Tuesday, January 26, 2010

Classes Really Ratcheting Up

Ok, so classes are really starting to up the ante!

Today will be my first preassignment (this is when I meet, assess, and develop a plan of care for a client before attending clinical the following day.) I'm going to a LTC (Long Term Care) facility here locally. This was the same clinical location I was at a year ago when I failed the first nursing course... and with the same instructor. The good news is that I think I have the expectations down fairly well, and think I will do well.

I do not think LTC is for me. With many mentally challenged and elderly patient, my plan of care will likely focus on mostly psychosocial things. I like IVs, medications, ongoing assessments, etc. I think I will do well, but only time will tell.

As far as skills, I've learned everything there is to know about IVs other than starting them. I can hang an IVPB (IV PiggyBack) bag and get the whole system running at the correct drip rate by gravity with a plastic roller clamp. It's very cool because during clinicals last semester I was not allowed to touch patient IVs, and most of my patients (who were hospitalized, i.e. acutely ill) had them. I'm looking forward to learning how to start them soon as well.

As far as skills, these are the official skills I've learned in the first two weeks of my second LPN semester:

  1. Full assessment (of course!)
  2. Applyinmg a dressing (dry and mosit-to-dry)
  3. Applying a pressure bandage
  4. Applying a transparent dressing
  5. Applying hydrocolloid, hydrogel, foam, and absorption dressings
  6. Negative pressure wound therapy
  7. Applying gauze and elastic bandages
  8. Applying an abdominal and breast binder
  9. Perform wound assessment
  10. Perform wound irrigation
  11. Performing suture and staple removal
  12. Managing wound drainage evacuation
  13. Surgical hand antisepsis
  14. Donning a sterile gown and closed gloving
  15. Preparing a patient for surgery
  16. Demonstarting postoperative exercises
  17. Performing postoperative care of a surgical patient
  18. Pouching a colostomy or an ileostomy
  19. Pouching a urostomy
  20. Catheterizing a urinary diversion
  21. Changing IV solutions
  22. Changing infusion tubing
  23. Changing a peripheral intravenous dressing
  24. Discontinuing peripheral IV access

Quite a few skills for the last two weeks. Throw in the fact I have about 11 one hundred question NCLEX-style tests and another class, and I'm pretty much swamped. The tests are body system specific Med-Surg tests, for example, Gastrointestinal - Med Surg.

I have another class called Nursing in Society; it's a little one credit, one hour once-a-week class to teach you about the LPN/LVN role and their legal and ethical responsibilities as a member of the healthcare team. It's basically like reading Chapter 1 of my Fundamentals book for an entire semester; not my idea of fun, but a definite gimme credit.

Thursday, January 21, 2010

New Semester, New Focus

Well, my second semester has started and I can tell it's going to be a difficult, but pretty cool semester!

First and foremost, I actually get to observe a surgery on 4/14 which will be awesome! I'm really excited about it; this will be my favorite part so far!

Now... the content of this course seems, as of right now, to be much more technical than the preceding course which emphasized the ADPIE nursing process, psychosocial issues, and a few various technical skills. This semester focuses on assessing for serious complications, technical skills, and a heavy dose of pharmacology.

I do better with technical stuff so this is actually good news for me! The first couple of days have been brimming with new material. We've basically covered the entire surgical nursing section of our course (pre-op, intra-op, and post-op) in a single 9-hour lab session. We needed every minute of that 9 hours too... everything from new ostomy care, removing sutures and staples, all the way to being alert for signs and symptoms of malignant hyperthermia from general anesthesia. It was quite an intense lab.

Theory starts tonight. I love my theory teacher. My teacher is a man (nice change of pace), is a NP, and reminds me of Yosemite Sam. His quote yesterday was, "Nursing school is a lot like falling down a flight of steps. There's lots of bumps, lots of pain, but you'll be at the end before you know it!"

I like people that take hard concepts and put them in the easiest possible terms. I think I'll get along with him just great this semester.

Oh, and I smashed my drug calculation test with a 100%. :)

Thursday, January 7, 2010

5 Reasons To Be A CNA Before Being A LPN/RN

I got an email asking me my personal opinion on becoming a CNA first before entering nursing school.

I'd like to say this: I think it's an excellent idea to be a Certified Nursing Assistant (CNA) before entering nursing school. There's several reasons I believe this:

  1. Getting over the awkwardness of touching people. I went into nursing school for the first time and the only job I ever had was a job as a sales representative. My touching experience was limited to handshakes. When I had my first patient, hell, even my first female nursing student, it was really awkward for me to touch them. You'll be doing quite a bit of touching your patients and getting over this hump as a CNA in clinicals is way better than being an LPN/RN student experiencing this awkwardness for the first time. You really need to be thinking about what your instructors are saying and you really need to get as much learning from your clinical as possible.

  2. Develop an immunity to gross things. Fact: nursing is gross. You will see all bodily fluids. Guess whose job it is to clean it up? Usually the nursing assistants. When you go into your role as a nursing student for a patient, you definitely don't want your gag reflex acting up. When you are a student nurse, you are the client's nurse and nursing assistant. Whether you are a CNA student, a nursing student, or even working as a CNA, it pains me to say this, but you need to be used to cleaning up bowel movements and urinary incontinence. Remember, on clinical day, nearly everything you do will be observed by your proctor and you don't want this on your evaluation. Just take it in stride; hopefully one day you will be delegating the poopy cleanup task. You need to come into nursing school with the ability to to look objectively and professionally at someone who needs to be cleaned up; making faces, gagging, or acting inappropriate is incredibly embarrassing for a patient who, more often than not, is absolutely mortified that they need your assistance at all.

  3. Get some healthcare experience! Just being around it helps. Quite a bit. As a CNA, I was taught all the basic CNA stuff (bathing, ambulating, dressing, etc.) and some more technical things (IV removal, urinalysis specimen procedures, post void residual bladder scans etc.) and it made that material second nature when I learned it again in my first semester of nursing school. I work overnights as a CNA and I heard a nurse griping about the previous shift giving a patient Lasik right before bed giving him obvious nocturia (that's night time incontinence; see I did remember something from my first semester!). Well, next time I was in class, the instructor suggested we give our patient's diuretics earlier in the evening. It's like my job and my school complement each other... at times. Textbook rules seem to go right out the window when I get assigned my alcohol detox patients at work ;)

  4. Figure out if this is for you! Faint at the sight of blood? Smell of poop make you hurl like a prom queen in the back of a pickup? Nursing probably isn't for you. If you can't make it through CNA class because of intolerance to these things, there's even worse things in the nursing world. A few examples are irrigating decubitis ulcers that look they they were formed from a claymore landmine rather than from laying on the same spot, inserting a rectal tube to relieve gas from a patient with a distended abdomen, or my personal favorite, removing fecal impaction digitally (FYI: We ain't talking about a PDA!) No one particularly likes these procedures, but we enjoy providing relief to our patients. Nobody enters into a CNA class or job without some apprehension to doing this, but if you don't feel you can get past it in time, then this might not be for you... just give it a few times to see if it gets easier for you.

  5. Complete part of nursing school before you go! Most CNA classes are 6 weeks long... plenty of time to get accustomed to your new career choice. I've often said that the 6 week CNA class was like the first 2 weeks of nursing school. If you've got that in the bag, you can concentrate on things you don't know about: drugs, pathophysiology, procedures, etc.

Can you do nursing school without being a CNA? Sure you can! It will be more difficult though. I entered nursing school after ten years of having a sales job: bad move... I failed out about 3/4 of the way through the class. I went and got my CNA license, worked for a few months, and now I'm doing much better than the average student in my class; and I still manage to work full-time!

If you're fortunate enough to have a place to stay and few financial obligations you're even more fortunate and you may want to tackle nursing school without a CNA license; I absolutely wish I had done this long before I had got married and had children!

Sunday, January 3, 2010

Inaccurate Anesthetist Article

A quick Google search of Nurse Anesthetist Vs. Anesthesiologist turns up a laughable article on a shady website attempting to sell people into the medical field. Perhaps the commission from a medical student inquiry is higher that of a nursing student. The article spreads false facts and makes the anesthetist seem like a poorly trained fool. Here's a few inaccurate statements:

"A nurse anesthetist is a specialized practicing registered nurse in the field of anesthesiology. The student training to become a nurse anesthetist must first complete a bachelor's degree in registered nursing. During high school a student interested in a nurse anesthetist career should enroll in the most advanced courses possible including advanced placement and honors courses. Upon completion of a registered nursing program the individual will apply to a nurse anesthetist program at a hospital or university."

Now this little paragraph makes it seem like anesthesia is a vocational program... this is an intense 24-32 month Master's Degree Program. There's nothing vocational about it.

"The nurse anesthetist works under an anesthesiologist and administers the anesthetic during procedures. Under the guidance of an anesthesiologist, the nurse adjusts gauges, monitors oxygen levels, and checks for any irregularities in breathing and heart rate during an operation or procedure."

This is a joke. First of all, anesthetists rarely ever need to be "overseen". Many states don't even require them to have a supervisor at all! Mostly, they are a part of an anesthesia team, but "the guidance of an anesthesiologist" quote is misleading to say the least. Now for my favorite inaccuracy:

The median income for a first year nurse anesthetist is close to $72,000.

Um, are you friggin' kidding me? I know several RNs that make this in a year. I also happen to have several nurse anesthetists in my family and they make well over $100,000 a year; some even clearing above $200,000.

Do yourself a favor and don't visit this crappy website trying to peddle medical and nursing careers obviously through some sort of click-link commission crap going on.

If you want some accurate CRNA information, visit WiseGeek. They have an excellent article on what a CRNA does, how much education it takes to get there, and what they can expect to be paid... accurately.

Under Construction!

In case anyone was wondering, this blog is being revamped a bit. I'd like to add more content, make it read more like a website than a personal blog, and write a bunch of articles, news commentaries, etc. in addition to my personal nursing experiences. More content to come!