1. Craig, Courtney BSN, RN


And it's time to take responsibility.


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An older man with a broken leg and sepsis is the most seriously ill of my three patients. He's very confused and requires constant reassurance. But I have other patients and must scramble to keep up. As the day goes on, I berate myself for not being attentive enough to each patient, especially this elderly man and his wife. And later, when my feet hurt and I'm mentally exhausted, I'll wonder whether I could have done anything more, for these two in particular.


I'm haunted by this constant self-questioning. I'm the newest, and probably the most intimidated, member of the nursing staff. Although I participate in my institution's residency program for newly employed nurses-in monthly meetings during the first year, more experienced nurses lecture on various topics and we discuss the challenges of our jobs-I've been working without a preceptor for two weeks now, with no one to check my work or respond to my every query.


This is a far cry from the 12 weeks of orientation, when I was rarely alone and was expected to ask for help. I spent time on the floor then, but also attended classes to learn about patient-controlled analgesia pumps and proper wound care, for example, and hear lectures on physical therapy and nutrition. Experienced nurses shadowed me as I worked on the surgical step-down unit.


Now I'm expected to know how to care for patients. My fellow nurses don't have time to assist me with my patient load. Today I arrived 45 minutes before my shift to get organized and learn about my patients. It's a typically busy morning- 12-hour checks, cardiac rhythm-strip reviews, reports. I take vital signs, measure glucose levels, perform head-to-toe assessments, and pass out medications. After 10 am, I assist my patients as they walk and complete chest physiotherapy.


But the unexpected occurs: I need to redraw a blood sample for a glucose measurement; I didn't get enough blood the first time. At the same time, the patient in the next room needs her pain medications, and the loudspeaker sounds, over and over: "Courtney, call on 603. Courtney, call on 603." I move fast, knowing I'll spend the afternoon monitoring patients' cardiac status every two hours and trying to pay special attention to the elderly couple. If there is a quiet moment, I'll spend it hoping something won't throw me: a physician who wants to discuss a case, a family member who needs extra attention, a patient whose condition worsens.


During one of my first days after orientation, a physician asked me to drain urine and other fluids from a patient's bladder using a Foley catheter and low wall suction. Was this even possible? I wondered. The other nurses on my floor hadn't seen it done before, but the case was unusual (the patient had an intestinal fistula draining into the abdominal cavity). Bewildered but determined, the charge nurse and I set about finding a way to drain the fluids. We connected the Foley catheter to a Pleur-evac (a threechambered drainage system normally attached to chest tubes) and connected that to the suction tubing. And it worked.


It's finally the end of my shift, and I'm giving report in the nurses' room. I look up and see the wife of my elderly patient approaching the doorway. "Hi, dear. Can I speak to you?" she asks. I had no classes, and just a brief lecture during orientation, on handling family members. Why is this stern-looking, gray-haired woman confronting me? I realize that she is my patient's beloved, someone with whom he's shared his life. But what if she yells at me? I feel suddenly exposed, about to be called out for my shortcomings as a nurse. Is there a way out of here without walking past her? No, there isn't, and so I turn to face her. When I do, she takes my hand and asks if he will be okay. "What if he doesn't get better?" she wants to know. "You can't imagine how hard it is seeing him like this." I put my arm around her shoulder and say nothing. I don't have to. It looks for the moment like I'm doing enough.


Section Description

Diary of a New Nurse is a new department chronicling one young RN's successes and difficulties.