Wednesday was a relaxing day at work, when we got there we only had 4 patients on the unit and there were plenty of staff available, so I got a day to catch up on some of the education stuff I’ve brushed aside while we were so busy. Michelle and I went over my post-orientation evaluation, I talked about my experiences and how things went, and where I think things could have been improved. I got to evaluate each one of my preceptors. I didn’t say anything I haven’t already told Michelle, like my two bad days and a few other experiences I had that were not so great. Other than that I think things went fairly well and there was so much going on with the transition to the new hospital during my orientation that it was more chaotic than it would normally be, but I survived it.
It was a fun day, there were two students on the unit doing their preceptorship from the local community college. I told them how when I was at that point in nursing school I felt so confident, much more so than I do now! It’s amazing what a dose of reality can do for you. But I did encourage them to pursue ICU if they want to do it. I’m looking forward to the point where I have my act together enough to take on a student or someone going through orientation.
For a short time, I got to work with Jill, one of my coworkers I’ve never been on the schedule with before. She had an orientee from the float pool and a nursing student with her, and they got a post-op admit, so I went in to help them settle the patient. Jill and I rarely work the same days but I thought she was great, so supportive and would be a great preceptor. She’s one of the newer nurses on staff but she had some nursing experience before ICU. I’ll keep her in the back of my mind for someone to ask for help when we work together once I’m off orientation. I can also schedule myself on the days when there are more supportive people available.
Thursday was another great day. I worked with Jill again as my preceptor and we only had one patient, one who was unstable after cardiac arrest the night before and was not doing well neurologically either, we started out the day thinking she was going to repeat her cardiac arrest and she was having all sorts of PVCs and runs of V Tach. We had Dopamine and Amiodarone going and the patient was almost completely unresponsive neurologically, it looked like the family might consider comfort care depending on what happened over the next day or two.
I was busy all day with calling about organ donation and the social workers and talking with family members, explaining to them what I was doing with my neuro assessment and what the assessment findings meant. It’s a challenge to explain things to family members without giving them false hope and getting the point across that the doctor made, that things don’t look good but they need to see how she progresses for a period of time before they make any major decisions, while being realistic and encouraging them to think about things. I spent a lot of time talking with the social worker and some of the family members trying to figure out what the family’s perception was after talking to the neurologist.
The intensivist changed the dopamine to neosynephrine and it got rid of her PVCs, which made her a lot more stable cardiac-wise, and that freed us up from always having to be in the room titrating the Dopamine down and watching her response, and responding to the monitor alarms every two minutes. It gave me some good practice at figuring out drip factors and titrating vasopressors, and understanding why Neo worked so much better than Dopamine for this patient.
This patient had an amazing support system from her family and friends. There were probably a dozen different people in and out of the room during the day who spent hours with the patient. The family kept thanking us for everything we were doing. They were so appreciative of our attention and they expressed it over and over during the shift. I kept thinking how nice it was not to feel overwhelmed and rushed all day.
I was busy all day with my patient but I had time to look things up, think about them, ask questions, and understand why I was doing everything. It was a perfect pace. I had time to give the patient a bath, and I felt like I could give the patient and her family all the attention and care they needed. Jill was there and I delegated a few things to her, but she wasn’t stepping on my toes, she didn’t try to take control of what I was doing, and she was there to answer my questions. I never had to go looking for her.
It was the type of day when I can enjoy my job. I love it when I have time to think and understand, and to give good patient care instead of being rushed and having to cut corners. I hope I’ll get to the point where I can feel this way more often than I feel overwhelmed.
Jill said she felt I was on top of everything and that I’m there, where I need to be to go on my own. She told me about her own experience going off orientation, how her stomach was always upset before she went to work and how after a few months it gets better. She told me it is normal to have those days where you do feel overwhelmed and you need to get the backup from everyone else. She’s only been off orientation for five months but it’s amazing how much she knows and understands compared to where I am. I hope in that much time I’ll be there too.
When I got home Thursday night, it was the end of my third day and I was physically tired but I didn’t feel emotionally drained even though working with the family all day was emotionally demanding. Now that I’m almost off orientation, I see how much it helps to have a preceptor with a positive attitude who knows how to step back and be a resource but not in control. I took back some of my confidence that I lost after that weekend with Bob.
I think being on my own will be terrifying and I’ll be sick to my stomach every morning before work for a while and I’ll need lots of help and have lots of questions and there will be horrible days and good days. I look forward to when things start to ease up. I know it’s a matter of time. I expect my first six months off orientation to be a repeat of everything I felt during orientation.
I have three more days with a preceptor. Everyone keeps asking me if I feel ready.
I’m almost at the top, about to look over the edge. I don't know what's on the other side. Just a few more uphill steps and I’ll have to jump off…
Peace, love, and bungee-jumping,
Towanda, ICU RN
0 comments:
Post a Comment