Wednesday, January 20, 2010

day shifter

So much for a nice, calm first time on day shift for me!

But first, I need to say that just my three days off to turn my body back onto a day schedule were amazing. I immediately felt like myself again. It was as if a light has been turned off and now it is on. I have motivation and energy and a spark! I woke up at 7 in the morning and I was so ready to go! I missed that.

Back to my first time alone on day' started off calm. I had two patients with the same exact problems.

Craziest of the day...they aren't allowed to give me three patients since I am still new, but they needed a 1:1 nurse for a new patient coming up from another ICU because he needed to be on a rotoprone bed! I have no training in this, at all. I knew my manager did NOT want to give me this patient, but she had no choice. These patients are SICK. My preceptor from orientation (aka: my ICU Mom) was like, "I cannot believe they are going to give you this patient. This is insane. I had to take a 10 hour class on this bed..." My manager felt that since it was at the end of the day, it wouldn't be a huge deal and she reiterated that she would never want me to have this patient for a whole shift. Not that I'm incompetent or anything, but I simply just do not have the experience.

After I gave up my patient to another nurse, I spent about 2 hours with the bed representative going over how the bed works. Wow, I feel like I don't need to go to weight lifting this week because I actually got a work out.

The bed looks like either a torture chamber or some sort of NASA device.

Numerous straps and buckles and controls.

I felt so anxious, I just wanted to go get the patient and bring him up! However, the bed representative was so helpful and reassuring. She kept saying how she would not leave me and I could call her day or night. Knowing that my shift was coming to an end, my fears began to alleviate.

My manager actually went up the open heart unit with me to help bring the patient down! The best part: I got report from my preceptor of my final semester of nursing school!! YAY!! She is so down to earth and similar in personality as me; sarcastic, etc.

In short, this patient was definitely sick. For those who have no idea what the heck this bed is or what it does: the basic premise is that it helps patients with severe respiratory issues, like ARDS. Basically, the patient goes into the bed (or...we put them in the bed) very tight, snug, and strapped in, and then the bed turns them upside down (prone) and starts rotating back and forth like a rotisserie. The purpose is to help perfuse other parts of their lungs and increase oxygenation to those other areas. That is the best I can explain it.

Here's a video I found on youtube. I have no association with this video, I am only trying to show what the heck it looks like:

I cannot give any info about the patient's diagnosis, but obviously their condition was sick if they were going into this bed.

The patient was obviously on the ventilator...with 100% FiO2. He/She also had the following drips: propofol, levophed, neosynephrine, xigris, D10, bicarb, potassium, protonix...I can't even remember what else! For lines, a swan, two central lines, and an A-line. Also, had a J-tube, G-tube, NGT, foley, Chest tube, JP drain, and blake...! In other words: sick.

Let's just say, it was A FREAKIN' pain in the ass to get the patient transferred, detangled, and assembled in the bed. Fortunately, the next shift had arrived, so the oncoming nurse (who happened to be my night shift preceptor) helped to set the patient up.

For this bed, all the lines need to be straightened (ha!) and placed in this wheel-device that turns with the patient and prevents everything from being pulled. All of that goes at the top of the head, while the foley, chest tube, and dignacare (or any fecal-management device) goes through the hole by the feet.

It took us about an hour and a half to get the patient mostly set-up. I left work at 6:45 (shift ends at 6), but I wanted to stay since we hadn't gotten to the point of proning him yet. The bed representative and I strapped the patient in. The freaky-ish part is this handle that you have to crank, which moves all of the cushions in towards the patient, squeezing them super tight. You need to turn the handle until you cannot anymore. It feels like you're going to just squish the patient to death!

When I left work, my legs hurt worse than they had in all of my life! I actually took an excedrin for them when I came home, and I never take medicine!

However, I can say that I did have a good day. Sure, I was nervous, but I learned something new. I feel like I need to be more confident and that is what I am going to work on. I need to prove to my manager and everyone else that I will survive on day's and everything will be ok! I think that majority of nurses trust me and think I am competent, but I just need the experience. For the most part, I want my manager to be comfortable with her decision to let me move to day's.

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Lauren said...

Thanks for posting my link! :) Happy to hear you are back on the day shift. I know whenever I was in the hospital the nurses never seemed to like the night shift.

Susan said...

Oh my goodness that is CRAZY. The closest my floor ever gets to having drips is heparin...ha. I don't even remember what a swan is...and I LOVE critical care in nursing school! Gah! I get excited just hearing about what you're doing. :) It sounds like you had a good first day on days...I've learned just in my short eight months as a nurse that a little experiences goes a longgggg way, so you'll get there soon!

Anonymous said...

Thank you for not being a complainer. :) Really appreciate nurse bloggers who can find the excitement and good in what they are doing. And this rotaprone stuff is HIGH TECH...I am going to talk to our nurse educator about it when I'm at work next week...wondering why we don't have one of those...FANCY.

Caroline (of

Unknown said...

Gewd times!
I have fond memories of working with the Rotoprone bed. It truly is a massive and intimidating piece of machinery - but the results are amazing! The beds work miracles for true ARDS patients!
I agree with Caroline you rock for turning such a high-stressed out day into a wonderful learning experience.
Keep it up