On my own in the real world

When I graduated nursing school 16 years ago, there was no such thing as a nurse shortage.

In fact, the closest large city had a hospital just lay off over 200 RNs who where competing with me for the few RN positions to be had.

I finally found an agency position that placed me in a large coronary care unit.

While waiting for morning report to start on my first day, the charge nurse asked me how long I had been a nurse.  I looked at my watch, and said, “Nearly 5 minutes now.”

She looked surprised and excused herself.  A few minutes later, the manager came by, said they didn’t allow new nurses to work in the CCU, and escorted me to the door.

I called my agency, who apologized, and offered me a home health care position taking care of a baby who needed 24/7 nursing care with a feeding tube, pacemaker and home vent.

After having a problem already with not being qualified for the assigned position, I was hesitant to take care of a patient on a ventilator, especially a baby.

They said the home vent was user friendly and I could go visit the nurse currently working there to learn how to fix the ventilator if anything came detached.

Day one as a nurse

I went for my orientation; it all seemed easy enough, so I agreed to work the next night from 7 p.m. to 7 a.m.

After a quick report with the off-going nurse, an introduction to the parents of the child who had been out of the house the day before, and a tour of the house showing me which areas I could enter and which areas where private rooms for the family, I was left alone with my very first patient.

I gave my first round of meds through the feeding tube and charted some vital signs. I thought things were going pretty well when the pulse oximeter started to alarm.

The SATs went from 100% down to 92% within the last few minutes.

I checked to make sure the probe was still on her toe and then checked to make sure all of the tubes from the ventilator to her trach were still attached (OK, I should have done those two things in reverse order, but it was my first day as a nurse, so cut me a little slack.)

The vent was working, but the SATs were dropping into the 80s now.

“OK, let’s give it a try … what is it?”

I tried to suction the trach, but got very little mucus up, and the SATs continued to drop.

I disconnected the vent and started using the ambu bag with 100% Oxygen connected directly to the trach.  SATs started coming up a little, but still not great.

The father heard all of the alarms and came into the room to see me bagging his daughter.

I handed him the page of emergency numbers they had provided me and had him dial the emergency pediatrician on call for me.

I explained the situation quickly and the doctor instructed me to do chest percussive therapy.  I responded with, “OK, let’s give it a try … what is it?”

I can do this!

After he started to explain what it was, that 5 minutes of nursing school came rushing back to me and I said, “Oh yeah, the cupped-hand back-beating thing.”

I placed the child in a head-slanted down position and started thumping away, dislodging a couple good sized mucus plugs. I was able to suction out and the SATs went back to 100%.

I put her back on her regular ventilator settings and was happy to see her SATs stayed at 100%.

Looking back on it today, 16 years later, I’m still happy I didn’t kill my very first patient.

I’m all in favor of letting new nurses try their hand at new skills, but think there should be a little bit more orientation and supervision for at least the first shift or two.

Also, to that CCU nurse who tried to get me fired on my first day as a nurse working in a hospital, THANK YOU!

Scary how much I didn’t know that I didn’t know anything.

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