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Week of 10.24.08

A Week in the Life: Nurse Joannie

Joannie Welsh, a 22-year-old nurse in the Hearst Burn Unit of New York Presbyterian Hospital, was featured in the NOW program "Nurses Needed." Welsh—who joined the hospital two months ago—has kept a journal of the challenges, trials, and triumphs she faced during her orientation.

Read an excerpt from her journal to gain insight into the unique challenges faced by a modern American nurse.

This past week proved to be the most challenging one since I began my internship. Early in the week, I took care of a school-aged boy in the pediatric ICU. About 60 percent of his body was burned.

Performing burn care on a child can be difficult for even the most experienced nurse. Children don't hide their emotions, and you can see the fear in their faces. When you change their dressings, they don't understand that that you're trying to help them heal. At the same time, thankfully, children are resilient. After you change their dressings they often quickly turn their mood around and begin playing. Even so, it's difficult to watch a child suffering from such serious burns.

During the first part of the week, I had Patrick, a preceptor, at my side. A preceptor is an experienced nurse who guides new nurses through the system and answers their questions. Because I'm still new to this job, I felt comfortable having this extra support.

A few days later, on my fourth twelve-hour shift of the week, things changed. My preceptor for the day, Ann, told me I was ready to work alone. I was assigned to take care of an adult ICU patient who had severe burns and inhalation injuries. Even though Ann would be nearby, I had butterflies in my stomach. I knew my experiences up to this point had prepared me to handle working on my own, but I was still anxious.

My first challenge of the day came after the doctor poked his head in the door requesting one unit of platelets, with a unit of PRBC's to follow, a stool guiac, gastic PH, an ABG drawn, and a number of other orders. AHHhhh! I had never hung blood, although I had watched the task and read about the procedure dozens of times. Even so, nothing compares to having total responsibility for completing a task on a patient. While the skills and concepts taught in nursing school are fundamental to the nursing practice—and I couldn't have asked for a better education—no one can teach you the time management, mechanical, and other challenges you face during your first job.

But on this day, I still had Ann to call on. After I performed the double check with her, and asked a few questions, the blood was on its way into the patient. In addition to my other responsibilities that morning, I also had to keep a close monitor on the patient in case of an adverse reaction.

One veteran nurse described good Burn ICU nurses as being obsessive compulsive: every burn care set-up must be completed under sterile procedure, hands must be washed and washed and washed, gowns and caps must be worn at all times, all the lines and tubes must be functioning, every port must we wiped with alcohol before accessing, and all the hourly checks must be completed at the top of the hour and not a minute earlier or later. You become attuned to the unit's many beeps (You learn to single out your own alarm beeping on the other side of the unit).

The hardest task of all was talking to a patient's family. It's terribly difficult when a loved one asks: "Is he going to survive; do you think he is going to be ok?" How do you answer such a question without giving false hope—how should you react when someone is looking at his loved one and then at you with tears rushing down his face? When the patient has been so unstable and is still clearly very sick, what should a nurse's approach be?

I used to always direct the family to my preceptor when presented with this question, but this week I was the person responsible for talking to the family. I learned that it's now my job to provide support to the family, to hold them when they're crying, and to tell them that their loved one is being cared for by a team of the best and the brightest. And to remind families to take every day one step at a time - not to look back and not to look forward.

Overall, I feel I made huge strides during the week. I took care of one of the most critically ill patients on the unit this week and was able to provide care while only asking a minimal number of questions. I am finally beginning to overcome my anxiety and doubt about being a new nurse. I am learning to trust myself and to use my critical thinking skills to troubleshoot problems, rather than just asking my preceptor immediately for assistance. And taking care of a patient whose entire body is covered in burns, whose abdomen is open, and whose airway is unstable, will keep any nurse on their toes.

Although this week was extremely challenging, it was also extremely rewarding. I worked on my own and truly felt like a real nurse for the first time.

Nurses Needed

Video: Interview: Nursing from Hospital to Home

In Your State: Nursing Excellence

Patient Update: Nicole Marquez

A Week in the Life: Nurse Joannie

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