Saturday, October 27, 2012

I see the light!!!

Today is the first day that I have been able to wake up and enjoy the sunlight in four weeks, and baby am I really loving it! Of course I have four night shifts this next week but this weekend I get to enjoy a little of that wonderful Vitamin D :-)

And in other ways I am seeing the light. I am seven weeks away from graduating. Eight weeks from nurse pinning. While they are a jam-packed seven weeks, I am finally close enough that the end is a small beakoning light on the distant shore leading me in. What a wonderful feeling that is!! Although I have no idea what life holds after that.

The thought of being an RN is a wee bit closer, a wee bit more realistic, and I can say though the last year has been painful, I'm starting to see the pay off!! 

Wednesday, October 24, 2012

Mid-Senior Practicum Reflection

This rotation has been a busy, chaotic, educational, lonely, and frazzled one.

I have never minded working nights. The pay differential is amazing, the evenings are usually more quiet and leave more room for really taking your time and getting to know your patients. However, that is when you are actually working, getting paid, and working your own desired schedule. When I did work nights, I did all three in a row so that I could have days off to myself....and I could be awake during days. Because I am doing three days of clinical and working at least one day a week, that means four nights a week I am doing something, and they aren't all in a row, which means I have to be diligent in keeping on my night schedule. So my "days" off are lonely nights spent watching tv, grocery shopping, and cleaning, much like tonight. However, it has proved a great learning opportunity to me.

The graduate NICU at PSL has allowed me a unique opportunity. Most of my classmates are also in ICU's or ED's, critical care units, on day shift. They are seeing tons of interesting cases/scenarios and taking care of some pretty intense patients. While I take care of a very focused population that experiences very similar situations, marked free of disease other than congenital anomalies, with disease processes that are understood and predictable. The unique aspect is that my preceptor is allowing me to take care of the babies on my own. She is allowing me the opportunity to assume being the nurse and making the experience really into the nursing role for myself. She allows me to critically think and provide my nursing reasoning skills in my care (and of course guides and corrects me when I'm not quite on target with her reasoning). What it is allowing me to do is learn time management, workflow, and clinical reasoning. I'm not seeing tons of interesting stuff, but I'm learning other aspects of nursing such as delegation, time management, critical thinking and reasoning, disease process, prophylactic interventions, physical assessments, etc. It's been an awesome rotation in that aspect. And I'm learning tons.

Contrary to adults, neonates bodies respond the exact opposite of how we learned adults respond to different disease processes or conditions. In that aspect, and in caring for neonates, it's all new territory.

The only problem will be studying for NCLEX, which is all geared towards adult med/surg after this rotation is done. I will have to go back and remember everything in the adult world. I guess it just means I will have to study even harder!! And go through tons of practice questions.

I've had a plethora of babies however. I'm currently up to taking care of 4 babies. I was able to take care of 3 babies all on my own last week. So much so that my preceptor was bored by 10pm and spent two nights playing games on her phone. This week (a week ahead of schedule), she thought me ready to bump up to 4 babies. We walked into a pretty high acuity 4 baby assignment, and while it was incredibly overwhelming, it was an absolutely great experience. We will be shooting to have 4 baby assignments for the rest of our time together over the next five shifts.

I've had respiratory babies, GI babies, cystic fibrosis, ostomies, OG/NG tubes, TPN/lipds, isolettes, open cribs, CF/HF oxygen delivery, and there is one baby who had a foley that I got to observe. All in all I would say I've been able to see quite a bit. I'm doing the initial assessment, cares, lab draws, etc. The only thing I haven't yet tried is starting a PIV, and that's because my only opportunity has been on a baby who is a notoriously hard stick and I'm just not going to do that to a poor little babe who has been nothing but a pin cushion since birth.

I need to get better at interacting with families, and confidence in myself, but I feel like that will come with time. It's a lot to take in and learn all at once. I feel like I'm getting there, slowly but surely. We will see how the next two weeks pan out!!

 This is me, while at work, looking out over the city through the 7A windows at work...while mostly you can see the desk and the reflection of what's behind me, you can also see the dots of the lights on the buildings. I thought it was pretty cool :-)

Monday, October 08, 2012

Senior Practicum Week One Reflection


I guess what's what happens when you work a shift at DH (staying up for 24h d/t class the next morning) and then turn right around and do 4 clinical shifts in 5 days. I'm also working nights right now so trying to get my body to readjust is sort of a pain in the butt. Sleeping during the day isn't too difficult but it isn't easy. My body really will only sleep for a few hours at a time. Therefore, I'm a tidge exhausted.

This has been quite the week!! I introduced myself into the NICU, and all it's unique needs, and newness of working with infants. And in four short shifts, worked my way up to caring for 2 lower acuity babes.

Like I said, P/SL was gracious enough to allow me into their graduate NICU, which is part of the Rocky Mountain Hospital for Children @ P/SL.

I like to call it the med/surg of NICU's. The babies are stable but are chronically sick. That means after the critical care aspect has been stabilized, they are sent up to the graduate NICU where they remain for quite awhile until they are able to go home. Down in Level III is more like the ED/SICU of the NICU. The graduate NICU is like the MICU/med-surg floors. The babies are adorable and acuity can be low to high. The babies need a lot of support either way. They range from "grower-feeders" to those that are on the cusp of possibly crumping without constant assessment and surveillance.

My time has been amazing. I worked my way up to caring for two of the babies on my own, with the support of my preceptor Tami, who is a wonderfully sweet woman, who has patience with all my questions and nervousness.

There is one baby I absolutely fell in love with. He had a very rough start to his entrance in this world. But over the four shifts I had with him, he captured my heart. He's a tiny little thing, though for his gestation he is normal. I guess I'm just not used to working with such tiny ones. He has this hair that just spikes all over the place. He has these incredibly dark eyes, and such personality. He is calm and mainly quiet, very patient as you work with him most of the time. He just stares up at you and roots around for his hands, or simply just lays and stares at you. If you face him towards the wall, he gives you this "Are you serious right now?" sort-of look. When you feed him, he doesn't have a blank stare. His dark eyes piercingly and quizzically look at you the whole time. While burping, he enjoys the time sitting up and relishes in being fully supported.

I'm not someone who has a desire to have kids anytime soon. But he could totally convince me to have children. Only if they were exactly like him. Despite all he's been through (the roughest start to life) he was the champ in the room, coming off of oxygen, feeding every other cares time, and maintaining really well.

These next two shifts we will move to a room that has a higher acuity, and I will continue to care for two babies. I might even take over caring for three babies on thursday ;-)

Until then, here's a little hello from the graduate NICU (night shift of course)!

Thursday, October 04, 2012

1st Day of Senior Practicum

Last night was my first night in senior practicum. I'm in what's called the grad NICU at PSL. It's the NICU where the babies go once they are more stable but still unable to go home. There's potentially still a lot of risks involved with them but the critical care aspect isn't as high as I was hoping it would be.

The staff at PSL is incredibly welcoming! They all welcomed me in and treated me with wonderful courteous-ness from the beginning. My preceptor is incredibly smart and knowledgeable and is a mom herself, so brings a mom-like quality to the table yet still expects performance from me.

The night went rather smoothly. We had as assignment of three small babes. Each one of them was getting antibiotics which meant they all had peripheral IV's. We do "cares" every 3 hours, which include taking temps, changing diapers, flushing lines, quick assessments, and feedings. The night stayed pretty busy due to this but also due to having to replace each one of the little babes IV sites.

Babies have tiny tiny veins to begin with. Add in their smaller size and then trying to get a PIV started is almost ghastly. Really to the point that on the 2nd baby I got queasy and had to step away (also might have had something to do with getting incredibly hot from standing under the warming light). What really killed me was the number of pokes done to each child before help or use of evidence-based practice was used.

We are taught, and it has been shown to be remarkably more effective, that with babies with such small veins doing a thorough search using the little illuminators works very well for finding and getting a vein. Not to mention warming up the site to make the veins pop, etc. Very little of this was done and the babies were poked up to 6 times before someone from the level III NICU (the more critical babies) was called in to also attempt. 10 pokes on one baby to get an IV when probably half, or well below half, of that could have been attempted had a little more time put into the extra measures.

Or perhaps that's just my opinion.

And then there's the whole doubt in my mind over sucrose and whether it really eliminates pain, or just overwhelms the babies system. I'm not a huge believer in the sucrose for pain relief. Then again I haven't worked with neonates for many odd years like these nurses have. It did help to calm the babies down, but I'm not sure I would call it a pain reliever.

A few ethical concerns while there but then again that's to be expected, I knew that going in.

Overall a really great night and really exciting start to the next five weeks of my time there!! By the end Tami wants me taking care of a 4-baby assignment. Think I'm ready?! We will sure see.

Wednesday, October 03, 2012


My first shift for senior practicum is tonight! I will be doing my senior practicum in the Level II NICU at Presbyterian St. Luke's Hospital. So many emotions going through me: excitement, nervousness, fear, trepidation, enthrallment, giddiness, anxiousness....I have absolutely NO idea what to expect in regards to any aspect of the experience, all I hope is that I can learn tons, enjoy the rotation, and become more of a self-actualizing nurse and not just a nursing student who follows people around all day!!

It's getting closer to pinning ceremony. 10 weeks and counting. Wow craziness.