Rori roars

Yesterday was our third clinical day. Last week most of my classmates had their own patients, but I had been on the cardiac floor with an LNA, so this was my first time with my own patient. It’s incredibly nerve-wracking to get a room number and a patient last name and have no idea what you’re going to encounter. But it was a good experience, all in all.

I got to listen in on my patient’s nurse receive report from the prior shift and I really appreciated that the nurse from the prior shift made sure to speak to us students as he was talking about the different patients we would be working with. My patient’s nurse actually had three students covering her patients, one other from my program and a girl from the local Catholic college, so I can imagine it would have been annoying for her, but she didn’t seem to mind at all and let us follow her around and ask any questions we may have had. Throughout the morning I got to know my patient pretty well. I felt bad for her, she was in so much pain and then ended up feeling sick to her stomach, but she was the sweetest thing, so worried about putting us out. She told us that she had wanted to be a nurse when she was young and she always liked watching what they did. I ended up getting to change the dressing on her IV site, which was pretty neat.

A big part of the learning process is working with the other students because we help remind each other of things we might have forgotten. Plus we get to see what each other’s patients are up to. And of course the patients teach us a lot, too. I was amazed at one woman who was going in for an amputation. You’d expect this to be a traumatic event in her life, but she was actually pretty chipper about the whole thing. After all the problems she had her attitude was one of, “Just take it off, already!” There was a woman last week who had had multiple surguries in her past and she was pretty matter-of-fact about it, too, even joking about how every time she came to the hospital she left with less than she came in with. Of course I don’t expect most or even many patients to face these things with that sort of attitude, but it definitely gives meaning to the idea of wellness within disease. We also had our second experience with a palliative care patient. The background was very sad… she was not an oncology patient but rather one who faced a sudden incident which was not going to have a happy outcome. What we have found most appalling about the two palliative care incidents we’ve come across is the seeming lack of the “care” part of the phrase. Our instructor suggested to the family that the patient’s nursing student could help to clean her up and they were so grateful mentioning that she always cared about her appearance and would want that to be taken care of. When the instructor and two of our students started her bed bath they found her cut underclothes still tangled around her, a BP cuff left on her arm, and a pile of sheets wrinkled underneath her. I don’t know whether this was the trauma department’s responsibility or that of the floor when she was admitted, but either way it’s no way to leave a patient, conscious or not. Perhaps the attitude is one of, “Well, why spend the time on daily care when she’s on her way out anyway?” But the family cares. The neighbors care. They want her spirit honored, even if her physical self is no longer able to know. We may not be able to save her, but we can make her exit from this world as peaceful and reverent as possible, can’t we? We can help ease the last memories for those close to her, can’t we? I wonder if we’re all going to lose this idealism. Whether, once we’re “real” nurses, we’ll get so wrapped up in prioritizing care that we will let these things slip that bother us so much now.

I felt strange being so close to death. I’ve never experienced that before nursing school. As the students were finishing up with this patient a priest was coming in. I’m not Catholic, but I know when the guy with the robe and the backwards collar shows up with the bible in his hand that he’s there to administer last rites and in a way seeing him there made it seem so final. Like, maybe there was a tiny shred of hope before that she would spontaneously recover. But in my heart I think that she was holding on until she had had last rites and her husband had returned. That was one out of two. It felt wrong and right at the same time. She was going to go peacefully, surrounded by those who loved her with her spirit prepared for the journey. Yet I could see the anguish of those around her. It’s times like that when I begin to understand more deeply why religion is so important for people. It puts a sense of peace and order to a process that is often anything but peaceful and ordered. Our brains may crave science, but how is the knowledge of the biology of death comforting? I’d say it’s the opposite. We need that spiritual side to be nurtured by the belief in the unknown, no matter what name we give to our invisible compass.

One of my clinical classmates forwarded this picture from our first day of clinical. Apologies for the quality, it’s actually taken from an (accidental) video shot…

So… apparently motivation runs out after about four weeks. Another of my classmates and I are sitting in the library during our four hour chunk of time between classes, time usually dedicated to catching up on work, and neither of us feels at all interested in studying. Never mind the two tests this week. Not sure if it’s just running out of steam, a sense of complacence from getting settled into the school routine, or (for me, anyway), not giving a damn about school because of other stuff going on. Well, not that I don’t give a damn, just have other things on my mind.

We’ve had two clinicals now. The first week was pretty hectic. I felt in the way most of the time, and more than a little incompetent. But it did feel good to actually be doing real stuff on real people. Last week another of my classmates and I ended up following a couple LNAs on the cardiac care floor, and I have to say that I feel a lot more confident with some of my basic skills now. I think I’ve finally got the BP thing down (that cuff looks pretty simplistic, but I managed to be incredibly confused when it came time to actually put it on someone), did my first rectal temp, and learned how to do blood glucose monitoring. The LNA I worked with was terrific. She was only 21, but has been an LNA since she was 16, works at two different hospitals (as well as waitressing on the weekends), and is applying to a couple ADN (associate’s degree in nursing) programs right now. She and the other woman obviously knew their stuff and were great teachers. The cardiac floor also seemed to be better organized than our regular floor. This week I’ll have a patient of my own. I’m not sure what all we’re able to do at this point beyond vitals and hygiene care, but I should at least be able to get into detail on what brought the patient in, how they’re being treated, etc. I just hope I get a good nurse… some seem happy to teach and work with us, others seem put out by our presence.

We got our grades for our pathophysiology/pharmacology paper and I ended up with an A-. Would’ve been nice to get the full A, but I’m not going to quibble, especially knowing that I totally blew the part about writing in APA (American Psychological Association) format, as did most of my classmates. Turned in my annotated bibliography last week and found out that people who have MS Office 2003 (or earlier) can’t open documents created in MS Office 2007. Yeah, way to go Microsoft. My professor was nice about it, though, and is going to mention the issue to the department’s technical support to see what can be done going forward. Otherwise I’ll just have to save everything as a 2003 version. We had our final medication calculation exam last week. We had to get over a 90 on it in order to pass the course, and most of us came out wondering whether we were all going to fail since there were a bunch of questions we weren’t expecting. Three questions ended up getting thrown out and I ended up with a 99. Phew.

This week we have our first pathophysiology/pharmacology test. We are taking it online and can do it anytime between now and Sunday night. Seeing as I haven’t studied at all… I’m thinking that it won’t happen until this weekend. Our professor assured us we should be fine. It’s 60 questions in 60 minutes, open book (though obviously with the time frame it’s best to actually have a good idea of the answers because there certainly won’t be time to look everything up) and will cover normal aging, pharmacology fundamentals, infection & antibiotics, the autonomic nervous system, and BP regulation (shock & hypertension). We also have our final exam in our health assessment and clinical nursing class on Thursday. After this week we’ll be at our clinical sites on both Thursdays and Fridays.

Other than that… I still need to call the senior center in Manch to set up my first visit with my “senior consultant”. I also need to start thinking about my analytic paper for my clinical inquiry class. I ended up picking alternative therapies for my topic and I think I’m going to discuss it from a cost/benefit analysis point-of-view. So I need to get working on that. And maybe, now that I’ve wasted a good hour or so, I should go start that now!

Another person from our class just sat down at our table and shared our general apathy. She’s being good, though, and actually doing her work.

Tomorrow my group will be the first to start clinical (the second starts on Saturday and the third was unable to get conference room space at their hospital tomorrow, so they’ll have to do their orientation at school tomorrow and have their first hospital visit next week). We found out today that we won’t be starting at 8am as originally planned… nooo, we’ll be starting at 6:30am instead! So… I have to get up earlier to drive the five miles down the road than I would to go the 40 miles to school. Does this make sense? Plus I have to factor in bus time since we’re required to park at a church parking lot a mile away from the hospital (though at least they HAVE a bus… far better than walking that mile!). On the upside, that means that we’ll be done earlier, so I can’t complain about that. More homework time (sad that I’m excited about homework time).

I’m feeling a wee bit fraudulent. Kinda like, “I’m not a nurse, and I didn’t even stay at a Holiday Inn last night. Mind if I poke you anyway?” It doesn’t help that our professors were all so excited this week that we were starting clinicals and were telling us all sorts of horror stories. Mmm… thanks, I feel better now (okay, in some ways it’s nice to know that a PhD was at the same point we are once upon a time and they made it through, but…). I’m trying to stay in my blissful state of denial at the moment. Well, not denial, just one moment at a time. Right now I must wash my socks for tomorrow. All I need to worry about right now is clean socks. That’s it. Don’t think about someone flinging a bedpan at your head (a la, don’t think about a pink elephant with purple polka dots).

Speaking of socks, I did buy myself some regulation socks today — we are supposed to wear navy or white, though I doubt that our clinical instructor is going to be going around lifting our pant legs to ensure that we’re compliant. For some reason I felt I needed new socks before I started clinical, though. Not sure if it’s to represent a new beginning or because I want to segregate the MRSA and VRE (those antibiotic-resistant bugs) clothes from the non-MRSA/VRE clothes. We had our Infection & Antibiotics unit in Pathophysiology/Pharmacology the past two weeks and I think it sufficiently freaked most of us out. This is made worse by the fact that, as students, there is nowhere for us to keep our things in the hospital, so we can’t bring a change of clothes with us. Ew… Makes me wish for some of those plastic seat covers they put on the driver’s seat when you take it in for service for the drive home from clinical.

Anyway, it WILL be nice to get into the hospital and actually make sense of all the stuff we’re trying to absorb in class and lab.

In other school stuff… did okay on the first two tests last week. The med calc test was pretty easy, the other one not so much, but at least I have a better idea for the next one… and I still beat the class average, so I’m not going to worry about it. We turned in our first paper on Tuesday and have an annotated bibliography due next Tuesday. I need to get cracking on that. Thankfully our workload for the other classes doesn’t seem too bad, so I should be able to dedicate most of my time to it. I am finally getting caught up technologically… I purchased Office 2007 yesterday. It’s weird. I’m used to 2003 and this seems kind of foreign to me. But I figured it was worth it to deal with the learning curve and have up-to-date software. It is SO nice not to have to use WordPad anymore for word processing… blasted piece of crap that was! Though it bugs me to no end how Microsoft-dependent we are. I still need to call figure out how to get my Palm software on this computer (I set it up on the guy’s computer initially). Guess I’ll call the vendor tomorrow or Monday to get that figured out.

Outside of school, my alma mater’s men’s hockey team will be playing two games locally this weekend, so I’m going to try to get to both of those. They had a really REALLY bad losing streak there for a while, but they’ve won their last three games (the last to a nationally ranked team), so I’m hoping they’ll come through for me this weekend. I’m hoping my current school’s men’s hockey team puts in a good effort this weekend, too. Their #1 national ranking was far too short-lived.

Week three and…

One bit of sad news: we lost one of our classmates. Not sure what exactly happened, but I guess she had some family issues and decided to withdraw. It was a bummer to me since she was one of the people I really enjoyed hanging out with. I just hope that everything is going okay for her and maybe she can start again next year.

Pathophys/Pharm: I need to write a brief (two paragraph) paper on Hashimoto’s thyroiditis for next week. Shouldn’t be too bad, I don’t think.

Clinical Inquiry: We had our first true Blackboard discussion this past week and the professor commented positively on one of my points. Go me! Passed in a draft citation for our annotated bibliography due in a couple weeks… I think I decided that my subject for that and the subsequent analytic paper will be on the relevance of hospitalists to nursing. Though “Information seeking & the internet” sounds pretty interesting. As does “Complementary therapies.” As does… oh, stop it, Rori, just pick one!

Care of the Older Adult: I started my reflective journal. This a bit fluffier of a class than I was expecting, but it’s interesting. One of the professors reminds me of one of my aunts.

Discipline of Nursing: Bah, theory be darned. Actually, I think it’s getting better. For our first assignment we had to interview an advanced practice nurse, so I contacted a woman my mom used to work for who is now CEO of a home health organization. It was interesting to get in touch with her after all those years and be able to talk to her as a future colleague. I think it surprised her to find out my age, though. For this week we have to write our own theory of nursing. Eep. That’s a rather tall order for a bunch of non-nurses… I’m guessing it will end up more politically correct and vague than what the traditional MSN students would write, but I’ll do my best.

Health Assessment & Clinical Nursing: We had our first medication administration quiz today. Seemed pretty easy. We also practiced drawing up injections and giving intramuscular injections on the dummies. Somehow giving an injection to a plastic dude doesn’t do much for my confidence in giving injections to warm, breathing, pain-sensing humans. Actually my confidence on any clinical skills is pretty much nil. Our labs are fun, but they’re not giving us much in terms of practice. I’ve heard of other schools where they practice everything on each other before going into a clinical setting, and I wonder if we’ll be terribly behind when we go out there. But our clinical instructors assure us that they’ll be there and that by the end of the semester we’ll each have three patients to care for on our shifts. Eep. Tomorrow we have our first exam on the other stuff we’ve been covering… not quite sure how to study for it seeing as most of the info seems like pretty common-sense stuff. Tomorrow is also our last Friday on campus… after this our Fridays will be in clinical. Eep!

Still feeling kind of disorganized. I’m not sure if this is part of the “grad school thing” or what, but it seems that there is no one repository for information for any of our classes. We’ll have some readings listed on Blackboard but then flip through the syllabus and find yet another course schedule with more readings listed on it. Then something will be mentioned in class that we’ll write down in our notes, only to forget that it was mentioned until one person mentions it the next week and the rest of us go scrambling to do it. A professor will decide to post an article at the last minute so even though you thought you had everything completed for that class you find out you were wrong. I’m not trying to be a whiny baby here. We know at this point in our academic careers that you just have to roll with the punches, but I know most of us spend a few hours a week just trying to figure out all the information we need to prepare for the next week… which is a couple hours I’d rather spend actually doing the work.

Oh well, at the very least it’s nice to be part of a group who is all going through the same thing, so we can vent to each other and help each other out when we need it. I’ll kinda miss seeing everyone every day after we split for our clinical sites!