Day 3 as an RN: Under Fire

Whew! So, lets go over this week.

Day one summary- Easy. "This job is awesome! I love being an RN! Woo! This is going to be GREAT!"

Day two summary- First patient. "This is great! I'm doing great! Running into a couple problems but easily solved. Helping out lots of others on the floor. Eager to learn more, do more!! Bring it!"

Day three summary- "WHAT THE HECK AM I DOING!!!"



And thats pretty much all I need to say. But I'll say more- have no fear, thats why I'm here.


The biggest lesson I learned throughout reflecting on the day (I actually learned it during my lunch break when I literally just sat there staring at the wall, breathing) was that although the day thus far had been CRAZY and there were MULTIPLE times I literally thought in my head, "I'm not cut out for this. I am in over my head, like way in over my head, and I cannot do this", I do realize that I DID learn a lot yesterday because of that insanity. Not only did I learn true prioritization and time management, but I will remember the skills I learned forever. It was all very fast and in the heat of the moment (s) and it was either do it or you don't do it and the patient suffers.

I guess what I'm confusingly trying to say is, I learn better that way. Under fire. When you really don't have time to over-analyze it, (but still enough time to do it the right way!).  If my preceptor is going to just calmly be like, "Okay, step one, you do this....and step two, do this..." and I only watch, and its all hypothetical, then I might learn that in the back of my mind but its not truly ingrained. Whereas in the heat of the moment, you remember everything that you did. Did it work? Okay, do it again that way. Did you run into a problem? Did you learn the right way to do it after that? That, you will remember forever. I guess I learn best via trial and error.


But anyway, I got through. And by the end of the day, I did everything I was required to do. I swam through the deep end and made it to shore. I got everything squared away with my complicated patient, and even had time to volunteer to do another nurses admission assessment, despite it being my first time doing it, I thought, "How hard can that be? The computer guides you through the whole thing." So I got to do that, that was cool.


Update on the doctors...I got to deal with a new group of doctors yesterday, well, residents really. Which was excellent. The residents are so....eager to help it seems. They are still learning so they are still so genuinely interested in their patients and actually like when you call them. And I even got to meet the resident bunch when they came to do rounds on the floor and I met the actual one I was doing most of the talking with on the phone, and I redeemed myself and made sure to not come across as a total newbie/idiot. So, cool. Getting practice....eventually calling them will be no big deal. Eventually!


I also encountered my first family gathering/update/education session....twice! My patient was 94 and with severe dementia so not much education was happening with her. However, midday someone came up to me and asked if I was the nurse for that patient. I said yes, and she introduced herself as the daughter-in-law and had a couple questions and wanted an update. So I gave her an update and suprisingly answered all her questions! Somehow. So, that turned out alright without any prior "prep time". If I had known she was coming I would have read through the chart furiously and gave her the best possible update. But I told her what I knew. And then a couple hours later, I was informed that the son was in the room and wanted to speak with me. So he had some more questions, which I was also able to answer all of them! I love love love finally being able to answer questions from families! Its been so annoying these past five years reciting, "I don't know, let me get your nurse."  Woot!

I went to a meeting at work, after my shift, that was all about how to handle angry patients and how to make them happy again so they pretty much don't leave our hospital saying they would never come back again. But point is, the speaker made a really good point that shed some light on my work and probably a lot of others, too. Despite how bad my day is, on my worst shift on the worst day, I am doing good. I am helping people. And, I get to go back home at night. I'm not stuck in a hospital bed, waiting for biopsy results, or listening to my IV beep, away from my family. No matter how bad the shift is, your patients day is probably worse. So an interesting perspective to think about when I feel like I am having the worst day.






Well, I have the weekend off! So, lots of drawing, some photography work, and maybe some writing I hope!! Yay!



Thanks for reading everyone,

~WNB

Day One as an RN: The Blue and the Green

WOW!

Where do I even begin??  My first nursing shift was today......7 am feels like it happened five years ago!

So much to say, I guess best place to start is the beginning?


So 7 am. I was as nervous as a jumping jelly bean. But at the same time.....kind of calm. Does that make sense? Nervous because I was starting a brand new, huge, important job. But calm because I was in a familiar setting with people that love me, and I kind of knew what was ahead of me. I was ready for the day. Thanks to my incessant and annoyyyying adhd, I just really wanted to get OUT there and start doing something. Getting report is essential, and great, but I'd so much rather just get out on the floor and go see my patients with the night nurse rather than sit at a table far away. The nurses on my floor used to walk & talk but we seem to be straying away from that thanks to hippaa (privacy laws). So now we give reports in little hushed corners where no extendable ears are listening (supposedly).

So first things first, I got acquainted with my preceptor and we sort of laid out the ground rules and what not. Today was strictly  (supposed) to be an *observation* day. Remember that, lol.

After that we got right into assessing our patients, one by one (we had four to begin with). Well, my preceptor quickly realized I was not about to just stand there all day and so she let me listen ( to bodyish sounds), assess, chart, etc. Then came time for meds. Normal meds. Since the med system at my hospital is something I'm totally new too, this took some time to get used to. As an aide, I was pretty much familiar with most everything else nurses do (like IVs), but meds and the medselect system was kind of foreign.

But then the "plan" went out the window. And soon after is when I learned that plans are great in nursing, but last for about five minutes before everything gets uprooted and changes again. One of our patients started having intense chest pain, so that took priority above everything else, even though we had all our meds laid out and ready to go on someone else. So that required a full asseessment, a stat EKG, doctor phone calls, labs, etc. After all that settled, we went back to those original meds for about five minutes before one of our other patients (psych) pulled out his NGtube (really not good) so we had to go rush and reinsert that. We got temporary placement, but when it came time to give him his meds through the NG tube, it was clogged and we couldnt unclog it and therefore we got to reinsert a new one.

So, phew!

After that we went back to the routine meds, and by this point she decided I had picked up fast enough that she let me draw up my own meds to give. Woo! So the rest of the day was a collection of lots of meds, working with a lot of IV's, charting (a lot), and reassessing. I learned a lot more about prioritization, and learned that there is just SO MUCH to do. 12 hours seems like such a long shift, but I'm starting to realize that its not even enough time to realistically do it all! Yes you have to always attend to the emergencies first, and then after that attend to stat orders, medicines, assessments, etc, but if you leave patient communication on the backburner or turning them every two hours, then that will slowly creep on you and it will soon become your worst enemy if you don't attend to it first in the beginning. So Nursing is a game of knowing how to do it all, at the right time. I get that now. I just have to perfect it.


So, whats with my title? Well, I've changed colors. Aides wear teal green throughout my hospital and now I'm wearing royal blue, along with all my other nurses. Its funny- All day I got a lot of confusing stares-even from the cafeteria workers and housekeepers- that I was "in a new color".  Sidenote: As much as I love the thought of self expression and coming to work in whateverhellscrubsyouwant, I do enjoy being able to go to the cafeteria and know where someoone works and what they do based on the exact color they wear. What do you think? End sidenote. lol.

Anyway, since I haven't been to work in like an entire month as an aide (thanks to NCLEX and the law), there have been a couple new hires (aides). And when I had some down time today (my preceptor went to lunch), I made some rounds in the hallway on everyones patients and went in and helped a couple people to the bathroom, answered a couple bells, etc.  Well, you should have seen the look on one of the new aides face when she saw me in the room, helping one of her patients. She doesn't know me and all that ran through her mind was, a nurse is helping me? Fo realz? It was quite comical.  Even some of my closer friends that are aides, I can tell they see my blue now and I can read their thoughts. I can practically read it in their eyes, hoping I don't become "one of them". One of those nurses that doesn't help, that is bossy and "too good" to clean out a bedpan, too good to help out wherever its needed. All I want to do is prove to my friends that just because I wear blue now doesn't mean the past five years as an aide hasn't taught me anything. Those five years are the entire backbone for the nurse I am today. I would *never* be where I am today without the experience, and without those friends to get me through. To get each other through.


But it is hard, separating myself from that role. Despite me wanting to prove I am not "that nurse", doesn't mean that I don't have a whole new set of responsbilities now that need serious attention. Sometimes you just have to delegate, and I see that now too. Thats where excellent communication comes in and treating your aides right and they will treat you right! :) But even just instinct. THe sound of a call bell- I still automatically start walking towards it. The sound of an emergency bell still makes me want to run. Today I felt like a bad person because I was giving meds instead of helping whoever was trying to get out of bed when the emergency bell went off and the aides were busy. I remember those days. Its hard going from being responsible for the entire floor to only responsible for 4 of those people on that floor of 30. Its a lot different.

I have full intentions on telling my aide(s) every day how much I appreciate their help. To say thank you for every thing they do and take nothing for granted, ever. I will never delegate a task that I could just as easily do if I am not swamped with charting, meds, ivs, etc. I will ask them with respect to help me with something rather than tell them to do something for me. I think every nurse should be an aide first! I really do though.


So by the end of the day today, my preceptor discussed with me how she was superbly impressed with my knowledge base (trust me, I was suprised too), my instincts, memory and bedside manner. So, yay! So her and my educator decided I was ready to move along to the next step: my first official patient comes wednesday! I make the decisions and guide the care, give the meds, chart and assess, all under (a lot) of guidance from my preceptor. Woo! It felt AWESOME to be able to explain to patients (finally!!!) why they are going for a test, or why their lab values or up, or why they can't have a regular diet, etc. I've been so tired of saying, "I don't know. Let me get your nurse."  Now I feel like everything makes sense!!!

I think I am most scared of: calling and bothering doctors (they always seem so bothered when you call), and putting in my first IV. Yikes.

Also, by midday today I wanted so badly to just practice what she kept teaching me. I just wanted to grab it and do it myself! So thats a good sign. At least i'm not afraid to do things. I remember in clinical I thought it was the end of the world if I had a patient with a piggyback, because I was afraid of it. Now I find it exciting! But then I finally DO get in the spotlight and asked to do something and then all the confidence leaves and suddenly I doubt all my actions because I am just so deathly afraid to do something wrong.


At this point, its all about finding my own "system". What works for me? What charting system, what assessing system, what medication system works best for me? How should I organize/plan my day? So it will take learning from a couple different nurses to find out which techniques I want to take from who and mold myself from that.


Well, thank you for reading this far. Really! Even if none of you made it this far, I'm glad I have this all in written form because in twenty years I will read this entry, my first day of nursing, and I will laugh myself silly most likely. Oh how things will change! But I can't wait :-) Let life begin!



Love you all,

<3 A Writer in a Nurse's Body