My First Year

Yesterday was one of the most difficult and frustrating days on the unit. My preceptor was assigned a modified section, less patients who create MORE stress. Taking one patient was more than enough. It was one of those days where it felt like no matter how much I did it was never enough. One thing after another with the most particular, nonstop requests. Leaving the hospital, knowing that I had off today, Mother's Day, it had me thinking about her mom who was at the bedside. Sure I get to leave at the end of my shift but her mom has to go back home with her. I began to feel empathetic more towards the mother than the patient. As the mother is the sole caregiver I can only imagine how much time she actually has for herself, to take care of herself, to relax by herself. I can only hope that I was able to provide some slight sort of "put your feet up and relax" relaxation for this patient's mom throughout the day. Sometimes when I leave the hospital after a crazy day all I need is something sweet. Last night it was a splurge with warm apple pie and vanilla ice cream... for dinner. This morning I did an hour of cardio to attempt damage control. Then off to pick up flowers at Trader Joe's, lunch in Brooklyn with Bubby and now back to the island for Sunday dinner with the other side of the family. Every day I am thankful for my mother, my grandmother, my Bubby and all the other motherly figures in my life. I am becoming who I am because of you all.

*True but cheesy, but appropriate PSA; take care of your patients the way you want your mother, grandmother, aunt, and other motherly figures to be taken care of. 

I don’t really know if this is the right terminology but at least I'm not confusing the word benign with malignant right now. I LOVE scrolling though insta about healthcare things. This morning I came across a post about an M&M (morbidity and mortality conference). However the post isn’t really what I gave a shit about. It was the comment that I found underneath. The user commented “we learn from our mistakes and errors not from our achievements or good outcomes it is called endurance- we are like elite athletes the more we practice the more we become experts, but in the way we certainly have mistakes.” Besides this man’s poor grammar it was almost as if he was watching me these past few weeks and just delivered me my horoscope of some sort. As a new nurse  it’s been extremely frustrating not knowing as much as i’d like to and making stupid mistakes (like switching the rate and volume on an IV pump and trying to suction a patient without the suction on and detaching a PEG tube without clamping it first). BUT THIS IS HOW WE LEARN-making mistakes. Yes I know that these things won’t necessarily cause death but they’re still mistakes, and i’m still learning and eventually, in a matter of months I will be down in the ER handling life threatening circumstances, and I can assure you that I will still be learning, making fewer mistakes!

This week I was in class. We went into depth about certain nursing policies and procedures and went over some equipment that we would’t be familiar with, being new to the hospital. It’s good to learn from your preceptor, of course that’s who’s molding your nursing practice and creating somewhat of a standard, your first few months of working, but sometimes you really need to hear things from a nurse educator.

 Being in the classroom this week, away from the unit, it had me thinking about my previous patients that left an impression on me these past few weeks. From DNRs at end of life to new masses found on MRI and CT and later biopsied. I want to know what happened after discharge, or if they’re on a separate unit, whether at my hospital or another. I guess this is part of when the healthcare professional must detach themselves from their patient. Yes, I think i’ve been doing a pretty decent job at this so far but nurses are human and like any other human being curiosity is a virtue. The first virtue to be exact; “[a] burning itch to know is higher than a solemn vow to pursue truth." - somewhere off google. However, no burning itchiness here, knock on wood. 

This week I had a lot of firsts. I dropped my first NG tube into someone’s stomach who was actively projectile vomiting blood, on the first shot- may I add. I also gave meds and feedings through a PEG tube. The learning lesson from that? ALWAYS CLAMP before you detach... unless you want regurgitated feeding contents and gastric juices all over you. On that same patient I suctioned a tracheostomy for the first time. This is by far one of the scariest things I’ve done. Knowing that you’re practically suffocating someone while trying to help them at the same time makes my nerves fire and blood rush to my face. 

I also made my FIRST big purchase. Queue price is right voice- “A brand new car”. It feels good to actually put some of my earnings and hard work in school and at the hospital lately into something that is tangible. Insta with witty caption to follow shortly. 

This weekend marks four weeks on the unit. A few “ups” a lot of downs and hell of a lot of, “omg I can’t  believe I just said/did that”. Also lots of first these past few weeks like straight cathing a women (blind shot), communicating with doctors and PAs with what I want for my patient, smelling...smells and explaining things in a logical manner to worrisome families. Yes, there are rewarding parts of the job, like helping people who actually need help and it actually feels amazing when they genuinely thank you with their words. But there’s also the shitty moments when you feel like you busted your ass in school for four years all to feel like a waitress. The major down side to that?... No tips. Ten more weeks on the unit...but who’s counting?

It was the first week of twelve and a half hour shifts, which usually end up being closer to 13.5. What’d I Iearn this week? People are nasty. They think that they are entitled. They simply don’t give a fuck. It’s not just the patient that’s your patient, actually. It’s their whole entourage. Essentially a package deal. After this past week I’ve come to the conclusion that all patients want is food, pain meds and to see the doctor. And when they’ve had enough of this alternate reality vacation, they just want to leave. However, that’s not just it. If they don’t get what they want ...THE NURSE- YOU, you are their voo doo doll. Their punching bag. They’ll sock you with their words. You must assume the role of the punching bag. You stand there and take it. You can’t walk away and you can’t fight back.  Show them that you’re the bigger person, excuse me- show them that you are the “professional”. Rebound back, don’t take it personal and move the fuck on. Be quick, firm, and confident in your answers. Know that you did your best and the best is all you can give. It’s what they deserve... no matter what they may do, say, or act. 

Firsts as an RN; Removed a foley, blood glucose shebang with insulin, manual BP (LOL for the first time in two years- I still got it), been corrected by a PA on something I never assured a patient of, dropped medication on the floor, given a shitty report to the night nurse with lots of unnecessary information. 

I could tell in an indirect way that patients this week were apprehensive about me giving them their IM and SubQ meds, knowing that i’m orienting to the unit. It’s easy to feed off a patients’ nerves in the beginning but it was nice to hear three patients tell me that the injection hurt a lot less/not at all, compared to the last  nurse who gave it to them. 

Third week in was three days of EKG class and two days with my preceptor. After two days of reviewing the two days of EKGs I probably spent in college we had a quiz. My first graded “thing” since the NCLELX. My brain on solid vacation it was time to get on that crash diet. Thankfully I didn’t crash and am considered proficient in recognizing basic dysrhythmias. I don’t how accurate that is though, considering I interpreted an V.Tach as Asystole.  Leave it to me. Right after the exam I went and scooped up my first paycheck. What a feeling. After four and a half years of school that is a sign of what I worked for (besides the health and well being of my patients, of course) 

I also met my preceptor this week. After running an extensive Facebook and instagram search I couldn’t find her anywhere. The only thing I had to judge her from was her name. It sounded young... and she is. Only a nurse for a few months short of two years she already seems like she's been doing it for years. Highly relatable and she seems extremely patient. Already I’ve learned so much and i’m positive i’ll have a good few weeks ahead of me.

The hot topic today was discharge, as usual... but even more so. Perhaps because it was Friday. It drew my attention because so many of the patients today had completely different point of views. One lady on workman’s comp changed her mind between homecare and rehab about four or five times, the three days that she’s been there. Another patient was so anxious to leave the hospital and go to rehab, he’d bring it up like a child just told they were going to the toy store if they were good. One lady who was a 23 hour obs wanted nothing but to go home, literally. While denying everything, from blood work to the incentive spirometer to pain meds, she was determined to be discharged. The husband however didn’t want her coming home. He wanted her there longer. He encouraged what we were encouraging. Family members like that seem to be quite ideal for the health care team, although he didn’t help much it’s still nice to have the support. 

Firsts: Paycheck, Answered the phone on the unit, Bladder Scan Machine 

Goals for next week: Manage two patients on my own, with as little assistance as possible from my preceptor. 

Your girl is finally off orientation, the classroom part of it anyway. Yesterday was the first day on the floor and first day I had to roll out of bed at 530a to get there at 630a. Paired up with a nursing assistant I ran around like a chicken with my head cut off. I was asked stupid questions about my age, smelt foul odors, and did things people who aren’t in nursing would never want to hear about. I never really pushed myself as far as I could in clinical for school but yesterday I definitely worked for that money. There was one other new nurse from my orientation paired up with another PCT on the same unit. In passing I said to her, “I don’t understand how you’re always smiling”. It was more of an annoying smile than a happy smile. Were her cheek bones fixed like that, was a patient slipping her their extra pain meds? Nuts. Besides staring at that Joker-esque smile the day went by pretty quickly. Later that night I was able to relax and forget about the day. Dinner with friends and then drinks and hanging out in Huntington is definitely more pleasurable when you have something to get away from for a little bit. 

First work weekend and last weekend of winter was a success. Lots of family time and lots of sleep was on the agenda and that’s exactly what was done. So proud of myself that I was able to roll out of bed at the prime time of 5AM to make it to the gym at 5:30 this morning. Workouts always feel so much better at earlier times like that. As weird as it sounds i’m going to try and cherish them until the 7am shifts hit. Ask me my fitness plan when 12 hour shifts happen and i’ll probably tell you it’s somewhere between running around the unit, like a chicken with my head cut off and going on a TPN only diet.

First day of general hospital orientation felt like the first day of a new school. New people, new surroundings, new opportunities, and of course new shoes. The first two days were pretty simple. Listening to different departments give their schpeal of what they do in the hospital. i.e. security, chaplain, infection control etc. etc. The second day I was thrown a bit of a challenge, getting to work in an impeding blizzard. We were expecting 12-18 inches, yet HR insisted “You are part of the health care system. This is what you signed up for”. Nevertheless, I woke up to more a slush storm than a foot and a half of snow outside my window. Dad persisted on driving me and I persisted on getting a jeep with 4 wheel drive as my next lease. The hospital definitely seemed more empty than the day before. Pussies

Wednesday through friday preceded nursing orientation. Sitting in a classroom with other new hire RNs, without going into specifics we discussed what would be expected of us as RNs at this specific hospital. We covered various policies and procedures, how to use the computer and other pneumonics “we’ll be using” while working as an interdisciplinary team. 

The orientation leader is quite sassy, but definitely means business. She keeps it interesting. When we first walked in she was encourage people to keep it moving, “this is nursing” she said, “we don’t have time to stand around a look pretty, okay okay, honey?”. I thought I entered nursing bootcamp at this time. She tells it as is and definitely lightens the mood of being stuck in a class room for seven days with the same people and a possible pressure ulcer developing on your sacrum. I found out she taught at my alma mata. Definitely makes me wish I would’ve had the opportunity of taking her, yet at the same time I question how’d she conduct class for students that don’t have their license yet. 

The best part about orientation is being able to talk to experienced nurses, who've been around the hospital block once or twice before. One nurse (on behavioral health -_-) definitely knows the ins and the outs of this profession. She explained to me how she started out 12 years ago on med surg, had her hand at home care, but found her niche in behavior health. I think for her it’s mostly about the nature of the position. They work 5, 8-hour shifts a week, instead of 3 12-hours, mainly because “what day care is open 14 hour days. I don’t got no time for that”. She also doesn’t seem to into the medical aspect of things, such as colostomies, catheters, NG tubes, all those fun goodies. Today she gave me her inservice of online classes for her masters. I learned to keep my mind open. You can really attend any college in the US for online classes even though you may not live in that state. Also she said go for something more generic like management and leadership if you’re unsure of what you want to do. I’d get paid more for a position that requires that degree (AKA not a staff nurse), on top of the additional pennies i’d be earning ontop of the hospital’s base salary for the position. She also shined a light on the possibility of teaching clinical with any masters. 75 dollars an hour to teach clinical once a week, i’d take it. We went into per diem rates and different rates at various hospitals too. Very insightful and grateful for meeting this behavioral health nurse. 

Monday to thursday starts week two-ish of nursing orientation and the plans for next friday are still unknown Sooooo that is where I stand for now. Happy St. Patricks day ya’ll from Nurse Lauren (and my three leaf clover pin)