Orienting

The last two nights at work, I got a new fun experience - orienting a newer nurse. The nurse I was helping came to CHOC with some experience in an adult medical/surgical unit and is getting a modified introduction to the NICU. All of our brand-new graduates get an extensive training program of about 5-6 months with classroom and hands-on work combined. This girl gets the book to read on her own, and a few months hands-on training time with experienced nurses in the NICU. Less than normal, so rightfully so she's nervous. But, other than running a little late on timing of getting all our tasks done we handled everything well.

She ended up working with me because I was given an assignment with a tracheostomy patient and colostomy patient. A tracheostomy is an artificial airway placed in the throat (through the trachea) directly into the lungs. Infants and adults get tracheostomies for a variety of reasons, but mostly surrounding poor upper airways (laryngeal, upper trachea issues, large tongue, etc). Our patient had issues with the upper airway and therefore needed this artificially created airway to help the baby breathe. On top of that, the baby remained on a ventilator to assist all the breathing efforts made. Our poor baby also appeared to have gotten sick during the day on Tuesday and required more help and medications from us yesterday and last night. Luckily by the time we left this morning, the baby was breathing more comfortably and the laboratory levels looked improved in several places. My newer nurse had not had much experience at all with a ventilator and none with a trach, so she was thankful for all the experience.

A colostomy is where the a part of the intestine is surgically opened to expel intestinal contents out of the body from the abdomen rather than connect through to the rectum. Usually a bag is attached to the abdomen to catch the stool once there is enough output from the colostomy opening. There is extra care involved around the colostomy itself and placing/changing the bag. Unfortunately our patient did not need the bag changed while we were caring for the baby, but it was still good experience.

I hope that I did a good job helping her learn. She expressed thanks to me and said she felt she learned so much the two nights we worked together, but I keep looking back now thinking, 'I should have gone over this, or that.' It being my first experience having an nurse follow me and not just a student - it was a very different experience. I feel I learned quite a bit also and would really love the chance to teach more. You remember things you've forgotten and it always help to solidify knowledge when you can spend time explaining something to someone else. There are some steps I need to take which I wasn't able to this year, thus hopefully next year I'll be able to work towards becoming a preceptor fully (having a new grad nurse follow me on many shifts throughout his/her training time).

I also think eventually I will move on from bedside nursing into something more of an education role in nursing. I would like to either become and educator, or a clinical nurse specialist and help to improve care and knowledge base of a population of NICU nurses somewhere. I have several co-workers and friends who have told me they also feel this would be a good place for me in the future. For now, I can try to help newer nurses learn things that I've learned along the way. It feels good to finally realize I am in a place in my career that I can begin to do so because I have enough knowledge base and comfort in my field. :-)