Banging My Head Against The WALLLLLLL!

I am so frustrated I could give myself a closed head injury. I feel like banging my head against the wall. That's what everything is like now. I am ready to pop out of my skin. Absolutely everything is bugging me. I need a vacation bad.

First of all I have been totally screwed over by my ISP, these idiots could not figure out how to transfer my DSL service from my last address to my new one. I still have no high speed internet access and my dialup was disconnected for several days. I am so frustrated. I need to find a new provider.

Work has been rather fucked up too. February so far has sucked. SUCKED.

SUCKED.

Gretchen. My new preceptor this month. Grrrrrr-etchen. She doesn't handle stress well. Dammit. I like her, but she's driving me crazy. I had my first new trauma patient, one with sternal and rib fractures with a chest tube and closed head injury. I took care of him for 2 days. There were other traumas at the time who were a lot more unstable. The first day there was one sick patient and we had another easy patient who transferred out to the floor early. The second day the sick patient had some problems when he went to the OR and Gretchen freaked out and basically shut me out. ,I had everything under control and was all caught up on my trauma patient, got all his admission paperwork done, and went to check on the other patient and Gretchen was so stressed out that she couldn't explain to me what was going on. She was hanging all these different drips, which is exactly the sort of thing I need to be learning. So I went in and started looking at what drips he was on, trying to put pieces of the picture together and staying out of Gretchen's way.

I was a bit frustrated but I thought the next day would be better. It wasn't. We got another trauma admit and Gretchen took over that one. I felt so frustrated. I talked to Bonnie who was charge, she said it's not good for me to see all that chaos, that it needs to be more controlled for me to learn from it. She said to hang in there and that not all traumas are a zoo. I am supposed to work with Bonnie later this month for a couple of days, I hope it happens. She should be good. Also on that second day I didn't get to prepare for rounding because I was so busy with the new trauma admit so I tried to wing it and I got lots of eye rolling form the doctors present there. Some days are better than others. The trauma docs are by far the most intimidating. Our pulmonologists (intensivists) are a lot nicer.

The second night I came home and dreamed about nasogastric tubes. My patient had pulled off his cervical collar (to stabilize his neck which was fractured), and pulled out his nasogastric tube. I got the collar back on him with the respiratory therapist there but never stuck another tube down. Gretchen thought he didn't need it and we were so busy that I didn't do anything about it except make sure he wasn't nauseous. He was getting reglan and he hadn't been putting out much of anything from suction, after it sucked out all his breakfast that morning there wasn't anything else coming up. He wasn't getting anything to eat or drink either. I tolf the nurse at shift change about it but she didn't look to concerned either. Then I went home and worried that he was going to aspirate. I kept thinking I'd go in the next morning and get my butt chewed by the trauma doctor. But it didn't happen. They left the tube out overnight and had changed the order to sips of clear liquids and oral medications by morning. But I also realized that I need to not always accept the judgment of my preceptor now and sometimes I need to make the call and be more assertive. I worried that he would aspirate. I slept like crap that night and knew the 3rd day would be tough to get through. Plus I woke up around 1:30 am with a raging cramp in my calf. I knew I didn't drink enough all day. My brain was fried and I was limping when I went in the third morning. But at least my butt stayed intact without teeth marks.

I went to MRI with my patient on the 3rd day. Gretchen was in charge so I was stuck with Kim,, a new nurse- she graduated a year ago. Kim was okay but she talked way too fast. My brain doesn't work that fast. Especially on my 3rd day with no sleep and dehydrated. We took my trauma guy again and then transferred out our other patient at 8 am, and we immediately got another trauma admit. This one was in bad shape and the worst horrible mean scary inimtidating trauma surgeon was on his case and was in the room, there were 8 people in the room- and they were putting in lines. I tried to help but there wasn't much I could do so I watched what I could and then felt there were too many people in the room, so I went out on the floor and started finding things to do. I sent some blood down to the lab and forgot to put the labels on. I felt like an idiot. Let's blame it on sleep deprivation. I ended up going downstaiurs to the lab and practically had to beg the anal retentive administrator-like-person-in-charge-at-the-desk-who-would-not-make-an-exception-to-the- policy to accept the samples so we didn't have to redraw. I mentioned the big shot surgeon's name and told her the patient was very unstable. Which was actually true. Finally she let go of the pickle up her butt and allowed the technician to process the blood.

Later in the day we had to take my patient to MRI. They have to stay still and it's claustrophobic and noisy. He was squirming around all over the place and we gave him pain medication and Versed but he was still squirming, and after an hour we called the on-call trauma doc and he told us to get anesthesia to intubate him so we could get the MRI done. It was 3 hours in that loud stuffy cold MRI room. The anesthesiologist was funny, he kept us entertained when he wasn't reading a magazine. At least Kim and I had each other to talk to. It would suck to be stuck in MRI for 3 hours with a patient if you have no one to talk to. Plus you can't leave your patient to go to the bathroom, get a drink, anything. You have to be monitoring them all the time. It sucks. I hate road trips when a procedure is long.

This week the weather was kind of weird. It warmed up and melted snow during the day, then we got a bunch of fog that froze and made things slick, and visibility sucked. As a result we had lots of traumas. I can remember thinking one morning at 6 am as I was getting dressed for work, hearing the sirens headed to the hospital- there's my patient. And it was. The unit has been full and so are all the beds in the rest of the hospital. Trying to get patients off the floor to make room for fresh traumas has been tough. Everyone is toast. Every time we get a bed we get another trauma. I look forward to when the new hospital opens and they can take some of them. I like the trauma stuff but I can't do much with them if they are unstable because I don't have the training. I won't be getting my TNCC until late this year. And by then who knows what kinds of patients we'll be seeing in the ICU.

Yesterday morning after report Jim came over and talked to me for the first time in a couple of weeks, gave me a hug and told me to hang in there. It's been so busy at shift change we can't even stop to talk. Two of the three mornings this week he was off the floor at shift change downstairs at the latest trauma. The third morning Gretchen was gone the second she walked in the door, off to the ER for a trauma. Michelle keeps having to come out and relieve the charge nurses because all of the staff is busy with unstable patients and can't leave to go to the traumas and the charge nurse has to go.

I am exhausted. I worked 3 on, now I have 2 off then I go back for two more this weekend. I finally got to the point this week where I hate orientation. I still have so much to learn, I'm now getting to the point where some of the tasks are getting easier and I can concentrate on learning new stuff. But it's awful. One of our new nurses looks miserable every time I see her. I have a feeling she won't be staying with us for too long. She seems so unhappy. It's so hard finding the people you can talk to. I've been getting a lot of support from Rick who is a traveler. We hope he'll decide to stay with us but he's talking about going somewhere else, maybe Denver. Rick always offers help and shows me how to do things and he's always in a good mood.

I feel so alone. It's a feeling of being suspended in the air and floating around. Unanchored, I guess. I hope I don't end up hating this. I do like it but some days it totally totally sucks. Yesterday morning I did go in the bathroom and cry once. I haven't done that in over a month, since before I started with Michelle. It's frustration now. I have to get through it. I know that there is so much I'll learn as I take the trauma classes and learn stuff.

Janaury in a nutshell was great. I was with Michelle for most of it and she set up all these demonstration things with the monitor so I could get some experience setting things up for when doctors do procedures at the bedside. I also got to assist with a lot of procedures, a trach at the bedside, rapid sequence intubation where they use paralytics and sedation and pain meds all together, and several central line and arterial line insertions. Michelle showed me the whole setup for a Swan with SVO2 and continuous cardiac output monitoring. We haven't had any patients with swans but who knows what we might get once the cardiac ICU shuts down and moves to the new hospital. I took two patients and was able to manage with both. They were fairly easy but kept me busy.

One day toward the end of the month Michelle was charge nurse so she put me with Joe, who has moved to days. Joe was the one I was with when my first patient died during my first month of orientation. We took a patient that day and had everything pretty much under control and then we got an MRT call. That's medical response team. An ICU nurse responds to those which are from nurses with patients on the regular floors who have a patient who is unstable and going downhill. They call for help so that they can prevent having to admit them to ICU. The ICU nurse goes and assesses the patient and usually it's a matter of reversing too much pain medication, or someone needs fluids or something easy. I asked if I could go on the MRT call. Michelle sent Joe so I went with him. The patient had a GI bleed and probably perforation of his gut. He was restless and his color was awful. Joe thought he needed blood and he got the doctor and they admitted him to ICU. We put the patient on the monitor and brought him to the unit and the doctor met us there.

We did the rapid sequence intubation, put a central line in and started pumping fluids into him, but the guy went into cardiac arrest on the bed right after the line was put in. It was weird. Michelle and the doctor were talking between themselves about whether we needed more help in the room with the guy as his heart rate started to drop. Michelle asked if he thought we should call a code, and the doctor said, I think we need more hands in here, he didn't seem overly concerned and then the patient went asystolic. I wasn't even thinking, I said out loud to Joe, better hit the code button, and he did. So there it was. I called a code. And everyone came running, and I was grabbing the cart and throwing medications across the room with everyone else and it was crazy. Michelle shocked him a couple of times and they were doing chest compressions and the code went on for about a half hour and the guy died. It was so awful. Then we had to clean him up and clean the room up for the family and the wife was totally devastated and screaming that horrible sound, and I realized that every time I work with Joe our patient dies. Anyway when I went home that night I was so tired, it was impossible to imagine going back for another day. Totally draining.

That was my first code. I'll be trained for it in April when I take ACLS and get the code class.

I am feeling so unanchored and unsupported right now. The other day nurse fresh off orientation is young. She refers to her female patients as "chick" as in, "Can you watch my chick for me while I take a break?" She says this out loud at the nurses station, when there are patients and family members able to hear. Makes me want to go crawl in a laundry bin with the poopy sheets. Omigod. Help me I might be with her for a week toward the end of my orientation.

The other things that happened in January were that I am still terrible at IVs but finally got one to work. I also attended my first falls committee meeting. What a load. I think I am going to bring a pillow next time. And I also had neuro, hemodynamics, organ donation, and transport class. We will be transporting some of our patients to the new hospital in the ambulance sometimes. No way do I want to do ambulance stuff. And no way could you get me on a helicopter.

Peace love and subdural hematomas,

Towanda, ICU RN