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!


AtYourCervix said...

You'll do fine! It's a steep learning curve, moving from being a student, to being out in the "real world". It truly takes a good 1-2 years of working as a nurse to feel comfortable, confident and competent.

PS - I've been a nurse for over 9 years and only ever put a male foley in ONCE. He was old, demented, screamed blood murder, and I think he had a fairly enlarged prostate. It was not easy, not pretty, and a bit bloody by the time I was done. But a female cath/foley - even on extremely swollen postpartum mommas - no problem.

Christine said...

I can't get a female foley in the old ladies... so far have tried four and have yet to get one. The young ones are easier. A male... soooo much easier! Have nailed it every time. So all in all its a skill not to be taken lightly I guess! But I bet once you get a male you'll be thinking it was all stress for no reason!

nurse XY said...

Heh. I think the males are easier. Maybe I have a little more experience, erm...handling the equipment.

At least you're not going to risk the patient telling you, "That's not going in the right place..." (In my defense, she only weighed 210kg.)

little d, S.N. said...

eeeew! I was always told that "if you put it in the wrong place, LEAVE IT THERE, get another kit, and try again, so that you don't hit the vagina again"

nurse XY said...

Never thought about leaving it in place to mark the territory.

That was a 3 person job, two people on fat roll duty, and then little ole me going fishing.

And the other two giggling up a storm behind their masks...

little d, S.N. said...

the two guys in my program would both beg me to do things like that instead of them. they call things like this "mysterious ladybits"