healthcare

The Beginning

It was interesting this week, I ended up discussing with some of my nursing students how clinicals were going. I was so happy to hear that they were vastly different from mine which I didn’t expect with the way everyone is short staffed now. Twenty years ago we knew that we would be headed toward a nursing shortage with the fact that the Boomers would be both retiring and presumably needing more health care at the same time. It makes me crazy that we’ve known this all this time yet it’s only the very recent time that anyone has really started to sound the alarm. Now after a pandemic and a great amount of nurses walking away from the bedside we are still lucky enough to have people who want to enter this career.

I thought back to my very first day of my nursing clinical. I was so nervous, it would be the first time that I got to use my new skills on real people and I would be under the direct supervision of a nurse. We had spent the night before gathering the information on the patient we would be working with the next day. Mine was a post-op gallbladder. These were the days before smart phones and being able to easily access journal articles. I went home and poured over all my nursing books reviewing everything that you would ever want to know about gall bladders and the care of people who had theirs removed. The pain meds, the doses, what side effects to look for, how the labs will change. I barely slept.

My clinical group was quiet the next morning as we rode the elevator to the 3rd floor of St. Francis Hospital. My friend Annie looked like she was going to puke. Our instructor just sucked down her coffee. I checked my pockets, 3 multicolored pens, a hemo stat, scissors, St. Jude prayer card and a sharpie. My brand new stethoscope was around my neck bad ass style over the dorkiest translucent white student uniform. It might actually get used today on a real patient. As we exited onto our unit, Lucy finished off her coffee and told us our last minute instructions. “I’ll be rounding to check on you but remember, the nurse you’re assigned to is really your go-to person. As instructor, I’m just here to observe how you are doing. Have a great day, meet back here at 1500.”

The five of us moved as a tight group over toward the glass enclosed nurse’s station where we stood quietly as we were ignored by every staff member imaginable. After about 15 min Elena, one of our top students, couldn’t stand there anymore. “Excuse me! Is- is the charge nurse around?” her voice cracking.

“Hang on,” the woman who made the mistake of making eye contact with Elena said. “Julie, I think you’ve got some students here.”

A tired dirty blonde haired woman headed over towards us, clearly figuring the shaking college aged, white uniformed clad group were indeed the students she was told about.

“Oh yeah, we have students today, let’s see,” she looked over her clipboard. She then started to point at us randomly and stated names,” You, Katie. You, Kim…”

She pointed at me and stated Denise.

We split immediately and went looking for our nurses. I looked at the assignment board and saw that Denise had 7 different rooms. I jotted them all down and went looking into each one. I couldn’t find her. Not one staff member made eye contact with us so I figured I wouldn’t ask where Denise was. I decided to go to my patient’s room and figured I’d meet her when she came to see him.

I stood in Mr. Woods doorway, not committing to completely entering yet. He had his eyes closed and looked comfortable. I didn’t think I should go in and start talking to him until I spoke with his, really, our nurse.

“Are you holding the doorframe up?” I was startled by a gruff voice behind me. As I turned I came face to ID badge with a quarterback dressed as a nurse who as her badge said, was indeed Denise.

“Oh, hi! I’m Kerry. I’m your student so I can give baths and do vitals and-“

She cut me off and put her finger in my face.

“YOU are the LAST thing I need to deal with this morning.” she made a motion with her hand clearly telling me to get out of her way.

I absolutely wanted to get away. Far, far away. But I had to pass this clinical. Oh my God I had to spend the next 6 weeks with this nurse.

I followed her into the room. Mr. Woods was awake now so we had an audience.

“I can help you, just tell me what to do. I’ve looked up all his labs and-“. Again she cut me off.

“I don’t want to see you, just stay out of my way.”

OK. That was worse than I imagined when I couldn’t sleep last night and it wasn’t even 30 minutes into shift.

I found Jen and grabbed her.

“Did you meet your nurse yet? Is she nice?”

“She’s a he,” she corrected me, “and so far he is super cool. We’re getting ready to pass meds.”

Damnnit.

“Is there any way I can tag along with you guys?” I went on to explain my glorious morning.

“Shitttttt, that does suck. I guess you and me can tag team. I don’t think Rick will care.”

Thank God.

Jen and I went to town on her patient, a cute little old lady who had broken her hip. We assessed her, gave her her meds crushed in applesauce and bathed her. I even put lotion on her hands and feet. She probably thought she was in a spa. All this time, Rick just let us do our thing, never asking if I had a patient of my own. I did take some breaks to check in Mr. Wood’s room to see if he was still there and I also peeked into his chart and made note of any new orders. It had become almost a game. It was made easier by the fact that most everyone else was not talking to each other. Not the camaraderie I pictured after seeing medical TV shows but I was fine with laying low.

Trust me, You’ll Have a Great Time

It was really strange setting up the room for the simulation lab I was going to be teaching. I put my ambu bag and O2 mask up on the oxygen flowmeter behind the hospital bed. I felt like I was setting up a room for a new patient. But this time I wasn’t getting a new patient, I wasn’t in the ICU. I didn’t have to run through my mind all the things my new patient would need because my patient was the manikin in the bed already. I had the familiar butterflies in my stomach though. I was going to teach my 1st lab today. I was going to have a bunch of new faces that had to listen to me explain the different ways to give someone oxygen. I started to get way ahead of myself. I wanted to show them everything, the 20 plus years of nursing experience in my brain to just hook up to their brains like a download from The Matrix. There is so much to know, then so much to become an expert on. I was excited in a way I had not been in ages.

The class came in as I had the bright idea to set up my camera to video myself. I had given talks occasionally before and found that I had a tendency to say “um” quite a lot so I wanted to make sure I could look back and troubleshoot my teaching. As I looked at the students coming in I really started feeling my heart race. I was running the show the next hour, there was just me to look at and listen to. I’m awful at names too so I was already trying to cover that up. All at once I wanted to just dump everything in my brain out. This was simple stuff, they would need to know just how often they’d be using all this equipment, that someday it would be something so simple and obvious but they looked like how I felt too. As I started I had so much to say all at once, I had to slow myself down. When I’m nervous, like giving book reports throughout my school career, I was always interrupted and told I was talking too fast. I already speak fast on a normal basis. I was trying to speak slower, be interesting and not say “um”.

I started with the nasal cannula, the clear tubing that people wear that goes over their ears and gives oxygen into the nose. As I handled it and showed it to them I was very aware that while a few of them were pretty new to nursing and might work in clinics or other places that don’t use these, there were definitely some for whom this was super basic. I got more anxious. I thought about the millions of times I’ve had to put these on a patient’s face or remind them not to keep pulling it off. I thought of the people who insisted it wasn’t working and there was no air so I’d dip it in a cup of water and show them the bubbles. I started joking with my class about the ways I’ve seen such a fairly simple device put on by the patient or their family or even by other nurses in completely wrong ways. How people will sit their bare bottom on it and stick it on their face before I could wipe it off. The ways people would chew on them or how sometimes you get panicky as a new nurse and you see that your patient’s oxygen sats are going down so you crank up the flow only to finally notice its not in their nose or the tubing is disconnected. As I started going through each piece of respiratory equipment, it was nice to simply explain why you use one over the other. I wasn’t having beeping going on with a patient suffocating and crashing. I was simply discussing oxygen masks. I started to relax, they were so polite and sweet, looking interested and laughing at my dorky jokes and when I reminisced about a few unrelated ICU nursing stories where me and my friends had some nutty situations. The hour was up before I knew it and I felt utterly exhausted but still excited. I was teaching!

Later on after work I got my phone out and watched my video. It was awful! I said “um” pretty much after every word. I also put the phone so it just focused on my double chin and from a particularly unflattering angle. I sniffled and had an annoying nervous laugh, I couldn’t watch the whole thing. I wanted to get myself a shock collar for every time I do something annoying. I immediately called my friend Alison and we had a great laugh. It was already funny thinking I was teaching since I was known for being pretty sarcastic and someone who regularly cursed like a sailor. I knew I had some homework for myself as well.