Wednesday, August 22, 2012

An APN Victory in an Initial Failure

One of the things our PICU is working on is figuring out how to get a full service APN team that collaborates with a fellow on service each week.

This equates to Nurse Practitioners being responsible for knowing how to do procedures (art sticks, line placement, intubation, chest tube insertion and removal, lumbar punctures, etc.), but not necessarily getting the opportunity to fully learn how to do so.

Every July through oh, about the end of the year, this is especially a problem.  Every July we get a new bunch of fellows.  And this equates to a new group of fellows who also are responsible for knowing how to do above procedures.

So there's this internal, not quite discussed conflict over procedures.  Except now it's being discussed a bit more.  APNs cover 100% of the night shifts, in conjunction with a fellow, and an attending.  Except 50% of the time, the fellow is covering the new Cardiac ICU and are no longer in the PICU.  So that means an APN is working solely with the attending...most of whom truly value their sleep!

So in this struggle over procedures, let's just say my orientation has not been all that enriching in this area.  Several of my patients have been intubated, several have had arterial or central lines placed, and yet all of them were done by the fellow on service.

And I must say, I wasn't all that disappointed at the time.  But now, as I'm almost done with orientation, and know that I will be held responsible for these things, I wish I had the opportunity.

So this week, when I heard a new patient needed an art stick for some labs, I was all over it.  It wasn't my patient, but I at least wanted the opportunity to try.  And while in some hospitals this is something that the bedside nurses or respiratory therapists do, at my hospital, only the APN or fellow does this.

So I got the opportunity to do my first every art stick!  And while I didn't get enough for a sample, I got a flash, and at least the feel for it.

In my defense, the patient was a 2 year old who ingested multiple medications from his father's medicine cabinet, and was neurologically intact.  In fact, he was kicking, screaming, and trying to hit me as hard as he could with the arm I was trying to get blood from.

So not getting this one on the first try wasn't too big of a blow to me.  I know that I hit the artery, and in response the child hit me, so I lost it (thank you fellow who wasn't holding him down properly!).  But I am grateful for the opportunity...even for something so small!

I think this is the APN equivalent of taking my first manual blood pressure or doing my first accucheck as a nurse.  And while I'm sure I will look back on this many years to come and think, "Oh newbie APN, an art stick is now something you could do with your eyes closed and one arm tied behind your back," it is something that I will mark down as a first for now.

So here's to a celebration of firsts.  And while after 101 of them, it may seem trivial, it is so important to celebrate the small victories.  Because PICU APNs...or APNs in general...know that it is the small things that get you through some days.

For all you experienced APNs, what was one of your first small victories??? And all you in nursing school, what are some victories you have had, or are looking forward to!?  Nothing is too small here...and this is coming from the APN who is taking a victory in an initial failure!

Thursday, August 16, 2012

Running with Infectious Diseases

OK, I think the title is a bit misleading.  I sat for a few minutes and couldn't come up with anything clever so I decided on the above.  Then I re-read it and decided it is quite disappointing, but that's all ya get folks.  My creative juices have been apparently zapped this evening.

The title is misleading because I don't have an infectious disease (thank goodness!).  And if I did, I certainly wouldn't be running!

But, what did happen was that I spent the week out of the PICU, and in with the Infectious Disease service. And, as I'll get to a bit later, this led me to having some great workouts!

I must say Infectious Disease this week was a great change of pace.  Scratch that- an amazing change of pace!

Never once did I hear the word "stat" used.  Decisions were made, but not every with a huge sense of urgency behind any of them.  And certainly while antibiotic/antifungal/antiretroviral treatments are extremely important, and life saving at times, it just can't compare to the day to day in the PICU.

That being said, I learned a ton. One of my [many] weaknesses is antibiotics...and I guess Infectious Diseases in general.  Rashes creep me out, if that's any indication!  So this was a great experience for me.

And who wouldn't like to be a part of a service that started at 9 am and got to leave between 4 and 5 pm!?!?  OK, well at least I did.  The fellow is pretty much on call 24/7.  But I got a sweet end of the deal!

Oh, and I greatly took advantage of the extra time in the morning...I was able to run 4 times this week! I'm pretty sure that hasn't happened since before I started grad school!  Holla!

Who wouldn't love running with this amazing view!
 *Even on an overcast day, the sunrise was still trying to peek through!*
*Gorgeous, bright and sunny morning!*

So here's to a great week of awesome workouts and a great Infectious Disease service week.  That's a success in this PICU APN book!

And to top it all off, I have a 3 day weekend filled with some bachelorette party and wedding fun!  Hope you have a great weekend in store as well!

Sunday, August 12, 2012

Start of a new week & a sigh of relief

So at the end of last week I had a bit of an internal freak out moment!  I thought it was my last day being precepted in the PICU.

My preceptor who has been my primary since the beginning said she was going to "let me fly solo" and she definitely did.  I felt great at the end of the night, knowing that I provided great care for my patients.  But despite that, I loved knowing that I had the safety net of a preceptor the entire shift.

I will be spending this next week with the Infectious Disease team and I'm so excited! My sister laughs at me when I say this (I think she thinks Infection = Gross!), but I truly am looking forward to learning about "bugs and drugs."  This is one of the cornerstones of the ICU and something that doesn't get taught appropriately in undergrad or graduate nursing school.

So back to my freak out.  The husband and I are taking a vacation/work conference for him at the end of the month.  This meant that I would have a week in the PICU, a week with ID, and then a week off.

Or so I thought!

I treated last week as my last one being precepted, and it was great being independent.

And then I realized there was actually another week in the month! Hello...way to calculate properly!  So I get a bonus week of being precepted and I'm excited about it.  I'm hoping that it will be an entire week of letting me "fly solo" just to prove that I can do it.

And then I can let my safety net go.

Except that's the wonderful thing about the PICU.  There are always safety nets.  That's what the fellow on our service is for.  And the Attending overseeing the both of us.  And the specialty services that we consult.

So despite shaking off my preceptor safety net, I have plenty of others to rely on.  And this is a safety net of its own.

So I will truly enjoy my week off the PICU this week, spending time with Infectious Disease.  It will be nice to have a week of a little less stress...ok, a lot less stress.  And a week of actually getting out on time ( or so I hear).

So here I come Infectious Disease....bring on all the grossness, the bugs, and the drugs!

Saturday, August 4, 2012

12 Hour Shifts

We started trialing 12 hour shifts this week with our APN team.  There are some definite kinks we need to work out, and some definite adjustments I need to do.

It wasn't that long ag, that 12 hour shifts were all I knew.  For my entire nursing career!  And yet after a short 3 months, I had forgotten just how LONG they are!

I'm realizing though, that in scheduling and 12 hour days (and pretty much every other facet out there), being an APN is SO different than being a nurse.

Bedside nursing 12 hour days meant being stationed in one or two patient rooms the entire day. Don't get me wrong, there were plenty of shifts that went by that I had not gotten to sit down, or eat, or pee.  But for the most part you were stationary in a small space.

APN 12 hour  days means a whole lotta walking!  Especially in our new hospital where there seems to be about 4 miles between the patient in bed 1 and the patient in bed 41.

Bedside nursing 12 hour days means that at 7 pm your relief gets there, and you tell them about your 1 or 2 patients. Most times this takes no more than 30 minutes. Out of there by 7:30 and on your way to enjoying a day off most working people don't get to enjoy.

APN 12 hour days means that at 7 pm your relief gets there, and you have to tell them about your 14 patients (this is one of the kinks we're working out...from 4 pm until 7 pm there is only 1 nurse practitioner covering the entire team). This certainly takes more than 30 minutes.

And if you have to get an admission, or 2 like I did on Wednesday, right in that 7 o'clock hour, well you can just kiss getting out of there at a decent time goodbye!

I left after 9 pm on Wednesday, and let me tell ya the prospect of driving a little over an hour home, then having to eat dinner, shower, get lunch and everything ready for the next day to do it all over again was nauseating!

So I'm not really sure how I feel about this whole 12 hour APN day thing.  It's only been one week, and it may grow on me.  I may enjoy the extra day off each week and not even care how late I get out.

So far, half of the APNs love them, half hate them.  And half of me loves it, and half hates we'll have to just wait and see!

What I DO know, is that all of me is glad to have this weekend off completely!  After 3 12 hour shifts in a row, most of which turn into 14+ hour shifts, I will cherish every moment of this weekend!  I hope you do too!