift. Can't wait!!! Adam, RN, ACLS

My life has been a blur over the past two months. Now that I am catching my breath, back from vacation, and slowing down slightly from the overtime, I now have more freetime. From a nursing perpective after being 10.5 months in, I am really feeling comfortable with my job. About a month ago, I had a patient on my second day with them showed some dizziness when PT went to ambulate them. I checked their vitals, blood sugar, and did a full neuro and they were all WNL. Called the MD to let them know, we decided to interogate the pt's recently installed pacemaker. Comes back normal. Doesn't sit right with me. Something is just not right with the pt, I even tell the MD this. I report off at the end of the shift for any RN to look out for these symptoms. Two days later, I am back on and have the pt with a nursing student now. Student reports to me that the heart rate is 41 with the auto cuff. Go in and assess the pt. They tell me that they feel dizzy and tired, the exact same as a few days earlier. Listen to the heart rate and I am counting 40 slow lub dubs per minute. BP is normal. Pt has a demand pacemaker set for a min of 75. This is before we move the pt from chair back to bed. Have the student and tech return the pt to bed and I go and activate the Rapid Response Team and call the MD. By the time the team got to the room, after making the mistake of going to bed one who looked dead with a non-rebreather mask (actually normal for that pt), they assess the correct pt and now is normal again. We call for EKG and remote tele hook up and then call for a interogation of the pacemaker again. Speak with the primary MD who decides to defer to the pacemaker MD. Fair enough. About 30 minutes later the arrogant pacemaker MD comes and interogates the PM and he says all is normal. I said is it possible it may not be installed correctly. Get a nasty there is nothing wrong with the pacemaker, something must be wrong with your ears. At this point I decided that I no longer want this pt on this unit, they need to be on the tele unit. MD refuses at first, but I stuck to my guns and said that this patient is no longer safe under my care. They need to be on the tele unit. Finally after 10 minutes the arrogant MD relents. But goes you are wrong and don't know how to listin to a heart beat. I bite my tongue not to say anything, I don't want to stoop to his level. Get the patient transfered, the Nurse who I reported off to calls up at one point to ask me a question on the pt and then states that I must not have been hearing the heart rate correctly and that I should have multiplied the 40 heart rate by two to get 80 and I will have a normal heart rate. Report this to my supervisor who called that RN's supervisor. We won't go there. About a week later, I saw the primary MD for that patient and asked how they were doing. Well, they were D/C, but not before having another episode, this time caught on telemetry, a heart rate of 30, with the pacemaker failing to capture. Turns out, that one of the leads of the pacemaker when the patient was sitting in a chair, was in the Superior Vena Cava. I saw the MD who said I did not know what I was talking about later in the week. I resisted the urge to tell him I told you so. It came back to me through my supervisor that the MD apoligized. I felt vindicated, because I caught something wrong with a pacemaker, and even when the MD refused to believe me, I stuck to my guns to get the patient the treatment they needed. I am loving this profession. And love everyday (even the rediculously hard ones where I get no break or lunch (which that shift and the next days shift was) and leaves me exhausted at the end of my shift.) More later. Got to get ready for another awsome shift of nursing tomorrow. Can't wait!!! Adam, RN

Yesterday, two of my patients expired. In the same room 9 hours apart from each other. I felt honored when the first family saw me walk in yesterday morning and asked me to be the patients nurse. The first one passed away at 9:15 yesterday morning. The patient was on a Morphine Drip, and when I assessed him at 9, he had just started showing the Cheney-Stokes breathing. I was expecteing it to be that he was going to pass away in several hours. At 9:15, a family member came out and got me. No heart tones or pulses. He went quickly. We were all expectinging him to hang on for at least another day. The family stated that he was a stuborn man and felt he was going to hold on.This was my second patient that had expired in the 9 months of my RN career. At 1615, I took report on another patient with a rather large family that was going into the same room. I would be starting the morhpine drip. At 1630, the patient and family arrived. I got the morphine drip started at 2ml/hr. At 1710, I bumped it up to 3ml/hr. Pt was in visible distress. That seemed to comfort her. Family called me in the room at 1750, she was in some distress again, I asked the pt if she wanted me to increase the rate again, she gave me a slow nod. I bumped it up to 4ml/hr. At 1800, a family member came out and got me. Did not say a word, just put his hand on my shoulder, I knew, and everyone in my unit knew as well, that my second patient of the day expired. Patient had no heart sound or pulses. I called the Doctor. Once the body was released, I did my second post mortom. Both of the families yesterday thanked me for both the care and compassion I had demonstrated during their familly member's final hours. I felt honored and privledged to be that nurse. And touched by their comments. I love my job. I have seen so much in the past 9 months. I have become effient and assertive. And I feel that I am doing nothing special. I feel that I am just doing my job to the best of my ability. I am just trying to be the best nurse that I can be. I don't let the stress of the day get to me (It is not worth it.) and at the end of the day, I leave my emotions of the day on the floor where they belong and I go home. I love my job, and I enjoy the days that I work. Bye for now. Adam, RN

I have been a practicing nurse now nearly eight months. What I can't believe is how well I am doing. I love getting up (okay I don't enjoy the getting up part) in the mornings to go to work. The second I put the uniform on, I become one with it and transform. My supervisor has been coming to me left and right (too the point I am started to go 'Oh no, not again...' each time.) a pin award because of compliments from my patients. More then a handfull of patients have writen it. And even recently one letter made it up on the unit bullitin board, that a patient's daughter stated that I exemplified the art of nursing. That I changed her position on how she felt about the unit. And how ontop of everything I was. Another patient dropped a card in the "Been caught fishing being the best" boxes that are all around the hospital saying that I was able to comfort and give a scared patient a peace of mind. And that they looked forward to when I was their nurse. I must have 30 pin awards now. They are all in my locker. Honestly, I choose not to wear them. Reason, while I know that I am a good nurse, I don't want to flaunt it. And also, all of these awards are extremely humbelling to me. I am just trying to be the best nurse that I can be. Making sure that my patients get the care they need and desearve. For me, I have found that nursing is the perfect profession for me. I go in there and do my job, and when the patient destabilizes, I am in there doing everything in my power, using all of my knowledge to get that patient stabile. I found that I am catching my patients constantly when something is not right. And I get on top of it. My supervisor has told me that she sees me in the crises situations very calm and very aware of what is going on. And she also feels that I am extremely thourogh and organized. And I feel it. I love my job and it shows. Tomorrow (3/27), I celebrate my 33rd birthday. I am taking the day off to celebrate. But if I see an accident, or someone collapses, I will go into Nurse mode and will calm that person down and make sure that they are stable and will stay with them untill help arrives. Like I said, I love my job, as well as my profession. Later, Adam D., RN

Your charting reflects more of the antics of the family then the patient. As the family is going balistic, you sit there smiling to yourself knowing that you are going to chart this.

You know you have a problem family member when your charting reflects more about the antects and harassement of the family member then the actual condition of the patient. Add that in to two RN's that called in with the flu, and the RN on availability was fired on friday, and you get 9 to 11 patients per RN. The good news, they held admits for our unit. And other than the fact that my patient's daughter was completely nuts, I had a pretty good day. The interesting thing, was when I saw the board, I didn't even blink. I just knew today was going to be a day that I would need to stay on task and continuely keep an eye on my patients. Charting would come later in the shift. I don't feel I compromised my patients care. I just prioritized them. And fortunately, I had most of them the day before, so I knew what to look for, and I was not flying blind. Now to my patient's daughter. Oh my god. Now I know why everyone has been complaining about her. She was the proxy for the patient who had dementia. Pt was pretty much non-responsive. Not once did I lose my cool with the daughter. Just kept on calling the nursing AD to the floor. And this person was well documented. Not only by me but by the rest of my unit as well. When I asked her to step out of the room so I could transfer the pt from the bed to the stretcher (which I normally do), she went balistic. She accused me of going to hurt the patient and that she was going to sue. (Never say that to a nurse on duty, because I will document it. And if you do sue, it shows alteriative motive and will 99.9% of the time get thrown out by the judge. I have a family full of lawyers, some medical malpractice,and they gave me plenty of advice on how to cover my backside.) Next she started following me around the unit, and at one point when I went to the pharmacy, she followed me most of the way there until I turned around and saw her, she turned around and ran back to the unit. Interesting. I documented that as well. I also documented every bit of care that I provided to the patient from the diaper changes all the way done to the how I put the pillows on the patient. I walked into the room at one point about 15 to 30 minutes after I had walked into the room earlier, I noted that the pillows that I had placed under the pt back, between the knees and under the heels were piled neatly on the garbage pail. I know I didn't and the tech didn't move them which just leaves one person. I just documented it. Then the daughter has the gall to accuse me of not turning the patient every two hours. Interestingly enough, the daughter was there the entire time, saw me several times go in and turn the patient. And then becomes obsessed with saying that I did not provide any care for the patient. The daughter was abusive towards me and my tech. And harrassed me. I just documented every bit of it. From 9 am till 1855. It took me two hours to document that one patient. Insane. The amazing thing, not once did I get angry. Not once did I talk back to the daughter. Not once did I raise my voice. I just kept the smile on my face and reminded myself that I love my job and that I am not going to let onc nut case change that for me. And that I was going to have a field day documenting all of this. I got commended from the Nursing AD on my professionalism today, and she told me that this was pretty much the same old from this person and that tomorrow, risk management is going to be taking a look at this person and also getting SW involved as well as a judge to remove the bi-proxy and transfer the care of this person to the state. I love my job. And I did not once allow this person to get to me. Yes she gave me heartburn. (Took mylanta, god that is the worst tasting stuff.) and took everything that she said with a grain of salt. Because, there is so much documentation from patients that states completely the opposite of what this patient said. Now I am going to go to sleep and enjoy the next 3 days off that I have. Adam, RN

My thing was BM and Vomit. Early on, when I was a student, I got over my vomit issue very quickly. How you ask, had a patient declare to me that she was nauseaous, and stuck a kidney basin in front of her mouth and then she vomited. THe vomit went into the basin out the otherside and onto me. I refer to that day as trial by vomit. My feces thing taken care of as a tech on a neuro resp unit in a day that was pretty crappy. I changed more diapers that day then I cared to remember. By the end of the day I was handling BM like a pro. To the point where I went to turn a pt and stuck my hands into a chocolate suprise bare handed. It happens. You will get over it. And yes, we all do pass out sometimes at the side of blood. I did so in a bloodless surgery after seeing Ears nose throat surgury which can be blood for days on end. ANd then a see a achillies tendon repair and pass out. Go figuire. It come with the territory. If you feel as if you are about to pass out, get your back to the wall. This way when you loose consciousness, you will slide to the floor and injury will be minimal. Adam, RN

Hey Rachel, I been praticing 6.5 months now, and I still feel like a student at times. I started feeling like an RN when I came off of orientation. I stopped feeling like a student after a few weeks when I stopped looking for the instructor to check my meds. In away, you will always feel like a student as an RN. And that is a good thing, because in nursing, you are always learning, and will always be a student as well as an RN. I'm glad to hear things are going well for you. Keep up the good work!! Take Care, Adam, RN

Christine, First, Happy Birthday. Second, good job. You did all of the right things. Sometimes you need to keep on top of what is going on. Chest pain can be anything. And there is such a thing as a silent MI, you have one symptom, and all of the others are missing. But again, good job, and again, Happy Birthday. Adam, RN