Labor and Delivery

I was able to watch three cesarean and one vaginal delivery during L&D rotation. I think, no.. I know I don't want to be an L&D nurse. I never thought I did. But rotation confirmed it. It was great to see these babies be born, but I don't enjoy being in the OR or dealing with the mothers. It's all the coaching that doesn't appeal to me. I love when the baby is out and doing the assessment on them, and seeing them for the first time, but really it was all I cared about... the baby. Dealing with mom's anxiety, pain, breathing techniques, position changes, monitoring contractions, checking cervixes, monitoring baby's heart rate, family hovering around was in no way appealing to me.

However let me share my experience. I was assigned to an RN that had a scheduled C-section. The patient was late 45 minutes so we just sat around and waited until she got there. We got her prepared and were waiting on the doctor for another hour. I was bored. We go in and I'm standing at her feet. I can see everything, and more than I wanted to. I'm hoping and praying that the smell of the cauterizer isn't going to make me pas out. I was good. She gets her anesthesia and my nurse is holding her hand and being all supportive "now just breathe, you're ok". They lay her down and strap her in for the ride. They start cutting her open. It took a long time to cut her open, they had to tape her belly on a bar because she was large so they could get low enough. They finish cutting, pull baby out, hand baby to nurse, and pull her uterus out of her body and plop it on top of her!!! I was in shock that they would pull it out of her just so they could stitch her uterus back together. The doctor calls me closer and starts pointing to the different areas "and here's her fallopian tube, and her ovaries, and this is her uterus, and we're going to do a ligation on here". Seriously. The patient is awake listening to the doctor talk about her insides. It was great. They stitch her uterus, shove it back inside of her, and start stitching her back together layer by layer. Oh that takes forever! I left the OR before they were done. It was pretty cool to watch the surgery and see all the water and blood. I'm glad I didn't pass out or puke in my mask.

The vaginal delivery was horrid! It scared the desire to have children right out of me! I mean the mess, the head coming through the birth canal... it was a little too much for me. I had a premium seat for this one too. She was pushing and pushing and I saw the head crowning and pushing and out baby comes. It was a mess, and mom had a tear and delivering a placenta. Oh it was just bad. I think if every teenager watched a delivery then we would eliminate the whole teen pregnancy thing. But again as soon as I saw the baby I was happy. I wasn't able to be involved with this baby because he was a preemie and there were tonz of people in the room. I mean like 15 health care people in there. It was nuts.

L&D was fun for the day. But definitely not something I ever want to do. I hope that when I'm pregnant I have sweet L&D nurses that love it, like all the nurses I came into contact with at this hospital. So because of that it would be bad if I went into it, because I really don't like it!

G: 11 P: 9

There are many people I know that have fertility problems. Good couples that want nothing more than to be able to have a baby of their own, some are waiting for a long time on somebody else to give up their baby for adoption so that they can raise that baby in a happy, stable home.

When I was in the mother/baby unit one of my patients was a 34 yrs old female that was gravida 11 and para 9. She was addicted to cocaine, bipolar and schizophrenic. I was told that CPS was involved and the patient didn't have custody of any of her previous children. And she wasn't going to have custody of this sweet baby either. Her little boy was a sweetheart. He was being treated with antibiotics because mom also had herpes.

After feeding him my nurse told me to take him to mom for a supervised 15 minutes visit. I was in there for barely 5 minutes and while she was holding her baby she was falling asleep and baby was almost falling on the floor. She asked to put him in the crib and take him away.

My heart broke for this little innocent baby boy. I wanted to take him home with me. I wanted to give him a life full of love and happiness. I wanted him to know that someone cared enough for him to hold him and cuddle him. I wanted him to feel wanted. I was so angry at this mom. I understand she has a long psych history, but I was still angry. While so many people I know want to be blessed with just one baby. She had been blessed with nine! Nine living children. And she had taken them all for granted that she didn't even have custody of them. They're in state's custody. Many women don't understand the blessing that fertility is. Many of them take it for granted, those are the ones that can have them by the numbers. Why is it that those that want nothing more than to be a mother can't and those that are shouldn't be?

I hope this baby boy goes to a family that wants him and that he is raised in a loving home. All I could do was love him while I was there. I fed him, and changed him, and held him as much as I could. I hope he felt wanted and cared for while I took care of him. Babies are a blessing and we should treat them as such.

Changing beds

Nothing beats the amount of times you need to change a bed in one shift for the same patients like diarrhea does. My sweet patient was an elderly lady that came in for renal failure and while in the hospital started having some diarrhea. I started the day doing her assessment and she had just started the diarrhea early that morning. The nurses kept saying it smelled like C-dif... I didn't know the difference. She has a catheter in place and felt weak so getting to the bed side commode was difficult for her. Shortly after the morning assessment she went potty the first time on her bed, so I got her out of bed, cleaned her up and changed her bed. She felt so bad, but I didnt mind. I tried to get a sample for it to be tested, but my nurse had given me tongue depressors to collect it with. I needed something more similar to a ladle to be able to get anything. But I tried,I got very little and sent it off to lab. During the morning she went four more times in bed. No matter how hard she tried she could never make it to the potty in time. I became her stalker after that. I was outside her door anytime I wasn't in another patient's room. AS soon as her call light would go off I would run in there trying to avoid changing her bed for the 5oth time. I was successful three times but by the end of the day I had changed her bed eight times in a ten hour period. The thing was that even though it was hard and really... a pain to change her bed so many times, in the end it became rather funny. She was very sweet, and enjoyed having me as her student nurse. I felt bad for her and didn't mind cleaning her, just for the simple fact that she didn't treat me like it was my job to do it. She was grateful. It was fine, just that simple fact. I would have changed her bed and cleaned her up 8 more times if I had to. It's patients like her that make me so happy I entered this field. No matter how much poop I encounter!

I love the NICU

I finally had my NICU rotation and I've fallen in love with those babies. I spent all day taking care of four sweet babies. Two boys and two girls. Two with tube feedings, one in an incubator. I just loved how mellow things were. Yes... things got busy if any alarms would go off, but it was so nice to not be running around from room to room trying to get my meds in on time. I was on the side with the growers and feeders. My nurse was kind enough to take me to the other hall where the sicker babies were. I saw all the tubes and ventilators and the super tiny babies. While I thought it would break my heart too much and I wouldn't be able to do it, I was wrong. It didn't break my heart, instead my heart was filled with so much love for these precious little babies that were so sick.

I still wonder if NICU will be too much for me to handle emotionally. I told my professor that I got the honeymoon side of the NICU since all my babies were pretty stable. I didn't take care of any dying babies. I still worry that a dying innocent baby may break my heart too much. I'm hoping to know for sure soon. I start applying for internships in January. The NICU of the hospital I did clinicals at really want me to apply to their internship. It's an amazing level 3 NICU, the nurses and managers were wonderful. Their internship is 6 months long after graduation. So I'm confident that they'll prepare me enough to take care of these preemies. However... part of me wants to do that year of med-surg. NICU was only for a day and while I loved it, I don't feel like I spent enough time there to really know I can do it. I have spent 2 semesters in med-surg and I know I can do it. Unlike my peers I enjoy med-surg. Oh the decisions!

I did it!

I finally put a foley catheter in a real person! My first one was even on a woman! This little 84 yr old lady was on her way to ICU shortly after I did the catheter. Now before you go thinking that it was my fault she was sent to ICU let me reassure you by telling you that the whole reason we were given the order to do it was because she was going to ICU and they were going to put one in there anyway. I was super excited and terrified at the same time. I had my instructor there and another student nurse, a smart buddy. :) The hardest thing for me was holding things open. My hands hurt afterwards and I could feel my shoulder shaking a bit. The "hole" was much further down than I expected and I really had to hold it open far apart to see it. I spotted it, cleaned her, and went. I got in first try. No problems. I couldn't believe it was actually going in. My instructors is "cheering me on" and telling me to keep going and I'm thinking how far am I going!!! And then I saw the most beautiful thing... urine coming down the tubing and into the bag. The tubing that I inserted! My buddy inflated the balloon and it was in for good.
My professor was very proud and she said I did great, and my buddy said she's never seen a better first try foley. I was obviously gleaming with pride. However the best thing came after everyone left and it was me and my patient. She was all clean and covered up again. I held her hand and she looked at me and asked if she could go pee, I told her she didn't have too because she had the catheter. She asked me again if she could go pee and I understood what she meant and said yes you can sweetie. She looked into my eyes with the most honest and grateful eyes I have ever seen and said thank you so much. I was touched by this, I felt like she had done me a big favor but she felt like I had done the same to her. It's just such a "degrading" procedure and you're so exposed that I really felt like she meant it and was honestly grateful for the catheter. It really was a great experience. It wasn't easy, but it was great.

A little strength needed

Blasted Sterility

Today I had my second check off for semester 2 on hanging IV's. That's all we had to do. Hang them. We didn't need to start the IV or anything. The demonstration was this the last couple of weeks was a disaster. It was like the professors didn't even know what they were doing for sure.
I was very frustrated and talked to my professor about it and she apologized and said things were a little more messy than she'd like. I was nervous.

When we walked into lab they made changes to the check off process, and I was irritated. But I went in confident that I had practiced it enough and my peers checked me off and I did great. But there was one thing that nobody, not even me noticed. The reason I failed the check off!

I get everything ready, do my three checks, five rights, prime my tubing beautifully with no bubbles, and then things start going downhill. I could not for the life of me find the little alligator tail piece that I brought in with me. So I raise the side rail, lower the bed, leave the room, get the darned thing, and go back in. Check my pt again just to make sure, hook the IV up, regulate my rate, and I'm thinking even with the stumble I did pretty good. My professor came and checked my drip rate and it was good, then my timer went off. And she said I didn't pass. I thought dang it! If only I had not lost the little tail piece.

But that wasn't it. Apparently I broke sterility because when I left the room I didn't recap the tip of my tubing and just placed it on the bed. I was flustered because we were never taught how to do it. I wiped it with alcohol before I hooked it to the port because I knew I had set it down but she said that wasn't good enough, but it was no longer sterile. I really wish our professors would get it together. How am I supposed to know these details if I'm not taught them? So off I go to recheck later this week or next.

NICU?

I've been thinking a lot lately of what nursing specialty I'd like to go into. For some time I've been thinking I'd like to take care of babies. I asked my professors and in order to work in nursery I'd mostly be doing post partum care with the mothers and spending very little time with the babies since moms are discharged shortly after birth nowadays. I don't think I'd enjoy L&D because again I'd be taking care of the moms. So I thought NICU! NICU would be perfect! I'd be taking care of babies all shift long, and of course there's the part of it where I'm comforting mom and dad about their baby. And there's lots of sadness about babies that don't quite make it, and babies that are in NICU because their mom was a drug addict and now I'm taking care of their baby in NICU that's addicted to meth and suffering because of it. But there's the happy part. The part of the couple that had been trying for years to conceive and they were able to get pregnant and their little one that they waited so long for is in NICU but fairly stable.

After taking of care of adults last semester I didn't quite love it like I thought I would. I loved the elderly in AL, but they were fairly health people and I formed a bond with them. In the hospital they are very sick, and grumpy, and uncomfortable and they're not nice. There's not much you can do to make them happy. Most of my patients were tired of being sick and just wanted to die. Most of them were suffering because of lifestyle choices they made like smoking and obesity. The major problems were hypertension, diabetes, and COPD. All three due to lifestyle choices. Even though I felt bad, and had sympathy for them, I often felt frustrated that they'd allow themselves to get to that point. But I digress.

I won't know for sure what to until I do my Pedis rotation. I may not have the heart to take care of children. I hurt for the parents and the children. I'll find out. I hope I can do it. We'll find out in October.

After I graduate I'm hoping to get an internship into the area I'd like to go into. The NICU internship is 16 weeks long. I'd have a preceptor that would work with me, a more experienced nurse that would teach me what to do. The majority of our professors recommend a year in a Med-Surg floor before going into any specialty. Med-Surg is the core of nursing. They believe that it would solidify our skills, improve critical thinking, time management, and dexterity. Critical care is a little out there for the amount of knowledge we have right out of school. I can see where they're coming from and it does scare me to go into a critical care setting right out of school.
My one question is this, med-surg is an adult floor, mostly older adults, so how would that prepare me to take care of babies!?

I have lots of decisions to make!! I'll start applying for internships around February 09. They start in June. By then I will have gone through Tele, med-surg, OB, Pedis, and Psyc rotation so I'm hoping to have a better idea of what to do! No matter what I choose I just want to be really good at it!

So much for not hurting anyone

My patient came in the hospital with hypertensive urgency. I wrote her two care plans, and did my pathophysiology statement, and wrote up all of her meds. I was ready. I came in the morning and gave her 0800 meds, shortly after that my RN comes to me and says "Her BP is at 193/96, you need to give her 1000 meds now". My instructor was right there with me, so she said ok and off we went to give her 1000 meds. She has Metropolol 20mg, Vasotec 5mg, and a Nitro patch. As I'm pulling these I'm thinking that is an awful lot of BP meds and the nitro on top of it all. But of course I rationalize it, my RN told me to do it, she has been working here for 30 years, and my instructor is looking over my shoulder, everything will be fine. Right? Right!

NOT.

About 30 minutes later my tech calls me and says "What the HELL did you do to your patient?". I'm a little confused and taken back at first and she proceeds to tell me that my patient is not feeling good and her BP is at 80/42!!! OH MY GOSH!!! I gave her the dang medication! I walk in the room and she is absolutely weak, completely dizzy, and a little out of it. Her husband was there and they were both very upset with me. I called my RN who walked in there and all she told my patient was that she was going to have to talk to the doctor and that he was going to lower her dosage. And she walks out! I was standing there like a complete moron not knowing what to do next or say! I apologized to my patient and her husband and asked if there was anything I could do for them. They said no and I left. The rest of the day I checked her BP every 30 minutes. It eventually went up, but it never went up to normal rangers. We left at 1630 and she was feeling a little better, still dizzy, and her BP was up a little bit. We also removed the nitro patch hoping things would be better.

I felt so bad! I understand logically I did nothing wrong. We couldn't really know that she would bottom out like that. But I feel like I should have known better, you know? Like I should have known to just giver her one BP med and check her BP 30 minutes later and if it was still high to give her the other one. I think when I'm an RN that's what I'll probably do.

First Semester

It's almost over! This semester has been full of up and downs. I've had issues with some of my friends, issues with money, issues with patients, and issues with college administration.

All in all though I've done fairly well. I passed most of my check offs first time, kept a B average on my lecture class, and the most important thing of all... I didn't hurt any patient!

I have 2 weeks left of classes, then we have finals, and we have 6 days in between semesters. It's lovely. I now have two patients each week at the hospital. I've grown used to being there and the nurses are very helpful on my floor. However there is one thing that I haven't been able to do. My clinical instructor can never know this. I am terrified to do assessments in the morning. I have done it once and that was because my instructor needed to check me off on it. I just feel like such an idiot going in at 7:30am to bug them about it. I understand logically that it is such an important nursing thing to do. I just can't bring myself to do it. It makes me very uncomfortable to have them grasp my fingers, have them turn so I can listen to their lungs, lift their gown, ask them about their last bowel movement. But I have to suck it up and do it. My goal for next week is to do it shortly after 8am meds, maybe right before depending on my instructors availability. I'll try to pick nice, good patients so I'm not as terrified.

Foleys

My last lab was all about catheters. Catheters scare me. They're the first invasive thing we're learning, and it's not on a place that is "modest". Couldn't they teach us something less embarrassing first!? Of course not... that would take the fun away from being a nurse educator. As we sat there watching in a bit of horror how far that tubing goes into someone I kept thinking to myself there is no way I can do this. I just can't. It's gross. Why can't I just put them on a diaper. I don't mind cleaning those. Our dummies went back and forth between male and female. It's quite interesting to have a female genetelia on a dummy without breasts. It kind of throws you off a little.
After all the demonstrations I thought it was doable, and then I started thinking of what it would be like to do it on a real person. That got me excited. Yes it's gross, yes it's awkward at first, yes I may fall over backwards when I first attempt to do it, but it's actual nursing stuff! It's not something I can delegate to my tech. It's a sterile procedure. It's beautiful.
I'm going to try to be the nurse that doesn't embarrass the patient to death, after all this is probably more humiliating to them than it is to me. I'm going to practice so I know how to do it correctly and my patients will be at a lower risk for and UTI. I'm going to keep them modest as much as I can. I'm going to make this invasive procedure as comfortable as possible.

And now a little student nurse humor:
(click on it to make it bigger)

Deer caught in headlights

Today was my first day of clinicals. I ended up waking up late because who on earth wakes up at 5am???? I made it on time to my hospital and chatted with my peers and professor. We were informed we'd be getting tested on BP so we needed to find a patient to do it on. Great!

I get on the elevator go up to my floor and get assigned to a nurse. She was very quiet, but nice. She had four patients and one admit coming in. We got there they were doing reports and I have absolutely no idea how they can remember half of the things that are said in report. For the first four hours of the day I felt like a deer caught in headlights. She didn't question my knowledge but I was having a hard time keeping up with the different patients and this one had nausea, and the other was a 10/10, and who again had bloody stools? Who wanted their morphine? What time is it? Where in the world AM I!? I felt A/O x1 for a good part of the day.

Lots of medications to get done and so easy to make a mistake. At one point my nurse forgot one pill sitting at the patient's bed side. As we're leaving I pull his tray over and see his little pill sitting there still in the package. I asked her what it was and she looked at me wide eyed, her turn to be the deer I guess, she asked me where I found it. Checked her MAR and she hadn't given the pt. the medication. No problem... it was only his heart medication and after all he was only there for a MI.

We had post conference and a lot of my peers got to do a lot more hands on stuff. My patients were very easy and somewhat boring. I was slightly jealous of my peers who got to help their nurses with catheters and baths and turning people. I really didn't touch any patient.

But moving on! Next week it'll be buddy up with a peer day and after day I'm on my own! My time will come and I will absolutely rock it (cross your fingers)

Why do you want to be a nurse?

About one month prior to school starting we went through two days of orientation. On the first day we did the awkward introductions. They actually made us get up, individually, and introduce ourselves. Our criteria was our name, whether we worked, family history, and the dreaded "why do you want to be a nurse?" question.

I was sitting in the middle front row, so I had some time to think about it. I sat there a little concerned because I really didn't want to sound like an idiot on my very first day. After all I am going to be with these 40 people for the next 16 months. I couldn't quite put my finger on it that day. I got up and just said that I just always wanted to be a nurse. I am the second youngest student in our class, I've always been a nursing major since I started college. Even though the answer satisfied my professor and peers, it just didn't satisfy me.

I kept thinking about it and the truth is... I didn't want to be a nurse for a while. I remember in high school during my Junior year I took the ASVAB. They announced it on the intercom and me being the nerd I am decided I was going to take it! The school was paying for it and I was curious. They "advertised" it as a career test. So I went through 4 hours of the ASVAB test. When I got my results I was not happy! First career that fit me was teacher, second nurse, third I don't even remember. Nowhere did it say "successful CEO" or "stock market broker". I was supposed to be a business woman! I disregarded the ASVAB completely. I'm not sure when it was that I decided that nursing was it. But by senior year it was done. I applied to all the schools that had great nursing programs. I worked hard in high school and graduated with high honors and a scholarship that I was told I could not use so off to the community college I went (whole other story).

I started college as a nursing major. Nursing just felt right. I still can't quite put my finger on it. All I know is that I want to take care of people. I want to make a difference, even as small as it may be in this huge world. I want to be the one nurse that holds a dying person's hand. I want to be the nurse patients are glad to have because they know I care about them. I want to be the nurse who is a patient advocate and is not afraid to stand up for them when they can't do it for themselves. I want to serve humanitarian mission trips and help those in poor areas. I want to be the best nurse I can be. And I truly believe that means I'm going to be one of the best. I'm not in nursing for the money, career stability, flexible shifts. I am in nursing because I love it. I am in nursing because I care.

Introduction

I am a stressed out nursing student and I decided to post stories from nursing school so I can have all the memories about it written down. I am in an Associates Degree in Nursing program and will be graduating in May 2009. It has taken four years to get here, but here I am!

I've been loving every minute of it. Week seven of school starts next week. So I better get going on past weeks!