So long overdue...the night I truly felt like a nurse
Guess my New Years desire to post more regularly has clearly fallen to the side, taken over by dealing with work and all that goes along with it.
Not having updated what's going on with me and work in far too long, I felt I really needed to after the night I had at work on Friday.
I was placed on the part of our unit that cares for the more immunocompromised kids, as well as the kids who are getting or who have received a BMT (blood marrow transplant). So these tend to be the sickest kids we care for, prone to infections of all sorts, as well as organ failure issues and much, much more. But at the same time, every kid inside I have taken care of, and have gotten to know them and their families - so I feel not only a connection but also a huge responsibility as their nurse, to get things right and give them the best care they deserve.
Which brings us to Friday night. As I arrived to work, I knew that my assignment from Thurs would change to a degree (only one of my kids was still there, and he is palliative care). The change was a bigger change than I expected - I was assigned to care for one of our sickest, if not the sickest kid, we have right now. It felt overwhelming and unattainable when I first saw my name next to his on the assignment sheet. But then I realized, this is what I do - this is my job, and until I bite the bullet and challenge myself on more intense cases, I won't feel safe or comfortable caring for them. So I agreed to keep the assignment I had been given.
I clearly had no idea what I was in for...
My shift started with the knowledge that I had to give PRBCs (red blood cells). But within minutes it changed as it was determined that the kid needed to go down for a procedure (one that could save or end his life),and before that could happen I had to give platelets and a Potassium bolus. But it was soon decided that his Potassium was too low and that the procedure would be delayed to the morning. And I got to be the witness as the surgery team told the parents the risks and complications of the procedure, and hear dad say, in response to the physician asking dad to repeat what had been said to him, "I'm not going to talk about it. I understand, and I agree to it, but I just can't talk about it out loud. I'll sign whatever you need me to."
My heart sank at the same time that I was feeling empowered as the nurse called in to be witness, and able to offer support to the family.
Of course, I also got to be there as they told the parents the procedure was being delayed til the morning, and then having to support them as I tried to get their child all the meds and products needed.
I literally did more for this patient in one night than I do for most patients in months...and I had to figure out the best timing for everything due to having a central line with two lumens, and having to be sure all the meds and fluids and blood products were compatible. Those that were I could give easily, but those that weren't I had to figure out when I would be able to find an open line and get the needed meds to him.
Along with all of this planning things running into the kid, I had to do vitals - lots and lots of vitals. Which, since I was in there so much, was easy to do.
I have to stop and say that without the other nurses I work with, both the nurse I got report from and the nurses on my shift, as well as our amazing PCA (nursing asst), I would never have been able to get done all I did.
Back to the night...after his platelets finished, I got his potassium bolus going, then I started his PRBCs. And as they were running we got the call that he had grown out cultures in one of his lines - which meant that as soon as the blood was finished I had to draw blood cultures, electrolyte levels, and start him on vancomycin (an antibiotic). Plus I still had other IV meds I need to catch up since I couldn't give them with his blood products or his Dilaudid PCA.
As I got close to the point where I was ready to start the next med or product, I checked my resources, making sure I was doing the right thing, and then I asked one of the senior RNs to double-check that I was thinking right.
By the time change of shift came at 11pm, there were only 2 IV drugs that the night shift had to give - all the other drugs and blood components and TPN had been given and started.
My night ended with answering a question dad had about one of the meds I had given. Dad didn't recognize it and asked when it was started and why. Rather than just say what I thought might be right, I told him that I would check and give him the right info, and that my head was full from all that I had been doing that night. His first response was, "You've done a lot for us tonight, Tom. Thank you."
So then I came back and gave him the information he had requested (it was 1120pm at this point), and then told him that I wouldn't be back on Saturday, but that my thoughts would be with them and that I would be hoping that everything worked out okay, and that I would look forward to seeing them when I was back on Monday. Dad's response was one of gratitude and appreciation, mixed with his own fear and trepidation and concern.
I left work exhausted, but also feeling like I did all I could have, and done it well.
Now, I can't stop thinking about that family, and the child, and how things went in the procedure.
I'm trying to remain positive - for me as much as for them.
Fingers are crossed, breath is held - I'll find out Monday where things are.
Not having updated what's going on with me and work in far too long, I felt I really needed to after the night I had at work on Friday.
I was placed on the part of our unit that cares for the more immunocompromised kids, as well as the kids who are getting or who have received a BMT (blood marrow transplant). So these tend to be the sickest kids we care for, prone to infections of all sorts, as well as organ failure issues and much, much more. But at the same time, every kid inside I have taken care of, and have gotten to know them and their families - so I feel not only a connection but also a huge responsibility as their nurse, to get things right and give them the best care they deserve.
Which brings us to Friday night. As I arrived to work, I knew that my assignment from Thurs would change to a degree (only one of my kids was still there, and he is palliative care). The change was a bigger change than I expected - I was assigned to care for one of our sickest, if not the sickest kid, we have right now. It felt overwhelming and unattainable when I first saw my name next to his on the assignment sheet. But then I realized, this is what I do - this is my job, and until I bite the bullet and challenge myself on more intense cases, I won't feel safe or comfortable caring for them. So I agreed to keep the assignment I had been given.
I clearly had no idea what I was in for...
My shift started with the knowledge that I had to give PRBCs (red blood cells). But within minutes it changed as it was determined that the kid needed to go down for a procedure (one that could save or end his life),and before that could happen I had to give platelets and a Potassium bolus. But it was soon decided that his Potassium was too low and that the procedure would be delayed to the morning. And I got to be the witness as the surgery team told the parents the risks and complications of the procedure, and hear dad say, in response to the physician asking dad to repeat what had been said to him, "I'm not going to talk about it. I understand, and I agree to it, but I just can't talk about it out loud. I'll sign whatever you need me to."
My heart sank at the same time that I was feeling empowered as the nurse called in to be witness, and able to offer support to the family.
Of course, I also got to be there as they told the parents the procedure was being delayed til the morning, and then having to support them as I tried to get their child all the meds and products needed.
I literally did more for this patient in one night than I do for most patients in months...and I had to figure out the best timing for everything due to having a central line with two lumens, and having to be sure all the meds and fluids and blood products were compatible. Those that were I could give easily, but those that weren't I had to figure out when I would be able to find an open line and get the needed meds to him.
Along with all of this planning things running into the kid, I had to do vitals - lots and lots of vitals. Which, since I was in there so much, was easy to do.
I have to stop and say that without the other nurses I work with, both the nurse I got report from and the nurses on my shift, as well as our amazing PCA (nursing asst), I would never have been able to get done all I did.
Back to the night...after his platelets finished, I got his potassium bolus going, then I started his PRBCs. And as they were running we got the call that he had grown out cultures in one of his lines - which meant that as soon as the blood was finished I had to draw blood cultures, electrolyte levels, and start him on vancomycin (an antibiotic). Plus I still had other IV meds I need to catch up since I couldn't give them with his blood products or his Dilaudid PCA.
As I got close to the point where I was ready to start the next med or product, I checked my resources, making sure I was doing the right thing, and then I asked one of the senior RNs to double-check that I was thinking right.
By the time change of shift came at 11pm, there were only 2 IV drugs that the night shift had to give - all the other drugs and blood components and TPN had been given and started.
My night ended with answering a question dad had about one of the meds I had given. Dad didn't recognize it and asked when it was started and why. Rather than just say what I thought might be right, I told him that I would check and give him the right info, and that my head was full from all that I had been doing that night. His first response was, "You've done a lot for us tonight, Tom. Thank you."
So then I came back and gave him the information he had requested (it was 1120pm at this point), and then told him that I wouldn't be back on Saturday, but that my thoughts would be with them and that I would be hoping that everything worked out okay, and that I would look forward to seeing them when I was back on Monday. Dad's response was one of gratitude and appreciation, mixed with his own fear and trepidation and concern.
I left work exhausted, but also feeling like I did all I could have, and done it well.
Now, I can't stop thinking about that family, and the child, and how things went in the procedure.
I'm trying to remain positive - for me as much as for them.
Fingers are crossed, breath is held - I'll find out Monday where things are.