NursingZen

An update to Things I wish I knew

Wow, you better sit down for this one. During lunch today my clinical mates and I flopped into armchairs in the lounge and looked at one another with wide eyes and goofy grins.

“I feel like a real nurse this week! Can you believe it??” we blubbered to one another.

Something special happened this week–our second to last week–a period that MEPN calls the “integrative Med-Surg experience.” (Other schools call this the “capstone” period.)

We were tired as ever, but somehow euphoric. The excitement is largely because we can taste The End of our Med-Surg clinicals, but it’s also because we’re functioning and identifying as real nurses.

Prior to this week, we were allowed and encouraged to “pre-lab” (research) on two patients the day before clinicals to prepare ourselves. We also took lunch whenever we felt like it, in addition to taking a 1- to sometimes 2-hour break for “post-conference” with our clinical group, to talk, gripe, snack, chill…

For the integrative experience, however, we arrive in the morning as real RNs do, figure out who our two to three patients will be, and hit the floor running. Our clinical instructor is no longer milling around to quiz us. Our precepting nurse is still ultimately responsible for our patients (and depending on the nurse’s personality and attitude, you can have little or a lot of independence), but we’re to do absolutely everything we can for two to three patients, in addition to making phone calls, directing nursing assistants, and taking care of all necessary administrative tasks. We schedule lunch as regular RNs do and we have no break-time with our clinical group. We’re involved from beginning to end, whether the end be 7:30 p.m. (on a good day) or 8:30 p.m. (as it was for me yesterday).

Prior to this week my clinical group had already transitioned to arriving the morning of clinicals to prepare for our patients (instead of a day earlier), so by this week we didn’t think anything would be very different for us. We were wrong!

Now that we’re charged with being on our own (not having to report to our clinical instructor) and now that we don’t have the respite of our afternoon group meeting to talk about our day and provide support, our sense of responsibility has–unbelievably–quadrupled. Suddenly my clinical mates and I became so wrapped up in our patients that we didn’t have time to stop and chat with one another like we used to. This week we didn’t even take breaks like we used to. I suppose this is partly what made me feel like a “real nurse.” But lest I get too caught up in this feeling, my clinical instructor told me today that we have to fight tooth and nail to keep from developing these habits. She charged my group with taking breaks together next week.

One classmate put it perfectly: “Today I got so caught up in tracking my patient’s I’s and O’s (input and output) that I stopped and said: “Hold on a minute! What about MY I’s and O’s? I have to start tracking my own!” (or else suffer dehydration and UTIs).

The sentiments in this entry are:
- There is sunlight at the end of the tunnel. Some of us might even be able to feel the sun on our skin.
- I can finally say: “This quarter has been hard but we learned a lot. I would do it again–but I’m glad I don’t have to.”
- I’m glad as all hell that I’m not in Schedule B–they’ve still got Med Surg coming up.
- I must keep enjoying the privilege we have as students to goof off just a little…so as not to get UTIs.

Next week will be bittersweet: I’ll be sad to say goodbye to the nurses I’ve gotten to know, but I’ll be ecstatic to close this chapter of MEPN and discover other aspects of what it is to be a nurse.

Sleet, rain, snow, and –6 degrees.

When I woke up yesterday morning and looked outside, the sight made me catch my breath. I hadn’t thought about snowfall in a long time. I touched the cold windowpane and remembered snowfalls when I was a kid on the east coast: how excited I was to wake up to the sound of the radiator whistling and clanking and see nothing but pristine whiteness outside; how I pressed my forehead to the window so that snowflakes filled my field of vision; and how the snow seemed to soundproof my neighborhood from the normal cacophony of people and traffic…

Today: stark, blustery, and still beautiful after some snow melted nearby. Reminds me of Poland in the Decalogue movies.

No, I’m not in San Francisco anymore. This past week I traveled far to see an aging grandma. I’ve had a little bit of time to reflect on my nursing school experience, but not as much as I’d like. I’ve finished with lecture and have only 4 more days of clinicals before a 3-week winter break, so essentially, I’ve already started my winter break. I’ll definitely write more about school and answer your questions over the next couple weeks. Happy winter to everyone.

This is what San Francisco looked like before I left for Thanksgiving last week; this is also my bike path to school:

FYI: My Burning questions? has updates.

Today was my last class of the fall quarter. For the next 4 weeks, except Thanksgiving, I will only have clinicals. Winter break will then be three weeks long. It’s still hard to believe that I won’t be back in lecture until Jan. 2.

The best thing about this quarter was the continuity between Intro to Nursing in the summer and Med Surg in the fall. Having these classes and clinicals back to back have been critical to helping build my confidence, skills and perspective as a student nurse. The continuity also has helped some of us strengthen our rapport with nurses on our units, so much so that many nurses now know us by our names and acknowledge our progress and contributions.

The downside is that some of the teaching continued to be shockingly bad and inappropriate. Since the beginning of MEPN I tried to keep a level head about one of our key instructors. I tried to understand that she simply has a different communication style, personality and background. Unfortunately, she proved time and time again that she truly doesn’t know how to teach nursing to 2nd and 3rd career changers like us and doesn’t know how to communicate with people like us who have had valuable life and work experiences that were not necessarily related to health care. Furthermore, she gave us no direction (or gave wrong direction) about her expectations for exams and assignments and focused on petty details instead of what was really key to our understanding of nursing.

During the summer quarter, many in the class tried to give constructive feedback about her teaching and communication skills, but still nothing changed this quarter. I understand change can take time, but some of us fear that the school might not take our instructor and course evaluations seriously.

It may seem petty of me to focus on one instructor, to let one person have such an impact on my experience, but it’s not something to be belittled. The MEPN curriculum is so compacted and the experience so new and intense that one person makes a bigger impact than in a more normal situation. My hope is for the faculty to listen to our feedback and believe that it comes from our desire to become good nurses and not because we don’t “get it” or because we want to be a pain in the ass.

That’s my venting and I’ll try to leave it at that. Life is good and vacation is coming soon!

I’m reminded time and time again that my life as a Student Nurse affords me the ultimate luxuries: the luxury of having only one or two patients to pour my energy into (i.e. Hello, let me check and empty your pee hat every single hour so I can track all your output) and the luxury of being able to ask stupid questions and make even stupider mistakes (i.e. disconnect an IV tube and fling the end of its sterile tip on to the bed like it was a telephone cord, or offer an NPO patient water and lunch, multiple times).

Because I know the day is quickly coming when I can’t fall back on student privilege, I’ve started keeping track of small successes after each clinical shift. I’m also trying to keep a list of details I missed during my shifts so that I can try to remember them next time.

Here are two small successes:

1) Advocating for a 68-year-old man with a tracheostomy tube

A tracheostomy can be a scary thing when you see—and hear–it the first time. I mean, to put it simply to my non-nurse readers, it’s a hole in a person’s neck (windpipe) with a tube coming out of it to make breathing easier. Hole, tube, neck (and blood because the hole was fresh) are what my mind latched on to when I first saw a “trach” last quarter. When the person breathes you can hear mucus rattling in his throat. When he coughs, the mucus gets squirted out of the tube that is sitting in the hole in his neck.

Last week, with fingers trembling just a little, I inspected my patient’s tracheostomy site. I could tell that the site would need thorough care and cleaning and I noticed that one edge of the neck plate (which holds the tube to the neck) was digging into his skin, causing a red sore on his neck. My nurse and I tried to clean the trach site but she then had to rush off, leaving me feeling mightily unsatisfied about the work we had done.

Throughout the day I kept bugging her about the sore on the patient’s neck, until she suggested that I call the Respiratory Therapist for advice. I called him twice. When he finally came around, he taught me how to properly clean the trach, take out the cannula, and how to reposition the neck plate. He recommended that Aquaphor cream be applied all around the site to protect the skin. When we were done, I was elated! I felt like I had made a tiny difference in this person’s care – and I didn’t even mind that he showed zero appreciation. That’s love, isn’t it?

2) The same patient: a pressure-sore discovery

It was reported to me that the patient had a Stage 1 pressure sore on his sacrum due to his immobility. Depressed, he lies in bed all day with very little movement, which is no good for his skin. (For my non-nurse readers, a pressure sore, also commonly called a bed sore, can go from being red and non-blanchable (stage 1) to total skin and tissue breakdown (stage 4) if it’s not taken care of).

As someone who has been terribly negligent about checking patients’ skin carefully, this time I was determined to do a thorough assessment. With my instructor’s guidance, lo and behold, I found a tiny spot on his butt that was no longer covered with skin. It was the beginning of a Stage 2 sore. If left untreated, and if the patient were to continue to lie on his back, that tiny sore would get worse.

I covered this Stage 2 with cream and a duoderm dressing, diligently turned him in different positions every 2 hours, and hoped for the best for him, because he’d need it: He was going to a nursing home the next day and sad to say, nursing homes = land of bed sores.