After the shitstorm

All hell broke loose after the events of last week.

The charge nurse from last week caught hell from our CNS over giving me a totally inappropriate assignment. After trying slow low efficiency dialysis for 36 hours and multiple vasopressors along with whatever else we did to keep him alive, the patient died at shift change Wednesday morning, which is surprising he held on as long as he did. He was going to die no matter what we did, but it didn't make our day Wednesday any easier, starting off in tears.

The CNS talked to the doctor who was being such a jerk and had to explain to him not to get on me about what happened because I was placed in a position that was way beyond my abilities and skill level and that I should never have been given that assignment. I didn’t even realize myself that even with the one patient and having a better start to my day, no matter how you look at it I should never have had that patient.

I should have said something to the charge nurse as soon as I felt like I was over my head that morning, instead I waited until rounding to show how unprepared I was. That was my mistake, I needed to be thinking about whether I’d be able to take care of those patients. Instead I got caught up in trying to survive the morning, which is my usual routine, I find if I can make it through rounding then things usually smooth out. But not that day, those patients were too sick.

Apparently our CNS didn’t even know that it was my first nursing job when she first talked to the charge nurse and the doctor. She talked with me after she talked to them, wanting to know what happened. She thought I had some prior nursing experience going into it. That made it even worse for the charge nurse. The CNS went back again and talked to her and the doctor after finding that out. The charge nurse wrote me an email apologizing and telling me she will be more careful with my assignments, that she realizes that it isn’t helpful to my development to put me in that situation, and that she hopes I will stay in ICU.

I have no intention of leaving. I wrote down some notes for myself because I feel like at this point, I am entering my 10th week off orientation and they tell me it takes two years to get comfortable as an ICU nurse, but I’m wondering what happens to fill the gap between 6 and 24 months? I have 16 months to go until my two year mark and I don’t want to fill the next 16 months with days like this.

I do feel prepared enough with basic skills to make it through the day when I’m taking care of stable vented patients like I am supposed to be getting. But most days my assignments don’t look like that. I am wondering how I am going to pick up the knowledge and experience over the next 16 months in a way that I will be competent and able to take on whatever patients we get.

I feel like I got my obligatory 6 months of orientation, first following someone around and then being followed, but not really learning a lot other than basic mechanical and technical skills. I can get through the tasks on a boring ordinary day, so that made me an ICU nurse. And then I was dropped. Buh-bye! See ya later! You’re on your own!

I feel acute anxiety over going back to work tomorrow. I don’t want to be there. The email helped, I feel better about having heard that from her, but I still feel like there needs to be a plan. I want to see some kind of progression so I’m not out there stumbling around for the next 16 months, hoping to get lucky and have a coworker or a doctor who is nice enough to teach me something worthwhile.

I tried not to think about it this weekend but I had time to think on the drive up to Leadville and then last night I thought about it more.

Coming into this organization during the transition of staff over to the new hospital halfway through my orientation, the inconsistency of the quality of my preceptors, and the unfortunate experience when the critical care instructor for our classes was fired and the educators in our department had to come up with a quick set of classes by the seat of their pants didn’t help either.

I don’t understand what happened with the charge nurse that morning. I like her, and she’s never given me a bad assignment before. They are always challenging and I like working with her for that reason, plus she answers my questions. She must have had a brain fart. I also don’t understand why the night charge nurse didn’t say anything to me or to the day charge nurse when he heard the assignment I got. I thought he was part of my support system. Apparently not, he must have “checked out” as soon as he gave report to her.

I need some kind of guidance, like a mentor. Someone to help me process all the stuff that’s coming at me, to help me clarify things I don’t understand, to help me solve the problems I run into, and to help me steer myself in the right direction of learning the things that are important to learn. The CNS and I talked a little about that. She sounds like she’d be interested in doing something.

I will go and talk with our manager this week, after she hears about the shitstorm that happened when she was out on vacation last week. I am going to propose some kind of plan, that I can do with the CNS. We’ll see what happens.

For now I feel like I slipped a few steps back. Down the slippery slope of shit. Tomorrow I have to wade uphill through it again. I'll bring my own toilet paper. Don't want to start growing mushrooms in the cracks.

Peace, love, and wipe front to back,

Towanda, ICU RN