Posts tagged ‘Clinicals’
Lessons learned
I saw a man die recently. Watched him code, watched CPR, watched intubation, assisted with CPR, watched him regain life (according to the tele monitor)….and moments from that I watched him take his last breath.
I am always amazed at how quickly people run the codes on the floor. You hear a code “blue” and then staff drops everything and starts running with equipment. Its like watching a symphony. Everyone is perfectly in sync.
As my time with this mentor is coming to an end, I find that I have learned more about myself as a person and a Nurse while working with her than I have ever learned in my life. Ive learned about the practicle side of nursing, the side that involves more than starting IV’s and giving medications. I learned more about critical thinking in 80 hrs than I did in 20 months of school.
The powers that be matched me with the perfect mentor. She is patient, kind, assertive, and f*cking brilliant. Im amazed by her. And honored to have been told by her that I will be an excellent RN.
Now is the down slope of the hump. Time to move on to my last half of mentorship. A new mentor, new location, new everything. But it is my final countdown, never again will I be doing clinicals like this for the first time. The conclusion that is imminent is overwhelming. Its hard to imagine how close the finish line is. Soon the patients will be mine, the decisions will be mine, and I will be using my “nursing judgement”.
Im ready…..
Back to clinicals/mentorship
I have two more days left of mentorship on the Resp floor after today. Then I will be halfway done with mentorship!! I should find out sometime next week where I will be going for my second half. It is much less stressful than waiting to find out about the first half.
There are some options of where I could be put. The instructor asked me what my preference is and I explained that I still really want to go to L&D. Unfortunetly there are not enough mentors for L&D so I cannot go. Sad. Very sad. I told her that I would love to go to the ED, but I understand that there are some people who are using this as a working interview so if they need to go there, I would be happy to withdraw.
I am hoping for either the ED, or the ortho floor. Anything else would just be mentorship….and I know that there is nothing that I cannot achieve. I can do it. Im just ready to be done.
What does DNR mean to you?
I had a sad encounted with a patient. Not much I can get in to on it, for HIPPA reasons. But I will share how it made me feel.
That was a big part of this experience, I feel something. For every single patient. I dont know if it is a new level of compassion or it is pregnancy related. But either way I am so sensitive to my patients and their struggles. I hurt when I see them hurt, I cry for their families.
Hospice is a wonderful asset to the hospital community. My own grandfather was able to make use of the hospice services and I know first hand how great it is. But I really saw them save the day with this family. I saw hospice make things better and the nurses are so compassionate and comforting to the family.
I want to be like that. I want to be the type of nurse who brings compassion with me to every shift. I feel like that is the type of nurse I am turning in to, I just hope I dont end up jaded.
But what does DNR mean to you? What condition would make you decide to be a DNR?
Surviving shift one
Im not young anymore. Thats for sure. I can feel it in my back, my hips, my legs, and I feel it in my feet. 12 hours actually turned in to more than 13. I did manage to take two short breaks and I drank a full 40 oz of fluids. I peed more times than I could count, thats something that I dont get a choice about the baby makes it so.
Being pregnant doesnt actually make me slower, but it makes me more precise. I feel more compassionate to my patients and their different situations. I thought about the strangest thing today, each one of my patients were a little baby once. Totally random, but it made me feel closer and want to make them better even more than I could have imagined.
I was told years ago that I would never be a great nurse unless I had children. I can understand that now. There are alot of good nurses out there, but I think parents develop an understanding for their patients. At least that has been my experience.
The biggest “oops” moment of the day….I tagged my EMR charting as “Physical Ass”. Everyone laughed at that. Oops!
I survived shift number one. And now time to get the log finished, and rest up for tomorrow!
Mentorship
Tomorrow starts my mentorship and the newest countdown until this portion of my schooling is completed. There are only 67 days until graduation, and around 75 until I head out to NewHome.
In preparation for Mentorship I have been reading about CHF, COPD, and pneumonia. I figured since Im gonna be on a respiratory floor that those would be the biggest things I would encounter. I got ahold of the hospitals policy on weaning from oxygen and the procedure for RT consults. Im reviewing my meds, and was reading my journal entries from when I was on this floor last time. Its a tele unit so I have been refreshing how to analyze tele strips. I need a ton of help on those! Hopefully by the end of the 80hrs I will be effective at accurately analyzing them!
Where did you do your mentorship/internship/externship?
Wait…you mean Im in charge?
Mentorship starts in a matter of days. I called and left messages for
My mentoring Nurse but it is difficult to get in touch on the weekend. But still I am pretty sure my shifts will start next week.
It hit me hard the other day, in a few short weeks I will be the nurse. I will be in charge of my patient load. I will be the one who has to trust my gut to make decisions. I will have to recall the information that I learned.
Crap! Thats alot of stress. After two years of “playing” nurse during clinicals its a little scary to think about moving into the real world.
School isnt that hard once it is the only thing you have to do. The first year I worked nearly full time and went to school, it almost killed me. I still maintained good grades, kept on the deans list and even kept my attendance up. But this year my hubby and I decided I should focus on school, so I quit and have only had to work on my Nursing stuff. Goodness it is so much easier!
I can only imagine what it is gonna be like to join the work force again. This time as an RN and mother.
Its really hard to remember that soon Im gonna be in charge. Didnt Nursing school just start?
The results
After the anticipation nearly caused me to stroke out, I found that I didnt get what I wanted. On the other hand I didnt get the shaft either. I did wind up in Med/Surg, in the Respiratory step down unit. Its a tele unit, so not such a bad thing.
I think that in general the assignments were handed out fairly. It didnt seem like the “favorites” all got their first choices, in fact those one seemed to get the most disapointment. And there were people who got the creme de la creme who I dont think deserved it. But I guess the choices were made based on more than what I can see from observation.
At first I got the assignment and thought “it could be worse”. Im relatively happy with where I will be, but I wont lie and say that Im not incredibly disapointed. I busted my buns in L&D, my grades reflect it. My evals from the instructors reflect it. But alas, I didnt get it. It took about two hours and now Im crushed. I feel a little let down that I was so clear about my preference and didnt get anywhere near what I wanted.
Im taking tonight to have my pity party. Tomorrow I will wrap my brain around trying to focus on the assignment and the tasks ahead.
The anticipation is killing me
Tomorrow I find out about my mentorship location(s). It could be a large multitude of combinations. Basically we get 10 weeks of mentorship split into two five week terms. We were asked to pick our top three locations, and I picked L&D, ED, and Pediatrics. I would even be happy with ortho though. I love ortho!
The areas for them to sort us all include these: L&D, ED, ICU, PEDS, Many Med/surg floors, and Long term care.
There are about 62 students in our class that have to be divided into those locations. We are supposed to have two separate rotations, so we each need two locations. Understandably this is a huge task. I know that there are many factors that go into sorting the student nurses into the locations. They take into account our request, our ability, available mentors, and students per facility. This means that basically, not everyone is going to get what they requested.
Because I have been so verbal about my general dissapointment with the program, and have been very outspoken with the short comings of this school, I have a feeling that I will not get any of the locations that I requested. Its just a gut feeling. I dont mean to say that they would flat out be vendictive and punish me, but….we will see tomorrow. Perhaps I will have to eat my words then. Perhaps.
Until then, all I can do is pray. I want to be an L&D nurse so badly. I love the autonomy and real difference a good nurse can make in L&D. I know that this is my calling in life. I can feel it. And I know how disapointed I will be if I wind up getting the shaft and spending my 10 weeks of mentorship in Long Term Care and some sort of post of recovery rather than where my passion can further develop.
Just a few more hours and I will find out. My Nursing career is just starting….I cant believe that this part of my schooling is almost over. It seems like just yesterday I started this blog. And soon it will be time to graduate from it. Time flies.
Only the NCLEX is left
Wednesday I took the last ever exams for my Nursing Career. They were the hardest tests I have ever taken in my life. I walked in feeling prepared, and confident. I got the exam in my hands and became tachycardic and diaphoretic (heart racing and sweaty to my non-nursing folks). Suddenly all the med/surg material was written in German. All the professional role development exam was written in Chinese. I was lost. I took twice my normal amount of time to finish the exam, and still feel like I dont know what I answered or if it was correct.
I will find out the test results early next week. And I am sweating it. I really wish that there was a little more instant gratification in testing. More immediate results. But alas that is not the way it will be. I have to wait.
So now, assuming that everything went well in the exams, I have completed the last ever exams in my nursing school days. Only the NCLEX is left.
I will be spending the rest of the weekend praying that I am blessed with passing scores.
Ch…ch..ch…changes
There are less than 100 days left until graduation and fewer than 120 until we move far far away. I am getting excited but…totally starting to feel the weight of all the things that need to be accomplished before we move.
On top of all of that I am starting to really notice changes in my body. The little bump, the sore hips, the increasing bust line, and the persistant nausea.
Not to mention the fact that I am having an affair with sleep. All I want to do is sleep. I lurve sleep!
According to my OB, now that I am into week 12 my miscarriage risk drops to less than 5%. Even though its not the real end of the first trimester (that happens at 13 weeks) my doctor considers 12 weeks to be the end of the first trimester and the start of the second.
Grow baby grow!
Oncology, ICU and the annoyance of cravings
Starting from the top…This week we are having our exam on Oncology, or as our instructor calls it “Altered cellular growth”. Basically its the cancer exam. This exam encompasses one day of lecture and one week of time to study. In other words, I feel like Im screwed going into this one. We had a guest lecturer, which is usually an excellent learning tool except this time the lecturer went at rapid pace and skipped back and forth over the topics. I felt like I wound up self teaching this entire topic, and since I was so lost from the lecture I was highly unmotivated while studying. In other words, it sucked monkey balls and Im thinking that my test score will reflect this lack of motivation completely. 
Now onto the ICU. I spent last weeks clinicals romancing the ICU. Walking in I was not looking forward to working there, when I first started in Nursing school I desperately wanted to work in the ICU, but after spending the clinical rotation in the L&D I have since decided that I prefer womens health care. The ICU is full of very sick people who often have poor prognosis, and I am very sensitive to that. Dying people make me cry. Their families make me cry. It is just too hard. And my guess was correct, it was very difficult. There is just so much emotion in the ICU, people are praying and holding on to their loved ones, Nurses are scrambling to complete each task and to truly keep their patients alive. Its so hard.
The strangest part wasnt that the emotional aspect was difficult for me, but that there was just so much noise in the ICU and I was having a hard time focusing. Not the people noise, but the noise from all the machines, the beeping of the IV pumps, the dinging of the OG feedings, the whooshing of the ventillators, the sucking of the wound vacs and hemovacs, through all that I was just really over stimulated. I never thought I would be that way. I love the noise of the ED (emergency department), I love the hustle and bustle of a busy night with a full moon on payday in the ED. Those are the best nights. I dont mind the noise of people talking, screaming, yelling, arguing, laughing, crying. THose are fine noises. But the lack of voice and over abundant amount of electronic noise was so….distracting.
I loved the Nurses that I was blessed to get to work with. Those nurses are super heros, they deserve so much credit and I would love to be considered to be brilliant enough to join their ranks, but I just dont think that I am cut out to be one of them. Its a sad realization. A sad end to dream. But I suppose these are the types of things that you are supposed to learn while you are in school.
And now the last of my topics, the annoyance of cravings. Baby is keeping me from eating. And when I do find something that I “crave” by the time I make that food accesible I can no longer manage to gag it down. Im tired and totally missing eating. Its hard to be nauseas all the time, its wearing on my nerves and while I feel like I should be enjoying every minute I am lucky enough to be pregnant with this baby I am torn by being bitter that I am so sick. The mixed emotions combined with the hormonal moods are making me cry.
This weeks goal is to pull my SHIT together. I will spend this week getting back to myself. This is a good thing for both me and the Baby. I cannot wallow in this bad attitude for the next 29 weeks. I cant.
What are your goals for this week?
Barbie hands and feet
At my appointment the other day the doctor took a quick peak with the ultrasound machine and while we were watching we were able to see the littlest hands and feet I have ever seen in my entire life. I wish I had pictures but his machines printer was not working. The heartbeat was 168 and the doctors commented about how much the baby was kicking!
The doctor said that once I start to really feel the baby move I am never gonna get any rest because he/she was just kicking up a storm!!
Only two more weeks until the NT scan and hopefully there will be some pictures then!
Now I gotta get headed to clinicals! Only 6 more clinical days left until this quarter is over!
When a photo is real…
Or better, when a photo makes things feel real. Thats how it felt when I saw the newest ultrasound. Crazy how a few images can make you catch your breath. There is a baby in my belly. A real, live, moving, heart beating baby. And we clearly saw it move, shake, wiggle, wave those little arm buds around and then listened to the sweet thud of its heart beat. Seriously that is the best sound in the universe.
I am a little disapointed that the Fibroid Friend (who shall remain nameless since I dont want it to stay) is still growing. Baby is measuring at about 1.5 inches and the Fibroid is 3 cm (2.54cm in an inch and that means that they are almost the same size). This is a vast increase from the last ultrasound where Fibroid was measuring just under 2cm. So assuming that it wasnt some measuring flaw last time (or this time) that means that the Dear Ole Fibroid has grown a serious amount in almost three weeks. This is annoying and concerning.
Atleast that explains the cramping Ive been having.
So what does this mean for Baby? Well, nothing for now. But if the Fibroid continues to grow and Baby continues to grow, it is going to be tight quarters in there towards the end. I have another appointment next week to discuss the ultrasound findings as well as to talk about the regular stuff. Ultimately Im trying to have faith that this will all work out.
As much as I am glad that this quarter it winding up and doesnt seem as time consuming as the last few, I almost wish I was doing my OB rotation now. I feel that I have such a better grasp of pregnancy and complications now, then I did in the fall quarter. Perhaps that is simply because of the amount of information I absorbed during lecture and now that I have the opportunity to put it into action it actually mean something. Maybe thats it.
Every day that goes by that I am blessed to be pregnant with this baby I believe more and more that my calling in life is to work in Womens health. I feel a drawing towards it. I feel like this is where I belong.
Are there moments in your life that make you feel drawn to something?
Nursing school midterm
I rocked my midterm. Only two little areas that she suggested I work on. I was thrilled! I am thrilled! It was the highlight to my yesterday.
I also finished and passed my final dosage exam! It was the absolute last one, and I am so happy that it is over.
This quarter is proving to be more challenging to me personally because of all the other things I spend worrying about. But academically I dont feel as pressured as I have in other quarters.
There are less than 4 months left until graduation and then its time for the BIG MOVE!
Dosage, midterm evals and the research paper
Today marks the quarterly dosage exam. For 5 quarters I freak out about this math test since I get horrible math anxiety and spend the week before it trying my hardest to relearn everything that I may have forgotten. Drop Factor, drip rate, Desired dose over dose on hand, etc. Every quarter I pass this exam with flying colors but spend days sick to my stomach about it.
This quarter is different. There are other things that seem so much bigger in the scheme of things (like dead babies, cramping, doctors appointments, and so on) so I studied a couple of hours but nothing like in previous terms. I take the test this afternoon so we will see if the new approach was effective. I feel pretty confident about it and I really hope that I did the right thing in maintaining my calm.
Tomorrow is my midterm eval for clinicals. I am really looking forward to this because I feel like I have been doing really well and really have the hang of assessment, diagnosis, planning, implementation, evaluation (ADPIE). I also feel like this quarter I have started to find my groove as a Nurse, I do my assessment in my own way. Its still systematic but instead of starting at the head, I start at the hands and got up and then back down to the feet. I feel that it gives the patient a little more “face” time with me before I start putting my hands on their heads. Im not saying its the best way to do things, but it works for me because I always start by shakking the patients hand and since I am there I can check pulses, cap refill, and strength. Im just happy that I found a way for me to make it work for me and still get all the neccessary things done. So I guess we will see tomorrow if my instructor feels like I am doing as well as I feel like Im doing.
I have a big research paper to work on this weekend. Not really excited about it, and even though I am still tossing back and forth about my topic I think I will just get on with it already. We were assigned the criteria to write the paper and the due date has to coincide with the topic we are discussing, and we get to pick the topic. I looked for interesting Neuro topics, but when the Neuro material was being lectured I was so busy with other things that I couldnt get it together. So we are now talking about Hematological stuff and I noticed that we didnt cover Hemochromatosis.
I had a coworker of mine who was diagnosed with Hemochromatosis a few years ago and I remember hearing and thinking how interesting it was. So I started looking into it and I think it would be worthy of my topic. Hemochromatosis an inherited condition where you absorb too much iron from food and it builds up in your blood. The excess iron causes damage to your liver, heart and pancreas and can lead to cancers, heart or liver disease and even death.
Interesting, right?
I think I find it the most interesting because I am iron deficient, and so the thought of having too much iron is facinating to me.
Alright, back to studying…..
Dealing with alcohol withdrawal
Working in just about any type of clinical facility you are likely to run into alcoholics and those who are going through withdrawal symptoms. I never really realized how dangerous withdrawal can be. It can be deadly. Amazingly the booze can kill you but so can discontinuing drinking abruptly.
I was talking with a Nurse on the unit today about a withdrawal patient and she was telling me about it is imperitive to ask patients if they drink and how often. And if it sounds like they drink frequently to push for how long it has been since their last drink. She said that sometimes she will even warn them about the importance by telling them that they can go into seizures and die if they go into withdrawal without the proper precautions inplace.
I knew a person a few years ago who was embarassed by his drinking and therefore lied to the doctors and nurses about how long it had been since his last drink. Sadly after 10 hours in the ER for an issue unrelated to ETOH and then being admitted and on the floor it had been about 20 hours since his last drink and he had a grand Mal seizure.
This poor guy wound up in Status Epilepticus secondary to alcohol withdrawal. Status Epilepticus is a serious medical condition that can be fatal.
Long story short, it is important as nurses not to pass judgement and to find a way to gain the trust and establish a relationship quickly with your patient so that they are willing to share this type of information. Never judge a book by its cover, just because the patient isnt a 50 year old homeless man with rotten teeth and booze breath doesnt mean that they arent possible alcoholics. Ask everyone. It can save a life.
And for those non medical folks, it is very important not to lie to your Nurses and Doctors. The information that they ask for is not because they are curious, it has a valid place in preventing serious complications.
And now, I step down from my soap box.
Happy Tuesday Everyone.
Being sick while in Nursing school
There are some things that just suck beyond belief, and one of them is being sick while in Nursing school. It is so hard to stay home and take care of yourself because you really cant afford to miss any of the classes. On the other hand, you dont want to go to school and contaminate the entire class room.
I have a low grade fever, cough, runy nose, congestion, upset stomach, and I am just exhausted. I would love to stay home but I have a presentation to do today for my Ethics class. Today is my long day of classes, a really long day. I hope I can make it through.
The second part of this that is annoying is that with being pregnant, there is almost nothing that I can take (ok there is, but it doesnt work). So I have to tough it out. And Im gonna whine about it. Alot.
The first day of Clinicals
Today is the first day of clinicals, and we are back to the Med/surg clinicals. This means that I am back at the Hospital with the sick people. No more fun OB patients, No cute peds patients. People are sick, very sick.
After going through the Renal portion of the lecture and hearing about End Stage Renal Disease, I can say that it is seriously awful when there is a kidney issue. Everything goes wrong when the kidneys go bad. I really never realized how important they were/are.
Strangely, this week Sweet Pea’s kidneys are formed and in just a few weeks time they will be functional. Its just kinda weird that we were covering the Kidney during the same week that this is the milestone. Crazy, huh?
Im a pregnant Nursing Student
Today is my first day of the quarter, its Winter quarter. Today I am 4weeks and 2 days. I have an entire day of classes, and only a short break for lunch.
This quarter is Ethics, Med/surg 111, and Med/surg clinicals. I dont start clinicals for another two weeks. But I am super excited to get started!
Yesterday was eventful in the pregnancy department. I was instucted to call and schedule an appointment with the OB doctor, they refuse to see me until after an ultrasound. I called my FP’s office and they said to call radiology and schedule an U/S. Radiology said that I needed to call my doctor back. And after like an hour on the phone, it hit 1600 and all the staff at the clinic turned into pumpkins. Typical of the Navy.
Up until yesterday I was really impressed with the care I was getting in regards to this pregnancy. Yesterday made me feel WAAAAY less secure. I sure hope that they are able to redeem themselves today.
Another Beta HCG will be drawn today, although I wont likely know the results until Monday. Keeping all my fingers and toes crossed!
So to all my reader mama’s tell me about how you found out that you were pregnant?
Grades…
I freaking rocked my grades this quarter! Including a 3.9 in my OB clinical! I am so jazzed! This quarter was so hard and I really am proud of how well I did!
Yippeeeee!! Time to celebrate!
A brief look at Nursing School year one!
During my first year of Nursing school I worked Full time and went to school full time, I did my Mental Health rotation and got to be restrained, and I learned alot in simulation including accessing Ports, Catherization, Chest tubes, IV’s, CVAD, and assessments.
Now here we are with 4th quarter just around the corner and I cant believe everything Ive learned…
What was the most important thing you learned in Nursing School?
Days away from the posting of grades
And I thought I should post about the most valuable thing that I learned this term. I learned that Children are extremely resilient. I also learned that a healthy child can bottom out in seconds, and a sick child will still smile at you even if they are incredibly ill.
Women in Labor can be the nicest people in the world, and the smallest gestures go a huge distance with this population.
I learned that all new fathers need praise, and reassurance that their babies wont get hurt from just being held.
I was told by my clinical instructor that she thinks I am a perfect fit for L&D. She said that I just have the personality for it. I was amazed. I love L&D.
What a great term, I almost wish it wasnt over. Almost.
Oh and the picture of the crabs…well it was just a picture from last summer that I found randomly!
Last day of peds clinicals
And I rocked my peds rotation!
Im so relieved that it is over. But yesterday we did a teaching plan for the kindergarten class on handwashing and it was so much fun that it makes me think I will miss this clinical more than any of the others.
Next quarter I am back in Med Surg and I am kinda excited. Mostly I am just shocked that I only have one more clinical in Winter and the Mentorship!
So excited!! Cant believe how close I am to the finish line!
And then after that its time to move. Another big adventure!
