CELEBRATION!

So I just got home from my very LAST CLINICAL DAY! And it was a wonderful uneventful day in which I actually knew all the medications I was quizzed over and got all my paperwork done before I left! Tonight (although I should be writing my speech) Megan and I are going out to Logan's to celebrate. And then we're thinking of doing something crazy like painting our nails - which is strictly forbidden in all of nursing clinicals!

For those of you who don't understand just how wonderful it is to be done with clinicals, let me explain. Clincal days consist of 11 to 12 hours providing total patient care to 2 patients. This means that we do what their RN would do, as well as what their CNA would do. That means that not only are we running around being quizzed on drugs, giving medications, changing dressings, inserting/removing catheters/IVs/etc, hanging IV fluids, and doing full head-to-toe assessments, we also get to give their daily baths (most can't get out of bed), change their bed sheets (keep in mind they can't get out of bed), and clean up any messes that happen along the way - which can be quite interesting! It's a LONG day and you're on your feet all day except for lunch. So now you should understand why I am SO happy to be done!!!!

Job status: I just heard from the manager of the Neonatal Intensive Care Unit. There's some nurses that currently only work a few shifts a month and don't receive benefits, so the hospital pays them an increased salary for opting out of benefits. The management has decided that this isn't cost effective so they're discussing getting rid of those positions and giving them the opportunity to become full time employees with benefits. The manager said that if this happens she will have eight baylor position nurses becoming full time, which will fill up any positions that she needed, so there will not be a position left for me. She said that we should know for sure in the next couple of weeks. I'm not too concerned, because right now I could really use a couple of weeks with no responsibilities!

Why Mom Hates Clinical Days

A phone conversation between me and Mom and few days ago:

Mom: Hello?
Me: I'm depressed.
Mom: Why? What happened?!
Me: I never want to work for real on a floor like this. It's like hospice.
Mom: Oh, it's a clinical day. I should know not to answer the phone on these days. I'm not going to anymore.

*Thanks for the unconditional support, Mom!

Today we get on the floor and another nursing student went to see if their patient was still in their room since they were supposed to be leaving shortly for dialysis. The student peeked their head in and saw the patient in the bed and a family member at the bedside. While listening to report from the night nurse when she reached that particular patient: "She dead". My teacher immediately whipped her head around to that student who replied "But she's in there!" The nurse then informed them that the family member was sitting with the body. It would have been a real shock for them if they'd hadn't heard report and had just gone it to get vital signs!

Since I was one of the few students who hadn't done post-mortem care, my teacher snagged me in to help. Definitely not my favorite experience from nursing school. Last night I had a dream that someone was tying the tag onto my toe (yes, that was one of my jobs). Definitely not a peaceful dream!

My primary patient was very sick. She got worse all day and wouldn't respond to anything that I did. I "milked" her finger when trying to check her blood sugar - a task that brings most patients to tears. She flinched, or even opened her eyes. I also gave a shot of a medication that looked like Mellow Yellow and is a pretty unpleasant shot to receive, but once again, no reaction. There was a family member in the room all day and kept blaming her unresponsiveness on the morphine she'd received very early that morning. By the afternoon, I realized that the morphine wasn't the issue. When her blood pressure, respirations, and blood sugar began dropping I notified her staff nurse who told me that she was aware of the situation and that she probably wouldn't make it through the night. The family member had been informed of this, but was in denial of the situation and insisted that the doctor's insert a feeding tube because the problem was that she wasn't getting any food since she couldn't swallow - she refused to believe that it had anything to do with the major hemorrhagic stroke she'd suffered. The family member was the patient's designated power of attorney, so what she said had to go, and if she's still alive today and her labs are stable, they will have no choice other than to insert the tube. She's also a "full code", so if she does die, the medical team has no choice but to resuscitate her - probably only for her to die again shortly. Just another reason I want a living will! I've become quite the little advocate for them here recently!

My other patient's only request for the day was a hot cup of coffee. Every time I'd go get it for her and she'd pour in the sugar, begin to stir... then transport would come to take her to some procedure or another - forcing her to leave her untouched coffee. By the time she'd return that cup was cold so she'd ask for another. This happened three separate time! It was 3 in the afternoon before she finally got to enjoy her morning coffee!

The job isn't looking so good considering I still haven't heard anything. I'm going to call if I still haven't heard by Monday. That's fine with me. If I don't have a job I can enjoy the beginning of my summer, then apply after I've taken my test and am officially a Registered Nurse!

Long hard day...

Today was very long and very hard physically and emotionally. My primary patient was close my age, and she simply made some mistakes. She was diagnosed with diabetes in highschool and didn't take care of herself. She didn't monitor her blood sugar levels regularly or pay attention to the things she put into her body. One night, while drinking with some friends, she had a little too much and passed out. Her friends took her to the ER, where they found that her blood sugar was in the teens (normal is 70-110). Her drinking had put her into a diabetic coma. She then went into cardiorespiratory arrest - her heart and lungs stopped working, which basically means that she died. They began CPR and had to put in an artificial airway and hook her up to a ventilator. They were able to resucitate her, but she'd gone so long without oxygen that her brain was affected and now she's in a persistent vegitative state. She had to have a tracheostomy in order to breath and a feeding tube surgically inserted into her stomach to receive nutrients. Her parents were unable to take care of her because of how much care she requires, so she was put into a nursing home. After being there a couple of months, they found that she had what's called a rectovaginal fistula, which means that a connection developed between her rectum and vagina, so fecal matter was leaking into her vagina. She was admitted to the hospital once again. The surgeon that took on her case was planning to make a colostomy to fix this problem. While she was on the table and the surgery was about to begin, her heart stopped beating again. She was again resucitated. Now no one will take on her surgical case for fear of her heart stopping again. This means that fecal matter is constantly being introduced into her vagina and causing terrible reccuring urinary tract infections. She was put back into the nursing home, but returned a few days later with pneumonia and tracheitis (a terrible infection of her trachestomy site). After that cleared up she went back to the nursing home, but returned last week due to a high fever caused by yet another urinary tract infection. She's always in pain, even though she receives regular pain medication. Her limbs are contractured- which means that they stay curled up and are very difficult to impossible to straighted. The saddest part of the story - her mind is there. She has absolutely no control over her body. I really felt for her. It was so hard for me to go into her room and see her face grimacing in pain and sometimes crying, then not be able to do anything about it. She couldn't communicate to me what was hurting, how it was hurting, or why it was hurting. I spent all day looking for little things to make her more comfortable. Another thing that was hard, was the fact that she had no visitors all day. I like to think that if I were put into that state I would never have to be alone. All of this because of a few bad decisions because every young adult feels like "it won't happen to me".

I was glad to have my secondary patient for a bit of a comic relief. She had a brain bleed and had to have two holes drilled into her head to drain the blood and relieve the pressure on her brain. Because of this she was a little confused. She constantly asked me to knock on her bathroom door and see if her family was in there. Once she even asked me to look in the shower for them. When her grandson finally did arrive, she made sure to let me know that she had found him. She also kept me on my toes. She was very shaky and it took myself and another nursing student quite a bit of time and effort to get her to the toilet. She told us it might be awile so I told Tara I'd come get her when I needed her help to get the patient back into the bed. I decided to take the opportunity and change her bed. While I was on the other side of the bed I noticed her trying to stand. I asked her what she was doing, and she told me "I'm getting in the bed!" I reminded her that she needed help for that and she was quick to let me know that she could do it herself, as she hoisted herself forward and nearly fell to the ground. I leapt over the bed and reached her just in time - but not before I whacked the back of my leg around the Achille's tendon on something pretty hard. I think it was the metal IV pole. Regardless of what it was, it HURT... and it still hurts!


As for the job - STILL waiting to hear. I should hear something this week or next!

I Passed!!!

Tuesday I spent my clinical day in the CVICU (cardiovascular intensive care unit). It was such an interesting day. The most interesting part was seeing a "fresh heart" come in. The patient had just had open heart surgery to have a valve replaced. As soon as they said they were on their way up from surgery all of the nurses rushed into the room that had been set up for him. As soon as his bed was wheeled into place everyone started rushing around in an organized chaos. They were doing assessments, hooking up all of his lines, setting up the ventilator, and all kinds of other stuff. One nurse was assigned to do nothing but chart. She wheeled that computer in there and was typing away as each nurse called out different things. There's no way I could have gotten everything! It was amazing how everything was so crazy, but flowed so well. I spent all day telling my patient that she had, indeed, had open heart surgery the previous day. She kept insisting that no, she hadn't had surgery yet - she was waiting to go back. Her RN came in and said "Doesn't your chest hurt?" Her reply was "No. Why would it?" (Maybe because the day before it had been split open!) The RN then said "Look down at your chest. Do you see that big bandage that goes all the way from your neck to your belly button?" She looked down and said "Yeah. Are y'all getting me ready for my surgery or something?" She also kept asking me to wake up her husband... who was not in the room. The RN told me that it was normal for them to not remember going back to surgery and to be confused and think people are in the room when they're not - but he said it's very unusual for them to deny any pain. They normally can't figure out why they're having intense pains, but as soon as you explain that they've already had the surgery they understand. I got to see some pretty cool things with her. When her family came in first thing in the morning they were really upset by her appearance. At that point she was still on the ventilator, she had lines running all in and out of her, we hadn't had time to wash the green cleaning stuff from surgery off of her yet, and she was in wrist restraints because she'd been trying to pull out the tube in her throat. A little while after her family left I got to watch them extubate her (pull out the breathing tube). When her family came back in they were amazed at how much better she looked with just that gone. My grandfather had open heart surgery, but I was so little I guess I didn't go back. I called Mom and asked if they let the family back while he was still on the ventilator and she said yes, and it was very traumatic. I believe it! After being back there and realizing how bad it looks I don't think I'd want my family to see me that way. I'd rather them just wait until I'm awake and the tubes are gone! I really enjoyed the clinical day there, but I don't think that I'd like to work there. There was so much going on I think I'd be overwhelmed with more than one patient.

This semester we have an NCLEX review class to prepare us for our licensure test after graduation. At the beginning of the semester we took a practice NCLEX predictor test and it said that at that point there was an 87% chance that I'd pass the NCLEX. To graduate we're required to pass this test with a 90% predictability or better. Our entire class was pretty stressed out about this. We took another practice test two weeks ago and it put me at a 91% predictability. This did not make me feel good since I BARELY passed it! I kept thinking that the stress would get to me and I wouldn't pass the real one. We had the for real predictor test today and I passed with a 96% predictability!!! Yay!

I should find out about the job sometime next week. I'm nervous about it because I have a feeling at least a couple of the others who applied will have experience- and I have none. I've decided that if I don't get the job I'm just going to wait until after the NCLEX to apply for any more since I'll be an RN after I pass it and I can apply as a registered nurse and not as a graduate nurse awaiting the NCLEX. That way I can also enjoy my summer for a little while and not have to focus on anything except passing!

At least now I know what I do NOT want to do

Yesterday at clinical I was "in charge", which means that I followed around the charge nurse on the floor. I was on the neuro floor along with three other FHU nursing students, but they all had patients. All semester I've been working on the cardiac telemetry step-down floor, and the charge nurse on that floor doesn't take on a patient load, so her job is strictly to be available for charge nurse duties and helping others. I thought that I would enjoy being a charge nurse after observing her during my 5 weeks there. Well, things are a little different on the neuro floor. The charge nurse also takes on a full patient load. Wow. I was glad that I was there to help since the hospital's charting system just went electronic. Not only was she dealing with her own patients (one of which was in very serious condition in the morning - we thought we were going to have to code him), she also had people coming to her wanting thier problems fixed. I spent the day watching the charge nurse try to figure out electronic charting, chasing her from one end of the floor to the other, cleaning up a patient's diarrhea - twice, making tomato soup, and watching a patient to make sure that she swallowed her medicine since she was notorious for holding it in her mouth until the nurse left, then spitting it out. These were all time consuming things that had to be done, but that the poor charge nurse really had no time to do. Needless to say, I doubt that I will ever willingly take on such a position! I also gained a tremendous amount of respect for my future charge nurses.

As for the job - still no word. I know they told me that it will definitely be after April 8, and will most likely be more toward the middle of the month before I hear, but the suspense is driving me crazy!