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.

I bought a new stethoscope while I'm speed-defrosting a turkey

I brought a Littmann Classic II SE for myself.  I needed a smaller steth than my CD-27 (which I love but damn, is it heavy!) for going to the clinic as well as for work, especially since they're going to be spreading the physical assessments over the entire day now instead of leaving the bulk of them to the night shift.   I will actually need to have a steth that works pretty well instead of the behemoth steth we keep in the drawer.  Plus, I'll need it for clinical when they start up.

It's also personalized with something important:  RN.  Meriwhen, RN.  Well, my real name plus RN...I don't think I'll be advertising myself as Meriwhen at work anytime soon.  Though I'm sure a few classmates have figured out who I am by now...but like I tell people when they call at the nurses station but don't have authorization to talk to the patients:  I shall neither confirm nor deny my identity on the board.

I forgot that Turkey Day is tomorrow and I didn't take my turkey out to defrost.  So I got a bucket from the garage, put it in, and filled it with cold water.  I'm changing the water q1h until I leave for work, then it goes in the fridge, then my better half will resume defrosting until I get home.  I hope it comes out OK.

Happy holidays!

So I call for the nursing supervisor...

and ask her to come on up to my unit whenever she has a chance, no rush.  She appears pretty fast, considering that it's the end of the shift.

I tell her I discovered that I made a med error yesterday:  when I was doing my nightly check of the MAR, I noticed that I missed signing off on an entry the day before (the day I didn't do a nightly check since I had a late admission).  I was about to sign it when I figured that since it was a narcotic (not really--it was Tramadol, but we do keep it with the narcs since it's usually given with Phenobarbital), I'd check the narcotic log to see if I did give it.  And I didn't.  That was a busy night:  I'm trying to pass meds and someone's knocking on the med room door q5 minutes to ask/tell me something.  It was very distracting. 

"So what are you going to do about it," she asks. 

I hand her a completed medication variance form and incident report.

"Oh," she says.

"You need to fill out the back part," I tell her, "since I was the only nurse here that night as well as tonight."

I think she was a little shocked that I wrote myself up.  In her day job, she's a nursing instructor, and I think she was preparing to lecture me.

To be honest, the odds are that the error never would have been discovered unless they decided to audit that particular chart.  I could have signed it and let it go, and I'd be a liar if I said that never crossed my mind because it damn well did...but my conscience would have gotten to me.  And once I start down that road of not reporting errors...pretty soon I'll be falsifying documentation, diverting drugs and barking at patients, "you're crazy, just deal with it".   So I did the right thing.  

Now I'm up to 2 reported med errors, but this is the first that is 100% my fault (the other was the one due to another nurse transcribing the order wrong then altering the MAR after I gave the dose--I was the one who filed the variance/report.  The unreported one was also due to another nurse's error in transcribing, but since it helped get the patient's HTN finally under control, the charge nurse and I got a one-time order to cover it).  

"Am I going to get fired for this?" I ask...not entirely in jest.

She laughs.  "Please...if only more people here did this."

I probably won't get fired, I take it.

I don't like making the errors though...the problem is when I'm the only nurse on the floor doing both charge and meds, it can be distracting especially when everyone is coming to me because I'm the resident RN.  I think I need to set a policy that, if I'm the only nurse on the floor, unless copious amounts of blood are involved or a patient is about to go off the psychotic deep end, that I'm not to be disturbed during the med pass.  Either that, or I need to get the nursing supervisor down here to cover charge for the 20 minutes.

Nurses do not get snow days

Or rain delays.  Or bad weather days.  Or holidays, really.  Hospitals can't just up and close for the day because there's three feet of snow or a ton of flooding or because it's Christmas.  Patients need care 24/7.

I say this because today I must set out and face the remnants of a tropical storm as I slog my way to work.  The brunt of the storm hit on my day off...though that didn't stop them calling me at 5am to ask if I could work anything at all.  I told them that my preschooler's school was closed due to the weather and unless they wanted to babysit him on site, I can't come in.  I think they were desperate enough to consider saying "yes."

My street is flooded.  Not horrifically:  the house is dry, nothing has floated off, and my car is high enough that the water never reached it.  But I know the roads are a mess everywhere and so driving in is going to be quite the trek.  I have a SUV, so now I'll get to see if purchasing one was worth it. 

I had to put in my holiday choices for the schedule.  Everyone has to put in for two of three winter holidays and two of three summer holidays.  We're not necessarily going to end up working them, we just have to be available for them.  I put in shifts for all three--two of them ended up on my regularly scheduled day (Friday) anyway, and I figured I'd put down for Turkey Day as well, in case I change my mind about working Christmas (I will gladly work New Year's Day, I think it's the most useless of the three days.  After all, the big event for the day is pretty much over by 12:05am--the rest of the day is football and parades). 

I don't want to work all three, though getting all that double-time would be nice.  But we'll see what happens.  They do try to divvy them up evenly so no one person gets slammed (or makes a killing, depending on how you look at it).

It's been busy at work.  For all of these new nurses they've hired, I've only seen a couple of them.  Nearly every day they're calling me to see if I can work or work extra, and all week I've stayed late per their request, so much so that half of Saturday will be overtime pay.  Unless they decide to send me home early...and given the weather conditions here lately, I doubt they'll have enough coverage to be able to do that. 

Detox has been jumping too:  I don't know if it's linked to the holidays or what, but it's been full all week.  Of course, that means a ton of paperwork for me...but it's the unit I know best, so I don't mind it.  I've got it down to a science, in fact.  I wonder if I'll be there tonight...lately, they like sending me to stepdown on the weekend evenings.  I'd rather be in detox, but I go where I'm told and make the best of things. 

Oh, what happened with my group....the other group person was out due to illness:  her doctor had her on bed rest.  At least she wasn't slacking, so I don't feel as bad over having to do the whole thing.  The instructor also posted that she had liked the group (my) assignment, though I haven't gotten the official feedback yet.  I turned this week's assignments in early, since with the bad weather I'm not sure if I'll lose my internet connection.  No more group stuff for a while though.

*sigh*

I got my first week's marks, and I didn't fare as poorly as I thought I did.   Actually, I did very well.

The next two homework assignments were turned in on time.  One assignment is utter crap though.  It was a group project...except my group wasn't really there.  They sort of got started, but one member had a family emergency of the life and death rank.  One member went AWOL. 

So that leaves me. 

I didn't mind--I'm not getting a zero by not turning anything in so if I have to do the lion's share, fine.  Also, family emergencies trump schoolwork, so I can respect that.  So all night I kept posting drafts and asking for input when possible.  All night I got nothing.  I wrote a few drafts on the board and countless more in Word.

Finally, with 5 minutes to go before the deadline, I had to call it a game and post what I wrote.   After reading it, it's crap compared to everyone else's, but I didn't have a choice.  One of the other groups pulled together beautifully.  The other group managed to capture the assignment beautifully.  Meanwhile my group...er, I...am trying to stay awake after being up for almost 24 hours. 

Then I found out after the fact that the group area we were supposed to work this in is visible to not only to the teacher, but to the other students.  I had thought the groups were private...so basically, everyone knows I did all the work.

*sigh*

What could I do?  Rock to the left, hard place to the right.  I'm going to sleep now.

Going to enjoy the ride this time around

As an ADN, it was all about grades:  I finished with 3.923.  I had one B--I missed the A and thus the 4.0 by 2 mere points...and I know what question I stupidly answered wrong too.  Yeah, it burned for a while.  But on the other hand, it taught me an important lesson:  the world didn't end when I didn't get the A.  People didn't think me any less smart.  People thought no less of me...hell, my classmates were still proud of me for what I achieved--and what I did to help them--that they let everyone know it at pinning.

Getting that 3.923 was exhausting work--I went above and beyond in studying for those two years.  My health suffered, my social life suffered, my family actually didn't suffer because my better half was/is a champ at picking up the slack when it comes to the preschooler.  My mind suffered though.  It was emotionally draining.  Everyone said I made it look easy; I tell them they should see the ulcer it gave me.

Now that I'm a BSN student...I still want to do well.  I don't know if my future includes a masters degree so I don't want to become an entire slacker.  But I'm not as stressed anymore over the grades I'm going to get.  If I get an A, yay.  If I get a B, yay.  If I get a C...ok, I have to put my foot down there--I will not willingly be a C student.  I already was once in my life, thank you.  Point being:  I'm going to focus less on getting the GPA and more on the class itself.  Slow down and smell the care plans and concept maps.  Look at the whole picture and not just the tests.  Enjoy more of what I'm doing.  Not let it consume as much of my life...and it being a part-time program, that should be easier for me to do.

Speaking of which, I better get cracking:  my homework is due this evening but I still want to go out with my friends tonight.

Mental note: read the syllabus

The first week of my first BSN (pre-BSN) class drew to a close.  It had a rough start as I got my dates mixed up and ended up turning the first assignment in a day late (thank God I decided to log in--I noticed all of the postings).  Participation-wise, I fell short too.  I thought I was participating enough but then I counted up my postings and was one post short of the minimum guideline.  Of course, had I bothered to read the syllabus fully on day 1, I would have had the answers to A and B and therefore no problems.  But I didn't because I thought I had several days before the first piece of work was even due.  I thought about telling my teacher about being sick and pleading for leniency, but you know what:  it's my responsiblilty to know what's going on in class.  I just have to suck up whatever grade I get for the week and do better next week. 

Lessons learned. 

I've combed through the class calendar and added the due dates to my Outlook, printed out the next two assignments and when they are due (end of this week), and today I plan to go through every inch of that syllabus to make sure I understand it all. 

I'm looking forward to going back to work.  Despite being sick and all the stress, the week off has been nice.  But I'm also bored and itching to get back on the floor.