Pee, Pee, Pee

It’s the Tuesday before Thanksgiving. I am really looking forward to my day off. I came in this morning and got report on several patients and was able to pick out two that seemed like they would be good candidates for a student nurse. Patient number one – elderly woman admitted last evening for TIA’s. Patient number two – middle aged Hispanic man admitted last week for abdominal pain and is one day post-op for cholecystectomy. Patient number one had a ton of meds and I forgot my blank med sheets today. Great! Patient number two only had one IVP so I was saved. I was able to administer a couple of early meds to my first patients before she was wheeled off for testing, never to be seen or heard from again (until right before I finished my shift.) While she was away I was able to catch up on her meds for when she returned. That was a blessing; unfortunately, I was never able to administer them to her. I was ready though. My other patient was pretty easy to take care of. I was able to help him walk around the unit once and assisted him to pee three times. That was the extent of my day. While I am sure that helping patients pee is noble in and of itself, it does make for a rather long day when there isn’t much else going on.

I did try to help the guy that was blind and deaf. That’s a sitcom waiting to happen. During report the staff nurse and I were told that he could write on your hand to communicate and that if needed an interpreter could be called. I heard his IV alarm going off and went in to check on it. It looked like he was trying to ask for some help so I let him know I was there by touching his arm. He took my hand and proceeded to write “PRXHG===HATYlQ” (at least that’s what I was able to make out). It is quite possible that I could use some training in tactile spelling. I called the tech in and she was able to make out that he wanted a bath even though he had had one the evening before (so she said).

Later that morning, one of the other staff nurses on my wing said that she had some IV changes later and that I was welcome to do them with her if I wanted. I of course said yes, but ultimately they were done after I had to leave. Also, the “flu shot lady” came around giving vaccines to staff that needed them. The nurse I was with today needed one. I promptly asked if I could give it to her and she promptly declined. She said it wasn’t anything personal, but I’m pretty sure it was.

-DV

OR Rotation

I was really looking forward to spending time in the OR today. Previously, I had observed a laparoscopic PEG tube placement, and that was pretty interesting. Today I observed a chemotherapy port placement and 1 ½ laparoscopic cholecystectomies. (I had to leave for post conference before the second was complete.) I was pretty disappointed during the port placement. Because of the x-ray use I had to be out of the room for much of the procedure. Also, it was a very tight fit for the necessary personnel who needed to be close to the patient, so I was kind of out of luck on this one. Next came the gallbladder removal. I had some idea of what was going to happen due to my previous OR observation. Indeed, the gallbladder is not a bright green color like it is in all of the text books. Having had this same procedure done myself a couple of years ago I was very curious as to how everything really happened. I am always amazed at how “simplistic” surgeries are when I see them. Everyone always thinks that operations are so complex, but really, surgeons are just “fancy people plumbers.” If you look through some basic home repair books and an anatomy textbook, you could probably have a pretty good idea as to what to do, where to go, and what to take out. Seeing as how there were two cholecystectomies today, I thought about asking if I could do the next one…. “See one, do one, teach one” right? Okay, maybe I am being a little simplistic here, but still, it seems pretty basic. Maybe good surgeons just make it look easy.

As far as my observation of the circulating nurse, I am pretty sure that position is not for me. I really like to be a bit more hands on. All of the charting that has to be done just does not sound like fun to me. I would much rather be assisting the physician or doing my own procedures. However, when my assigned RN went to lunch, she was replaced by another RN who said that she had always wanted to be an OR nurse. She started as a scrub tech and went directly into an RN program. She had never worked on med-surg and started after she graduated in the OR. It takes all kinds. I am really glad there are people like her who enjoy that aspect of nursing. As of right now, I am still pretty unsure of where I would like to end up some day.

All in all, today’s observation was a good experience. However, I am hoping for a little more blood on Thursday. Does that make me weird?

-DV

Man Down...

Only 2 hours (lecture) into my cardiovascular section and I'm already behind. It's going to be a long four weeks.

-DV

I failed, but then I didn’t.

This last test over respiratory was a big kick in the seat of my pants. On my previous tests, you may remember that I scored 78% on both. My efforts to make that grade were very substantial. For the second test I studied really, really, really hard; harder than for the first test. For my respiratory test, I decided that maybe I was trying too hard. My grade did not improve and I had no extra time to do anything. My respiratory lectures were going well and I felt like I really understood the information. It was time for a new strategy. I decided to take it a little easier and not try so hard. That didn’t work. Initially, I ended up with a 68%. I was pretty average with the rest of the class from what I understand. I heard several students coming out of the testing center stating that this was the hardest test so far. Many had made 70%. By the time I got home I had decided to go back to studying like I had been and just hope for the best. About an hour after I got home, grades were posted to our online accounts. 74% WooHoo!!! I passed. My decreased efforts only cost me 4 points. Two of the questions were thrown out and two answers were accepted on another question.

I was pretty determined to start studying for cardiovascular ASAP. After looking at the reading assignments and all of the study materials I need to get through before the next test I realized that it will not be possible to make it through every word in the text. After some deliberation I’ve decided on another method of studying that I think will make more sense. It’s really about knowing what to do as a nurse if any of these diseases or medications makes it onto your floor. That will be my focus for the next three weeks. Reading just for readings sake just isn’t cutting it for me. Let’s hope for the best on the next test.

-DV

2:1

Today was my first day with two patients. It was also my first day to take care of patients on the fly without any preparation the day before. Suffice it to say that I was extremely busy this morning after I got report and picked out my two patients. It was nice having the evening before off, but the work it created the next day was a bit daunting. I had all of my med sheets with me and only had to look up three new meds for the patients I had chosen. I felt very lucky. After checking in on my patients I proceeded to look at what I was going to have to take care of for the morning. I had a couple of 0730 meds followed by 0900 meds so I needed to prepare for the first two. I still forget some of the little things like which labs to look up for certain meds. I hope that will come with more practice. The RN that was on my wing was very helpful today though at times I felt a little pressured by her. She would ask if I was ready to give meds 30 min before they were due. I know that is an allowable time, but I felt a little rushed. I am pretty sure that she just wanted to get on with her job too. She would ask me questions about what was going on with the patient as well and what I thought was causing it, what labs to look at, etc. In general she grilled me pretty good at times, but I like that sort of thing. At the time, it is a little unnerving, but it really makes me think about what I am doing. Ultimately, I actually learn something from nurses and instructors like that so I do not mind when that happens.

Overall, the day went by very fast. I was pretty much as prepared as I could be and will try to stay prepared for Thursday when I have to do it again. Little mistakes happened all morning so hopefully Thursday will go smoother. I have to admit, I do not know how RN’s do it with 7-8 patients at a time. Time management is something that apparently has to be learned.

-DV

Spider-Man for a Day

Today I was the "Nurse Manager" for my clinical group. It was also the first day for the clinical group to NOT pick patients the day before actual care. It was quite a sprint for the first couple of hours. After reviewing some of the care plans with my instructor I went upstairs to the floor to check on my peers and see how they were doing. I was not able to find anyone at first. We where an hour into clinical and there was no patient care begin given. I eventually found three of the students in the break room filling out paperwork. While they were getting work done (the work that they were supposed to be doing), I am surprised that they were not near the patient rooms getting this work done. As a RN, we will not be able to get our paperwork done in the convenience of the break room. We will be on the floor getting interrupted by call lights, coworkers, family members and other various situations that arise. I am a proponent of being where you are supposed to be when you need to be there. Occasionally, this does not happen: you go to the restroom, you are helping another person in another room, you are observing other procedures in other rooms or other parts of the hospital, etc. However, for the most part, as a student nurse, you need to be seen by faculty, staff and other students doing the work and being available for patient care, nurse assistance, etc. Basically, you have to make yourself look good in front of others. That was my soapbox. Now I will step down.

On my part, I think that I could have served my peers more today. After seeing the stress that many of them were put under today, I think that I could have offered to assist them more. The leadership position is not about the glory of the title, but it is about serving and being an available reference for others. I have to admit that I did not give everyone in my clinical group the amount of time that they needed. Some I could have given less, others more. I had a very basic understand of the patient needs after visiting with the other students, but to be in that position every day would require a little more diligence on my part to make sure that everyone is receiving appropriate nursing care. Today was about diving in and just seeing what it is really like when you are responsible for more than just yourself. I hope that more opportunities like this come up. I would like to practice my leadership skills a little more in an informal situation. I suppose that these skills do not have to be practiced just in the hospital; they can really be practiced in the classroom, the home or in the community. That reminds me of a really good quote…

“With great power, comes great responsibility.”
Peter Parker
a.k.a. Spider-Man

-DV