Lots of finance graduates think their jobs deal with matters of life or death. But this one really does
It may seem strange for a person who majored in finance to share more similarities with Gaylord Focker than Gordon Gekko. Like Ben Stiller's character in the movie Meet the Parents, I am a male nurse. I first opened my eyes to the field of nursing after my father passed away following years of fighting cancer. The nurses who took care of him were unceasing in their care and compassion, and this inspired me to follow their example.
After graduating from the University of Pennsylvania Health Care Management Program with a Bachelor of Science degree in economics from the Wharton School (for a slide show, click here), concentrating in finance and health-care management, and a BS in nursing from Penn's School of Nursing, I began a job at UCLA's Cardiothoracic Intensive Care Unit. I knew I wanted a job where I could serve people. After considering options with my economics degree, I decided that bedside was where I wanted to begin.
UCLA Cardiothoracic Intensive Care Unit
BS Class of 2005, University of Pennsylvania Wharton School and School of Nursing
Starting off in the ICU straight out of undergraduate school is no cakewalk, especially at UCLA's CTICU, which does lung transplants, a wide array of pediatric and adult open-heart procedures, and—in general—the highest number of heart transplants in the country. Life in the CTICU is fast-paced. Even though I've been here a year, I am constantly learning. One thing I have found is that no day is quite the same when working in the CTICU. Here's my day:
4:00 p.m.—My alarm goes off. I stay in bed a bit and slowly come to my senses and get ready for the night. I check my e-mail, read a little bit of the news, do a light workout with the dumbbells in my room, put on my scrubs, and start getting ready for work. The good thing about being a nurse is that I don't have to think about what to wear.
6:20 p.m.—After a big "breakfast," I get in my car and drive to work. My commute is about 25 minutes, and I don't have to get on a freeway, which is great since L.A. traffic is atrocious.
6:45 p.m.—I arrive at work and start getting ready for my evening. I look on the work board and see that I will be taking the patient in Bed 3.
7:00 p.m.—I get a report from the day-shift nurse. The patient I will be receiving had a bilateral lung transplant a few days ago. I've had this patient for the last few days, and we've developed a good relationship.
7:30 p.m.—After getting a glimpse of what happened during the day, I give the O.K. for the day-shift nurse to leave.
8:00 p.m.—After doing an assessment, I begin to plan my day. Lung-transplant patients receive a huge amount of medication. I give the patient his eight-o'clock medications.
8:10 p.m.—The bed across the way from me is empty, but a patient who is having heart surgery will be coming up. The first few hours after returning from the operating room is often the most critical. The nurse who will be caring for him asks me to help her out upon admission. I agree. We also get word that two heart transplants may arrive later in the night.
8:20 p.m.—The surgeon who performed the lung transplant comes in. I give him a sketch of all the pertinent information and what the current situation is. If the surgeon wants more details about a certain situation, he will ask. After updating him on the progress of the patient, he gives me a few standing orders for the night to help me plan my care.
8:40 p.m.—The wife of the lung transplant patient comes in. Oftentimes in nursing, it's not only about treating the patient but also about helping the family cope. The wife informs me she is going to sleep here tonight. This a common request; she has been sleeping here in the ICU the last few nights. We allow family members to stay in our ICU 22 hours per day. The other two hours are when we give shift reports to the following nurse.
9:00 p.m.—Just before the patient goes to bed, I wash him up a bit. He is weak, but I try to give him as much autonomy as I can. The loss of autonomy can be a very difficult thing for a patient, especially one who stays here for an extended period of time.
10:10 p.m.—As we are hooking up all the monitors to a patient in Bed 4—a 47-year-old who had coronary artery bypass surgery—he dumps 2.2 liters of fluid and starts to bleed from his chest tubes. His heart rate increases, and his blood pressure skyrockets. This is worrisome because high blood pressure puts a lot of strain on the heart and could cause one of the stitches in his heart to tear. We immediately administer drugs to lower his blood pressure. The surgeon also orders us to begin replacing the fluid that the patient has lost. I begin to push fluid into the patient's central line, which goes directly into his heart.
10:25 p.m.—The blood pressure remains high, so we start other vasodilators to try to lower it. In the meantime, I am still pushing fluid into the patient. We get lab results that show the patient has a low red-blood cell count. Through another central line, we begin to give blood. We tell the unit secretary to notify the blood bank to be ready in case we need more blood.
Lab results also show that the patient's electrolytes (such as potassium and magnesium, which can affect heart function) are low and must be replaced, so we begin to restore them. There are three nurses and the respiratory therapist inside the room as well as the hospital intensivist [a physician who specializes in the care of critically ill patients] and the surgeon directing. The great thing about working here is that everything is a team effort. As I'm helping stabilize this patient, another nurse is making sure my other patient is O.K.
11:00 p.m.—The patient is beginning to stabilize; however he's not out of the woods yet. We get word that one of the heart transplants is also coming up soon. One of the nurses leaves to prepare for the admission of this heart transplant.
11:30 p.m.—It looks like the patient is stabilizing. The other nurse begins to chart on the computer all the steps that we took to stabilize the patient. It's important to keep all charting up to date for future reference, so anyone who might look at our charts would get a good picture of what happened tonight even without having been there. A saying in our unit sums it up the best: "If you didn't chart it, you didn't do it."
Midnight—With the patient in stable condition, my fellow nurse—who has more than 10 years of experience—spends a little time explaining the intricacies of what happened on this admit. I have a good idea of the situation, but I've worked here only a year and am constantly learning. It's great to be in a unit where teaching is encouraged. I know that I have the freedom to ask any questions and not be frowned upon.
12:30 a.m.—I thank the other nurse for watching over my patient and begin trying to catch up. My patient across the way had a front-row seat to the whole admission process. Although ventilated and unable to talk, he has a conversation with me by writing everything down. We talk about his wife and his four kids and how this lung transplant has changed his view of life. I always find it a blessing and enlightening to talk to all my patients, who have so much more life experience than I do.
12:45 a.m.—Every night we draw blood and check a myriad of data and lab values. I have to "stick" my patient to draw some arterial blood. Although the patient understands the need to draw blood, nobody enjoys having a needle stuck in. I then send the blood to the lab for testing.
1:25 a.m.—I finally get a chance to sit down and get a quick bite to eat. A pot of coffee is brewing in the kitchen. I wasn't a coffee drinker before, but ever since I started the night shift, I drink a cup to get me through.
2:00 a.m.—The nurse from the staff office comes up, and I begin to give her a report on another patient in Bed 2. She is an 79-year-old who is having a second aortic valve replacement done.
2:30 a.m.—The front door of our unit opens and the anesthesiologist and surgeons come wheeling the new patient into Bed 2. While I gave a report to the new nurse, other staff had set up Bed 2 with all necessary monitors and emergency medications ready to go. Just as we did during the admit earlier in the night, my fellow nurses and I work together as a team.
3:00 a.m.—This admission goes much better than the previous one. After the patient is hooked up to all the monitors and is relatively stable, I receive a report from the anesthesiologist, who informs me how surgery went. I then go into the room and do my normal assessment routine, making sure all monitors are working and that the patient is in a safe situation.
4:30 a.m.—The patient starts to wake up. I tell her she's in the ICU and that surgery is done. After completing a neuro check, I turn the sedation back on until I get new orders from the surgeon.
4:40 a.m.—I start filling out paperwork, charting everything that has happened thus far.
5:00 a.m.—Although the patient is somewhat stable, her cardiac monitor numbers seem marginal at best. Because of her age (79 years), this patient will probably be staying in our ICU longer than someone younger. The surgeon tells me to increase her inotropic medications to give her heart a little extra kick for now.
6:00 a.m.—My shift is almost over. I try and clean up the place a little bit. Nursing is a 24/7 job, so I don't want to leave my day-shift replacement a mess.
6:30 a.m.—The surgeon comes in, and I give him an update on the patient's progress. He tells me to titrate the sedation a little. The patient still currently has a tube in her mouth that helps her breathe. That tube will probably be extubated sometime in the early afternoon. She'll have to be awake for the extubation.
7:00 a.m.—I give a report to the day-shift nurse. Everything looks good so far. I personally think she'll have a good day, but you never know.
7:30 a.m.—I get in my car and drive home. Listening to the radio, it sounds like it's going to be a nice sunny day in L.A. with temperatures in the 80s. I'm not working tomorrow, so if I get up early enough, I just might head to the beach to catch the last remaining rays of today's sunlight.
8:00 a.m.—I arrive home. The first thing I do is get out of my scrubs and take a shower.
8:30 a.m.—After a refreshing shower, I make myself some "breakfast" (or "dinner," whatever you prefer). One of my roommates has just woken up and is making himself some breakfast, too. I ask him how his day was yesterday, and we chat for a bit while we eat.
9:30 a.m.—My roommate gets ready for work and is on his way out. I unwind a bit before I get to bed. I check my e-mail, read a little of today's newspaper, and watch a little TV (thank God for Tivo).
10:30 a.m.—I jump into bed and begin to think about my day. It's always nice to think about what went right and how I could improve. It invigorates me for the next day.
11:15 a.m.—I finally fall asleep. Some people have a hard time sleeping during the day. I am definitely not one of those people. I'm out until my alarm wakes me up in a few hours.
Although I did not need a business degree for the job I have now, I know that it will help me in the future as I progress in my career. There are so many opportunities that come with being a nurse. Many nurses stay at the bedside, where their experience and skill are unmatched and a necessity in all situations. Many nurses also go back to school and get a master's degree for various occupations, whether nurse practitioner or nurse anesthetist, MBA, or even an MD (see BusinessWeek.com, 8/7/06, "B-School is Hip Again").
Oftentimes, especially with the nursing shortage that the nation is facing, the problem isn't finding a nursing job but finding the right nursing job that fits you. I went through UCLA's summer externship program the summer before I graduated to give me a better clue as to which unit fit me the best. After spending time at UCLA's emergency room, operating room, and departments of oncology, liver transplants, gerontology, and cardiothoracic, I finally decided that cardiothoracic fit me the best right now.
If I had to go back to college and take more courses, I think I would take more history, psychology, or sociology classes that would help me understand human emotion and culture. Because when it comes right down to it, a nurse's job is to heal, not just physically, but holistically, and to understand human nature and provide compassion.
Patient information and procedures were changed to ensure patient privacy.