Neuro Icu Reflective Journal

Reflective Journal #2

Dates worked (80 hours):

After 80 hours of work in the Neuroscience Intensive Care Unit, I am still amazed and loving it. My preceptor as taught me so much and taken the time to make notes and other things for me to take home along the way. All the nurses on the floor make a point to come get me when they have something interesting or a teaching point that I could learn.

This unit does extremely well with time management and delegation. With this being the neuro ICU, one must do more than just vital signs every hour. In this unit, you must also do a full neuro check every hour. This includes pupils, corneas, cough and gag reflexes, Glasgow coma scale, and movement to stimuli. The nurse also has things that must be implemented

every two hours, such as repositioning the patient and restraints if applicable. Then there are your assessments in which everything is done every four hours. These are just your scheduled things that must be done and documented daily. This does not include your medication schedule, any scans, or anything else that might pop up during your shift. The nurses on this unit make these things look easy. I know my first shift of having a patient primarily by myself that I struggled keeping up with the time. As soon as I got done with everything to do that hour and documented it was already time to start the next hours. I was told this is something that you will get better at as you go. This unit does not have very many techs. In the shifts I have worked only one had a tech. Therefore, delegation has been between nurses. If one was busy with something else another nurse whose patients didn’t need as much assistance or the charge nurse would step in to help. These nurses communicate so well with one another. I have never felt uncomfortable asking anyone on this floor for help in any situation. From turning a patient to baths, no nurse must do it alone on this floor. I personally think that alone makes for great patient care. The manager on the floor takes a democratic approach to leadership. She ultimately has the say on decisions but depends a lot on her employees to make decisions as they come. She is very laid back and easy to talk to which means a lot to me in a leader. She is one that would go over and beyond for her employees if they were doing what they are supposed to. She has an open-door policy. I know I have dropped in there a few times and she always makes me feel welcome. I never walk in feeling like I am interrupting her or annoying her in any way.
The nurses on this floor show exemplary professional practice in many ways. Involvement with the patient’s family is a big thing on this unit. When the patient is admitted into the unit one family member can become the primary support person. This person gets a certain armband to be able to always come in and out of the unit. This support person also sets up a password with the nurse where they can call during visiting hours and check on the patient if they are not able to come. We aren’t legally able to tell anyone other than the support person what is going on with the patient. The nurses and health care providers do well as scheduling meetings with the families when they can all be there to discuss big changes or decisions needing to be made. This unit has also shown structural empowerment. They have gone over and beyond in supporting me and helping me learn the skills and knowledge that I need to become an excellent nurse. My preceptor has taken the time out of her day to write our blood pressure scales for certain things with neuro patients, along with many other things so I can succeed as a NSICU nurse. The nurses on this floor also do a great job with transitioning new nurses into the unit. I did my externship on this floor and I started the same day as the new graduate nurses. When I came back for my synthesis I was amazed as at well those new graduates were doing. They do not even seem like the same nurses. These new grads were just as nervous as I was this past summer and now they have been teaching me many things. This just goes to show the type of nurses on this unit and the way it flows.
While continuing my synthesis, it has really made me work on myself in many ways.

I am a borderline introvert and this unit has really made me step out of my comfort zone to provide for patients and communicate with members of a team. I must say it has been worth it. I have seen the smiles of many patients and family members that I would not have seen if I would not have taken the extra time to speak with them just because it makes me a little nervous. I have also made wonderful friendships with nurses just from stepping outside my comfort zone. I continue to improve on my skills as this experience goes. I feel very confident in giving medications and hanging piggy backs. My preceptor as also enforced looking up my meds or going through them with me if I was unsure of what it was for which has helped me learn a lot about medications. I even taught her something. If you did not know, Reglan which is commonly given in the NSICU is contraindicated if the patient is experiencing PVCs. I have also found weaknesses or rather areas to improve in, such as starting an IV or time management as I spoke on earlier. Overall, I could not be more pleased with my decision of choosing the NSICU for my

synthesis.