Yesterday (Friday) I participated in my last simulation for Senior 1. It was the exact same simulation that I participated in as a Junior 1, only this time I was on the other side of the same coin. It was terrifying…especially after hearing stories of my classmates breaking down into tears on Wednesday (some of us went Wednesday, some of us went Friday).
I had nightmares about this simulation on Thursday night. I dreamt that I froze and couldn’t do anything…and then I dreamt that we were notified that the simulation was canceled due to SNOW! That’s how badly I didn’t want to participate. I knew that I would be all by myself (the instructors had released the wrong schedule to us – the schedule that showed us who we’d be paired with and which patient we’d have) and the pressure was intense. Most of my classmates were paired with another S1 and everybody had two J1s. Except for the lucky few of us that they decided would be alone with their J1s. I was told later that they specifically picked the strongest of us to participate on our own (a blessing and a curse!).
So when I got to campus yesterday morning I reviewed some of the paperwork that we had to chart on and steeled my nerves as best I could. I didn’t feel at all prepared but I had to do it so I just had to deal.
The first thing we did was practice with IV pumps for about 45 minutes. This was EXTREMELY helpful to me since I’d never been able to practice on one in simulation OR clinical. So I actually feel like I could work an IV pump for the first time! I had a lot of fun doing it and I think it really helped me calm down.
Then we moved on into the “ER-triage” part of the simulation. This time, instead of being stationed at one patient to get a thorough history and assessment, the S1s were paired off (except me) and rotated amongst the five patients in order to do a quick assessment and move on. We were supposed to be able to get enough information to be able to prioritize the patients afterward. I thought this part was a bit harder than I was anticipating. Completing a “quick” assessment is not an easy thing for me to do, plus I think I was so nervous and scatterbrained that I did not ask all the right questions or get all of the information that I needed.
After the ER we spent a bit of time together as a group prioritizing the patients, and then we moved into the ICU lab in order to take care of our patients for the actual simulation part of it.
I was paired up with two J1s and was given a CHI patient (closed head injury). At this point in the simulation, since everything had been happening in “real time” since Wednesday, my patient had decompensated quite a bit. His GCS (glasgow coma score) was 3 which is usually an indicator of brain death (although it’s not confirmed until other tests have been performed), he was intubated, his ICP was 22 and climbing, and really we were there to make sure his body remained viable.
I really wish we were given more time than 45 minutes in the actually simulation to get things done. I had been told in report that the patient’s ICP was 22 and if it was above 20 for over 5 minutes the physician needed to be called. So the first thing I did was check the patient’s safety equipment, vent settings, IV fluids, and took a quick look at the monitor to make sure that there weren’t any pressing concerns other than his ICP. Then I set about trying to call the physician about his ICP. And after the physician gave me orders to give the ordered Mannitol, it took me FOREVER to give that med! I wasn’t sure how long to IV push the med so I had to call the charge nurse. Well the charge nurse told me it couldn’t be IV push so I had to dilute it and give it IVPB. Then she says “wait, let me double check that,” after I told her the only form we had the Mannitol in was for IVP. Meanwhile the J1s are doing a thorough assessment (thank God) and checking the patient’s blood glucose.
Finally I’m given the go-ahead to give the Mannitol as IVP so I have to draw it up and prepare it, and then give it. Well, while I’m giving it, one of our instructors walks in and goes “that’s enough interventions for now! Time to start cleaning up and preparing for the next shift to come in!”
WHAT?! That wasn’t enough time at all! I didn’t even have time to get anything else done!
At least I didn’t walk out of there crying. I thought I just might. But I really should’ve managed my time better and I should’ve been able to get more done during our shift than just give the Mannitol. Ugh. I’m disappointed in myself.
But hey, that’s the purpose of these simulations, right? Figuring out how to be a nurse and manage time and take care of the patient?
I just hope that next semester when I am (hopefully) following a preceptor around that I will learn very well how to manage time and take care of my patients. I’m ready to be a nurse but I don’t want to feel like I can’t organize well enough for this job!