tRiguN

Please excuse what may seem like a rant, but I can't vent anywhere else and the relative anonymity of cyberspace seems like a safe space. I've currently been working on a cardiac step-down for a year and have been looking within my institution for critical care positions. I generally like my floor, the patients, and my co-workers, etc... but sometimes the gossiping/cattiness/laziness really, really gets to me. Many times I feel like the nurses I work with, especially some of the older gals, just want to do the bare minimum of work, throwing a fit when I (or anyone who is the designated "team leader") give them a higher acuity patient or a central monitor pager in order to try and make everyone's assignment as fair as possible. Many times these nurses will sit on facebook while their patients' call lights are double blinking. Don't get me wrong, I like to check my e-mail and facebook when (if) ALL of my tasks/charting/patient care/reading progress notes are done, but sometimes it is ridiculous; if I notice another nurse's light has been double blinking for a while, with no techs in sight, I will go answer it myself. Granted, some of the other nurses gossip about these individuals' slovenly work, but they also like to nit pick other, irrelevant things about everyone. It makes me paranoid that whenever I enter the conference room and it's quiet, that they were talking about me the second before I opened the door. I have very little trust for most of my co-workers and I'm tired of cleaning up after them. Many times, their assessments have been lacking, missing very important things, like fixed pupils, femoral bruits and such. By no means am I perfect, but for whatever I lack/mistakes I've made, I've done everything I can to learn from them as well as helping out my co-workers when they're in a bind. I feel stuck between a rock and a hard place since I'm fairly new there and don't want any suggestions/constructive criticism to be taken the wrong way, which it would be by many of these individuals, so I bite my tongue, be helpful and nice and bide my time until I can try and confront these individuals in a constructive way. I don't know if management needs to get involved. The other night I was running from sundown to sun up with a difficult patient who really belonged in the ICU, but the service wouldn't transfer. I was proud of myself for handling his difficult, demanding family and exceedingly complex care needs...by the morning his temp went down from 40C at initial assessment to 36.5, HR from 130s to 80s. In-between paging, calling, hanging gtts, passing meds, doing an admission and generally taking care of this very sick patient and my others, I wondered, if this is what it's like in the ICU, it seems like nobody would have the time or energy to really sit around idly and gossip, play on the computer. I was ready to pass out during report because I gave my patient and his family everything I had. I seem to remember being impressed during my senior year in school about the cohesiveness of the nurses and doctors in the SICU where I had my clinicals and wondered if it was a general ICU phenomenon. I have very high standards for myself and thus for my brothers and sisters in this profession. I don't know why they became nurses, but I did it because I want to help ameliorate people's suffering and save lives. Please tell me there's a Valhalla out there somewhere for a young, motivated, Type-A, detail oriented nurse like myself who is tired of indolence and cattiness. I have reached a turning point in my first year, where I no longer cringe at difficult situations, where veteran nurses are now asking ME how to do certain things on the unit and I feel like I'm ready to step it up a notch. Please tell me if I'm deluded with my critical care dreams... If you reached this sentence, thank you for taking the time to listen...

These are all great pieces of advice and very true, having just survived my first year as a nurse on a cardiac step-down. As a (fairly) new nurse, I will use some of my more cringe worthy mistakes at the beginning and valuable lessons learned through the year. 1. Sometimes artifact can look very convincing on multiple leads at a quick glance and sometimes paced patients without spikes CAN look like they're in idioventricular rhythm (usually you can tell they're paced even if the spikes aren't there, but there was one patient on our unit that had the charge nurse running in there before their nurse came and said, "it's okay, he's paced, I forgot to put the pacer settings on!") When in doubt, run to the patient's room. My doing so has saved 2 patients and all the other times, I didn't allow myself to feel too silly. 2. Beta-blockers. ACE inhibitors. Calcium channel blockers. Blood pressure? Heart rate? Borderline? Page the doctor and if they order you to give it, especially if it's a new med for the patient who has borderline vitals and they're supposed to be getting other vasoactive meds, document who told you to give it! Cover your butt. One of my first patients off of orientation, I gave ordered metoprolol to and he went into a very symptomatic junctional rhythm. Needless to say, docs decreased his dose from 50mg to 25mg and I learned a valuable lesson. 3. Get comfortable with basic neuro. Check all of your patient's pupils and pulses. There are so many times when I've gone into a room after seeing another nurse's assessment "pupils bilateral equal, reactive...." when in fact they are fixed or unequal. Check your new, unanticoagulated afibs (especially w/ rapid ventricular response) for signs of stroke or PE. I had a guy who had just had a stroke and NO ONE other than the neurology team had done a neuro assessment on him (when I put him through the paces he was like, "are you from physical therapy?" haha). I put it in the order for routine neuro checks....especially since I found he had left hemiplegia and a drift. 4. Do not be afraid to talk with the doctors and barge in politely, especially the attending MDs during rounds if you're at a teaching hospital. I hope that some of the interns will come back as attendings someday to our floor because they are going to be excellent "bedside" doctors and colleagues. Others I have not been happier to have seen gone because of their complete idiocy (not to say I'm perfect obviously, but some of these interns should just stick to research and stay the hell away from real patients). 5. Related to above. PAGE PAGE PAGE the doctor when in doubt or try to hunt them down if you have any doubts or something isn't right, be it something a patient said, or a questionable set of vital signs. 6. If a patient is feeling dizzy and they are able to stand safely, you should always automatically do orthostatic BPs and check the most recent creatinine and look at your I&Os. It might just mean a simple fix to a fairly simple problem (dehydration) and save a lot of paperwork for you if your stubborn patient decides to go to the bathroom when he's wobbly as a new fawn and falls down. 7. If you have time and your patient wants to talk, listen to them. Not all of the therapeutic communication stuff you learn in nursing school is ********. By cultivating my listening skills, I was able to learn from a patient exhibiting subtle drug seeking tendencies that he was suicidal and had plans. But when I asked him why he hadn't killed himself yet, he said he still had a little hope that things would get better. I went through the appropriate channels to do my best to get him help. 8. Codes. You WILL be TERRIFIED. When someone else's patient codes, jump in there, preferably as the recorder. You have a very valuable role, but you are away from the action and get to observe and learn. Don't worry if you make mistakes on the recording sheet..everyone does..just recopy it if it looks like a huge mess. Make sure you get names and don't be afraid to ask what the drug is that's being pushed so you can write it down with the time. 9. GET ACLS CERTIFIED. YOU WILL NOT REGRET IT. These are just some of the tidbits I can share from my both terrible and wonderful first year as a nurse on a chaotic cardiac step-down unit.

I feel so defeated...what happened? The first 3 days on nights were awesome, went smoother than a criminal, (This is month 3 of orientation on a hectic Tele/Step-down unit), and the last two have been simply, self-defeating, frustrating hell. I'm on my own this Sunday and tonight is my last night on orientation. I started having having panic attacks a few weeks ago, which I've never had before. Work haunts my dreams. My preceptor told me today at the end of the shift when I stayed over to finish all of my charting from the heavy load I have that she thought I was doing really well, but that I just get too flustered and lose track when something aberrant happens. She's partially right; I do get flustered really easily and I know that's gonna have to change if I want to not drop dead of a simultaneous heart/head implosion. However, mostly it's just because I'm slow and cautious; if I went at the speed she and some of the others went, I would hurt people, probably myself as well. I hope they are lighter on my assignments in the beginning or my computer may be in danger of drowning due to some major eye leakage as I seek solace on allnurses... I guess I just gotta restrategize and work around my relative slowness, which is fundamentally a disability at this point... I want to talk to my patients and listen to their stories... there's just no time though... one of the greatest tragedies of all. Maybe I should be a psych nurse- I think I might be good at that... or I should've just followed my head and been a biochemist instead...