Nursing Student Chronicles

I hear that phrase all the time and, to be frank, it is driving me bonkers.

There are so many students who talk about what kind of nurse they would really like to be…perhaps OR, ER, Critical Care, whatever! Yet, they decide to become general med-surg nurses for the experience so they aren’t pigeon-holed.

I’ve talked to many types of nurses on many types of floors to try and get to the bottom of this. Weigh in if you will! So far, what I’m finding is that while getting the one year of experience has been good in the past, it isn’t so much the case anymore. People are becoming so specialized that wherever you go…you may be pigeonholed.

Several critical care nurses/managers said they don’t like taking floor nurses in because it is fairly difficult (if not impossible) to break their old habits and make them think like an ICU nurse. One nurse that I had met in clinicals on a ICU floor got sent back to the floor because she couldn’t get out of her floor nursing habits. At one hospital I rotate through, the med-surg nurses are getting certified for that specialty! I have a friend in PICU who tried to move to another hospital closer to her new home. They said she was overqualified for their PICU, too specialized for general pediatrics, and had no experience to be in the E.D. So, she continues to drive over an hour and a half to work.

My thought? Go where you want! I want to be a PICU nurse. No wonder the burnout rate is so high! If I have to go to an geriatric floor, I’ll probably cry. [Yes, I know a job is a job. But my happiness counts for something. So yes, I'll be happy I have a job if that's all I can get...but I'll still cry because my dreams of being in PICU will be so far away. Just keeping it real...]

I dunno. What are your thoughts on the matter?

After much consideration….

I have decided to post again. I know…the comings and goings are a bit much.

There’s so much hoopla right now about HIPAA this and HIPAA that. I got cold feet. But then, after much prodding and poking from my mother, I realized I have to finish what I started. It would be quite an incomplete chronicle if it finished right before senior year, right? Right.

So here I am.

School started. We spent the first week in skills labs practicing changing a central line dressing, hanging blood, and IV push meds. Finally! The exciting stuff from day 1.

The next week was spent doing our leadership class where we have Quality Improvement project with Geriatric Fellows. I hate to be a bad sport…but I’m not too excited about all this extra work that won’t help me out when it comes to passing the boards. Especially when it means driving all the way to the hospital [along with my 37 peers] to meet with them for one hour. I digress. At the very least, my fellow seems nice. So there’s that.

Monday, Tuesday, and Wednesday of this week were spent in clinical immersion. It was meant to get our feet wet again in a med-surg envrionment since last semester was mommas and babies. It was a great week.

I had some heavy stable patients, and one patient who tried to have chest pain and difficulty breathing at one point. I LOVED being back on the floor doing patient care on my own. The first day we had one patient and the next two days we had two patients. I felt pretty cool since I was one of the few with patients that were considered ’serious’ instead of ‘fair’ or ‘good’. Alas, no ‘critical’ since we are all on a general medicine floor.

Tomorrow is first day of lecture. 8-4.30 is a long day for lecture. Aye yi yi.

So…that’s what you missed!

In other news, I caved and bought the new Kindle 3 and am majorly geeking out over it. It should be arriving tomorrow and I’m bummed that I have to wait ALL DAY for it. AND we’re selling our house. Yeah. 1700 square feet is much to much for these 2 people. Especially 2 people who are anxiously wanting to feed their new-found-grown-up taste for the modern and minimal and open floor plan. Something which this townhouse is not.

I really have the best readers. Thanks for sticking by me. I mean that.

Love,

Laney

Getting Organzied

I can’t believe how unorganized I had been before! When it comes to clinicals that is.

So, in first semester, they gave us a CPT or a Care Planning Tool. It was like 3 pages stapled together and it ran through the whole assessment with blocks for you to fill in. It had Vital signs, then areas where it asked about GI/GU, Cardiovascular, Respiratory and so on and so forth. On the last page you filled in your nursing diagnoses/interventions/etc.

After 2nd semester, they weren’t mandatory each week. We started printing off the nursing rounds reports and using that. I’ve asked a few others and it seems like everyone pretty much gave report off of whatever popped in their head and we just wrote down a long list of everything that we heard. It wasn’t very concise or organized.

Example of the poor/former way:

“Here is Mr. Jones in room 5555. He was admitted for R knee replacement. He’s been doing pretty well today- his wife is at the bedside. He’s got a PCA pump and PT/OT should be coming around after lunch. Um, what else? Oh yeah, he’s got the polar ice machine by the bed. He uses the bathroom on his own and his wife helps him. His last bowel movement was yesterday. His diet is regular. He’s been appropriate, everything sounds great. Yeah, pretty good patient, you should have an easy day. Alright, see you tomorrow!”

My sheet would look like this:

Mr Jones room 5555, R knee replacement
PCA pump
PT/OT after lunch
wife at bedside
polar ice
regular diet
bathroom on own
appropriate/clear

I never understood why our reports took 2 minutes when the nurses took 15.

Now I know to go system by system. It’s more accurate, especially when your patients are sicker.

My sheet gets set up like this now:

Hx:

Neuro Resp Cardiovascular (CV) GI/GU

Neuro: were they appropriate, headache, cough/gag reflex, pupils, muscle strength, hand grips, dorsiflexion/plantar flexion, level of consciousness (LOC), increased cranial pressures (ICP…more in the intensive care units)

Resp: average rate, work of breathing (WOB)- any nasal flaring or grunting, lung sounds bilaterally, any treatments such as albuterol, oxygen needed if any, trach, frequency of suctioning, secretions

CV: max temp, average temp, ranges for heart rates and blood pressures (so you know their baseline), pulses, edema, murmurs, skin temp warm or cool, cap refill, arterial or central lines if any (more for ICU)

GI/GU: diet, tolerating well or not, route of excretion whether its voiding or catheter or ostomy, strict Is/Os, what output has been like, are they getting up to the toilet or using bedside commode/urinal/bedpan

And then you can add any notes like wounds, special requests, what treatments need to be done, what tests have been ordered. We also go through and check orders and meds so the next nurse or you know whats being given and why and if you disagree with something, that’s when you can go and talk to an MD about it.

I feel so much more organized now! It also helps with your charting when you get report like this cause you already have the whole picture in your head of what you’re looking for. Before, I used to start charting and forgot to check something and have to run back in the room or do my whole assessment with my CPT. Now, I don’t b/c everything is already on your brain. The girls in my class also doing PNA have experienced the same thing so at least I know I wasn’t behind before or anything. Anyways, hope it helps! If not, what works for you?

Love,

Laney

Tumblr

Hey all! Today I’m enjoying a lazy day and decided to, at the suggestion of my friend Dash, create a Tumblr.

Of course, I’ll still blog here the nurse-y things and all the normal stuff. I’m not really sure what Tumblr is for or whatever, but Dash assures me I’ll get the hang of it. So far, I’m using it to post songs, pictures, whatever catches my fancy etc etc.

SO!

http://loveandscrubs.tumblr.com

Follow me so that I can follow you!

Love,

Laney

How to Survive Overnight Shifts

I’ve gotta admit- I’m loving these night shifts. I was on day shift for one week and the rest of the summer have all been overnight. I can’t believe how much I was yawning when I was on days. Yeah…7p-7a works for me. It’s so much more relaxed than day shift too because you don’t have all the services coming in and out or all the managers and JCHAO worries.

So…how to survive it if you’re new.

I try to stay up as late as possible the night before (like 5am) and then sleep through until it’s time to get up and get going. If that doesn’t work, I’ll take a nap at, say, 2am until 5am and wake up for a little bit. I’ll do errands, laundry, watch TV- whatever- and then go back to bed from 9 or 10 until 5pm when I wake up for work.

At work, space out your snacks and food. They keep you awake. Some drink coffee. I take two Diet Dr. Peppers with me. I usually only need about one and a half, but you never know when there’s a slow night.

Anyone else want to weigh in? How do you manage during the graveyard shift?

Love,

Laney

Breathe Me

I did chest compressions for the first time. I lost my first patient.

Man, that was hard.

The adrenaline rush of being in the middle of a code is like nothing else. The way the floor falls out from beneath right as you realize that you’re about to pull the code bell is…well, we call it a “shit-your-pants-moment”.

I was asked what it was like. It’s like no other moment I’ve experienced. I’ve been on the outside of many, many codes before. In the doorway looking in. This time, I was on the inside looking out. Not trying to sound dramatic or anything- but it’s true. You’re in this small room looking at your patient, looking at the monitor, looking at your supplies and seeing this kid turn gray and hearing the alarms sounding off. The code bell goes off and in an instant there are 20 people piled into your room and spilling into the hallway- not to mention the passersby stopping to rubberneck.

It’s like a TV show that I should be watching at home. The attending and I make eye contact and I hear them say to push another 120ml of normal saline bolus. I grab the full syringe, lock in, and push. Then it’s time to draw up more, switch out and keep going. I stood there next to my preceptor alternating between my fluids and her epinephrine doses. I did my first round of chest compressions and brought pressures back up to an acceptable level where we could feel a pulse again.

It didn’t last.

I take comfort in the fact that we were able to save this patient long enough for the family to get there. It was a long time coming.

It’s surreal. I can hear the screaming exactly like a remembered movie and, yet, it’s so distant that I can’t recall it at all- like a nearly forgotten dream.

Going home was weird. I’m standing in an elevator with other people talking about their night, someone else on the phone, someone else looking at me as if they cant tell if I have bad attitude or if I’ve had a bad night. And I’m sitting here typing this thinking how crazy it must have looked to see me- the youngest in the room with big glasses and, most likely, panicked eyes- bent over a small bed looking like a kid trying to save a kid.

It’s crazy, but this is still where I want to work. This is not the normal day to have your patient go. More people get better than don’t. I have a renewed strength and want to be an amazing nurse. My preceptor is amazing. I want to be just like her when I grow up.

That’s all for tonight.

Pay It Forward

So, Ishaq and I had a date night tonight. He started a new job and had to be gone for five days in a city two hours away last week. Before that, we hadn’t been separated for more than a night the whole time we’ve been married. Meaning that it was very difficult and we were much in need of a date. Luckily, I had been working overnight so it hadn’t been too unbearable. I digress.

So we went to Barnes and Nobles for coffee and dessert (he had a chocolate chunk cookie while I munched on a giant rice krispy treat). Afterwards, we saw a movie (Get Him to the Greek) which was pretty hilarious. On the way home, he had a late night hunger craving, specifically for the Waffle House on the way home. Besides, what else is open at midnight? And yes, you heard me right- Waffle House. I live in the South after all!

We sat down and talked and split a meal. The waitress comes up to us as we’re finishing up and lets us know that the gentleman that had been sitting behind us only minutes before had paid for our meal, but he didn’t want her to say anything until he was gone.

Color us shocked! I saw him when we went in- we made eye contact as I was getting out of the car. He was a young, black kid- not much older than Ishaq or I- just eating a late night dinner. And for some reason, he decided to pay for our meal.

That has to be one of the craziest things that has ever happened to me. Ishaq feels the same. What triggered that?? So selfless! We both felt this crazy, tingly, antsy shock and feel the need to “pay it forward” somehow. It made me feel good- like a compliment- and at the same time, a little guilty when walking out of the restaurant without even glancing at my wallet. Weird night, right?

Wherever you are, I wish I could return the favor!

Love,

Laney

Ask A Question

Hey everyone! Happy Father’s Day!

I got a question from Sandy in my comments section that I have heard before. “I am worried though because I am easily grossed out by lots of stuff – blood, bodily fluids, you name it. Will I be able to handle it once I start? Has anyone you know left the course b/c they found everything too gross???”

In my opinion, for the most part- you get used to it. My first clinical rotation at the VA hospital found me dry-heaving over a trashcan while cleaning an incontinent bottom. But, you get used to it. However, I will say that just about everyone has their one or two things they absolutely cannot stand no matter what. Like on floor nurse I know will say that you can throw up on her, poop on her, bleed all over, whatever- it’s not a problem. But she HATES suctioning trachs. The sound of it gets her.

Myself, I could be ankle deep in blood, turn my lips down ever-so-slightly to poop, suctioning is a-ok….but I hate the smell of really concentrated urine. It just turns my stomach. The last time I cared for a patient with really concentrated urine, I had to put toothpaste on my finger and hold it under my nose when I emptied the hat b/c the first time I had done it, I was dry heaving once again. Not cute, right?

As for people dropping out b/c of it, they are few and far between. Usually, the ones who have left that couldn’t handle it had other problems too such as not enjoying nursing and couldn’t handle it in that sense. Or they got partway into the program and just realized nursing was not for them.

You can do it though! One of my good friends at school started off saying she didn’t think she could handle blood and guts and bodily fluids. She’s super girly and still turns a frown when she has an incontinent patient, but she gets the job done just fine.

Good luck!! Keep me updated. How about you guys? Any advice you want to give or observations you want to share on the matter?

Love,

Laney

PNA- Week 1

So, I’ve completed my first week on the floor. It is AMAZING. No joke. I am so in love with this type of nursing and am determined to get a job here as a new grad.

It’s been amazing to actually see some of the more critical aspects of diseases and put the pieces together between what I’ve read in my textbook or heard in lecture with the patient in front of me. I’m a very visual and hands-on learner. Sometimes, I can reread a paragraph over and over about the technicalities of something, but if I can see it or do something with it hands-on it’s as if I’ve got a photographic memory.

For example, I have read about respiratory and metabolic acidosis and alkalosis a bunch. I’ve heard it in lecture and it didn’t make much sense to me. Outside of being able to look at a gas and figure out which type it was, I didn’t know much more than that. So I could look at the gas and see pH: 7.26, CO2: 60, HCO3: 22 and go “Alright, that’s respiratory acidosis.”

BUT after I saw a patient with that on the unit, I was able to remember verbatim from my preceptor about how they had acidosis because they weren’t able to blow off enough CO2 and the treatment would be to give sodium bicarbonate, which is kind of like baking soda, because it is a base. It is often given for metabolic acidosis, but is definitely given for respiratory.

AHHHHH! MINDEXPLOSION!! It sticks now! I’m just so excited!

I also saw 2 kids go on ECMO pump (a machine that acts as your heart and lungs), 2 code blues, one kid have “neuro storms” (where the brain was misfiring), several desats (where oxygen was needed emergently), an open chest cavity where I could see the beating heart under a piece of tegaderm, and much much more!

I’ll be sure to break it up into pieces and go in more detail. I just wanted to give a brief overview.

I’m on all night shifts this month and I’ve gotta say that I LOVE it. I may want to work night shift after I graduate! My preceptor is just beyond amazing. I want to be just like her when I grow up. She’s only been out of school for 3 years, but the way she talks you would think it was for a lot longer. She has this incredible wealth of knowledge and teaches everyone around her with a question (including undergrad pre-med students who were asking her questions). She explains everything while she’s doing it and I feel I’ve already learned so much in a week- my brain hurts! It’s really a match made in heaven.

To sum it up, week 1 couldn’t have gone any better!

Love,

Laney