I have arrived

I finally feel like a nurse.

Oh, I still have to double check stuff with my co-workers, but they do it too. No one pretends to know everying. Doses, interactions, compatabilities...we question everything.

Last night the census was low--only 4 patients in a 7 bed ICU. There were 3 of us plus one orientee, who's a long time nurse, but new to our unit.

Marie, acting as charge, gave me two assignments, and they were the two hardest. I knew the patient she took for herself, a young man with end-stage liver failure. I had taken care of him last week. There was one other patient, given to the other nurse and orientee. This patient had just come back from the floor, where I guess we'd transferred her to for less than a day, and she came back in Acute Respiratory Distress, so they intubated her just moments before I walked in for the night. She was a little riled up, so the sedation wasn't yet kicking in too well.

Both my patients were difficult, and busy. One was kicking and flailing up a storm, and was not on a ventilator, (though, should have been) so I couldn't sedate him too much, but he was definitely agitated so it was an hourly dose of 4 mg Ativan to keep him calm enough to clear his congested airway, suctioning him via a thin nasal canula. I suspect when I go in tonight they will have intubated him too, which would have been appropriate...his lungs sounded terrible.

My other patient had had a thyroidectomy, and immediately I salivated and did a mental dry hand wash. "Danger of a thyroid storm!" I thought. I've only read about it in books. All night long the poor thing was vomiting and nauseated, her abnormal heart rate and rhythm would jump from the 120s to 150s, then back down to the 130s. From SVTs (supraventricular tachycardia) to A-Fib (atrial fibrilation) with frequent PVCs (premature ventricular contractions) She was everywhere.

It seems she'd had an acute event in the OR during her surgery (hey, anesthesia...how did you react? were you ready? Did you get enough experience?) and her heart rate went up into the 190s and they did all the standard stuff to get it back down to normal sinus rhythm but nothing worked (cardioversion, amiodarone, atropine, etc)

At some point in my shift, she converted back from Atrial Fibrilation to Normal Sinus rhythm, and the sage nurses said "HEY! your heart rate! what did you do? You FIXED her!" So it's nice they are accepting of me in that way. They must see I work hard because what they do is talk about the nurses who just sit on their butts all shift and do nothing.

I never once complained to Marie about the assignment, about me getting two, let alone the two hardest patients, and I did ok. I was busy. So busy, I never got caught up with the charting until around 7 am, just as the day shift was walking on.

I had managed to get my labs in, written the results on the chart, replaced the electrolytes that needed replacing, given all the meds that were charted on time, bathed both patients, administered PRN (as needed) meds, and documented everything.

I walked out of there thinking "maybe I can handle it afterall." For the next six months, I really hone the critical care knowledge I need to get back into the program. No stopping me now.