peds, ob, preceptorship, bla

I am a horrible blogger.
Nursing school is moving along quickly. I haven't even looked at my last post, so I can't say where we left off.
I am currently in my peds/OB rotation and lecture. Let's just say it is not my favorite, but I am surviving. My last clinical is this Tuesday because then everyone else will start Community, which I finished during the summer, so I am free!!
I took my med-surg HESI last semester and I got a 98%, which means I get to choose where I complete my preceptorship. After much deliberation, I decided on the CSICU. I had a good experience there, but I am still scared shitless. Part of me wanted to just choose telemetry to gain confidence and skills, but the other part of me feels that I have worked hard to earn my HESI score and I KNOW I want to be an ICU nurse, so...why not?
There are many fears though, like what if the nurses think I am an idiot because I don't know how to do something? What if they think, "Gosh, why did she choose to come here, she should have gone to MS, she knows NOTHING!!"
Silly, I know.

code blue!

omg, I just had a mock code at school in the lab with sim man. IT WAS SO FUN. But holy shit, we had a group of about 50 new students WATCHING US, LIKE AN AUDIENCE! How embarrassing is that?? especially when you don't know what you're doing?! hahah. wow, so funny. We saved the sim man life though. Stan.
The first time we did it, it was a mess and we were bumping into each other, etc. Second time was much better. They said we did like 435 times better than the other team who also had an audience.
You definitely need to be in good shape to do CPR and run a code. I could hardly breathe once I got to 30. Good thing someone else finally decided to start counting along with me!!

Yesterday I was in the MSICU. For the most part it was awesome and I am still sure I want to work in the ICU, but yesterday was a bit boring only because my preceptor's patients were stable and getting ready to transfer.
I was only there for about 15 minutes when this 90 year old called me over to his bed. He said, "I've been watching you....and I just wanted to say, I wish I could go back in time and become your adopted grandpa." aw!
Then this man just would not STOP TALKING. He seriously talked FOR-EVER. He kept going on and on about how life moves too quickly and how he loves one-on-one conversation. Then he was talking about books and he asked every single person if they have seen the movie Soylent Green. He seemed obsessed with this movie. He said he loved words and learning new things everyday. Seriously, I have never met someone so happy, not even for a 90 year old, but for a HUMAN. He was kick ass.
Later, they did an endoscopy at the bed side (he was a GI-bleeder/MI) and they clipped some blood clots that had formed from his billroth II (that is what I got out of it anyway). After, the doctor called me over and handed me 3 color, glossy photos of his stomach for me to keep. I was like, "Oh, is this my souvenir?" haha.

I also saw them insert a swan-ganz catheter.

EMERG-N-C

I'm in the ER tomorrow! I'm excited, but a little nervous. I hope I get to start a lot of IVs, insert a foley, and maybe drop an NGT. I have never had the chance to do an NGT, so I really would like to accomplish this goal.
I will post after clinicals.

critical care

My day in the CCU was so awesome! My preceptor was a male, which I have never really had before, but he was totally cool and you could tell he loved to teach, etc. We had two patients who were stable and self-sufficient, so he said it wasn't a good picture of his normal patients, but I didn't mind because it gave us a chance to discuss a lot of the going-ons of an ICU. Since I thought the ICU was a place I'd like to be, but I was still waiting until I actually went to know for sure, this definitely helped to reiterate this is the place I want to be. However, as I've mentioned in previous posts, lately I've been debating whether I should do the year MS experience or just go straight into a critical care internship program. I know everyone has a different opinion on this, but for me personally, I don't think I would be ready or safe as a new grad in the ICU. Another option that my preceptor brought to my attention yesterday was starting in progressive care first (step-down unit) and then applying for the CCIP!
For some reason I thought these internship programs were only for NEW GRADS, but I was wrong.
I think this is an awesome idea! The reason I am not so keen on MS is because I am going to school for all this time, learning all this neat stuff, but once you go to MS, you're just so busy that it doesn't even give you a chance to honestly learn everything about your patient and apply all the concepts we've learned. All you have time for is passing meds, dealing with paperwork, doctors, and that is pretty much it. The reason I like critical care is the fact that you have to know everything about your patient and you actually get to apply the things you learned in school. HOWEVER, in MS, I could get a lot more experience with time management, brushing up on my skills like foley's, IV's, NGT's, etc. If I can start in a progressive care unit with tele, etc., then this will most likely give me the chance to do all of the these things, as well as not lose all the crap I am learning now. OH, and the hospital I want to work in has a Progressive care course internship program!
I am worried though because I graduate in August and I bet those internship programs begin in May since a lot of people graduate then. I need to look into this.

First MS2 exam

I got an 88%.
pft. It is decent, but considering I stayed on top of reading and reviewing everyday after class, I expected a lot more out of myself. I mean, there isn't much else I could have done. I was studied out, but it would just be nice to see a grade in the 90's again. However, even a 92.4 is a B, soooo.
I wish I could just be happy with my B grade, but I'm not. I have high standards for myself. I don't want to know that I can pass; I want to know that I can kick ass and truly understand this information. 88 means I missed 6 out of 50. The average was 84.9.
ARGHHHHHHHHH.

Semester 3

I need to be much more frequent with my posts!!!

I am officially in my 3rd semester of 5 and things are moving along quickly! This semester I am taking Med-Surg 2 and nursing inquiry (a research course). The summer was good, but a bit boring, which explains my lack of updates. Let's see...
This semester is not as difficult as the previous ones, as far as course load goes, but the content is still hard, as always. I have my first exam on Monday and it covers Hematology and GI. I feel that my work as a PCT on a MS GI/telemetry floor has helped somewhat, but probably not as much as I would like. A classmate and I have been reviewing after each class, so I feel pretty prepared. Usually I am freaking out by now, but I do feel like I have a good grasp of the information; not that I won't be studying my ass off the rest of the weekend, but at least I know I can relax somewhat.
For clinicals, we only spend about 7 weeks on the floor, with the other weeks being filled up with rotations in the heart cath lab, Main OR, CCU, ER, PACU, MSICU, and CSICU. So far I have been to the cath lab and main OR. My regular floor is an oncology MS, but they pretty much get everything, which I like the best. Also, the nurses have been helpful and friendly, which is always great. The best part is the view. The floor overlooks the beach, ah. And when it comes close to 5pm and the sun is lowering, it looks beautiful.
On Tuesday, I was in the OR. I saw: right colectomy with hernia repair, a laproscopic gallbladder removal that turned into an open cholestcystectomy because of too much scar tissue/fat. And please don't hold me to the spelling because I am too lazy to look this up right now. Following that, a quick drainage of a breast abscess. After this, I heard there was going to be a LEG AMPUTATION. This excited me beyond belief. All of my teammates who went into the OR pretty much saw a bunch of gallbladder removals, nothing too exciting, so leg amputation? Pretty exciting stuff! I saw a stent put into an artery and then FINALLY the leg amputation. It was so cool. This guy already had a below the knee amputation, so they were just removing what was left plus above the knee. I was amazed by how quickly it was done. They just cut it open, and pretty much electrically sawed it off. The surgeon handed the stump to the nurse and he put it in a what looked like a bucket that you used to play with on the beach!!

So, I've been contemplating the future A LOT lately, especially in regards to what area of nursing I want to work in. In 4 more weeks, I am in the ICU and I honestly feel like that is where I would like to be. However, I have such conflicting gut feelings about getting experience first in MS or going straight to ICU through all the great orientation/internship programs that are offered. I honestly do not think I would be ready or safe for the ICU, but if that is what I want to do, then I will be trained. However, if I go straight to MS and then to ICU, I would have missed out on a cool critical care internship.
Decisions!!!!
I still have 4th semester, which is OB/Peds/Women, so who knows? Maybe my entire choice will change, but I highly doubt it.

rock this town.

You know what I hate?? When someone is alert, yet confused and someone will talk about them like they aren't there. For instance, today I was with a male tech and this one woman could respond (most of the time) to questions, but she was a bit disoriented. Anyway, she was incontinent of urine, so he and I were changing her bed and getting her cleaned up while she was still in it. Now, this woman will literally be smiling and then within the snap of a finger, she will look like she is praying and then BAM---bawling!! So of course, she starts to cry and I am holding her hand while he is trying to clean her up and he is just like, "Makes you look forward to old age, huh?" I was like..ha yeah, but I was actually kind of like...annoyed. I mean, this woman is exposed to the world (ok, maybe just me and him, but either way, no one likes to be exposed like that), she is obviously having some anxiety issues, crying, and all he can say is some smart ass comment like she isn't even in the room?
Seriously. I don't like that. Yeah, she may be confused and it is frustrating dealing with mentally unstable patients, but they are still human, geez.

I learned that coworkers can ruin a good thing. Like I said, I like my job so far and pretty much everyone has been helpful and/or nice, but you know how someone can have a bad attitude and it just irks you? Well, I learned to focus on the patient because--truly, there are some very grateful and cool people out there who are happy for your help. Of course there are some people who will never be satisfied, but if I just really focus on the positive patients, who thank me profusely for doing something as simple as helping them take a shower, then I think that will make my job worth doing. Today I got a page that said, "Raspberry Stethoscope is needed in room__." The male tech was like, "Wow, she must like you!" since usually it just says "Room__ needs bathroom/water/whatever." She said she was only comfortable with me! booya.

NAME CHANGE

I just want to inform all of my readers of the NAME CHANGE of this blog. As mentioned before, I am becoming more and more concerned with friends, faculty, and possible coworkers discovering this blog. Since I own a raspberry colored stethoscope, I thought the new name was fitting. It is all I can think of for now. ha.
Any comments?

death

Yesterday one of my patients died. She had been there for awhile and she was DNR, so it wasn't a shock or anything. I don't know what she had honestly, but she had on an oxygen mask and her respirations were like 24, as if she were gasping for air every breath. The last time I saw her I was trying to get a set of vitals, but the machine couldn't pick up a temperature or blood pressure. I guess because she was just too cold from all the blood rushing to her core. After that, a bunch of nurses and PCTs went in the room, but I stayed outside because I didn't want to crowd the tiny room. A few minutes later at the nurses station they told me she was gone. I was kind of interested to see what I would have had to do, like clean the body and bring her down the morgue, but I left at 3, so I never got a chance. It was sad, but also happy because obviously she was quite uncomfortable. One unfortunate thing was that her son was flying in to see her, but he did not make it before she died.

annoying

I am so sick of non-BSN RNs putting down the BSN students. All they ever say is that BSN doesn't have enough hands-on skills or that we don't like to "touch the patient." Whatever the HELL that means. All I know is my friend goes to the local college, is getting her ASN and she has one day a week in a hospital and guess what? I HAVE ONE DAY A WEEK TOO. ALSO, she doesn't even go into the hospital until the second half of the semester, whereas we start from day one and now we have 12 hours. So wherever people are getting this idea,I DON'T KNOW. I think it ultimately comes down to them being self-conscious about someone with a "higher degree." If I went straight from high school to university, why would I get an associates? To me, that was never even an option. In fact, I didn't even know what an associates degree was until I graduated. I don't ever say, "ooh, ASN RNs have less education and they are stupid!" NO, because it is not true. Therefore, I do not appreciate older people putting down my choice and my education. I go to a GREAT school and it is highly competitive, so I'm not going to feel like less of a person just because someone feels bad about their own choices.

End of life issues

I have to write an ethical paper related to end of life issues. I need to present both sides of an issue, etc. Problem is, I can't think of anything interesting to write about. I was hoping everyone could offer some suggestions!:)
I want to do something unique since I am sure the majority of people will be focusing on assisted suicide, DNR, advance directives, etc.

These are the guidelines:
a. Dilemma must be an ethical/legal issue relevant to nursing
b. Make sure you state BOTH sides of the ethical dilemma Remember, each side of an ethical dilemma has at least one “good” position; that is what makes it a dilemma.
c. Each side of the dilemma should be supported by factual material i.e. nursing statutes, Florida state statutes or laws (or another states legislation), ANA standards, the Nurse practice act, peer-reviewed journal articles, research articles, etc.
d. There should be evidence of using the ethical decision making processes discussed in class for example the one listed in the text, the ANA code of ethics, the ANA position statement.
e. Your position should be CLEARLY stated). The best way you can present your opinion is to be able to discuss why the other opinion is ‘less correct’, as well as why yours is better.
f. How the outcome of the dilemma might impact nursing practice

Hola!

Wow, so today I had about 8-9 patients and half of them were spanish speaking only!!! 4 out of 8, that is crazy. I need to learn spanish! I took two years in high school and two semesters in college, but I pretty much let the bucket go dry on that one and forgot everything I knew. Well, not EVERYTHING. I still know quite a lot compared to nothing, but when you need to say medical-type phrases or ask questions, it is hard.
I'm thinking of purchasing a medical spanish book to refresh and learn some new phrases that related to medical/nursing stuff.

I might be a bit sick in the head.

Today was my second day on the floor. I worked with an older black woman named Mary*. She was very nice. At first it seemed like she wasn't going to be much help to me, but as time progressed, I saw how she was and I like her. Surprisingly, the day was incredibly slow and somewhat boring. We had about 7-8 patients, but most of them could do everything for themselves. I did get to see a chest tube taken out, so that was pretty cool. That is one awesome thing about my floor is I see a wide variety of things, so I get to learn. I swear I didn't do much today, except vitals, helped a woman bathe, and kind of observed. The last like 2 hours were sooo quiet. I basically sat with this very talkative 45 year old woman because there wasn't much else to do. She had a great sense of humor and she was sarcastic, so we got along. I'm sure I'll see her Sunday, when I work next.
I finished all my ethical-legal for the week, so I have nothing to do Saturday. I suppose I could work on a paper or project, but pft. My boyfriend is away for a month and a week, so I am lonely.

Maybe it is only because I'm still a student and I'm learning, but when I compare my experience with the hospital to the outpatient clinic--I definitely love the hospital a lot more. I think when I become a NP, I would rather work in a hospital. However, I might change my mind after working in the hospital for so many years.

Something happened today that made me feel like maybe I was a bit morbid. When I arrived on the floor, the other PCT told us that a patient had just died and they brought him/her down to the morgue. I thought to myself, "Damn, I missed it!!!" I know, it is horrible, but I want to experience these things!!

Oh, one nice thing about today--when I left, a patient actually hugged me goodbye and thanked me a lot for helping her, so that felt nice.


I keep thinking of more things to add to my entry, but I just wanted to say how much starting my job has made me miss clinicals. When I'm there, I keep looking for opportunities to do things, but then I remember--I'm in a PCT role and I am not acting as a student RN. I want to go to clinicals, so I can start IVs, do assessments, give meds, feel smart, etc! I always knew I liked this stuff, but I am realizing how much more I like it now. I just want more experience to better my skills, I suppose.

*Name changed*

Hello everyone!
It has been far too long and I apologize. I've been a busy little girl. I got a job at a great hospital only 15 minutes away as a PCT in an "internship" program, which basically just means I get to make my schedule and they are very flexible. I've only had one day on the floor so far and I basically followed around the PCT. I'm finding it kind of difficult only doing PCT stuff and not actual nursing stuff, but it is a good learning experience nonetheless.
School? Incredibly boring. My community nursing lecture is...so.bad. The information isn't that horrible, but the professor is a major bore and she does not respect us much either. The other class I am taking is online Ethical-Legal Nursing, which has some okay reading, but then it is just quizzes, discussion board, and a paper, so it isn't all that exciting. I am doing a geriatric based community clinical at the very big local cancer hospital, working one-on-one with a nurse practitioner. The experience is nice, but I don't feel like I am doing all that much, except observing. Overall, I'd say this summer is boring. However, me and another student are doing a project for Commnity and we might make a brochure that could potentially be printed for the clinic, so that is exciting.

Lately, I've been getting nervous about someone finding this blog, so I want to change my name. ANY SUGGESTIONS? I would like for it to include the Student nurse or nursing student theme.

Semester 2 of 5: FINISHED

I finished the semester yesterday around 8:45.
My final grades are:
Med-Surg: 85 B
Psych nursing: 94 A
Pharm: 90 B

I managed to get a 970 on my psych HESI and a 1017 on my pharm hesi.

WOO FOR SUMMER (even though I start summer school in about 10 days).

the end is near!

Thanks everyone for the comments on my previous entry. I know that nursing is a tough career--physically and emotionally. I am not some idealistic nursing student with unrealistic expectations about the career I am throwing myself into.

With that, I am moving on.

This week coming up I have no exams, but then the following week I have an exam every single day, except Tuesday.
Last week I got an 86 on my MS exam, so even if I get a 100% on my final, I will only have a 92 (B) in the class. Now, I just need to make a 73% to get a B in the class, which will happen easily.
Pharm--I got a 98 on my cardiac exam. Highest grade in pharm yet. I am pretty sure I'll be getting an A in this class unless the HESI kicks my ass. Today I plan to work on the study guide.
Psych--90% on the final, so I need about an 88% on the HESI for my A. I have heard the psych HESI is easy, so I hope I can pull it off.
Time to get moving.

hmm, disgruntled much?

I just received an email (to a place I don't normally receive email) from obviously someone who is very disgruntled and bitter about the nursing profession. I thought I would share it with you all:

Dear Nicole,

I just found your blog and have enjoyed reading it very much. You seem like a very intelligent, idealistic person with a lot to offer the world.

However, your comments regarding the person in intake who was lamenting the way things are in the nursing profession worries me. I hope you do not get too disillusioned when you graduate and start working and you get the eye-opener that is the first nursing job. I saw you were recently taking three patients. Try caring for eight or nine, all of whom are ridiculously sick and your floor is shortstaffed. When you ask management for the staff you are "supposed" to get according to the hospital's staffing grid, they will tell you they will "see what they can do" but nothing ever gets done about it and meawhile you are left holding the bag. What are you going to do if more than one of your patients start coding at the same time? If something happens, no matter how perfectly and how well reasoned your clinical skills and decision making are, if one of those people dies it will be blamed on you, and be your fault, because "you're the nurse! Why didn't you do X, Y, Z" which of course naturally would have solved the probelem of how you are going to be in two places at the same time. And why didn't you catch the DOCTOR'S mistake in time? and don't forget about your other six patients who also have problems going on.

I am very sorry to hear about your classmate getting attacked. I hope she is OK. But please don't kid yourself regarding that psych patient that attacked your friend/classmate. People with psych issues walk among us every day, not all of them are safe in the psych ward and not all the people who attack are mentally ill. Some are just mean. My first year out of school I had a co-worker whose little old lady patient (who did NOT have psych issues btw) attacked her by trying to strangle her with the stethoscope worn around her neck during her morning assessment. And even if you are not physically attacked, you will definitely be verbally attacked by patients and their families, and often physicians. And don't forget the little old men who like to pinch butts or try to 'kiss the nursie".

Anyway, if nothing else, do yourself a favor-- go to the local courthouse and listen to the malpractice cases being heard. I guarantee it will scare the hell out of you. Just last fall there was a nurse in Wisconsin who was charged with a felony with possibility of jail time for a medication mistake. While you are young, while you are still in school, and still have time to make a change, do it. I would love to be able to recommend the nursing profession as you are right, the world does need nurses, but I cannot do it because what that nurse in intake was saying is TRUE.

If you still want to be a nurse, more power to you, but please really think about what you are doing. There are other, equally wonderful ways to make a difference in medicine. Nuclear medicine, radiology-(especially CT or MRI!) , sonography, pharmacy, are great ways to contribute to the field. But please don't buy into the imagery of what the hospital industry would want you to believe nursing is, because it is all a marketing lie. Even when you are in school- even in your last practicum- you are still so INSULATED from the realities and the level of unrealistic expectations that you will not be able to see how things really are until that graduation ceremony is a well worn memory and the celebration of passing your boards is, too. You will not see it because it is intended that way. If it was shown to people training for the profession beforehand, no one would do the job, and hey, the world needs nurses. How many nurses do you see running BACK to the bedside? Not many, I bet.

The funny thing is, I used to think the way you do about nursing.

One last thought in closing: Do the math. Literally.

Median wage of a nurse= in Florida about $24. New grads of course, start MUUUUUCH lower. MAybe $18. But start with the median.

$24 divided by the number of patients assigned to you as a full assignment (conservatively 7 on med surg) remember, you are responsible for these peoples' LIVES.
Grand total? $3.42

Yep, the hospitals are paying you $3.42 per patient per hour for all those nursing skills you are studying so diligently to acquire. A babysitter gets more than that. And the approximate base charge to the patient for a day's stay in hospital bed, not counting meds, treatment, etc= $1500/day. What's wrong with this picture???

Just a thought.

Good luck to you in however you choose. But choose wisely, as said in Indiana Jones and the Last Crusade.

Kelly

Why this person chose to pick me out of all the 4353543 different student nurse blogs, I don't know. All I do know is that I really do not care, so please do not email me again. Also, I find it quite disturbing to think this person took such the time to write out this letter. Honestly, I didn't even have time to read all of it when I posted it. What are people thinking writing something like this to me??

OH OK, I THINK I WILL CHANGE MY ENTIRE CAREER NOW BASED ON WHAT YOU SAID!! Yeah, Mom, I decided to quit nursing school because KELLY sent me an email telling me how shitty my life is going to be? You know, I should just jump off a bridge now because my life is obviously going to suck a lot. What? Who is Kelly? Yeah, no idea.
C'mon people, seriously.
Also, I am only semester 2 and we're only supposed to have 2 patients, so when I took 3, I was pretty damn proud of myself, so please do not take that away from me, whoever the hell you are. And why do people always comment on the entry about the guy attacking my friend? And yes, I realize psych patients are everywhere, they have reiterated this point to us over and over and over and over to the point if I hear it one more time, I just might vomit.

Now, it is 7am and I need to go dry my hair because I have class at 8 am and an exam at 12pm. I hope I pass so I can make $3.42 an hour!!! wow, what a dream.

recap

I know, it's been far too long since my last post. I've been keeping extremely busy with school, but everything is beginning to come to a rapid end.
Let me recap.
Last week I finished almost everything that needed to be done for both MS and psych clinicals: case studies x 2, AA meetings, SOAP notes, etc. I am now technically done with MS, but since I missed one day, I need to return this Tuesday. Psych though? FINISHED! woo. I am happy. I did not enjoy psych clinicals all that much. It was pretty boring and when it wasn't boring, it was more scary. Not fun for me.
As far as MS clinicals, I am happy and sad it will be over soon. Happy so I can sleep in and not wake up at 4am on Tuesdays, as well as two days in a row off from school, but sad because I know I am missing out on opportunities to grow and learn more skills. I actually feel like I've been learning a lot. I attempted another IV insertion. Got it in, got the flash of blood, but when I went to hook up the flush thinger, accidently dislogded the catheter--woops. At least I got blood, right??

As far as classes--
MS
-I have a high B, but since we only have one more exam and the final, the only way to bring it up to that 93% would be if I scored like 98% on both, which is highly unlikely. I can live with my B, thank you!
Pharm
-Had a low A, now I have a 91, but we still amazingly have 50% of our grade to go, including the HESI, so I think I can definitely bring it up to an A *crosses fingers*
Psych
-Grades so far: 87.5, 100, 96. This averages to about a 94.5, which is an A. We have one more exam (final) and then the HESI. I think and HOPE I can pull off the A. I heard the HESI for psych is a lot easier.

What's in store for this week? Amazingly--nothing! An entire week of no tests or presentations. I'm enthused. However, the following week is going to be PURE HELL. 3 exams in one week--ms, pharm, and psych. I doubt you'll be hearing from me until hell week is over.

My last day is May 4th, then I am off for about 10 days and summer session starts. I am taking Ethical-legal nursing online, as well the community lecture and a special geriatric based clinical. Usually, community is taken during 4th semester with peds/womens/ob stuff, but we can opt to get it over with early. I thought I might miss out of some aspects of community by taking the geriatric focused one, but I figure I will get it done now with less hassle 4th semester. Also, I live in Florida, so it can't help to learn as much as I can about geriatrics!

OH YEAH and I've applied to a few jobs for the summer.

I am so glad the week is over!
Monday I had my cardiac exam--88%. I can live with that.
Yesterday was my second psych exam, which I was worried about because the first one I got an 87.5, so I definitely wanted to do well, but I've just been way too tired to study the way I should have. Well, I got a 100%!!!! I know it is because she has two bonus questions at the end, woo.
I have one more week and then I am off for Spring Break! Not that I'll be getting much of one considering we have our 3rd MS exam the day we come back--evil.
This thursday is my fourth pharm exam. I am doing pretty well in that class. My grades so far: 97, 91, 96. I'm not too worried. I usually make notecards, but this time I am going to see how I do without them. Mostly just because I am behind on the reading and it takes way too long to make the cards.

My car is broken, so I can't go anywhere. I don't think I will have somoene look at it until NEXT weekend. I just can't deal with that crap when I have tests to worry about.

Goal for the day is to finish pharm reading, study a bit, and then hope to hang out with the boyfriend.