First I must start this post off with saying that I just got a 94 on my second nursing exam. I can't even begin to express the excitement of seeing that I only missed 3 questions out of 50 on topics such as Legal, Ethical, Cultural, Death and Loss, Communication, Nursing and Healthcare, and Medical Asepsis (basically this is about infection control). I left the exam feeling like I had done REALLY well, but thought that was a bad sign since I pretty much felt that way with my first test in which I only scored a 78 on (yikes!). The good news with all of this is that I pretty much solidified the fact that I will pass the class. I need to get a 60 or higher on the final, which is cumulative by the way, in order to pass. I think I can manage that. I can also totally get a B in the class, which is what I am going to aim for. Unfortunately, I would need to get a 98 in order to get an A in the class, and while that is not impossible, it is very improbable. Nevertheless, the competitive overachiever that I am, I will try.
Now onto the good stuff- my very first clinical day.
For our first day, my clinical instructor paired us up with another student so that we wouldn't be all alone on our first day. We met up with our group (there are 9 students and 1 instructor) in the hospital cafeteria where we get our hospital assignment and an info sheet on the patient we will be seeing that day. I started reading my patient's info and immediately realized that my patient was going to be VERY complicated. Aside from his lengthy medical history, he has glaucoma, macular degeneration,(a vision problem), is hard of hearing with hearing aids in BOTH ears, and upon meeting him, found out that we would need to write every single thing down in order to communicate with him. He was a very nice and patient man but it was a real challenge and very stressful to have to communicate with someone that way, for long periods of time.
How our day is supposed to go is like this: go into the patient's room, get their morning vital signs (pulse, respiration rate, blood pressure and temperature), do a physical assessment, and then provide morning care which consists of a bath (which could be a complete bath, partial bath, or the patient will do it all them self), oral care and changing the linens on the patient's bed. If all goes as planned, this should all be complete by 10am. By then, we would start writing up a draft of our nurse's notes (we have to practice charting, but its not really going into the chart, yet). Then, for the rest of the time we are to answer call lights or follow our nurse around and do whatever needs to be done.
This was not so on our first day. Since the majority of the time it took a long time to communicate, things went very slowly. It was almost 9am before the patient started eating breakfast, and we hadn't even done our assessment or given him his bath yet. On top of that, we fed the patient since the nurse suggested that was a good idea (apparently he was able to eat by himself, but perhaps he wasn't eating as much). After he ate, we worked on our physical assessment. This assessment is a head-to-toe check up of sorts, including observing, touching, listening, the whole 9 yards! I have to say, but I think our guy was in pretty bad shape. He had been admitted 9 days prior for COPD (its an issue related to his lungs). He had edema (swelling due to fluid) in one of his arms and both of his legs. He was an insulin dependent diabetic, he had high blood pressure, on about 20 meds, and was on aspiration precautions (any liquid had to be thickened with these packets of thickening nectar because he was at risk for aspirating if he drank liquids too thin). He had to take most of his meds crushed up in applesauce. His breathing was pretty awful, too. You could hear the rhonchi (mucous in the lungs) without even needing to use the stethoscope- it was very audible. It was actually so loud that I couldn't even hear his heart sounds with the stethoscope and this was even verified by my instructor- a former cardiac nurse- she could barely hear it either. Once we finished our physical assessment, it was the better part of 11am, and he still needed to get his bath. He was unable to provide any assistance, so we had to give him a complete bath ourselves. Oh and I forgot to mention- since he couldn't get out of bed, he wore a diaper. I've changed plenty of diapers in my life, you'd think I was a pro, but it is a whole different ballgame on an adult. You can't just grab two ankles and life the feet up in the air and whip off the diaper and whip on a new one. No. You have to roll the patient onto their side and changed it. But the patient doesn't always stay up on their side. Then they roll back down. That makes it hard. Actually, I ended up asking the PCA (patient care assistant, which is another name for nurse's aide) to help us, because we just couldn't do it, the useless newbie nurse wannabes that we are. She made it look so easy. Plus, when we rolled the patient onto his side, the energy he exerted rolling onto his side caused his oxygen saturation levels to go below 90%, which isn't very good and of course made this poor little nursing student a little flustered.
We had finally finished up with the bath when physical therapy came in to move the patient out of bed and into the chair. They had come earlier, but we had really needed to get the patient bathed first and they were very cool with working it out so that they could come back and we could do what we needed to do. It was wonderful that they had orders to do this because we needed to change the sheets on the bed and even though I know how to make a bed with a person in it, I really don't want to have to do it. Once our patient was sitting in the chair, I changed the bed linens with some fresh ones very quickly because it was nearing the end of our time there. By then, the patient's lunch had arrived, and thankfully speech therapy came by to check on the patient and offered to thicken up his liquids and get him started with his lunch. His nurse was very nice and I really hope to get to work with her next week. She asked if I wanted to and was allowed to do the patient's accu-check which is a finger stick to check the patient's blood sugar before giving him his insulin. We went off to ask my instructor who gave us the green flag and I pricked the patient's finger- all by myself! (How exciting, I know, ha!).
At that point, it was time to go. I hadn't sat down once during our little shift there, and It was a good 6 hours straight on my feet non-stop. That is something I haven't done in years, so my feet were really hurting. I actually didn't even realize how much they were hurting until I sat down at our post-conference meeting and tried to get back up after a half an hour. My feet were like jello.
I was so exhausted- mentally, physically- from that day that I came home and was so drained, coupled with the fact that I really don't think I want to be the medical floor type of nurse (I still feel like L&D, peds or ER are where my interests lie right now), and I think that made Ray think that maybe I didn't want to do nursing anymore. That's not the case, although, I can see where he was getting that feeling from. Truth is, it was my first day. I could barely take care of 1 patient with a partner. These nurses- they take care of 6-8 at a time. I can do it, I will do it. But it was my first day. I've never done this before. I don't even know where they keep the pillow cases. And hopefully one day I will work on a floor I am really interested in working on. But it was my first day. It can only get better, right? A little easier, in a way, right?
No. I definitely don't want to stop. I am sure there will be times I feel like I might want to, but I really don't.
Next week, I am on my own; not completely, but I won't be paired up with anyone. I will get to take care of a patient all on my own. My instructor has promised us all easier patients since we all had a very tough first day. She admitted she thought it was tough, but she didn't know when she got the patient infos from the charge nurse that all of our groups patients were going to be difficult cases. She said she was very proud of us and that we did a good job.
I hope that eventually I will be able to NOT wonder about my patients when I am at home. I don't know if thats a good thing or a bad one, but I have found myself wondering about how my very first patient is doing right now, wondering who helped him with his dinner tonight, wondering if he has family to visit him, wondering how he is going to take care of himself once he goes back home. I hope he's doing alright and that he's not lonely- is that a bad thing? Maybe, maybe not.
I'm excited to see what next week brings.
Now onto the good stuff- my very first clinical day.
For our first day, my clinical instructor paired us up with another student so that we wouldn't be all alone on our first day. We met up with our group (there are 9 students and 1 instructor) in the hospital cafeteria where we get our hospital assignment and an info sheet on the patient we will be seeing that day. I started reading my patient's info and immediately realized that my patient was going to be VERY complicated. Aside from his lengthy medical history, he has glaucoma, macular degeneration,(a vision problem), is hard of hearing with hearing aids in BOTH ears, and upon meeting him, found out that we would need to write every single thing down in order to communicate with him. He was a very nice and patient man but it was a real challenge and very stressful to have to communicate with someone that way, for long periods of time.
How our day is supposed to go is like this: go into the patient's room, get their morning vital signs (pulse, respiration rate, blood pressure and temperature), do a physical assessment, and then provide morning care which consists of a bath (which could be a complete bath, partial bath, or the patient will do it all them self), oral care and changing the linens on the patient's bed. If all goes as planned, this should all be complete by 10am. By then, we would start writing up a draft of our nurse's notes (we have to practice charting, but its not really going into the chart, yet). Then, for the rest of the time we are to answer call lights or follow our nurse around and do whatever needs to be done.
This was not so on our first day. Since the majority of the time it took a long time to communicate, things went very slowly. It was almost 9am before the patient started eating breakfast, and we hadn't even done our assessment or given him his bath yet. On top of that, we fed the patient since the nurse suggested that was a good idea (apparently he was able to eat by himself, but perhaps he wasn't eating as much). After he ate, we worked on our physical assessment. This assessment is a head-to-toe check up of sorts, including observing, touching, listening, the whole 9 yards! I have to say, but I think our guy was in pretty bad shape. He had been admitted 9 days prior for COPD (its an issue related to his lungs). He had edema (swelling due to fluid) in one of his arms and both of his legs. He was an insulin dependent diabetic, he had high blood pressure, on about 20 meds, and was on aspiration precautions (any liquid had to be thickened with these packets of thickening nectar because he was at risk for aspirating if he drank liquids too thin). He had to take most of his meds crushed up in applesauce. His breathing was pretty awful, too. You could hear the rhonchi (mucous in the lungs) without even needing to use the stethoscope- it was very audible. It was actually so loud that I couldn't even hear his heart sounds with the stethoscope and this was even verified by my instructor- a former cardiac nurse- she could barely hear it either. Once we finished our physical assessment, it was the better part of 11am, and he still needed to get his bath. He was unable to provide any assistance, so we had to give him a complete bath ourselves. Oh and I forgot to mention- since he couldn't get out of bed, he wore a diaper. I've changed plenty of diapers in my life, you'd think I was a pro, but it is a whole different ballgame on an adult. You can't just grab two ankles and life the feet up in the air and whip off the diaper and whip on a new one. No. You have to roll the patient onto their side and changed it. But the patient doesn't always stay up on their side. Then they roll back down. That makes it hard. Actually, I ended up asking the PCA (patient care assistant, which is another name for nurse's aide) to help us, because we just couldn't do it, the useless newbie nurse wannabes that we are. She made it look so easy. Plus, when we rolled the patient onto his side, the energy he exerted rolling onto his side caused his oxygen saturation levels to go below 90%, which isn't very good and of course made this poor little nursing student a little flustered.
We had finally finished up with the bath when physical therapy came in to move the patient out of bed and into the chair. They had come earlier, but we had really needed to get the patient bathed first and they were very cool with working it out so that they could come back and we could do what we needed to do. It was wonderful that they had orders to do this because we needed to change the sheets on the bed and even though I know how to make a bed with a person in it, I really don't want to have to do it. Once our patient was sitting in the chair, I changed the bed linens with some fresh ones very quickly because it was nearing the end of our time there. By then, the patient's lunch had arrived, and thankfully speech therapy came by to check on the patient and offered to thicken up his liquids and get him started with his lunch. His nurse was very nice and I really hope to get to work with her next week. She asked if I wanted to and was allowed to do the patient's accu-check which is a finger stick to check the patient's blood sugar before giving him his insulin. We went off to ask my instructor who gave us the green flag and I pricked the patient's finger- all by myself! (How exciting, I know, ha!).
At that point, it was time to go. I hadn't sat down once during our little shift there, and It was a good 6 hours straight on my feet non-stop. That is something I haven't done in years, so my feet were really hurting. I actually didn't even realize how much they were hurting until I sat down at our post-conference meeting and tried to get back up after a half an hour. My feet were like jello.
I was so exhausted- mentally, physically- from that day that I came home and was so drained, coupled with the fact that I really don't think I want to be the medical floor type of nurse (I still feel like L&D, peds or ER are where my interests lie right now), and I think that made Ray think that maybe I didn't want to do nursing anymore. That's not the case, although, I can see where he was getting that feeling from. Truth is, it was my first day. I could barely take care of 1 patient with a partner. These nurses- they take care of 6-8 at a time. I can do it, I will do it. But it was my first day. I've never done this before. I don't even know where they keep the pillow cases. And hopefully one day I will work on a floor I am really interested in working on. But it was my first day. It can only get better, right? A little easier, in a way, right?
No. I definitely don't want to stop. I am sure there will be times I feel like I might want to, but I really don't.
Next week, I am on my own; not completely, but I won't be paired up with anyone. I will get to take care of a patient all on my own. My instructor has promised us all easier patients since we all had a very tough first day. She admitted she thought it was tough, but she didn't know when she got the patient infos from the charge nurse that all of our groups patients were going to be difficult cases. She said she was very proud of us and that we did a good job.
I hope that eventually I will be able to NOT wonder about my patients when I am at home. I don't know if thats a good thing or a bad one, but I have found myself wondering about how my very first patient is doing right now, wondering who helped him with his dinner tonight, wondering if he has family to visit him, wondering how he is going to take care of himself once he goes back home. I hope he's doing alright and that he's not lonely- is that a bad thing? Maybe, maybe not.
I'm excited to see what next week brings.
5 comments:
Wow! I'm so impressed! I love it! I'm so happy for you and excited. You are accomplishing so much. Keep up the good work no matter how tough it gets. At the end of the day it will all be worth it!
Finally a post. Way excited for you.
Hey, I didn't post because I had a big test and see it paid off, lol
Sounds exciting, Gabbs! The feet will stop hurting in time; and first days usually leave you with an overwhelmed impression. If you are the competitive, overachiever type you will probably love ER. At this early stage do they allow you to rotate through OR at all?
I think theres a possibility we can observe a procedure in the OR, but I will not do any rotations at all thru OR. I think the beginning 8 weeks of my last semester I will get to be in the ER, or have a chance at being in the ER during my Cardio rotation.
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