Moving Madness and Mullets

I woke up at 2:30 this morning and could not get back to sleep. So much unfinished business and so much on my mind. I go to work today, I heard the census is low so I hope I can get the patients. I can't see myself doing online crap all day. That would suck. Dale has been working super long hours. Today they have an "open house" for the public at the new hospital. He's practically living there until it opens. The floors had to be done and the administration insisted on everything being open for public viewing, even if one side of the floor was the mirror image of the other side. I am so glad I am not going there.

We moved last weekend. Finally in the new house, and of course it snowed again. Every freaking time we move, it snows. We did finally get a snow shovel. It only took 6 weeks but we did get one. I think I am most excited about the bathroom. I am painting it this color called "ionic sky". It is a bright intense light green-turquoise color. We also splurged and got a king size bed. We needed a new bed forever and almost got a queen but decided what the hell and I am so glad. It is great to have room to stretch. Maybe we will sleep better now. The dogs love their new house- lots of trees in the backyard with squirrels in them. The only thing they aren't so thrilled about is how high the new bed is. I have been shopping for things for the house and I feel like such a yuppie. I am buying things that match colors. Even my toothbrush matches. (That was by accident.) It will be nice to eventually have real furniture. We have lived like college students forever and it's good to settle in one place. In front of our new house you could build an igloo on each side of the driveway, the snow is still piled six feet high between each driveway all up and down the street. Our next door neighbor has a snowblower and he does the sidewalk on both sides of the street for everyone.

I have no DSL. I have to wait. And wait. I am tired of being on the phone with the earthlink people in the Phillipines. And I am tired of dealing with the automated voice at Qwest who can't understand my voice. Qwest didn't transfer our long distance service when we moved either and I don't have long distance until next Monday. How can this happen in 2007? Techno-fucked.

Work has been great with Michelle as my preceptor. I am sorry this month has gone by so fast because I only have a few more days with her. I do feel like I've made amazing progress this month. I have assisted with two procedures in the past week- a percutaneous tracheostomy and a PEG tube insertion. I took two patients one day and one was vented, and managed all the care myself. I've been talking at rounds, calling doctors, all the things that still intimidate me but I'm doing them. I have so much to learn but I feel like it's been so much more relaxed on the floor since the new hospital staff left and we have our core staff. It looks like I will have mostly good preceptors next month too. Michelle is talking about taking me off orientation a month early. That is scary. She says I'm independent now, and the only difference is that I won't have someone following me around. I'll have to track down more people to ask questions. That in itself scares me.

I was so proud of myself one day last week when I caught an issue in the patient's labs that no one else did. My patient's sodium was low and that's always a concern with head injuries. I noticed that as I was going over her labs and mentioned it to the doctor before rounds, then he brought it up in rounds again with everyone there and it was a point of discussion for a while with nutrition and pharmacy and everyone else there, so I felt like I did something right! I want to know what's going on with my patients and right now as a new grad it's hard enough to get through the tasks that you have to do to get through the day. Thinking about what's going on with them comes later. Two years, they say, before an ICU nurse feels comfortable and can start seeing the whole picture.

There are so many times when I'm doing something and I'll have a flashback to nursing school and I can hear something Roger or the Amazon said. It's like I have my pocket version of Roger on my shoulder. Usually it happens when I'm in the med room trying to look up something, or when some cardiac issue comes up. The more I get away from nursing school I realize how little you learn in nursing school. With the exception of Roger and the Amazon, and maybe some of what the chihuahua said, I don't find myself using much of what I learned.

I survived the first "two patients on my own" day. We have had some sad patients lately. I felt exhausted by the end of the day. I had a psych patient who attempted suicide, shot himself- which I'm not so sure was a suicide attempt- and ended up in the ICU twice because after the first surgery he started bleeding and had to go back and get fixed again. The other one was a young woman who had a stroke, she has been in for a couple of weeks. The huge woman I took care of a few weeks ago died after her surgery.

One day I got to play all day with the monitor and things, Michelle set up all these different lines for me so I played with the Swan, the continuous cardiac output and SV02 setup, the ventriculostomy, practiced setting up arterial lines and CVP lines, and played with the pacer/defibrillator/portable monitor that we use. She also did a simulation of different cardiac rhythms and I had to decide what to do about them. The hospital is looking at doing a 40 hour week of critical care classes through AACN instead of having to go down to the new hospital. The politics of this split have been interesting. Sounds like the people at the new hospital are being jerks to Michelle. She is trying to set it up where we can have our own classes. That would be better, I don't want to have to drive down there every time I have a class.

I went out with one of the other new nurses for breakfast yesterday. She works nights and graduated less than a year ago, she got off orientation right before I started. We had a good talk about stuff. She sees the same things I do- how nursing is such a burnout job and how we would like to go part-time within a couple of years to be able to keep doing it. She still has frequent bad days when she is in tears and feels totally overwhelmed. She said it's better when you're off orientation, at least you don't have someone following you around all the time. You can organize your own time and no one sees you crying. She likes nights because of the pace, except for not having a life.

I am running well, feeling strong and good on my training runs. Multiple out and backs at the reservoir are now a piece of cake. It's time to start dragging my slow ass a bit faster. I went up there yesterday morning before going out to breakfast and did two and a half hours. It was getting light when I parked and got going. I happened to park down the road from one of the runners from the club, and ran past her as I was headed up the dam. She is one of the faster runners around here, she was doing almost the same course. She said she was out for a slow run. So we ran about 5 miles together until she had to turn around. That was nice for a change. I didn't know I could run fast and talk going uphill. I must be doing well.

One morning I got up early and went running downown near campus, past our old neighborhood to the cemetery, which is where I used to run all the time when we lived here before. It was 9 degrees on the big time and temperature display at the high rise bank downtown. Funny it didn't feel that cold. I must be getting used to it. The snow is driving me crazy though. We still have six foot high piles of snow all over town and many of the sidewalks are still under several feet of hard crusty dirty snow. That morning I saw some interesting things on my run. I saw a homeless person sleeping in the front seat of their vehicle. It was a beat up old pickup with falling apart camper shell on the back. It had a Bush Cheney sticker on it. I guess that guy must like sleeping in his truck when it's 9 degrees out. Good Merkin. I also saw a bumpersticker on another car that said, "I love mullets".

Peace love, and mullets,

Towanda, ICU RN

Owning It

I got to practice my foley catheter insertion skills this week, I've been lacking experience catheterizing men. I got two of them this week. First guy was in agony, he had an enlarged prostate and was retaining urine and he was yelling the whole time as I put it in. I felt so bad for the guy. It was another nurse's patient and I think maybe he could have been premedicated before it. Next time I need to ask first if there are any prostate issues. The second one was on a new trauma, the guy had sternal fractures but was cleared for any other type of pelvic injury. He was supposedly sedated on propofol but he wasn't getting much- he was squirming all over the place. Michelle said if I got that one in I would be an expert. I remembered to "own it!" and I got it in no problem, I wonder if that means I qualify as a "penis genius" now.

I came into work the first morning of my new week with Michelle, and I saw Jim wearing an isolation gown outside the room of the 499.9 pound patient. They were taking her to the OR that morning. He said it was the worst thing he's ever seen. He must have heard something about my experience with Erica the preceptor from hell because he brought it up and said he doesn't like her either. Even being an experienced nurse she talks down to him, and he said she gets off on trying to act like a know it all and superior to everybody. That was nice to hear because it validated my feelings after last week, but I am glad we're getting rid of her.

The new hospital people are gone now. It's nice, even though we are short staffed and short on preceptors. I don't know what will happen after this month but I hope I get someone good.

After three days with Michelle I feel so much better. She thought I did well and she says I'm ready to take it to the next step- less stable patients. We are going to work on getting patients who are challenging- with lots of drips, lines, and ventilated. I had such a better week. We were busy and I had to go to radiology with a patient, and she was at high risk for a PE or a stroke, and I was scared but I had someone with me explaining things as we went along. I was alone with the patient but I wasn't alone because I had the backup if I needed Michelle. I made a lot of decisions on my own and talked to a lot of doctors, and felt like I was putting the pieces together on my own. It's so weird how being with a bad preceptor, I felt totally incompetent and frustrated. I haven't gained any more skills since last week, but I felt so much more relaxed.

Today I talked to my friend Anne from nursing school for a long time on the phone. She was with me for the first three semesters then wisely decided to take the summer off and do Block Four this past fall. She passed her boards yesterday so we had a long distance virtual margarita session like we used to during nursing school, without the margaritas. It was great to talk about all this stuff. I miss having the support of my friends from nursing school. I'm starting to develop a support network with a few coworkers. I'll get there but I still feel kind of lonely.

I was telling Anne that being on orientation as a new grad is like being perpetually PMSing. I feel drained all the time. I feel completely vulnerable to every gut wrenching emotional response there is. Only 14 more weeks of this, and then I'm on my own- which the other new nurses tell me is ten times worse!

We can start moving into our new house tomorrow! Wahoo! It's freezing outside, about zero degrees and then a wind chill on top of that. Feels like 20 below. I look forward to moving stuff in and getting settled. I'll look forward to doing my laundry inside the new house too. Right now I have to go outside to the detached so-called garage to use the dryer. There wasn't an outlet for the dryer in the house. It's so fun to go outside to put your wet clothes in the dryer when the wind is howling and it's below zero. Having outdoor laundry at your house in the desert is one thing, but we're not there anymore.

Peace, love & PMS,

Towanda, ICU RN

Ready for a new year!

I am now in my 10th week of orientation. I look forward to the rest of the month because I am now with Michelle, our unit educator, for the whole month of January. While we're in transition before the new hospital opens, we have a change in staffing and we lose all the people going to the new hospital. Not a loss, but a blessing. I feel like once they are all gone, we will have a good group of people. I like the people who are staying. Michelle will be filling in on the floor to do patient care so I will be with her. She's going to make sure I am where I need to be going into my second half of orientation. She is good.

Week eight I hit a milestone. I took two patients and did all of their care and kept up with their orders and almost all of what was going on. Only one patient was on a vent. The other guy was stable and should have been on the ortho floor but there were no beds available. I felt a lot better about that, like I have made some progress. I can't say I felt too much more confident in general but it was a big step for me. My preceptors were good and I didn't feel like crying as much either. I only felt like crying because of what I knew was going on in the patients' lives.

Week nine sucked. I thought I hit bottom and then it got worse. I had one crappy day with a preceptor from hell who basically ignored me all day and sat out at the nurses station talking, and I felt like crying all day, and then I had a mediocre day with her the next day. The third day was the worst yet. I don't think I ever had an experience this bad since I started nursing school.

I had a patient who weighed more than the bed scale. We don't know how much she actually weighed but the bed scale only goes up to 499.9 pounds, which is what the bed scale said when we weighed her. She was in because she has these wounds on her legs that are infected and they are so disgusting, it was like the inside of a corpse. All this dead, grayish green necrotic tissue in her legs which were hugely swollen, and the amount of flesh she had hanging off her body was unreal. The smell was nauseating. We were doing dressing changes with bleach solution and it took five of us to do the dressing change- it took three people to hold her leg up. I won't even go into further detail because it brings back all the smells and the icky feelings about it. What she needed was an amputation, but she had so far refused it and she is going to die soon if she doesn't get that leg off because she is going to be so septic she will crash. Which is exactly what she started to do the day I had her as my patient.

I started the day with my least favorite preceptor, Erica. For some reason she is like a nagging mother hen who tells you what to do, as if you couldn't have figured it out yourself. Then she disappears at the nurses station and is never there when you need her. I always have to go track her down when I have a question, and I pretty much gave up on that and started asking other people for help instead. The only feedback I get from her is negative feedback. Nobody else has been this bad.

I started out the day doing the usual stuff. I felt confident and ready to go after coming off the previous week. I went in and did all my stuff in the room with the lines and alarms and monitoring stuff, did my morning assessment and got help for the dressing change, and finally got started charting around 10:00. I barely got my assessment charted when she started crying for help. I went in the room and looked at her. She looked fine, and I asked her what was wrong. She said, Can you get my nurse? I said, I am your nurse, what do you need? and I looked up at the monitor. She said, I don't know. She has been anxious and needy so my first thought was she was anxious. Her blood pressure was a little lower than earlier but not low. Her color looked okay and her sats were fine. Then she said, "help me, I need help" and I wasn't sure what the problem was. She didn't look like she was having any problem. She was on contact isolation so I was supposed to gown up in order to go in the room. I asked her if she could tell me what was wrong and she didn't say anything else. I yelled for Erica, who was at the nurses station talking with the doctors. She looked over at me to say, I'll be there in a minute, and went on talking. I grabbed a gown and started putting it on and got some gloves on to take a closer look and our charge nurse Shannon was walking down the hall. I asked her to come in and look at the patient because I wasn't sure what was wrong. Shannon grabbed the stethoscope and listened to her lungs. (DOH! I should have thought of that first- airway first! ABCs) she said calmly, go out and see if one of the docs can come in. I went out to the nurses station and asked the pulmonologist if he could come in, and Erica snapped at me, "don't come out here in that gown, you contaminated the nurses station", and something else about not coming out asking the docs for help, and I said, There's something wrong with the patient! I ran back to the room and Shannon yelled, "get someone to page respiratory." I called that out to our unit assistant and Erica and the doctor came in, along with about three of our other nurses, followed by the respiratory therapist a minute later.

We all converged on the room and the patient's blood pressure was suddenly down to about 50/30, and we lowered the head of the bed and started a bolus of normal saline, and the doc decided he was going to intubate her right there. There were about 8 people in the room and Erica started barking out orders to me, telling me to be the one to give meds. She rattled off a whole bunch of supplies we were going to need that I needed to get ready, and told me to get Versed ready, and I had no idea what supplies we needed, where to find them, or what those things were. Fortunately Linda, one of the nurses I like, recognized that I was over my head and she said I'll get the supplies, you get the Versed. That I could do. I asked the doctor how much he needed and he told me. Fortunately this doctor is nice. Then Erica yelled over to me, someone needs to record. She said to me, "You record." First of all, I have no training in this. I attended one trauma and have never been on a code before so I don't know what to record, how often, or anything. I figured I needed to put down vital signs and medications but I didn't know how often or what to do. That was when I felt myself hit bottom. The tears started running down my face. I had no paper to write on except paper towels and I had been so busy giving meds, hanging fluids, making sure suction canisters were hooked up, and doing little tasks to help the doctor and respiratory therapist because the patient was so huge, it was impossible to pay attention to what was going on in the big picture. Erica kept yelling lists of things at me and I couldn't follow her, and I felt totally overwhelmed. I didn't even try to listen to her. I figured if it was that important, she could do it herself.

Fortunately we were able to get her blood pressure back before she lost her pressure completely, and we didn't have to call a code. We got her intubated and on the vent and stabilized, and Erica never said anything else to me throughout the whole event.

Then I got no help the rest of the day, except occasionally Erica would come over and tell me something else I needed to remember to do. I didn't want her around. For the rest of the day I asked Linda questions when I needed help and got the unit assistants to help on the afternoon dressing change. I didn't even sit down to chart anything else until about 4:30 in the afternoon and I spent the whole last three hours of my shift catching up on charting. I did escape for lunch around 1:30 and when I went in the breakroom I knew I looked like hell, my eyes and nose were bright red and my nose was running and I felt like if anyone talked to me I was going to start sobbing. One of our other nurses and one of our CNAs were in there and they both looked at me and asked what's wrong so I told them and they both gave me a hug and listened, and the CNA said he has a problem with her too, that he doesn't like the way she talks to him. The nurse said she hates that eat their young mentality. I think that's what it is, too.

I felt better after telling them about it and thought about talking to Erica before the end of the shift to let her know that she wasn't being helpful and it wasn't a good learning experience for me, but I realized that was the least day I have to be with her, and I won't be working with her because she's going to the other hospital, and by the end of the day I didn't have the energy to go there, so I decided to get through the day and put it behind me. I felt like I already put out enough energy crying and I didn’t want to stir everything up again while I was still on the floor. I needed to get out of there.

The thing that still bothers me about it is that she was my preceptor and when I needed help because my patient was in trouble she blew me off and then she was totally oblivious to the fact that I wasn't trained to handle a code, so I needed to be doing either simple tasks or observing, and not getting overwhelmed by someone telling me all this crap. The next day I told Michelle all about it and a few other people who asked, and then I felt like I was done with it. But I still felt like crying when I was talking about it.

I look forward to moving on and I will now remember to always go back to ABCs next time I am wondering what is up with a patient, and other than that I will continue to run out in the hall and yell for help even if I am in a freaking gown covered with beasties! FUCK YOU, ERICA!

And I thought about how I am so thankful I got mostly nice preceptors for my first two months because if I had started out with Erica it would have been a disaster.

Other than that I missed being at the new years race. I woke up in the middle of the night and sent messages to friends who are running. I look forward to getting back to ultras.

I have three classes this month- acute coronary syndrome, hemodynamics, and neuro. I'll be doing a lot of online coursework too. Then in February I'll be back to the patient care again. In February I start out with another preceptor who is fun and a little crazy too. She works nights now and is switching to days after she takes a vacation in January. I liked her on nights, I think she'll be great to work with. She always makes me laugh.

We thought we were going to get another blizzard, they were predicting 29 inches but we ended up with about 9 more inches. I ran to work again. I realized I have not driven my truck once in over two weeks. That is awesome! It's been nice living a mile from work. Our new place will be 1.85 miles from work, according to Mapquest.Still easily runnable, but I need to get a town bike to cut down on the time. I'll run to work when the roads are too slick.

Things are going well with the new house, we got through the inspection and they actually did almost everything we wanted, except for the radon mitigation system that they will pay for half of. That is fine with us. We are thinking about putting in a sunroom off the kitchen. We can move in as of January 12th but we will paint and put some carpet in. We have this rental until February 15th. I look forward to no more scraping ice off the inside of the windows. I have 6 blankets on the bed piled on top of me. I freeze at night until I get warmed up. Dale thinks I am crazy. But it is cold! I need a warm blanket wrapped around me all the time. Maybe my desert blood will wear off after a while.

It occurred to me that last year was a blur. So much has happened since a year ago. I was halfway through nursing school, and since then it's been nonstop. I am ready for life to settle down. Once we get moved into the new house, I am going to enjoy being home and settling in.

Peace, love, and happy new year!

Towanda, ICU RN