**NOTE: I take measures to ensure that no names, dates, room numbers, or other identifiers are present. Even for the nurses I work with who are aware of the actual events, I have to make sure that even they would not be able to identify the patient. Patients identities will be protected through various ways including changing of dates, names, sex, race, etc. My intention in this blog is not to share stories about patients but stories about nursing.**
A new fall quarter has started. Only last year that was me starting my final quarter of nursing school. So looking forward to the end of it, but sad at the same time. Dreading the NCLEX that was approaching too quickly and being so afraid that I wouldn't pass. I was looking forward to starting my career but I knew that I wouldn't be working along side my best friends. It all has me thinking about my journey as a new nurse. I started this blog to document my growth as a nurse and to share with my family and friends.
Each day as I grow and become more comfortable in practice, I hear the words and see the faces of the nurses who I have been lucky enough to learn from.
I am thankful to every nursing instructor I had in school for pushing me to be more than "good" and encouraging me to be great! Every instructor that I had taught me more than just the book; they taught me critical thinking, leadership, compassion, and humor.
I am thankful for every preceptor that put up with me and allowed me to follow them and learn from their triumphs and their failures.
I am thankful for the nurses I work with now for sharing your wisdom and guiding me into the world of big girl nursing.
I am thankful for my best friends, the nurses that shared in my happiness and helped me shed a tear. We somehow made it through school together and now we're alone and trying to make it. Thank goodness for Facebook, cell phones, and blogs. :o)
A very special thank you to the Sandstone for putting up with this baby nurse. They have taught me to have fun at work because if you don't, you'll never make it. They make the long nights of call lights worth it. They are the biggest help and I would never make it through a night without them. I think some have yet to learn your value, but they will. ;o)
And a thank you to my family & friends for the unconditional love through the crazy years at school, the switch to night shift, and dealing with the rants and excited stories of this nurse. They are amazing! <3
Without these nurses, tech's, and family & friends to push me, love me, educate me, and laugh with me, I wouldn't be where I am today. I am a good nurse because of all of you. One day I hope to be a great nurse because of you. Maybe one day I can be the voice of encouragement to another nurse.
Wednesday, September 15, 2010
Wednesday, September 1, 2010
Ramblings of a Night Nurse: My First Code
**NOTE: Sorry for the length of time to post. This was due to time constraints and ensuring that there are no patient identifiers available. I take measures to ensure that no names, dates, room numbers, or other identifiers are present. Even for the nurses I work with who are aware of the actual events, I have to make sure that even they would not be able to identify the patient. Patients identities will be protected through various ways including changing of dates, names, sex, race, etc. My intention in this blog is not to share stories about patients but stories about nursing.**
After more than a year of working in the hospital and several more years of being in the hospital on a fairly regular basis, the inevitable finally happened. My first code.
I had a patient in "B" bed and another nurse had a new patient in "A" bed. Going in and out over the first few hours of the evening, "A" bed was not doing well. He started on 1 liter of oxygen at 1800 and was on 6 by 2300, then on CPAP where he started doing much better. His O2 sat improved into the high 90's and he seemed more comfortable. Lasix was not working, even after several doses in just a few hours he had very little output. I wonder what he sounded like? His rhythm on the monitor was very irregular and he was having a lot of PVC's. But that too improved once on CPAP.
Around 0030 the patient started ringing out with sats in the high 80's again. I was busy with my patients in another room. When I left and went to the nurses station to catch up on my charting he hadn't rang out in a few minutes. Soon he rang out at 83%. Something in my head went off and I remember thinking, "a patient on CPAP shouldn't be ringing out..." I turned and looked at the monitor behind me and it said 81%, then 78% before I could turn to run to his room. "OH SHIT!" would be the words I murmured as I turned the corner.
When I came into his room I saw the monitor first, it wasn't picking up a sat. Then I saw him. He had his CPAP off, crumpled over in the bed, gray. I started calling his name; nothing. I shook him; nothing. My mind was racing, this voice in my head screaming at me to hit the staff assist and another one telling me to give him air to breathe, to check for a pulse...I tried to do it all at once, I guess it worked. I barely remember hitting the button for help. I do remember waiting for what seemed like an eternity for help to arrive. I know it wasn't long at all. Just felt like it. I was trying to keep his CPAP on and trying to find a pulse...a pulse that I couldn't find.
My co-workers arrived. (Insert sigh of relief here). And things just went moving in a motion that I cannot clearly recall. I remember drawing the curtain between the two beds. I had this little voice in my head from school, I wish I could remember who said it, to remember to protect the patient in the next bed from seeing it. And so I did. I feel like I rambled around for awhile. What do I do? Someone asked if anyone was writing down what was happening and I found what I needed to do. I think there were two jobs they told us not to do during the first couple of codes, first was manning the code cart and second was charting what happened-cause in your first code you don't know. :o) Well, I did it and I survived with a little help from my friends.
I have always worried about when this would happen. When I first started the internship I remember waking up, getting ready, and saying a little prayer to myself that there wouldn't be a code because I wouldn't know what to do. I have seen a lot of intubations and have a relative feeling of comfort because of it. It feels weird to talk about it like that; someone's misfortune that I learned from and feel confident in handling. Huh. And I'm certainly not begging for anymore codes to happen. Not at all. I am glad that this first experience is over though. Now I have some idea of what to expect.
I think the worst part for me was trying to explain what had happened to my patient in the next bed. I still hope that I did it the "right way." I don't want to give away information about another patient but this was a frightening thing for my patient to experience. I don't think anyone ever taught us the "right way" to tell another patient about a code. Maybe I should ask around before the next one...
After more than a year of working in the hospital and several more years of being in the hospital on a fairly regular basis, the inevitable finally happened. My first code.
I had a patient in "B" bed and another nurse had a new patient in "A" bed. Going in and out over the first few hours of the evening, "A" bed was not doing well. He started on 1 liter of oxygen at 1800 and was on 6 by 2300, then on CPAP where he started doing much better. His O2 sat improved into the high 90's and he seemed more comfortable. Lasix was not working, even after several doses in just a few hours he had very little output. I wonder what he sounded like? His rhythm on the monitor was very irregular and he was having a lot of PVC's. But that too improved once on CPAP.
Around 0030 the patient started ringing out with sats in the high 80's again. I was busy with my patients in another room. When I left and went to the nurses station to catch up on my charting he hadn't rang out in a few minutes. Soon he rang out at 83%. Something in my head went off and I remember thinking, "a patient on CPAP shouldn't be ringing out..." I turned and looked at the monitor behind me and it said 81%, then 78% before I could turn to run to his room. "OH SHIT!" would be the words I murmured as I turned the corner.
When I came into his room I saw the monitor first, it wasn't picking up a sat. Then I saw him. He had his CPAP off, crumpled over in the bed, gray. I started calling his name; nothing. I shook him; nothing. My mind was racing, this voice in my head screaming at me to hit the staff assist and another one telling me to give him air to breathe, to check for a pulse...I tried to do it all at once, I guess it worked. I barely remember hitting the button for help. I do remember waiting for what seemed like an eternity for help to arrive. I know it wasn't long at all. Just felt like it. I was trying to keep his CPAP on and trying to find a pulse...a pulse that I couldn't find.
My co-workers arrived. (Insert sigh of relief here). And things just went moving in a motion that I cannot clearly recall. I remember drawing the curtain between the two beds. I had this little voice in my head from school, I wish I could remember who said it, to remember to protect the patient in the next bed from seeing it. And so I did. I feel like I rambled around for awhile. What do I do? Someone asked if anyone was writing down what was happening and I found what I needed to do. I think there were two jobs they told us not to do during the first couple of codes, first was manning the code cart and second was charting what happened-cause in your first code you don't know. :o) Well, I did it and I survived with a little help from my friends.
I have always worried about when this would happen. When I first started the internship I remember waking up, getting ready, and saying a little prayer to myself that there wouldn't be a code because I wouldn't know what to do. I have seen a lot of intubations and have a relative feeling of comfort because of it. It feels weird to talk about it like that; someone's misfortune that I learned from and feel confident in handling. Huh. And I'm certainly not begging for anymore codes to happen. Not at all. I am glad that this first experience is over though. Now I have some idea of what to expect.
I think the worst part for me was trying to explain what had happened to my patient in the next bed. I still hope that I did it the "right way." I don't want to give away information about another patient but this was a frightening thing for my patient to experience. I don't think anyone ever taught us the "right way" to tell another patient about a code. Maybe I should ask around before the next one...
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