We did the best with what we had! I feel like a real RN for the first time in 1 year

[Morettia2, BSN, RN]

I usually post here about how much I hate where I work, and the lack of teamwork on my floor.

Well something AMAZING, just short of a night shift miracle happened last night. Although when we started shift at 1900 we thought was going to be a giant disaster.

So 2 nights ago one of the RN's threw a hissy fit b/c she was being pulled to the CCU and she calimed she was sick and went to the ER, they gave her 2 sick days. So during the night I looked at the schedule for the following night(which was last night) and realized that the nurse that was sent home was susposed to be charge nurse last night. Since she was sent home "sick" with 2 days off, I noticed there would only be 3 of us. And ALSO realized that it was me, i have 11 months into my first year, another RN 1 WEEK OFF ORIENTATION and a BRAND NEW NURSE, and another RN who just completed her first year and has 2 more months exp. then me.

I said to the Charge nurse who is also the Nurse Manager at night for my floor, "Ok so whs is going to be charge tomorrow night?" and Showed her the staffing grid. She was like "ohhh..."

So I get to work tonight, I work on an Interventional Cardiology, CCU step down unit which is a HUGE unit. I was kind of excited to see what disater is going to happen with 3 new nurses runing the floor. I was kind of hoping that one of the experienced night shift nurses would come in, BUT, no one wanted to come in, which was a blessing in disguise.

So I see that my girlfriend, who has 2 more months more exp. then me is going to be charge, this is her first time EVER. She came in and freaked out, called the director for my floor, and the director said, "oh you will be fine" and hung up. Now my girlfriend is 8.5 months pregnant and going on maternity leave next week. The day time chrage nurse gave her a horrible pt. assignment of 5 pt's..no charge nurse at night ever gets that many.

I had 6 pt's normal for me, I have had 4 of the 6 for the last few nights and the new RN also had 6 pt's. Out of the 17 pt.s on the floor, we had 10 complete care pt's that were CVA pt's with every thing a horrible CVA can do to a human being. We had 3 isolation pt's, which my girlfriend being 8.5 months pregnant can't take an isolation so I said I would take the pt. and switch one of my pt's. So I ended up with 2 isolation pt's, no prob. We also had one pt. on a pt. watch A.K.A one to one, but the pt. really didn't need the one to one.

So I pulled my girlfriend aside and said, we are going to work as a team and we can do this. I said that I would help the BRAND spanking new RN, 1 week off orientation with what ever she needs. I also said it was my 3rd night in a row and I pretty much know all the pt.s on the floor, and since neither of the 2 RN's had worked in a few days, I was able to answer any questions they had or was able to point them in the right direction.

So during shift change, one of the pt's that the new RN has, the SP02 desated to 69 and the pt. was dyspenic and unable to verbalize how she was feeling due to expressive aphagia, plus the p.t is IDDM. I had that pt. 2 nights ago, and knew the pt. and the pt. and her family loved me. The new nurse kind of freaks, is running around the unit trying to figur out what to do. I went in the room, assessed the pt. Calmed the new nurse down and said get a non-rebreather, and I will page the tele resident. The resident comes and is aksing 1 million questions to to the New RN, she is flustered, trying to answer, I know HOW that feels. I said the pt. had been recieving 0.45 NS@ 80cc/hr for the last few days and it was d/c'd a few hours ago. The pt. output was decent, pt. had a foley. Pt. had NO Hx of CHF, or Renal inuffiency. BS was 150, pt. and since I had been with the pt. for the last few nights, she didn't look edematous at all, and upon assessment didn;t have any pitting edema. So the MD orders lasix, but only 20mg IVP, the pt's isn;t hypotensive and the K+ was 4.5. Anyway, SNAFU, but pt. was in fluid overload to say the least, with B/L crackles. But we got it under control.

So around 2200, I hear and see that one of the new RN's IV pumps is beeping, she was so busy and I told her I would help as much as I could b/c I knew or had had half of her pt's. I go to flush the line and see that the IV is infiltrated. This is the one to one pt. Pt's in bad condition, and has been on the floor for 2 weeks. I had taken care of her last week and pointed out the the MD she was hypovolemic last week but the pt. was CHF so pumping the pt. full of fluids could prove disaterous, the pt's about 80 lbs, 95 y.o., no family and when she was verbal was one of the sweetest people. But her condition changed in the beginning of the week when one night ( I wasn't working) the pt. managed to get out of bed and walk across the room to see her roomate in the bed next to her, the pt. hasn;t ambulated in over 5 years but decided to give it a shot and when the RN taking care of her found the pt. the pt. was on the other side of the room sitting on the floor next to her roomates bed. The pt. didn't fall out of bed, unless her bed had an eject button that would throw her on the complete opposite side of the room, but decided she was tired and wanted to sit down indian style with her hand folded and smiling. Since the event, she is now non-verbal, unable to move and the one person responsible for the pt. made her a DNR, and has that stage IV heart failure look to her face, which the new nurse had never seen. I said once you see it, the look, you never forget it.

Anyway I grabbed the new nurse and said come here, you have to see this as a learing exp, she was said" what did i do wrong?" I said, "YOu didn't do anything wrong, the line was able to flush before you started the Levaquin IVPB, I saw you flush it was ease, it was a new line that flushed beautiful, these things just happen sometimes. But have you ever felt subq tissue emphysema?"I showed her that since the pt. was so cachexic, when the IV infiltrated it caused the arm to have crepitus or like subq tissue emphysema. I said feel the area that is puffy and swollen. Don't push on it but just palpate it, it feel like human bubble wrap. That's crepitus, although it's not a pleasent thing for the pt. to exp. it is a great learing and visual exp. She said, "are you sure ou have only been an RN for 11 months, how do you know this stuff?" I said, "I had the best clinical exp. in college at 15+ hosp. and healthcare settings, I got my fair share of these situations in school and on this floor as an RN."

I said i would page the Medical resident and the house MD for her, b/c she was in the middle of hanging heparin when this happened. I said grab a cold pack from the pyxis supply and I will wrpa it and elevate the arm. I told the MD's what happened, and that we applied a cold pack, I said the edema did decrease and we d/c'd the IV. They didn't seem to concerned since we caught it right as it happened and implemented cold paks and elevation of the arm and d/c'ing the IV. By the end of shift this morning, you would have never known the arm swelled up, it was back to normal.

Anway to continue the night, my girlfriend who was charge said to me, how about we split the charge duties. I said ok, we can both learn from this, plus I didnlt want her to stress and because she's ready to have that baby any time, and because we have about the same amt. of exp. we can feed off of eachothers ideas, and she's one of my bestfriends on nightshift. I also said I would deal with all of the annoying phone calls, she lauged and said, "Thank God, Ang you are the nicest and most caring RN I know, but when you need something to get done you are firm and blunt with out being a *****, and that's where I have a hard time, beacuse I am a push over."

So we deemed ourselves Super Charge Nurses 1 and 2. She was 1 and I was 2. Our tele tech. who has been working on my floor for years, said ,"In all of my years working on this floor 20+ years, and even as a LPN(she retired from being an LPN and took the tele tech position) I have never seen first year nurses, even the experienced nurses pull togeter like the way you two are doing and run this floor the way it should be run." That felt good comming from her.

And the night goes on..So we get a phone call from the Nursing office at 2330 telling us that there is no pt. watch aid, or nursing assistant available to watch the one to one pt and that our regular 11p-7a CNA would have to do it. The new nurse took the messgage. She told me, and my girlfried. My girlfriend said to me, "Ang, here's your time to shine"..We began laughing b/c I had told her I would take the ANNOYING phone calls like this one...as my girlfriend was sitting next to me, we decided that the pt. is in a room right at the nurses station and can been seen at all times no matter what, call it convience or a miracle, we knew we had 10 complete care pt's and a few partial care ones and needed our CNA, and that our CNA wasn;t going to do the pt. watch, because the pt. wasn;t in danger of hurting her self, the pt. was like I said before, Stage IV heart failure, and since her little yoga demonstration 1 week ago hasn't been a problem since.

I called the nursing office, told the supervisor our situation, he gave me the run around. I said, "How come last night you sent 4 11p-7a CNA's to our floor at the same time to watch this patient when we only needed one, and that was on top of the 2 CNA's that are our permant full time 11p-7a and one CNA orientee. Did not one of the 10 staffing clerks you have down there read the staffing grid last night and think maybe they should schedule one of the 4 CNA's that were sent to our floor last night to do the job of one, to come in tonight for the pt. watch. You know we had a sick call for one of our RN's tonight, we are only 3 RN's, one of whom is 1 week off orientation and a brand new nurse. It's the charge nurse's first time EVER being in charge, not to mention all 3 of us RN's are first year nurses." He said to me, "well we are going to pull your CNA to another unit tonight (basic tele unit but the pt's are not as heavy as pt's as we have b/c ours are CCU step down and Inter. Card. pt's, I have worked on that unit a few times so I know), b/c they only have 7 nurses." I said, "You are not going to pull our 11p-7a CNA to that unit. And what is the nurse to pt. ratio on the other unit??" He said, " Well the charge dosen't have a pt. assignment, and the other 6 nurses are 5:1." I actually had to hold back the slew of curse words that were ready to come flying out of my mouth. I said, "My charge has 5:1 ratio and is 8.5 months pregnant and this is her first time ever as Charge, I have 6:1 ratio and the other RN is a brand new RN which I stressed also has 6:1 ratio. Also did I mention we are all first year nurses? I think that floor can manage since the charge dosen;t have a pt. assignment and can help her fellow RN's. We also have one pt. with constant CP who is unstable and one pt. that desats when she takes off her Non-rebreather, and we have one to one with no pt. watch aid available so our CNA is not going to be pulled to that floor. I think, actually I know that floor can manage with out our CNA." He said, "Well..your CNA can stay." I felt like a ****** lawyer, and that I just I won a court trial, pleeding our case. But hey I got my CNA to stay on my floor, which she is awesome along with the other CNA that works 11p-7a but was off for the night. My CNA was sooo happy she got to stay.

So my girlfriend and I tell her she dosen't have to do the pt. watch, she was so happy, and that we would help her with the complete pt's, she said to us "Angie has been here the last few nights with me and she knows which pt.s to help me with, not a problem for me." I told her that I would relieve her for her break and I let her take a 1.5 hour break, I didn't mind, she is also one of my bestfriends at night.

I also had the awesome news that the night before, my other favorite CNA and I found a brand new Vital Signs Machine on another unit and asked them if we could keep it, they said sure, and we hid it from day shift CNA's and let it charge all day long. We have about 20 vital sign machines on my floor and NONE OF THEM WORK EVER!! And the day shift CNA's never plug them in to chrage, so when my NOC shift CNA's so the vitals the machines either don't work or are broken. We told her how we dismanteled the machine, so it wouldn;t work if the day CNA's were to find it. We are evil I know but these ladies work their butts off at night, the day CNA's, which there are always 4 of them leave my 2 night CNA girls with a ton of work. And we are lucky if we have both Night CNA's. She was so happy when I got the machine out of hiding, its a brand new machine, and cuts her time in half for doing vitals. I also made a pot of her favorite coffee, but I do this all the time.

So the Night Nursing Supervisor is making her floor rounds and comes on our floor. She's one of the best supervisors the hosp. has ever had, and has been there 38 years. She says, "Soo Bobby, how's being Charge Nurse feel, I will help you with the updates not a problem, I remember my first time being charge nurse I threw up on the floor assignment sheet b/c I was only 6 months into being a new RN. And Ang, I heard you gave the evening Nursing Supervisor hell about pulling your CNA...GOOD some one on your floor actually stuck up for your RN's and CNA, and that's the first time in my 38 years at this hosp. that an RN from this floor put their foot down and stuck up for their collegues and didn't back down. So let me guess, you two are splitting the charge responsibilites and Ang you are the resourse RN for the new RN off orientation." My girlfriend and I just looked at her in AWE, that she said that. Our faces gave it away, she said "Girls, I have been doing this for 38 years, eventhough I am the hospital nursing supervisor at night, I am and will always be an RN. I know how you feel and what you are going through being first year nurses and I am just amazed every time when I see REAL TEAM nursing. You girls are actually smiling which I never see on this floor, and you feel like a TEAM which is also rare on this floor. I am so impressed with how you handled what could have been a disaterous situtaion and used your knowledge and skills as RN's to delegate, manage and make decisions. Angie and Bobby, you were able to plan and play off each others strengths and weaknesses and collloberate as a unit, the 2 of you took responsibility as charge nurse. The fact that the two of you have only 1 year exp. as RN's, and were able to come up with a plan of how to manage the unit, with in a matter of minutes of getting report, shows that you have become REAL (in the sense of we found we are just more than Staff RN's, we can run the floor, and we had more confidence than we thought), responsible RN's. The two of you did an excellent job, and If I was a staff RN, I would love to have you 2 as my charge nurses. I am going to tell your Floor Director what an amazing job the two of you did with what you had and what little was handed to you. The 2 of you didn;t back out or give up when you saw what your responsibility was tonight. Congrats and I know when the 2 of you leave at the end of your shift, you will feel a great sense of accomplishment!!"

These words comming from this Nursing Supervisor, was an honor. She's the head cheese of nuring supervisiors, and one of the nicest women I know at that hospital. And for her to say this to us, we had the deer in headlights look.

After the NOC supervisor left. I looked at Bobby and said, "We should do this more often, you and I running the floor at night." She said at the same time i did, "I think i could actually learn to love and not hate this floor if we ran it!!"..we began laughing ALOT.

So we did the pt. assignment for the day shift RN's. Day shift arrives and is congratulating Bobby on what a great job she did as charge nurse for the first time. She got up, paged all the RN's to the front nurses station. She said, " I appreciate all of your congrats for making it through the night the first time being a charge nurse, BUT I am not going to take all the credit, I can't and I won't. I had my Charge Nurse #2, Angie, she was my balls of steel, she was the one who was the UNIT voice to mangement and pushed to keep our CNA, she was the one who was the backbone for our UNIT last night calling the MD and telling them to come evaluate the pt's., and she was the one who was Maria's resourse RN for the night. She was the one I went to when I found out I was in charge and gave me encouragement and the kick in the A** to know We can run this unit, and run it the right way and we will do it together as a team. She even took care of ME, she found a fan for me b/c she saw I was sweating and didn't even have to ask if i was hot, she found a Floor fan and placed it right at the nurses station. I looked at her and said 'what the H** are you trying to do' as we are laughing and I realized she was putting a fan at the nurses station so I could cool down. And as we were talking about how hot it was on the unit, she handed me a cup of Ice chips, started laughing, and as I had my back turned, and shoved a cool pack down the back of my scrubs. I jumped 10 feet in the air, but my god, It felt good on my back and the baby gave a good kidney shot, but that ice pack was what I needed. We proably laughed more tonight then our entire year here on night shift, which the stress just melted away. It felt good to know that I have someone that I can count on, and still have a smile on her face even after she argues on the phone for 30 min. with the evening Nursing Supervisor. She's the one who was really the Charge Nurse tonight."

I said, while hysterical laughing and barely got the words out, "Yea but you made the extra $1.00 an hour as charge." I then said, " We did it together. I think that every night we work, we should have the mind set and sense of UNIT support knowing that we are going to work as a team when we start our shift. This is the way the we should run this UNIT on night shift. If every night was like this, like we said earlier, we would actually enjoy commming to work. But when you feel like you have no support from anyone, it makes for a tough night, which is all too often. Lastnight, I knew what the situation was before I came to work. And my nature is to help people, hence the reason I am an RN. But Bobby and Maria didn't know what they were walking into lastnight, I did because I worked 3 days in a row. I wanted to tak stress off Bobby b/c she's pregnant and i wanted to help Maria b/c she's a new RN and I know how that feels."

All I can say is that last night was the ABSOLUTE BEST night I have EVER had as an RN. I feel like I actually know what I am doing, I am teaching other RN's, using my knowledge and showing potential for becomming a preceptor, or unit manager and at the same time getting a new found sense of personal satisfaction knowing I can do this which I REALLLLLLLLYYY needed. I was able to prioritize, teach, delegate, manage, plan, communicate, negotiate, actually use authority (which felt d*** good) laugh, create a TEAM work atmosphere, and enjoy work, (which is a ******* first ever for me cause i hate where I work).

I became the RN last night I have been striving for, for the last year. I feel like I became a 'REAL' NURSE, as my night shift Nursing supervisor put it. I was given the chance to show the poeple i work with what I am capable of and what I can actually do. I even suprised my self ALOT lastnight with my abilities to be a 'REAL' RN, and think wow I have arrived, I CAN DO THIS, I always knew I could I was just waiting for the right time and situation and lastnight was my 'time to shine'. I proved to myself and those with me, I know what I am doing. NEVER at any point lst night did I doubt myself, or allow some to make me feel stupid or I don;t know what I am doing, this is the first time ever I have felt this way at my job, I have been there 1 year. I am an RN, and I can do this.

[Tweety, BSN, RN]

I love these kinds of "moments" when we feel like a "real nurse". Thanks for posting. (and thanks for making paragraphs. :))

[SusanKathleen, RN]

Hi Angie,

Enjoyed your story. Thanks.

[streptococcus]

Hello

I really enjoyed reading your post about how you and your team mates did an awesome job in such a precarious situation, especially as new nurses! Since you are a relatively new nurse, I am hoping you can offer some advice to me, such as where do you believe is the best area of care to begin as a new nurse?

My situation is probably very different than that of most nurses you have met. Most new nurses are probably 25 year old females in their first career. As a 45 year old male, I understand I will be out of place, and maybe even snickered at a few times. That’s ok, I can handle it.

My main career is as a Fire Lieutenant and Paramedic for my fire department where we respond to every type of call. Because of my duty hours, the only avenue open for me to obtain my RN degree is through Excelsior College, which involves a tremendous amount of self-study. This sort of program is open to LPNs and Paramedics. My shift consists of working from seven in the morning until seven the next morning. 24 hours on duty and then I am off duty for 24 hours. I work this 24 on and 24 off shift for three cycles, and then I am off duty for four complete days straight. So, if I understand correctly that most RNs only work an average of three 12 hours shifts per week, I should be able to work full time as an RN as well, while off duty from the fire department. Confusing, I know.

I love my current career as a firefighter /paramedic and only plan to work as an RN while I am off duty. I need the RN job so I can send my two girls to college. It’s my job to make sure my two girls grow up to be better than their dad, so off to college they must go!

Based on your experience, what area of care in a hospital do you suggest I try to work as an RN first? I know that no matter where I initially start, I will have a lot to learn. However, I desire a position that requires continued learning.

I will appreciate any advice.

Thank you

David

[Morettia2, BSN, RN]

I guess sine you have paramedic exp. I would naturally say the ER. But you can work Telemetry also.

When I graduated last year I was one of the youngest in my class at the age of 26. I am 27 now and will soon be 28. Most of my class mates were in their 30's and 40's, both men and women. I had a friend who was a paramedic for years and decided to become a nurse. He was in my class, he was about 36 y.o. He was married with a baby on the way when he graduated. He got a job at The University of Maryland in the Shock Trauma unit, which is unheard of as a new nurse. And espically since he only had his A.S.N. The hospital didn't care, although they really only accept a B.S.N. But since he had exp. as a paramedic they took him with out any questions asked.

My fiance is a police oficer with the NYPD and works very close with the FDNY. One of his FDNY friends is in school to become an RN. He asked me the same type of question. My response was, "Since you are in a field where you have to be on you feet at the drop of a dime, I think ER or Critical Care is you best bet. Being on the floors you may be bored b/c of your experience." He graduated from nursing school and works in the ER as an RN. Every time my fiance sees him while he is on duty, the guy says,"Tell your fiance she gave me the best advice, I love the ER".

But ultimatly it up to you. I love being a nurse, but I REALLY love being a nurse during codes. and I have been told my place is in the ER.

Good luck and if I can help in anyway let me know!!!

[streptococcus]

Thank you for your advice and your time. I will give your advice a lot of thought

[rnmomtobe2010]

I thought I was a writer, this was awesome. Thanks for sharing!!

[RNAnnjeh, MSN, CNS]

So proud of you! You and your team deserve KUDOS...good on you for sharing this story. I remember having some nights like that...remember this time often...it will remind you why you became a nurse and what you are capable of!

RNAnnjeh

PS: must be an "Angie" thing LOL

[Morettia2, BSN, RN]

Thank you guys so much for all of the kudos!! It means alsot comming from my fellow nurses. And by the way my Regual Floor director never said anything to me or my girlfriend for what a good job we did. Infact she has ignoed us all togehter. Oh well. I don't need my Unit Director to tell us what a a great job we did, I know in my heart we are Good, Great nurses!!

[prmenrs, RN]

Great work, young'uns!!

[shelly304]

Your story made my heart race! I was grinning from ear to ear!

YOU GO GIRL!:yelclap::yelclap::yelclap:

[SuesquatchRN, BSN, RN]

Nursing at its best.

:)