Who Says Nursing is Stressful? New to MedSurg Residency

[chemshark, BSN, LVN, RN]

# NMCSD RESIDENCY EXPERIENCE SEPTEMBER 2017

## WEEK 2

As I get more familiar with the staff and learn to pace myself for the daytime 12 hour shifts, I begin to find myself getting comfortable. This has its pros and cons.

Pro: I'm feeling more "at home" in my med/surg unit.

I can now tell the difference between an Alaris pump running dry, a call bell, or a bed alarm going off. A week ago, whenever the bed alarm screeched, I would jump up from the nursing station and rush to the room in a panic--worried that my patient had fallen off. Now I don't think twice about it because my Corpsman will do it for me! Why? Because they are young and between the ages of 18 and 22 so 1) they can react faster than me and 2) are willing to drop *everything* at a drop of a hat if a patient leaves the bed. You see, the Corpsmen allow me to stay at my computer while I chart feverishly my nursing assessments, 24 hour nursing notes, strict I/Os, VS, TX, and invasive lines before my next ICU TOW (transfer onto ward) patient gets wheeled in. It's great to have a dedicated Corpsman assigned to help me every single day!

Con: I'm still feeling out my role in the unit.

I think the reason why the Corpsmen are so keen to help me is because I have been so willing to help them during the first week. When I do something for them, like help clean or turn a patient, they thank me *loudly* in front of their peers. "THANKS FOR GETTING THOSE BABY WIPES FOR ME, HOWIE," is what they say, usually in the direction of the nursing station. I think they want to feel like they're no longer the lowest ranked personnel on the unit. But I'm no fool. Military rank is not a form of currency to be used as leverage in a hospital ward. A Corpsman who feels disrespected will neither tell me when a patient needs a stick or an IV, nor setup the butterfly needle, vacutainer, and syringe so that I can grab the sample and send it to lab stat (withdrawing from PIV lines is not allowed). He or she will not pass on relevant patient information to me when I'm swamped pushing meds with my preceptor or running out to different floors chasing down End Tidal CO2 equipment or begging for Yankaur tips from other units. He or she will not *ahem* cough at me when I am in a room with an obese PVS trach patient that we have to turn and clean which means that I have to not never ever forget to re-run the TPN to prevent her from aspirating and then remember to clear & chart the TPN flush q2h while the entire family glares at me in the tiny room blocking my way out until everything is in order. Or worse, the Corpsman will not help me find extra pillows! (It's impossible).

The interns are funny, too. My preceptor, at 22 years old and one year as an RN, is so competent that she dances around interns like Muhammad Ali. She demands orders to be written *right now* and calls them back if parameters are not to her satisfaction. "As long as [the interns] don't [bleep] with me, I won't [bleep] with them," she said to me.[^does not apply to attendings] I'm glad I finally have access to Essentris to chart because I have about five minutes to annotate my comprehensive assessments based on two minute mini-assessments of each of my patients before we start pulling 9 o'clock meds. And let me tell you that Essentris is a disaster compared to EPIC because I have to type in a number to input an intervention but it wasn't designed with usability in mind. I.e. if I want to chart a numeric pain scale of 0/10 I have to type '1' in the cell! How inept is that? (I'm really thinking about getting into nursing informatics now because whoever designed this software was not a nurse). It slows me down and my preceptor gets irritated when she proofreads my note and finds my neurologic assessment saying that the pupil is 6mm when I clearly meant to type the number '6' so that it would chart that the pupil was 3mm.

Yet somehow I still find pockets of self-arrogance like when I watch the residents do assessments on my patients while they teach their med students. One time, I saw a fellow show a wide-eyed med student a comprehensive neurologic test on a patient with AMS. I became very concerned when I saw what he did and said, "Whoa. Did he just have a positive bilateral Babinski's?"

"Yes, that's right!"

"Well, sir, I don't have much experience with neurologic degeneration, but...what's his prognosis?"

I can't believe I said that. The patient was AxOx1 but at that second I knew it wasn't the most appropriate question to ask. I was clearly too attached to my patient or was tired at the end of the shift because c'mon, what kind of answer was I hoping to get from that question?

"Uh, it depends." was what the doctor said. Saving me the embarrassment of putting him in an awkward position. They quickly made their exit but at least when I looked down at my patient he had a smirk. He didn't know what year it was or where he was at but even he knew that I asked a dumb question.

WHAT I LEARNED THIS WEEK: Time is the best medicine. And management of time (whether cutting it or extending it) is the nurses' best intervention. This week I realized that if I listen and take time to understand the unit's high rushes and low lulls, I can prioritize nursing interventions that take longer but can be forgotten such as hanging continuous infusions. Then I can focus on fast & easy tasks such as prepping discharge paperwork while waiting for the order to come through. This, then, allows me time to focus on giving high risk meds w/ my preceptor such as novolog or morphine or when I'm helping my preceptor setup IVPBs so she can give them without incident or helping her manage her other patients while she stays in one room to administer blood.