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.
Wednesday, October 31, 2007
Monday, October 29, 2007
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.
Anyways, going to try to get SOME sleep. Want to be awake for tomorrow.
Friday, October 26, 2007
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.
Thursday, October 25, 2007
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?
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?
Tuesday, October 23, 2007
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.
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.
Tuesday, October 16, 2007
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.
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.
Monday, October 15, 2007
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
Join me in reading about the daily lives of nurses.
http://www.nursingvoices.com/index.php
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