Staying Oriented

As an over-thinker, the majority of my time is spent analyzing whether success is based off of luck or effort. At this point in my life, I don’t think the two can be separated that easily. If something works out, the way travel nursing has for me so far, then it’s a combination of the two. I’m gonna say it’s 90% effort and 10% luck. Except for my first assignment. That was the reverse.

When I started as a nurse at my first job I was a member of the staff in a medical intensive care unit. I was not on a travel contract and I had been working on latte art for the past two months. I was living in Pittsburgh, comfortable in my attic apartment near Highland Park. I was living with my best friend and had a steady boyfriend. My life was beyond stable.

Orientation consisted of two weeks in a critical care course, and six weeks (which due to a change in which ICU I was assigned, turned into eight) on the unit with a my own preceptor. In the nursing world, this is the nurse that teaches you how to be a nurse. Forget four years of lectures, clinical, and flu shot clinics. This is the real deal.

I was blessed with my preceptor, J. She patiently waited for me to lotion my patient’s feet when I should be charting. She also humored me when I wanted a podiatrist consult for another patient. Looking back on it, I had an unhealthy concern with the state of my patient’s feet. Then again, I don’t know a nurse who can stand curly q toenails on a patient. Especially when said nurse runs the risk of getting scratched by them claws if a patient gets riled.

J. also taught me basically everything under the sun (including the fact that no nurse knows everything so I damn well better ask if I don’t know something) and gave me the confidence I needed to start as an ICU nurse. However, orientation has been a tad different while traveling.

My first assignment was at a medium sized hospital in Los Angeles. Kath and I would be working together on the same unit and living together. A piece of my life from before was there to ground me, and it was definitely what I needed. We received our orientation schedule maybe five days before our start date. From there, we saw that we had a one day computer and hospital orientation. And that was all that was scheduled.

We contacted our department and found that our orientation on the unit would be one singular day shift. It was as we expected. The unit was telemetry based and not ICU, so we thought “seems reasonable”. We thought this even though we would train on a dayshift and then work nightshift for the next 13 weeks. My preceptor was J2 and, much like the movies, the sequel was wompity womp womp da womp womp. By the end of my shift, I was confident that I had to keep my patients alive and safe. Forget charting, how to access the med room, and any policies and procedures.

I worked dayshift on Thursday and came back Friday night on the verge of peeing my pants due to fear and caffeine overload. There is a real science when flipping circadian rhythms. Thats science is C8H10N4O2. Kath and I walked into the cramped conference room for huddle. I threw a few weak smiles to the strangers around me while Kath genuinely beamed at everyone. Then, the charge nurse listed off three last names that would be floated to one of the ICUs. She stated, “BLAH, BLAH, and Garcia… Go to the ICU”.

Now I don’t know how this bozo did not realize that I was the first Garcia on the unit in a while. That she had never met me, I was clearly new, and I definitely knew nothing about being a nurse at this hospital. I swear I heard Drake whisper “no new friends” as I walked out in a daze following the other two nurses single file off a metaphorical bridge.

I entered the other unit’s huddle with my fellow soldiers. The staff nurses were already assigned so we were given what was left. These patients in the ICU can be compared to hand-me-downs. Patients are usually in the ICU for some time, and some get a bad reputation. Mostly as being high maintenance, dangerous, having family issues, or a combination of the three. Sorry to all my peers out there for revealing to the public that nurses don’t always like their patients.

I was fine with whatever headache they wanted to give me. Patients that are harder to deal with are the healthier ones. If they are able to complain, then chances are that they will live to see the light of day. On my first day, at my first assignment, with no one to act as my resource, I was cool with not dealing with death.

So naturally I did not think they would ask “Who can take a swan? We have two”. A Swan Ganz catheter. This is a way of monitoring the function of the heart via a type of IV line. Sounds benign, right? An IV. But not quite. The monitoring portion can be fairly complicated, but the real issue here is that it indicates a sick patient. And that was clear when the other nurses looked down at their shoes (the adult version of “nose goes”) and the room went silent. Panic set in as I realized I might be the only one with the experience required, and there was not much experience on my end.

I gave in to the silence. I took one of the swans on as my assignment. I survived the night. Every task had an extra 20 minutes tacked on because I had to ask where everything was and the bare minimum that was required to be charted. my patients were stable throughout the night. I made it and watched the sun rise next to a huge Scientology building. Sunrises after nights like those must be how a majority of new members turn to Scientology. I could just barely spot the skyline through the smog. LA man. LA.

Seattle was better. Hospital orientation lasted a few days. We learned how to use the equipment provided and we were given our log in names. We were shown how to use the lift equipment for bariatric patients. I had never seen a facility that was so dedicated to turning patients and keeping my vertebral discs in line. I think I had six shifts in the ICU with my preceptor, L. She had traveled as a nurse before. She actually taught me. She printed out policies. She encouraged me to take my full hour break. She introduced me to staff and showed me the paging system. And what amazed me was that I felt like I was ready by my second or third shift. If my faith in nursing had been broken, it was restored during this assignment. I mean, it smelled like cedar wood and pines when I left the hospital every morning.

NYC orientation has proven to be the same as Seattle, minus my partner in crime, Kath. I was given about six or so shifts in the PACU (Post Anesthesia Care Unit) with a previous traveler, R., as my preceptor. She taught this snail to snap on some roller skates and zoom around the unit. She laughed at my dumb jokes and made sure I had haggled for the best stipend. She put the patients first, tough but never rude. She was the closest to J1 I have seen.

That was the week of the bombings in Chelsea. It was also the week that the NJ Transit was threatened and postponed. I left way early, worried I would get lost in the perfect grid that is NYC. My train was an hour late and I was 15 minutes late to hospital orientation. The next week, my sister and I rode in to the city. She had a doctor’s appointment so she left earlier than usual and we waited together. I made it to work 20 minutes early and sat in the break room eating breakfast. R. came in and asked if I saw the bad NJT train accident in Hoboken. I immediately sent my sister a text to check on her. Angie was confused and then saw the wreckage on the TV in her doctor’s office.

When I saw her later that night, she told me that she would have been at the station at that time if she hadn’t had her appointment. I felt like throwing up or crying and she just sat there eating her mac n cheese and scrolling through instagram. Sometimes I hate being the dramatic one, but DEAR LAWD THAT WAS A CLOSE ONE.

Anywho, life goes on. I’ve made it through every orientation, hell every day of my life. The balance between the luck and the effort stays 100 (one hunnit). It is about the luck of having good teachers, the effort it takes not to give up or be discouraged. Most medical professionals can attest to this balance. I can only hope it all continues to add up for me.