Thursday, June 24, 2010

Nursing Skills- I have some of them

In nursing school one is expected to learn nursing skills. This should be self-evident. By graduation, there is an entire catalog of skills you are expected to have mastered. Now, nearing graduation, I feel compelled to make something of a list, both of those skills I actually HAVE, and ones I only have in THEORY. The reason for this dichotomy is that, shockingly, there is never a guarantee that you will be able to practice a skill in nursing school on a real patient while still in school. You have to be assigned a patient who NEEDS you to perform a given skill, and that's never a given. It does, however, keep you on your toes, as you never know if THIS will be the day you need to perform a skill you learned a year ago and performed once, on a dummy, in a lab. Also, most of these skills tend to be "sterile field" skills, just to make you even more sure you'll kill someone.

1. Catheters- The Theory- a nurse should be able to catheterize just about anything
In Reality- I am comfortable placing straight-caths for urine, in women. I have NEVER placed ANY catheter in a man, and I've never actually done a Foley. This is because the only patients available who NEEDED Foleys were men, chronic foley-users, who had some sort of obstruction or problem with said Foley, and no-one wanted me mucking around with it. Therefore, I live in fear.

2. Suctioning- The Theory- A nurse should be able to do oropharyngeal, nasopharyngeal, and, I assume, MAGIC suctioning with any kind of tube set up, through trachs, ET tubes, adjunct airways, etc.
In Reality- I can do non-emergent Yankauer suctioning and trach suctioning with one of those in-line setups relatively well, and have done it on many occasions. I have yet to do emergency-Yankauering outside the ambulance, and have NO idea if my technique is ok. I have never suctioned an ET tube, and still am convinced I'm going to cause a lung to collapse.

3. Wound Care- The Theory- Nurses, armed only with a set of vague orders "cover with dry sterile dressing (DSD)" should be able to come up with a spiffy dressing setup that prevents infection, decreases healing time, and makes the patient look like a rockstar. The nurse should also apparently be familiar with all sorts of epiffy expensive gear.
In Reality- I can actually do a dry sterile dressing job pretty well, if the wound is fresh (like a recently evacuated pilionidal (sp?) cyst, or on a patient whose wound has been previously dressed by someone competent, so I can just re-create their work of staggering genius. I have NO idea, however, how to choose which kind of dressing, aside from the general theory of "if it's wet, dry it. If it's dry, wet it", and "DONT EVER LET IT LEAK EVERYWHERE". Given the option, i will cover everything with 4-by-4s and tape. Lots of tape.

4. Assessment- The Theory- Nurses should be able to complete a physical assessment on just about anyone, note minor as well as major changes, bring all this to the attention of the proper physician, and catch tiny warning signs before the patient even knows they're sick. They should always be thinking 4 steps ahead to the implications behind each test result, and have plans in place for contingencies.
In Reality- I can do a pretty kickass physical, if I do say so myself. I'm good at details, and I've gotten REALLY good about asking history questions for clues to possible Very Bad Things. I cannot, however, think more than 1 step ahead, and still regard Real Nurses with superstitious awe.

So that's where I am!

Tuesday, June 22, 2010

Home Health Firsts

Home health, while NOT my favorite part of nursing, nor something in which I would like to make a career HAS given me a few "firsts". On Friday, I did my VERY first non-supervised wound dressing on something other than a fresh suture-job. On THREE pressure wounds on the same guy, who ALSO had a colostomy. And lived in an exceptionally bad neighborhood. In a house that was LITERALLY falling apart (wet carpet you were sinking into, as if the floor was giving out underfoot, ceilings and walls pulling apart, etc.)

I was proud of myself for doing it, but i was TERRIFIED the whole time. My partner and I got assigned to a nurse who works in BAAAAAAD parts of the city, and we, taking a few of her patients by ourselves, were therefore right in the thick of it. I'm a country girl (not in the southern twang sense, in the "oh look, bears and moose" sense) from an area where People Do Not Get Shot, except in the occasional hunting accident, or by shooting themselves. Nor are stabbings common. Carjackings are virtually unheard of. Therefore, even though statistically the likelihood of getting attacked personally is low, its still scary as hell. But I made it, my last day is tomorrow, and I'm following Hospice around, so its not like I can get into any trouble.

My Mistakes: Unfortunately, the VERY first day we had patients, our professor chose US as her group to supervise. I almost forgot to wash my hands (in FRONT of her, I'd purelled the heck out of them about 5 minutes earlier), and I forgot to make the patient sign for the visit, necessitating our driving around the block and coming back. I was SO embarrassed, and not a little annoyed, because I had given my PARTNER all HER cues so SHE wouldn't forget, then she COMPLETELY FAILED TO HELP ME AT ALL. She apologised afterwards, but said "i was just so relieved to be done with MY patient!" Grrr...i sort of think she just wanted to look better than me...which is a terrible thing to say, but there you have it. I didn't know her before this clinical, we were paired randomly. Grmph.

Sunday, June 13, 2010

Hiking Safety

One of my very favorite non-nursing activities is hiking, and I'm training to do Wilderness Search and Rescue. I guess the love of the outdoors runs in the family, since my "little" brother actually has a JOB in the outdoors. We've been discussing people getting injured and putting themselves in danger for a while, and I thought, since it's summer, I'd just post some general tips for not making yourself into a statistic in the great outdoors.

1. Pack an Emergency Bivy. Emergency blankets suck. I've used them on car accident victims, and they blow off in even a light breeze. Invest in a "bivy sack" for emergencies. They're under 20 bucks, and TOTALLY worth it. It's basically a metallic sleeping bag-style sack that's orange with reflective stripes. If you were to be caught out or hurt you could climb in WITH all your gear, and survive the night, or wait for rescue. REALLY WORTH IT.

2. LOOK AT THE MAP BEFORE YOU GO. The main reason people call for rescue in MY favorite mountains (the Whites) is that they overestimate their abilities, and get "exhausted" before they make it back to the trailhead. If you've never done more than a mile or two, DON'T plan on going THREE miles to the pretty waterfall without remembering that it's ALSO three miles BACK. If you DO call for rescue, (and can GET a cell signal) it could be some hours before people can get to you. Rescuers are volunteer, and a crew may have to get out of work, pack their gear, and hike in from quite a distance, depending on where you are. Therefore, MAKE SURE YOU CAN SPEND A NIGHT OUTSIDE. If you're not critically hurt (fell off a rock wall climbing, stomped on by a moose, fell in a stream and broke your leg, etc) you should be prepared to spend a solid night outside before you could be rescued. If simple exhaustion is your problem, think about this- IF you could wait overnight, would you THEN have enough energy to hike out? If this is the case, DO IT.

3. has a good list of hiking essentials, but my top gear list would be the following:
NON COTTON clothing (cotton does not insulate when wet, and is heavy)- shorts and teeshirt
-raincoat and pants (dont need to be expensive, but need to keep water out)
-fleece jacket of some sort (the cheap ones work fine)
-iodine tablets (in case you have to be out there a while, to purify water)
-headlamp (seriously, dozens of people every year need rescue because "it got dark out"...BRING A LIGHT!)
-hat and gloves
-plenty of water

that's the minimum. hike in peace, and enjoy the outdoors!!!

Monday, June 7, 2010

For New Nursing Students (Some Advice)

So I've only got 2 more months (actually, slightly LESS at this point) of nursing school. I figure that this is an excellent opportunity to tell all you (theoretical) incoming nursing students a few things I've picked up in the past 2 years which I hope will help you.

1. PAY ATTENTION IN ANATOMY & PHYSIOLOGY!!! - I know you might hate it, I know it's occasionally boring, but dear lord, SO much of what we learn in nursing classes is predicated on the fact that you KNOW your A&P. For example: you have a patient with a heart condition like a-fib, and are giving a medication for it. You need to know your A&P to know HOW the heart works, WHICH parts are the atria, what a-fib IS, and why it is that a particular medication's action HELPS with this. If you snooze through A&P, it's going to SHOW when you take nursing classes.

2. PAY ATTENTION IN CLASS- I recommend NOT using your powerpoints on the computer. Either print them out and take notes on paper, THEN transcribe to computer, or just take written notes (which is what I do). This way you will have NO excuse for getting bored and going on facebook, looking at lolcats, or IMing your friends. Seriously, you're already SITTING THERE!!! Think of it as built-in study time, and pay attention! Worst case, it means you're bored, but have SEEN all the information AT LEAST ONCE!!! I cannot overstate how important this is. The kids who were on facebook the most in my class had the lowest GPAs. Just saying.

3. You are NOT alone- when you start out in nursing school, you have all these horrible visions in your head of killing your patients, of patients with their intestines coming out their surgical site, etc. Even if your patient DOES code, or dehisce (have their wound pop open), THERE ARE ACTUAL PROFESSIONALS AROUND! And fellow students! You can ALWAYS call for help.

4. You and your classmates are a team- deal with it. You're all in this together. And in clinical, you and your clinical-mates HAVE to work together. I had this one HUGE Patient, very complex, lots of work. SIX of my classmates teamed up with me to bathe, turn, change, and fluff his pillows. We were done in 10 minutes FLAT. Then we ganged up on the other patients. It made a VERY tough workload a piece of cake. DO NOT underestimate your classmates. Some of them might have picked up random skills that will really help you. They are also invaluable when you forget your stethoscope or drug guide.

5. There is ALWAYS time to pee- unless you are actually DOING COMPRESSIONS OR BAGGING A PATIENT, there is time to pee. Don't get into the habit of denying yourself basic physical needs like a quick bathroom break, or ducking behind the nurses station or into the breakroom for a bite of a powerbar or a drink of water. You wouldn't deny these things to a patient without a damn good reason, don't deny them to yourself. Masochism is SO counterproductive.

6. You will get through it. Really. Then you'll be panicking about job searching instead. :-p

Sunday, June 6, 2010

Intro to Summer

When you're a cold-weather person like me, hot weather is The Devil- until this year I have rarely slept in weather where it stays above 70 at night. This just...doesn't...HAPPEN at home very often- even when we lived in the Big Scary Desert for a year the temperature would PLUMMET at night to a nice comfy 55 or so.

With the weather this hot, it's time to make sure everyone remembers that Summer Is TRAUMA season!!! Everyone is outside, even if just out on their porches, and the more people out and about, hot and cranky, the more assaults there are, on top of all the usual barbecue accidents, near-drownings in pools, dehydration/heat exhaustion/heat STROKE incidents, and just plain stupid decisions.

One of the big ones in this weather to remember is: If you know any elderly people, CHECK ON THEM FREQUENTLY. They may not sense temperature appropriately, and may forget to keep themselves hydrated and properly electrolyted...(is that a word? I'm going to say it is.) which, given that older people are frequently on electrolyte-sensitive heart medications, is a PROBLEM. Therefore, CHECK ON YOUR ELDERLY RELATIVES AND NEIGHBORS!!!

Also, make sure to REAPPLY your sunblock. My parents both have horror stories from the early '60s, when it was considered "not vacation yet" until they had sunburn-induced fevers. Let's just NOT repeat their mistakes, m'kay?

First day of home health tomorrow- orientation at the place (Way Catholic Home Care)

Saturday, June 5, 2010

The Climate

This week has settled it. No warm climates for me, unless they come with a GUARANTEED constant sea breeze. Good lord, it's been HORRIBLY hot for the whole week here, and I feel like I'm melting. Really really melting.

As a result, and the temp being almost 90 all week (if not above), my brain isn't working. Coherent posting will resume when the weather breaks.

Thursday, June 3, 2010

Home Health Intro

Okay, yesterday and today were my orientation for my VERY LAST nursing classes (of my BSN). Here's what I have learned so far about home health:

1. We may be going into Bad Neighborhoods, but, in the words of my professor, "I don't care how much you cry, or if your parents call the dean. You are GOING to your assigned locations, or you don't graduate. So deal."

2. Wound / ostomy care is SO not going to be my specialty. It's not very fast paced, and, frankly, it smells bad.

3. I am most definitely going to get lost trying to get to these people's houses

4. It is UNLIKELY (but in no way impossible) that people will have guns sitting out on tables. If they do, ask them politely to put them away. This has only happened once so far to my professor.

5. This is going to be a long three weeks if this heat doesn't break...its REALLY FREAKING HOT here.