- undergrad RN
- I'm a twenty-something Canadian student. After stumbling through a few years of college, I finally managed to get into the nursing school of my dreams, where I hope to graduate in 2012 with a nursing baccalaureate degree. I want to offer an honest look into how a modern nurse is educated, both good and bad. Eventually I hope to compare my education to my day-to-day career and see how it holds up. Whatever happens, it should be somewhat entertaining. Find me on allnurses.com!
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We arrived on the unit for 0700 report and I was again assigned 2 patients, both of which I've been assigned to before. You may remember my friend Mr. Willie (as in Groundskeeper Willie), of "Ach! Stop pulling me family crest!" fame. There was also Mrs. S who was about the sweetest old lady on the planet. She had arrived on the unit about 8 weeks prior, all skin and bones due to severe malnutrition. She was quite the success story as she worked her 78 year old ass off in order to get out of incontinent products and to self-transfer to the commode and wheelchair so she could get off the unit. She did a great job of building her strength up and she was going to be discharged off the unit into the nearby rehabilitation hospital. She still looked like a skeleton but you could see that she was gaining some weight. Seriously - any people with body image issues reading today? Starvation is NOT attractive. Go eat something while you still can!
So my first task was to go in and get vitals from Mr. Willie, who was sound asleep so I tried to be quick and non-annoying about it. Unfortunately he wasn't in an especially chipper mood so I attempted to be jokesy yet subdued and hooked him up to the vitals machine. I put the cuff on his arm and he yelled "Godammit woman, didja put your hands in the icebox this morning??"
Yikes. Apologies ensued. I didn't think my hands were particularly cold!
So I hooked him up and pressed 'Go' and waited for the vitals machine to do its magic. Unfortunately it couldn't find the BP so it kept inflating/deflating the cuff. Finally I just killed it and attempted a manual. Shit! Mr. Willie has Parkinson's disease complete with hand tremors. I was trying to palpate his radial pulse but I couldn't tell whether it was a pulse I was feeling or if it was just his wrist flexing. Yarg. By now I've spent 20 minutes trying to get a noninvasive set of vitals and he is thoroughly awake and not in the best mood. Finally I just estimate and inflate the cuff to 160. As it's coming back down, past 120, past 110, past 100, I'm thinking - crap. I can't get his BP manually either. Nurse FAIL.
Then I hear it and see the mercury jump around 97. Hooray! As I was charting it I realized that he has chronically low BP. I PROBABLY should have checked his baseline first! lol!
So I let my instructor know that I couldn't get Mr. Willie's pulse because of his Parkinson's tremors. She suggested I go for it and find an apical pulse for the first time. I went back into his room, ready to attempt it, and There. He. Was.
Approximately 700 feet tall with sparkling eyes, dimples, and a great smile. Then he said hello in a rich Aussie accent. I felt MY apical pulse flutter. Swoon.
I introduced myself and said I was going to attempt to find Mr. Willie's apical pulse. Nurse McDreamy had Mr. W's G-tube out and was going to aspirate it and started explaining everything he was doing to me. In that luscious accent. Double swoon. Did I mention Aussies are third on my list of automatically-doable-men? That's my list of, regardless how ugly they may be, men that I would go out with if their accents were svelte enough. Irishmen are first. I really don't know what it is about them. Maybe I'll just blame Colin Farrell on that one. So after Nurse McDreamy was done his G-tube assessment, he started helping me find Mr. Willie's apical pulse. Poor Mr. Willie, being my guinea pig all morning. Lest you think I was neglecting him in the testosterone-laden presence of McDreamy, RN, actually the opposite was true. I actually made more of an effort to involve Mr. W because I felt so embarrassed from swooning over a fellow nurse at the bedside! I started with the 5th intercostal space and I couldn't hear anything. Just Mr. W talking. I jovially told him to zip it and kept listening. He continued making small noises and I realized it was his Parkinson's, so that was really distracting. Then McDreamy started pointing to different areas to listen to. Still nothing. Nothing, nothing, and nothing. I could hear him breathing but no heart sounds. McDreamy took my scope and tried. He couldn't hear anything either. Later he showed me the chart where it said that Mr. W had some kind of cardiac pathophysiology where his S3 and S4 sounds were muffled. If the cardiac specialist couldn't hear his heart sounds either, then I felt justified.
Mr. W is not one to beat around the bush, as it were. So he was washing his face and axillae, and suddenly said - "I believe that I peed."
Okay, said I, no problem. We'll get that cleaned up as part of your bath.
"Well, good thing, because now I have to shit!"
"Uh, okay, Mr. W. Would you like me to draw the curtain for you? We'll give you some privacy." He nodded and I went to draw the curtain closed. Suddenly, McDreamy stopped me and rhetorically questioned what kind of rational human being would want to have a bowel movement in bed. Only, the language he used was slightly more crass.
So he started getting Mr. W up from the bed! Let me remind you that a few short weeks ago, Mr. W was entirely bed bound. Yes, he is technically CAPABLE of walking, but not very far, and not to the toilet, and definitely NOT while trying to maintain bowel control, you know?
I should have said something.
I SHOULD have said that Mr. W was better off just using his incontinent product in the bed because I didn't think he would be strong enough to make it to the bathroom, much less in a hurry, much less while squeezing his sphincter shut. And that sacral ulcer would make it very uncomfortable if not downright damaging to use a bedpan.
McDreamy RN was becoming a whole lot more like McAsshole RN while he insisted that Mr. W stand up and walk to the bathroom. His patient care went right out the window. His manner was short, somewhat condescending, and I was mortified for poor Mr. W who was just doing what he was told. That accent of his wasn't doing anything for me now except make me even more pissed off.
Except, he was not. With a splatter I saw that exactly what I expected had come to pass. My first Code Brown, ladies and gentlemen, and for a man on G-tube feed - well, you can imagine the scene.
Mr. Willie's Parkinsons tremors had gotten worse and worse to the point that I was afraid he was going to keel over. The nurse had him over by the bathroom so I let them go the rest of the way while I started cleaning up. He was sooo agitated, and so I was I. How awful. What a terrible loss of dignity. McA RN finally got him on the toilet and we got to work cleaning it up. He was cursing under his breath and rolling his eyes at the whole scene. I could have smoked him in the nose. Bahhh, I was so angry! Luckily one of my clinical buddies seemed to pick up on my agitation via peer ESP and came into the room bearing deodorizers. She sprayed it everywhere and that seemed to help. Unfortunately there was BM on my scrubs, on my shoes, on my arm (eww.) and just about everywhere.
So that's the first part of my, ahem, shitty day. There's more to the story but I am heading home from work now. I shall continue the story at a future time.
4) Tell me what your dream stethoscope would be
5) Does it have a name?
6) Tag all your nursing friends (Including the one that tagged you) and dont forget to leave a comment on their blog telling them that you tagged them!
Thank you for posting that review of Fireproof. I decided to rent it on iTunes and it really struck a chord with me. Yes, it appears that men really are capable of being real men all on their own and shouldn't require careful prodding from a woman to do the right thing.
I started to realize that I'm a bit of a pushover and I shouldn't have to take the B.S. that I have been, but I keep taking it hoping that everything will be smoothed over in the end. I need to put a stop to that and start demanding the respect I deserve otherwise I may never get it. Well, I don't know if it will work out or not, but I have to trust that Someone has my best interests in mind.
"A real man needs to be a hero to his wife before he can be to anybody else"
You may have started something big in me. Thanks, I think ;)
Monday we worked the PM shift on the unit from 1400 - 2200. It was probably the best one so far. We each had our own patient assignment and were responsible to handle all of their hygiene and repositioning. My clinical instructor winked at me when I was reading the assignment sheet, saying I'd 'have fun' with my new patient. I didn't know what to think!
So I sat down and read his chart, and he's basically an elderly Scottish guy who's got a case of old-age-itis and had a variety of problems catch up with him to land him on my unit. His chart was scary to me. Pressure ulcer on sacrum, fully dependent, NG tube, lived alone, no family. I had a picture in my mind of an angry, aging Groundskeeper Willie, who yelled at everyone who came to help with peri-care.
Picture my surprise when I peek around the door and I see the tiniest little man lost in a huge air bed, peeking out from beneath 3 blankets.
"Hi, my name is UgRN, and I'll be you're student nurse today, Mr. M!"
He said something very quietly.
"Sorry, Mr. M, what was that?" I leaned in.
He chuckled a little and said "I sez, 'why, halloooo, lass'! They keep sendin' me the pretty young nurses. I haven't had so much attention from the ladies since I was in uniform! Or the men, either, for that matter."
So set the tone for the entire shift.
You may remember that I spent a memorable 6 months gallivanting around Scotland with my backpack, a few pounds in change, and a job working for a coastal horse trekking outfit. So my patient and I had plenty to reminisce about. He's an Edinburgh man and I didn't spend nearly enough time there but I did remember the long ardurous hike from High Street, down to Holyrood, and then over to Princes Street. I also remember how crazy packed the streets were (I kept hitting people with my overstuffed backpack) and how I couldn't afford anything :) But I did buy a tartan Christmas ball.
It was kind of funny, really, how we all seemed to congregate at Mr. M's bed when there was nothing else to do. He kept us in stitches all night. He was a total saint, too, when we were experimenting with proper peri-care for a fully dependent man with an indwelling catheter. It turned out that out of all of us, the one person who did not have a chance to practice peri-care was the only male in our clinical group. So we voted him to be the one to do it. There were 6 of us with nothing to do so we made ourselves "useful" by fetching pillows and offering, uh, "helpful" instructions to our poor classmate who didn't know if he was coming or going. We rolled Mr. M back and forth all over creation and he swiped good naturedly at us, saying "Hey! Don't pull on my FAMILY CREST! There's not much there as it is, you know! You lady nurses are always so rough with it but this man here is ever so gentle." OMG, I was in tears, I was laughing so hard.
A little later I was reflecting that I had a completely wrong impression of him from his chart. He wasn't a scary recluse at all! And how different it must be for him to come from living indepedently with hardly any social interaction at all, to coming into the unit totally bedfast and charming everyone to where his bed was the local muster point.
Anyway. It was a great shift. We also got to watch the nurses swab for MRSA/VRE and then put the swabs in the vacuum tube and shoot it over the the lab. Fricken SWEET!
Yesterday we learned (finally) how to do blood pressures. Man, I can't find a brachial pulse to save my life. I was poking my partner's arms all over the place until our lab instructor whizzed over, touched her lightly on the inner elbow, and said "Here".
We had the coolest stethoscope ever. It's a teaching stethoscope with one chest piece and two earpieces! So she found the brachial pulse and set it all up, and I could finally hear what I was listening for. So we did about 800 BPs on each other until our fingers were tingly from lack of perfusion. My BP was, like, really low. 90/60 or somesuch when the instructor was doing it. She asked me if I was fit - not really! But I guess that explains why I see stars all the time when I stand up.
Anyway, my bus is coming soon so I will complete this when I get home from work. Tsk, blogging at work!
In Potter and Perry, it was mentioned that students can find touch stressful, but they learn to cope with intimate contact by changing their perceptions. As we were getting Mrs. E into bed, she was so tense that she was lifting her head and shoulders right off the bed. As I started the bed bath for her, it was initially very task-oriented for me: now I dip the washcloth in the basin, now I wring it out, is it too wet, oh, now is it too cold? Now I make the mitt – how does that go again? Now I touch the skin, not too firmly, not too gently. As I started getting the hang of it I realized I had run out of limbs to clean and it was time to do her abdomen. Mrs. E didn’t bat an eye when I undid her gown and she had her most private self exposed to me, but I saw a body that at one time had probably been reserved only for her parents or husband to see. And now, just about anyone wearing a uniform and an ID tag could see it.
I knew then that my perception had changed. She was much, much more than the unlucky recipient of my first bed bath. She was a person all her own and I had the privilege of helping her with her most intimate necessities. After that moment I began cleansing her abdomen knowing I was washing a unique human being. The task of washing became more of an act of caring. No longer did I concentrate so hard on the procedure. My focus was on helping Mrs. E take care of her needs. From there, I was more comfortable handling her body and the washcloth. As I relaxed, so did she! By the end of the bath she was lying flat out, completely relaxed. I could see that my touch had probably helped provide both relief from feeling unclean and, when I relaxed, my touch eased her into finding a position of comfort.