Saturday, January 23, 2010

Hi! My name is Jo, and I'm a moron.

This cat looks suspiciously like Flashes.

Yeah, so. I'm grumbling my way to work on the night shift the other night, wondering why it is that I have to put in some undefined time on nights before I'm allowed to work days.

After all, I'm an experienced nurse, right? I have my routine down; I'm afraid that I'll lose that rhythm on nights, because they're so different from days. And it's not like I don't know the surgical patients in the CCU; I've worked with them now for years and years. Besides, other nurses got to go straight to days, and I know there are openings on days, so why the hell am I messing with my circadian clock?

Grumble, grumble, grumble.

About two-thirty, just as I was meditating on how odd it was to be eating tuna and cauliflower in the middle of the night, another nurse came over and asked the nurse sitting next to me a question about positioning a post-surgical patient.

I realized I did not know the answer.

*Blink* *blink* *blink*.

You can say what you want about me, call me every name in the book, but don't you ever dare imply that I'm a quick study.

After only three soul-crushing weeks on nights, it became apparent to me why they put new CCU nurses on the overnight shift: It's because we don't know jack shit.

There's time on the night shift to think. On days, when I felt like I was slaloming down that double-diamond slope, I didn't have time to think. All I could do was react to things and *maybe* anticipate problems if I had a minute to clear my head. Now I have time to read the charts, form something resembling a synthesis, and actually plan for disasters.

I also have time to, you know, learn the niceties of positioning people with big free flaps covering their whaddyacallits or their humunuhas. I have time to replace the pressure tubing for central venous and arterial lines, over and over, until it becomes routine--and more importantly, I get fast at it. I have time to jack with wound-vacs and figure out how to troubleshoot them. It's not a huge deal if labs get done at four rather than at three. The fiddly business of sterilizing reconnecting a ventriculostomy tubing is less loaded when nobody's breathing down your neck as you do it.

That morning, when the day shift came in, I asked one of the girls who'd gone straight from her internship to day shift if my theory held water. "Oh, shit" she replied, "Starting on days sucked. I was never out of here before eight-thirty or nine at night, I never had a chance to eat lunch or even pee, and I was totally out of my depth from the start. It's only in the last year or so that I feel even halfway confident." So, um, yeah.

If I had the chance to give the internship directors three pieces of advice, those would be these:

First, split the neuro group away from the CV and MS groups. It's a great idea in theory to give everybody an overview, and there's a time and place for that, but it doesn't work to have us all together at the same time. Us neuro babies learned about pressor drips (which we use occasionally, but only occasionally) and nothing about things like hot-salt and mannitol, which we use all the freaking time.

Second, (and this is a subset of item number one) give us more than two days on neuro review. Anatomy and physiology review is all well and good, but the internship as structured gives us very little preparation for what we'll actually see in the CCU on a day-to-day basis. I left that internship with the feeling that if I ever got a patient with a Swan-Ganz catheter, I'd do fine (four days on that), but that if I hadn't seen a neuro patient with a bleed before, I'd be screwed (one day on bleeds).

And third and most important, don't blow smoke about *why* we're placed on nights. I got as many stories about that as there were instructors in the internship, and not one of them was actually the truth: They put us on nights because it's the only place we'll have a chance to really learn stuff. That business about "setting your routine" and "learning the flow"? Is bullshit. The two shifts differ so radically that there's no translating one to the other.

So for now, I'm approaching this whole thing with a new attitude. It may not last through the end of this week, which is crazy as far as my schedule is concerned, but I'll try.

In the meantime, I'm going to make plenty of vegetarian sushi and little bento-box-esque munchies for the middle of the night. After all, I do get time to eat.


bobbie said...

Ayep ~

Michael Guzzo said...

They put us on nights because it's the only place we'll have a chance to really learn stuff.

Yeah.. keep telling yourself that. They put you on nights because you were the one who didn't say "no".

Jo said...

Michael: *Everybody* starts on nights. There have been two people in the last seven years who haven't, and that was because staffing was dangerously low.

Me: Ayep, indeed!

Mr. C. said...

Ayep. I concur.
I started out on nights because I wanted the extra money. Went to days because I thought I deserved it... Went back to nights 1 month later. You get to think at night. You just react during days.

RehabNurse said...

Love,love, love the WoundVACs. Once you figure them out, they're a breeze.

Good luck in your adventures with them! We use them lots and lots at the Hotel.

AfterGirl said...

Hey, I work for the company that makes the VAC (the original one that is). Love your sense of humor,