Thursday, February 02, 2006

First Clinical Day

(To protect patient privacy, I will always change names of the innocent...)

Today pretty much went the way I thought it would:
0645: pt report. Wait, I don't know who my RN giving report is!
0703: Find nurse. Missed report.
0708: Find LPN. She's already been in my pt's room to DC his nightly tube feeding.
0712: Meet my patient.
0722: Meet my SN buddy for the day's pt in the next bed.
0728-0745: Attempt to find:linens, MARs, our preceptor. Not much luck.
0746-0835: Attempt cleaning my buddy's pt. He's bedridden, and we have trouble moving him around. Get a diaper under him, but needs to be slid down lower. No luck with this. We attempt to find the LPN. Again, wandering the halls. Preceptor arrives to inform us he needs to be repositioned. I brush his teeth. He cannot speak, and with the letter board signs to me "blue suction." I had not been told by my buddy he had trouble swallowing until now. Good times. Give pt "blue suction." Fortunately he waves off shaving: I might end up doing some bloodletting. I think he's scared of us two blondes. We do various ROM exercises with him, and then I ask him if he know any blonde jokes. I get a smile out of him.

0900: Standing vigilant next to med cart. Positioned here until my preceptor arrives to review my pt's meds. Fortunately my guy only has a Lidoderm patch and two other meds through a PEG tube, which he is able to do himself. My buddy SN's guy isn't so lucky. We wait for our preceptor until 0945. My pt shows me the PEG tube technique. The preceptor, and the pt's mother are watching my poor buddy attempt the feeding tube "juggle" with the meds. Her hands are shaking and she spills a bit onto the pt. As we leave, the pt's mother says "Thanks for the entertainment girls."

1000-1115: Various running around, not knowing where things are. Check with other students, whose pts are in PT or in for a shower. They are relaxing in the break room eating snacks. "It looks like you guys are having to work the hardest" one says with a mouthfull of chips, as we look for our LPN to show us the electronic hoister. She's having a break, too. Now we wait for her to come back. We get the hoist, and the batteries are almost dead. We (finally) get my buddy SN's pt into his chair and out into the reception room.

1135:lunch until 1215.
1215:post conference, where we go over care plans, etc.
1230: done for the day.
only 3 more weeks of this. Maybe by week 4 it will be flowing a bit better. Bit like a train wreck today.

My husband says, "this is what it is supposed to be like: you are a student. ..."

Monday, January 30, 2006

Fourth Year Nursing Students

They are just starting to do IV's around here during clinicals? Someone please help me to understand this..

We had a fourth year with us this weekend in our Emergency Department. I am an ED tech (as a paramedic.) As a tech, I routinely do things such as IV's, Foleys, dressings, OCL splinting, and various scutwork. She, as an experience nursing student, was well-versed in the five phases of nursing process, documentation, pharmacology, etc. But, as I threw the IV prep kit at her during a chest pain, her eyes got the "deer in headlights." She whispers "but I have never done this on a live person." OK, her RN preceptor tells me to walk her through it while she tends to the pt. He ended up being a very hard stick, but her preceptor and I made it her mission for the day to at least get a few sticks under her belt.

Now, I as a paramedic student, well into her second week of school, had to practice on another student. It is one of my fond memories of medic school-the part where I nearly passed out from my partner spending what I thought was minutes poking around inside my hand. Nice "hematomato" which took weeks to finally go away. So, where in nursing school do they take one of the more important aspects and throw it into the last semester, like it isn't important?

Well, what ended up happening, upon me offering my hand for some "poking time," our ED PHYSICIAN steps in (he must've been in an extremely good mood) and sits down. It's time for the SN to get her first IV. She looked like she was ready to cry. Three or four of us stood by her with encouragement. The doc directed it. BOOM, she blows through the vein on his left hand. Could've gotten about a 16 into that one, but we were gentle on him by picking a 22. It' OK, he offers his other hand. She didn't get that one either, but c'mon, first live stick on the doc, that'll stay with her forever! So, then it was my turn...I offer up my left hand, and then a few others get into the mix. By the end, we were all walking around with pink Coflex wrapped on hands and arms.

During this whole event I, too, was listening and learning to each one's advice. Everybody has got a bit of a different technique (but the basics are the same.) I have been struggling with my sticks (at about 50%) and have been attempting to figure out the day it is the "dive bomb", which I fixed, but there are other issues (like the "rolley veins", and my favorite at the moment, catheter size selection vs.vein size), and I am trying to get better. So, I do not criticize the SN, heck, no. The only way to learn in theis case is to DO. And, I am sill the information sponge. I am also seriously looking into some extra schooling-maybe a one day class or a day with the IV nurse? We'll see, I barely have time right now.....