I am an RN with 20 yrs of hospital based experience in a variety of settings and have worked every shift there has ever been. I currently work 7P-7A in a 15 bed ICU at a community hospital in Central Florida(I started out as a Nursing Supervisor for the first 8 months but realized I am nurse and not an "administrator"). My background prior to that had been over 8 yrs of ER nursing in 2 different states, I had always wanted to try ICU but didn't think I'd like it. Anyway the other night a man I had taken care of several times in the past (with a very long cardiac hx and bad heart) started going south on me at 5:20 AM. His wife was staying in the sleeping room of our waiting area so I sent someone for her first. He had been sinus rhythm 70-90's all shift and all of a sudden now he is sinus tach vs atrial fib 130's and SOB. I immediately increased his O2 to 6L/NC, turned off his Dopamine drip and hung Neosynephrine to boost the BP I was losing too, changed his O2 to NRB 100% after a few minutes. I annoyed his MD by waking him up just before 6AM and told him Mr. M is trying to die(Mr. M had made himself a DNR the day before) and got orders for resp treatments, Morphine IV and to cover the Neo too.
Resp tx may or may not have helped but the family knew I was doing what I could. Monitor was saying V-Tach but didn't look like it(pt had an AICD that hadn't fired yet) and I considered Lidocaine but didn't want to lose the pulse if I relaxed the heart too much. When the rate increased and looked more SVT vs A-fib I considered Lopressor but the Neo was still working to bring up his BP and that would have tanked his pressure. The Morphine helped him to breathe better and for a little while he was quite gray and seeing dead relatives(which is never good), but I held his hand and continued talking to him throughout this. Next thing I knew the dayshift RN was behind me for report, we got the cardiologist involved but Mr M just kind of pinked up and HR went back to sinus 80's. When I left the room Patti (one of recent grad nurses on nights was sitting with our unit secretary(Teresa) and smiling at saying "she was right". Apparently the secretary had told Patti to watch me telling her "if there is anyway or anything that can be done to keep Mr M here
then Paul will do it". I was a little taken aback by that and almost embarassed by it but since I have gone into ICU back in April I have pulled all stops to do whatever is necessary to keep my patients going on my watch and hadn't realized until then that apparently someone had taken notice of this. I may not be the best ICU nurse but I use my critical thinking skills, ER experience and general nursing experience and knowledge to the best I can for my patients and consult with my colleagues and docs as well because they're why we are here in the first place. So I guess I do okay......
Nov 19, '06
It does sound like you do "okay". It sure is nice to hear someone say it to you once in a while tho, isn't it. You sound like someone I would love to work with and learn from. Keep up the good work.
Nov 26, '06
wow, you are amazing. I can only hope to be so efficient one day.
Nov 26, '06
You did way more than okay Paul. Great save and great judgement too. WOuld love for you to care for me or my family members if we ever need ICU care.
May 19, '07
God I would love you as my preceptor !!!!!!!!!!
May 25, '07
Wow is all i can say. Can you precept me?
Jul 4, '07
paul -- great job! I am a nurse with only 6 months experience. I admire you for your knowledge and courage. You are the nurse I strive to be -- I will keep your story with me! Thank you for sharing!!!!
Last edit by JennaRN1006 on Jul 4, '07
Jul 4, '07
Please add me to the list of "will y ou precept me" in 2 yrs?? haha. You sound awesome dude.