Goodbye....

Yesturday I heard some very bad news. A mentor and friend passed away. He was the one who was always supportive, who cared a lot, and who always put others first before himself.

He was not only a mentor, but a father of 3, a husband, a physician, a manager, and a friend.

He will be greatly missed.

I PASSED!

I have another announcement.... I PASSED MY THESIS DEFENSE!!! I am now, except for a few revisions, done my Master's degree!

I have told everyone who knows me that the have to call me Master Elaine for the rest of the day. HAHA it did not go over so well, but anyway, I"M FREEEEEEEEEEEEEEEEEE!!!!

Procrastination

My Master's defence has been scheduled for Thursday at 2:30. I'm excited, a bit nervous, but overall, feeling pretty good. I need to prepare more.. re-read some articles, etc, but i have NO MOTIVATION!

I have had a taste of freedom, with no schoolwork, no assignment, no STUDYING, and I love it.

It's hard to get motivated when you know that pretty much unless I totally blow it, I will pass the defence.

Announcement

So, FINALLY, I have official confirmation of my final placement in nursing school, where I work 450 hours in a nursing experience. I applied back in July, and I finally heard today that I AM GOING TO THE EMERGENCY DEPARTMENT!

I'll be working with a preceptor (mentor) there, in a small community hospital. I'll be commuting 40 minutes, and even though there are bigger, tertiary care hospitals nearby that I am not placed at, I'm not that disappointed. The Emergency/Critical care areas are very competitive, I'm surprised I got a spot.

Anyway, I also went to a conference this past weekend to present my master's work . I'll tell you a story about that later!

Diabetes

Its hard to believe that in less than 90 years, the treatment for diabetes has journeyed from palliative care of children in their teens from the result of keto-acidosis, to people living long and fulfilling lives with only some complications.

In my current rotation, I see the effects that long-term poorly controlled diabetes. I'm on a combined unit of orthopaedics and vascular surgery. Today I spent a day looking after people who had lost their limbs because the sugar in their blood eventually caused blockages in their arteries and veins.

I saw a woman, who at age 37 was blind, had both legs amputated, most of her fingers were gone, and was in renal failure.

I saw a man, who with type 2 diabetes, had already lost his right leg, and was on the way to losing the left.

I saw others for whom their wounds are not healing because they have poor blood flow to the area.

I see people who are fighting so hard to live. Where was this fight 20 years ago when they were first diagnosed? Is this their fault? Can we give blame to someone who is told they radically have to change their life, and be expected to comply EVERY DAY for the rest of their life? Are we not getting the word out about the complications of diabetes?

It makes you wonder.

Proud of myself

Every time I go to the hospital to work as a student nurse, I try and remind myself that I am there to learn and that no task is 'too small'. Yes, I want to see the cool stuff, and try to do the more complicated nursing tasks, and yes, I HATE bed baths, but I do it without complaint because, as mentioned, this is the place to learn and to build my observation skills.

I guess that has paid off. Every single placement an RN has mentioned that I should work there after graduation. And this is not an obligatory statement made to the group of us because they are short staffed, this is a nurse either pulling me aside or talking to my instructor and saying that I would be an asset to their staff. I am proud of this, and I hope in a few years time I'll actually be worthy of those statements. For now, I'm a newby student nurse that hopefully one day lands herself a job in the Emergency Department.

This day was no different. I had low expectations of Labour and Delivery because of how much time was spent sitting in a room doing nothing last time. Today it was different... it was relatively busy, and I ended up working with 2 placenta previa patients. Placenta previa is a condition for which the placenta has implanted low in the uterus, so that it actually covers the internal os, or in layman's terms, covers the cervix. If this happens, the baby cannot go out the vagina like it normally does, as the placenta is in its way. This can lead to major bleeding if the cervix tries to open, which can not only can kill the baby, but also the mother. Patients with placenta previa have c-sections to lower the risk of hemorrhage.

At first, I have to admit the nurse I was assigned to was not easy to get along with, and she seemed to not like me. She made some rude comments, and did not like that I had to follow her around. I figured it wasn't me, but that she didn't like to work with students. I think that I did a good job of interacting with the patients we were working with, and yes my nursing histories took longer then the average nurse, but that is normally the case because as a student we are not familiar with the forms, and actually ask all the questions on there.

After numerous hours of working with this nurse, I guess I must have proved to her that I was competent as a student. Perhaps it was my ability to locate some things for her on the internet, or it was the fact that I was capable of doing the tasks she required. But her annoyance for me dwindled. At the end of the day, she asked me where I wanted to work after graduation. I mentioned the ER and she said I should apply to L&D. She even mentioned it to her nurse coordinator that she should put my application at the top of the pile!

Although I am unsure of whether I would apply to L&D, I did enjoy it while I was there. I've always enjoyed the fetal development process, and the idea of helping out with labour is fascinating. Perhaps when I'm sick of traumas and older people and drug users/abusers, I'll put in an application for L&D.

Scrubbed in...

Today was a decent day, the last day of Labour and Delivery.

I saw another c-section, and they actually let me scrub in! I helped the scrub nurse make sure that all the equipment was available, and I was THISCLOSE to everything.

Bonus, I even knew the resident, she was on the emergency response team with me back about 5-6 years ago. Today she is a junior resident, but she did almost the whole c-section with the consultant right next to her. It was amazing how much responsibility residents are given so soon after medical school graduation. She did a great job, and the lady probably won't even get a big scar.

I never realized how much yanking and pulling c-sections require so that the baby can come out of the little incision they make. I realize they want to minimize the incision for scarring etc, but wowzers I've never seen skin pulled that much. It didn't tear, and I'm sure it's standard protocol to do what they did, I just was surprised. No wonder the ladies feel so sore afterward!

The baby came out screaming, which is great, and COVERED in vernix. The baby was completely white because of it. Vernix is the slimey white stuff that protects the baby from the amniotic fluid so they don't get all pruney like we do after a bath. Remember, babies live in amniotic fluid for 9 months, they need something to protect their skin.

Scrubbing in was interesting. I've never done that before, and they don't give you a crash course in scrubbing in prior to you having to do it. My instructor just told me to wash for three minutes and did a brief example. Good thing there was directions on the wall. I bet I'm not the only nursing student to need them, either. They have so many medical clerks and nursing students going through to observe that they need the directions. Overall, I think i did well as a scrub nurse assistant. I didn't do much, but I did get to see everything and help out when I could.

Almost done!

I can't believe it, but I am almost done nursing school.

Thursday was my last exam of this degree. Friday was my last presentation. I have 6 clinic days left this term, one in labour and delivery and the rest in orthpaedics/vascular surgery.

Next term I do a practicum in the hospital. I don't know where it is just yet, but I'll let you know as soon as I do. This practicum is supposed to solidify everything we've learned in nursing school. Essentially, we're going to be working full time as nurses. When our preceptor works, we work.

I'm looking forward to this part, yet at the same time I can't believe we're done all the coursework already. LOOK OUT WORLD, HERE I COME!

I have my reasons...

So i have been neglecting this blog recently. I have had a paediatrics exam, and my master's thesis was submitted this week. Thus, I have a right to ignore this blog. HOWEVER, I will be back in full force soon.

One thing I am grateful for is my experience with emergency response. I have been involved in prehospital emergency response for about 8 years now, and I teach advanced first aid (also known as Emergency First Response) to those wishing to be a part of pre-hospital care, such as police officers and firefighters.

Anyway, the reason I'm glad that I have this experience allows me to be better able to prioritize my nursing care. We had simulation lab this week for post-partum, and one of my classmates decided after the patient complained of cramping that he would get her some acetominaphen. I'm sorry, but when your patient who is post-partum is complaining about abdominal cramping, you need to explore this pain. You need to know if their uterus is contracting, or if it's not. If it isn't it could mean that the patient is at risk for hemorrhage. In this simulation, the patient did in fact have a non-contracting uterus, and was saturating a pad in less then an hour.

I was sitting near them (i was given the job of the 'observer'), and I wanted to scream "She is bleeding! She is bleeding! Do something about it!" but I didn't. Later the nursing instructors did talk to my classmates about their prioritizing, but I don't know if they truly understood what they did wrong.

Airway, Breathing, Circulation (and you can add a 'D' for Defibrillation). I have yet to take an ACLS course, but I'm sure that the priorities are the same. If you have someone who is bleeding, that is the priority, period.

Change of Shift

Change of Shift is at Emergiblog.

Enjoy!

Thesis update

So my thesis committee was able to read my thesis in time, and has approved my thesis for defence!

YYYYYYYYYYYYYYYYYYYYYYYYYYYYEEEEEEEEEEEEEEEEEEEEEE
EEEEEEEEEEEEEEEEEESSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSSSS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Now I'm drinking wine and chatting with the bf, who I haven't really seen all week.

Have a great night.

Today could be called....

... a waste of time. I went to Labour and delivery today. 3 people in the rooms, only 1 more then 2 centimeters dilated. The new staff nurses recently hired got those ones. What did I do today? I stayed in the waiting room and did a bit of schoolwork. Then, I went to break. Then I went back to the room. Then I went to lunch. Then I went to an empty patient room and pretended to watch videos of "the development of your baby". And then I went home.

The only delivery of the day was right before we left, and everyone was allowed in the room EXCEPT the nursing students. The staff nurse, the training nurse, the 2 residents, the med clerk, the consultant, the family, AND the "take your kids to work day" 14 year olds were there, but the nursing students? Nope, we were in the hall.

I realize that L&D is come and go. Sometimes there are TONS of babies delivered, sometimes nothing. I wish our nursing instructor, once lunch hit, would have sent us home. We did not learn anything today. What a waste.

First Day in Labour and Delivery

So if you have been following my blog thus far, you know that I have been shuffled around a lot this term between paediatrics, paediatric emerg, adult emerg, mommy/baby (ok there was nothing going on the day I was there, so you probably haven't heard about that), and now, finally, I have been assigned to labour and delivery. I'll spend a measly 3 shifts there (1 for which I have already completed) but at least it's an experience, or so they tell me.

I didn't tell you that I have completed my last content course of my nursing degree. I have some seminars later this week and next, but overall, I'm pretty much done most of my nursing degree! Now only if I can survive the next few weeks of exams and assignments, I'm free!

Ok back to labour and delivery. Today seemed like it would shape into a pretty boring day. On the board there were three women delivering. One was at 2cm dilated, 1 was almost there at 9cm (but one of my group-mates would get that experience as he was going to PACU instead of labour and delivery the next day), and the other was just there for a ?labour. The one nurse with the 9cm dilated woman had to train new staff, so we lost out on watching that one. So, with 6 of us needing to get some experience with L&D, it didn't look so good. However, there was a scheduled c-section that day, so things were looking up.

It turned out that most of us were able to assist with this delivery. One of my classmates scrubbed in and helped the scrub nurse with the section and tubal ligation. Another classmate followed the circulating nurse. Yet another classmate stood back and also followed the circulating nurse. THEN, there were two of us assigned to the baby assessment area, plus our instructor who would guide us through the assessment.

It was my job to do the initial assessment on the newborn baby. Essentially, the baby would be taken out of utero, given to the circulating nurse, who then would take the baby into another, smaller room to get it ready to see mom again. During this time you need to do 2 apgar* scales, one within 1 minute after birth, and one 5 minutes later. You also need to clean the baby off, to get it dry, put the hat on him/her, assess breathing and heart rates (and quality), give erythromycin to the eyes, and a vitamin K injection into the thigh. THEN you need to shorten the cord (if need be), diaper the kid, and swaddle him/her. All of this should be done fairly quickly, so that baby can get back to mom.

*the Apgar scale was developed to assess the health of a newborn. The scores range from 0-10, with each of the 5 categories having a maximum score of 2. It involves appearance, pulse, grimace, activity and respiration.

Of course with a student doing the assessment, I think it took twice as long as it probably should have taken, but I must say that it was a very interesting experience! Good thing there was no problem with the baby, as even with all the first responder training I have completed, if something went wrong I think I still would have freaked a bit. Of course my instructor was there (she's an RN and a midwife so she looks after babies all the time), but still, it was a tense situation.

I enjoyed it today... I would have got to see another c-section but I had to leave for an appointment. I'll update you further how tomorrow goes.

Change of Shift!

It's Change of Shift time over at Nurse Ratched's Place.

Check it out!

My day in the Emergency Department

So as you know I spent the day in the Adult Emergency Department.

First, to preface everything, I could not sleep last night. I don't know if it was because I was nervous, or because I was excited, or because I was anxious. All I know is that I woke up every half an hour pretty much all night. I reluctantly dragged myself out of bed at 5:30am so I could make it to the ED on time.

I was assigned to be with a nurse that was my age. She had graduated the same year I had for my first degree, yet she didn't lord over me, she treated me as an equal, for which I was grateful. It was weird that she has already had 3.5 years of nursing experience, and here I am a 2nd year accelerated nursing student, graduating this upcoming april at age ... well lets say 25+.

I have to say the very beginning of the shift was disappointing. Although the nurse was a great person to work with, we were assigned to work in the Ambulatory Care area. This is the area in the emergency department when the lowest acuity patients go. This is for the patient who is feeling unwell, who has abdominal pain, and who has a infected wound, etc. These patients are not going to die anytime soon, but can be also considered the "walking wounded". These patients generally didn't need much except to have blood drawn for labs, and not much treatment treatment besides IV fluids and a prescription for pain killers, antibiotics, etc. This was NOT what I had expected for my one and only day in the adult ED, as I really wanted to see a trauma or VSA, or something with higher acuity.

What started as a craptacular beginning quickly proceeded to change my mind once the nurses started working. I observed a lot of blood taking, and IV starting, for which all the nurses were more then willing to teach me the theory and what to look for once I am able to do those tasks*.

*IV starting and blood taking is an advanced skill not taught to nursing students in Ontario until during their practicum or even post-graduation. It is a designated act by a physician, although now it's mostly nurses initiating any peripheral IV.

Once the nurses felt comfortable with me, and I guess I showed them an adequate amount of knowledge, they then got me to do assessments on people, as well as start bringing in people from the waiting room! I felt like a pseudo-ED nurse.. I have only called people from a waiting room because I taught birth control, I have never done this in the ED! The patients thought I was an actual nurse (until corrected), which was cool, even though I introduced myself as a student nurse.

By the end of the day I was bringing in people, updating myself on the chart, asking a few questions to the RN's to make sure I was on the right track, and then assessing the patient by myself. I'm sure if they had an issue with what I had said, or if I hadn't answered any of their questions, they would have followed up with the patient. It felt nice that they were comfortable with me doing these assessments. Dont' get me wrong, I realize I am a student and I still have lots of learning to do, but it's nice to think that the RN's trusted me to do the right job.

Although I didn't end up observing any traumas or any high acuity patients, I enjoyed my day. I enjoyed the non-routine, and that the patients changed constantly. This is a great sign... perhaps now I can be more assured that ED nursing is for me.

ER here I come

I have been selected to observe in the ER tomorrow. I'm really excited.. of course now I can't sleep. I'm sure with my luck everyone will be ok (sometimes I'm the guardian angel that keeps people healthy while I work with them). Although, not to be morbid, if something's going to happen, can it please happen around the mid-sized-tertiary-care-center Ontario between 0700-1400h? That would be FANTASTIC! Maybe they'll let me do more then just observe, but who knows.

Anyways, going to try to get SOME sleep. Want to be awake for tomorrow.

The life of a Grad Student... urgh

So I submitted a copy of my thesis to my thesis committee. If they like it, I can then just do a quick fix of what they wanted changed, and submit it an exam committee. I am so close I can feel it!

My supervisor, though, brought up the possibility the other day that due to unforeseen circumstances, my committee might not be able to read my thesis for a MONTH. What does this mean? It means that I might not be able to defend in early/mid December, the last possible time I could defend. You see, it seems simple, but in my department the exam committee needs a month to read it. Well, if my thesis committee is not going to approve my thesis, I wouldn't be able to submit my thesis to the committee until at least late November, which is too late for a defence in December, and it would get pushed until January.

I'm tired of this thesis. I've towed the line. I've done the work. Just let me defend and get this over with! I hate the idea that I'd have something overhead over the Winter break.

Why sometimes I don't like nursing school....

Just so you know I haven't always had a thrilling time in nursing school. First, I didn't expect to become a nurse, when I first entered university it was the last thing on my mind in terms of a career. Yes, I have to admit, I was a medical school wannabe. A few attempts later and a couple of degrees further, I realized that I needed a job, and that nursing would provide me many opportunities within the field of health care, and after 1.5 years of nursing school I feel as though I will be a confident, and competent nurse in the future. I'm looking forward to pursuing nurse practitioner after a few years once I get some experience under my belt. I don't' regret going into nursing school whatsoever.

Today was a very frustrating day in nursing class. My classmates and I are in an accelerated program: we have done 2+ years of university prior to entering this program, and are almost all mature students. For the most part, they are very open minded and not quick to judge. However, today was a different story, and it made me sad to think that these people are not willing to necessarily put oneself out there for the sake of the patient.

We were discussing abortion today in class. I'm not talking therapeutic abortion, where the patients choose to have a termination of pregnancy. What we were discussing was the medical term abortion, or in other words, a loss of a child in utero from all causes (both therapeutic as well as spontanious). One of my classmates had mentioned a clinical opportunity she had for which a medical resident asked questions about her patient's previous obstetrical history. This patient had a TPAL* of 1-0-2-0. She was shocked that the resident had brought up the abortion history, as it is a sensitive topic. I'm not 100% sure, but perhaps this resident had brought up the topic during an inopportune time or around the husband, which the student nurse thought was inappropriate. Anyway, after this, my classmates went on a bit of a rant about medical students and about residents and how 'socially stupid' they are.

** TPAL is used for obstetrical histories. It is an acronym for Term Premature births Abortions and Living children. Each number represents the amounts of each. A first time mom with a premature living baby would have a TPAL of 0-1-0-1.

I think her story and subsequent rant was in incredibly bad taste. This resident was asking RELEVANT patient history as the patient was about to give birth, which I quickly mentioned so I could stop the discussion about "inappropriate docs/med students". This quickly caused ripples and more adamant doctor-bashing discussion.. most opinions were pretty much thinking that I was wrong with agreeing that he needed to know the information, yet making the patient uncomfortable. However, I did quickly mention that I agree that perhaps the way that the resident was approaching the patient may not have been ideal, but as a medical professional, it was their responsibility to ask those questions, despite the possibility of awkwardness or uncomfortable-ness for the patient.

This goes for nursing as well. If I have a 13 year old patient in front of me complaining of abdominal pain, spotting, and frequent urination, I will ask the patient if she is pregnant. In addition, I will ask if she has been pregnant or had an abortion in the past. This is relevant history taking! Yes, this may make her a bit uncomfortable, but how are we to do what is right for our patient if we feel that asking the questions makes them squirm? In my mind, we're doing our patient a disservice by not asking these questions, and assuming that the patient would be uncomfortable. What if the other nursing student's patient had a therapeutic abortion, and was willing to talk about it? How are you supposed to know until you ask? Perhaps it wasn't a therapeutic abortion, and the patient had a history if placenta preva leading to a still birth at 19 weeks? This is VITAL information as it would determine more specific monitoring patterns as well as increased risk for both the mother and baby.

My other question is this: Why do nurses feel that it is their right to bash another professionals' practice? This does not just happen in my nursing class, this also happens on the nursing floor, where some nurses are very vocal on how "Dr so and so" can be such an idiot. Oh and don't worry, I have seen firsthand that nurses oftentimes eat their young, as well as criticize social workers, personal support workers, and pharmacists. Each profession is skilled in a different area. Why do some nurses feel they could accurately judge the professional practice of a doctor? Did they go to medical school? Unless the other professional is about to harm the patient, and their practice goes against everything the nurse learned about that particular condition, who are we to judge how the person approaches their work? Note it, and mention it to their supervisor, don't gossip to other nurses! As nurses we are taught to look at ourselves and try to remove our bias before we work with a patient. Perhaps we should do that with ourselves and with other professionals too!

Nurses are experts at nursing. Social workers are experts at their job. Why can't docs be experts at their job?

Where are the parents?

I haven't been posting recently due to a swampload of work with both Nursing, the part time job, and my thesis work.

This week I had the opportunity to observe in the paediatric Emergency Department at the local children's hospital. Although paediatrics isn't my thing, I am more and more convinced that ER nursing is where I could fit. I like the system that is set up at this particular ER, for both adult and paediatrics (I even had the opportunity to observe in the Adult Emerg in the resuscitation room)

Today I was shown how lack of parenting is effecting the treatment of children, and how nurses sometimes have to be firm to get the point across.

This one child and his parents came into triage today. Apparently the child had had a series of respiratory infections, which eventually spread into a fairly serious case of otitis media; a fancy way of saying an ear infection. Anyway, the parents had taken him to the urgent care center here in town about 4 days ago, had been given the diagnosis, and had been given a prescription for the medication to treat it. The parents filled the prescription, and had also been giving the child some children's analgesics for the pain. Here is where the problem lies. The child is a fussy child, and the only child of the parents. He's 4 years old, and doesn't like hospitals. This is totally understandable for a sick child who maybe associates doctors or nurses with needles and pain. What got me was that because he was a fussy child at home, he had refused to take the prescription medication. Again, totally understandable, because he's a fussy child. Which brings me to the crux of this rant: The parents did not make him take the medication. Here is a child of 4 dictating what he can and cannot get medically! What sense does this make? What type of parents are these that don't even give medication needed to benefit the child? Who are the parents here? I would be more able to understand if they had some cultural or religious views on this particular medication and could not administer it for that reason, but to not give a child medication that he needs because the CHILD DID NOT FEEL LIKE TAKING IT? Come on!

So now the child has a worse ear infection, is in more pain, and the parents are at children's emergency because the ear was now leaking purulent drainage. Surprise surprise that the ear infection got worse. I had a hard time observing this because the child did NOT want his temperature taken as well, and the parents were trying to reason the kid into doing it. OK after teaching the kid what we're going to do, sometimes the parents need to take control of the child and do something for his/her benefit. Again, the parents did not step up. I was really tempted to hold his arm down to help the triage nurse, but alas, it is not my role to do that, it was the parents.

What happend? Why aren't parents stepping up to the plate? Don't they know that by their intent to not "hurt" or cause the child any discomfort, they are actually making the child worse?

I'm glad the ER nurse sat down with the parents after this and discussed the situation. I just hope they have learned a lesson from this. I sure have.

Final days of paediatrics

I know that I have been posting a lot about paediatrics. Truth be told, the rotation wasn't as bad as I made it out to be. Except when kids were crying, it was a decent experience.

Today I had a reasonable day, with two general surgery kids- one with appendicitis with an abscess, and another with Crohns with a new ileostomy. An ileostomy is an opening from the small bowel to the abdomen, which is used instead of the rectum to expel stool. It is managed through special appliances so it doesn't smell and most people with ostomies can live normal lives. Typically, the higher up the bowel you go, the more watery the stool is. This kid had one temporarily so that any fistulas (a connection between bowels that is not supposed to be there) he had due to Crohns would heal. It'll be a few months before they do surgery again to put everything back together again.

Working with general surgery patients can be quite busy. When you arrive on shift you are to do vitals and 0800 meds. This means you need to set up secondary lines to IV's if need be, or in my case with paediatrics, work with buretrols ( a secondary chamber where you can put medications into it). Next, after flushing that line, you need to assess your patient to make sure that the medications aren't causing interactions, do a full systemic assessment, and then get your patient up and out of their bed for their first walk. This all has to be done before first break, and if you're not a student, you have 4-5 patients, not just 2. Also, because they are a surgical patient, they typically have a bunch of drains and tubes in every orifice, which of course need to be inspected, drained, and monitored. You also need to get rid of the drainage and record how much fluid was lost.

While I was in general surgery for my adult acute care rotation, I didn't realize how much work I actually did compare to my classmates. I thought they were all doing as much work as I was. Now that I'm on a general floor in paediatrics, where kids are sick but not all surgical, I realize how much extra work those drains/tubes end up being. I'm not trying to say that my classmates didn't work hard, I'm sure they did, but it seems to me that general surgery cases tend to take a lot more time. I had general medicine cases the last few weeks, and I had time to go on breaks, and time to read the chart. Today, even though I have worked with general surgery cases before, and they were fairly straightforward cases, I barely had a chance to eat lunch.

If I don't get into ER for my 4 month practicum next term, I said I would do Gen Surg. I'm not 100% sure I'll like it, but it'll definitely give me a large amount of skills and efficiency with complex cases, so applying to the ER will be more successful later on.

Nursing Forum

I have been active in a new Nursing Forum!

Join me in reading about the daily lives of nurses.

http://www.nursingvoices.com/index.php

waaaaaaaaaaa

This week was a challenging week in paediatrics. Although I am starting to get the hang of things on the floor and feel that I would be able to take more responsibility and more patients, I am also coming to the realization that paediatrics is not for me. The reason I say this is not because I do not like children, it’s because there are some circumstances for which paediatrics will be incredibly difficult. First, I think I like kids too much to see them in pain, and to see how much the parents are worried and scared for their child. Second, as much as kids can tell you a lot, a baby is unable to tell you what kind of pain they are in, and what is wrong with them, which makes working with them incredibly frustrating because you want to help but do not know how.

I found myself out of my element. I hate when kids cry. I mean, I really hate it. The reason I hate it that much is because of the uselessness I feel when working with them; I don’t know what is wrong with them, and I feel terrible that I cannot help them out. I also get incredibly frustrated because after some prolonged crying I feel as though nothing I have done has helped.

This week I had the opportunity to work with two little girls, one 3 years old, and one 23 months. The 3 year old had an undiagnosed mass midline and left lateral of her neck inferior to her hyoid bone. She was admitted because she had a fever, and a possible urinary tract infection along with the mass. Her foster mother had roomed in since Saturday with her, and had only left to go to the bathroom, and to have a shower (while the girl was with her foster father). The 23 month old had gotten caught in a conveyor at a dairy farm, and had a severe friction burn on her left lower arm. This friction burn required skin grafts, and unfortunately the first graft didn’t take- she had to have a second graft completed. This resulted in her having multiple dressings on her left arm, right arm, and left leg. Both girls had IVs as well as antibiotics to hang, which I feel more confident about giving.

I looked forward to the challenge of working with these two girls, as I had yet to work with anyone in paediatrics under the age of 11. They also seemed to have interesting medical cases, and their moms both were present, which made getting to know the girls a lot easier. The challenge for me, however, was when the 23 month old’s mom left. To give some backstory, this little girl had cried the entire beginning of the shift, a full 5 hours. At first, I thought the crying was because she was tired; her mom stated she hadn’t had a nap all day. We had gotten her to sleep for a bit, but because of protocols we had to check vitals every 5-10 minutes after giving morphine, so it ended up waking her up. Finally, at 8pm, we were able to get her to sleep. By this time I was exhausted; as you know I had spent earlier in the day with my brother for his knee surgery, and in total I was on my 18^th hour of a 20 hour hospital day.

I dreaded going back and working with her the following day, as I knew the 23 month old girl would cry when she saw me. To my dismay she did, and also the 3 year old, generally a delight to work with, was acting up and crying too. Not only did I have 1 inconsolable crier, I now had two. Luckily, mom of the 3 year old took care of most of the crying, and helped out when I needed to do assessments. In the end, I spent over an hour and a half working with the 23-month-old, trying to console her after her mom left. I think she was finally comforted after she realized that I was not going to leave her alone.

I felt so helpless! Stop crying! Please stop! I think that I’ll have to black out for the first 5 years of my future children’s life, and let the hubby deal with it. I just can’t stand the crying.

Universal Health Care

An election has just finished here in Ontario, and I keep thinking about our 'universal' health care and somewhat comparing to what our 'neighbours to the south' have. In Ontario it would be political suicide for any politician to suggest a two-tiered system, yet more and more health care procedures are becoming less 'medically necessary' and thus dropped off the formulary for funding.

Costs for universal health care are skyrocketing due to the ability to keep people alive longer, labour demands, increasing technology, and an aging population. With all this, the question of supplementary private healthcare has emerged as possibly being the solution to reduce the waiting times for surgeries and cancer treatment. In addition, with salaries being higher in the United States, it is not uncommon for Canadian-trained physicians and nurses to head to the US to get a better salary. This means less health care workers staying here in Canada, where they are also desperately needed, yet paid less.

I was recently in the USA and I met people who were working in the local mall. Being the health conscious person I am, I kept wondering to myself if they would have insurance through their jobs. In my experience, working retail doesn't give you a huge paycheck. What kind of healthcare insurance could a low-income worker expect to get? It seemed very odd to me that the person who I was talking to at the clothing shop wouldn't be able to go to a family physician without worrying about the cost. They aren't different then myself, yet I have no worries about paying for my last physical. I didn't know this, but I just looked it up and according to the U.S. Department of Health & Human Services, 43.6 million people in the United States, or 14.8% of the population, had no health insurance. Those people then delaying primary and preventative care, and then head to the emergency department when things get really bad, ultimately costing them more money, and taxpayer money as well. Compared to other countries, the US spends the most on health care, yet they still are unable to provide it to all their citizens.

I strongly believe that universal heath care is the way to go. As a future nurse, already I see people who would never be able to afford health care (or have jobs where they wouldn't receive private insurance) be able to get quality care because they need it. I think my ultimate fear as an upcoming nurse would be wanting to help someone but having them head home without my help because they couldn't afford it. Although universal health care does have its flaws, I don't think it should be up to your wallet size.

I have heard that the "greatest country is not the country who has the most stuff, or is the most rich. The greatest country is the one who takes the greatest care of their poor". That hits home and makes me think.

I would love to hear opinions of those who are against universal health care, and why.

part deux

So my bro has been staying at my place all day, surrounded by mom and his girlfriend. Apparently he's been vomiting throughout the day. I hope it stops so he can keep some of those percocets in him. I keep thinking of the bloggers who talk about how Doc's give prescriptions of those out all the time, and the people who sell them on the street for $5 a pop. Well, I dont' see the draw, as those things knock you out and make you feel nauseated!

Anyway, he's doing well, sleeping on the futon until after his appointment tomorrow. One good thing out of all of this is that his girlfriend is stepping up and taking care of him (something I didnt' think she'd do), so that means I dont' have to wake him up every 4 hours to take meds! YAY!

Well, my 20 hour day is catching up with me.'night.

From the patient point of view....

Today my brother is having ACL surgery and is from out of town, so being the wonderful sister I hosted him for the night and took him in to the hospital today. 6am, at the hospital, for an 8am surgery. It costs 9.95 for wireless at this hospital PER DAY, so I'm trying to make the most of my time on the internet because this is truly costing me a fortune (yes I can't go a day without internet!)

I've been in the surgical area before, as a nursing student, and its interesting to see the differences between being a patient/family and being part of the medical/nursing team.

When I came to watch surgeries as a student, I frantically came in at 7am, got my green scrubs, and went to the pre-surgery area to introduce myself to my patient and hope that they would give me permission to watch. Then I went around with the nurses and they told me what they do to prep for the surgery. Watching the scrub nurse maintain sterility and knowing how many gadgets they need to prepare astounds me! Operating rooms, at least at this tertiary care center, are NOT AT ALL similar to ones on ER or Grey's anatomy. They are not large, spacious rooms with an observation area and homey covered walls. In fact, they are cramped because of the equipment, white and VERY bright so the surgeon can see what the heck is going on. Between the instruments needed for the surgery and the PEOPLE required to be there (especially at a teaching hospital), there isn't room for anyone, let alone the patient. There are the consultants whom oversee the surgery, then there are the senior residents, who mostly do the surgery, the junior residents who pop in and out depending on the severity and how many people are watching the floor upstairs, then there are the med student observers, the respiratory therapy students, the scrub and circulating nurses, nursing student observers, anesthetists, and their residents! Crazy eh! I enjoyed watching surgery, but honestly I dont' know how they can stand for 8 hours straight without walking anywhere. I don't see myself as the scrub nurse, although it was interesting to watch!

Anyways, its funny how being a family member of a patient makes the experience different. First, we had to get here at 6am to register. We waited in line for 30 minutes before the receptionist sent us up to the preoperative area. Then we get to the waiting room, my brother goes back by himself and they get him set up with a hospital gown, IV, and markings on his legs to tell the surgeons which leg to work on. Then after about 45 minutes of this, they call me in. It is now 7:40am. The nurse clinician explains post op stuff to both my bro and myself (at least I will remember it, my bro is like most non-medical people and has no clue what they are saying!), and then the circulating nurse also comes in to make sure the paperwork is done. The doc shows up briefly, in her scrubs, and then goes off to talk to another one of her patients and to prep her residents for the surgery. Finally, at 8:15am, (and a Code Red later), they ship him to the operating room. I am to wait in the waiting room for x number of hours until they get him to the post-surgical day unit, where I will take him home.

If I didn't' know the system, and how surgeries worked, I think I would be much more concerned and hesitant and feel really out of the loop. As a nursing student, I saw beforehand how the flow through surgery works... each person has their job with checks and balances to make sure things go smoothly, and the right area is worked on, and how long things can take. If I was not experienced with this stuff, it would be a very scary place to be. I would be taking everything the nurses and doctor said for granted (waiting times, etc), and waiting on edge until the doc or resident comes in to say everything went fine. I think it takes a lot of trust to sit here and wait to see if your loved one made it through surgery, and to trust the people with the scalpels that they know what they are doing. Personally, I feel weird sitting here when I have watched surgeries in the past. I want to watch this one! haha.

Although I have seen residents at work and know they are doing a great job and are overseen by the top surgeons in the area, I still know that they are learning and things can go wrong. I think sometimes the surgeons don't make it clear that they have a TEAM of residents and med students working on their patients, not just themselves. People put so much faith into that ONE person, the surgeon, and they don't realize that most likely the surgeon won't even be doing their surgery!

Anyways, I probably should do more then blogging if I'm to be on this extremely expensive internet. I'll update you on the progress of my bro as the day goes by. Did I mention that I also have to be at clinical placement today at 2pm, and it lasts until 10pm? Yes, that's right, 20 hours in the hospital today. woohoo!

Happy Thanksgiving!

For those Canadians out there, Happy Thanksgiving, eh!

Whilst I am stuffing myself silly with... um... stuffing... I'm reminded of some things I am thankful for. In no particular order, I'm thankful for: stuffing, family, relationship, friends, stuffing, gravy, pumpkin pie, my cat Amber, and how about... the line of credit that I have been using to go shopping!

I have recently been howling at the comedy of Russell Peters. If you are from anywhere multicultural, you will LOVE his standup!

"Roosell....come!" haha

Wowzers

This week presented a challenge that I have never experienced before. As I was trying to get air out of one of my teenage patient’s IV line, I brought up the subject of his previous hospitalization- he had been hit by a car. Sensing that our rapport could handle some light teasing, I joking said “So, did you jump in front of it or something?” and he said yes. First, this made me think ‘oh crap now what am I going to say’. But luckily, my nursing-mode kicked in (apparently I have one!) and I firstly apologized for making that joke, and second asked him his thought process surrounding the incident. Apparently something inside him had told him to do it, and although he knew it was wrong, he still placed himself in front of the car. I asked him if he heard specific voices, which he denied. I also asked him if he had talked to someone or told someone that he had jumped in front of the car. He said that he hadn’t, that this was the first time he had ever said anything to anyone, and that “all they knew is that I got hit by a car”. I was saying that perhaps he should talk to someone, and was about to ask him questions about his risk for suicide now, when his dad arrived. This was ultimately a conversation shifter, as we never continued this conversation after Dad arrived. Unfortunately, I did not see my patient’s face when his Dad came in, or I would be better able to tell how the arrival of his Dad had affected him.

Once this admission happened and I had introduced myself to Dad, I left the room knowing I had to say something to the nurse that was supervising me. I pulled her aside and told her what my concerns were; that my patient was probably being discharged today yet he had mentioned these self-harmful things. I noted that this needed to be addressed somehow, and asked what we should do next. The staff nurse then told me that I needed to chart this, and that when the team came down to view his x-ray they needed to be told of the conversation, so they could decide about future treatment. I also told my clinical instructor, who helped me organize my thoughts and my observations about the interaction so I could chart it properly and effectively.

After charting this, I went back to visit my patient to chat and to spend time with him and his Dad. When Dad went to go get a drink downstairs, I seized my opportunity, played videogames with my patient, and tried to further develop our therapeutic relationship. I got more information out of him; his parents had divorced when he was young, and now his father was remarried and living in another town about 1.5hours away. He didn’t get to see his Dad much, but when he did, he enjoyed it a lot. He also mentioned that he and Mom moved around a lot. When asked where he had lived, he mentioned that he and his mom had lived in New Jersey, and that one day he was travelling into New York City when he saw the plane hit the World Trade Center. This struck me as odd: Two serious admissions in one day? Yet some of his facts checked out. I wondered, however, if his story was true, and how much of his comments were done in a self-attention manner. Overall though, these comments led to a picture of boy with some serious psychological assessment needed.

Before I entered nursing I thought I had a pretty open minded view on mental health; that it was an important aspect of health and that sometimes it needs medical attention, just like an infection or a chronic cough. I never truly realized, though, how much sometimes people need help to cope with life. I also forget that sometimes people don't want to admit that there is a problem. At first the above patient's mom was VERY upset with the idea that her son needed some sort of psychological consult. I don't blame her. This is sort of saying that something about her son's mental health is not necessarily ok, and bringing in that stereotype that her son was 'crazy'. Even though I can openly say that he needs someone to talk to to work out these issues, I'm somewhat of a hypocrite because I would feel weird to talk to someone if I was in a similar situation. I'd probably even think it was unnecessary, and make myself feel stupid for seeking help. Although I am currently working towards changing that within myself, I can have a better appreciation of the hesitancy some people feel about going to a mental health professional.

Can't sleep

After 3 days of being ill, I still have the bug going through my system. It has, however, decided not to settle into my lungs but to stay in my head, making me very fuzzy. I'm hoping that the extra strength cold medication will mask my symptoms enough that I can make it through clinical tomorrow. Yes, I am going, even though I perhaps should stay home.

My problem right now is that I have to wake up ridiculously early (5:30am) but I cannot, for the life of me, get to sleep. I have been trying for over an hour, to no success. This past weekend I couldn't' go for more then 2 hours without needing a nap, and, now that I am needing to get sleep, ironically I am awake.

I was told to prepare for paediatrics with learning how to assess a child. Also, I am to know the normal vital signs for children. This is understandable, since I am going to be on a paediatrics floor, getting my first paediatrics patient on Wednesday. However, I do not know which age range my patient will be, nor do I know anything about the floor I will be working on. Apparently this is supposed to be found out tomorrow during my first shift, where I will be paired with a staff nurse who will show me the ropes. Also, my currently classwork has been soley focused on prenatal and labour/delivery, not paediatrics. We haven't even cracked the book on that yet, although we'll get there later this term.

I also haven't mentioned that I tend to scare children under the age of 4. Perhaps this was just earlier in my youth when my excitement to see them tended to come out as being over-the-top and intimidating for young children. I hope that with maturity comes less enthusiasm, although the last baby/toddler I have played with was my own younger sister (who is now 17!), and my cousins (who are now 15!). Over the age of 5, my camp skills come back and I think I could handle it. Although I must say, my experience with having a non-stop crying 5 year old for the tots camp is haunting me now. Wish me luck, I'll have more to post later. I think that soon I may be able to sleep. I hope the 2nd nighttime cold medication will kick in.

Urgh..

So life has finally caught up to me and I am, at 4pm on Sunday, still in bed. I have a brutal head cold. I guess this is repayment for the lifestyle I have been leading the past few weeks. Somehow, I noted the other day, I had lost a month. I mean that I have missed out on a month's worth of stuff because I have been working myself like an animal trying to get things done.

The bugs have been flying all over campus, so it wasn't surprising that now I have succombed. I hoped it would be next week. But alas, here I am coughing and blowing my nose.

A funny story of the day (and to show you how out of it I really am), I woke up from a nap today, looked at the time, and flipped out because I was late. What was I late for? I was late for orientation (by then it would have been finished) for my nursing class for our upcoming paediatrics rotation. I was also late for teaching birth control, as it was 3:21pm. After freaking out and running around for a few minutes looking for a phone to call the clinic, I realized something... it was still SUNDAY. I hadn't lost a day, I'm just a sick dufus who is too out of it to realize the day had not passed yet.

Sigh. Well wish me luck, i have to try to catch up on readings. Perhaps 10% will stay in my brain.

Kids these days

I had a funny run in yesturday while at work until 3am. Some first years were walking around and all I hear is "avada kadavara!"... and "crucio!"

It's amazing how much pop culture can influence us.

One note... of course they had to use the forbidden curses to yell at each other! They couldn't use "expelliarmus!", or "furnunculus". Naw, they have to use the curses that could take them straight to Azkaban.

I love the HP series, by the way. I couldn't put the 7th book down, and finished it within 24 hours.

Feeling the crunch

I need to be more with it. I have assignments coming up, as well as other commitments that are putting me into a tizzy.

Divide and conquer, divide and conquer.

Some people call me a machine. I'm not 100% sure what it means, although I take it as meaning that I keep going and going and going.. sort of like that cute pink bunny with the drum from the battery commercial.

I have a secret for everyone who thinks I'm a machine... it's a facade.

Work, Work, work.. yet no play equals a high strung, addicted to caffiene, emotionally unstable, and physically exhausted person. And that's just my significant other! (joking hunny!)

I feel bad for neglecting both my health, my family, and my friends. My wish is that this is only temporary, and that some day I will have a regular, normal, less harried life.

It has been 8 years. I still wait for that day.

Long day

I know I have done this to myself, but today was a particularly long day.

I seem to regularly over-extend myself. Some of the activities I participated in are necessary, and others may not be as much, but I'm a person that keeps my commitments as much as possible.

Hence my long day today.

It started at a reasonable hour, 9:30 class... which turned out to be an interesting lecture. After this followed a 1 hour meeting/lunch with my classmates for a group assignments, and another lecture.
Its now 3:30, you'd think I can pack up and go home. NOPE. I then head over to the clinic where I do birth control counselling, and teach for 2 hours. Not done yet, I have a volunteer commitment until 10pm. a 12.5 hour day isn't bad, but I'm not done yet.

I then procede to go BACK to work at a different locale, and will continue this shift for another 6 hours.

My day ends at 4am.

So what have I done in total?

1) went to school for a 6 hour shift
2) went to work for an 8 hour shift
and 3) volunteered 5 hours.

I still have to catch up on reading, I have thesis work to do, I have a meeting with my supervisor and I"m not done the prep work, AND I'm volunteering again tomorrow night.

I love life.

Holy Reading Batman!

I will not be writing much tonight as it's 9:40pm and I have a case study for which 150+ pages were assigned for reading. Today is the second 'reading day' we've had this week ( I guess specifically for these pages) but since my priority is my graduate work i have put off even opening my textbook. Well it looks like it'll be an interesting night.

rrrrrrrrrrip goes the shrinkwrap!

All you can eat sushi

Tonight I took the evening off and went with my boyfriend, a nursing colleague, and her boyfriend to a local all-you-can-eat sushi place.

Sushi is something I never even thought I would like until I tried it in residence in first year university. From then on, I was hooked.

Now, 3 hours after we left the restaurant, I'm STILL full. God bless crunchy spicy salmon rolls.

My computer's name is Fluffy

No joke. In fact, my boyfriend cut me from internet access because he thought my computer was a hacker or a virus.

I called my computer that because first of all, it's funny that a solid, metal object could be called Fluffy, and two, I just realized that the name symbolizes a lot of what I am 'learning' in nursing school. Don't get me wrong, this program is very busy and can be incredibly stressful as well as challenging. But what I find is that there are a lot of "caring and sharing" classes, understandable as it is a nursing program, but I am a fact-oriented person, not a caring/emotional person. I do develop a good therapeutic relationship with my patients/clients and I pride myself to get to that point of trust with a patient. But I will not be the nurse that will hover over a person and go 'aww that's too bad' at every complaint that a patient has. It's just not my personality, and if I did that I think the patient would feel I'm faking it, and the therapeutic relationship will become strained.

Right now we are in maternal/child health. This is a topic I find very interesting; I've always enjoyed learning about developmental biology/physiology and about the birthing experience. Today we are having a lecture on the health promotion of pregnancy, and what I've found so far that the information we're presented seems very subjective, and loosely based on theoretical constructs. Shouldn't we be learning about how to give health promotion to the client? What information is important to give? But instead we are once again talking about non-scientific concepts, and family dynamics. We have spent over 3 hours on about 20 slides. This is ridiculous and a waste of my time. I have yet to learn anything I have not known before, either through my education in Health Science, or in life experience. Give me the textbook reading, and instead in lecture focus on what we are to do with these clients.

I've decided to just shut up in lecture, and suck it up and take it in. There's no point in trying to provide scientific/factual or even direct information to the class, the professor skirts the issue. Nurse BS here I come!

The life and times of a long term student

Eight years. Yes, ladies and gentlemen, the horror stories your parents heard of their friends- friends'- friends' daughter continuing in post-secondary education much longer then anticipated are indeed true.

Although at first it seems ridiculous that one person could be in university that long without at least starting a PhD, my story seems to have some sense. After an undergrad where jobs after were rare, I turned to graduate studies. During the second year of graduate studies, realizing once again jobs were scarce in that field, I then again turned to undergraduate. This time, however, I had a plan: utilize my knowledge for health studies within the nursing field. Thus I am currently completing a 2-year intense nursing program and will be complete in spring 2008.

This blog will be focusing on the struggle to deal with the stresses of this program, the struggle of being in school for 8 years, and the successes (hopefully!) that will come out of being in this program. Also included will probably be rants and raves, which, honestly, is a reason to read this blog!

I look forward to writing, and hopefully, you will look forward to reading. See you soon.