NOW I remember

I have been a bit disillusioned this term with nursing. Although the theoretical content has been good, and challenging, and biology based (finally – but that’s a whole other post), my clinical placement has left a lot to be desired. My instructor is wonderful, my group is great, and most of the nurses that I work with are pretty good. The problem is the acuity, or lack there of is a better way to say it.

In my program, this term is supposed to be our acute med/surg placement. Most of the placements our school got are pretty good, but the one I got stuck in is just not acute. I’ve found myself getting really bored, and losing motivation when at clinical. The fact that I have to get up at stupid o’clock and travel over 50 miles (yes, that’s right – 50 miles of nasty city traffic) does not help matters.

As the weeks went on, I began questioning. What have I got myself into? Is this really what nursing is like? Am I just going to be a glorified care aid? Is that really why I’m working this hard????

And then Friday came. I got to take 3 patients (something that is rare for our placement because there are too few patients, but very common in the other placments). And the day was going ok, until my 58 year old patient suddenly had a GCS of 6. Between working with the doctor to get the code status clarified, trying to comfort the family, keeping an eye on my other pt who just wanted to chat every time I went into the room, and doing the discharge teaching for my surgical pt, I was actually busy. And challenged.

And that is why I went into nursing! To be challenged and to help.

Uniforms

I’ve been wanting to rant about this for a while….. (please note that the following rant does not apply to pediatric nurses)

What is up with some of the uniforms that people wear? Flowers, butterflies, Strawberry Shortcake, Teletubies, cartoon characters??? SERIOUSLY?? For a profession that is trying to take itself more seriously, uniforms like that certainly don’t help! I’m sorry, but I just have a hard time taking you seriously with Goofy staring back at me from your shirt. How do you expect patients, their families, Doctors, and other health professionals take you seriously?

As stated above, Pediatric nurses are excluded from this rant. In their setting, I can understand why they wear some of these uniforms. The kids think they are cool, it’s something to talk about with the kids, it’s familiar. Fine. But when you are working with adults????

Before my nursing life I worked in business world, both profit and non-profit. Some offices I worked in were formal and I wore a suit every day. Others were more informal west coast style and jeans were ok… as long as they were nice jeans, with a nice top and good shoes! No matter the dress code, there was always a level of professionalism. To me, cartoon characters do not convey professionalism.

The reality is, we live in a society where image does matter. Whether people realize it or not, the way that you portray yourself and dress yourself, conveys a message (I have a Communications degree so I actually know what I’m talking about with this – it’s not just a ramble). Ridiculous scurbs simply do not convey competence and confidence to me. Perhaps to others it does, but to me it does not.

So there is my rant.

Bad practice

In school, we are always taught “best practice”…. as in, the perfect-yet-often-unrealistic way. For the most part, I do skills in the clinical setting the same way that I learnt in lab, except for catheters. I don’t use the fenestrated drape – too much of a pain in the ass!

One of the best things about being taught best practice, is that it makes bad practice so much easier to recognize. I worked with an LPN on Saturday who was just awful! Now let me clarify right now – he wasn’t awful because he was an LPN. I have worked with many fantastic LPNs. He was awful because he didn’t care AT ALL about is patients, he was tossing them around in their beds with no regard, he had no respect for their dignity or privacy, and finally, he was changing a patient’s briefs without gloves on. Eewwww!!! That is beyond gross.

Wish I could focus

I love my acute med/surg class. It’s intersting, biology/pathology based (unlike most of my other nursing courses, but that is another rant), challenging, and most importantly – applicable!

Unfortunatly, my fluff classes of hte semester (research, and leadership) have tons of readings and small assignments that take my time…. time I wish I could spend diving deeper into my med/surg class!

Down girl

Welcome to Emergency! Here are your restraints.

This was the greeting that one of our patients got this weekend. The cops brought her in and she screamed bloody murder and every swear word imaginable for 20 minutes until the massive doses of drugs kicked in. Even the seasoned nurses were appalled by her behavior.

She woke briefly when we took her for her CT scan. She swore, kicked and screamed until 4 of us got her tied down on the CT scan bed, and she passed out again. After the test, we repeated the same sceneario: brief wake up, kick, cream, swear, 4 people to restrain, once tied down, passes out.

The nurse I was working with gladly let me take care of her since she doesn’t like dealing with violent clients in the midst of drug highs combined with psychosis (so why does she work in the ER then???), but I enjoyed the challenge.

Trial by fire

I finally got to work my first shift on the weekend! I was hired back in July as a student nurse to a busy ER, but due to poor organization, they did not orient me until the end of the summer. Which means that I got to spend my summer break NOT WORKING and now that I’m back in school I get to try working. Such fun. And no, I ‘m not bitter… not at all.

Anyways, I finally did get to work and I did 12s on both Saturday and Sunday. After a full week of school then back at school today, I’m beat! While I’m still in school, I think that only one weekend shift will suffice.

Like most ERs, the one I work in is chaotically busy, understaffed, not enough room and busy all the time. I got tossed right into the mix on my first day. My scope of practice is limited (since I am still a student) so I worked on a team with a nurse both days. I felt like an incompetent moron for most of the time because I just didn’t know where things were, or how things worked. But I slowly got the hang of it, and before long I was running around like the rest of them.

After telling my darling hubby about the chaos of my days he asked “So, do you like it?”. My response: “I LOVE IT!”

Never Assume

We have been taught to NEVER assume anything about a client, particularly based upon their appearance/race/ethnicity/culture, etc. I even took a whole class centered around cultural safety – it’s completely ingrained into me!!

And yet, I did assume. I had a delightfully sweet elderly client the other day when I was working post-op. As I was getting ready to wheel her to the shower her husband showed up. She excitedly announced that she was getting to have a shower and would be back soon. He bent over to kiss her and tell her he would be waiting. It was so sweet and brought up images of that old couple sitting on the front porch, still holding hands after 50 years.

As I wheeled her to the shower, we started chatting. “How long have you two been married?” Innocent enough question considering the circumstance, right? WRONG! “Oh we aren’t married. We’ve been going at it for 15 years. We went together for a while when we were kids, and then found each other again later in life.” I stand corrected.

So even when it’s the cute little old couple, just can’t assume they are married.

The small things

I had my first day of clinical this week for my acute med/surg rotation. Although the hospital is REALLY far away (it’s a 2 hour commute each way), my instructor, group and unit all seem good which makes a huge difference.

Today we shadowed a nurse to get an idea of how their unit runs, what the typical Dx are, etc. The nurse I worked with was fantastic, did thorough assessments, and had great rapport with clients. But she also did some of the “little” things. She didn’t do a safety check (suction, O2, brake, etc). She flushed a saline lock without alcohol swabbing. Like I said, little things.

I know that as nurses practice, they develop their own habbits and realize that some of the things they drill into us in nursing school probably aren’t as important as the school may make us believe. Honestly, I hope that I never get there. My hope is that I am able to maintain standards of practice that would live up to any nursing lab. Am I an idealist? Probably. But I figure might as well shoot high. That, and I’m a total Type A personality that sets high goals for myself.

Neuroscience

With seven months to go in my program, I’m starting to count down! We just got our clinical placements for this term. The good news for me is that I got a great group of people and an interesting unit – neuroscience! The bad news is that it’s stupidly far away from my house and I’m going to have a 2 hour commute to clincal in the morning. At least it’s only two days a week!

Nursing school – heaven or hell?

Before I started nursing school, many people told me that it was tough, hard, long, brutal, etc. I nodded, and plowed on to getting into nursing school.

On my first clinical placement, I had a few nurses I worked with tell me that nursing school is hell, but you just have to get through it because its SO GREAT once you graduate. I listened carefully and clung to those words a month later as I finished up the insanity that was my first term.

So why is nursing school hell? I think that it’s because you have the combination of a full load of classes PLUS several shifts of clinical a week. So while you still have the general student life of staying up late to finish assignments, you have to balance that with early mornings and tough shifts. For me, it led to a loss of sleep.

Some of my reasons for thinking that nursing school may be specific to my school, but I have spoken to other students who have similar experiences. We don’t get information until the last minute. In spite of having to arange rides and lives around our clinical schedule, we don’t get our placements or times until the last minute. Information in general is usually disseminated last minute, which is very frustrating.

Probably worst of all is the actual content of some of the classes. Nursing is my second degree (first degree is a BA in Internation Studies and Communications) and I thought that this one would be very different because it was a science degree. I was wrong for the first year. I wrote so many papers and spend ridiculous amounts of time in pointless discussions. Our lectures focuses primarily on the pshycho social elements of nursing (which are important, don’t get me wrong) while the biology would be a passing thought at the end. How are we supposed to assess our patients if we don’t understand what’s going on?????

Thankfully, this semester is looking better, at least in regards to the last matter. I finally got the lecture that I’ve been waiting a year for – all hard core science, specific interventions and the critical thinking process to decide on those interventions. To fluffy stuff – finally!

Now, all of that being said, I must also say that nursing school is heaven in some regards. In my nursing school, I am surrounded by an amazing group of SMART people who have similar interests and passions as me, which is always exciting. I can tell them stories and they won’t get grossed out. I can share the things I get excited about, and they won’t give me weird looks. I have a group of people that I can count on to push me further and harder in my studies, while also being there to help me along in them. The insane stress of nursing school has made us into a tight bunch and for me, that is what makes nursing school heaven.

So, what was nursing school for you? Heaven or hell?