nursing student | 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

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.

Orientation

Hey all! I’ve just recovered from orientation week!

I had 3 weeks of vacation after school was out where I mostly slept and cave-dwelled in my basement. It was so refreshing! Last weekend, Ishaq and I went to the beach for a mini-vacation before it was time to hit the ground running. Fun times were had.

It’s busy here at home. I started my orientation for the summer externship on Monday, Ishaq started his new school on Monday AND his new job on Thursday. Needless to say, we won’t be getting any breaks for a little bit.

On Monday, I started orientation and it was just welcome to the hospital, computer stuff, and a bunch of mandatory things like point of care, fire safety, etc etc.

I got my schedule though and found out that I’m gonna be a resident vampire for the month of June. All of my shifts are overnight! But, that’ll be a good thing because night shifts have quite a few things less to worry about than day shift. I’ll be in the Pediatric ICU so I can focus on my critical thinking and WHY I’m doing what I’m doing b/c there will be a calmer environment. I won’t have to be running to MRI or X-ray or having an excess of visitors coming in. I’m hoping to become less task oriented and improve my critical thinking skills this summer. We’ll see.

My first floor shift is Monday night 7p-7a. I’ve done overnight shifts before as an HUC, so we’ll see how it is as a Nurse-in-training.

Minor Meltdown

I guess I don’t go into my personal dramas too much on here. I don’t know why. I guess my first thoughts after wiping away tears and gorging on junk food isn’t to update my lameness for the world to see. But, I thought about it today. Most days I’m fine, but today there was a minor meltdown. So here I am. But, I don’t want to talk about it like “me, me, me” so I will instead do a case study write up.

Case Study #1

Pre-nursing school Laney was mostly on her A-game. She cooked dinner regularly, had laundry folded and ready to go, was usually cracking a witty joke or three, and had time to go to out for movies/dinner/walks/tennis games/etc.

Intra-nursing school Laney is a wreck. She picks up dinner most nights or asks her husband to on his way home, is usually living out of baskets of clean laundry, cracking many jokes b/c lets face it- she’s hilarious, and will go out to the occasional movie/dinner/walk/tennis game while thinking about how much studying she is going to have to make up for it later.

Intra-nursing school Laney also has a lot of guilt. She will think that simple comments such as “What time did you get up? Oh right, we woke up at the same time” are secret judgments that say “why on earth on you tired if we woke up at the same time and I’m not tired?” She will also have occasional hateful thoughts when people say “Oh I’m so tired, I had an 8-hour shift today” because I had a 12 hour-shift and will have to go home and study after. [That's not a good attitude at all. I know this on some level. Truly. It's ugly thinking and I know it.] Her eye also twitches when people assume that clinicals are not tiring because, in actuality, it’s working an 8-hr shift + school for free. Free labor which does not pay the ever-growing mountain of bills that are neglected on a desk at home. Furthermore, she may suffer from hypertension from all the arguments and complaints from her friends that don’t understand why she can’t go out…again. It’s not from neglect, it’s from the fact that the first day of class, the instructor said “Tell everyone you know and love that you’ll see them in two years” and was not exaggerating.

Intra-nursing school Laney is sometimes a bitch.

Nursing Diagnosis: Emotional Distress r/t (related to) lack of mental sanity secondary to nursing school AEB (as evidenced by) lack of sleep, fits of crying, glaring, and state of being irrational and/or inconsolable unless near chocolate.

Potential Complication: Mental Insanity, Hypertension, Cardiac Failure, Zero Friends outside of school/work

Good write-up I think. Pathetic? Definitely. I just keep trying to tell myself that this time next year, I will be a nurse and a much better person. Now if you’ll excuse me, I’m gonna go grab a brownie.

Love,

Laney

Postmortem

I have to backtrack a little bit. A couple of weeks ago, on my second day of floor orientation as an NA II, I had to do post-mortem care for the first time. What are the odds that it would come up so quickly.

This patient I had seen the previous day as well. We weren’t doing anything for this patient except for comfort care. They had been agonal breathing for a long time and were already pretty much gone. So, I think it wasn’t as traumatic as if it had been a walking talking patient that randomly crashed. It was one of those situations where it was good for the patient, who was needing constant morphine for pain, and the family.

So, here is what I learned about post-mortem care. I don’t want to sound all morbid, but my husband had asked me what all we had to do. I figured other people may be curious too, especially the ones who haven’t had to do it yet. But if you aren’t curious and have no desire to know what happens after death b/c it freaks you out then stop reading and I’ll see you tomorrow! (Good disclaimer, right?) Otherwise here ya go:

You clean and strip the body and get the toe tags that have been prepared by the HUC.

If an eye donor, rinse eyes with normal saline and put saline gauze over eyes to preserve them. If a medical examiner case, leave all the IVs and tubes in.

Go downstairs and get the transport stretcher with box that goes over the top to mask the outline of a body.

Come back up, place body in bag. Make sure there is a tag on the body, bag, and bag of possessions if applicable.

Put box over body, transport to morgue. Take papers to medical records office.

And that’s that. And let me tell you, it was a lot of work. I was sweating by the time we were done. That’s another aspect we have to remember as nurses/students. We help people to get better and we heal the sick, yes. But there are times when we have to help people to die…and that’s sometimes a shock to the system.

That’s all she wrote. Hope that helps.

Love,

Laney

Rise and Shine

First day back to school. I had the worst time falling asleep last night. I think it was a mix of nerves, panic from not being prepared for my test, and the funky sleep schedule I had gotten myself into. I laid awake forever, finally fell asleep, woke myself up with a coughing fit, lay awake for another eternity, and then finally fell asleep for good.

Before I knew it, I heard soft guitar sounds. My phone was ringing. I wearily reached for it, assuming it was my alarm. I see it’s a call and answer. On the other end, ready to wake me up? A screaming teenager.

Ah yes. My sister. Remember, the one who can be ghetto? I jumped up in a panic. She was doing a screaming/crying mix. Once I understood her, I found out that noone died or wsa in the hospital like I assumed. Instead, I heard a rant about how my stepdad didn’t take her to school b/c her clothes were too low and revealing but she didn’t want to change b/c she thought it was fine. My stepdad is like the bus. Not ready on time? He’ll leave. And he did.
She wanted me to take her to school. Last time she got left at home, I took her and my parents said, hey you’re defeating the purpose if she thinks she can just get around it and call you.
So I told her I couldn’t take her.

Commence screaming and crying and borderline hyperventilation before hanging up the phone on me while I was mid-sentence.

It’s going to be a beautiful day.

Love,
Laney

Back To The Grind

I’m headed back to the real world tomorrow after being more or less bedridden since Easter weekend.

That’s a whole week and a half! Plus two visits to the doctors, multiple meds, and a whole lot of side effects. Blah. I’ve got a test tomorrow to makeup that I’ve hardly been able to study for.

Bah. I only have EIGHT months until graduation. So close and yet so far away.

I think I’m in one of those funks where it’s like, man, is it even possible? Will I ever get there? Is this all worth it?

I know logically the answer is yes. But, I’m feeling run-down. Maybe once I get going that feeling will go away. I hear some of my classmates saying the same thing. I mean, it’s been nearly two years already of the non-stop go-go-gadget. Can you believe that? Two years! It’s crazy to me.

I think I can, I think I can, I think I can….

Love,

Laney