5.06.2008

No More Student Nursing

Today was my last shift as a student nurse.

Acadmics are trivial, tests are laughable, this has been the real test.

I could have kept my rotation in the inner-city, an hour away from home at the crack of dawn, and probably had an easier time. This is in spite of the fact that I don't "do" mornings very well and nearly failed out of the program last semester due to lateness.

When the Program Director suggested to me that I switch to an evening shift, I balked, figuring (correctly) the advantages of a familiar environment would outweigh the concordance with my circadian cycle. The director (wisely) dangled in front of me the opprotunity to study under a particular instructor that I've been wanting to work with since day one, an instructor that serves in the role I want to one day occupy (emergency), an instructor who seems much more "with it" than her colleagues.

I knew I could very well have screwed myself for signing up for her rotation, but I did it anyway. This was the trial by fire. She came into this knowing she might have had to bounce my ass back a year, and I knew I might have screwed myself for requesting it, but sometimes I guess you have to go with your gut. My gut told me that this was the best educator I could have hoped for, and if I didn't make it through her rotation, I had no business being an RN.

She passed me. Barely. There's a lot I need to work on, and she gave me some sound career advice: to get my ass into a med/surg orientation instead of taking the state mental hospital job. We'll have to see what happens, who wants to hire me, but I have been on that same page since day one. There's a local hospital that has a kick-ass graduate nurse orientation in emergency that takes them through every unit in the hospital that I'm salivating over, but the state mental hospital is still a viable "plan B".

From now on, my entries will not be submissions to my instructor but the unrestrained words of myself, from me.

Many of you have said that my writing has been too formulaic, too systematic, and I'm hoping that the fact that I'm no longer submitting these posts for a grade will result in a looser, more organic read.

So, let's meet my last two patients as a student nurse (having two with no meds was somewhat anticlimactic after four with meds, but it was a welcome gimme):

Patient X was admitted for respiratory failure secondary to pneumonia. He was intubated for about three days ONE MONTH before I saw him, an occupant of our hospital the whole time. He had a slew of interesting co-morbidities, including COPD with severe restrictions, A-fib, Hep-C and that's just for starters.

His pneumonia was resolving when I met him, and his plan was to get discharged by the weekend. His breath sounds were great. His oral mucosa was dry and the papillae on his tonge were prominant. He continuously requested oral hydration, but he was NPO. Most of my interactions with him were centered around oral hydradtion and debriedment, usually around the time we had to reposition him (q2h).

He was thirsty. His oral mucosa told me he was thirsty, he didn't have to tell me. He was getting jevity via g-tube, and I had to wonder, given the osmolarity of his jevity feedings, how much "fluid" he was actually getting (he wasn't getting any IV fluids).

Oh, he was also a Traumatic Brain Injury Patient, which was why he was total-care. I pride myself on being able to decypher aphasia, and Patient X tested the limits of my ability to do so. I was in every 15 minutes or so to moisten his mouth, and it was never enough. Ironically, my oral-swab excursions produced a greater coughing effort (probably due to small-volume aspiration) than he was able to initiate himself (his coughing efforts were mostly groans).

One of my classmates knew Patient X from a Skilled Nursing Facility and checked up on him often. I wish I could have shown her better how well I was taking care of him...how well I understood his slurred and aphasic speech, the times I made him laugh, the overall quality of the care I was giving him..but all I got were rolled eyes when I cracked jokes to him. I made him laugh a couple of times, and that's worth more to me than..well...anything.

Patient Y was admitted for cellulitis of the lower extremities. She had an interesting cardaic history as well, and I was confused intiially as to whether angina or cellulitis-related pain was responsible for her hospitalization.

I got to use the bariatric bed-weight on her for the first time, an interesting contraption that hooks up to a 'tarp that we fold out underneath her to get her weight similarly to placing her in a hoyer lift.

She drew some strength from her roomate, I kept drawing back the curtain so they could see each other, but someone else kept pulling it shut again. I can't be there all the time, and the supporting relationship these roommates had couldn't be replaced by anything.

I felt so useless not being responsible for any medications. I spent a lot of time helping the other Assistants, doing a lot of hygene and measuring a lot of Intake and Output, and I felt that for my last day I was performing the duties of a tech and not of a Nurse.

I Love the Techs we've been working with this semester, for the most part. The facility I spent this last semester at has retained some dedicated, patient and wise people to perform what seems like the lowest and perfunctory role, but truely is central to the unit's operation. This is obviously true of the Unit Coordinators as well.

I seem to be gravitating towards the private hospitals, or at least the hospitals under a certain size, where it's harder for the slackers to blend it, where everyone depends on one another. I know not every facility can provide an environment like that, but I deeply appreciate all of the environments I've been graced with, small private hospitals and large inner-city hospitals alike.

So where to now?

It seems clear that to shephard my skills I need to take on an intermediate or criticla care orientation as a graduate nurse...but we'll see who hires me. The state mental hospital remains as an alluring "plan B". No matter what happens, I feel that I have a long, fullfilling future in a profession that needs me (AND YOU!) desperately.

...and I will do all that I can to elevate it.

Join me.

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