It’s been a year since graduation from nursing school. I’ve been working for 9 months and I guess you could say that one year after graduation is some kind of milestone to measure my progress. I know I’ve come a long way in the sense of being able to get through the everyday tasks it takes to take care of patients but I haven’t come very far in being able to think about what’s going on, where we are in the big picture for the patient, and why and when we are doing what we’re doing. That probably doesn’t make any sense but it does to me. Every day still feels like a new world, even if I’ve had a similar patient with the same diagnosis, medications, and treatment plan.
This past week I worked four out of 5 days in a row and it really is too much. Even three in a row is pushing it. I was ready to strangle my patient by the end of the last day, and her family too. I had a patient who has chronic pain issues. There is a lot of psychological crap going on and when you deal with the family you can see the whole family drama dynamics. It really sucked.
It sucked even worse when at 7:10 pm the mother of the patient is freaking out about the pea-sized sore on the patient’s butt that she came in with and we’ve been treating since she got to the ICU. I was on my 4th day of 12+hour shifts and about to give report when between the mother and sister they came out and got me four different times in the last half hour of my shift. And each time it was something else I couldn’t do anything about right at the moment. The only thing I could do was turn the patient on her side and look at the sore on her ass, which was healing perfectly.
Unfortunately we extubated the patient and then she was able to whine about every little thing even after I gave her Tylenol, maxed out on her pain medication, turned her on her side, got her a soda, and addressed every other little thing she whined about since we pulled the tube out of her throat. Should have left the damn tube in until I went home…
Yesterday I also briefly got to take care of a patient who came to us after she had a laparoscopic surgery where they accidentally nicked her vena cava…oops. I was away at lunch when we got a little “mini” report which didn’t tell us the real story- that she had lost all her blood, had no blood pressure for 15 minutes, was given epi, bicarb and calcium in the OR and a few other little minor details…I got the patient but when she came up it was pretty obvious that she was way beyond my capabilities. Plus she was unresponsive and they brought her up on Dopamine. By the time we settled her we had turned the dopamine off and her blood pressure was shooting up into the 200 range. We tried propofol, morphine, ativan, metoprolol and hydralazine and nothing was working. By the time I gave her over to an experienced nurse we had her on a nitro drip.
I was scrambling to get all the pieces put together, get report, assess her, get orders, and start carrying out everything, while the charge nurse and CNS helped me get all the tasks done, drawing all the labs and transfusing all the blood products, except for setting up a CVP which makes total sense but didn’t occur to me at the time…or to the people helping me, apparently. And then I found out…
The Big Mean Scary Most Intimidating Trauma Surgeon was the one who was called in to fix the vena cava, so of course BMSMITS called wanting to know her volume status (CVP). The patient had been on the floor for an hour and a half and we didn’t have the CVP set up yet. We had everything else. Only takes a few minutes. And guess who had to talk to BMSMITS?
“Why don’t you have a CVP." the slow, low gravelly monotone voice said.
It never sounds like a question. It's almost like he expects you to screw up and he's stating that fact. All the words come out in a slow, deep monotone.
“How long has she been on the floor. What’s taking so long.” Then he started asking me things I could answer, like labs and urine output. I told him all the other stuff he wanted to know and they got the CVP set up by the time I was off the phone.
Once I gave report to one of our most experienced nurses, who took the patient from me, I went back to my chronic whiner, because that's what she was, and I caught up on charting until the mother and sister started to pester me.
By the time I walked out at 7:30 pm I burst into tears in the usual place, where I hit the fresh air once I walk out the west door of the hospital into the little shaded area by the brick wall. I don’t cry there every day but it seems like it happens a lot on my last day of a long stretch when I feel totally depleted from everything I’ve done all day. Four out of five days is too much. Even three in a row is pushing it for me.
I can’t think of too much I have to say about being a year past graduation. I do have some interesting trivia, though.
1. I know most of the people in the obituary section of the local paper on almost any given day.
2. I can watch people take a shit on video camera, among other things they do.
3. I finally lost that last pound sometime in the past two weeks. I have lost all the weight I gained in the process of nursing school.
4. I admit I am one of those nurses who digs into the huge bowl of chocolate in the break room at 3 pm whenever it’s there.
5. It doesn’t matter if you’re a clueless new grad, if you go anywhere in the hospital as an ICU nurse you get instant respect, more than any floor nurse would get. Hell if I know why, but they want to trust your judgment on anything. That’s scary.
Peace, love, and chocolate,
Towanda, ICU RN
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