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:

1. Mr Jones room 5555, R knee replacement
2. PCA pump
3. PT/OT after lunch
4. wife at bedside
5. polar ice
6. regular diet
7. bathroom on own
8. 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

There are a few things about where I work that I definitely don’t like and that had kind of turned me off the PICU idea for awhile. But here, at this other hospital, it was great! I asked questions about how they ran certain aspects and it fit me perfectly. I clicked well with the staff and the charge  nurse liked me so much she introduced me to the nurse manager AND gave me her number and email saying I could use her as a reference anytime.

I’m super stoked.

Hopefully, I’ll get my summer externship there and will have a leg-up on getting one of the new grad positions there.

=D

Overjoyed. Today was an amazing clinical day. I felt the spark reignite. The same one that had been dull and waning for awhile. Woo-hoo!

Love,

Laney

Oh yes. Pap smears.
I went to an OB-GYN clinic today. The morning started off painfully boring because I wasn’t allowed to do anything but observe. I was bored to tears.
But then, in the afternoon, it got busier and I was actually allowed to do everything from taking patients back to assisting the doctor with his appointments.

And they were all pap smears.

The first couple, I was thinking ‘Alright, seeing something new. Getting to participate. Woo-hoo!’
The next couple were like, ‘Hmm. Well, see one, you see them all, right? Not my thing for an everyday career personally, but that’s okay…’

By the end of the day, it was, ‘If I see another pap smear again, it will be too soon!!’

That was pretty much my day.

Love,
Laney

PS- Here’s some help with beating those nursing smells…learned in first semester

I have to say, I really enjoyed it! Who knew?! I was not expecting that. It got slow at times, but once the pushing got started, it was a fast-paced environment, good turnaround of the patients, AND you got to build a rapport with them. Everything I love!

I hadn’t realized how much the bedside nurse does. The MD or midwife really only came in after the head was on its way out. They were there to pop the baby out, deliver the placenta, and repair the perineum. That’s it. All the baby care, the comfort, the assistance with labor, being a labor coach, doing the vaginal checks, being there for the pushing which ranges from 10 minutes to 3 hours (a patient yesterday pushed for 2.5 hours!)…that’s  all done by the nurse.

I really liked the continuous monitoring (q30min for baby, q1h vitals for mom) and the fact that there is so much to keep track of. Plus, there is a mini-OR on the unit for the C-sections. How cool is that! One of the nurses today was bedside all morning and then went and was the scrub nurse for the C-section. Very cool.

And it’s exciting. Everyone has a different story and a different history. Bringing new life into the world is always exciting. It’s an infectiously happy environment. AND I liked the nurses there. They are good at what they do and they were willing to teach, which is important. It was so awesome!

Granted, I had an intimidating instructor, but it was still a great experience overall.

Maybe I’ll be in purple scrubs after this??

Usually, for me, clinicals are exciting and I’m learning new stuff and kicking butt. It’s my strong point. In my book, clinicals trump testing.

Some of my peers hate clinicals though. Or they struggle. Which is fine, everyone has their strong points.

So, imagine my discomfort when I fail at life on the floor. Okay, maybe that’s exaggerating a bit. But, today was probably the roughest day for me. It wasn’t terrible, but it didn’t meet my standards for sure.

This instructor is new and a bit intimidating. She also expects us to be on the level of new grad. Which we are not. Because I still sign “SN” for STUDENT nurse after my name. Which means that new grad expectations are a little high. She will ask questions in a drill instructor format and if you take a second to think about it, well, then you must be unprepared. She has a really dry sense of humor which I find funny most times, but at other times you can’t tell if she’s joking since she is the instructor and you’re the student.

I’m not exaggerating- one of my classmates cried today!

I’m walking by in the hall, she says “Got a minute?” Sure, I say! Go to postpartum, grab a bed, come back, finish string up my LR and Pitocin since I am in L&D. Actually, I didn’t even finish. I was in the middle of it when a nurse walks by with an IV kit and my instructor stops and says “Oh, Laney can go!” I can what?

“Go start the IV in 10.” Can I have a minute? “Why?” she asks. Well, I’ve never done one on a real person before and the last time I saw it done was last semester. “Oh, well don’t tell the patient that!”

In I go, kit in hand- sweaty hands that is. Into a room of a patient who I haven’t met yet and is staring at me angry, tired, and pregnant. I get it started and rip my tape. I open my needle and insert. “Wait for flashback, wait, wait. You need to be able to see flashback.” I see it, it’s right there! I start advancing the cath, she takes over and finishes advancing and then is like “retract the needle, retract it, now, now, now…” Well, I thought you were taking over, how do I know what you want me to finish and not? So I retract. Is there a little trickle of blood like in the simulation hand at school? Nope. Gushing blood! It’s shooting out of the hub! Blood all over the sheet. I mean, I didn’t know blood could do that. I panic and try to plug it some, which is not good. So she’s telling me to “grab that, grab that” and pointing at her blood vials that are on the other side of me. She had said originally for me to step aside after retracting the needle so that she could do the blood draw. Well, I did. And then she’s telling me to come back with her stuff and how come I stepped aside. I hand her the stuff and get it all taped up. Her telling me not to touch a certain spot where I wasn’t actually touching,  but that’s alright. Clean her up and get out.

“Your technique was terrible.”

I realize that. I also realize that I would’ve done better with a quick review before doing my first stick on a human after being interrupted from hanging my meds on my actual patient.

OH and she brought up my tendency to be running late. Not actually being late. Just me running late from my house and getting there right on time instead of 15 minutes early like some of my peers. She said “I hear you have a tendency to run late.” True. I don’t do well with mornings. I have a hard time waking up. But why are you bringing it up to me when I have not been late to one of your clincals. I have only been late to one clinical my whole time in nursing school. Yesterday there had been admittedly a mix-up and I went upstairs because I had seen a different class in our meeting spot. It was one of those times where I was riding on the up elevator and she was riding down, so we missed each other things. But I wasn’t late and the unit staff accounted that I was up there waiting. So why is she telling me “You need to work on that” when I haven’t been late.

Bah. I felt so flustered after that and dumb. I hate feeling like that.

Now I know though. So I guess that’s something. I’m the type of learner that does something once and retains it over reading it in theory. Simulation lab is definitely different from real life. Bah.

I ended up staying two hours past my clinical rotation was over, (8-6 instead of leaving at 4) but it was oh-so worth it.

My legs hate me though. I stood at the bedside for an hour and a half to help hold mom’s leg while she pushed. Dad was on the other side.

“It’s okay legs, you got to see something amazing and beautiful. You helped with a life come into the world”, I told my legs.

“Don’t care”, my legs replied. “We aren’t friends tonight.”

So my legs and I are hanging out in bed and I’m about to type up my weekly evaluation AND my 250 word essay for a summer externship program.

I promise to elaborate on everything over the weekend including the birth, the baby care, and the PNA program.

Hope you guys had a lovely week!

Love,

Laney

But I promised pictures. And by pictures, I mean one picture.

Ahh home at last.

Oh yeah, I’m pretty short if you didn’t already know. I kinda look like an oompa loompa. Just purple instead of orange. But I’m a full 5′3 aka fun-sized.

Love,

Laney

I’m in Labor and Delivery meaning I’ve got the PURPLE SCRUBS. Oh, last semester I pined for purple scrubs. Not because they’re particularly fashionable. I look like a big ‘ol grape. I only wanted them because that meant that I passed second semester.

Speaking of passing, I got a 91 on my Test from Monday. SO EXCITED. I’ve never broken the 90s on a test before since nursing school started. I did in my pre-req’s but not in the nursey classes. I’m a 89 student. So close, yet always so far. Haha! I win! Maybe pediatrics is really where I belong…

Anyways, I’ve got tons of pre-clinical homework to do tonight. Postpartum was pretty easy in comparison, so I didn’t realize how in-depth we’d be going for L/D. After all, we are training to be nurse generalists (aka not specialized) right? And L/D is super specialized. Well, I was wrong. I need to be more prepared. Today was orientation and we went into detail about all the stages of labor. I need to brush up. I know the basics, but the applying it requires a quick review on my IV insertion and foleys etc etc. I know how to do a great foley and string my IV bags…but this instructor is very particular on the steps you do and everything is a lot more tense when you have an instructor staring at you when you try to do some skill in front of a patient. Gotta be on my P’s and Q’s.

So, I will be studying Pitocin (to either induce labor before  or stop some of the bleeding after birth), IV insertion (I’ve only had a chance to stick dummy’s so far. Ooh, lemme clarify, mannequin’s. Not dumb people….), and my other L/D meds.

I’ll take a picture in my grape outfit tomorrow.

Love,

Laney