The Intensive Art

A good preceptor can make all the difference between a good day and a bad day while training on a new unit. Frankly, I’m long past the days in which a preceptor could have an effect on my sense of self-worth, or make me question my decision to pursue nursing. Instead, I’m finding that I have time to really sit back and notice the strengths and weaknesses of different styles of nursing and precepting.

I thought I would highlight some of the different preceptors I have had so far during my ICU orientation, and discuss how their personalities have effected my experience. I think we’ll all recognize these folks in those that we work with in any setting.

My very first preceptor was young, beautiful, and hip. She was dry, sarcastic, and witty. She was absolutely fantastic and thorough at her job, but wasn’t shy about explaining her goal to do as little work as possible. She didn’t cut corners or skip tasks, she simply didn’t make work for herself. She wanted her patients to be stable, sedated, paralyzed, and orphaned.

Her personality was fine with me! I laughed hysterically all day–which was a welcome experience considering it was my first shift. I was completely in a state of fear/shock/anxiety/panic, but she was very warm, and welcoming–not afraid to talk to me about the unit, look for interesting things for me to see, and get me involved with hands-on care.

“Have you ever drawn an ABG from an art. line?” Was one of the first things she said to me.

“No, actually, I’m not certified yet. I haven’t done the classroom theory or the exam.” I meekly responded.

“Pfffffft!!” she laughed. “Here’s the syringe. You’re going to do it.”

My second preceptor was completely different. He was just finishing up the last few days of his Master’s degree. He had just defended his thesis and was waiting the results. He was also doing some last shifts in his final Nurse Practitioner practicum.

He was a nurse that was extremely controlling of his environment. Every last moment of the shift was filled with checking, rechecking, adjusting, and readjusting. I don’t think I will ever again see a CVP/ICP/Art. line zeroed so many times in one shift! Lines were checked (all twelve of them) several times during the day–carefully followed from the patient to the label to the machine to the bag. IV labels were torn off and replaced with his nicer looking writing. Dressings were changed if he didn’t like the way the tape was positioned.

Every time he did anything at all, he would turn to me, explain exactly what he was doing, why he was doing it, and (not joking) list several research papers and their list of authors that backed up exactly why it was the best practice.

I remember how he listed all the things he would tell the team on rounds, and how they would respond. He explained what he expected the new goals for the day to be. He was spot on! Rounds went almost word-for-word how he predicted.

I loved the shift I spent with him. It proved to me how research and intellectualism play an integral part in the ICU. Every little move we make is because somebody spent years researching the practice. Often this research had been done by nurses and doctors within our very own ICU.

I also learned just how NOT controlling and detail-oriented my nursing practice is. In my mind, the jury is still out on whether I am OK with that.

My third preceptor was a delight! She was very warm, friendly, and encouraging. She wanted me to dive in and do absolutely everything I could. She helped me work toward being a bit more independent.

“So, Sean. This is your third shift. Are you ready to present a patient at rounds?” She said with a sickeningly sweet smile. I had been dreading the day someone suggested this very thing.

“ACK! NO! But the way I see it, I will never feel ready unless I just do it a few times and get a feel for it.” I responded. I’m sure, by the way she looked at me, that I had turned white as a ghost.

There were many “first times” that day, and each and every time, she told me how great a job I was doing. At the end of the day, she said I was doing great and let me go early.

I left that day on cloud nine! I was loving myself, my job, and the ICU.

My fourth preceptor was again completely different. She had twenty years of experience in the ICU. She was a very quiet and silent person. She rarely said anything unless it was to tell me I had done something wrong.

She didn’t let me dive in and try anything unless I specifically asked, “Would it be OK if I did that while you watch me?”

She always seemed surprised, and responded with an, “oh…OK…I guess.” And if I didn’t ask her in time, (which happened a few times)and I found her mid procedure, I would have to ask her what she was doing, and what her rationale was.

I tend to be a very shy person and struggle with starting conversation. Generally I find that I am on the receiving end of someone trying to make conversation (note to self: work on that!). However, by the end of the day I found myself desperately asking her questions, trying anything possible to break her out of her silence.

Now, she was a very nice person. She was never mean to me. It was just that she didn’t make a great teacher. However, she was a HUGE source of knowledge, and whenever I did prompt her for information or explanations, she was able to provide it with depth and little effort.

At the end of the day, she said, “Wow, I feel so useless today! You’ve been doing everything!” I took that as progress for myself.

I don’t necessarily think there is a perfect preceptor when learning a new job. In fact, I think every single nurse has something very important to give to new staff–whether they’ve been there six months or thirty years.

This is why I don’t personally believe in having one single preceptor during orientation or a practicum. Every single nurse I have had has shown me the ICU from a slightly different angle. Just like in nursing school, I am poaching my favorite practices of each nurse that teaches me. Picking and choosing my own style.

Seven more preceptor shifts to go. Then the REAL test begins!

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I found this blog post fascinating (link and excerpt below)! I have heard many people at work express opinions and thoughts similar to these.

By the way, I’m assuming that a Matron=Nurse Manager.

It often seems to me that a nurse manager’s role is SO far removed from bedside nursing that it seems like a complete waste of resources. Would it be better to get them back to the bedside and replace them with actual managers (as in people that have a degree in management)?

Sometimes I wonder if a properly trained manager would do the job more efficiently and with more verve.

Then I argue that nurse managers are surely much more in tune with the needs of nursing staff since they have experience as nurses. But as we all know, this certainly isn’t always the case.

Give the article a read. Tell me what you think.

Militant Medical Nurse: Stupid Bitch Matrons

At my hospital we always had a saying…”Matrons are like ghosts…we know they exist but we never see them.”

Who are the modern matrons? They are highly trained and highly educated nurses who take on clinical specialist/ management roles. Highly trained and highly educated nurses are great at the bedside. Research has shown that patients have a higher survival rate when they are receiving total care by a degree educated RN. Even better if she has a manageable number of patients.

Many of our modern Matrons, however, are as useless as tits on a bull. They have no soul. They have no interest in patients. I would rather eat c-diff positive shit than bestow the honourable title of “Nurse” onto one of these people*.

NurseAuction.com Aims To Alleviate Nurse Shortage With Online Nurse Bidding

A new website, NurseAuction.com, has launched in hopes of filling the current and projected void. “The site is based on the law of supply and demand,” said Dr. Olusanya, company founder. “There’s obviously an enormous need for nurses. However, many nurses are leaving the field because they are overworked and underpaid.”

I love the idea of nurses becoming contractors and making a LOT more money!

I have officially finished the classroom portion of my ICU training! It was three long weeks of sitting in a classroom listening to lengthy, yet fascinating, lectures. I learned absolutely TONNES, but I’m glad it’s over. I can’t wait to actually get some hands on practice.

Not that I’m complaining! Getting paid to sit on my butt–not to mention having weekends off–was a nice change.

I have even finished the requisite theory exams that we are required to write. They were as follows: ECG interpretation, Hemodynamics, pharmacology, Pacemakers, defribrillation, and two or three others that I’m having trouble bringing to mind. Now, I just need to work my butt off to get all my return demonstrations done (three times for each skill) so I can start working more independently.

Over the next year, I will take certifications in PA catheters, ACLS, CRRT, as well as code blue team training. I’m extremely eager to gulp down these further skills, but I have to relax and let myself become comfortable. But darnit! I just want to know everything, and now!

I have seven “buddy” shifts left. Now that I have my tests (mentioned above) done, and have completed computer training, I can take a much more hands on role during these shifts than my two previous buddy shifts. I’m a bit tired of just sitting back and observing, desperately trying to figure out what’s going on.

I picked up my uniforms the other day. I love the light greyish-blue colour. I can’t wait to not look like an outsider thanks to my “wrong” coloured scurbs!

Anyway, as you may have noticed, there’s really not a heck of a lot going on. What can I say about sitting in a classroom eight hours a day?

Can I just say…

The ICU is full of the nicest, warmest, most welcoming people I have met in the nursing field so far. The images I’ve both had and heard of the cold, mean, snobby ICU nurse are such a myth!

I just felt the sudden need to mention that.

What a DAY!

Today I helped care for a traumatic brain injury patient, which was a definite first for me! She was sixteen years old and had flipped her car while skipping school see to her forbidden boyfriend.

I think, in my naiivity, I didn’t realize just how sick she was until another nurse came by and shook her head, looked at the ICP, and stated, “You guys have been fighting one heck of a war with this one”

I was absolutely engrossed in the dips, waves, dives, swoops, climbs, peaks and creeps of her ICP, CPP, MAP, and brain tissue oxygenation. All day it was: Mannitol, propofol, ativan, Hypertonic saline, levophed, open the EVD, close the EVD, and on and on.

We weren’t titrating medications, we were titrating hope.

Speaking of EVDs, I actually had the opportunity to see the neurosurgeon drill a hole in her head and guide the EVD into a ventricle. Oddly, the insertion actually seemed a lot less complicated than setting up the lines for the transducer and monitor!

And she was the first person I ever “bagged.” I was standing there as we prepared her for a head CT. “here” said the respiratory therapist. “Bag her for me while I figure out the oxygen tank.” And so I discovered what it feels like to literally keep someone alive just by squeezing a bag.

As I left the unit she was being whisked to the OR to have a bone flap removed. The EVD just wasn’t relieving the pressure.

She will either die soon or have a VERY long recovery. I thing the former is more likely.

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I have never been a fan of Sherri Shepherd from The View. It started with her fundamentalist Christian leanings, progressed with her belief that the world may be flat, and climaxed when she seemed confused that some people believe the earth and society existed before Jesus.

She’s just plain dumb!

I was hoping to find an actual news story to describe what I heard her say on The View today so I could link it to my blog. However, It would appear as though it will be me breaking the story.

Granted, her comments today were not as shocking previous behavior, but it certainly made me roll my eyes.

She was talking about her experience with having the stomach flu last week when she causally mentioned her ambulance ride. Seriously Sherri? You took an ambulance because you had the stomach flu?

Then the story progressed into a commentary about the fact that no cars would move over and let her ambulance by. She related this to the fact that she was in New York, and, well, that’s what New York is like, right?

Actually, Sherri, I’m thinking, nobody moved over because you had the stomach flu and the ambulance was probably going at a normal speed with it’s lights off. I’m sure the drivers were rolling their eyes too.

Of course, I don’t know any further details of the story, so it could have been much more serious, but it just seemed outright silly to me! And the rest of the hosts didn’t even flinch or take the chance to question her on her choice of transportation. Perhaps they too think this is an appropriate use of resources.

Hospital workers fired for snooping in Spears’ files

Updated Fri. Mar. 14 2008 8:49 PM ET

The Associated Press

LOS ANGELES — UCLA Medical Center will fire some employees and discipline others for snooping at the confidential medical records of Britney Spears while she was hospitalized in its psychiatric ward, a hospital official told The Associated Press.

CTV.ca | Hospital workers fired for snooping in Spears’ files

I was browsing at a local bookstore, flipping through Love in the Time of Cholera (a book I keep meaning to buy but never do). Two young women walked behind me, one with a newborn strapped to her. They were mid-conversation.

“And do you know what I heard!?” The lady with the baby said in an urgent, warning voice.

“What?” Her friend responded. I thought I caught a slight tone in her voice that indicated she wished her friend would shut up and stop babbling.

“Now they are saying that epidurals cause autism too!!!! Epidurals are SO evil!”

With my head still buried in the book, I gave a GIANT eye roll. It wasn’t so much about what she was saying (OK, it was. I am so tired of hearing about the increased autism/increased vaccination correlation, and I really don’t want to have to start hearing about it in regards to epidurals) but rather that I’m tired of hearing women shame other women into feeling guilty about using epidurals.

I GET IT! some women think other women are failures if they use them, and that they’re terrible terrible mothers who are obviously directly harming their babies–it’s getting old. And it’s mean to even imply that.

Fortunately, I looked over and saw this woman’s friend rolling her eyes even more than I was. I think she was thinking the exact same thing I was.

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I wanted to respond to a comment left by Lee-Anne on my last post. I was very interested by what she had to say and I have been ruminating on it all day as a result.

I would like to caution you about not getting caught up in all of the technology and remind yourself that beyond everything else there is a person in the bed connected to the technology who has a family who loves him/her.

I don’t find it fascinating to watch a dying heart on a monitor. It represents the end of someone’s life and the sorrow that will follow.

Always remember, it is a privledge to nurse a patient and care for the family when someone is dying.

The reason I wanted to respond was because I completely disagree with part of the sentiment of this comment. I want to emphasize that I respectfully disagree. I don’t disrespect Lee-Anne’s opinion, I only want to share how mine differs.

I simply do not see being fascinated by technology and science as mutually exclusive to nursing practice–even in the case of a dying patient. In fact, my fascination with human biology and medicine is what began my interest in nursing, and it’s what keeps me interested in nursing as I dive into my career.

I understand the ideology that nurses can be swept up in the machinery, monitors, and equipment, completely forgetting that a living being is laying on the bed suffering. It is important to care for the patient rather than the machines–but I fully disagree that it is wrong to be fascinated by these machines at the same time. I must add that I just can’t imagine not being fascinated by dysrhythmias, disease processes, and complex procedures!

Nursing is NOT just hand-holding and kleenex dispensing. It’s also a large set of hands-on skills; it is the implementation and collection of scientific knowledge; it is advocacy; it is ethics; It is SO many things! So, I feel that to diminish the entire facet that includes scientific knowledge as less important than the traditional ideals of “care” is in error.

Perhaps it is only because I am male, or perhaps it is because of my personality, but I’m not a huggy-touch-feely nurse. Being emotionally supportive of families is not my strength. In fact, I think most would consider it awkward if I tried to be emotionally supportive of families in the same ways as females–holding hands, long hugs. I am emotionally supportive, but not likely in the same way many nurses are.

The science and skill of nursing is my strength. Many nurses may find satisfaction in their job from the emotional care of patients/families, but I find my job satisfaction by seeking out knowledge and perfecting procedures. I don’t see anything wrong with this. After all, don’t all nurses differ in terms of strengths and weaknesses?

Put simply and succinctly (I know–too late) I do not feel that it was wrong for me to pursue more knowledge about the electrophysiology of the dying heart. Furthermore, I do not feel it is unethical to be fascinated by this knowledge. Lastly, I understand that it is a privilege to care for a dying patient, that was never forgotten at the moment.

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