2.01.2008

A New Site

Yesterday was orientation for my last acute med/surg rotation before I graduate. First semester was in a small private hospital, the next two were in a large community hospital, and this semester is in a large private hospital. Although the faculty claim to take geographical location into account when assigning clinical rotations, I've never driven less than 40 minutes to a site, even though there are two within 20 minutes of me. I can't complain, really, it's worked out well this way. I'm excited about this new hospital. I was so impressed with the Cerner computerized charting and medication administration record I applied for a job on the spot, during our computer training. I finished this training long before anyone else, even the students who had been here in previous semesters. I always get bored in those computer training situations. I couldn't suppress a squeak of glee when I saw the automatically generated fluid input/output graphs, and nearly lept out of my seat when I saw the ad-hoc charting interface. I decided I wanted to work there purely based on their computerized charting. The last site I worked at had a crummy application developed in-house, and the only feature that was being used was the bar-code medication charting. The one before that used paper. For everything.

Hopefully some day I'll be able to capitalize on the fact that I can function as a "superuser" (a peer that answers questions and trains peers on use of the IT resources) in a clinical setting after about a tenth as much time spent in training. After training a bunch of elderly secretaries to use the Office suite, everything else is cake.

Unlike my psych orientation, this orientation actually included a tour of the unit we'll be on. I like it. It's arranged in a torus shape, with the nurses' station in the center. Half are single-bed rooms, the other half are doubles. It's a relatively small unit, compared to other med/surg units I've been on, so we'll all be working closely. They use a lot more symbols on the door than other places I've been, there are different symbols hung on the door to signify DNR, various types of precautions, neutropenia, same-name and a bunch of other things. In the back of the unit are a couple pediatric rooms and a treatment room. We're told the treatment room doesn't get used much, you can bet I'll say something if someone tries an invasive treatment on a pediatric patient in their bed next to an empty treatment room (children sleep better if you don't try to stick things in them in the bed they'll be sleeping in).

The instructor is going to be a delight to work with, I can tell. She's energetic, focused and keeps current. I'm told she has high expectations, but she's also flexible and fair. One of the things I have to prepare for my first shift on that unit is a notes sheet for organizing care for the patients. At the last site I just printed out the orders and medication sheets for each of the patients and jotted down notes in the margins. No more of that! I have to come up with my own one-page chart for planning each day, since we're not supposed to rely on printouts. Since all of the charting is done on computers here, that shouldn't be too much of a problem.

I think the thing that we were most thrilled about was the end of the CDF. The CDF (clinical data form) was a monstrous 17-20 page stack of sloppily arranged spreadsheets that we had to populate with data from our clinical experience that week. All the meds, all the relevant interactions and side effects, all the assessments, care plans, functional health patterns, you name it. It's good that they had us go over all of those things, but it represented 3 or 4 hours of grueling look-up and data-entry (some of my peers were spending 12-15 hours a week on this!). Last semester we used a slightly condensed form that relied a little more on narrative. This semester, we write journal entries! Woohoo! We still have to present all the relevant data, but we can present it in a free-form manner. Our CDFs were only really scrutinized in our first two semesters, but I have a feeling our instructor is the type that actually reads everything we send her. Here's hopin', anyway. I like feedback (even the squealy amplifier type).

At the end of the semester I have to do a peer-teaching project, on a subject of my choosing. I'm drawing a blank on what to do it on, I'll have to keep an eye on the newsfeeds for ideas. It will be hard to plan for even with a topic, since I won't know ahead of time what room it will be in, or what kinds of facilities will be available. I enjoy this kind of thing, my case study presentation and lecture on the benefits of meditation in chronic illness went over well so I'll have to go out with a bang.

For our trends and issues class, we have to develop a group response to a question each week, and post it in a discussion forum specially designated for that assignment. For reasons I can't begin to comprehend, my classmates want to do the discussion in private, through email and person, and then only post the finished product in the discussion board. It's called a discussion board..shouldn't that be a clue? It seems like computers and nursing are mutually exclusive in a lot of cases, just like nursing and politics (beyond office-politics, which are excessive). Maybe it's the reading speed, maybe it's the typing speed, but the message forum format is definitely alien to a lot of my classmates. Maybe the message-forum format is familiar but learning through dialectic instead of lecture is alien. Who knows. Someone mentioned to me once that learning through dialectic is considered to be a feature of the study of Medicine, so why not Nursing as well? The answer to that question is probably the answer to a lot of questions that irritate me. Tradition. Habit. Convention.

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