I previously have [nearly] hated the teacher who was our clinical instructor. She was pretty alright this go around, I must admit. By the way...her last name starts with an 'A.' I think it is hilarious that the class sometimes calls her MRSA. (Mrs. A. MRSA is methicillin resistant staphylococcus aureus. A really bad infection causing bug. HA.) Now to see how she graded us last week.
I worked at a different hospital for this clinical and they have a really good team in ICU.
If you've never been to an ICU before, many are set up like this. Private rooms, secluded by sliding glass doors and/or curtains, with a dedicated table in front of each room for charting and for nurse perching.
My clinical experiences were with a woman who was heaven-bound in the throes of Septic Shock, who was very low on the Glasgow Coma Scale, a woman in CVICU post Femoral-Popliteal graft surgery, and a woman who let bronchitis/sinusitis go too long and ended up very dehydrated which caused Acute Renal Failure.
Thank god this very educated, prim and proper mother started hallucinating and talking about crazy stuff, or her kids may never have made her go to the hospital.
Lets see...what all did I see....
When you're dying of Septic Shock, you may third-space all of your fluids. That means fluids aren't in the veins (vascular space) and your kidneys no longer work (organ failure), so you're not peeing it out. So it seeps into your tissues until it weeps out of the skin or splits the skin. I was glad she was unconscious and had plenty of morphine ordered.
Fem-Pop graft surgery may change your life. If you have intermittent claudication (pain from lack of oxygen getting to your extremities) ask your doc about this surgery. My patient who had this was really doing well only 1 day post op.
Dehydration is serious. SERIOUS. Please don't kill your kidneys with infection and too little water, thanks.
If you do hurt your kidneys, I'll be forced to give you Sodium Bicarbonate. Heh, that's the same stuff as Arm and Hammer, you say. Yes, you're right, but putting that in a vein IV is pretty darn painful. The sodium bicarb is to help you not be acidic while your kidneys are unable to do that for you.
Not my patient, but saw a woman decompensate before my eyes. That was full blown Metabolic Acidosis, and she had no blood pressure. Pretty exciting. Everything was just like they taught us in class. Rapid, deep breathing (Kussmaul breathing) to blow off all the carbonic acid from the acidosis. We put her on her head (in bed, head lower than feet, "Trendelenburg" position) to try and get blood perfusion to her brain. She had a non-rebreather at 100% oxygen, and as they said, she kept trying to pull it off, saying she was smothering. We had to keep trying to tell her that she MUST keep the oxygen mask on.
The nurses got her going again, after the Hospitalist came down and ordered a couple of code-type drugs to be pushed. Except she wasn't in a code yet, so there were some questions. And then there was the almost-mishap in which the nurse pushed the med but did not flush the line after putting the med in the line...So the patient did not get better right away. Thank god she had fluids going and the fluids eventually flushed the medicine from the line and into her body.
It just goes to show how crazy things can get when a patient is circling the drain.
Oh, also, if you insert a PICC line into a patient, and the tip should be in an Atrium, and it ends up too far in, in a ventricle, you'll have a patient in V-Tach...one very small step away from getting a shock to fix the heart. 7 x-rays later and a pull-back on that line TWICE, the guy's heart quit with all the irritability and beat normally. Yay!
Also, when your mom was almost dying, treat your nurse with respect, you high-and-mighty-investment-banker types. You never know...your nurse may have been one, too.
Sunday, July 17, 2011
Sunday, July 10, 2011
A post to a friend about something I was glad to know I wasn't the only one was experiencing...
Originally Posted by XXXXXXXX
"... I felt clinically and scientifically neutral, I recognized it as a learning experience. However, another part wonders if it was normal for me to feel virtually nothing. Am I in shock, professionally mature, or just plain cold? I should mention that my behavior with new experiences has been very strong and I am always surprising my self. In nursing school I have seen, smelled and done some very nasty and gruesome things. Most of the time I was aware of what I was about to do or witness. I would panic at first and then tell myself its part of the job, just do it. When it came down to it, I have always done the difficult job as if on autopilot. When I was done, I would be surprised that I was not crying, vomiting, fainting, scrubbing my eyeballs etc. Maybe that strength is included in seeing the dead body? I am just confused about my experience. Any thoughts, comments, similar experiences appreciated."
Me:
I really REALLY appreciate your post. I can relate to the question of shock? maturity? cold?
I have recently been questioning myself, too, in regards to an afternoon in the med room with another nurse and an extremely dehydrated 2 month old. I was at first worried about participating in the cath and IV stick, and yet, when it was time to help position and hold him down, I went into auto-pilot, much as you mentioned. I felt nothing. (being honest.)
I came home and cried later...not because of my nursing actions, because I knew getting fluids running had already helped the little fella. I cried because I asked my husband, "What kind of monster doesn't hurt inside when doing a procedure on a baby?" And of COURSE, I didn't want the baby to hurt, but I knew that the end (re-hydration) justified the means (an IV start.)
Anyway, I fought the same feelings you're expressing about seeing the deceased and wanted you to know you're not the only one. It helps to just talk about it and debrief a little. We're not cold; we're doing our job and helping people...and many can't do what we do.
Hugs,
"... I felt clinically and scientifically neutral, I recognized it as a learning experience. However, another part wonders if it was normal for me to feel virtually nothing. Am I in shock, professionally mature, or just plain cold? I should mention that my behavior with new experiences has been very strong and I am always surprising my self. In nursing school I have seen, smelled and done some very nasty and gruesome things. Most of the time I was aware of what I was about to do or witness. I would panic at first and then tell myself its part of the job, just do it. When it came down to it, I have always done the difficult job as if on autopilot. When I was done, I would be surprised that I was not crying, vomiting, fainting, scrubbing my eyeballs etc. Maybe that strength is included in seeing the dead body? I am just confused about my experience. Any thoughts, comments, similar experiences appreciated."
Me:
I really REALLY appreciate your post. I can relate to the question of shock? maturity? cold?
I have recently been questioning myself, too, in regards to an afternoon in the med room with another nurse and an extremely dehydrated 2 month old. I was at first worried about participating in the cath and IV stick, and yet, when it was time to help position and hold him down, I went into auto-pilot, much as you mentioned. I felt nothing. (being honest.)
I came home and cried later...not because of my nursing actions, because I knew getting fluids running had already helped the little fella. I cried because I asked my husband, "What kind of monster doesn't hurt inside when doing a procedure on a baby?" And of COURSE, I didn't want the baby to hurt, but I knew that the end (re-hydration) justified the means (an IV start.)
Anyway, I fought the same feelings you're expressing about seeing the deceased and wanted you to know you're not the only one. It helps to just talk about it and debrief a little. We're not cold; we're doing our job and helping people...and many can't do what we do.
Hugs,
Saturday, July 9, 2011
Update 2 of 2
So I got to do 2 12 h shifts in the ER. LOVED IT.
There is such a swagger, a don't-stress-out-about-this-sh*t attitude there, and I was instantly in love.
When the floor realized they had a willing student, I got 8 IV starts and I hit 7. What a confidence boost!!!!! I've not started IVs in like MONTHS, seriously.
I learned how to do blood draws with the vacuum tubes, butterfly blood draws, and set up chest leads for EKGs. I gave injections, pushed a helluva lot of Dilaudid (super great/strong pain med), I coordinated with CT on people who were finished with their Contrast-Lemondade, and I discharged patients.
A total blast. I didn't have any patients who had extreme trauma, so I don't know how I would've been in that situation, but I did get to help set people up with severe chest/abdominal pain in the triage, slamming bp cuffs, leads, oxygen, you name it, on folks to determine where we're at. LOVED IT.
(side note: I also applied to the ER, but they are done hiring new grads there for the minute, and so they told me in my interview that they would be declining me on that. Fine. I've got a lot to learn; may be best to learn it in a less extreme environment.)
So for ER, they had us do 11a to 11p so we'd get to see lots. Because a lot of the best stuff creeps up in the night. ;-)
And it did. We had a tweaker who had rubbed all the skin off of his nose (crank-bugs, anybody?) but was there for a real reason; he'd had abd surgery a week ago, didn't rest after the surgery (tweaking!) and now has probable infection. That crap gets serious in a second. This was my miss in the IV department. Hard to hit a vein when they are all burnt up and gone.
We had another suspected psych/tweaker who claimed to have suicidal ideation...who was bored and decided to put an insulin syringe in her vajayjay. *sigh. Really? The on-call doc spent 15 minutes trying to convince a nurse to do the pelvic exam, lol.
The verdict? NOTHING. I know, right?
Anyway, I love the craziness, the crazy people, and the fast pace of the ER. Maybe I'll work there some day.
Which almost brings me up-to-date. In between all the good stuff I've posted about, I've been doing Med/Surg on a Bone and Joint floor. I actually like it quite a bit, but I do not want to do Med/Surg, really. Heh heh, looks like I don't have to, huh? (though I know that Sainted Big Dog Hospital is really bad about floating nurses from floor to floor, so I may do more than a little Med/Surg afterall...)
I had a day in Simulation Lab to learn how to hang blood and watch for transfusion reactions. I also got to learn Central Line care and how to do blood draws from Central Lines. Cool.
Now I'm in ICU. They save the most critical patients for last, and as you can imagine, that is the smartest way to do it for students. The crap I thought was hard 7 months ago doesn't hold a candle to 1:1 care of an acutely ill person in ICU.
My first week of ICU was this past week and my little old lady was pretty much palliative care only. (YES. = comfort care only) So I got off easy the first week. No, I'm not happy she was almost dead, I'm just saying I was able to get all of my nursing tasks and my mountain of paperwork that Ms. Acute Care teacher requires each shift.
Poor patient. You name it, she had it, and she finally just couldn't fight anymore. She had cancer and the treatments pretty much left her susceptible to the really CRAZY sh*t that only people with full-blown AIDS get. In a week's time, she'd gone from just ill and confused, to completely unresponsive to anything but pain, and only then would moan. She was in Septic Shock, which at that point, you have multi-organ failure...and you usually don't come back from that. So I kept her weeping extremities dry and bandaged, and kept her morphine coming, and that was pretty much my day with her. I had lots of time to do the stupid paperwork for my instructor.
PRECEPTORSHIP
So that is the final block in the wall, the final jewel in the crown, ha. Pick someone in nursing to follow around. I have a friend who is a Nurse Practitioner, and she was an easy choice. She works in Internal Medicine and huge practice and it was REALLY neat to follow her Friday.
We saw a crap-ton of upper respiratory/sinus/ears problems (for which I have a crap-ton of steroid shots), a case of Bacterial Vaginosis, a huge mass on a shoulder, and a 40 something woman who is rapidly losing her ability to breathe. She got a CT - hope I get to see the follow up on that.
Monday, I'll follow a doctor's RN from the same practice (thanks to my NP buddy for setting that one up) as she makes hospital rounds. I have really wondered about how that works, an RN making rounds...as opposed to a Nurse Pract.
So I've got RN hospital rounds and a pee test to look forward to tomorrow on my 'day off,' and then 3 12 hour days in the 60-degree ICU, followed by another day shadowing my NP friend on Friday. Busy week.
There is such a swagger, a don't-stress-out-about-this-sh*t attitude there, and I was instantly in love.
When the floor realized they had a willing student, I got 8 IV starts and I hit 7. What a confidence boost!!!!! I've not started IVs in like MONTHS, seriously.
I learned how to do blood draws with the vacuum tubes, butterfly blood draws, and set up chest leads for EKGs. I gave injections, pushed a helluva lot of Dilaudid (super great/strong pain med), I coordinated with CT on people who were finished with their Contrast-Lemondade, and I discharged patients.
A total blast. I didn't have any patients who had extreme trauma, so I don't know how I would've been in that situation, but I did get to help set people up with severe chest/abdominal pain in the triage, slamming bp cuffs, leads, oxygen, you name it, on folks to determine where we're at. LOVED IT.
(side note: I also applied to the ER, but they are done hiring new grads there for the minute, and so they told me in my interview that they would be declining me on that. Fine. I've got a lot to learn; may be best to learn it in a less extreme environment.)
So for ER, they had us do 11a to 11p so we'd get to see lots. Because a lot of the best stuff creeps up in the night. ;-)
And it did. We had a tweaker who had rubbed all the skin off of his nose (crank-bugs, anybody?) but was there for a real reason; he'd had abd surgery a week ago, didn't rest after the surgery (tweaking!) and now has probable infection. That crap gets serious in a second. This was my miss in the IV department. Hard to hit a vein when they are all burnt up and gone.
We had another suspected psych/tweaker who claimed to have suicidal ideation...who was bored and decided to put an insulin syringe in her vajayjay. *sigh. Really? The on-call doc spent 15 minutes trying to convince a nurse to do the pelvic exam, lol.
The verdict? NOTHING. I know, right?
Anyway, I love the craziness, the crazy people, and the fast pace of the ER. Maybe I'll work there some day.
Which almost brings me up-to-date. In between all the good stuff I've posted about, I've been doing Med/Surg on a Bone and Joint floor. I actually like it quite a bit, but I do not want to do Med/Surg, really. Heh heh, looks like I don't have to, huh? (though I know that Sainted Big Dog Hospital is really bad about floating nurses from floor to floor, so I may do more than a little Med/Surg afterall...)
I had a day in Simulation Lab to learn how to hang blood and watch for transfusion reactions. I also got to learn Central Line care and how to do blood draws from Central Lines. Cool.
Now I'm in ICU. They save the most critical patients for last, and as you can imagine, that is the smartest way to do it for students. The crap I thought was hard 7 months ago doesn't hold a candle to 1:1 care of an acutely ill person in ICU.
My first week of ICU was this past week and my little old lady was pretty much palliative care only. (YES. = comfort care only) So I got off easy the first week. No, I'm not happy she was almost dead, I'm just saying I was able to get all of my nursing tasks and my mountain of paperwork that Ms. Acute Care teacher requires each shift.
Poor patient. You name it, she had it, and she finally just couldn't fight anymore. She had cancer and the treatments pretty much left her susceptible to the really CRAZY sh*t that only people with full-blown AIDS get. In a week's time, she'd gone from just ill and confused, to completely unresponsive to anything but pain, and only then would moan. She was in Septic Shock, which at that point, you have multi-organ failure...and you usually don't come back from that. So I kept her weeping extremities dry and bandaged, and kept her morphine coming, and that was pretty much my day with her. I had lots of time to do the stupid paperwork for my instructor.
PRECEPTORSHIP
So that is the final block in the wall, the final jewel in the crown, ha. Pick someone in nursing to follow around. I have a friend who is a Nurse Practitioner, and she was an easy choice. She works in Internal Medicine and huge practice and it was REALLY neat to follow her Friday.
We saw a crap-ton of upper respiratory/sinus/ears problems (for which I have a crap-ton of steroid shots), a case of Bacterial Vaginosis, a huge mass on a shoulder, and a 40 something woman who is rapidly losing her ability to breathe. She got a CT - hope I get to see the follow up on that.
Monday, I'll follow a doctor's RN from the same practice (thanks to my NP buddy for setting that one up) as she makes hospital rounds. I have really wondered about how that works, an RN making rounds...as opposed to a Nurse Pract.
So I've got RN hospital rounds and a pee test to look forward to tomorrow on my 'day off,' and then 3 12 hour days in the 60-degree ICU, followed by another day shadowing my NP friend on Friday. Busy week.
July 2011, already? Update 1 of 2
Gotta do another 'catch-up' entry.
I helped welcome the new Accelerated BSN class at my university. Can't believe that almost a year has gone by and now I'm giving info to the next hopeful and excited class. ;)
I gave them good info like BUY A PARKING SPOT (super limited at my university), actually study, etc. It was fun.
I applied to 6 jobs. I applied to 2 jobs that are an hour away, one in Respiratory nursing, another in Transplant. Hey, shoot for the moon and be happy with a star. 3-4 weeks later, got the ol' rejection email.
I also applied for a job at St. Jude Children's Research hospital. Super glad that I was "not selected." I got to spend 2 days at my state's own research hospital, and while is is an AMAZING hospital, and a ridiculously AMAZING with kids, I hate it. I'll go into the whys sometime. :)
I applied at a local hospital's One Day Surgery/PACU. It was only a part time position, but I REALLY loved PACU (see above posts) so I thought, "hey, good foot in the door." Yeah...still haven't gotten a call from them.
Which leads me to Sainted Big Dog Hospital. They told us in a recruitment luncheon, that they would be actively pursing our class of Accelerated students, and she wasn't kidding. I applied on a Friday night and received a call Monday morning at 9 am!!!
The Interview
I interviewed the following Friday. Talked to the HR/Nurse Recruiter lady for an hour about my past work experience, best parts and worst parts of me, times when I was able to work through conflict, yadda yadda.
Guess she liked me. She had me watch the Big Dog customer service expectation video, and when it was over, retrieved me from that room, handed me a packet of drugs and calcs to know for an exam, and asked if I had time to meet the manager of the Unit I'd applied to. ErrrrmYES.
So she walked me up the hill to the hospital and to that Unit and I had another interview on the spot. This manager seemed REALLY cool. A really great conversation, even if I *did* get a little excited in talking with her. She seemed not to mind, and even commented that she thought that I was very much a people-person (indeed!).
The verdict? She offered me a 7p-7a position right on the spot. YAY!
I'm going to be working the Clinical Decision Unit. It is a unit for people who aren't sick enough to still be taking up real estate in the ER, but the docs/nurses aren't comfortable with sending them home just yet, either. A lot of it will probably be late night chest pain, and holding them until AM for stress testing. That's ok by me. Manager says that they TRIED to have this unit in the past, but it really just ended up being an overflow. They shut it down, did the research, and are trying to do it right this go-around. I think that is why they brought her on board; to start it.
So yay, I think I'll be able to see a lot and see it fast in this unit, and I'm SUPER excited to already have employment.
Tomorrow, I go in for the obligatory pee test, physical, hand in my mountain of paperwork and copies of cards (cpr, social security, etc) and take my darned meds/calc test. I am fine at dose calcs but it does make me nervous.
They are giving a huge leeway. You can make an 80%. Which I can't believe, because you're technically killing or harming 20% of people, but it definitely is in my favor.
I told my classmates on our private group page on Facebook that I had a position, but I'm not announcing to the world until tomorrow is all done.
I helped welcome the new Accelerated BSN class at my university. Can't believe that almost a year has gone by and now I'm giving info to the next hopeful and excited class. ;)
I gave them good info like BUY A PARKING SPOT (super limited at my university), actually study, etc. It was fun.
I applied to 6 jobs. I applied to 2 jobs that are an hour away, one in Respiratory nursing, another in Transplant. Hey, shoot for the moon and be happy with a star. 3-4 weeks later, got the ol' rejection email.
I also applied for a job at St. Jude Children's Research hospital. Super glad that I was "not selected." I got to spend 2 days at my state's own research hospital, and while is is an AMAZING hospital, and a ridiculously AMAZING with kids, I hate it. I'll go into the whys sometime. :)
I applied at a local hospital's One Day Surgery/PACU. It was only a part time position, but I REALLY loved PACU (see above posts) so I thought, "hey, good foot in the door." Yeah...still haven't gotten a call from them.
Which leads me to Sainted Big Dog Hospital. They told us in a recruitment luncheon, that they would be actively pursing our class of Accelerated students, and she wasn't kidding. I applied on a Friday night and received a call Monday morning at 9 am!!!
The Interview
I interviewed the following Friday. Talked to the HR/Nurse Recruiter lady for an hour about my past work experience, best parts and worst parts of me, times when I was able to work through conflict, yadda yadda.
Guess she liked me. She had me watch the Big Dog customer service expectation video, and when it was over, retrieved me from that room, handed me a packet of drugs and calcs to know for an exam, and asked if I had time to meet the manager of the Unit I'd applied to. ErrrrmYES.
So she walked me up the hill to the hospital and to that Unit and I had another interview on the spot. This manager seemed REALLY cool. A really great conversation, even if I *did* get a little excited in talking with her. She seemed not to mind, and even commented that she thought that I was very much a people-person (indeed!).
The verdict? She offered me a 7p-7a position right on the spot. YAY!
I'm going to be working the Clinical Decision Unit. It is a unit for people who aren't sick enough to still be taking up real estate in the ER, but the docs/nurses aren't comfortable with sending them home just yet, either. A lot of it will probably be late night chest pain, and holding them until AM for stress testing. That's ok by me. Manager says that they TRIED to have this unit in the past, but it really just ended up being an overflow. They shut it down, did the research, and are trying to do it right this go-around. I think that is why they brought her on board; to start it.
So yay, I think I'll be able to see a lot and see it fast in this unit, and I'm SUPER excited to already have employment.
Tomorrow, I go in for the obligatory pee test, physical, hand in my mountain of paperwork and copies of cards (cpr, social security, etc) and take my darned meds/calc test. I am fine at dose calcs but it does make me nervous.
They are giving a huge leeway. You can make an 80%. Which I can't believe, because you're technically killing or harming 20% of people, but it definitely is in my favor.
I told my classmates on our private group page on Facebook that I had a position, but I'm not announcing to the world until tomorrow is all done.
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