Fellowshipping: Month 8

Saturday, August 29, 2020 Sacramento, CA, USA

It's time again for that monthly update, and this time, I'm done with month eight of my fellowship! The month in general has been full of...changes...and really put my flexibility to the test, as I completed my off rotation in trauma/ED then went off to neurocritical care. 



The first week was my last week working the inpatient floors. It was bittersweet, as I left the team I've been working with since day one on the job as an NP fellow. Well, I didn't leave the team literally, but I definitely do not work as closely with them now as I did before. I am so thankful and grateful to have had mentors who have been supportive and patient with me as I grew into the role and learned the ropes of being a new nurse practitioner in a new specialty and hospital system. 


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My second week of August was spent working in the trauma/ED department. It was a different workflow and environment than I was used to, and I admit I mainly just observed during my time in this rotation. The rotation was just a week long, three 12-hour shifts. One day in the ED and two days with the inpatient trauma team. 


The day in the ED started and ended quickly, going by really "in a flash," as they say. Literally, the 12 hours disappeared...and that was really it for the ED portion of my off service rotation. Being in the ED and seeing trauma APPs put their ATLS/TNCC knowledge and skills into play gave me a better understanding and appreciation for the different job functions we have in the different departments. 


My two days in the trauma inpatient department felt a little more like home. Perhaps it is because the job function was pretty similar to how it is on the neurosurgical inpatient floors, maybe minus the team rounding and the population. What I learned having been on the trauma service for two whole shifts is that trauma really functions as a sorting station. They do the initial workup after the patient is in the ED and make appropriate referrals if needed. Sometimes, other services will pick up a patient and be the primary service for that patient. For others, they are followed by the trauma inpatient team until discharge.


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My last two weeks of August were spent in the neurocritical care service, or neuro ICU. So far, the learning curve has been steep, and I've been working hard studying during my time/days off. 


I had thought neurocritical care was neurosurgery...ICU style, but it really is a combination of being primary on ICU-level neurology patients and taking more of a consulting role for ICU-level neurosurgery patients. Often times, the lines are blurred (or maybe it's just me) as to which patient is more of a neurology patient versus a neurosurgery patient. This is something I'm trying to figure out myself, along with the mix of learning the routine of neurocritical care. 


So far, it has been a fun, yet tiring experience in the neurocritical care rotation. It has been fun learning so much every shift and working alongside another supportive team thus far. Granted, I haven't met all of the members, and the team will change about every month as new residents rotate through. Yet, it all has been tiring because I'm pushing myself to learn, learn, and learn. Most days, I've come home feeling defeated. I feel so behind and not as knowledgeable as my colleagues -- like why this treatment? or that treatment? I admit, I don't expect to know it all by December. I am my own harshest critic. For now, I can only keep working hard and reminding myself, I've only just begun. 


Since I will call this department my home until December, I wonder how much I will grow when I reflect back on this post. Will it be like neurosurgery, where I look back and can see that I have grown somewhat and know a little bit something? Or will I just never understand anything?


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Conditions, medications, and things I've learned about this month in ED/Trauma:

  • Tranexamic acid
  • Sarmiento brace
  • Sugammadex
  • Postembolization syndrome
  • FAST ultrasound
  • Pringle maneuver


Conditions, medications, skills, and things I've learned about this month in neurocritical care:

  • Lumbar puncture (skill)
  • Precedex
  • Propofol
  • Fentanyl
  • Midazolam
  • Cisatracurium
  • Pheylephrine
  • Rocuronium
  • Pentobarbital

I am not quite sure what month 9 will be like, how much I will grow (although there is definitely room to grow), and what kind of opportunities will come my way. All I can say is I'm looking forward to learning and growing, and getting that research project presentation out of the way!

Nicole G.

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