Slacker

Wow, I have slacked with this blog. My apologies. In my defense, nursing school takes up a lot of time, but in my...not-defense, I kind of forgot about it. I promise I'll get caught up over the summer, which begins in T-minus 18 hours.

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!

First Day of Psych Clinical

Well my first day of psych clinical was a week later than the rest of my group’s – the night before what was supposed to be my first clinical, I randomly got sick and spent the entire night in the fetal position with the worst abdominal pains I’ve ever had, afraid to move for fear of throwing up. Needless to say, I had no business being 1) around non-sick people and 2) on my feet for 8 hours. Luckily my clinical instructor was really understanding and let me make up what we did while I was already at clinical instead of coming in another time. For the majority of the last month or so, every time I’ve thought about my psych clinical it has been with intimidation – and even though that hasn’t completely gone away, it has been further alleviated by experience; I think not knowing what to expect was a large contributor to my apprehension. We talked with the patients we were assigned for about an hour; my girl was shyer than I expected and didn’t really elaborate much on the questions I was asking, which made it pretty hard to get a good assessment. In her defense, I can’t empathize in any way with her situation, so I can’t imagine talking to stranger after stranger and living somewhere like that away from my family. I felt like some of the things she said were rehearsed from having told so many people, but I do think I connected to her, at least a little bit. She actually said she wanted to be a drug/alcohol counselor in the future, which, if true, shows that she knows she's capable of getting herself out of the situation she's in; I hope with all my heart that she makes it there some day. We also sat in on the treatment team, and it was really interesting to hear the nurses, doctor, social worker, etc. talk about where each patient had come from and what their plan with them was. But as interesting as all of it was, it was mostly sad; talking about how many of these kids had come from abusive homes and/or from a family with a lot of history of mental disease, I couldn’t help but think that these poor kids didn’t stand much of a chance at normalcy. The cycle seems to be perpetuated over and over, and I wonder (though I hope not) if the children of some of these patients are going to be in the same situation 18-20 years from now. It’s just really frustrating and eye-opening, especially having come from such an easy childhood; I literally called my mom as I was leaving and thanked her for always being there for me and, although no parent is perfect, doing a pretty damn good job. I just can’t imagine how people can abuse or neglect or not actively love their children, and I certainly can’t understand people who abuse the system and provide another shitty environment for these kids who just deserve a decent chance. I don’t pretend to understand why some people (like myself) are born into wonderful, loving families, while others are born into the situations they are; of course I’m grateful that I’m the former, but it doesn’t seem fair. I’m not going to make any definite decisions until I’ve experienced more, but I’m keeping psych nursing in the back of my mind. I’m still a little intimidated by the boys, since they are all bigger than me and there are more of them, but I definitely had a good experience this week and look forward to what more I can learn.

Psych (not to be confused with "sike!")

Let me start off by saying how much of a psychology nerd I am...if it weren't for nursing, that's what I would have majored in. I wish I had had time for more psych classes because I just think it's the coolest. Anyway. No matter how excited I am to geek out about psych-related things once again, I will admit that I'm really intimidated by psych in a clinical/mental health situation. It only made matters worse when we received information about how we can't wear our scrubs because they intimidate the patients, and we can't wear jewelry or our hair down because we could get injured by the patients. Um, College of Nursing, if what I wear is that big of a deal, aren't you concerned with the distinct likelihood that I'm going to say something to upset a patient? My fears were simultaneously alleviated and worsened by our orientation at the facility; although I realized that these people deserve to be respected and treated like human beings so it's not fair for me to be scared of them, it was intimidating that a huge majority of the patients (although "pediatric") were easily bigger and most likely stronger than me (no matter how much I like to think that I'm scrappy). My group will be at a state mental health facility specific to children. I'm trying to keep an open mind because, for all I know, psych could be where I end up working in a year and a half. Orientation just meant we went over the basics, some of what to expect, and the rules (oh and basic self-defense maneuvers. Yeah). It seems like this experience is going to be mostly observational; we're going to observe the children in their interactions with others as well as to interact with them ourselves so we can get a better idea of how to assess and talk to and work with patients such as these. As one of the nurses we talked to put it, "Every nurse is a psych nurse first." No matter where you work (and especially if I end up in the ER), one of the first things you do with a patient is assess his/her mental state, which requires experience and familiarity with psych. I think once I get over the initial insecurity/intimidation, that it will be a really interesting, rewarding experience.

End of the First/Start of the Second

I've heard that the first semester of Upper Division is the hardest, and I really hope that's true. Despite working harder than I ever have in my life (I've always worked hard in school, but, until this semester, I knew I could work hard, but not too hard, and still get the grades I wanted), I now feel more strongly than ever that this was the right choice. The burnout for the semester was unbelievable, and by exam week, admittedly, I was kind of done; somehow I managed to keep my GPA above my goal of a 3.5, and I feel I learned more than I did in high school or the first 2 years of college.
The second semester is made up of two clinicals and their lectures, along with a couple of other classes. Half of us take psychiatric/mental health nursing this semester, while the other half takes pediatrics/obstetrics; we'll switch next semester and take the other so that everyone gets the same clinicals. In addition to psych or peds/OB, we all take medical/surgical nursing. Those of us in psych have room for one nursing elective (either genetics or emergency preparedness) and, because of my interest in disaster response kinds of things, I enthusiastically chose emergency prep. We all also have a skills lab for med/surg in addition to the clinical and lecture times, and an online research class (which I'm already forgetting assignments for because it gets put on the back burner. Ah crap). I think it will be another challenging, busy semester, but I'm even more excited about what we're going to learn than I was last semester. Here's to learning a lot, having fun, a still graduating with honors!

Patients

Due to HIPAA (Health Insurance Portability and Accountability Act), I can't ever discuss the details of a patient's medical history, treatment, etc. with anyone besides the other healthcare providers working with that patient. That being said, I can share certain things with family, friends, etc. so long as I don't say the patients' names. I have talked and will talk more about the procedural aspects of nursing school and about what we're doing in regards to my life, but I wanted to take a minute and talk about, not the medical aspect of these patients' lives, but the human aspect. As even a nursing student, we're given an amazing opportunity to be let into people's lives and to really talk to them and get to know them; that's probably the main reason I chose nursing over being a physician, and I'm more than thrilled to see that it's already coming into play this early in my career. Even though it's only necessary to look in their chart for what's medically relevant to our patients, one thing I really like knowing personal details about the person so they feel like a human being instead of just a diagnosis and a list of meds. It's so easy to see the patients in the nursing home just for what they are now - old, broken down, sick, but these people's lives are just as complex as ours. They were our age once, and have done so much more with their lives than sit in a nursing home. One of my patients was in the Air Force, and probably fought in at least one war; it was odd because when you picture military, you think of men and women in the height of their physical strength and capability, but now that he's older, it's hard to imagine the man that he was. One of my favorite patients was born in Germany (in the same area where my family is from, actually) so I loved talking to her about it; then she told me she hadn't been home in 30-something years, and I tried to imagine what it was like the last time she went. Then I remembered her date of birth; she was my age when World War II started. I never did ask when she left Germany, but I imagine it was before or during the war, and I tried to imagine how I would feel, at my age or younger, leaving my country because of a war in our backyard. I would have liked to talk with her about it, but I didn't know how bad of a memory it was; if she hasn't been home very often, maybe it's because she wants to forget. I just would love to see through her eyes how different the world is now versus when she was my age. Another lady was in a similar situation, (she was never my patient so I didn't talk to her long), but from Italy. She, like the other lady, had just a hint of an accent in her English, which I absolutely loved. She told me about how she ended up in the nursing home after a car accident but also said she was grateful that her body was what failed her instead of her mind. She told me about her late husband who had remained in great physical shape all of his life, but his dementia got so bad that all he could remember was his name and Pearl Harbor. He didn't even remember his wife (he recognized her as a friend, but not as his wife), but he remembered what had happened to him at Pearl Harbor. That really stuck with me because I'm sure the same thing will be said about 9/11, which happened in my lifetime and which, since I was 11 at the time, I'm still processing. It just really put things into perspective and made me realize how complex people and life are. One thing that all of the patients told me was to "stay young and beautiful." Every time they said it, I would laugh a little, but in a way, it's great advice; I realize it's not actually possible to avoid aging (celebrities: that means stop trying), but seeing how much of a struggle it can be to simply get out of bed or walk or feed yourself had made me appreciate my health and youth so much more. Youth and life are so fleeting, so I plan to make the most out of it while I can; the worst thing in life, I think, wouldn't be to die young, but to be 80 years old, feeling like I wasted my life or didn't make the most of what I had when I had it. I hope not to ever be in a nursing home, but if I am, I want to be as inspiring to the nursing students taking care of me as my patients were.