It’s time to be a Strong Nurse

I was about to ‘boost’ a patient up in the bed with a colleague and I noticed how strong she was. I hardly did anything! Later that night, a patient coded and she started CPR. I noticed that she could do it for such a long time with so much force. She’d take a break just for a few minutes before she took over again.

When I took over, I realized how little endurance I had. I was wiped out after a minute.

After the code, another colleague mentioned how she heard pumping noises right before the code was called. She knew that it was that strong nurse doing CPR.

After I went home for the day, I felt my abs hurting.

This made me think about all the strong nurses there are. Especially in the ICU. Especially her. So she’s my strong nurse idol. I want to be a strong nurse.

I bought new running shoes and workout clothes yesterday from Adidas. I haven’t had a sports bra since high school (I’ve been swimming instead). I have to build my endurance. Do free weights. Etc.

It’s time to be a strong nurse.

And I’m bringing my boyfriend along for the ride.

Strong nurse!

My First ICU patient who passed away

He officially passed away this morning
while I was on break. DNR status.

Yesterday his son asked for my thoughts.
“I think he’ll make it tonight.”
Even though he was slowly deteriorating,
Maxed out on oxygen and 3 drips to keep up his blood pressure.
On fentanyl to make him comfortable.
He made it.

I returned last night.
It was a different story.

“Jessica, how’s he doing?” His son asked.
The generic “he’s fine” is off limits. It was time for the truth.

“Last night his respiratory rate was 9 or 10. Now it’s 15-18.
Often when people are nearing the end of life,
it goes from slow to faster and back to slow again.”

“But his heart rate looks ok. It’s 85.”

“Yes that’s true.
But his blood pressure is slowing decreasing.
His heart is still trying to compensate.”
He cocked his head. I tried again.
“His heart is trying to get enough blood to his body
but it’s not working. It will eventually give up.”

Optimism in his voice,
“But wouldn’t the heart rate slowly taper off?
I thought he would live a couple more days.”

“No, his heart can suddenly stop because it’s giving up.
I’m not sure if he will make it through the morning.
His drips cause his blood vessels to constrict.
That explains why his hands are cold
and the oxygen probe to not read well.”

After midnight, his HR was suddenly dropped to 42. RR was 9. SpO2 77%.
“Can you give us an update, doc?”

“Well I’m not a doctor.”

“It’s ok. We’ve promoted you. Just give it to us straight.”

I started to tear up a little bit.
It wasn’t easy for me to tell them what I thought:
He’s on his way out.

They told me that they’ve shed their tears already
and were waiting this.
“Thank you for taking great care of him.
You should be proud of you and your coworkers.
Tremendous sense of purpose and goal and comradery.”

His blood pressures stop reading.
Apnea alarm sounds.
That probably should’ve been my cue.
I still felt a carotid pulse.
I checked my drips.
Gave report and went on break.

I came back from break and looked at the monitor.
His was black.
“Your patient expired.”
Icy cold hospital terminology.

I debriefed with the experienced nurse covering for me.
What could I do better next time?
1. Listen for his heartbeat, not only feel for pulse.
2. Consider the BiPAP machine delivering breaths for him.
What’s the rate set at and what is his RR now?

In the final progress note
Include: heart rhythm- PEA,
who pronounced time of death,
which doctors notified of death.
Family at bedside or contacted.

In the end,
This family was ready to accept their father’s fate.
The son shared his friend’s voicemail message:
“How did they prepare the chicken?
They told him he was going to die.”
We chuckled.
Humor can start the healing process.

After I gave report,
I said bye to the family
And they all gave me a hug
And thanked me again.

I drove home
Half crying
Trying to drown the feeling
By turning up the radio.

I showered, ate, and wrote this down
So that I don’t forget.

Med-Surg to ICU Interview Questions

I’m so excited to announce that I was recently accepted into the MICU (medical intensive care unit) at my hospital! Critical care class starts in 2 days and I just finished my last shift on the telemetry med-surg and orthopedic unit!! I loved my team there– the people are truly incredible. The CCPs, PCAs, management, my fellow night nurses and day nurses made my time there truly amazing. It felt like a great teamwork every night, making sure essential things get done and always going above and beyond. ๐Ÿ™‚

One year ago, I started at a nursing home for a month. 11 months ago, I started at the hospital on the telemetry unit. My hospital is having some of our ICU nurses go to another hospital in the system to build up their units so this great opportunity came up for me to go work in the ICU.

Fortunately, the interview was a “formality” but it’s no excuse not to prepare! With nearly a year of experience under my belt, it was much easier to come up with experiences showing my leadership. And remember, people relate to specific STORIES more than generalities! Here is a list of questions the nurse manager asked me.

  1. May I see your resume? (Asks questions on the resume especially regarding additional schooling aka your future plans and previous experience)
  2. What made you interested in coming to the ICU?
  3. How has your experience prepared you?
  4. What kind of drips have you used?
  5. Have you called a RRT or a neuro RRT or code before? What happened? What was that like?
  6. Describe a busy night for you.
  7. If you have several things going on, how do you deal with that? (Delegation and priority- give specific examples where this came in handy!))
  8. How do you keep your ancillary staff accountable? Do you always or only sometimes have huddles? Do you meet up with them again? How do you make sure they do what you asked them to?
  9. What do you do when you’re unsure of something?
  10. What is a strength you have? A weakness?
  11. What have you heard about this unit?
  12. Do you have any questions for me? (The answer is always yes and you ask questions!! Such as the type of patients, the ratio, the professional nursing organization, scheduling, etc)

I hope this helps! If you have heard of additional questions, I’d be happy to add in more to get a more comprehensive list. And happy thanksgiving to everyone!! I have a lot to be thankful for, including the readers who have given me positive feedback through emails, comments, and likes. ๐Ÿ™‚ so thank you!!!