Least Favorite Words

The four words I absolutely dread hearing come from the mouth of a patient are (in this particular order):

It could just be an anxiety attack or pain from an injury (shoulder or rib fractures to name a couple) but it also might be a freakin' heart attack, y'all. It's happened to me a few times already, and what follows that evil utterance is a barrage of tests which include:
1. EKG (which you hook up in a nonchalant manner to give your patient the impression that you do this all the time at 3:00 am)
2. Troponin labs (which will then have to be repeated every few hours, oh and it's fun to draw someone's blood under stressful circumstances when you're a new nurse and not a great phlebotomist so far)
3. Chest x-ray (also totally normal at 3:00 am)
4. You peeing your pants a little because you're afraid they actually are having a heart attack and that they just might code on you (#4 does not require an order from a doctor).

Dear Diary

It's hard being a (new) nurse. These days I feel like I'm always asking questions or needing help with something --all the time.

The other day I was in the midst of transferring a patient and thought to bladder scan her because she'd been having low urine output, and lo and behold she had over 600 mL of urine hanging out in her bladder (that's over half a 40 oz for all you ghetto fabs out there). That meant I'd have to straight cath her which can be difficult to do on a female patient because the anatomy is not as clear cut as in the picture I just linked up there (I wish). I tried and failed and had to ask for help, and fortunately the nurse who helped me is one of my all time favorites in terms of being available and willing to help. She never seems too busy to lend a hand. An hour or more ended up passing before I was able to transfer the patient to the other floor. I was flustered, didn't take my meal break, lost my assignment sheet and my stethoscope (I thought). This was one of those days that I felt was my time to cry on the job. Luckily it didn't happen. I told myself I'd just have to stay as long as it took me to get the job done. But in the back of my mind I worried that I'd get in trouble for a) missing my break and b) leaving late.

What's a rookie to do?

I Love Nursey

Sometimes I feel like the Lucile Ball of nurses... a well meaning, clumsy and comical nurse who accidentally trips on an IV line and rips it out, who steps on a patient's broken foot, or pats someones back which happens to be covered in 3rd degree burns (all done lovingly, of course).

I can picture myself in one of those comedy sketches from the 50's where they're tripping all over some poor injured patient and he's screaming in pain every time they accidentally let his tractioned broken arm come crashing down on his chest full of broken ribs, or let him fall to the ground as they try to help him into a wheelchair. And all the while the patient is getting madder and madder, screaming, "WHY YOU LITTLE...!!"

Compassion Fatigue

"Compassion fatigue (also known as a secondary traumatic stress disorder) is a condition characterised by a gradual lessening of compassion over time. It is common among trauma victims and individuals that work directly with trauma victims. It was first diagnosed in nurses in the 1950s. Sufferers can exhibit several symptoms including hopelessness, a decrease in experiences of pleasure, constant stress and anxiety, and a pervasive negative attitude. This can have detrimental effects on individuals, both professionally and personally, including a decrease in productivity, the inability to focus, and the development of new feelings of incompetency and self doubt."

You hear a lot of talk about compassion fatigue in nursing and I feel like I've seen it. We had a patient from another country who was involved in a serious car accident while on vacation in the US in which a relative of the patient died. The patient was on our unit for several weeks and I would often hear nurses complain about how needy or whiny the patient was. I know I'm new (and I hope this doesn't explain my empathy) but imagine yourself in a hospital in a foreign country where you don't speak the language, you're in a pretty good amount of pain from your injuries, and you've just lost a loved one to boot. I think I'd be pretty needy too.
I wonder why with experience and exposure to patients with acute or chronic pain it seems we become detached from the moment and start to see the patient as a just a complainer. After watching a patient sobbing in pain with tears streaming down their face this week, asking themselves and me why God would do this to a person, it never crossed my mind that this patient was a whiner and I hope it never does.

Flying Solo

This was my first week at work without my mentor/preceptor. I've finally finished orientation and I'm on my own...!

There are so many steps and phases in this profession. First there were the prerequisites, then actual nursing school and clinicals, next graduation, and after that passing the NCLEX and actually becoming an Registered Nurse. I thought it would sort of end there but then there was the months-long orientation with a preceptor, learning the ropes, and finally independence!

I was/am nervous about being on my own but luckily I've had a good first week so far. It can get REALLY busy and I haven't quite mastered the art of being in four places at the same time...

Spleen in the Spotlight

So I've only been on the floor now for a month or so and there's a huge learning curve, people! ...But sometimes I forget or just don't know things that I might be expected to. I am supposedly a NURSE after all which I guess means I should come complete with encyclopedic knowledge of the human body upon graduation (not really). Anyway, over maybe the past week and a half we've had not one but two patients involved in similar freak tripping accidents in which they have fallen onto a chair, stool, box or some other object landing directly onto their spleens and causing a splenic laceration (or splenic "lac" if you're cool). This got me thinking... where the hell is the spleen again and, uh, what does it do exactly?

The spleen is part of your immune system and is located on your left side. Old red blood cells are filtered out in the spleen, and platelet and white blood cell storage also occurs there. Extra blood is stored in the spleen and its removal can make a person more susceptible to infection.
I read in wikipedia that "spleen" is a Greek word and that the Greeks considered kind and considerate people "good spleened."

All Thumbs

 

Some days I feel like a complete dunce. I sure can't wait to feel like I've got everything under control (that WILL happen, right?). I guess this is why orientation lasts three months.

First (almost) Successful IV Insertion

I attempted my first IV insertion yesterday and actually got it in on the first try but then the vein blew out! We tried twice on the same patient and both times the same thing happened, we got flashback, but after advancing the catheter and checking placement it wasn't in the right spot.

IV insertion is really tricky --I feel like I need about four hands to do it! Not only do you have to find a good vein and get the needle into it correctly, but then you have to slide the plastic catheter off the needle once it's in the vein, retract the needle, and connect the hub to a saline flush -all while trying not to make a bloody mess.

phlebotomy! phlebotomy!!

I've had this song stuck in my head all day -except I sing "phlebotomy" where they sing "lobotomy" in the opening lines :)

I spent the whole today at a lab drawing blood. No more Shakey Hand McGee over here! Next hurdle: IV insertion!!

I'm Still Here!

I've been in orientation now for three weeks now, with a couple more days to go until I actually hit the floor. I want to keep writing about my experiences at the hospital in my new role but so far... uh... I haven't had any! Orientation has been long and we are all dying to get with some patients, but it's good that the hospital is so thorough. It's been a lot of review, a lot on policies, etc. They want you to go into the job knowing how to do things the right way, which makes me very happy.

There's been a lot of scaring the crap out of us too... a lot of stories about medication administration errors, code blues, mean doctors, mean nurses... When I started on this journey I thought that when I finally came out of nursing school I'd know how to handle ANY situation. I soon began to realize that that just isn't so. It takes a lot of time and a lot of experience that school just can't begin to prepare you for.