The whole technical aspect of the job is no longer a mystery – needles of all sizes, penis tubes (foleys), leg bags, medicine, IV bags, insulin, bedpans, colostomy bags, calculations, etc – No longer great, insurmountable obstacles. I used to envy the way I saw nurses just draw up a medicine into a syringe, choose an amount of fluid to use, and hook up a patient, all while carrying on a conversation with another nurse about their kids or their recent vacation.
At first, just the act of drawing a medicine out of a bottle could take me 5 minutes. Some mild obsessive-compulsive behavior on my part was to blame. I would stand in the med room – nearly paralyzed by the little vial of medicine in my hand and all the various needles, bags, and syringes laid out before me. The task itself, against a background of chaos, 11 patients, people in pain, and the general unpleasantries of ER personalities, often placed me very close to the point of just running out on my job. Now add on the countless double- and triple-checks I would do in my head:
“Ok. Metoclopramide. Same thing as Reglan. 10 mg in 2 ml. Draw up 2 ml. Metoclopromide. NOT Metoprolol (which it sits next to in the drawer and which has a very similar bottle). Metoclopromide. 2 ml. 2 ml. Expiration date? 2008. Is it 2008 right now? No, it’s 2007. . . Shit. This isn’t Metoprolol, is it? No. Metoclopromide. 2 ml. Not expired. Reglan. 10 mg. 2 ml.” Of course, the minute I would have the medicine in the syringe, I would start to doubt it’s contents, suspicious that perhaps it had magically turned into metoprolol and I was now going to bottom out my patient whose pressure was only 89/55. I spent a lot of time my first two weeks fishing vials out of the garbage, quadruple-checking that they were NOT metoprolol.
This behavior was obviously not conducive towards taking lunch breaks or even running to the bathroom. Especially since I was giving maybe 15-25 IV meds a day. The other nurses would shake their heads as I burst forth from the med room, sweaty and red-cheeked, muttering to myself, “this medicine is [insert name here] and it is [insert number here] milligrams.” I was very close to being totally dysfunctional.
I still mutter to myself while I draw up meds – but I now have a system. I look at the bottle once. I verify the name, the dose, and the amount I am going to draw up. I check the expiration date. DONE. That’s it. Final check. In fact, the process has become automatic so that I really don’t have to think about it anymore and I can keep myself focused on the larger picture of what is going on with my patient.
And I try to do this with everything. One careful, final check. I try to keep my head from spinning and focus on whatever I’m doing. Not just these little technical tasks, but the larger picture of my day as a nurse.
Ian, over at ImpactED nurse (thank god he came back!) wrote this really great post last year (Vertical Nursing), while I was still in nursing school. I liked it then, but it has become a sort of mantra I return to at work whenever:
“I feel flummoxed, and my mind is speeding 3 tasks ahead of my hands.”
I just read it again. It’s so good. I certainly can’t report that I have been experiencing much of this vertical practice in my first four months as a nurse [four! already?], but as the technical part of my job becomes somewhat automated, I am now free to slow down a little, breath, focus on improving my practice, and sometimes, every once in a while, take a bathroom break.
