It was doomed before it even began. I asked my agency if the hospital would offer some sort of orientation other than the few online courses they provided. The answer was no. I talked to the shift supervisor at the hospital and she assured me that this was normal. She said, “The charge nurse will know it’s your first day and she will help you out.”
Fast forward to shift change, 7 AM.
I let the charge nurse know that this is my first day on the unit and she asks me:
“Have you had any orientation?”
“No.”
She rolled her eyes and continued trying to figure out the assignments for the day. Welcome to agency nursing.
So I was assigned one really sick patient, on two pressors, probably going to die, with a crazy family that was not dealing well with the situation. The other patient was a paralytic receiving a bowel prep for possible endoscopy. This is my worst nightmare of a two patient assignment – One patient unstable on pressors, the other patient stable and awake enough to know that they are lying in shit and the nurse doesn’t have time to come and clean them up every 30 minutes because her other patient is to unstable.
After getting report on both patients, my head started spinning. I didn’t even know how to get into the computer system and look at my patient’s orders. It’s true that I took an online course a couple weeks ago but I had never actually gone into the system and learned how to use it. Meanwhile, there were worse things. Patient #1 was alarming because her BP was 80’s over 30’s. SHIT. Her vasopressin had run dry, or better yet, the night nurse left me with an empty bag of vasopressin. Okay, so I didn’t know how to work these IV pumps at all but I managed how to figure out how to program a few more cc’s into until I could figure out where the hell the vasopressin was. I asked the charge nurse. She stopped what she was doing and went to mix me some. Okay, so I go back to figuring out what to do next and my spinning head turned into pure unadulterated panic. I didn’t know what I was doing, I didn’t know how to use any of the equipment, and I couldn’t even get into the computer. SHIT.
I started thinking about something I learned in nursing school, which was that you should never accept an assignment that wasn’t safe, and this assignment was starting to look pretty darn unsafe to me. So I told the charge nurse, “Look. I’m feeling completely overwhelmed. I don’t know how to use any of the equipment.”
She said, “Well, this is how agency nurses are supposed to work.”
“Nonetheless, I don’t feel like I can handle this assignment without any orientation.”
So she asked if I wanted to go home. And the minute it was offered I said, YES. Oh how I desperately wanted to go home. It was easy enough. I called my shift supervisor and the shift supervisor for the hospital and told both of them that I couldn’t handle the assignment. The charge nurse reassigned my patients, I gave report to the other nurses and left.
Walking to my car, I felt about as lowly as a human being could feel and there were two things that made it worse. When I reported off to one of the nurses, he refused to make eye contact with me while I was giving report. It was like I could feel him seething with disrespect for me because I was abandoning my assignment.
Then I called my husband from the car. I was almost in tears and I needed to talk to someone right away. His reaction? Silence. Just plain silence. Which was not what I needed to hear at all.
So then I spent the next week feeling I feel like I was under a blanket of failure, not knowing what to do about it. I only started to feel better a week later when I ran into one of my nurse friends from the MICU. I told her what had happened. She told me that I have to insist on an orientation and if the hospital didn’t want to give it, then I shouldn’t accept the assignment. How right she was. The terrible thing was that I had accepted the assignment out of sheer financial desperation (so you can begin to imagine why there was silence from my husband.)
I am now very carefully starting to plan my next career move, and you can bet it will not be a decision arising out of desperation.