Saturday
May222010
the ICU. like woah.
Saturday, May 22, 2010 at 1:04PM
This past Monday morning, smack dab at 7a shift change in the ICU, I leapt head-on into a world of unknowns. With a census of over twenty patients, most nurses doubled or tripled up, a table of eight first-year residents, at least a dozen second and third year residents floating in and out, and a handful of various respiratory, radiology, EKG, housekeeping, and magement staff, I could barely remember my own name much less anyone else's.
There's a lot of folks in our ICU. Both in the beds (at times) and around them.
In some far away land of perfection I would have already had the prerequisite order entry training classes before day one in the ICU. Instead I was vaulted into the chaos, hovering nervously next to my preceptor as she deftly entered chart orders, paged doctors, ordered various and sundry bits of equipment, and generally ruled the roost.
In five minutes I saw how much of a mother hen a unit secretary really is.
Five minutes later I realized I needed to become exactly like her to be useful to the team.
I lost track of time because when I came up for air it was lunch time.
---
After five days of training I've seen and learned more than I imagined possible. I have another three weeks to go with a preceptor, but by Thursday I was comfortable sitting on the other side of my ICU (ours is a sort of loop with two sides) working as independently as possible. There is definitely much more for me to learn around protocols for ordering certain therapies and equipment, but I have a really solid foundation and am starting to build up my own work flow.
What I didn't expect, or rather, what I was amazed at, is how frickin' awesome the staff would be. It's a little early for me to guess why, but I think it has something to do with critical care in general. It takes a village, and no matter how seasoned the nurse or doctor, everyone relies on everyone for help when it is needed.
One of the senior nurses took me aside on Friday and explained a little of the magic of the team to me. I'm paraphrasing of course, but it went something like "Honey, if you have a question about something, never ever be afraid to ask. That's our job. We question everything constantly. You should too. Someday soon you'll know which orders look right and which ones don't. Ask someone. If you want, find me and ask me even if it isn't my patient. We all work together sweetie. All together."
That exchange blew me away. Good stuff.
---
The hardest part for me right now is any sort respiratory order. I'm comfortable reading medication sigs, although we don't transcribe them. I've learned what labs and procedures are generally ordered for new admits and morning rounds, but there are still outliers I'm unfamiliar with.
When it comes to respiratory orders and therapies, I'm a blank slate. Bipap machines and vent settings don't make much sense to me, and the various breathing treatments are completely new in my world. One of the senior nurses, the very same one who took me aside for the above pep talk, agreed to show me around a bipap and vent next week at my request. I sort of think if I see the machine and how it works, the orders will make a bit more sense to me when I'm seeing one written in physician scratches in the chart. At least I hope so.
The other hard part, the one that will fade away in time, is the bajillion phone extension/pager numbers that are part of the web of communication needed in any ICU. I swear both of the senior clerks are human Rolodexes, able to conjure up phone numbers in the blink of an eye.
You know how I remember phone numbers? I program them in my iPhone so my lazy ass can touch a name on the screen when I need to call someone. That won't fly at work anymore.
I've dialed more phone numbers in the past week than I've dialed in the last ten years. Everyone tells me in time the digits will stick in my brain, but until then I'm constantly sifting through internal web pages for phone numbers. I've started a spreadsheet with the most common physician/department numbers I use, but it'll be quite a while before I'm able to recall all that information.
---
So week one down and dusted. There's a ton more to learn, but I actually work in a hospital. In critical care. With cool people.
How'd I get so lucky?
---
There's a lot of folks in our ICU. Both in the beds (at times) and around them.
In some far away land of perfection I would have already had the prerequisite order entry training classes before day one in the ICU. Instead I was vaulted into the chaos, hovering nervously next to my preceptor as she deftly entered chart orders, paged doctors, ordered various and sundry bits of equipment, and generally ruled the roost.
In five minutes I saw how much of a mother hen a unit secretary really is.
Five minutes later I realized I needed to become exactly like her to be useful to the team.
I lost track of time because when I came up for air it was lunch time.
---
After five days of training I've seen and learned more than I imagined possible. I have another three weeks to go with a preceptor, but by Thursday I was comfortable sitting on the other side of my ICU (ours is a sort of loop with two sides) working as independently as possible. There is definitely much more for me to learn around protocols for ordering certain therapies and equipment, but I have a really solid foundation and am starting to build up my own work flow.
What I didn't expect, or rather, what I was amazed at, is how frickin' awesome the staff would be. It's a little early for me to guess why, but I think it has something to do with critical care in general. It takes a village, and no matter how seasoned the nurse or doctor, everyone relies on everyone for help when it is needed.
One of the senior nurses took me aside on Friday and explained a little of the magic of the team to me. I'm paraphrasing of course, but it went something like "Honey, if you have a question about something, never ever be afraid to ask. That's our job. We question everything constantly. You should too. Someday soon you'll know which orders look right and which ones don't. Ask someone. If you want, find me and ask me even if it isn't my patient. We all work together sweetie. All together."
That exchange blew me away. Good stuff.
---
The hardest part for me right now is any sort respiratory order. I'm comfortable reading medication sigs, although we don't transcribe them. I've learned what labs and procedures are generally ordered for new admits and morning rounds, but there are still outliers I'm unfamiliar with.
When it comes to respiratory orders and therapies, I'm a blank slate. Bipap machines and vent settings don't make much sense to me, and the various breathing treatments are completely new in my world. One of the senior nurses, the very same one who took me aside for the above pep talk, agreed to show me around a bipap and vent next week at my request. I sort of think if I see the machine and how it works, the orders will make a bit more sense to me when I'm seeing one written in physician scratches in the chart. At least I hope so.
The other hard part, the one that will fade away in time, is the bajillion phone extension/pager numbers that are part of the web of communication needed in any ICU. I swear both of the senior clerks are human Rolodexes, able to conjure up phone numbers in the blink of an eye.
You know how I remember phone numbers? I program them in my iPhone so my lazy ass can touch a name on the screen when I need to call someone. That won't fly at work anymore.
I've dialed more phone numbers in the past week than I've dialed in the last ten years. Everyone tells me in time the digits will stick in my brain, but until then I'm constantly sifting through internal web pages for phone numbers. I've started a spreadsheet with the most common physician/department numbers I use, but it'll be quite a while before I'm able to recall all that information.
---
So week one down and dusted. There's a ton more to learn, but I actually work in a hospital. In critical care. With cool people.
How'd I get so lucky?
---
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