CCU & CSR

Written by: jettrc
July 22nd, 2009

Ronald’s Post 

Last  week I received the opportunity to have one full day on MCCU which is a medical cardiac unit and CSR which is a cardiovascular open heart intensive care unit.   My day on MCCU was really busy and intresting to say the least!   I received report on a patient with my preceptor who was experienced on the unit. The patient was septic, had cardiac issues that led to being on the balloon pump the previous week. I took at trip down to CT scan to see if there was hemorrage in the brain.  It came back negative. So I thought the night was going to be pretty good and would just take care of my one sick patient.   Then, soon we had to draw arterial blood gases (ABG) because the patient’s 02 sats started to drop and the pH level was very abnormal and low. Numerous bicarbs were given and soon the patient’s cardiac rhythm changed and became pulseless.  My preceptor and I began CPR and we got the code cart as well; a code blue was called. We got him back after epinephrine and atropine were given and a good round of CPR successfully completed.  Little did i know that this would be the only beginning of my long night.  The patient coded about two hours later and expired.  Of course, I realize as a critical care RN I won’t be able to save every patient despite my most valiant efforts!  However, it was still hard to lose a patient  Although difficult, it was a learning experience and I took a lot from what I learned that night.

     My day on CSR was interesting and informative!  I learned how to pull chest tubes, do cardiac outputs manually and take care of patients with Swanz, central venous pressure (CVP) and arterial lines together. I also did dressing changes that were needed after an open heart surgery.

      Overall, both experiences went very well and I’m glad I received the chance to take a look at other critical care units.

Ronald, RN

A change from days…Night Shift

Written by: jettrc
June 16th, 2009

From Ronald-   

  I made the switch on my orientation from days to nights. I’m into my fourth week and it’s actually going well!  I’m staying awake a little more than I thought I would. I thought by the second week I would be a walking zombie, but I have been hanging in there. I am getting more into the routine of doing things by myself and just going to my preceptor when I definitely know I have a question or do not know how to do something. Night shift is somewhat different from days. When I am starting my shift, I usually get report and review orders to make sure everything has been taken care of and then see my patients. There were a few times where the doctors were still in and I had some stat orders and blood cultures to draw that were more of a priority than follow my usual routine. But for the most part, I am getting “My” routine down and becoming comfortable as to what I should do to manage my time effectively.

     When I have time, I try to look over the orders and history of the patient(s) to understand why he or she presented to the unit, causes, and treatment plan to carry out.  So far, everything  is going well. I was involved in a code last week and I received the chance to use my ACLS. It was a good feeling to understand and put to use what I had learned. I pushed a few IV medicines like epinenphrine and atropine. I know I still have a lot of to learn with handling emergent situations but I believe I am off to a good start. 

-Ronald , RN

The Real Thing…

Written by: nicolelg
June 16th, 2009

Wow…it has been a whirlwind.  My first couple weeks of being “on my own” have just flown by!  I apologize for not writing in a while…so here goes!

Well, I am not going to lie…every day is scary for me.  Not in a bad way, but just scary because it is new.  I think that it is ok to feel scared.  It makes you even more focused on what you are doing with each of your patients.

Along with being scared though, I have learned so much already.  I know I have a long, long way to go….but each and every day I learn how to handle new situations and how to do new and different tasks.  And, I cannot thank the staff enough for all of the help they give me.  I am constantly asking them questions but they never make me feel like I am a bother.  They are always ready to help me in any way that I can.  They truly have made this transition so much easier.  I have definitely gotten practice talking with the doctors when something goes wrong with a patient or a patient needs something.  I am also getting a lot of practice “pre-oping” patients for different procedures in the morning.  This has allowed me to learn about a number of different procedures and what they actually entail for the patient.  That is one of the perks about night shift, the majority of the time you are able to sit down and look at the charts to understand a lot more about what is actually going on with your patient.  I have really enjoyed that aspect because day shift can be so busy that there is hardly enough time to read your new orders, let alone review all the past information.  This is actually one of the duties you have on night shift.  You do, what is called, the “24 hour chart check” where you review the chart for the last 24 hours to ensure that every things has gotten done and is correct.

Something that has been really hard for me is my sleep schedule now that I am on nights.  I seem to sleep more than I ever have but still feel like I don’t ever get enough sleep!  From what I have heard thought, this happens to a lot of people.  This shift just takes some time to get used to.   

There have been some scary situations that I have faced in these first few weeks.  And thinking about being on your own…I would think, “Oh gosh, I am by myself…what if something happens?…how will I know what to do??”.  The best thing I have learned about night shift is that we all work as a team with all of our patients.  We bounce off ideas with one another and everyone gets involved when a patient starts going down hill.  You are never alone.  My coworkers have helped me out so much.  They have been there when my patient has gone into an uncontrolled heart rhythm and they have guided me in the steps I needed to take to correct the situation.  They are AMAZING!

Like I have said, its a continuous learning process…every day brings something new.  But I enjoy the feeling at the end of the day when I realize I have learned how to do something completely new to me.

I’ll keep you updated!!!

-Nicole

Don’t Worry!! There’s More to Come!!

Written by: warnerre
May 12th, 2009

Thoughts from Human Resources….


It’s so amazing that Nicole & Ronald have both been in orientation for as long as they have now!! We are currently getting ready for a another group of “new grads” who will be joining us pretty soon….that doesn’t mean we’re letting Ronald & Nicole get away quite yet though!!

We are looking forward to continue to watch them develop into the outstanding Providence Nurses we know they will be!! They’ll keep up posted via their blog on things they still experience for the first time or never thought they would be able to handle.   Really, they’ll remind us all the “Learning Never Ends”!

We’d love to hear from YOU…our readers!! Please comment/ask any questions of these folks. We provide this information to be helpful to you as you search for a position!! If there is something you really want to know…ask!!

Kudos to both Ronald & Nicole for their committment to this blog and for their dedication to our Mission!!! And….to you both….Happy Nurses Week (your very first one!!)!!!

Almost done…

Written by: nicolelg
May 12th, 2009

Nicole’s Post…..

So, this week is going to be my last week on orientation….and one word really sums it all up for me…SCARY. 

   I will be doing my last week with my preceptor on nights this week.  I am going to try to take it all in as much as I can.  It doesn’t seem like it has been twelve weeks…but I guess it has.  I still feel brand new…still unsure of myself at times.  I guess there is really no way to get around that though.  I think this feeling will stay for a while.  I am trying to look at the positive…I will soon be on my own…starting my career…and I just need to keep learning.  That is the only way I can become the nurse I hope to one day be. 

     With all these emotions I am feeling…it is hard to find the confidence I have gained.  But I know I can do it…and I know I have the resources around me to help me any time I need.  It is normal to be scared of anything new…and this is going to be very new! 

      These last few days will be bitter-sweet…but I am going to try to learn as much as possible!

     I also have ACLS classes soon.  That also makes me nervous.  I am not familiar with handling code situations so the thought of running one is a little frightening.  Again, I need to remind myself that this is the purpose of these classes…and the only way to learn is to DO IT! 

-Nicole

CRRT

Written by: jettrc
May 12th, 2009

Ronald’s Post….

Last week was a very busy and different week. My first day for the week on the unit was Tuesday.  I started off with two patients.  One was very sick, in multiple organ failure, septic and so on.  The patient was also on at least seven drips and with antibiotics also ordered as well. My other patient was not on any IV medication.  So, it was morning shift and I would go into the most critically ill patient room first to assess the status and to get a baseline. I did an assessment along with getting vitals, blood sugar every hour from being on a insulin drip. After assessing the sickest patient I then moved onto the other. This was quite a faster assessment than the other. After around 10, my multiple organ failure patient was to start on CRRT(Continous Renal Replacement Therapy). The patient was in renal failure and gases and organ functions were really bad. Plus they were in fluid-overload. So I went down from having two patients to only have one really busy patient.

     My preceptor and I started CRRT and she guided my through the set-up. It was a confusing process at first glance but once I received hands-on with this, It made more sense. This day was very challenging, and even though it was probably one of my busiest days; I really learned alot.   Time management and communication with the doctors really was a task for me and I received the chance to accomplish both.  The next day I worked with the CRRT machine all day. I got use to charting, emptying drains and following the order protocol and settings for the machine that would work for the improvement of the patient. I can say now that I am  more comfortable working with a patient on CRRT than I was before!

Insecurities

Written by: nicolelg
May 5th, 2009

Nicole’s Post…

There are a few parts of this whole learning process that seem to be taking more time to be comfortable with…….

 

    I think one of the hardest parts of orientation that is taking the most time to learn is remembering how to do the different kinds of admissions for different patients.  An admission from CSR is different that an admission from the ED or a direct admission from another hospital.  There are different steps to take and different people to call. 

 

    This brings me to another aspect of nursing that I am still nervous about at times….calling the doctors.  For some reason, I just get flustered when I need to call one.  I guess it is because I am still so new and do not yet have the confidence in myself to speak to them without feeling a little uneasy.  It is also difficult for me to remember all the different doctors for each specialty.  There are even different PA’s or Nurse Practitioners for each doctor’s group…so it just becomes a lot to try to remember.  I never am sure of who to call or if it is something that truly needs to be called for.  THANK GOODNESS for my preceptor!  I am just worried about the time when orientation is over…and it is now completely up to me! 

 

    I spoke with a nurse the other day and she told me about some stories that had to do with calling doctors.  She said that there were many times when she would be floated to a floor, new to the people working there and the doctors on call…and when a patient issue arose, many of the nurses told her that it was a normal situation or that it probably wasn’t anything to worry about.  Her gut told her otherwise with one specific patient…and she took it upon herself to call the doctor…even if that doctor got upset with her or thought the issue was insignificant.  As it turned out, the issue was significant and ultimately saved the patient’s life.

 

    This really made me think about it all.  I would rather call the doctor with something that may not be important, than risk causing a larger issue for my patient.  My patient comes first…and I need to try to remember that when I get nervous or am unsure about whether to call the doctor or not. 

Just wanted to share that!!!

 

Nicole

Making sense & ACLS

Written by: jettrc
May 2nd, 2009

Ronald’s thoughts….

Since the last time have blogged a few things have happened. I have moved up to taking care of two patients sometimes or having one unstable/critical patient. I took care of a sick guy which was known as a “true ICU” patient meaning he was septic, low bp, on antibiotics for control of infection, drips for keeping bp up and in an adequate range. I received the chance to look at the pts. rhythm and identified which rhythm was showing which was an acc. junctional rhythm. It took me a few minutes to noticed because it was somewhat different what I was used to seeing but I got it! Before the week was out, the pt was off of most of his vasoconstrictors, and medicines that helped increase cardiac output. It was a good feeling, I really felt like contributed in an improvement in care.
About a week ago I completed my Advanced Life Support Class. I was a little anxious and nervous about taking it because it was my first time completing the course and I was the only new graduate that I knew was taking it. So I tried to look over things and in my mind of what I saw happened and could do in previous code blue and white that I was in. After completing the class, I feel the very opposite as I went in. I know the algorithms and meds and just in general what I should be doing as a nurse in life-treatening situations. I feel more comfortable knowing that I am certified and equiped with knowledge and skills to carry out ACLS.
Orientation on the floor with my preceptor is going very well. I feel less unsure of myself and more confident when using my skills and carrying out procedures. My assessment skills have improved as I have been practicing and asking my preceptor question who is very knowledable. Some days are better than others in that I have to ask my self “What did I just learn or do”? Or “What could I have done better to get it the first time”? It is really a learning experience and I am learning what to do and what not to do and what’s the best way to carrying out care for my patients.

It is moving along so fast…

Written by: nicolelg
April 20th, 2009

Nicole’s Post…
   
Orientation is moving along very quickly.  I must admit that I am scared of the day that I am “on my own” regardless of the fact that I know I have all of my fellow nurses to answer any questions I have or assist me in any way that I need.  I know I can go to them.  My fear still remains…and I think this is normal.  I am sure we all have this fear.  I dont think you feel ready, even though you are technically “off” orientation.  I guess my point is…as my orientation time continues to get closer to the end date, I am scared of being “on my own”.  I know my friends who are going through the same thing feel this way as well.  The only thing that eases my mind is knowing that I do have the knowledge and guidance of the nurses on my floor to assist me whenever I need. 

Okay, more about my expereinces now…

So, the other week I did my first rotation of nights.  I had never worked a night shift before…not even as a nurse tech.  I think the latest I’ve stayed at work has been 11pm.  So I was excited to see how my body and mind would react to working all night.  The first day before the shift was odd though.  I tried to stay up the night before but could not…I just wasn’t in that groove.  So trying to sleep that day before the shift was impossible.  I think all together I got about 3-4 hours sleep during that day.  I’ve since been told a lot of folks just nap during the day when they first start.

During the shift I felt pretty good…not as bad as I thought it would be.  But…by around 3 or 4 am…I could tell that my body was not sure what was going on.  Luckily, around 5 am I began to get really busy and forget that I was even tired!  There were medications to pass out, blood sugars to check, dressings to remove for the doctors in the morning, etc.

The rest of the week was not too bad.  It was more “weird” than bad.  That is the word I have been using to describe nights…”weird”.  It is just something that I think takes some getting used to.  But it is another great way to learn.  I still get admissions, just of a different kind.  You may have to pre-op patients.  There are a lot of ways to learn still.  Prior to working a night shift, I thought nights might be almost boring.  I thought…well, what are you really going to do?…the patients are sleeping for most of the shift…..SO not true!

There may be nights like that…they may be very quiet at times….but there are also nights that are incredibly busy!  For example, one of the nights I worked during the night, we had five direct admissions.  They just seemed to come back to back.  So, needless to say, there was not much “sitting around” that night!  But, it was a great learning experience and I enjoyed the different aspects of nursing care that I was able to see and experience.

I am still working on my ECCO classes every Monday as well.  My goal is to finish them by the end of the month.  I have learned alot from doing them.  Each module goes into great detail about each system of the human body.  It has really answered alot of questions I have about different aspects of nursing care.  The great thing about the modules is that as I have new experiences with my preceptor on the floor, I can go back to a specific module, even if I have already passed the test for it, and read/review to relate my expereinces to the information provided.

I have learned that repitition is the key.  The more I see it, the more I know how to handle it.  There is no reason to feel bad for not knowing something…we can only learn by experience…like everyone else has!

So…that is what is going on with me.  It is still new experiences every day…still days where I feel like I know NOTHING!…still days where I am proud of the way I handled something…I am still learning every single day!

-Nicole

The end of ECCO & the beginning of another week.

Written by: jettrc
April 14th, 2009

Ronald J.    

 Last week was a pretty busy week for me.  I took care of a sick patient that was multi-sytstem organ failure and had other diagnoses that were a part of the history.  I had the chance to titrate meds (like insulin drips, vasopressors and heparin) according the hospital protocol and best-pratice.  A few days later I was able to discharge the patient to a non-critical care floor.  That was a great experience for me because just days before the patient was in critical condition.  Giving report to the next nurse went smoothly as I tried to be very specific and hit the details on why the patient was admitted to the hospital as well as the care provided on my unit.

     I also admitted another patient to my floor the same day and carried out the orders and treatments to stabilze the patient. Overall, I was very pleased with what  I learned.  I did a transfer, admission and cared for critical patients.

     Today, I finished my ECCO class.  Coming into I was thinking I have so much to learn and remind myself of what was taught  in nursing school as well as also gain a better understanding of what I didn’t feel as comfortable with in nursing school.  After reviewing all the systems, disorders, treaments, complications and evidence-based pratice, I now honestly feel more comfortable as to what I am praticing on the floor and learning why I am doing things instead of just doing the routine. Its a good feeling!

-Ronald ,RN