Tired and wired.

Last night we were a nurse short for the shift. They couldn't fill the shift. In the rural hospital where I'm doing my final placement, we only have 3 nurses on at night. Well, now we were at 2. This means the ER nurses don't get a break. They have to work the full 12 hour shift straight.

I consider myself a half nurse. A psuedo nurse. An extra set of (somewhat skilled) hands during crunch time, but still slower then the regular RNs and still needing guidance. As a student I think I'm in the top percentile, but compared to RNs I'm low in the overall RN pool. I think I'm adapting well to the ER but I definitely have a long way to go.

Last night was a test of sorts. My preceptor really needed a break... she was having a hard time concentrating and didn't get much sleep before the night shift. She was practically falling asleep standing up, despite us being busy. The other nurse sent her to the back for a power nap and figured that between her and I we'd be fine, as there were only about 5-6 patients in the department and they were all very stable. The staff nurse would then be my supervisor. Well, all of a sudden there were 4-5 more people to triage, and as a student I cannot and should not be triaging. So that left me all alone looking after ALL the patients in the department. The staff nurse watched over me (popped her head out a lot and checked in) and the doc was there for questions if I had any, but basically, I was on my own.

I tried to prioritize, and managed to do quite well. I prepared Pantoprazole for one patient, hung some metronidazole for another, gave a little girl some trimethoprim/sulfamethoxazole, dispensed some medications for another, and then started an IV on the pantoprazole guy, started on the 2nd line (which i missed, twice, grr) and had to eventually call the other nurse in to start it ;ater (we only get 2 attempts if it's not an emergency). I was slow at what I was doing and the patients were getting.. ahem.. inpatient... (hee hee) but I managed to do ok.

Because I don't' know the medications sometimes, I have to look them up. That takes a bunch of time, and I wanted to make sure I didn't screw up. I kept chanting... 5 rights, 5 rights, 5 rights... to make sure that I didn't give improper medications to the wrong people!

Not only that, but there were crazy things happening on the other floors. Later on ICU needed someone to intubate, and the ER doc had to do it. Since I have yet to see an intubation (tragedy, i know!), I quickly ran up to the 2nd floor with her (my preceptor was working again so it wasn't a problem). I ended being the one who was bagging the lady (SpO2 hovered around 83 prior to intubation) until the RT on call came in and put her on a ventilator. The ICU nurses even stated that I could start tomorrow working for them! I'm not interested in ICU, but that was a nice compliment.

Overall synopsis: I must have done well. The staff nurse called me an "RN" today. Aww shucks (*blush*).

And another thing...

I got offered a job today! WOO HOO! It's official... I , as of May, will be an Emergency Nurse! Not a student... A REAL WORKING PERSON! Scary, eh (the Americans in the crowd have officially snickered at the "eh", but you can't take the Canadian out of the girl). After all the work I have done the past 8 years, I am thisclose to being done.

I won't accept the job until I hear from the other hospital I applied to. In the meantime you can stew in your juices trying to guess which one I will choose!


Sigh, soon it will be time to start paying back those loans I've been ignoring....

Interesting

this is a first for me.

I have been notified by the manager that a patient I took care of is going to court. I have to give a statement. Good thing I wasn't the primary nurse!

Can't say any more about it, but it's definately a first for me, and probably the first for my class!

I'm sorry

I have been an awful poster. Soon though, soon!

Good news though, I have interviews at my little rural hospital and the bigger university hospital in the city. The downside is the interview at the larger center is NOT at the trauma center.

I'm disappointed about that, and I'm torn between the two.

1) I know the staff at the small hospital
2) The small hospital is by a major highway so there are some interesting traumas, I dont' know about the large hospital because I haven't been there, but I'm sure they get traumas too, but more often then not they are bypassed
3) the big hospital is both a cardiac and a stroke center
4) the smaller hospital has nurses do more because there are no support staff, whereas the large hospital has RT's, PTs, med students, residents, personal support workers, etc. I don't know which I would like more.
5) I wouldn't have to commute more then 5 minutes to the large hospital, whereas the small hospital on a bad snow day could take me over an hour.
6) Small hospital is near my parents' place, so I could stop in there, visit, or stay overnight if I needed to
7) I wouldn't have to (or want to) move to an area near the highway if I worked at the big hospital
8) Eventually I'd want to work at a big hospital anyway, yet not this particular big hospital (not a trauma center) but this big hospital is affiliated with the trauma center, and apparently I can't work at both places.
9) Either way does it really matter? I want to be an NP most likely in about 5 years.

ACK! I have an interview Friday at the small hospital, and an interview Monday at the large one. Wish me luck!

A first...

The other day I looked after an 87 year old male from a nursing home. He was DNR, but if he needed medical care beyond the ability of the nursing home, he was to be transferred to an acute center for treatment. I had a chance to work with him on my first night shift of two. He had come into the ER by ambulance. The nurses at the nursing home had noted that he had a lower LOA, and wasn't acting normal, so they shipped him to us.

He was fairly out of it, probably because his BP was hovering around 60/40. Also on his short list was depression and Parkinson's. We gave him a load of fluids, and his BP was still low, around 80/40. Turns out he had pneumonia as well. After numerous hours and a bunch of treatments, we sent him back home more lucid, with his son by his side.

The next evening we were working with an emergency physician who was also a coroner. Unfortunately, that same man passed away that evening, at the nursing home.

I have experienced a code, but the person was already dead by the time they arrived to the ED.

This is the first time a patient whom I dedicated a lot of my time to, and whom I had gotten to know his family, had died. I guess I should get used to it, because people die, no matter what we try to do and stop it, and in this case, I'm wondering if death would be welcomed. I'm hoping his family was with him at the final stage. Rest in Peace, Mr. X.

Worn out.

In the fall when I was on my way to completing my Masters, and I was finalizing the rest of my nursing courses, I told myself that in January/February, I'm going to have time for myself. I'll even start making dinners for my Honey, and overall start pulling my weight more around the house.

Well it's now February, and I'm still seemingly as busy as ever.

I'm one of those people that just seem to always be busy. I schedule myself out too much. For instance, I'm on a DDNN rotation, with 5 days off. I'm on day 4 of the 5, but today was the first official day off. Friday through to Sunday I taught a First responder course out of town. Tomorrow, I'll be heading to work for my former Master's supervisor to do some Research Assistant work. It's good money, but I start my next DDNN rotation on Wednesday, and I don't feel ready or rested.

I know some people get burnt out, and in the fall I definitely was... to the point I needed professional help to get over my anxiety and sleep problems. Now I'm just feeling tired. I hate this tired feeling and I am not a bitter person, but I still hate to think what affect this has on my patient care, and my learning.

I used to have 4 part-time and casual jobs on top of being in school. Now I just have these 2 casual/part time. I would love to not do them, but with the amount of debt I am in (approaching 60k because of 4 years of school that I've paid for myself) I just can't justify putting myself in any more debt because I want a few days off. Sigh.

Accidental death....

I heard about this one case from one of my classmates, who also works in an ED. This is an incredibly sad story. For privacy purposes some of these elements have changed.

A family of a 2 year old were in the living room. Mom was on an elliptical machine, Dad was nearby on the computer, and their 2 year old was on the couch. Child manages to get off the couch, but in the process falls into the elliptical, which was still being used by Mom, and gets crushed. Mom immediately stops, gets off, and then calls 9-1-1.

Child ends up dying.

I cannot imagine what it must be like to lose a child. I can't even fathom how someone must feel who had unintentionally caused their child's death. My sincerest condolences to this family.

This is a fear I have, working in the ED. I have fully admitted I"m not a fan of paediatric nursing, however I am coming around and learning to step up to the challenge. The idea of having to work on a child who was severely injured makes me sick to my stomach. I can't imagine how the staff felt that day, and how they could go back to working on the sore throats, injured hands, etc that we generally get in Emerg.

Blows my mind.

I heart Emergency

I'm starting to get the feel of being an Emerg nurse. Call a patient's name, take them to the room, do an assessment depending on their complaint, inform the physician, and treat the patient until they are 1) admitted or 2) discharged. Fairly straight forward.

Today however, was different. In 1 shift:

- I was 2 for 3 for IV starts on patients.
- I was 0/2 for foley insertion (to give me credit, a total of 7 foleys were attempted on this patient, 2 by me, 5 by staff!)
- I saw first hand the confusion/disorientation associated with post-ictal states.
- I helped a man who had tried to commit suicide
- I helped out with a trauma; multiple stab wounds with a possible hemothorax.
- I was the one to do report to the charge nurse of the big-city hospital about this trauma.
- I set up and completed four 12-lead ECG's.
- I feel confident in the plan for cardiac patients
- I saw the devestating effects that a brain tumour can have
- I talked to a lady who has a severe degenerative disease who came in with exacerbation's of symptoms, and tried to develop a therapeutic relationship with her and her husband.
- I cut clothes off a patient
- I spent over 13 hours on my feet
- I am ridiculously exhausted

Overall, I had a FANTASTIC day.

Life of a student in a small town ED

I've started to feel more comfortable in the small-town ED. Now that the nurses are getting used to me, they have been making sure I get "learning opportunities" all the time....

"Student!... want to do another glucose?"

"Student!... want to take out some stitches?"

"Student!... how about you do the interview for room 3, both kids have a rash."

"Student! ... go and pack that abscess wound"

I know that I'm the runt of the pack right now, and I take it in stride. Honestly, this department has been really welcoming, a change from other floors I have worked on as a student.

Although I still feel I don't know very much, I'm starting to feel more comfortable doing assessments, and doing basic treatments without the aid of my preceptor. I still check in with her and we do a lot of stuff together (I'm surprised she's not sick of me yet!), but I'm feeling more independent.

My first I&D.....

I have been reading in a few emerg nursing blogs about abscesses, and having to drain them. Some people apparently hate it, some love it. I am officially in the 2nd category. If you have a weak stomach please don't read!

Tonight we had a 20 yo female in with an abscess from her arm pit for which redness had travelled to midshaft of her humerus. After some IV antibiotics, the doc needed to drain it so that it could heal properly. Being the only nursing student in the Emergency Department makes it easy for me to be remembered when they get to do interesting things. "Hey student" (not Elaine.. they probably dont' remember my name yet) "you want to come and see an I & D?" I say "Of course!!" and then stupidly ask"what's an I&D???"

"Incision and drainage." They snicker, thinking that I'm going to be grossed out. They don't know me just yet. "WOW COOL" I say in the nursing student way.. and off I go to the room.

The doc was just getting set up, and I helped grab some additional supplies. Finally, she dons the surgical gloves and starts incising. Pools of serosanguinous (pus and blood and goopy stuff) fluid poured out of this girl's arm... most people by this time would be fainting.. I'm thinking this is AWESOME. After a bunch of incisions, even a bit of internal cutting to get all the exudate out, it was over. We cleaned her up, packed the wound (ok ok i didn't but I got to watch) and then sent her home with some pain killers and told her to return tomorrow.

I can't wait to see the next one!

20 something year olds shouldn't die

My first nightshift was fairly busy. I didnt' work nights as a student, so this was my opportunity to see if I could transition and stay up all night. At first it was fairly steady, if not slow. Around 0200 patients that were on hold were finally settling down for the night, and we didn't' have many in the waiting room.

Suddenly, the ambulance phone rings. My preceptor picks it up. It is dispatch, warning us that we were getting a 26 yo male VSA. As she is announcing this, my adrenaline pumps through my body. "This is what I have been waiting for", I think to myself. I have spent 8 years as an advanced first aid volunteer, I teach CPR, yet I have only done it once. This is my first experience with a code in the hospital. I try not to look too excited, as the story could change and as far as we know the patient is fine. However, there is a definite spike in energy in the staff, and it is decided that my preceptor and another nurse would be in the room, and the 3rd nurse will do triage and also take care of the rest of the patients. Being a small-town hospital, when we get a code in the ER at night, staff from the other floors are called down to help.

We wait in anticipation to get confirmation of the code. 5 minutes later, dispatch calls again. Confirmed, 26 yo male VSA, 2 minutes out. My preceptor gets on the phone and calls the code, and we prepare by getting on gowns and masks. Time inches by, it seems. It look longer then we expected... apparently the guy is not doing well at all, and the medics were going to try to get
him called on the scene. We waited, and we waited. 20 min later the ambulance calls, base hospital doesn't want to call it because of how young he is. He is on route.

Finally the ambulance arrives. The patient is pretty blue, and by that time the medics have been working on him for over 40 minutes. There was minimal chance we were going to get him back. I wasn't expecting to do much, but I got to do compressions, along with another nurse. My preceptor and an ICU did the medication pushes, and the Doc gave the breaths and watched the monitor. We didnt have much hope for him to return, and unfortunately, he did not make it.

This really made me think because apparently this gentleman played sports earlier, felt unwell and went to lie down. His fiance went to check on him and found him unresponsive. What caused his death? As of right now, no idea. There was no signs of trauma, and from the story it didn't sound like a drug overdose. He was the same age as me.

More and more 20-somethings are getting heart attacks, or other cardiac related symptoms. The nurses in emerg were saying how they are seeing more and more young people dying of cardiac related causes. This man had no history of heart problems, and yet he too passed.

Recently I have known that there have been some other 20-something related VSA's that some of my pre-hospital first response colleagues have responded to. It makes you really think about taking care of yourself, and cherishing the moment you have with loved ones.. you never know what can happen.

Synopsis... My first few shifts as an Emerg Nurse

I have just finished my first DDNN rotation in the small-town hospital Emergency Department.

WOW. I don't know anything about nursing! In nursing school, they try to give you a lot of theory and practical information so that you know how to help and work with people on the floors. They teach you how to do assessments, what general diseases are out there, and how to do various nursing skills. They also give you experience on the floors so that you feel comfortable giving injections, doing basic wound care, personal care, working with IV's, talking to patients, etc.

In the emergency department, there are SO MANY MORE THINGS TO LEARN. I need to learn the flow of a patient through the department. I need to know what is a standing order, and what I need to get an order to do (which the ED nurses know already, and just get started on things, but I feel clueless!). Overall, I feel stupid most of the time, and try to ask a lot of non-stupid questions. I used to be proud that I felt comfortable doing nursing, and that I was looking foward to increasing my learning and the acuity of my patients. Well I feel i'm on a sharp steep hill, struggling to stay upright. I hope it gets easier, and so far, every day has seemed a bit easier, because now I know where things are, and I sort of know how the flow goes.

There are also a lot of skills that ED nurses complete, yet as a student nurse I won't be able to do until after I pass and work as an RN and complete the competancies or testing within the hospital. Examples of things I won't be able to do as a student include: taking verbal orders, give meds below the drip chamber, and triage (i can observe but that's it until i have worked in the ED for over a year). I'm sure there are other things that as a student I should not be doing, but that is the list so far. I also do not know how to read ECG's, but I am proud to say that now I know how to use the machine to get one!

This emerg also has paediatrics, so I need to be on top of my paediatric assessment skills, something I am not good at, and I am still intimidated by those little people.

After reading ED nursing blogs for almost 8 months now, I have thrived in the stories and felt that I could really like working in Emerg. Now I can kind of relate to their stories about not having enough space, about people waiting for a room, seeing drug-seekers first hand, holding patients in the ER because they have no beds available in the hospital (our lack of beds right now is due to a norwalk-outbreak). I also, unfortunately, know what it's like to work 12 hours without a break, because the ED was so busy.

Overall, so far, I REALLY LIKE IT. I like the fast pace, and I like the learning. I can see myself working in Emerg after I graduate, and so far it looks like they need nurses badly so I could probably get a job there!

Hello, I am Elaine, and I AM AN EMERGENCY STUDENT NURSE!

Orientation Day

I think I will finally start having some interesting posts in my blog!

Wednesday was the orientation. I was correct in suggesting that my placement hospital is a tiny hospital, but I am so far happy to say it's busier then I thought it was going to be.

I am the ONLY student who is full time in the ER. THE ONLY ONE. There is only one RPN student who is doing the ER clinic (sort of like the ambulatory care area.. walky talky belly ache's, scraped knee etc), and that's it. Of the RN students.. there are only 3 of us. THREE. I'm used to seeing students everywhere, because my school is a fairly big teaching area. The rest of the students doing their final placement are RPN consolidating students, of which there are maybe 5. I dont' know a soul (RN's or RPN's) because I wasn't in their classes and none of my classmates are consolidating there, but meh, I'm ok with that.

The average age of the nurses on staff is 48. I didn't see a single young nurse there. (although I do happen to know there is one younger then me that works in OB/Labour&Delivery, but I digress...). In all my other clinical placements there were tons of younger RN's. Perhaps the older ones were in management, or have left practice. I have no idea, but having an RN to work with who has 20+ years experience gives me confidence in the profession, as well as their skill. That being said, I'll have to make sure that what they are teaching me is best practice- it has been a long time since they have been in school, and hopefully they have kept up to date!

I love how my clinical placement organizers did not tell us RN students that we were supposed to arrive at 0830h to get an ID badge, that I needed to bring paper proof of all my immunizations including 2-step TB, AND that orientation was until 1700. So I felt like an idiot showing up for 0900 and not having the paperwork. How am I supposed to impress these people enough to get a job if they are setting me up with a bad first impression?

My orientation book was approx 5 inches thick, for which I was supposed to know most of it by my next shift, which was, conveniently, Thursday at 0700. (I'll post more on that shift later!)

I will *almost* never have to do straight blood draws because the lab does it. I will, however, get to do IV starts once my preceptor feels I am capable with the general nursing stuff. I will also be able to draw blood from the IV when I start it. That I am ok with, and am looking forward to learning this new skill! It's interesting that they waited this long for us to start it. Yes, starting IV's and using IV's for meds etc is a more complicated skill, but honestly, in the end, it is a physical skill. Working on assessment is more important, and yet they didn't emphasize that nearly as much as they did IV's. (or perhaps in our minds it was a bigger deal then it actually is!)

I do a DDNN schedule starting Thursday. HOWEVER I also have a random Wednesday during the month. Conveniently it happens to be next week on Wednesday.. which means I will have worked for 5 days straight, have 1 day off, and then work a 8-8 in the middle of my 5 days off. Grr.

One final thing is that when I applied for this placement, I wanted to go into an area that I would like to work in later. I'm happy to say that they have essentially stated that they would like to hire us to work there post-graduation. They demonstrated that by giving us the same orientation as 5 new staff (4 RPN's and 1 RN) that started this week also.

It'll be weird working with RPN's, as except in Long term care, I have never worked with them. What can they do? Apparently everything but the patient has to be predictable. What does that mean? No clue.

Overall, I'm thinking this will probably be a good experience. First, I dont' have to share the cool stuff with other students. There aren't even any residents or med students or RT students etc, so nurses there get to make more of the decisions. That I find awesome, and forward thinking. Second, they are also going to be implementing a full version of the computer system for computer charting, not just the some-paper and some-computer method they use now.

I'll post more about my first few days later. For now, I need to get ready for another shift!

I should be tired

In my winter-break month-long hiatus (well deserved, but yes I realize I was spoiled this year!) I have been getting into the habit of all night-people.. staying up till 3am and waking up around noon. However tonight is a night I have to convert back to a "normal person" schedule.

My attempt at rationing my sleep last night was an utter failure. Not only did I feel tired all day, but I am STILL UP AT 3am. Unfortunately for me, however, my alarm will be going off at 6:45, so I can be at orientation for 9am.

Tomorrow is going to be painful. I just hope I can keep caffeinated enough to make it home safely.. if I get tired I can fall asleep anywhere, including while driving (yikes!) . Typically I manage with downing copious amounts of coffee, antacids and opening up the windows to the Canadian winter.

Perhaps its the orientation, and the placement that has me edgy. I have been thinking about it a lot, and I have come to the realization that I do not feel at all confident in my nursing skills. I have pre-hospital experience and training, and feel really confident with that.. but throwing in a detailed respiratory assessment, anticipating an intubation, IV starts (which in my nursing school they don't teach us until the final placement!), blood testing (again same with the IV, no-can-do until the final placement), circulation medications... That's a lot different then checking ABC's as an advanced First Aider! I know 3-5 drugs as a First Responder... aspirin, epinephrine (through an EpiPen), nitroglycerin, ventolin (only to be used as prescribed), and various illicit and recreational drugs. That is very different than needing to know the 100's that nurses know and use on a regular basis! I think my first year (or more) will be spent with my nose partially in a drug book.

I should have more stories as more experiences occur.

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.

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.

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.

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.