Day 1 off Orientation

Day 1

Disclaimer: These blogs highlight my own opinions, and do not represent the opinions of my employer. Thank you!

Today was insane. So much happened today. It was pretty nuts. The night shift AUM told me that they gave me an easy assignment. If this is an easy load, then I don’t know what I’m going to do. Each person had their own specific issue that I dealt with today and it was absolutely exhausting to get my bearings on everything. Now I must give myself some grace because it could have been worse if I didn't start the morning off a bang. The night shift report started my day with many problems such as a broken TV, with the patient not willing to do hemodialysis without television and breakfast, and a missing engineering department because of Memorial Day. I ended up stopping my PCA, before she got busy, and an engineer, as he passed by to go home, and fortunately they were willing to help me. Yet I was just handed a cluster of issues, especially since this nurse needed to finish a blood transfusion on one of the patients, but we had to move on. It was insane. Let’s talk about it yeah?

So, my first patient came in after she finished hemodialysis outpatient due to complaints of chest pain that was worsening. She had Shortness of Breath, so the dialysis company rushed her to the hospital immediately. They did a Chest X-Ray and CT and saw that she had Chronic Bronchitis. She was a former smoker, and many assessments indicated crackles in the lungs, but honestly, I didn’t hear any. They were clear for me, so I decided to start weaning her off her oxygen to see how she does. Due to my luck of getting her the TV fixed and breakfast, she signed the hemodialysis consent with me and then got the work done in the afternoon. Honestly, one thing that I’d like to highlight as important for next time is to check her skin. I feel like so much happened in the morning that I didn’t get the opportunity to look. She had redness in the mepelex per the last shift’s report, and the night shift nurse corrected me about it, but I think there was just a shock in the transition of being on my own that I didn’t check. That's okay, just do better next time, you know what I mean? I also didn’t report that the patient spoke Spanish, so I'll do better about that next time.

Next patient was the blood transfusion patient. Initially, she was there because she had a syncopal fall and she had head trauma. It seems that she was lightheaded from the blood she was losing from a GI bleed. In the ED, they gave her three units of a packed RBCs and then this morning they gave her one pack RBC. I at least saw that her hemoglobin looked a lot better now going from 6.4 to 9.9. But honestly, the main issue was that she had to get a colonoscopy done, so they were holding all of her anticoagulants. I learned this crucial information because my shift lead educated me about how crucial it was to look at the other interprofessional team member’s notes after getting night shift report. This is so you know everything that you need to do today. I also need to be asked why for everything! Every intervention should have an indication, so I need to be asking the night shift report why things are happening always. I’ll explain this when I talk about another patient. One thing that I prided myself of having with this patient is compassion. This patient recently had a liver transplant and was immunocompromised, or unable to fight bacteria, and so she was terrified of sharing a room and having so many people travel in and out of the room. Due to a fully occupied patient floor, we couldn’t put her in a single patient room. This was something I do commemorate for myself as I asked this to the night shift report, but she didn’t know as well. At the end of the shift, and after I was able to express empathy to the patient and the family, we were able to get her a single patient room on another floor. It was definitely a step in the right direction. She was transferred immediately before shift change, and regardless of how tired I was, I still made the effort to inform the family of the situation because I knew that it was going to eat at me if I didn’t say anything. The mom was extremely grateful and honestly made the entire shift just worth it by telling me how much she appreciated me taking care of her daughter. It was just nice you know? I felt like, initially, she was very nervous and anxious, but in the end she was more calm with me. I felt like we had built that rapport. She was willing to let me check her, give her treatment, and she was willing to be more open in conversation with me. She said that she was I was great which is something I appreciate. While I'm still working on my nursing skills and adjusting/ transitioning into my role as a nurse, it's such an amazing feeling for somebody to say “Gerald thank you for what you did for me“, “thank you for keeping me updated.” The mom was even saying, “You know I'm going to write a survey on you because honestly thank you so much for keeping me updated about the situation.” It really makes up for the rough days. And I know there will be, especially now that I'm on my own, many thankless shifts but it’s knowing that you're making a difference for people that makes me want to get better at this job. It makes me want to improve, it makes me want to make a difference in people's lives, it makes me want to grow. Yeah, I'm tired and I'm exhausted… honesty I'm so exhausted and there were times where I was just overwhelmed. However, I'm very happy. I don't see myself leaving like I felt with research where I saw myself leaving in a heartbeat. You know what I mean? While I didn’t say some information to night shift report on this patient, I still feel like I did a good job with this patient. Everything was overwhelming today, and it was the final stretch, but I know that I still did a great job. You'll get better at this you know? You just have to keep working on it. Like everything will get done, everything will get resolved, you just have to do your best.

Anyway, that was nice. So, the next patient had acute heart failure as the main issue. He was kind of grumpy initially because he thought he was getting discharged today, but we ended up keeping him because the discharge was unsafe. This was my first exposure to me making that judgment as a nurse, and I worked with the case manager, and we both found out that this patient didn’t have oxygen at home even though he was extremely oxygen dependent. He was like “I’ll hold my breath it’s ok let me go” and I put my foot down and explained that we’re going to wait for the portable oxygen to be delivered before even thinking about discharging him home. It was the first time that I was the one in charge of making that call, and it is a little weird having this authority. But I’m glad that I was able to keep my patients safe even though they don’t agree. In the end, he apologized for the attitude, and we had a good time for the rest of it. I told him that I understand that he’s ready to go, but I want to make sure that you don’t need to come back. So, he was cool for the rest of the time.

My final patient was here for an acute kidney injury where she ended up having concerning altered mental status. She had a past medical history of liver cirrhosis and that caused her to have an obese stomach due to the ascites. I felt so bad for her because of the immense amount of pressure wounds that she had, and the generalized tenderness. She had 13 wounds! And they all had Wound Care orders. One thing that I’m proud of and shout out to my patient care assistant (PCA) if you’re reading this ever LOL is that we completed all the orders that she had. I don’t know if everyone else was doing the wound care, or had time, but I’m glad that she was more comfortable with proper treatment. It took a hot minute, but I know that she was suffering. They performed a CT scan with her, and an ultrasound of the bilateral lower extremities and saw that she had a blood clot in her legs, and a worrisome mass in her brain. So, they need more detail with magnetic resonance imaging. However, that was still pending when I left so hopefully, she was able to get it done.

When I was giving bedside report to the night shift nurse, that’s when I noted all the things I was missing. While the night shift nurse was a little frustrated, I at least got to see how she would quickly look at different results for surgeries and the notes that she was mainly looking for which was helpful for next time. Hovering over the results gives the indications and I noticed looked at the physician’s notes to get the plan of care for the patients. I’m not beating myself up on it because it is my first day, so I know that I’m still learning.

Anyway, I need these couple days because today was just so challenging. Nobody died and that’s a win LOL. That's a win in my book and I took care of them. I'll get better at this, you know? I'll follow up with people, I'll talk with people, and I'll just be more involved as a patient advocate. It'll happen, I know it will. Anyway I'm going to go now, bye-bye.