The other day I made a bunch of food and brought it to work for a welcome luncheon for our new orientees. New staff that will go through the ICU consortium and have an experienced staff preceptor for 3-4 months. Most have hospital nursing experience and are moving up into the ICU arena. I myself, came a a new graduate out of nursing school. I was fortunate to have had 10 weeks in the Harborview CCU for my last quarter of nursing school, and I was welcomed with open arms in my current workplace. My unit has been through drastic changes over the past 2+ years that I have been there. There was seriously a "Nurses Eat Their Young" attitude when I started. Older, bitter nurses who greeted every new person with a rude, hazing process that would only end after you either proved yourself, or told them to fuck off. Over time, our nurse manager left and the bitter staff moved up the ladder. We were left with basically zero direction or feedback for many months. We were a unit with very little experienced staff and had only ourselves for guidance and praise. Over time our culture has evolved into one of welcoming, acceptance, loyalty, sacrifice, and true friendship. These new orientees will be lucky to work in this unit - if they make it through.
We have a poor record for ICU training survivorship. I was one of three, the next group had one of three, but this last batch had 3/5 make it. There is a lot of pressure, you have to be anal, thorough, be willing to screw-up and take the heat, deal with family and death, handle crises while your hands are shaking and people are screaming at you whilst there are wailing loved ones in the background. There is a lot of shit. A lot of bodily fluids, really fat people, genital warts, and other unpleasantries. You also have to have focus, see a holistic picture, be able to stand scrutiny, residents, whole team rounds where they try to make you seem stupid and invisible. Most of all you can't be a fucking idiot either.
There has been death my friends. I will not go into too much detail, as my coworkers have discovered this blog, but take me out for a beer sometime... New orientees can have the power of life and death in their hands, and sometimes make stupid choices. Not maliciously, just a really morbid learning curve. You don't send people to the bathroom when they need 100% oxygen, you don't infuse whole bags of sedation within 10 minutes, you don't follow every order you are given blindly, especially when is is by the med student who is actually thinking about another patient. A while ago, I was out for drinks with coworkers talking about some orientees. My coworker said the "newbie" was very smart, but was not able to get the big picture. She had the skills, but lacked the judgment to be safe. "Lisa, look at me. She will kill someone. I mean it. She will see an order on the computer and just do it. I love her and she will be a good nurse, but she just isn't that smart yet. I'm telling you, someone will die because of it." Maybe I will have someone else watch my patients when I go to lunch...
I have almost killed someone. I will admit it, I went through the proper channels, had to write a report, call the doc, I paid my dues. I have learned, when you are done with a bag of medication, you get fucking rid of it. You don't leave it hanging to be accidentally hooked up and bolused in quickly like it is an antibiotic, when it is actually heparin (anticoagulant) and your patient is a GI bleeder, shitting out bright red blood like there is no tomorrow. I was on orientation. My preceptor was fantastic, always proud of me, made me feel smart, capable, and comfortable. He called me out of the breakroom to check out this guys IVs. I went in cocky. "What?" After a minute, I realized my error. My heart dropped, my face fell, and I could see he was thinking: "She's going to kill someone". I learned to trace my lines carefully, get rid of the shit that I was not going to use, and to always second guess my self.
These new orientees, like myself when I started out, will come into work everyday, sweating, praying that they won't kill someone. New staff should be scared, 'cause if they aren't, they're fucking scary. These are the ones who will hurt someone, not really care, and do it again. Then, they are shamed back to the floor, and out of the ICU, hopefully.
I have a new orientee myself. My first one is now on her own, and I couldn't be prouder. She calls herself a Code Whore too, and is doing fantastic. She was always excruciatingly meticulous and didn't really mess up once. Her time will come I am sure, but at least it isn't on my watch (We are all human N..). My new one is just starting consortium. He will then follow my schedule for 3-4 months. I will work with him everyday. Christ. He will get to know my very soul and I will see his. I will yell at him, make him feel stupid, build him up, maybe cry with him, and if he pans out, send him on his own. Precepting can be a bitch. You have no space, they have to follow you around like a dog and do what you say, you always have to be on your game, and be responsible for everything they do. By the end, you are so happy just to be alone with your sedated patient, enjoying the silence. "What are the benefits?" you may ask. Initially, I just get to hear myself talk all the time. You all know that I love that. We fight for the sickest patients and get to have cool experiences. They get to see me talk in rounds, stand up to the attendings, handle families and emergencies. And later, they will take over the care and I will be the back-up. Wingman. They have to do all the charting, talking to families, and practice skills. You become like a mother, wanting them to succeed and do well. You want them to be better than the other orientees. Like a play that you are in, or a song that you get to sing; they become a reflection of you.
