Impatience (10-29-2008)

I am so frustrated with this place in my nursing journey. I know I am in a transitional position and I suppose that perspective is the only thing getting me through, knowing that this too shall pass. Right now I am at the point where my head is full of knowledge and I have to learn to transfer what I know… to what I do. (Easier said than done.) Nursing is one of those things that you can read about your entire life but until you actually “do” a procedure on a real life unpredictable patient you really don’t know it at all. That is why I understand we need to be tested and tried. Coming back for our second year it feels a little like our instructors have just pushed us in the pool and are watching from the bleachers to see if we sink or swim. And I get that. Right now if we sink they can rescue us, we still have backup. Soon enough it will just be us against the tide. Understanding however doesn’t always bring comfort.

         Now we are working in the hospital on the Medical-Surgical floor. This is the real testing ground in my opinion. We have done specialties such as Long term care, Pediatrics and Obstetrics but here you get people with all kinds of problems, here you have to understand it all. Here you have to know how each piece of the puzzle ripples its effects on to the next piece and the next piece. With each patient you have to look at them holistically. If they have come in for a knee replacement, I can’t just focus on their knee. They have had surgery so I have to take into consideration all their pre and post operative needs related to the surgery itself. How will anesthesia and pain medications affect this person? Will it make them lethargic, constipated, or nauseated? How do their medications in the hospital interact with the ones they take at home? I have to look at their current overall health. Do they have a chronic condition such as diabetes, heart disease, or asthma? How will that affect their care? What kind of surgical wounds will need to be treated? How strong is their immune system, how soon will they heal? What are their nutritional needs? What will the treatments and their health conditions do to their electrolyte balances and therefore their kidneys, their liver, their heart? How will being immobile affect them? How will I ensure they are safe when they do begin to walk post-surgery? How is their psychological outlook? Do they hate being in bed, or do they want to lie there and whine for days? How is their cognition? Can they understand my teaching and care for the surgical wound when they are discharged? What about their social situation? Do they have support for recovery when they are ready for discharge? The answers to these questions and more determine my patients care and in turn their outcomes.

                While I have been reminded that I know a lot, I also know there is a chasm of things I do not. It is that portion that strikes fear in me. I am not generally a fearful person, but when you are this close to having a person’s health and well being in your hands I think it may be healthy to have some fear. I want to reach the point where I have a balance between reverence for the responsibility I take on and confidence in my knowledge and ability to care for my patients. I have concluded that the main source of my current frustration stems from my lack of experience. So for now I will try to remain patient, choosing to believe that confidence and comfort will come. For now I will try to focus on the opportunity I have to learn and spend my efforts soaking up all that is presented to me that will in time shape the nurse I will become.

I am so frustrated with this place in my nursing journey. I know I am in a transitional position and I suppose that perspective is the only thing getting me through, knowing that this too shall pass. Right now I am at the point where my head is full of knowledge and I have to learn to transfer what I know… to what I do. (Easier said than done.) Nursing is one of those things that you can read about your entire life but until you actually “do” a procedure on a real life unpredictable patient you really don’t know it at all. That is why I understand we need to be tested and tried. Coming back for our second year it feels a little like our instructors have just pushed us in the pool and are watching from the bleachers to see if we sink or swim. And I get that. Right now if we sink they can rescue us, we still have backup. Soon enough it will just be us against the tide. Understanding however doesn’t always bring comfort.

         Now we are working in the hospital on the Medical-Surgical floor. This is the real testing ground in my opinion. We have done specialties such as Long term care, Pediatrics and Obstetrics but here you get people with all kinds of problems, here you have to understand it all. Here you have to know how each piece of the puzzle ripples its effects on to the next piece and the next piece. With each patient you have to look at them holistically. If they have come in for a knee replacement, I can’t just focus on their knee. They have had surgery so I have to take into consideration all their pre and post operative needs related to the surgery itself. How will anesthesia and pain medications affect this person? Will it make them lethargic, constipated, or nauseated? How do their medications in the hospital interact with the ones they take at home? I have to look at their current overall health. Do they have a chronic condition such as diabetes, heart disease, or asthma? How will that affect their care? What kind of surgical wounds will need to be treated? How strong is their immune system, how soon will they heal? What are their nutritional needs? What will the treatments and their health conditions do to their electrolyte balances and therefore their kidneys, their liver, their heart? How will being immobile affect them? How will I ensure they are safe when they do begin to walk post-surgery? How is their psychological outlook? Do they hate being in bed, or do they want to lie there and whine for days? How is their cognition? Can they understand my teaching and care for the surgical wound when they are discharged? What about their social situation? Do they have support for recovery when they are ready for discharge? The answers to these questions and more determine my patients care and in turn their outcomes.

                While I have been reminded that I know a lot, I also know there is a chasm of things I do not. It is that portion that strikes fear in me. I am not generally a fearful person, but when you are this close to having a person’s health and well being in your hands I think it may be healthy to have some fear. I want to reach the point where I have a balance between reverence for the responsibility I take on and confidence in my knowledge and ability to care for my patients. I have concluded that the main source of my current frustration stems from my lack of experience. So for now I will try to remain patient, choosing to believe that confidence and comfort will come. For now I will try to focus on the opportunity I have to learn and spend my efforts soaking up all that is presented to me that will in time shape the nurse I will become.

True Crime in a Small Town

True Crime!

I am aware there are pros and cons to living in a rural area. I think that the low crime rates may fall into the pro column. Here is a list from the local police blotter recently printed in the newspaper.              

(Seriously…you can’t make these things up)

You dirty bird!

A (address given) family reported the theft of an expensive birdbath on the 18th.

Mystical furniture

A (address given) man reported that a week prior to the 16th, someone took his lawn furniture. When he returned the furniture was back in place.

Man was on the moon? Surely you jest!

A (address given) woman who called 911 on the 15th was annoyed to find that the operator had her address and wanted to know how that was possible.

On the 8th day, he called the cops

A (address given) man called police on the 15th to point out that he owns the entire river and people are trespassing.

Not so Comcastic

A (address given) family reported getting a bill from Comcast for $ 2, 989.07 on the 14th. They do not have service from the company.

Colonel Sanders would put them in a bucket

A (address given) family called to report chickens roaming in the yard eating flowers and seeds on the 11th. They wanted to know what they should do with them.

Java Junkie

Police reported a man with a flashlight looking in the windows of an espresso stand at 3 a.m. on the 23rd.

Death Wish Dude

Callers on the 11th reported a kid on a skateboard cruising down the middle of (address given) blocking traffic and flipping drivers off.

Beware of Campers

A (address given) woman reported that a man stole a sleeping bag from her garage sale on the 13th and was seen running into the woods.

The Difference 120 Years Can Make (10-22-2008)

Duties of nurses in 1889

The list starts out, “In addition to caring for your 50 patients, each nurse will follow these regulations:”

1. Daily sweep and mop the floors of your ward, dust the patient’s furniture and window sills.

2. Maintain an even temperature in your ward by bringing in a scuttle of coal for the day’s business.

3. Light is important to observe the patient’s condition. Therefore each day fill kerosene lamps, clean chimneys and trim wicks.

4. The nurse’s notes are important in aiding the physician’s work. Make your pens carefully; you may whittle nibs to your individual taste.

5. Each nurse on day duty will report every day at 7 a.m. and leave at 8 p.m. except on the Sabbath on which day you will be off from noon to 2 p.m.

6. Graduate nurses in good standing with the director of nurses will be given an evening off each week for courting purposes or two evenings a week if you go to church regularly.

7. Each nurse should lay aside from each payday a goodly sum of her earnings for her benefits during her declining years so that she will not become a burden. For example, if you earn $30 a month you should set aside $15.

8. Any nurse who smokes, uses liquor in any form, gets her hair done at a beauty shop, or frequents dance halls will give the director of nurses good reason to suspect her worth, intentions and integrity.

9. The nurse who performs her labors and serves her patients and doctors faithfully and without fault for a period of five years will be given an increase by the hospital administration of five cents a day, providing there are no hospital debts that are outstanding.

Poison Ivy (5-31-2008)

I am itchier than a kid at summer camp who rolled in poison ivy and then applied a poison sumac cream after taking a bath in poison oak. *sigh* I want it to be Summer soooo bad. Like now. Today would be good. Yesterday would be even better. I am not drooling over warm weather, beaches and sunscreen. I am not whining about the long winter or the rainy spring. I just want to be done with school for a little while. I want to get up in the morning and think..”hmm what shall I do today?” I want to say to my children for once, “yes, I do have time to play with you!” I want to put my computer away and only use it to pay bills and occaisionally check my email for messages from out of state relatives, because I will be staying in touch with local friends and family with no need for convenient email conversations. I want to go for walks, play in the sprinkler, have water fights in the back yard, and picnics in the front yard under blanket tents the kids made. I want to go to the library and read frivolous little books that make me happy and require no memorization whatsoever. I want to cook for my family and keep the laundry caught up. (OK…maybe not the laundry one..I hate laundry and let’s face it, I will not want to do laundry no matter the season.)  I want to relax on my front porch listening to the birds as the sun goes down. I want to water my plants, weed my flowerbeds, and give my rose bush the attention it needs. I want to drink gallons of iced tea, and have watermelon seed spitting contests from the back deck. I want to drive all the way to Forks with the window rolled down and the music turned up because Sydnee read about the town of Forks in a book. I want to have the time to be grateful for the things I have, the life that the swirls around me, and enjoy the people that I love. So…yeah I am itchy. But it won’t be long summer is almost here and it’s going to be a good one.  

Who Wrote This Test? (3-20-2008)

Who wrote this test??? Dick Dastardly?

So, my final in Ethics today?? So many questions were ambiguously written at best which I find ironically borderline unethical. A great example:

Who wrote the Code of Ethics for Nurses?

A: The NLN

B: The ALA Board of Directors

C: The ALA with input from other nurses

Now…A can be easily eliminated as I know it is written by the ALA. But the other two? I make the educated guess that they would ask for input from other nurses.

After the test I peruse my copy of the Code of Ethics and believe it or not on the third page in between copyright/publisher info is a list of “contributors” to the publication. There is a list of about 12 nurses with multiple little letters after their names. The first 5 say “Board of Directors” after all the other letters and the other names are starkly bare without this distinction. So, in short I picked the right answer.

But what kind of question is that? I get I should know the ALA is responsible for this collection of wisdom, but how many of them sit on the board of directors??? Why not just ask me to name the third nurse down in alphabetical order including their favorite song and whether or not they enjoy walks on the beach and good wine? Grrrrrrrrrrr

I feel confident I passed the class overall and the final (as crappy as it was). So I am going to stop venting now, and let it go. Time to focus on the Nutrition final for tomorrow. Maybe they will ask me how many Carbs Regis Philbin consumed last Thursday while dining with Donald Trump and David Letterman in a helicopter overlooking a spacious golf course.

American Idol (3-12-2008)

      Seeing as my name is not Simon, you probably don’t care at all what I think, but I love American Idol. I don’t watch too much TV but American Idol makes me happy. It just does. Some years are better than others, some contestants excite me more than others, but it is always interesting and fun to watch. So now we are down to the top 12…Last night was songs from McCartney/Lennon how cool is that?

So, Chikezie…he has a good voice, a Luther Vandross feel that I like, but every week for me he has been completley boring. Until this week. He came out with this fun, different, upbeat performance and I was like..Oh..that’s who he is? Now I like him much better. I hope he keeps that up. Cause smooth smoky Luther will get old real quick.

David…little cute sweet David. He is adorable no doubt. I think Paula said she wanted to “pop his head off and hang it from her rear view mirror” he was so cute. (Seriously, she needs to get off the pain meds.) He is very good too. His voice is much deeper and richer than you would expect. So far every week has been interesting and somehow special. This week he was advised to pick up the pace and stop with the ballads. He did, and it didn’t go well, he even forgot some words. He will recover though and be around for a long time I think.

 

David…rocking David. I love him! He sang Lionel Ritchies ’Hello’ on 80’s night, but he rocked out with his guitar which I could never have imagined would work, but it was really cool. He is just the real thing. If he went home tomorrow someone would snatch him up and record him the next day.

David…girlie David. I am not a fan. I loved his version of “Papa was a Rolling Stone” that was good. But then he sings Celine Dion and Whitney Houston songs. I don’t know. He hits the notes and all but….eh?

Jason…sweet Jason. I love him! He has a very natural 70’s singer/songwriter feel to him. His smile is infectious and he just makes me happy every time he sings.

Michael…warm Michael. I really like him. He was originally my favorite. His Bohemian Rhapsody was great…and that is a hard one to do any justice to at all. To me though, while I like the tone of his voice very much, he has had pretty boring performances since then. I am waiting for him to do something exciting.

 

Syesha…long tall Syesha. She looks great and is technically great. She can belt a Whitney song with the best of them, but the thing is I couldn’t care less.

Ramiele…tiny little Ramiele. She is good. Suprisingly big voice for such a little thing. She has been playing it safe so if she wants to stay around I think she should do something big.

Kristy Lee…young Kristy Lee. She is ok, she is basically a Carrie Underwood type but no where near as good. This week she chose “8 days a week” and made it into this sped up fiddle and banjo laden Bayou thing. It was awful! Simon stated it well I think. “It was like Dolly Parton on helium” She should be going home soon. No worries though, she has a solid future in singing the National Anthem at a state fair near you.

Carly…Irish Carly. I love this girl! She reminds me of Ann Wilson. She belted out “Crazy on You” and it was amazing. I think she may well win it. If not she likely deserves to.

Brooke…sweet Brooke. I love her. I don’t know that she can win it, but I think she will go far. She has a very Carly Simon, Carole King feel. She always makes me smile.

Amanda…fellow nurse Amanda. I love her. I don’t think she will win either, but she will have a record deal no problem. She is so unique and so fun. I love the bluesy Southern rock style she has…and she’s quite a dancer too. Besides, I have to root for a fellow nurse right?

So, prediction time? Who is going home next? I am thinking Kristy Lee or girlie David. One can always hope right? Do you watch Idol? What do you think? If you missed it and you want to watch you can find the performances on youtube. =)

Rudeness Abounds (3-23-2008)

We have a good sized hospital…and an old one; in fact it was founded in 1918. I am sure when they originally built they could not foresee the future need for the additional square footage now in place, let alone the parking needs of the over 70,000 patients that come through the ER annually. I would have thought however, that more recent CEO’s and board members would have been able to keep up with the issue. Harrison has terrible parking issues. They recently added on a couple one level parking structures for the patients, which I am sure was well intentioned. However, I was there not long ago with my mother to visit a relative and we had to circle the hospital for 20 minutes before finding a spot on the complete opposite side of the building from where we wanted to be. The availability of parking for staff is no better. There are about 3000 employees and even if you split them up into 3 shifts that makes 1000 employee cars per shift. There are 9 different parking lots surrounding the hospital designated for staff, (Of course one of those is Doctors only) but they are all relatively small.

When we went to Harrison’s mandatory orientation we were told to park in ANY designated employee parking areas. We were given a lovely color coded map and told to park in ANY of the 8 green areas. So, being good little students we did as we were told.  In reality there are only 15 of us working at the hospital right now and many of us carpool. So our impact is minimal. On week one a nurse came up to me waving her finger in my face and accusatorily asked me, “Where did you park today?” I told her I had parked in the H lot. She told me that was for employees only and I shouldn’t be there. I explained that is where we were told to park, and then listened while she ranted about not being able to find a spot that morning and nearly being late for shift report. I dismissed the issue to her having a bad day and continued to park in lot H. Then this last week, 3 of us (who carpool due to the parking issue by the way) got out of our car and were walking into the hospital when an elaborately adorned  woman in her frilly paisley scarf pulled up to us in her BMW. “Excuse me,” she drawled, “are you employees of this hospital?” We answered her question (which she clearly already knew the answer to) explaining we were students. “Well, this parking lot is for employees only.” We then politely explained we were instructed to park here by the hospital. “I see.” she replied.  “It is just that some of my staff is having difficulty finding parking and I just wouldn’t want them to take it out on you.” The artificial concern in her voice was sickening. We dismissed the rude encounter and went on about our day. A couple of hours later I heard the overhead PA system paging “OC nursing instructor”. That is odd to hear and I wondered if something had happened to one of the students. A few minutes after that, my nursing instructor came to tell me if I didn’t move my car immediately it would be towed. After explaining that we carpooled she went and gave the news to my friend whose car the BMW driver had seen us get out of. Apparently this woman has clout, because she not only authorized my friend’s car to be towed, but she had security issue a new student parking policy to our instructors by the end of the shift. We received the same lovely colored map as before only this time it had one small spot circled and highlighted and it is the only place OC students are now allowed to park. This small square of gravel, by the way is probably ½ a mile away from the hospital. It is across the street from a teriyaki joint and a bank. So this winter when I arrive for clinicals in the darkness that is 6 a.m., I will be trekking uphill ½ a mile in the snow and ice just to get to the building. Then I have to wind through the maze of corridors and take two flights of stairs in two different stairwells to get to my floor on the complete opposite side of the building.

Truthfully it is not the inconvenience of the parking location that really frustrates me. What I don’t understand is why now? The parking issue is not new, the presence of OC students is certainly not new. The hospital clearly didn’t think we lowly students needed to be banned to the outcast lot. So this woman decided she wanted the parking space we had and took time out of her day to be vindictive. She has power so she got her way and now all future OC students will feel her wrath. I just don’t appreciate the attitude with which we were treated. I understand there is a hierarchy in a place like this and seniority can play a role, however that was not the issue here. The issue here was just someone with an attitude of superiority inflicting her desires on other people.

Lessons Learned (3-16-2008)

Wow, what a day today was. Wasn’t it just last week I was journaling about having patients who don’t need my help?  The day began with focusing on ambulating my patient, who no matter how much encouragement I gave refused to get out of bed. She quite proudly informed me with a big smile on her face that she was having a lazy day, and was too tired to even get dressed. This made completing my interventions a little difficult, so I was invited to observe a catheter change on another patient. The procedure went smoothly until the new catheter was inserted and the patient had nearly 900 ccs of urine fill the bag within minutes. The urine was not only high in volume; it was thick, white-ish in color, and opaque. It was assumed that his previous catheter had been clogged and a call was put in to his doctor to inquire if a urine sample would be needed.  The same patient needed both a bed bath and dressing changes as well, (and my patient was now napping) so I stayed to help the other students with bathing and observe the wounds. As we gathered supplies and begun the patients bath I noticed that we had correctly pulled his curtains for privacy but his window blinds were still open. I wondered to myself if we should close the blinds for privacy, but I dismissed the thought and we continued with the task at hand. Only a few minutes later the aid came in to check on our progress and immediately scolded us for leaving the blinds open stating that if someone saw it, she would be in trouble. We closed them promptly. I should have paid attention to my instincts and closed them earlier.

 

“Ideas pull the trigger, but instinct loads the gun.” ~Don Marquis

During the wound change I noticed that one of the students assisting was brushing up against the catheter bag repeatedly as she went back and forth to retrieve the supplies. It occurred to me then that she might be pulling on the catheter tubing. Not wanting to disrupt the flow of the procedure I waited until she was not busy to say something. I didn’t want to seem accusatory but I wanted to make her aware of her proximity to the equipment so I asked her to check on his output level. She reported that it was fine and I felt I had addressed the situation by bringing it to her attention tactfully. Only a few minutes later while positioning the patient the catheter was disconnected and fell on the floor at her feet. Urine began to flow out of the tubing and on to the patient and our instructor. The wound care nurse quickly clamped off the catheter until we could finish changing his dressings and reinsert a new sterile one. My inaction may have contributed to a situation which caused the patient to undergo invasive procedures which would not otherwise have been necessary. I should have been more assertive and voiced my concern to the other student clearly rather than subtly. My concern should have been focused on the patients well being over the students feelings.

 

 

Happiness hates the timid! So does science!” –Eugene O’Neill

 During the reinsertion of the second catheter the student was preparing to deflate the balloon. She was unsure of which port to use and asked if she had the correct one, someone said yes and only a moment later she attached the syringe and proceeded to draw up 10 ccs of urine. I had known from the beginning that she was using the wrong port. When she chose that one and another student agreed with her, I questioned my judgment and said nothing to the contrary. I should have had confidence in my knowledge, spoken up and told her what I knew, rather than stand by and watch her perform a procedure incorrectly.

 As it turned out the ensuing events were complicated further by the clamped tubing which then became occluded. If we hadn’t been able to fix the problem a physician would have had to be called and the patient would have been put through even more unnecessary procedures. All of this was likely preventable and I certainly learned some important lessons about trusting my instincts and not being afraid to speak up.  

 

 “A great deal of talent is lost to the world for want of a little courage. Every day sends to their graves obscure men whose timidity prevented them from making a first effort.”

~Sydney Smith

Surgical Observation (3-12-2008)

Wow…what an amazing opportunity we were given to observe! To begin with I was surprised to learn that the woman conducting the pre-operative interview was an R.N. I suppose the job just seemed primarily clerical in nature and so I presumed that she was not a nurse. Silly me! Although this woman was fairly young, I can see where this would be a great job for a nurse nearing the end of her career or a nurse who had a health issue that prevented her from being able to pull 12 hour shifts on the floor. Any nurse could choose this field of course, but the pace seemed more relaxed and the office chair pretty cushy! =)

The patient she was interviewing had quite a history. She explained to me after the interview that she had given him the abridged version because he was what they term a “frequent flyer” at the hospital. He is 56 years old, 5’4″ and weighs 269 lbs. He has diabetes with an insulin pump installed. He has a portable wound vac attached to the non-healing surgical wound on his abdomen he was about to have a skin graft done on. He has had 3 hernia operations. He has hypertension, high cholesterol, COPD, lung cancer which led to 2 of his right lobes being removed, “bowel cancer”, severe back pain, knee pain, sleep apnea, heart murmur, Hx of Congestive Heart Failure, edema in his arms and legs, sensory neuropathy in his hands and fingers, constipation, and depression. To top all of this off, he lives alone with his cat who recently scratched his thigh leaving a 4 inch open wound which isn’t healing either. *sigh* And yet this man who hobbled into the room short of breath with the aid of his cane, lugging along an insulin pump and wound vac….was surprisingly pleasant. He was chatty and polite. He was patient with the nurse who dismissed his concerns in the beginning of the interview and yet advocated for himself until she addressed the issue to his liking. He was happy to see me there, and applauded my career choice. He encouraged me to pursue my goals and said if I ever got to work with his doctor I would be extremely fortunate because he was the best in town. Somehow, he was making me feel good and I hadn’t done a thing except observe quietly jotting down notes in the corner. By all accounts, this man should be (and probably is) miserable. And yet his attitude was remarkable. He was grateful, patient, pleasant and polite. What a great example of the difference an attitude choice can make in a person’s life! I know I won’t soon forget him.

The first procedure I observed at the surgery center was a 50 yr old man having a routine colonoscopy. He was a little nervous of course, but his nerves came across in chattiness and humor. He is a single gentleman and a lifetime Navy sailor. During the nurses history it soon became apparent that he was a heavy drinker. He confessed that he used to drink 4-6 glasses of hard alcohol a day but had cut back when his doctor told him he had pancreatitis. The nurse very professionally asked how long ago he had cut back…”oh, it’s been about three weeks now I guess.” I watched her “nurse face” come on and she calmly said “o.k…and how much would you say you drink in a day currently?” “Only about 4 or 5 glasses of wine now.” He replied proudly. Her nurse face stayed glued on, but he began to get defensive as her questions continued. She very non-judgmentally explained to him that she needed the information only for anesthesia and medication concerns. He calmed down and soon the anesthesiologist came in to introduce himself and do his information gathering. He described the medication regimen he would be giving as a “cocktail”. Later after he left, the patient expressed concern to the nurse about having to drink the meds. He had just drank all the awful medications to clear out his colon and wanted nothing more to do with drinking medication for a while! Again, I saw her extremely professional “nurse face” come on as she explained that when the doctor said “cocktail” he didn’t literally mean a cocktail!

 

 

Lesson 1 of the day; How important it is to put on your “nurse face”! All I could do was envision the anesthesiologist bringing the patient (who was already lounging in a recliner not altogether dissimilar to a beach chair) a coconut drink with a little pink umbrella and some curly straws…”That’s it…just drink the yummy medicine and you will feel good in no time!” Fortunately for me, the patient had a good sense of humor and laughed at himself allowing me to crack the smile I had been squashing.

 I observed the colonoscopy which was somewhat interesting and then accompanied the patient to recovery. This is where I learned Lesson 2 for the day; Honesty may not always be the best policy. As he was becoming more oriented he began to ask me questions. Did I have fun? Did I see …um…you know…anything embarrassing? Like his rear end? (I assured him I saw nothing more than his leg) Then he asked me how long the scope they used was? I answered truthfully with a pleasant smile on my face…eager to be of service, that it was about 4 feet long. I think if he could have fallen out of a recliner, he might have. He jumped back in his seat, grabbed the arms of his chair and gasped. “REAALLY???”  I immediately began to explain that there are about 20 feet of intestine and so 4 feet really isn’t as far as it sounds. And that the scope has to follow the twists and turns of the intestines so it is not really going straight up as it might seem. He calmed down after that but I sure felt terrible. In retrospect an answer such as, “oh…not that long.”, would probably have sufficed. Fortunately, given his history of alcohol abuse he had to be given four times the amount of normal medication to be sedated, therefore I doubt the Versed will allow him to remember my oh so honest answer!

The second surgery I observed was not very interesting until I got to the recovery unit. I was unable to witness the pre-op portion and was told to go straight in to the OR with a different surgical team. I did as I was asked and throughout the procedure, which only lasted about 10 minutes, it was as though I did not exist. The surgeon and the anesthesiologist were, as cliché as it sounds, chatting busily the entire time about travel plans, preferred airlines,  and the best restaurants to choose once at the destination. I know this is not uncommon but to my eyes it seemed very nonchalant and crass. I was perfectly o.k. with them ignoring me, but it seemed they were ignoring the patient too and that really bothered me. I just stood quietly making a mental note to myself, (as the surgeon was suctioning blood out of the patients nasal passage and chatting about restaurant views) never to choose this surgeon should I need a procedure done. In the recovery room however, I met a wonderful nurse. She has been a nurse for 37 years and I really enjoyed watching her work. When she had done the most of her documentation, and the patient had begun to regain consciousness she asked me if I had any questions. She was kind enough to answer my questions and then she asked me if I had ever seen A-Fib on a heart monitor, and when I said no, she tore me off a piece of the paper strip and drew a normal rhythm at the end so I could compare and contrast it to the patients. She was also wonderful about letting me actually do small things to assist the patient. I helped her lift the head of the patients bed, get the patient water, hang his IV bag etc. While they were small tasks I think she knew that it made me feel better to do something rather than to just stand back and watch all day.

My final surgery of the day was a breast lumpectomy. It was here I learned the most. During the pre-op portion the patient continually referred to the wire in her breast and how miserable the insertion had been. I had never heard of the procedure so I was very curious what she was talking about. After entering the OR I got to see the scrub nurse setting up the sterile field and the anesthesiologist doing his work to help sedate the patient and make her comfortable. When he was not busy I asked him about the wire. He was eager to show me, and brought me to the light box to see her films. What I saw was breast tissue, a wire running through it, and a drawn on circle at the deepest portion of the wire. What I expected to see, was a lump, a dot, a white spot…something indicating the lump they were removing. The anesthesiologist said, “So, you see that?” I said I did, but really I didn’t know what I was supposed to be seeing at all. I felt so foolish. He then said, “See how the breast tissue all looks the same? How you can’t see the lump?” “OH, yes. YES I Do!” Whew! Was I relieved! He then explained the need for the wire so that the surgeon could find the exact location of the lump. Lesson 3 for the day; Don’t ever claim to see something you don’t!  The surgeon entered shortly after that and I was standing off to the side, behind the scrub nurse. I was trying to stay completely out of the way and yet still see something of the procedure so I repositioned a time or two. The anesthesiologist noticed my predicament and placed a stool at the patients head and brought me back to stand on it. He lowered the sterile drapes so I could lean over them carefully and look down on the surgery. It was amazing! I am so grateful to him for giving me that opportunity. The doctor then began to talk me through the procedure telling me what she was doing, and why she chose each technique. She could have taken short cuts but preferred to take a little more time to ensure as much as possible that the patient would be left with minimal scarring and dimpling from the removal of tissue. She showed me the lump as she took it out and explained how it looked benign to her. The circulating nurse immediately passed the specimen on to the proper staff who walked it next door to the lab as we watched out the window. While waiting the doctor asked me how many surgeries I had observed. I told her this was my first day, and really the first procedure where I had really witnessed a surgical technique. She said she was impressed that I had not fainted while standing on that stool. Personally I was thinking, if this makes you faint, why would you be here, in an operating room wanting to be a nurse? Lesson 4 for the day; Take compliments where you can get them. (Go me! I didn’t faint). She asked me if I wanted to be a surgical nurse, and I told her that while I do find it interesting, I want to be an oncology nurse. She remarked that it really takes a special person to work in that field. I was thinking, it really takes a special person to do what she does all day. The scrub nurse said she could never do anything like that, she was only suited for surgery. Lesson 5 for the day; It takes all kinds of nurses to provide complete care. Within minutes the lab had called to confirm the specimen was sufficient and upon first testing appeared to be benign to them as well.

I thanked the doctors once again for taking the time to teach me. I am so grateful for the kindness of everyone I encountered that day. My experience at the surgery center was very positive. From the warm greeting I received at the front desk, to the way the pre-op team made me feel like a part of things rather than an outsider, to the anesthesiologist who welcomed questions, to the surgeon who took the time to explain her technique and the rationale behind it as she worked, to the nurses who encouraged me and gave me advice in the recovery unit, I felt like a welcome participant the entire day. I found this was my best clinical experience by far!

1st Quarter Grades (12-30-2007)

So, grades…those little numbers and letters which bring with them so much anxiety.  I have tried to adjust my feelings on grades this quarter. I am so used to being  a good student and having the numbers be my proof of this. The numbers are how I monitor my progress. It is how I know if I need to adjust my efforts. They are important to me, but I am not a perfectionist as some have accused. I do not feel I “must” get any particular grade or score. I only hold myself to the standard that I know I am capable of and I try to be realistic. I am only hard on myself when I know I could have done better. One of my professors referred to me this quarter as one of those “structured types”. (She of course is a very “unstructured” type) I will accept that label. I am a structured student and I know it.

It was interesting to watch my classmates as the quarter wore on. I think many of us are high achievers and we have all worked hard to get here, but by mid quarter I was hearing (and occasionally repeating) things like “C’s get degrees!” and the ever popular “What do they call the doctor who graduates bottom of his class?…..Doctor!” The commonly spoken phrase when viewing test scores, was “Oh well, at least I passed.” So, I have tried to lower my own standards for myself accordingly given the difficulty of nursing school, but change like this comes slowly and I am far from mastering it.

As for actual grades, I did manage to pull off A’s this quarter, including four 4.0’s and five others ranging from 3.5-3.9. I was very pleased with my grades, surprised but pleased. I spent so much of the quarter focused on individual test and project grades I hadn’t looked at the big picture much. Also, a few professors didn’t give back grades on projects til the quarter was over so I had no idea where I stood until grades were officially posted.

During finals week I had to have an evaluation meeting with my clinical instructor. I think I was more nervous about this than I was the finals that day. It was supposed to be like a periodic job evaluation, you know..”Well, Mr. Smith, what do you think your strengths are? What do you think your weaknesses are? This where I think you need to improve” blah blah blah. I know some of my fellow students were specifically asked about strengths/weaknesses etc. so I was trying to prepare myself to answer those questions. Did I mention my clinical insturctor is a PhD, Masters in Nursing, a Nurse Practitioner on the weekends and a PSYCH nurse by specialty? So if I answer my weakness questions too strongly I will have self esteem issues. If I answer my strength questions too strongly I will have issues with realistlic self reflection.  I just hate being put on the spot in situations like this. I am not a good job interviewer. So I enter his office and sit down…rehearsing my answers in my head. He pulls up a chair next to me and opens up my clinical notebook to the grading rubrick in the front. He starts to add the individual totals and then laughs at himself when he realizes I got a perfect score all quarter and no math skills are necessary.  I was shocked! How could I get a perfect score??? I wrote a notebook full of papers and journals surely one point could have been missed somewhere. He watched me do a physical assessment on a patient, surely I missed some little detail? Apparently not in his mind. He went on to tell me that I am creative, and an excellent communicator both verbally and written. He said I had no idea how much he looked forward to reading my papers each week. How can anyone enjoy, (no matter how well written) a paper on growth and development? I just said “thank you” quietly after each compliment. I didn’t know how else to respond. He asked me about my future plans and I told him I wanted to go into oncology. He asked me if I planned to go on to get my BSN or MSN. I told him I was going to start working as soon as possible for my families sake but that I did hope to pursue more education slowly in a part time program. He was glad to hear that, and then told me that I am a “very talented woman with a great deal to offer” and that he would hate to see me stop here with an ADN from a community college. Finally, he said his only suggestion for me to improve upon in the future is to keep gaining new skills. For what seemed like the hundredth time I thanked him, and I left. He never once asked me my opinion of my strengths or weaknesses. Just 15 minutes of compliments and career advice. I was blown away. I am still humbled by the experience, but it does make me feel more confident going into next quarter, knowing that even though I often feel like I have no idea what I am doing…maybe I can do this after all, and not just do it, but do it well.

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