So with the completion of my shift yesterday, I am officially one-fourth of the way through my first assignment. Hard to believe it's gone so fast - although I suppose, given how easily three years slipped by in LA, I shouldn't be surprised when three months feels like the blink of an eye.
I am surprised by how fast I think - I hope - I've caught on here. In the end, I was given a grand total of one shift of orientation, had a couple of days on the stepdown unit, and have been in intensive care (which they insist on calling ITU - InTensivecare Unit? Doesn't make sense, people!) ever since. The first handful of shifts were frustrating, to say the least. Not only was I rusty from four months off, and struggling with the transition to the physical, political, and procedural landscape of a new workplace, but in some ways, things over here seem designed to be handicaps, especially in a critical care setting. Every medication, for instance, has to be checked by two RNs as it's reconstituted, drawn up, and administered. On one hand, this makes sense - the meds sent up by pharmacy at UCLA had already been checked once (in theory), so it was only necessary for one nurse to double-check them before giving them. On the other hand, some of the meds that have to be double-checked here - furosemide, PO sodium, etc.? I'm sorry, you'd have to be an idiot to give such a wrong dose as to be harmful.
Secondly, in order to give intravenous meds, you have to be officially assessed and signed off. I was under the impression that this would be a quick process: draw up a dose, check it with a sister (charge nurse), administer it correctly under her supervision, and be done with it. When I asked about it yesterday, though, I was told that if I "thought I was ready for it," I should get in touch with the clinical educator for a "packet" I'm supposed to read through. On top of that there was some hoo-hah about one of the CEs being out on maternity leave, and the other not "back" yet (not sure what that was about, it seemed a bit deliberately vague), so it sounds like I'm not going to be getting signed off anytime soon.
This, as you can probably imagine, is aggravating. It's not even so much that I feel a bit slighted with my, oooh, three years' experience - they have a policy, and everyone has to abide by it, I understand that. But it is beyond frustrating in a situation like yesterday afternoon: two babies just back from the theatre/OR with all the busyness that entails, a third with IVs going bad and pumps going off incessantly, and then my sick little one, who was suddenly being un-ventilate-able to the point where the MDs wanted to change out his ET tube. They'd written up the intubation meds for me, but I couldn't even draw them up to be checked, much less give them, because in my un-assessed state I am only allowed to be the double-checker. I hated having to ask to pull other nurses away from their own pressingly important tasks, but in the end, what's more important than airway? (Well, circulation, apparently, per the AHA, but you know what I mean.) They were all absolutely lovely about it, fortunately, but I still felt bad. And more than a bit like a broken record, towards the end. ("If you have a minute, I have to give..." "When you're free, I need..." "Sorry to bother, but they wrote for...") At least I'm getting plenty of practice in the English habit of prefacing every request with an apology.
It's a similar problem with the issue of peripheral lines. The placement thereof is a medical task - here, at least, John Radcliffe being a teaching hospital, although that's not so much the case in other facilities, according to one of the nurses. Now, I'll be the first to admit, I am terrible at PIVs, so I was happy enough to learn that the responsibility was taken out of my hands. It took no time at all, though, for me to realize that I much prefer the minimal lag time between recognizing the need for a new cannula and trying to start one myself, or at least find someone who was proficient, rather than waiting on the doctors. Again, it's not their fault - they have schedules and priorities of their own, encompassing the whole unit. But it did mean, for instance, that I was giving antibiotics three hours late the other day, and staying until 8.30 to finish my (did I mention PAPER) charting.
I can't imagine how the other nurses commute to work and make it home again at night; I can barely manage the 90-second walk from hospital door to my door before losing the ability to remain upright.
I did say, though, that I was catching on fast? All complaining, founded or otherwise, aside, that is still true. I spent those first few shifts feeling like a new grad again, but the experience I already have has made the learning curve much more easily surmountable, this time around. I was unnerved when I discovered that all of the suctioning here is open as opposed to in-line, but after a day or two with an intubated kid, I felt like an old hand at it. On my first day on the high-dependency unit, I had THREE babies (cut me some slack, it was only my second day overall), but it turned out to be no big deal. I feel that this experience has been pushing me to grow as a nurse - not only in confidence in my own abilities, but in knowledge of topics, such as respiratory management, that were heretofore only barely part of the scope of nursing as I knew it. Additionally, I can feel myself becoming more flexible, as I learn to accept being slotted in wherever I'm needed, as well as doing without various luxuries that I took for granted at UCLA.
Next professional goal: learning to work with "plain" flour, "bicarbonate of soda," "arrowroot," et cetera. I think it's about time I started baking for work again...
