Tag Archives: nursing

On How Time Flies (When You’re Working Your Ass Off)

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One of my buddies/clinical group-mates is leaving the state. He got a job at a hospital in Oklahoma, and so he’s departing from the great state of Texas and heading north. In honor of his departure, he threw a little get together at a local bar. A handful of people from my nursing school class showed up, and we all sat around and swapped stories about what it’s like to work in our own little corner of the hospital. Transplant, L & D, ICU, Med Surg — There were all sorts of different types of nurses represented. We all finished nursing school with the same (ish) knowledge base, and now each of us have specialized into different areas. Each of us has our own daily nursing vocabulary. Each of us has a different set of problems that we face every day. Some of us deal with ventilators and central lines. Others deal with Apgar Scores and fetal monitoring. Becoming more specialized is part of growing as a nurse.

What I didn’t realize, though, is that it hasn’t even been six months. Some of the nurses that were there tonight aren’t even off orientation yet. Six months isn’t a very long time. But in six months, we have all developed our practice to the point that we would be able to discuss our jobs with our co-workers in a way that our classmates (in different areas of the hospitals) wouldn’t understand exactly what we were talking about.

So much has changed in six months.

Today I had to insert a feeding tube into a patient. Inserting a feeding tube isn’t an overly complicated task. You just measure a tube, and then you put it in the patient’s nose (or mouth, sometimes). But there are different types of tubes, and some are more complicated to insert than others. Today, I had a patient who had the most complicated type of tube, so of course, the patient pulled the tube out about halfway through my shift.  I’d been in that kind of a situation before — a situation where a patient pulled out some tube that they weren’t supposed to pull out. The first time that happens, it warrants a freak-out. I called in other nurses and flipped a lid, and they all helped me through the process of fixing the situation, making sure they docs were aware, and then documenting all of the happenings accordingly.

Today, I didn’t freak out. I walked into the room, realized the patient had pulled the tube, and then I just… fixed it. I stopped the tube feeds, I got a new tube, and I put it in. I got an x-ray to make sure it was in the right place, just like I was supposed to do. Then, once the tube was cleared, I started the tube feeds again. And I did all of that because I knew what I was supposed to do. And not only did I know that all of that was supposed to happen, I knew that I was the one who was responsible for making it all happen. The situation didn’t call for me to get one of my former preceptors to walk me through what I should do step-by-step like I would have 4 months ago. The situation just required the nurse (that’s me) to use her brain and do her job.

I know that sounds kind of simple. I know it’s like, “Yeah, good for you because you did your job.” Or maybe you’re reading this and you’re a nurse, and you’re thinking, “Are you seriously making a big deal about dropping a Dobhoff?” And if you’re thinking that, I totally understand where you’re coming from. But bear with me, because the fact that I put in a Dobhoff without any other nurses in the room today isn’t really the point. (It is the first time I’ve done that, but, again, not really the point.) The point is that there is a change happening within me — a change that is taking me from a terrified brand-new nurse who doesn’t feel empowered to do ANYTHING without supervision, to being the kind of nurse who can see a problem, know what the solution is, and then make that solution happen. (And moreover, who is willing to make that solution happen without first consulting a whole gaggle of nurses and doctors to validate her thinking.)

Basically, what I’m saying is this: Today I felt like I knew how to do my job, and that, my friends, is a very good feeling.

Today’s Poop Story*

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Words that I heard today: “Um, Sarah? There’s poop dripping on the floor.”

Those words came from one of the 8 nursing students I had in my room at that particular moment, all of whom were accompanied by my nursing school clinical instructor. The student used her keen assessment skills to notice that my fecal collection bag was SO FULL of poop and gas (fart-in-a-bag, delicious, right?) that it was rupturing. RUPTURING. It’s always fun when the person who trained you how to be a nurse is in the room when something awesome (and completely avoidable, if you’re, you know, paying attention) happens. That’s a sure-fire way to impress a former instructor and a group of nursing students. Fumble some POOP. Super, super smooth.

Luckily, I managed the situation with some quick delegation (Ex: UUUUUHHHH, YOU**! GET ME THE BUCKET OUT OF THE BATHROOM!) and the swift aid of my instructor, who, thank God, happened to already have some gloves on. Sure there was some splashing involved, but luckily for me, I happened to be in the middle of bath time when the whole crowd of students rolled into my room, so there were towels everywhere. And, I’ll have you know, I used those towels preemptively. Not reactively. BOOYAH. NURSED!!!

*Almost every day has a new poop story. Almost every single day. Such is my life.

**In CPR training, they teach you that you should specifically choose one person to call 9-1-1. You shouldn’t just yell, “SOMEONE CALL 9-1-1!” because everyone will think someone else is doing it. Be specific, they tell you. As it turns out, emergency poop situations require a similar delegation technique. When there are 10 people in a room with an exploding poop bag, you have to pick a person to go get the poop bucket. You can’t just be yelling out for “someone” to go get the poop bucket. You have to be specific. Thank you, 9-1-1 training, for preparing me for these emergency moments.

On Rembering The First Death

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They say you always remember your first death.

As nurses, we see a lot of people die. That’s part of our job. We get to experience life in its best and its worst moments, and death is a big part of that. Eventually, we see enough of life’s worst moments that we become calloused to them, and they don’t affect us as deeply anymore. But new nurses don’t have callouses yet. And we all know that we have to watch out for the first death.

My first death was months ago. An elderly patient who was well loved and well cared for. I thought that I would be sad about it, but I wasn’t. The patient had a good, long life, and was surrounded by a loving family. I kept waiting for the feelings of sadness to wash over me, but they never came. I almost teared up as the hospital chaplain prayed with the family, but just as I was about to cry, an alarm went off that I had to silence. Work comes before emotions when you’re in the hospital.

I’ve had a few deaths since then. Some were sadder than others, but nothing that made me cry after I got home. At-Home-Crying is the easiest way for me to judge my emotional involvement.  People tell me all the time that I have to learn to leave work at work and not take it home with me. Maybe that’s a skill that comes with becoming calloused. I try, I really do try. Most days I succeed. Today, I have not succeeded.

I picked up an extra shift at work today. I didn’t have to work, but I chose to–partly because we were short-staffed–but mostly because I really liked the patients that I worked with yesterday. Liking the patients that you’re working with makes all the difference in how difficult your day is. If you’re working with patients that are incessantly auditioning to play opposite Walter Matthau in the next Grumpy Old Men, it makes for a long day. If you’re working with sweet, gentle families, days go quickly and smoothly. I had sweet, gentle families and good patients yesterday, so I chose to come back today and work with them again.

Nobody died on my shift today. When I agreed to come to work today, it had never occurred to me that someone passing away on my shift was even a possibility. As soon as I realized that death was (not just possible, but) imminent, I prayed constantly that nobody would die on my shift. I really, really didn’t want anyone to die on my shift. But as the shift started to draw to a close, it became very evident that my prayer was being answered in a literal way. The patient was not going to die… on my shift. The night shift nurse was going to have to do their own interceding if they wanted to change their fate.

It’s hard to say why some patient’s situations hit home and others don’t. There are some reasons for my emotional reaction that I understand, and there are others that I don’t. All I really understand tonight is that I am having the reaction that I expected to have months ago when my first patient die. I am having this reaction even though it wasn’t my first time, and even though nobody died on my watch.

The Reality of Nursing

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There are days when the reality of nursing starts to set in. And, oh, does it ever weigh heavily upon the shoulders.

These are the days when you realize that one medication given incorrectly could result in a life-altering or life-ending event for your patient. These are the days when it becomes clear that all of the knowledge in the world about disease processes and assessments doesn’t do you any good if you don’t know the correct intervention. The days when you begin to understand that being able to accurately identify the right thing to do from a multiple choice list is absolutely nothing like what it feels like to stand in a room and have to create your own multiple choice list with the information in your head. With an “OR ELSE” attached onto the end.

Not OR ELSE you’ll get a bad grade. Instead, OR ELSE your patient will die.

I was there today. Standing in the brilliantly white shoes of a terrified nursing student who knew just enough information to know exactly how bad the situation* was, but had absolutely no idea how to go about fixing it. The only multiple choice options in my head were a.) call a code, b.) call a doctor, c.) run and scream, d.) cry in the corner, or e.) all of the above.

It’s easy to forget what the purpose is here. It’s easy to get lost in studying for tests, to get into the habit of putting this information into the brain’s short term memory just so that we can survive from one week to the next. There are so many tests; there is so much information. And there is so little time. So, so little time.

But the purpose is bigger than the test. Studying is about more than the grade. Even though right now it feels like we are studying for our survival, we’re really not. We’re studying for someone else’s survival.

And on days like today, that truth becomes readily apparent.

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*Thankfully, this particular situation was in a simulation lab, where our instructor creates scenarios that we work through with the members of our clinical group. The patient who was dying was a plastic mannequin, but that didn’t make the reality any lighter. In the end, we saved the mannequin, and I walked away with a crisp reminder of why learning is more important than grades. I’m sure by that measure, the instructor would call the simulation experience a success.

On Muttering, Bewilderment, and Public Health Nursing

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Author’s Note: This is a post that Boo will not read. It’s too long, too ‘boring,’ contains no caps-lock moments, and no pictures. Consider yourself forewarned. : )

There was this moment today in class when I got so overwhelmed I couldn’t even speak.

I had raised my hand as my professor was explaining a concept, wanting to ask her a question. Alas, she was on a bit of a roll, so she acknowledged that she’d come back to me, and kept going. In the mean time, she barrelled on through a few more thoughts that only served to complicate the things she’d already been saying.

She was talking about public health interventions, complicated systems, how living in the tension of complexity fosters creativity, and about policy and how that’s the way we typically aim to implement positive change in communities (large and small).

She’d spent the first 20 minutes of the lecture talking about living in complexity, and how if you create too many rules, it stifles creativity. When that happens, communities have a harder time trying to implement self-initiated change. Then she talked about how these systems (or communities) are incredibly complex, and they are all interrelated, and if you change something in this one system/community, you’re going to be changing any number of things in this other system/community. And then she went on to explain that the way that we bring about change in communities is by way of implementing new policies.

Then my brain melted onto the desk right in front of me.

I reeled backwards at the mention of policy, another word for ‘rules.’ I thought, if we’re implementing rules to fix problems, how do you stop yourself from implementing so many rules that it hinders the community from being able to create solutions to their own problems? And what about the fact that we tend to create more and more rules all the time (as a society) and so if we put rules in place, we’re going to hang the policy/rules rope wtih which a community can hang themselves by endlessly adding to the restriction by creating more and more rules! And then on the other hand! What if we don’t put any policy into place? Things tend towards chaos, then everything goes downhill, so we need these policies! So, (and this is the golden question, I suppose) how do we find the right balance between having enough policies in place to guide people in the correct direction without implementing so many policies that people are locked down into legalistic parameters that don’t allow them to function inside of the community because of the ‘oppression’ (be it creative, legal, social, etc.) of the rules/laws/policies that have been put into place?

Like I said. My brain melted onto the table.

Then the professor chose that moment to return to me, allowing me to ask the question I’d had when I’d raised my hand earlier. I stuttered around for about 2 minutes, (an eternity when the whole class is melting the back of your head with radiation stares), and finally just gave up. I muttered something about it all being too complicated and oh my god. I muttered.

This isn’t the kind of professor you want to mutter in front of, by the way. Of all the people who teach at my school, she is the one and only professor who strikes fear into my heart. I try to carefully calculate every sentence I am going to say to her.  She is a highly accurate, incredibly intelligent individual who has a firm grasp on more realms of knowledge than I can even count. The woman is brilliant. The woman is not the kind of person you want to mutter in front of.

So there I was, muttering. Muttering and awesomely embarrassed. I literally said something to the effect of, “It’s all so complicated, how can you ever move forward? Oh my God.” Then followed it with a, “Okay, nevermind that, I can’t even ask that question apparently,” and went on to ask my original question.

She said something like, “I’m going to answer both of your questions. The answer to your first question is just this. Yes. It is all really that complicated.” She affirmed that my baffled composure was really just a sign that I was starting to grasp the depths of chaos that is policy making and public health nursing. Then she answered my second, less profound question.

So what’s the moral of this story? Sometimes, when you forget about composing your sentences, and you just mutter around because your brain is all melty and you can’t even wrap your head around the concepts you’re trying to think through, that’s the right answer.

Bewildered muttering can be the right answer.

The Progression of Bleeding and/or Crying

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I have been sitting in my office all day long, being super effective at NOT writing this paper for our research class.  I have made a stew. I have surfed facebook.  I have pondered my future in nursing and in life.  I have done everything you can imagine except a.) laundry and b.) write a paper.  Those are the two things that I actually NEED to be doing.

Alas, I am not. Instead, I am ponderings the stages the body goes through when dealing with trauma.

Though I can’t remember its name (nor the names of its stages), there is a theory that says your body has stages for reacting to acute trauma.  For instance, when you get a cut on your finger, your body goes through this series of stages when it’s fixing the cut by stopping the bleeding.  The stages are something like this:
– Recognition (there is a problem, I am bleeding.)
– Reaction (I will trying to fix the problem by sending clotting mechanisms into action.)
– Stabilization (the clotting mechanisms start to work, a.k.a. the scab starts to form.)
– Recovery (healing, or, if you’re me, picking the scab 100 times, and starting the whole process all over again.)

The theory says that our bodies can’t stay in the ‘reaction’ stage forever, because eventually we will run out of our resources.  In the example that I gave above, if the body stayed in the reaction stage forever without ever getting to stabilization, the person would bleed to death.  Bleeding to death is never good.

You with me so far?

Okay, so I’m sure that the whole system that I mentioned above has something to do with hormones and the nervous system.  This is a fair assumption since everything in our body is basically controlled by hormones and the nervous system.  More scientifically, I’m guessing that has something to do with the turning on/off of the SNS/PNS systems (read: going into the fight-or-flight adrenaline response) and the release of cortisol (read: steroid released in the body in response to stress) into the body.

Before I started thinking about any of that, I was thinking about crying.  Specifically, I was thinking about why I can’t cry right now (because of the depression medication).  Then I thought about how funny it is that we can’t cry on demand (unless you own an Oscar), and then I was like, wait, what causes us to cry at all?  I don’t know anything about crying.  Some quick googling tells me that it’s somehow connected to the Parasympathetic Nervous System (bing! That’s on one end of the Fight-or-Flight teeter-totter), but that’s about all I have dug up so far.

Then I was thinking about trauma and crying and how they are both related to the same nervous system, and I realized that if you were to chart the progression of an intense emotional reaction a.k.a. A Good Crying Session, it would graph out exactly like the Recognition-Reaction-Stabilization-Recovery.  Which made me wonder: do the same systems control both things?

This is my attempt at helping you understand what the hell it is I'm still droning on about.

Because I can only weep for about 15 minutes before I start to feel better, and I could only bleed (and I mean BLEED) for about 15 minutes before I’d be dead.  I haven’t completed my scientific research on this yet, but I just thought I’d clue you guys in. It’s fun to be on the breaking edge of science and/or The Insane Progression Of Pseudo-Scientific Thoughts Inside Sarah’s Head, Now With Visual Illustrations!

P.S. In case you wanted to know how the stages specifically relate to the crying process, it goes like this:
- Recognition (Quivery lip, teary eyes, RUN FOR THE BATHROOM, FAST.)
- Reaction (The weeping itself.  With the snot running down your face, getting all over everything.  Bonus points if the snot is getting all over your husband.  Zack LOVES that part of my weeping.)
- Stabilization (Unstable breathing, big gasps, the tears start to run out.  This is usually when you’ve stopped crying and your head is in somebody’s lap and they’re loving you even though your face is swollen up like you’re having an allergic reaction and you’re bright red & covered in all sorts of bodily fluids.)
- Recovery (This stage often involves ice cream for the general public.  For me, it mostly involves margaritas.)

Journal Entry: Hospital Day 1

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Part of my homework from my clinical days at the hospital is to write a journal entry reflecting on the day.  There are very loose parameters regarding what I have to talk about.  After I wrote my journal entry I realized what I’d actually done is write my instructor her very own blog post about my first day in the hospital.  So here you go:
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There’s nothing like getting up at 0515 that will make a person want to go to bed at 2130 hours, you know?

Orientation day was exactly what I expected orientation to be like.  There was a lot of sitting.  There was a lot of talking.  There was a lot of information about and discussion of HIPPA laws.

I think orientations are especially cruel in nature.  They are inherently exciting because they mean that you’re starting a new thing, usually a thing you’ve been waiting for and are super pumped about.  But orientation doesn’t really mean that “that thing” is starting.  Oh, no.  Orientation means that “that thing” is going to start soon, but not quite yet, so just sit there and think about how much fun “this thing” is going to be really soon, but not now.

The real kicker?  There’s nothing that can fix the cruelty of orientations*; they are a necessary evil.

Despite the fact that stepping foot into a hospital whilst wearing scrubs didn’t magically morph me into a fully-knowledgeable nurse, I still consider the day to have been a success.  Something I really love about the health care setting is that you can’t help but learn when you’re in it.  Whether at the hospital, at school or at my regular doctor’s office, every time I’m around any kind of a health care person, I learn something new.  Yesterday we weren’t there to learn new “nursing” information.  We were there to learn about hospital policies and making sure we use our standard and contact precautions when necessary.  But even still, I learned information that will be applicable to my career as a nurse.  (E.g. 1 million medical abbreviations: CHECK.)

One of the reasons I’m excited about being a nurse is because nursing is a profession that requires lifelong learning.  I don’t want to ever stop growing in my knowledge of how to care for people better and how to do my job as well as possible.  I want to always be striving to learn more about how the body works and how disease processes work.  Being in the hospital today only affirmed that I’ve chosen the right path.  If simply being under that roof means that I’m in an environment that lends itself to constant learning, then I’m in the right place.

The flip side: sometimes it’s overwhelming to think about how much I have left to learn.  Relative to the knowledge base that the nurses and other medical professionals have in that building, I know nothing.  I just tell myself that it’s okay, though.  I’m going to learn what I need to know a little (or sometimes a lot) at a time.  My knowledge base will continue to grow and grow as I gain more and more exposure to the health care environment and progress through more and more classes.  I can’t be in a hurry to jump ahead of myself.  I just have to take deep breaths, and remember to enjoy where I am now, ogling giant toilets and the idea of having West Side Story Style dance fights with the other school’s nursing students.

I can’t wait for next week.

*Note: Hospital orientation with you was a lot more fun than, say, nursing school orientation with the university.  My rant about orientations being “bummer days” isn’t personal at all.  I was happily surprised by the insane amount of fun we had yesterday despite the fact that we were being lectured on wearing personal protective equipment for the 4th time in 4 days. :)

Scrubs!

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A few weeks ago my friend, Stocktoc, told me that she was itching for a new sewing project.  I told her that was funny, because I had no idea that she could sew.  She told me that she couldn’t, but that she wanted to learn how.  She thought that making some scrubs would be a good place to start, but she didn’t know anyone who would need scrubs.  EXCEPT ME.  So because I’m lucky enough to be the only (future) nurse she knows, she made the scrubs for me.  I sent her 1,000,000 measurements and she sent me
<– these, along with a note that promised to bring over a bottle of wine and get rowdy after she moves back to Texas in a month.

Scrubs and booze?  My friends, it just doesn’t get a whole lot better than that.

P.S. The first day of nursing school was great!  My sunshine-and-rainbows tune will probably change tomorrow after class when I have to choose between the following two options: a.) keep up with my reading so I will be ready for Friday’s test or b.) abandon my reading in lieu of getting ready for Wednesday’s test.  I think Wednesday’s test is going to win, but I’m really going to regret that on Thursday.  Apparently, there’s no such thing as gentle immersion into nursing school.  At least I’ll be flailing about stylishly in my scrubs.