Faith

One thing you learn more and more about working with the families I do is Faith is an amazing thing. Kids that are just beyond sick going into surgery in situations where as medical professionals we know they shouldn't make it out. Parents tell us they'll do it, just have faith. Two weeks later the kid is still on the floor hanging in there, no oxygen requirements or anything. Faith is just an amazing thing. The little boy that I have been writting about that relapsed and his parents decided to let him have fun until the end. FAITH! The boy had the time of his life and didn't feel bad until 2 days before he passed. Medicine cannot explain that. FAITH! Yesterday he passed, his family once again has put it all to God. As his father wrote, "he will now and forever will live with my Lord and Savior Jesus Christ. Lord, please give him a kiss for mommy and daddy." Amazing. I guess we just all have to remember when things get rough- have a little FAITH!

Sometimes it just sucks.

Since I have been on the floor for over a year now I have started to notice trends. Right now we are in a trend where we have several of our patients that have been discharged back on the floor with post transplant complications and we have several who have relapsed. I hate seeing how sick and miserable these kids get on the floor, the huge sores in the mouth, the nausea and vomiting, and they get through; usually without complaining half as much as any adult would. And then the crap hits the fan. I have a family that I loved going to plan a funeral for their 8.5 year old tomorrow, just getting ready for the inevitable. I have another patient that has been fighting for a long time who gets through transplant to end up on a ventilator. Give my kids a break! We have so many families going through rough times now in the Duke 5200 family. Just send out some prayers for them if ya have a chance. Can ya tell I am getting frustrated?

Ya take the good, Ya take the bad

So working up here I get to meet fantastic families, it's one of my favorites about working here. I had a family that I worked with a lot during orientation- they were great and never made me feel like I was the ignorant new RN. I got to see this family do special things together like movie nights in the room with a projected picture and popcorn. I got to watch the siblings hang out and support each other and just see a really neat family. The child has now relapsed, and the family is spending as much time together as possible for whatever time they have left. The kid knows what is going to happen, the parents have let them know. It amazes how these families cope. I am also amazed by the amount of faith they have. Just say a little prayer tonight for a family that is trying to embrace all the time they have left with their kid.

Oh what an update!

So I figured I have a lot to post. Multiple milestones for me and some hardships too. I guess I really stopped because I was doubting myself. So here goes things that have happened with work over the past almost 3 months!

First Transplant!
So I kinda did my first transplant. I say kinda because I didn't get to do a full one while I was on orientation so I had lots of help with this one. So the patient had neuroblastoma and what usually works with this population is lots of radiation and chemo and then they get their cells back (if it's a tumor the thought is the cancer cells aren't in circulation) to save them from the rough treatment they have had. This kiddo did great, he was 2 and sat in bed eating a lollipop the whole time. By the whole time I mean 13 minutes. Yep, that's all it takes to get the small amount of cells in that can save this kids life. Crazy stuff.

I have done several admissions now, none our usual bone marrow transplant (BMT) admission. They have lots of blood work to be done. I got called in on a day I got forced to stay home for one admission. That was a crazy day but the baby didn't have her central lines in yet so I didn't have to do all the labs. I am sure my time for that will come soon.

I am getting better at figuring out what works for me. I was told time and time again during orientation that I would find my groove and way of doing things. Slowly I am seeing this happen.

We have a unique situation on our floor where each patient has a team of nurses. There is one primary who will work with that patient pretty much every shift she works and then 4 or so other team members who work with them if the primary isn't on that shift. This is so the families have some consistency in care and we can better care for patients and note changes in them if we have them more often. You have to be off of orientation for 3 months to sign up and I started this past week. I signed up this week for a patient that is just starting all their chemos and actually has their transplant today- Happy Transplant Birthday! Yesterday the patient was so sick, throwing up and then just taking it all in stride. I lost count of how many times they got sick. And still no complaints. Amazing!

I had my mid-year evaluation this past week. Guess that's really why I started blogging again. My boss said I was where I should be and everything was positive. I guess it gave me a chance to realize there are more days where I go home feeling confident and less like a blundering idiot and I am not as anxious every time I get a kid I haven't had before. Maybe I'll be ok at this after all.

My co-worker's rock!

Last night was a little crazy. So what could be more fun than being a new nurse learning the ropes? Being a new nurse learning the ropes with a new computer charting system. Our floor switched over to a new charting system on Tuesday day shift so last night was my first go at it. It isn't so bad but until I get the hang of it there seems to be lots of room to forget to chart.

But that's not why it was crazy. Then why was is so crazy you ask? Well, to start things off I realized at the beginning of shift that both my patients had ton's of labs to be drawn at midnight, both reached milestone times in their post bone marrow treatment where they get a ton of tests. So from the get go I knew around 2300 I would be getting all that together. I also had a patient with only one line who didn't have a ton of meds so that wasn't bad but the other had 2 continuous drips and TPN and Lipids and and and... So really I only had one line for a lot of meds to go through. Still, this met things would be busy but ok.

I got to finally opening the new charting system somewhere around 2200 and started to get my labs stuff together around 2300 when one of my patients called out. This patient has a NG tube on wall suction and the suction wasn't working. I went in and tried to flush it and changed out the suction equipment and then we were going to see how things went. 15 min later they called out again and it wasn't working. I ended up have to flush a lot which caused the pt to vomit some pretty nasty stomach stuff up and took a lot of time. No problem. I came in and out of the room a couple of times to get various things and my wonderful co-worker got all my lab vials and stuff together for me for both patients- what a huge time saver!

So I was done with my kiddo on with the suction problem, labs drawn and sent and into my other patients room. It was already midnight by this point and I was feeling rather rushed. The thing with sending labs is we usually get results by 0130 or 0200 and start ordering and giving any blood products or electrolytes they may need. With 2 patients with one line to do this I was feeling slightly flustered. So, when I went to draw the other labs this patient has a port. When I went to draw labs it would flush but not draw back. I needed around 13 mL total volume and couldn't get any. I repositioned the patient which helps a lot of the time, even made them mad enough to scream which also helps. No luck! I started by flushing the line with heparin and letting it sit for an hour, usually this will help. I asked the MD on the floor to order Alteplase in case the heparin didn't work, kinda like heparin on steroids. No luck again, so it's around 0130 and I still don't have labs drawn for this patient and I have to give the other patient platelets and potassium. That takes about an hour or more each.

While I waited for the Alteplase my other patient was having NG issues again. And I flushed, and they threw up. These kids amaze me, the stuff coming up was just pitiful and when I asked if the patient felt better afterwards, I got a "Yes", a smile and back to sleep. Amazing! Adults would be demanding medication and complaining. That is why I love the Kids! The tube station at work was down and it was 0430 before I got the Alteplase in the line, waited the hour for it to work and then after a lot of repositioning the line finally drew for labs. Then my other kids platelets arrived. While all this was going on I was trying to get stuff charted in the new system which took longer than I was used to. My wonderful co-worker once again helped me out and checked both of my Medication Administration Records. Jona saved my butt.

Another night, lots learned and lots still to go.

And this is how it goes...

So I have workefd 5-6 shifts on my own now. It's such a scary thing. I constantly second quess myself and needless to say ask my co-workers questions all the time. So far I have only had nightshift. Nightshift is totally different, no line changes, no dressing changes but usually lots of labs and replacing blood products and electrolytes as needed. I have learned that there is no such thing as checking too many times or asking too many questions. That my co-workers are amazingly supportive and if you wear pajamas to work you get really tired!

I worked halloween and we all work "jammies" to work. By the end of shift we were all dragging so bad, but hey we looked cute!

The kids had a big Halloween party and costume parade during dayshift. Hate that I missed it, I love seeing the kids get a chance to do "normal" things.

I am looking forward to this getting easier. And yes there are still many shifts when I wish I had just stuck with the peds office I worked in, it would have been a very easy transition. This, this is hard! It will be worth it, just got to keep plugging away and trying to learn from all the bumps in the road.

*Graduation*

So today I graduated from being on orientation to being on my own. Tomorrow when I go to work I will have my own patients and no one responsible for me. SCARY! The past two days have been great. Yesterday I got to take care of a patient that I had when I first started orientation that had gone home and is back for a brief stay. It was great seeing them and how good the patient was doing, and how I had kinda come full circle!

I have had such great patients the past few days and gotten out of there on time. That always makes me feel like I have accomplished something. Now if I can keep that up the next 3 nights I am working.

I will update you more as the week continues. Hopefully all will stay smooth sailing.