December 5, 2009

New graduate growing pains

Work has been rough lately. I had the week from Hell.

First day of the week I’m floated to another unit to help for an hour, during which three codes happened. Medical, elopement, out of control. Two of those three were on the unit I was on…guess which two. Yep. At least they brought him back pretty fast, and I learned that an IM cocktail of Haldol + Benadryl + Ativan = SLEEP for even the most gigantic and violent of patients.  It was a frightening experience because it all happened so fast...but overall, that day wasn’t too bad.

Next time I’m in, they put me as the charge nurse of the intensive care unit and only left me with an LPN. I’ve worked ICU before but usually as med nurse with one of the unit’s regular RNs with me. I did charge there once during orientation, with both a med nurse and the nursing supervisor (whose job it was to orient me that night since that was her home unit anyway) keeping me company. The overnight supervisor apparently thought well enough of my work that she thought I could hack it with just an LPN.

Except that I’m not used to the ICU in the daytime. I’m used to the evening ICU. Everyone had to go to court for their hearings, and I didn’t know what I had to do to get them sent off to court. Everyone came back involuntarily committed and was angry. Now THAT, I knew how to handle: have the med nurse get the PRNs ready. Then two actively psychotic patients come in (one violent), four more admits are on the boards, one patient on 1:1 for suicide, another on eye view, all these assessments to do, staffing wants to take my techs away since we “only” have so many patients, I’m not familiar with the medicines the unit favors, the treatment plan, the patients, the psychotic patients…

I called for help a lot–I think the nursing supervisor was sick of me by 10am. Still, all the stress kept building up, the workload kept getting larger, and even though I had a team of techs that knew this wasn’t my home unit and kept me on track, I was getting really frustrated and anxious…I was ready to scream and/or walk out of there. When the DON asked me if I wanted her to come over for a while to help, I was going to say "no" because I felt like her offer was a vote of no confidence.  But she must have heard the stress in my voice, so I came to my senses, got over the ego and said “sure”.  She came over, sat with my 1:1 for an hour, got her to eat, stayed another hour or so afterwards, and also got another RN for me for part of the shift to help with assessments.

I survived. No one died, no codes were called. So by my own standards, it was a good day.

When I finally wrapped up my paperwork (an hour late), I stopped by the DON’s office to drop off one of my forms, and it ended up being a debriefing. She said that I handled it well considering everything that went on, my lack of experience (both on that unit and because I’m a new grad) and that it was a sign of growth that I knew I needed help and asked for it. She was actually very encouraging--in fact, she even thanked me for giving her an excuse to get on the floor because she rarely gets to do that anymore.

Last day of the week. I’m back home in detox. Low census so it’s just me with a tech. I know the faces, I know most of the turf. Most. Apparently not all, as I goofed up on a taper order–I misunderstood what the doctor had wanted, and she got an extra drug that she didn’t need. Plus, the admissions department got a crazy use and medication history from the patient, so when she got up here, we’re not sure of why she’s here and what she should be on.

So on my fourth call to the doctor as we try to get this all sorted out, I tell him what she’s received so far today…and found out I got the order wrong. Surprisingly, I didn’t get raked over the coals for it. He was actually pretty sympathetic to the fact that I’m a new grad still learning the basics, and was quite encouraging in his pep talk. He asked me what training I had had in detox and I told him what they covered in orientation (which isn’t a lot), but I’ve been reading up on most of it on my own because I find the field fascinating and that I wanted to get more involved in it. He said he wasn’t upset with me for the order mix-up–though issued a new order for me to discontinue that drug–and that he was going to look into getting an in-service for those of us who work there regularly, so we can learn more about the protocols. He also thanked me for my dedication and work there, and that he was glad that I had called him because it was better I did call when I needed to than not to call and wonder if I’m doing the right thing.

Of all the people to tell me to keep my chin up and offer help, it was a doctor. Go fig.

The tech and the LPN who visited me at the end of the shift told me I should relax, I shouldn’t stress so much over my work. I told them I knew that but that’s just how I’m wired, but I am still going to try. Funny enough, both of them said to me the things I say to myself and to others. The tech told me that no one died, so it’s all OK; I echo those sentiments every shift. The LPN told me that what doesn’t kill me makes me stronger; I had said that to someone after my day in the ICU.

I guess I just felt frustrated these days because I feel like…well, like a new grad. Stumbling and bumbling and not knowing my ass from my elbow…and yeah, the fact that I was valedictorian just makes me feel that I should be the last person stumbling and bumbling. I should know this stuff cold–I did on the tests. I did in class. And I know that really practicing as a nurse is a world different than what I did in class and on the tests. I still felt incompetent though, even though I know I’m not.

I’m hard on myself though. Sometimes too hard. I was like that in school too…still am. For my talk of not caring what grades I get in the BSN program as long as it’s at least a B, I’m going into the final week of the class with a 99%.

Well, if I’m smart about this (and I plan to be), I’m going to take all that happened this week and see how it can help me grow. And not go into my next shift with the attitude of ”I’m going to stumble and bumble again” but that I’m going to do the best I can. After all, if no one dies and no codes are called, it really is a good day at work no matter what happens.

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