Cristin Wright

Hello hello! Today was my last shift in the ICU for this semester's preceptorship. It really is bittersweet. I am relieved that I accomplished the 225 hours, yet I am sad because I will surely miss the whole critical care team, especially my wonderful nurse who has taught me so much throughout these past months! I ended the experience with another great/busy day. I again, had one patient who was my full responsibility. There were many ethical decisions that had to be made throughout the day pertaining to my patient's code status and other components of care. This situation was a very intense one, and my nurse and I teamed together to try and resolve the dilemmas as much as we could.  I also participated in another code! The outcome for the patient was a good one, and we were successful in our resusitation efforts. I got to see a temporary pacemaker insertion at the bedside, as well as the insertion of a dialysis catheter.

Once again, I continued to practice my daily skills by assessing, administering all medications, documenting, turning and positioning, and mouthcare/suctioning via the ETT. It is always helpful to become more familar with the certain drips and medications that these critically ill patients are on, which I saw alot of today.

Anyway, graduation is less than a month away and I cannot even begin to explain how ready I am!! These hours that I have spent in the ICU have truly prepared me to start my own career as a registered nurse. It is just what I needed to boost my confidence in my clinical skills and really has allowed me to engage in critical thinking when performing patient care. I have taken everything I have learned these past four years at Pace, and applied it to the clinical setting. YAY CLASS OF 2012!!! :)

Hello again! This weekend was a really productive weekend in the ICU. I had a total of three patients between today and yesterday, however I was pretty much intiating all of the care for one patient out of the three.  This patient was a 79 year old who came in to the ER with a systolic blood pressure in the 60’s and diastolic in the 50’s and was later diagnoses with acute pancreatitis, septic shock and ARDS. I was able to completely take over all of the care for this patient which included: taking report from night nurse, prioritizing and initiating all care, administering meds, drawing and interpreting labs values, assessments, documentation, tracheostomy care and suctioning, and I communicated a complete end of shift report to the night nurse. My preceptor calls this “bridging the gap” and from this day forward, I will be taking on one patient each week, where I will be initiating and responsible for all the care. I am so excited for my increasing independence and my confidence builds each day as I continue to perform different nursing skills. Some other exciting things that I did this weekend (not pertaining to my patient) were:  observed two central line placements, applied central line dressings, drew up labs from central line, discontinued central line, placed an oral gastric tube, assisted with an intubation, and inserted a Foley. Lots of things going on!  I’ll check back next week with more updates! =)

 Wow what a weekend in the ICU! The unit was full and we were extremely busy all weekend. This was great because it was day full of experience and good practice. On Saturday, we started out with two patients. Due to the fact that both of my patients had extensive cardiac histories and acute illnesses regarding heart function, my weekend was mainly focused on the cardiac system and cardiac care. During the morning multidisciplinary rounds, where the whole critical care team goes over each patient on the unit with the intensivist, I was interested to know that one of my patients was what they would consider a “cardiac cripple” because of his ejection fraction of less than 20% and his large cardiac history of illnesses. I also was able to become more familiar with ventilator settings today as I spent a lot of time with the respiratory therapist. It is imperative for the RN taking care of the patient to know the ventilator settings so I thought this was very beneficial for me. Turning and position these patients also were routine throughout our weekend as well as restraint assessment for our patients on ventilators. I also did a lot of suctioning with the closed suction system and routine oral care as well.

I also was able to give some psychosocial support for a patient that had anxiety related to the hospital admission and the complex surgery that the patient had underwent. As students, it is nice that we sometimes have the extra time to actually sit down and chat with a patient. It’s important not to loose site of this when we become RN’s, however we will definitely be much busier!

Later on in my shift, things really started to get exciting. They had a very interesting case come in the ER so I was able to accompany another critical care nurse down to the ER. This patient was found unresponsive and was hypothermic with a heart rate in the 20’s. After the patient was “stable” and on pressor drips, the patient got a pacemaker placed and I was able to observe. The physician doing the procedure was very helpful and pointed out lots of teaching points. It was very encouraging to be thanked at the end of the day by the nurse and physician for helping them in such a hectic situation. I was glad that I could be of some help, even though I did not know everything to do in that situation since I am still learning! I had a great time!

     As of this past weekend, I have completed my 84th hour of precepting. I am beginning to feel very comfortable and confident in the critical care setting. My preceptor has been so great and accomodating throughout my whole experience thus far. Many people on the unit have already told me how lucky I am to have her teaching me, and I now have come to realize this to be very true!

     I have had the opportunity to see and care for a variety of complex patients and diagnoses. From intubations to perserving a body for organ donation, there is never a dull moment in the ICU. I am actively assessing, giving medications, and documenting on my assigned patients, under the supervision of my preceptor of course!

     This past weekend, I worked for two consecutive days which was nice because I was able to follow this one patient through his admission and two days following that. I felt so comfortable with his diagnosis and plan of care, that on the second day, I was able to take over and be his nurse for the day. I was in charge of prioritizing his care and at the end of my shift, I gave full report to the night nurse for the first time.This entire experience really helped me to build confidence in my role as a nurse, and I am grateful that my preceptor gave me the chance to do so. I still have much to learn and am so excited to see what else this experience brings!