Archive for October, 2007

Oct 30 2007

Autumn musings

Published by nurseSF under Uncategorized

1. Fall is here, and it’s beautiful and makes me smile to myself.

2. We’ve hit a mid point: There are only 5 weeks left to the quarter.

3. I’ve been treating MEPN as a break or pause in my real life, as though after I’ve completed the program, I will go back to my regular life. This is a detrimental way to look at my next few years, because I end up looking to the future instead of living in the present. What I need to do is embrace my everyday life now. I need to see MEPN as part of my real life. This means not thinking too far, not rushing or feeling rushed to get my NP license or Master’s, not forsaking time with my friends, and not forgetting my other interests and creative pursuits.

4. It’s going to be weird when I’m working and not surrounded by classmates. It’s even going to be sad and bittersweet. It’s going to feel a little lonely walking amidst strangers again and not running into a familiar face for days at a time.

5. When I’m an RN, Med-Surg is going to be tough without having peers who understand exactly how I’m feeling.

6. The days move so fast that it’s hard to feel like I’m really getting to know anyone, or that anyone’s getting to know me. I hope I’ll have a few close friends who will be a part of my life after MEPN.

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Oct 23 2007

Observation Days: OR, ED, and ICC

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This quarter I have most Tuesdays off from school, except 3 days when I go to a different department in the hospital to shadow a nurse to see just how different each unit is. My placements have been extremely valuable for assessing my options and interests:

Week 1: Operating Room
I have a relative who works in the OR and she said the nurses there love it and would never leave, so I went to this observation with great interest.

Oh, is that it? I was fully underwhelmed.

I stood in a cold room and watched one nurse hand tools to the surgeon and watched the “circulating” nurse keep an eye out for problems, remind an MD to put on his mask, and play Solitaire on the computer.

The operation was interesting, of course, but since I’m not trying to be a surgeon, it was kinda moot. (I did, however, like to see how I’d react to blood, flesh and guts! Blood and guts? OK; Cauterized flesh with a little smoke arising from it? Not so OK.)

The OR rotation reinforced for me my love for patient interaction and my aversion to boring, sterile work, therefore, the OR is out.

Week 2: Emergency Department
Now this is more like it! Hustling, bustling, adapting, flying, running, communicating… I could tell my preceptors were loving their job, and better yet, didn’t mind taking me along for the ride. In my 12 hours in the ED my nurse dealt with: a woman trying to come off crack, a woman in respiratory distress, a 10-year-old bipolar boy, and a young woman with multiple personality disorder.

I asked three fairly young nurses how they chose the ED and what they liked about it. They all said they knew they wanted to work in the ED as soon as rotated through it during nursing school. They like seeing a lot of different patients and conditions throughout their day, they get bored by med-surg’s chronic care patients, and they like the fast pace. I also noticed that communication between nurses and MDs in the ED were very different than on the Floor. Somehow more collaborative and respectful. I also found it highly amusing that some of the ER docs reminded me of George Clooney’s character on “ER.” I guess that show got it right on the money.

Man, after this observation I so wanted to be able to imagine myself as an ER nurse! I think there’s definitely a coolness factor with being an ER nurse: It is badass to be able to handle anything that comes your way.

But, alas, this department didn’t click with me 100% either. The ED remains an option, but I’m still searching for the ‘one.’

Week 3: Intensive Cardiac Care
Hmm … The ICC is probably the most disconcerting place I’ve been to so far. The acuity of the patients and their multiple tubes and IV drips were quite intimidating. Each nurse is responsible for 2, maybe 3 patients (vs. 4 or 5 on a med-surg floor)–that’s how critically ill each patient is. But my charming, Irish preceptor quickly put me at ease. She said she likes the ICC because the team works wonderfully together and the management is extremely supportive. A few MEPN new grads have done their step-out year in the ICC, but generally, an intensive care unit is challenging for new grads.

There is an amazing special feature that follows a new grad in the ICU for six months, by the Boston Globe. It is fascinating. It’s the first feature of this kind in the mainstream public media. Its intent was to give the public a really deep, insightful look into the work of nurses. It also scared the crap out of me in a thrilling I-hate-scary-movies-but-I-have-to-watch kind of way. It could inspire you, too. Check it out at: http://boston.com/news/special/nursing/top/

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Oct 18 2007

Mind vs. body

Published by nurseSF under Uncategorized

6:17 a.m. Some mornings I wake up and wish I had a regular job. So that I can call in sick. It’s a herculean battle between mind and body.

Yikes!! I’ve missed my pledge to blog once a week. I’ve got to leave for clinicals in 5 minutes, but very quickly these are the two important entries I’ve been crafting in my head:

- The public image of nursing and how nurses are working to change it for the better. I’m on board for this. I’m proud to be a nursing student and nurses are the most hardworking, undervalued professionals I’ve seen.

- The face of nursing school and nursing. Both seem to be dismally underrepresented by ‘minorities,’ while the face of our patients is increasingly diverse. Are schools retaining students of color? (No.) Why aren’t there more professors and nurse leaders of color? What’s being done about this?

Ok, gotta run. Have a good week!

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Oct 06 2007

Scatology!

Published by nurseSF under Uncategorized

I learn something new every day. For instance, I didn’t know that there’s an aerosol bottle in every patient’s room that can be sprayed to help mask foul smells. When a patient poops into the waterless commode, I have to stand near him/her to make sure s/he doesn’t fall off. For the past two months I just stood there each time, suppressing the urge to run and silently begging for a reprieve. (I’ve got willpower like you’ve never seen before, unless you’re a nurse.) Then one day a nursing assistant took that little spray out of my patient’s closet and turned my life around.

Some laughs:

Morning report
Night nurse to morning nurse: …so Mr. X had xyz and abc, and he had explosive diarrhea this morning.
Me: Ha ha ha!
[Morning & Night nurse: faces blank]
Me: Sorry.

Changing soaked bedsheets with overweight patient in bed
Nurse [whispers]: She has the biggest bladder I’ve ever seen.
Me [feeling the cold urine through my gloves]: Mmhm. Wow.
[Patient farts in our faces while I hold her on her side]
Nurse to patient: Are you done?
[Patient nods]
Me: [Ha ha!]

Giving report to my class
Me: My patient is an 85-year-old male, status post diarrhea. He developed…
Teacher: No, you wouldn’t say status post diarrhea.
Class: Ha ha!

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Oct 04 2007

First cry on the job. A hundred more to go?

Published by nurseSF under Uncategorized

I finally have some time to journal…last week was the toughest week for me since school started. I had my first back-to-back 12-hour shifts that went something like this:

Wednesday: Went to hospital to “pre-lab” a patient, meaning pick a patient to work with during your shift on Thursday. I chose an elderly man admitted for dehydration and a UTI. Upon being treated for dehydration, he became overloaded with fluid and developed acute renal failure. I asked his current nurse if the patient was very complex or was he someone that I could take care of on my own. She said, “Oh, he’s fine. He’s really easy!” Went home and researched everything about the patient’s condition and all his medications.

Thursday: Woke up at 5:30 a.m., biked to the hospital, and had a busy morning putting together all the meds and assessments my patient needed. I thoroughly understood his condition and had pieced together his whole history, complete with lab values to back up the history. At 7 p.m. I reported about the patient to the on-coming night nurse, and left the hospital feeling light as air because I thought I had done my job as well as I could.

Friday: Woke up at 5:30 a.m., biked to the hospital, and started preparing my meds again.

8:00 a.m.: My nurse and I helped the pt. avert a diarrhea disaster in his bed.

8:30 a.m.: I asked my clinical instructor to watch me give the medications. She said: “Sure! Now, tell me about this one. And this one. And what kind of anti-hypertensive drug is this? And is that the right dose? What’s the therapeutic range? What blood pressure is considered hypertension? What are the side effects of this one? And that one? And this one?”

Yesterday I had the details, today I had only the general idea. It wasn’t good enough.

“You’re not ready to give these meds.”

My confidence imploded. She was right. Shame flooded over me. If only she knew how many hours I spent preparing for this patient. If only she saw how prepared I was…yesterday—but that doesn’t matter. What mattered was that I had gotten sloppy already.

I sniffed back tears while I assessed my patient. When I noticed how sick he was–sicker than the day before–my shame grew. When I couldn’t choke back the tears, I snuck into his bathroom to talk myself down.

12 noon: My patient is looking worse. My nurse gives me no guidance, takes no initiative.

3 p.m.: The doctors order an EKG stat because his potassium level is too high.

5 p.m.: He may be transferred to palliative care. We tell his family. They burst out crying. I try to console them.

7 p.m.: I go home mentally and physically exhausted. It boggles my mind how nurses can take care of 4 to 6 patients at a time. I go home and make all sorts of worksheets to help me organize and learn my medications.

I found out later that my patient died the following day.

Lessons Learned: Don’t rely on busy RNs to see things from your perspective. Don’t get overconfident. Don’t be too hard on yourself.

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