SICUshortCait

This is something that’s been on my mind for a little while now. I’ve been hearing recently how what nurses are being exposed to is just part of the job. Death is part of the job that’s true, but that doesn’t change the toll it takes. Seven years later I remember the first patient I lost. I remember her name. I remember that she was an EMT who wanted to become a nurse. I remember that her squad was going to pick her up from the hospital when she was discharged. I remember how we braided her hair that day. I remember how she was transferred to the floor, but threw a fat embolism and came down coding. I still remember the chills I got when one of the nurses I respected most, came to give me a hug, but I had to stop her so the tears didn’t start pouring down my face. I remember that same nurse meeting me at my house with a bottle of wine that night. We spent hours talking it all through. When I think of grief and loss, I can picture the fluorescent lighting of the unit against the dark windows and the cries of the moms who lost their babies. Now as a mother myself, I have moments where these losses invade. I go to pump and I think of the mom who needed a hospital grade pump to donate milk after the loss of her daughter from a traumatic birth. I hold my son and I have to close my eyes and will away the memory of that same weight on my arms as I gently lay someone else’s child on the table of the morgue. I remember their names. I remember their funerals. I remember their families. Sometimes at weddings I remember the husband that came in to say “that’s my sweet wife you have there… we talked about when this day would come” and the look of love and sadness on his face. The thing is I don’t even work at the bedside anymore. I left in 2019 before masks became reusable. I felt the loss, the stress and the under appreciation back then and I left. We had time to process back then. Each loss was an event. It wasn’t the norm. We came together, we mourned and we’re still haunted by them. What HCWs are going through now is not just the job. It’s the trauma of trauma. It’s real, and it matters and we need to do better.

It'll cost you an arm and a leg

We all know we have to keep it objective and professional when we write a note, but clinical notes are really masterpieces of restraint. They summarize our chaos in a way that makes us look like Daenerys Targaryen calmly walking through fire as everything burns behind her. Let's be real though; the sense of humor we have gained from this job can only be kept at bay for so long. Any nurse could write a book about their life and entertain the masses enough to retire like JK Rowling and be done with it. Our notes, however, appear to be lacking that certain je ne sais quoi that makes us who we are. That is, until you know what it is we are really saying. At this point even the MDs are able to joke about the note that will follow our conversations. So keep on writing your notes, hopefully with a smile, and know that I know what you really mean by: "MD aware. No new orders received" aka told physician and nobody cared; butt covered "Patient arrived to unit" = Here we go again. All hands on deck "Patient alert oriented and independent" = yessssss "Patient Intubated and sedated" = That'll do donkey. That'll do. "Will continue to assess and notify MD with changes" = RN knows something is up; will continue to harass physician until something is done about it "Patient repeatedly reminded to..." = oh my god. oh my god. sttaaahhhhpppp "RN called provider to bedside, provider at bedside to assess" aka They saw this **** too, it was not just me! "RN asked provider for...; provider said not necessary at this time" = Oh man I told you so "Notified charge nurse patient requiring 1:1 care" = Can someone throw me a life raft over here? Anyone? Anyone? Buelleeerrr?? "Lab notified RN specimen clotted" = are you serious..seriously.. "Medication not available" = Sorry sir our pestle and mortar downstairs must have broken today "Respiratory Therapist at bedside" = I needed an adult. They can't even breathe around here without us today "Patient had large bowel movement" = Code Brown! Save yourselves! How was the ceiling even in range?! "Patient ambulated around unit" aka I am NOT about to disimpact you today sir "Patient managed to get out of restraints and..." = ...sigh. Houdini over here. What the *... We've got a lively one over here folks! "Patient demanding to sign out AMA" = oh please oh please I triple dog dare you (jk please just get better and be nicer) "at 0745 RN noticed patient showing sings of distress, 0830 first unit hung..." = so this is the first time I've sat down, my day was a ****show and my shift is over. This is going to be one long run on note and that's that "RN notified resident... resident stated we will discuss on day rounds" = Where are the adults at this party? can we get some coffee up here? "RN walked into room, found family touching equipment" = AW HELL NO "At 0700/1900..." = because of course that's a good time to start anything "D/C teaching complete; patient being discharged today" = You're on your own now. You know what to do. Take your meds. Don't talk to strangers. You can do this! buhbyeee The truth is our notes can never really tell the whole story, so if you're not one of us: buy your nurse friends a beer and ask them about their day. Steady your stomach and prepare for some anonymous stories and an all around good time. We documented. It happened. Just check our notes.

So he said hold my beer.. .And then he did what?!

I had a charming "seasoned" woman who said "You're just like your father and make your mother cry" ( I am but she doesn't know him, nor does he make my mother cry); that I was a Big dumb A-hole; and that I was running around like a little cockroach haha she instantly became one of my favorites. I had a gentleman however who attempted to "compliment" me by saying "you have the magic touch" when I put on a condom cath....That in turn made me want throw up in my mouth. You win some ya lose some I guess..

To use the study materials? Didn't know! Will certainly delete the above haha thanks!

Borrow some study books from friends and focus on the chapter tests and your weaker category of test questions

Kaplan has online options that are more affordable. If possible just purchase their question bank. Keep taking mini practice tests of 20 questions from the bank so you can get through them fast and really read the explanations. Look at the categories you're weak in and take a bunch of mini tests only in that category. Then start again and attack your next weak area. Two days before the test take a full length set of questions. Read the explanation but don't panic at the score the questions are all above the passing line. The day before the test do something fun and don't study. Then eat a good breakfast take a deep breath and go get your RN!

Thank you! Of course you can!

I was a new grad hired to the SICU/NSICU last year! I love this article because it shows how important the impression you make as a person is as opposed to always focusing on just the paper. My manager said "You're all smart; you're nurses. We can teach you trauma nursing and critical care; we can't teach you how to connect with people. That's what I'm looking for"

My friends and I often get asked why we want to talk about work when we're not there. My answer is usually because I'm a nurse. Now, traditionally I'm supposed to say it's because I love my job, and often times that's true; but what about the other times? There's an interesting culture among nurses that we have to love our jobs all of the time. It's the precursor to every story, every venting session and the default answer whenever someone asks how do you like it?”. The immediate response has to be I love my job, (insert rest of sentence), but I still love it”. I Know that even putting these words to paper will cause an outcry that maybe I should choose another career. Is that really fair though? For once I am going to be honest and tell you why I love being a nurse, but not all the time 10. If you didn't document it, it didn't happen”. This is a cardinal rule of nursing hammered in our heads since school. This means that no matter how busy the night gets, no matter how many units need to be hung, doctors we call, or hands we hold there will be times when I'm only as good as my flowsheet. 9. Treat your patients the way you'd want to treat your mom” I would love to. Truly. There are times I have left and cried to my friends because I felt like I wasn't able to live up to this. I remember a particular night having a patient use the bedpan because I just didn't have 4 people to help me get him up in the middle of the night. My mother would have wanted to cry and I know that and it killed me. Or, when I have patients who are in their 90s and want nothing more than a glass of water, not thickened to the point of being jello, but real water if that were my mother I'd let her have it. When it's your mother however I can't. 8. There are times when your family member passes that I am so relieved. Times when I am sad that when I come into to work to take care of them that they're still there. Not because I don't wish they would get better, but because I know they won't and I want them to find peace. I don't wish to come into work and poke needles into their arms and turn them every which way unless I truly believe it will help them. 7. On that same note, Science has not beat mortality, nor has longevity of life bettered its quality. There are patients we cannot save. There are days where you will sit on my unit with your family, I will step out of the room, take one look at your face and my heart will break. I may offer you water and tissues but I cannot mend your heart. I may have spent 12, 24, or 36 hours in your family member's room. They may have become my grandma, my mom, my friend for the week and I know there's nothing we can do. I may have just done compressions moved as fast as I could to hang blood I may have silently prayed that this time I'd find their pulse, but I lost. 6. So that I can stop the tears while I write this, Do you like poop? I don't. Not when it's coming from where it comes out of you and me, not when it's diverted into a bag, and especially not when it's vomited (yes that happens). If you want me to tell you I love cleaning it I just can't. What I can tell you is that I love that I can tell you that it's okay everybody does it, that I can try to make you feel dignified when you want to feel mortified, that I can cheer for your bowel movement like you scored a goal. I love that I can get you to the point where we're both laughing about it and you feel better. 5. How simultaneously long and short 12 hours can be. There are times that I would love to hear every story from the time you were a child until now. Truly, if there were a a certification in patient chatting I would sign up yesterday. I love getting to know you and what you've done in your life. Unfortunately, there are times I have to cut you off mid story to run to my other patient, to answer my zone phone..Oh zone phones that'll be number 4…, or to help another nurse. The worst part for me is that you may be thinking your stories aren't important or that you're not my priority. The truth is that nothing could be further from the truth. I think about you from the moment I get there until long after I'm home, and probably after you're home too. 4. Zone phones. We have a love hate relationship. Before I was a nurse I was a unit secretary and let me tell you I get zone phones, but man are they annoying. Half the time when they ring I'm in a contact room or doing a sterile procedure or mid conversation with a patient. What I do love is when I sneak one to a patient's ear because while they can barely remember where they are they want to call their wife or husband and hear their kids. I could listen to that all day. 3. I'm not perfect. I hate this part. Don't you? The truth is we all make mistakes. Unfortunately my mistakes can have big consequences. Life and death consequences. Nurses need coffee to think just like any other person shuffling to work. We need sleep. We need to not have real life happening at home. Nurses like you know this is not how life works. Sometimes we're tired, we're stressed, we get one second of distraction like anyone else and mistakes are made. Some people make typos in a big presentation. Some people leave their boss on speakerphone when they meant to hit mute. Us? we can have med errors. People can get hurt. People we work our butts off to protect and care for. These mistakes haunt us forever. Trust me. I've made mistakes before, that luckily were harmless, and I still think about them everyday. So nurses be kind to each other when this happens. 2. I love my patients. Is she getting confused? that sounds like a good thing… Give me a second. I love my patients so much that when they hurt my heart hurts. When they pass away I cry on the drive home. We call each other to say ‘hey I heard” and talk to each other for hours. It's your family and when we are at work we will comfort you. We will cut locks of hair for you to remember them by and stay with you as long as we can, but when we leave we lost someone. I worry about them constantly. I come into work hoping their name is still in MAK but they've gone to the floor. I hope that they're extubated, I hope that their pain is relieved, I hope that if I ever see them again it's because they want show us how much better they are. I high five and hug them when they move an extremity they weren't able to move the last hour. I am PROUD of them. 1. I don't like that I don't always love my job. I worked my butt off in nursing school. I fell in love with trauma nursing during clinical and I was hooked. I went to the Surgical/ Neuro Science ICU straight out of school and I couldn't get enough. I would stay late just because I didn't want to leave. I loved every second. I hate that I don't always feel like that anymore, but I think it's important to recognize that it's okay to feel that way. We work stressful jobs. We have hard days. What I know I do and always will love is that I have the opportunity to be your nurse. Every time I hold your hand when it hurts or you're scared or you're grieving I feel so lucky to be able to do my job. When you tell me you never thought you'd get this far I will choke out the words I'm so happy you did” and I will feel so thankful to have been a part of that journey. Every family member hug I get, every patient smile, every handhold, every word of encouragement from my coworkers are the reasons I may not always love my job, but I'll keep coming back for more!