About Me

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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Sunday, March 28, 2010

First rotation! Medicine on Unit 3L

Wow, after finishing up that post yesterday, I realized how much I had to talk about! There is a lot so I needed to think about how best to split up my thoughts. This term (since January 4) has been straight clinicals. 5 week rotations at different sites here in the city. So I'll give an overview of my week and then delve into my experience in each rotation afterwards.

So, my week. Wow. I am absolutely INSANE for working as much as I do. My job with the City (and the associated union contract) stipulates that I must work a minimum of 21 hours per week. Unfortunately my clinical rotation hours were all over the map between 0700 and 2300 so I couldn't work during the week. This meant that I worked full 8 hour shifts on Saturday and Sunday and worked another 5 hours on Monday after my lecture time on campus.

This means that I have been working 7 days a week since January with the odd singleton day off every few weeks from clinical schedule adjustments or school holidays.

In order to have some semblance of a day off I chose to work Saturdays from 1800 - 0200 and Sundays from 1600 - 0000 before lecture time at 0800 on Monday. That way I'd at least get the weekend days to myself. However that meant that Friday night was my only "night off" to go out with friends and have a life.

The stress has been eating at me though. I've always been the kind of person who thrives on busting my ass during the week and then utterly recharging on my days off. I haven't been able to do that every week or even every two weeks. I'm gaining weight (like 10 pounds, QQ) and losing my hair, and I wish I was joking about that. It's been falling out all over my head for the past few months and it's way thinner than I've ever seen it. My apartment looks like hell and my car looks like it ate a hurricane, and I've been sweet talking my mom into doing all my laundry. I feel like Marge Simpson in that episode when her hair starts falling out and she goes batshit crazy.

Happily, I am now in the final stretch of this clinical term. I am on the second week out of five in my last rotation and I will be done on April 24! I have never wanted anything as badly as I want to just go back to regular work with regular weekends. I don't even know what I'll do with myself. Sleep? :)

So, to any curious about whether they could pull off fulltime clinicals and a solid work commitment... it was a dumb move. I mean, I'm technically DOING it and I'm still alive, but I hate every second. Clinicals are my time to roll up my sleeves and be excited about nursing! But I'm so exhausted from never getting a rest day that I just can't wait to go home all the time and don't want to put in more than the bare minimum of effort. I haven't done something 'just for me' in months. Hobbies? What are those?

Next year, if I am still with my job with the City (I'm considering picking up a brainless job with no commitment required), I am going to apply for a leave of absence from January to April. Seriously. I can't do both again.

My first rotation was on 3L, an 20-bed medicine unit at a hospital about 40 minutes from my house. My instructor was a younger nurse, maybe in her late 30s. She came from a critical care background which is something that interests me. We were her first clinical group so it was new for both of us! Our schedule rotated 8-hr shifts with days one week and evenings the next. Mondays from 0800-1000 were classroom time at the school, with all students doing that rotation (not just our clinical group). After that we'd head down to the hospital to get our patient assignments for the week and do the research. Typically I'd go through my pt's chart to find out admitting dx, medical hx, health determinant information, plan of care, relevant lab values, interdisciplinary care from OT/PT/dieticians, and I'd copy down the laundry list of medications for research at home or at work.

Monday lecture was a joke. Attendance was mandatory or else we'd have to put in extra time to "make up" the missed lecture. Ridiculous. Our instructor (the same facepalmingly awful instructor from Nursing) claimed that we were not allowed to cover new material so all we did was rehash bitterly boring discussions about caring and stuff. How would I have chosen to spend this time? How about talking with the whole group about their clinical experience? It seems clear to me that the lecture time SHOULD be about getting as much shared information as possible. What did we actually do? Well, one class was spent reviewing some acronyms found in patient charts. Two hours. One class was spent role playing how we'd teach different groups about choking. Another two hours. FML. May I add that I was working until midnight the night before these "lectures"? I determined that it was actually less effort to go to class and space out for two hours versus skipping it and having to show some kind of "research" instead. Sad...

Anyway, about the clinical! The unit was similar to the one I was on in first year, being a med unit. However the hospital had a very different setup and it was positively spacious and well-organized in comparison. At report on the first day we were assigned two to a buddy nurse. It was a way better experience than first year, IMO, because we had the initial OMGAPATIENT freakout out of the way and we could just watch and learn the routine. Wow, were there a lot of meds being dished out. Our nurse, Michelle, had 6 patients with at least 5 pills each. It seemed like by the time she finished passing 0800 meds it was time for the 1000 ones. Sheesh.

We did 2 buddy shifts like that and then we were responsible for one patient from Tuesday through Friday. We did all patient care, charting, and most meds (PO, sub Q, and IM, including all narcotics). In fact the only thing we did not do was IV anything including saline flushes.

Over the 5 weeks I worked my way up to caring for 2 patients. I had some really interesting cases and I thought it was a great experience. I managed to do almost every procedure at least once. The nurses thought I was great because I'm the type to find opportunities for myself. "What's that, a patient in 77-3 needs an intermittent cath? I'll do it!"

A brief summary of my more memorable patients:

  • A middle-aged man with CHF, gross edema his lower abdomen & scrotum, pitting edema to his arms and legs, kidney and liver failure. He was one sick guy. It was amazing because I started with him and had to do med teaching for obvious things like potassium supplements (he was on Lasix) and he was really kind and patient. However I was able to observe his very subtle decline and I charted about him "seeming slow to respond to commands" which made me feel silly. Boy was I ever glad because 2 days later he was acutely delirious and he came very close to being transferred to the ICU. I had to do neuro assessments on him q15 and the rapid response team was in and out asking questions. I got to observe his CAT Scan [Photo Credit]. I got a ton of interaction with the physicians and I was very assertive and sure of my observations, and they listened to me. It was a very, very good experience. I felt like a Real Nurse for the whole week. His family asked me many questions and they were very glad I was there to look out for him. I also got to do my first foley on him with the son present (aahh!). In addition this particular patient had phimosis and I wasn't even able to see his urethra. I was kind of shooting blind, so to speak...
  • An older lady with dementia who suffered a fall at a nursing home - she had been on the unit for some time and was having a lot of changes in mental status. She would swing from drowsy spells to moments of complete lucidity. Sometimes she would be very confused about what procedures I was doing. She swung at me while I was trying to palpate her abdomen. I asked what the matter was and she yelled "It's not appropriate!!!" Other times though she'd be pleasantly confused. I caught her once trying to get out of bed. I asked her why. "I left a bag around here, somewhere," she told me. I went through the motions of looking around her bed and table and asked her to describe the bag. She looked at me pityingly as if I were a complete moron and said "It's got urine in it!" ..... she meant the foley ..... uh, yep, it's right here.
  • Another elderly woman battling depression, awaiting transfer to LTC. Wow, older people and depression... I'd no idea how common it is until I started my psych rotation. She'd just lie in bed and "sleep" the entire day. She'd do the bare minimum and that was it. She was SO hard to engage and part of me just about cried every time I thought about it.
  • A 70-something male who was on heparin and had massive nosebleeds. He had foam stuck up his nose the whole week and he was so angry about it. It was up there for ages while the med team decided whether to cauterize or not. He started refusing his heparin. I don't blame him. He was also incredibly constipated and the twice-daily Senokot and Colace weren't doing anything for him. He was the recipient of my first glycerine suppository, he had the world's largest BM, and he was SO HAPPY after that (nose foam and all!), it still makes me smile :)
  • A little old lady (seeing a trend here with the ages? lol) who was blind in one eye and deaf in one ear, who's children had all died, who's husband had died, who lost all her family, and had just found out she was terminal with lung cancer. She was incredibly plucky in spite of all she'd lost and she told me, as I was changing her chest tube dressing, how she was born under a lucky star... I don't even know how she managed such a positive outlook. For all her losses, she was hilarious. My classmate was giving her peri care and she burst out with such quips as Hey! be careful with my 'jewel'! and Bedbath, eh? You gonna wash my pussy? An octogenarian... I also got to watch her chest tube insertion. Wow, that was awesome! They aren't gentle at all! An NP put it in. They cut through her chest wall into the pleural space and shoved their fingers in her to make sure it was clear. Then they inserted the tube. Nothing came out so we rolled her onto her back. Woosh! 1.5L of serosang pleural effusion drained within a matter of seconds and we had to clamp it to prevent too much drainage at once. It was remarkable. She was so tiny! Where was all that fluid being stored??
  • Another patient who impacted me a lot wasn't technically assigned to me. He was in his 90s and was close to death. There wasn't much to him - he was just a skeleton! One morning, his breath was harsh and rattling. His eyes were so scared. He looked like a man drowning in his own lungs. He was lying in his bed, gasping for breath, with each arm out straight in a white-knuckle grip of the bloodied side rails. 4 hours later, I had the privilege of being at his bedside, with his family, when he died. His chest rose slower and slower and finally did not rise again. The resident checked his apical pulse and pupillary reflex - nothing. When it struck me that he had passed away, I was very thoughtful. I'd never seen a dead person before, much less the transition from life to death. It was very odd for me, and I kept expecting him to breathe suddenly and sit up. I wondered if I should be sad; I wasn't. If anything, I was relieved. He wasn't suffering anymore. It was a very sombre experience but very, very inspiring - the nurses were so respectful of him. They talked to him and addressed him by name as they took off his brief, disconnected his IV, and gave him a final bed bath. I really felt like they upheld the CNA Code of Ethics:

    "When a person receiving care is terminally ill or dying, nurses foster comfort, alleviate suffering, advocate for adequate relief of discomfort and pain and support a dignified and peaceful death. This includes support for the family during and following the death, and care of the person’s body after death."
As far as procedures for my first rotation went, I did pretty much everything there was to do on my unit. I gave all my patient intermittent meds and PRNs. I gave narcotics PO and SC (and once PR...). I did straight caths and foleys. In fact, I did my first straight cath on an obese woman and had a hell of a time keeping her abdomen and vulva clear of my sterile field using only one hand. Finally I had to get my instructor to hold her. Actually I think that this (NSFW?) is a great invention, not for its intended use, but for cathing ladies with somewhat cavernous vajayjays ;) I did bladder scans and blood glucose strips. I did a dressing change. I primed IV lines and spiked new bags. I observed a V/Q [Photo Credit] scan and a CT scan. I sent urine, sputum, and feces off to the lab. I picked up PRBCs from the blood bank. I did all my assessments and charted pages and pages. I talked with patients and families. I made a care plan and wrote an essay. I made a ton of beds, fetched a thousand towels, ran all kinds of errands for everybody and between everything I asked every single question I could think of.

I thought the staff were patient and knowledgeable, if not overwhelmed with enthusiasm at having second-year students. I got along great with all of my classmates. We celebrated the end of clinical with a few beers and we all chipped in to get my instructor a gift certificate for a very nice dinner. It was a great experience!!

Man, that took way longer to type than I expected. I'll follow up with my second and third rotations in another post. My fingers need a nap :)
Saturday, March 27, 2010

*Tap Tap* Is this thing on?

*Cough* *wheeze*

That’s me blowing the dust off this URL.

Wow, people, can you believe it’s already almost April? I’m almost halfway to being a registered nurse!

Geez, I think there’s an echo, it’s so empty in here :)

You may be wondering why I took an extended break from blogging. The truth, friends, is that my life is Just That Busy, and blogging was an additional stress that I decided to avoid for a while. So instead of apologizing and making promises for content that I can’t keep, I’ll do a brief summary of this past few months and then I’ll get to the rant that brought me back to my blog. I hope you are all coping well with your equally busy lives :)

The fall term from September to December was probably one of the most intense I’ll face in school, content-wise. The term was packed with classes including Patho, Health Assessment, Nursing 270, Mental Health, and 2 labs per week. There was also Pharm on the table but I was smart in taking it last summer because that was a very memorization-intensive class. In all I was taking 17 credit-hours in the term.

My most enjoyable classes were Health Assessment and Mental Health. HA was very cool because it involved all the classical assessment techniques including inspection, percussion, palpation, and auscultation. Our instructor was a seasoned ER nurse who had a ton of stories to back up all body system assessments. She was especially great because she had that snarky, straight-to-the-point way of talking that made things humorous and memorable. Head-to-toe assessments are still tough for me though; I think that’s one of those things you need years to really master.

Mental Health was also an interesting class. I won’t lie – I really wasn’t sure if I like the idea of being a psych nurse. However the instructor for the course is an AMAZING RN who specialized in mental health. The thing that really got me about her was how intelligent she was. She can talk about anything with anybody and be very clear and direct about it. She can argue circles around you. There was no slacking in her class because she would not be duped by a half-assed effort. She saw right through work that was done the night before – she knew exactly how much effort everyone had put in, and graded you accordingly.

We had to split into teams to do a debate in that class. Would you believe that people were actually clamouring to have me as their partner? Do I strike you as fiesty? lol! The debate was great. Our topic was burnout - nurses' fault or system's fault? Our position was assigned and we had to argue that burnout WAS the fault of the nurse and not the system. Tricky! Everyone said we did a great job though.

Patho was a pain in my ass because I absolutely hated the instructor’s teaching style. Call me too picky but I (still) STRONGLY believe that the instructors I am paying good money to teach me a class should be doing that field as a career. At the very least I want a Biology graduate teaching me a class about biology. Unfortunately I had a super-sweet, absolutely batshit crazy RN teaching Patho. I don’t know why. She wasn’t the expert in anything about Patho and any question just dumbfounded her. She didn’t even design the course. She was teaching one developed by someone else. I am a very linear learner. Show me how one theory leads to another and I will be right there with you. But she was so scatterbrained that she would jump around between body systems and the majority of the class would just stare at her. In all honesty, I didn’t go to her lectures much – they confused the hell out of me. My Patho knowledge was almost completely self-taught from a very, very good textbook** (see below for my advice on textbooks!)

Nursing – oh, boy. This was the second-year “meat and potatoes” class about (you guessed it) nursing. Now, after a lot of time spent on allnurses.com browsing the Student Forum, I think how my school handles the nursing content of nursing school is very different from how other schools do it, particularly those in the US. Other schools have classes geared towards different specialties. Medicine, Orthopaedics, OR, OB, CCU... I think that would be incredibly useful for getting a SOLID base of knowledge for each specialty before rotating into one during clinicals. Unfortunately my school believes that all you need to know about nursing is how to think like a nurse and the rest will just come naturally.

I disagree.

I postulate that in order to think like a nurse, I need to understand where nurses are basing their clinical judgement, and to do that I need to have a solid knowledge base.

Yes, you can teach me about ADPIE and NANDA and NIC and NOC, but all of those things are pretty much meaningless without knowing where patients are supposed to be baselining and what interventions we have available, and – most importantly – WHY we would use them!

So what did we learn in NURS 270? Well, several (SEVERAL) classes on meaningless hippy jargon about the power of caring and crap like that. Pardon my language and perhaps condescending attitude but either you care about people or you don’t – talking about such nebulous concepts as “the power of caring” and different ways of "living the patient experience" is a waste of time for everyone. The people who do care already have the intuition needed, and the people who don’t care aren’t coming to class. Even if they were, it’s not something you can teach in a classroom. I think if someone seems like they can’t or won’t care about a patient, it’s probably better addressed in a one-on-one clinical evaluation. The vast majority of us found all of the exercises to be common sense. IMO, the people who really needed their viewpoint adjusted were skipping class anyway.

We learned absolutely nothing about any of the nursing specialties. No baselines for knowledge, whatsoever... just whatever we gleaned from Patho and Pharm and lab time. I most definitely felt like this inhibited my learning experience in clinicals for this term because I had to learn everything on the fly. Which was in itself a good skill to learn, truthfully.

So, anyway, the Fall term was all classroom time. Some more useful than others. Some instructors I loved, some I loathed. Some great learning opportunities, and a whole lot of self-teaching after class in the library. I definitely learned a lot! More than I would have believed could ever fit in this skull of mine ;)

Well, I think that summarizes the Fall semester. I do have a lot to say about this term as well but I’ll make another post about it.

If you’re a new reader, welcome, and if you’ve stuck with me since my last post... wow, I appreciate you :)