Tuesday, February 15, 2005

Okay, so I'm tired....REALLY TIRED


Nursing school started out being one of those experiences that I couldn't wait to start. When I began nursing school, I has this hunger...ambition...drive for the knowledge. When I studied, I could read chapter after chapter of etiology, pathophysiology, clinical manifestations and treatments as though it were a juicy novel and now when I think about opening a book, I feel like throwing it across the room and delving into reality TV. What happened?

My school is ridiculous. They don't seem to understand that being a good parent is very important to me. The seem to think that I should let my children self-destruct so that I can say I made it. They think that I should spend 25+ hours a week in clinical, 15 hours a week in class, 10+ hours per semester doing community service and 30 hours a week studying. When can I fit in 2 hours a week for housework, 2 hours a week for laundry and 10 hours a week to help my kids with their homework? (I am serious if someone out there has some ideas, please share them!) Right now, I feel like quitting school. I know, I say that every semester, but I am really thinking about it this time. The school could care less about my mental breakdown. And the administration is SO MEAN.

They feel that all of this crap that they are putting me through is preparing me for my entry into the nursing workforce. I have to wonder if this is really what I want to do. I have worked for years in the customer service industry, and I can't tell you how many times I wanted to become an anthropologist on an archaeological dig in the middle of sandy dirt digging for artifacts and remnants of civilizations past. I thought, out there, no one would bother me. I could work at my own pace. I could make my own hours...Etc But I bet that even archaeologists have something to bitch about. This dirt is too dry, my hands hurt, this delicate pottery broke as soon as it was unearthed...Etc

I hope that when I become a nurse that I never become old and crotchety. I hope that I can still relate to the people instead of looking down on them from my Mercedes Benz! And when I have students, I promise to listen to them and address their concerns instead of assuming that their lack of participation in school activities are avoidance behaviors. That's much better....


Last week's clinical was pretty uneventful. My stand out patient this week was a guy who came in because his caregivers thought that he was in diabetic shock. They wanted us to give him insulin. He came back and he was very weak. He was also very preoccupied with his penis. His mentition was altered and he was wondering around looking for a place to pee. His punishment...Foley catheter. I come back into the room and I told him what I was going to do and he said, "Foley, hmmm, will this hurt?" and I explained to him that there might be some pressure and that I would let him know everything I was going to do. So I began preparations to place the catheter and I put the betadine on his penis. He goes, "Oooo, that's cold." Then I warn him that I am about to advance the catheter. Meanwhile, he is laid back with his hands propped behind his head watching me. It was nearly pornographic. Then he said, "Oooo, that feels different." Different? That is a new one for me. Interesting...

Then I had a cute little patient who came in complaining of abdominal pain. She was curled up in a knot. We asked her when her last period was, and she said about a month ago. Then we asked her if there was any possibility that she might be pregnant, and she said she had her tubes tied after the birth of her 12 year old. Long story short, her tubal ligation back-fired and she was pregnant in her tubes. Surprise! We sent her quickly to surgery to have her ovary and tube removed.

Wednesday, February 09, 2005

So nurses really do eat their young.....

I once heard someone say that nurses eat their young and I thought it was just one of those little funny things that people say that makes them feel better about having a really hard time with a fellow nurse. But I have to wonder if there might not be an element of truth to the saying.

In this particular day and age the nursing profession experiences one of the highest turnover rates of any profession. Could it possibly be because nurses really do eat their young? It begins in nursing school. Really, it's true! There have been many times when I was on the floor and due to inexperience I was a little hesitant in answering a question or performing a procedure and because of this hesitance I got yelled at by my nursing instructor. Here is a shining example:

It was my very first day on the floor where I had to do everything short of IV's and passing meds. I was assigned a patient that had a growth removed from his abdomen. It was his first day post-op. He was about six foot two inches tall and weighed well over 200 pounds. I was responsible for bathing the patient, doing an assessment, emptying his foley, changing his bed and when all of that was done I had to take him for a walk around the floor. This man was in a WHOLE LOT OF PAIN. I mean he was tossing and turning in the bed, gripping the sheets and moaning really load. His wife kept constant vigil at the bedside because there were "mistakes" being made and she was tired of her husband being abused by the medical staff. (Welcome to nursing!)

He had a long mid-sternal incision and a PCA pump (that's patient controlled anesthesia for the novice). This method of pain management was inappropriate for this particular patient because he was unable to follow a verbal command, which meant he did not push the button for pain relief, which meant he was miserable. Retrospectively, I would have requested that anesthesia come back and re-evaluate the patient and give him a basal rate of anesthesia in addition to the PCA. But as a student nurse on her first day on the floor, how would I know that? I was terrified to take this man out of the bed because whenever he stood up he would start to sway, and being that I am only a little over five feet tall, I thought he would fall on me. So I did my assessment and waited for more support from the more experienced nurses. This was a bad idea. Even though my preceptor told me not to get the patient out of bed by myself, she denied it in front of the charge nurse and in front of the instructor. So who do you think got in trouble? The student nurse of course.

Now if I wasn't determined to be a nurse (and saddled with student loans), I would have quit nursing school that day. But then I have to wonder how many nurses have been turned off by nursing because of experiences like mine.

This year of nursing school has been kind of interesting. The dynamics of the nurses on the floors vary from unit to unit. It varies even from one side of the floor to another. When I was in Peds, the age seven and under unit was a more micromanaged environment than the age seven and older side. It was hard to believe that it was the same hospital. At times, the nurses on the hostile side seemed very reluctant to teach up and coming nurses. I wonder how attitudes of veteran nurses impact the nursing shortage? I imagine that alot of the problems are related to staffing and pay, but that agitation has a tendency to spill over into relations between employees and eventually quality of patient care.

I am learning how to conduct myself in different clinical areas. I am learning that in the ED it is normal to get yelled at sometimes. Sometimes you can get completely ignored, but that is the nature of nursing. This ugliness has got to stop! (stepping down from soapbox)

The one really awesome thing that I can say about nursing (most of the time) is that nursing is a team sport. We all work together. And nursing is all about advocating for those who cannot or do not know how to advocate for themeselves. Nursing is a profession in which I have laughed and cried....I have felt my full range of emotions. I LOVE NURSING! And despite the previous rant, I have had a really great experience in the ED. What can I tell you?

I had a patient yesterday that was involved in an accident. His head was covered in blood and he had cuts and broken glass all over his body. He kept saying, i don;t understand why this guy hit me. It was a head on collision. Then the other accident victim came in. He too was covered in blood and broken glass. He said, "I think I hit somebody, or something." He admitted to taking five oxycontin before attempting to drive to blockbuster and return some movies. WHen the tox screen came back, it turned out that he had taken cocaine, benzos, oxycontin and a plethora of heart medications. Then there was a gentleman who worked in a factory and injured his hand in some machinery. When he opend the gauze, his hand looked like ground beef. And the crazy part was that he had the same injury to his other hand a few years ago. Ack! Those were my most exciting patients. Oh, then there was a kid who shot himself with a nail gun, right through his hand.

School is becoming a pain in the butt. I really wish that I was finished so I would not have to be bothered with writing papers and such. I am still trying how to figure out a way to balance motherhood and studenthood and life. I would love my house and car to be clean, but these are the sacrifices I make to be a nurse. I miss all the cool field trips and school functions. Sigh...