Thursday, September 25, 2008

Clinical Difficulties

Well, it appears my nursing care plans are not quite up to par of what is expected. What is expected? I'm not quite sure actually; I think I fit the parameters of the assignment to the tee. However, I've scheduled extra time with my nursing instructor on Monday to hone some care plan writing skills and my assessment skills.

My assessment skills are another matter all together. I forgot to turn in my assessment at the end of class so my instructor was stating that my assessment skills were weak; however, I think the assessment, when I did turn it in, was much better than my previous one. I'm waiting on an email from my instructor to confirm whether or not this assessment was adequate. I hope it is; I documented everything. My assessment tool is a 12-page packet of papers covering absolutely everything about the patient. I hope I don't need work on this too; I'd really only rather have to have one thing to work on.

I've always been a straight A student, so being told my papers are not acceptable is something I'm not used to hearing. I got a friggin' 31 and 32 on the ACT exam in the English sections! I'm beating myself up pretty bad about it, but I'm not giving up; my clinical experiences thus far have pretty much forged in my mind that is the career I want to have, no matter what.

My clinical Wednesday went well. I spent lots of time with my patient assessing him, interviewing him, teaching him, helping him and working with him on various things. The highlight of my day was when two physical therapists came up to me asking for help. They wanted me to help a 600lb+ lady stand for the first time in months. I operated the electric Foyer lift to help get her in position, lowered it, and helped her stand. She was so happy she started to cry and everyone in the PT room was applauding. Definitely a moment that will stay with me. Forever.

Wish me luck thought, I guess I'm not doing as hot as I thought.

Friday, September 19, 2008

Hospitalist Thinks NPs are "Uneducated"

Check this blog out: The Happy Hospitalist

I've chosen nursing as my particular profession. I'm in school and eventually I'd like to become a Family Nurse Practioner (FNP). This particular blog is really rubbing me the wrong way... is this how I'm going to be seen by doctors? A substandard care provider? Uneducated? Will my 7+ year education mean absolutely nothing to the high-and-mighty physician?

My personal experience with NPs has been positive. I had a back injury a few years back, and I was under the care of a CRNP in my neurosurgeon's office. Saw my neurosurgeon for maybe 30 seconds after a total of 3 office visits. My CRNP was great, knowledgeable, and he even read my MRI. He suggested an appropriate course of action and followed up. He filled out my short-term disability forms for free and very quickly. And I formulated this opinion before entering nursing school; in fact, it was one of the driving reasons for me to decide on nursing and not PA school.

However, I love how this guy throws out comments about his superiority:

"I know the value of my medical education and experience and how that compares to the education and experience of a nurse."

" There is not a lot beyond basic single step medical decision making that I would place my trust in."

"Would I trust them to be a hospitalist? Never. Not even close."

Do you think this an ego trip? I think so. Honestly, I know a few RNs I'd let do surgery on meand I know physicians I wouldn't want taking my temperature. And vice versa.

Medicine and nursing seem to be at each other's throat. Medicine says nurses don't have enough schooling to give primary care. Okay, understandable, but when community colleges offer 2-year Physician Assistant programs, I think that statement may be a tad on the hypocritical side.

Nursing Neglect Damages My Father's Hand

Restraints are very important for intubated patients. My father had a ventilator a few weeks ago when he was admitted to the hospital with complete respiratory failure due to his case of extreme CHF. He, of course, had soft wrist restraints to prevent an accidental extubation.

I'm not arguing the importance of the restraints, in fact, I'm glad he had them on. They may have saved his life. However, when I visited him, I found that one of his restraints was so incredibly tight that it was cutting his wrist and his hand was more swollen that I have ever seen anything and I know that I need to be able to fit two fingers between the wrist and the restaint , so I loosened them so I could barely fit two fingers and I alerted the nurse.

Well weeks later, he's back in the hospital. His hand is in so much pain, he literally is screaming in agony. He's been sedated with morphine for days now. He may have lost use of his hand permanently, though last update I got, he was able to move his fingers a bit. There was massive nerve damage in his hand.

Guess what the hospital diagnosed him with? Carpal tunnel syndrome. It couldn't possibly be related to his wrist restraints being on too tight, even though the pain happened after his hospital visit and he had no pain before the hospital visit.

I'm planning to complain to the board of nursing, and I plan on consulting a lawyer. I am happy they saved my father's life, but I am very upset that his hand is all but useless due to gross neglect.

Remember... check restraints every hour, or more if possible. Or you might end up like my father.

My First Clinical

Clinicals went well the other day, and most importantly, I know I'll never have another first clinical day ever!

I was oriented on the building some more, and it was kept fairly simple. I took some vital signs, had some conversation, did a small assessment of the skin, helped with a bath, and that kind of thing. I was so nervous about going in and talking to a patient and touching them for the first time, but it ended up not being a very big deal at all. My least favorite part of my clinical experience, believe it or not, was sitting around and talking about while my favorite part was actually getting up and doing it.

I royally screwed up my first care plan and I forgot to assess my patient's bowel sounds (very important because he has gastric ulcers). I didn't check my manual blood pressure reading with the automatic blood pressure manual to verify its accuracy (since the whole blood pressure cuff thing is new to me; even though I did pass my skills test on it). I know what to do, and what not to do when I go back next Wednesday, which I hope to do a full head-to-toe assessment on my patient and see if he has any, as of yet, undiscovered pressure ulcers which wouldn't be much of a surprise considering the particular facility I am doing my clinicals at.

My patient is a really cool guy and I'm happy he's my first one. He's in good spirits, nice, helpful, and even willing to allow my fellow students that are not assigned to him to poke and prod on him as well. He has an AV shunt in his arm, and it was my first experience listening through the stethoscope to such a sound. I compared it to sheet metal being moved and flexed to which my clinical instrcutor responded that she had never heard it described that way and I let her know that she definitely would've heard that comparison if she'd had more male nursing students! Feel the "thrill" and hear the "brewy" is what she called it.

I was distrubed by quite a number of things I've noticed which I think just aren't right. Most irritating of all, is that I think we can do a little better than hoisting our PVS patients into a geri chair and parking them about 2 feet from the threshold of their door. I mean is there any socialization? Stimulation? Just because someone can't do for themself, there's no reason in this world to park them wherever so you can meet the bare minimum for a federally required standard. There's no way to tell, at least for a nurse, how alert someone is, even if they are considered PVS, so why not find out from family members what kind of music she likes? Television shows? Movies? We're parking our elders in hallways because we assume they don't know what's going on. And that's wrong. I don't care if you think that meets the legal requirement; in no way, shape, or form, should that meet our ethical and moral standard. I'm here to help people; not take the easy road and do less work just because I know that a patient can't complain about my morally questionable behavior.

I hope I never become like the nurses that seem to have lost their caring for people; people near the end that need it most.

Tuesday, September 16, 2008

First Day of Preassignment

Ok, here's where the class is really starting to get going.

I was just oriented on the facility I am going to be doing my clinicals on. There is just so much information to take in; it feels like Niagara Falls trying to fit through a garden hose... I just can't take in information as fast as its being dished out!

Charting is definitely going to take some getting used to. I took my first look at a chart today and they are huge, and right now in my educational experience, very unorganized. This facility does not use computerized charting, and it is very difficult for me to find anything, however, my clinical instructor and the staff nurses all seem to move through this mound of paperwork effortlessly.

I interviewed my patient today and I thought I did well at this aspect. I gathered a ton of information just having a simple chat and I enjoyed talking to him/her. I am more worried about applying skills practiced on a dummy to real, breathing human being. I'm less worried about patient care than I thought I would be and way more worried about charting and documentation than I thought I would.

Time will tell... tomorrow is my first clinical.

Friday, September 12, 2008

Brutal!

Nursing school is certainly brutal. I've only been in a classroom setting so far, but there's tons of material to cover and even less time to cover it in. As I've said before, I don't think anything is extremely difficult, it's just quite a bit of moderately challenging work. Topics that I've been practicing so far:
  • Stethoscope use to listen to heart, breathing, and bowel sounds.
  • Locating all pulse points.
  • Making an occupied bed.
  • Repositioning patients.
  • Moving patients from bed to chairs.
  • Lifting patients up in bed.
  • Psychosocial nursing diagnosis with an emphasis on stress and coping.
  • Nursing care plans with a focus on a self care deficit.
  • Taking accurate blood pressures.
  • Oral care.
  • Bed baths.
  • Urinal placement and use.

These items were the focus of this week. I've spent eight hours a day for the last three days doing this. Also I've been maintaining a 40+ hour work week at my current job at a major wireless carrier. I've been very tired lately

On the brighter side, all my hard work finally got me a little perk. I was given an invitation to join Phi Theta Kappa, the international honor society of the two-year college. I'll get put in a database of honor society graduates, I'll have a special seal on my degree, a pin, a membership card, and I'll even get to be participate in a commencement ceremony!

I also was asked to join a men's nursing club locally at the college and help recruit more men into nursing. I think it's awesome how great things are coming together; I just hope I can handle the stress of this extremely demanding program plus the demanding needs of my current job.

On Tuesday, I will be attending my first preassignment and Wednesday my first clinical. I'm very excited and not nearly as nervous as I thought I would be. I think I'll be tired, beaten, worn out... however, for the first time I think I'm going to make it through just fine.

Friday, September 5, 2008

First Two Days of Nursing School

Wow, nursing school is cool! Difficult, I can attest to that, but very interesting.

When I first got to my class, I found out that I was one of four male nurses in a class of sixteen: well above the national average. My instructor, a woman, welcomed all the men and told us that we were as welcome in her class as any other and the other instructor, who mainly deals with our clinical skills, is even a member of the American Assembly for Men in Nursing. So the whole male thing will pan out very well this year I think!

I've learned about several important topics the last two days; this course is fast-paced and includes many different types of education, including online, skills, clinicals, etc. Below are my current lecture topics about nursing I have studied so far:
  • The Nursing Process
  • Nurses in History
  • Legal Issues with Nurses
  • Nursing Ethics
  • Critical Thinking in Nursing
  • Maslow's Hierarchy of Needs
  • Basic Nursing Care Plans
  • Basic Nursing Outcomes
  • Nursing Diagnosis
  • Basic Nursing Interventions

My skills labs were a bit different. As of right now, after only one skill lab, I have learned the following:

  • Isolation Procedures
  • Proper Handwashing Techniques

GLOW GERM liquid was put on our hands prior to handwashing to show how bacteria still live on us, even after proper handwashing techniques have been employed.

Next week will be much more intense. The classes are interesting and I actually enjoy going to them. Looking at my syllabus, I don't think anything is really that incredibly difficult; just very time consuming. I'm totally engrossed in the lectures though... they are very interesting and I'm enjoying this class more and more as the days go by.

My first clinical day will be 9/17/08 and my first preassignment will be the day previous to that. That's when things will get really interesting!

Tuesday, September 2, 2008

Class Starts Tomorrow

Ok, class officially starts tomorrow, and I am officially nervous.

In addition to my Nursing 101 class, I will be taking an online blass, BIO120, Clinical Nutrition. I had my orientation today. Same old stuff; all the online classes are formatted similarly. I usually do well in these so I am not too incredibly worried.

I just hope this whole thing works out. I'm excited, nervous, and scared all at the same time. I've worked in my job for nearly seven years; I haven't been the new guy for a very long time. I'm used to being the veteran but tomorrow marks the day I'll be as rookie as they come...