July 31, 2011

Dealing with grief

Today I spent the day shadowing another nurse on the unit. She was absolutely wonderful about taking the time to explain everything to me, and teach me as much as she could. It was hectic and crazy right from the start. We only had one patient, who had come to the emergency room just a few hours earlier. His only complaint was shortness of breath. Within an hour, he declined so quickly he had to have an endotracheal tube placed and was put on a vent. When we received report, we had learned that he had pneumonia, and a suspected pulmonary embolism that was later ruled out. He was on maximum support on the vent and was receiving 100 percent oxygen. Despite this, his O2 sats were only in the 60's and stayed that way all day. He was septic and despite all of our interventions, he was getting worse. I felt sad for this man while helping to provide his care. I wondered if he could hear us despite the sedation, or how aware he could possibly be of what was happening to him. I wondered if he was uncomfortable. He was not expected to survive.

Many family members came to see him. I watched the nurse as she spoke to the family. I observed the reactions and listened to what all the family members had to say. One thing was said frequently by many, "But he was fine yesterday", "But he just said yesterday how well he felt". The wife, the brother, the sister, the niece, the son in law. They all said the same thing. I saw the shock on their faces. Their pain was so intense, you could feel it along with them. It was in the air around you. It was hard to witness this. I had to look away when the teenage granddaughter sobbed. It was so unexpected to all of the family, and in my opinion, that makes it all the harder to deal with.

I was on that side of hospital bed 15 years ago. My mother had a horrible accident that put her in the intensive care unit for approximately 5 months. She was not expected to survive either. Driving home after my shift, I cried. I cried for that man, I cried for his family, and I cried for my mom. I briefly questioned whether or not I was strong enough to do this. But I know I am. This is why I became a nurse, so I could help others in their time of need. I need to recognise that I'm human, that I have emotions, and that it is ok to feel these things, and cry if I need to. I called my grandma, and told her about my day. She cried a little with me, as we both remembered what my mother went through. She told me she was proud of me, and that  my mom is watching over me and that she is proud of me too. I felt better after talking to grandma, it was just what I needed.

The man was transferred to another hospital. I will probably never know if he pulled through.

July 23, 2011


So I've begun my general orientation for my new job in the critical care unit. I realize that I have alot to learn. Yes, I've been a nurse for several years, and while I have plenty of trach and vent experience, none of it is in acute care. Home health is a completely different ball game from the hospital and I'm worried about my lack of nursing skills. I've never started an IV. I've never even had to do CPR (though I'm quite proficient at changing plugged trachs and bagging with O2 when necessary). I've had minimal opportunity to work with IV meds during my clinical rotations in nursing school. I've completely forgotten all about how to interpret EKG strips. I barely remember the common treatments for various disease processes that are more common in adults. I can't even  remember the indications, action, and side effects of alot of the medications commonly used by older adults because I've been in pediatrics for so long.

Luckily the unit I'm on is going to consider me a "new graduate" even though I have many years of experience under my belt. This means that I will get to work very closely with the nurse educator and a preceptor for a full 6 to 8 months. The drawback is that I'm not fresh out of school like the other new grad that started the same time as me. I'm hoping that I didn't forget as much as I think I did, and that as we review the material, it comes back to me fairly easily.

So far today is my second day working with the nurse educator. I really like her. She seems to love what she does, and she is very honest and direct. Her expectations are clear and seem very reasonable. She wants us to succeed and has told us that she will not set us up for failure. It seems that I will get the support and education I need to become a good critical care nurse. The fact that this hospital gives such a lengthy orientation makes me feel good that I can succeed at this.

July 16, 2011

The Next Chapter

It's been a wonderful experience, but I'm ready to move on to the next chapter. In my 5 years in home care, I've seen alot of things. I've gotten to know alot of wonderful people: grandparents, parents, children, other nurses, and the staffing coordinators worked diligently to ensure that families didn't go without a nurse for the day/night. I've also seen a lot of not so nice things: dilapidated and dirty homes, homes with rats, mice, cockroaches, and a myriad of other unwelcome critters, neglected children and their stoned parents, shootings outside the child's bedroom, drug deals, unwanted sexual advances from fathers.....the list goes on much longer than I have time to type. But those things came with the territory. Children with medical needs come from all walks of life, but they all have one thing in common: They all depend on someone to provide them with the love and care that they need.

I gave my employer over a month's notice. Telling all my clients that I was leaving was the hardest thing I had to do. Most were upset I was leaving. There were a few families that I didn't think would mind so much but surprised me the most by their level of disappointment and fear that I was no longer going to be their clinical manager. I reassured everybody the best that I could and hugged everyone one last time. I will miss them all.

The job interview went well. Very well. I interviewed them as much as they did me. I toured the unit. Spoke with a few nurses that worked there. Overall, I had such a positive vibe when I left the hospital. It was less than a week later that I got the phone call and official offer of employment. It's a small critical care unit in a small town hospital. I will be driving about an hour every day to get to work, but it will be worth it. Even though I'm not a new nurse, I'm new to acute care and they will be giving me 6-8 months of orientation before I'm expected to function without my preceptor.

I'm ready and looking forward to my new career as a critical care nurse!