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!

1 comment:

  1. That is so interesting! I just did my firs blood test 3 weeks ago, as where I trained and worked, only doctors and phlebotomist did blood tests so we were never trained to do it. It felt great. It is still hit and miss at times, but hey, getting there! :) I also did my first intradermal injection a few days ago. So excited it felt like the first time I gave an IM! ;)