First Day of Med/Surg Clinical

Despite being initially reluctant to go to clinical on Friday (my friend Caroline was having her 21st birthday party, which sounded a lot more fun than essentially having class/work), it ended up being completely worth giving up my Friday night; I got to practice a lot of skills I had never practiced outside of simulation, and I feel like I learned a lot and performed pretty well. The patient I was assigned had multiple feeding tubes (a “G-tube” and a “J-tube”), a PICC line (basically an IV that goes directly into her heart instead of in a peripheral vein), a colostomy, and received a lot of medications; even though I was really sorry that someone had to be that sick for me to be able to do all of the things I did, I couldn’t help but be a little excited about what I was getting to do. I don’t know the patient or her family, apart from the few hours that I was working with them, but if I were ever in that situation, I think someone being able to learn from me would be one of the best outcomes, considering. I gave meds, like I said, in the PICC line through an IV push – only nurses can give meds IV push because they do go directly to the heart, so in the case of a med error, it would be far more serious of a reaction; it also takes a little more skill to give the meds over a minute or 3 minutes or 10 minutes or however quickly or slowly the order calls for. I had to flush the line with saline before and after each injection, so I got practice, in addition to drawing up the meds, in working with the flush and the PICC line itself. I also helped hang the formula for her tube feeding and got practice with the machine that controls the rate and flow of the formula; not having worked before this year, I can’t really say, but I’ve had several people indicate to me how much easier and more efficient some of the technology, especially with charting, has made nursing. I was also able to see a colostomy and watch it being changed, which was honestly good practice in getting used to some not-so-pleasant smells. One patient needed his catheter out so another nurse let me do that; it was really good because, even though I had put a catheter in, I had never taken one out, so now I feel more confident with both steps. Later in the night, a lot of patients needed injections of one thing or another, so I was able to give meds through 2 routes besides the PICC line – intramuscular and intradermal injections; I’ve done intradermal before, but it was my first IM, so there was another thing to get practice with. After how spastic I was on a weekly basis in fundamentals, I was really surprised at how not nervous I was performing the different skills; I wasn't cocky by any means, but I'm pretty proud of the progress I've made in just a few months. Honestly, the hardest part of the night was charting; it was kind of intimidating putting my name on something as serious as medical charts, but Maureen (my clinical instructor) reviewed it, and, having seen it once, I think I’ll better know what to do next time. The night went pretty quickly with all of the running around, but I did still have enough down time to work on my care plan; Maureen seemed pleased with all I had done and with what she saw of my care plan, so overall I felt like I was really “getting” this whole nursing thing. Even though it’s hard to give up my Friday night, it’s unquestionably worth it for the experience I’ll get and things I’ll learn; I was starting to question my choice to do DEU (Dedicated Education Unit - where you’re one-on-one with the clinical instructor instead of in a group of 7 or 8), but now I definitely think it was the right decision. It doesn’t hurt that Maureen and I get along so well, and I’m really looking forward to my semester in clinical!