Paralell Universe Begun

This post is way late because I have simply not had a single spare moment to write it since...last thursday! I had friday and saturday off and it was spent either sleeping in (MUCH needed- TRUST me, packing (moving into a new apartment in less than a week!). Craziness!

But its been on my mind, and I definitely wanted to share.

Recently I had a post about working with student nurses, and that I liked it. Well, that day when I made that first blog, they asked when I'd be working again with them and we figured out it would be this past Thursday. I was actually looking forward to teaching them again and all week anticipated their arrival.

However, when Thursday eventually came, we decided THAT morning to switch how we do our entire med pass system, in anticipation of our upcoming major medication renovation system. We are slowly converting to a much more modern and convenient way of doing our med passes. However just because its going to eventually be convenient, doesn't mean its convenient to switch now when I'm in my fifth week and just learned how to do med pass in the first place. Yikes.


So, here I am, on thursday. I have a pretty high acuity patient load. I had a very unique set of patients and no one in my section was particularly easy, one of them being the hardest yet I think I've ever had. Like, Ever. As an aide too.

So, processing my interesting section in my head, trying to organize my thoughts and getting used to these new med carts, all of the sudden, I see the students in the hallway.

I thought to my self, there is no.way. I cannot handle a student right now. I can't! I cannot. I am already behind, and swamped and how can I give a student report on my patient when I can't even gather my thoughts long enough to know what the hell is going on!? Part of me at that moment wanted to hide and wished I didn't have a student that day. I just didn't think I could take it on.

But, sure enough, a student came up to me. All bright eyed and ready for the day, with her new notebook. They already know wayyyy more about my patient, because here's how it goes:

Me: I get a 5-10 minute report on what my patient is in for, what we're doing to help him, how he/she did overnight/what has to be done this coming day and when he/she can go home. Thats it. 5 minutes

Student: Come the night before, write everything down from the chart (like, lab values dating back to two weeks ago), go home, research that ONE patient, and come in the morning, read the chart again to see if they missed a detail or two, and then  they come say hi to me. 

Boy, do I miss those days. One patient for the day. Research all night before you get them.

I used to think, when I was in clinical, that I better know everything on that chart because the nurse is going to quiz me! I thought for sure the nurses knew everything in that chart, and if I didnt know every detail then I was definitely going to fail. But as it turns out, I haven't "looked through" a chart, since I've started. Other than what I've HAD to do, to figure out why an order is the way it is, or to sign off on orders, or to track progress, etc. I have not had time to venture beyond "physician notes, nurses notes, and history and physical (thats if I'm lucky)" No time!

So, the students know more information than me, yes. But they don't know how to use  it. They don't know what it means. They haven't learned yet whats important.

So, back to my story, this student comes up to me. Even though in my head, I'm thinking of how far behind in the morning I am and how much I reallllly don't have time for a student, I put on my happy/nice nurse face persona and gave her report (did my best). She asked if she could not only do anything involving the patient she was assigned, but also follow me around for the day. I told her I was a little frazzled, to be honest,  and that I needed to just make a plan for the day and collect my thoughts but that I would definitely pull her into any out of the ordinary learning experience any of my patients had.

Eventually, I got in to see the patient she was specifically assigned to. She was with him doing therapeutic communication (even though I can't say I've heard that patient talk more than a whole sentence strung together at one time, so i'm not sure how that was going....) and I taught her how to do my kick-ass nursing assessment that I learned from my school. After we left, I taught her my kick-ass way of documenting that assessment on my paper before I had time to put it in the computer. After that, we went to go assess my other patient, who had far more interesting abnormalities, so I got to teach her a lot about why that was the case.  I made sure to answer every single one of her questions, and make myself open to ask more questions if she so chose (I think thats really important). That way, even If I DO get really busy with other patients, she shouldnt

So I got to do a lot of education, about medications, assessments, vitals, nursing in general, and that was just me "getting by", I was really just trying to do my best with her and praying she wasnt thinking I was a complete neurotic nut that was all over the place.


Well, turns out, when she was done for the day, she was supposed to come give me "report" on my patient. I remember those days too, but now that I think about it- that concept is pretty silly. I was with the patient as much as she was and was already familiar with what was going on, but I listened to her report anyway.

She gave me a tiny report (there really wasnt much to say on the guy) and then right before she left, she told me something I'll never forget. She told me that I changed everything for her. That she learned more from me in two hours then she has learned all this time so far in school ( I found that hard to believe!), she told me that driving here on the way to clinical, she thought to herself that she didn't think she could do this anymore- this nursing profession road. She thought she wasn't capable, that it wasn't for her. She told me that after last clinical, she had such a rotten time that she went home crying (I remember those days, too). But today (thursday), everything changed when she was with me. She told me I made things make sense. It just did. She told me I made it possible in her eyes that she could do it too one day, and reassured her that there were nice nurses still out there. She thanked me a million times for being so understanding, kind, patient, caring and thoughtful and overall a fantastic nurse.

I have to say, I pretty much just stood there, looking at her. I did not know what to say- I couldn't believe what I was hearing. Was she talking about me?

She then went on to say that everyone in her nursing class should have a one day session with me as the nurse, and that way everyone could learn as much as she did that day.

I was absolutely flattered. But I couldn't believe it! I even told her, that she was very sweet but that I was honestly just doing my job. I explained to her I was just recently in her shoes less than a year ago and will never ever forget what its like. I won't forget tomorrow and I won't forget in twenty years. Nursing students, despite their lack of critical thinking and overall knowledge base, are the future. If you want future nurses to be terrible, then don't teach them. And then be pissed at them all the time when they are new graduates and never learned the right way. Or, take the time to really teach them. Show them tricks, take them under your wing, be NICE. From that you grow a nurse just like me. Thats how I grew. Not only did I learn from bad and good nurse examples in clinical and remember every moment on how I was treated as a student, but I have spent the past five years watching good and bad nurses on my floor. 


So, she told me that because of how great her day went that day, that I changed her mind about her career, and now she wanted to stick with nursing. I was honest and told her there was a long road ahead, but its so worth it in the end. Its worth it. And, it gets better, it really does. I also gave her my number if she ever had another crises where she didn't think she could do it anymore and needed encouraging words. Was that too far over the top? Probably. Who knows. But to know that I changed someones life? Thats huge! Hopefully she'll make a good nurse and I changed her life for the better. Its just amazing and hard to believe that because of me, because I was at work that day taking care of that patient, that I changed how she thought of the entire career. Pretty cool :)



As for myself, I'm definitely putting some thought into becoming a student again sometime soon within the next two years. Its crazy how much I'm already learning. I can't wait to take my experience back to the classroom and learn even more to build on top of the experience I'm already getting. In this lifetime, I will never go to med school to be a doctor. I'm already 23 and that is never going to happen. However I'm starting to realize that I probably could have been a doctor, but I'd make a better nurse. I'm starting to get to that point now that I can anticipate what the doctor will want when I call him on the phone. I suggest things for him. I come up with diagnoses in my head (I dont share them...yet- in fear of being wrong). I know being a doctor has got to be one of the most stressful jobs ever. Especially when they don't know whats wrong and they have to figure out the mystery. But besides that, they just follow protocols, follow standard type treatments, treat abnormal lab values, infections, surgeries, maintain health, etc. They have guidelines (for 70% of their patients).  But who knows....I'm sure it really is a lot harder than I think it looks. I didn't think nursing looked (that) hard when I was just an aide. I was way wrong.



So, its been a fantastic couple of weeks. So much learning, so much fun.....I have a good set of patients this week and can't wait to go back tomorrow.



Goodnight, with love--

~WNB




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Why Thank You, Doctor!

So I am getting to be a LOT better with doctors. I never thought I'd hear myself saying that, but I guess its human nature to eventually get better at things you suck at. And in the nursing world, either you get better at it, or you fall drastically behind. You have *no time* to be bad, you have no time to be nervous about talking to doctors, you just have to do it, and quickly. Know what you're talking about, try and have as much information available as possible, and ask the right questions. And be really, really nice. That always helps. :)

I'm getting to be pretty comfortable with the doctors, too. The other day I called one out on 2 mistakes he made med-wise that could have been pretty unfortunate if I hadn't questioned it. So, yay!

So far all the doctors I have worked with have been very cordial. Which is awesome. And for the scarier ones, I can get by with doing the above and being super nice. However, being new has its extreme disadvantages. For example, we don't have "pictures" of the doctors. Eventually the nurses just meet each doctor one by one and memorize what they look like. But when I'm new, there are a bajillion things on your mind, and memorizing doctors isn't high on that priority list (yet). There have been days when my preceptor is like, "when you see Dr. Blahblah, make sure to tell your patient is blahblahblahing" and I'm all like, "okay." And then five minutes later I realize I haven't the slightest idea what Dr. Blahblah looks like.

So eventually I'm meeting them one by one. I embarrass myself frequently by staring them down in the hallways, trying to get a good view of their nametags and memorize their face. They aren't a huge fan of that (me staring at them funny). I try and do it like as I'm walking by or tying my shoe or something, but...well, you know. Also, whenever *any* type of doctor,( primary, secondary, consult, hospitalist, etc) is in to see my patient, I introduce myself and try to make myself memorable so they know later who they're talking to on the phone. I'd so much rather walk right up to a doctor in person and introduce myself rather than talk to a doctor I don't know on the phone.


And thats why I came up with a brilliant idea. Granted, nurses must face hardships when starting their first job.  Its unavoidable, and necessary. Older nurses training younger nurses play it off as, "eventually you'll learn the doctors". But the way I see it as, patient safety is nursing number one concern, right? Right. Not learning doctors. Why make an extra stressor for ourselves (for new nurses) if we don't have to, and could instead be stressing on how to advocate best for our patients? Doctor and nurse communication has improved, but is still lacking. And thats in general. New nurse and doctor communication is suffering even more. Which circles back to patient safety. If new nurses are afraid to speak up to doctors, then they might not speak up at all. Advocacy suffers, less phone calls are made and the nurse is definitely not going to make the extra effort to give you (the doc) as much information as possible.


So this is my cure. A luncheon! Yeah!

No really, I'm serious. What if hospitals adapted a monthly luncheon for doctors to meet all new staff (and anyone else that wanted to come?). At first, you may laugh. Especially if you happen to be a doctor reading this blog. But seriously, hear me out.

This benefits the doctors too. Believe it or not, (especially big hospitals), new doctors come on staff all the time. If I were a doctor I'd like to attend and graze over a couple friendly nurse faces that I'll be working with on the floors. Also, c'mon...free food. From the hospital (probably?).

Who would attend? Residents (new and old), doctors, Interns, surgeons, etc. As many different types of doctors that wanted to come as possible. And new nurses would be required to go, and old nurses highly encouraged to go.

Granted, no one wants to go to "these types of things" ever. So there would have to be a cool incentive to go, like cake. Everyone likes cake. And money. But cake is cool too.

What would people do there, besides eat and stare at each others name tags? Well, hopefully talk. Strike up some conversations. If it was totally awkward like a middle school dance and no one talked, I would have to bring out the icebreakers. Like actually getting a podium and introducing new staff for all to see. And maybe make them say a five second blurb about themselves. But thats the last resort.



So, granted, the hospital wouldn't want to pay for this, doctors wouldn't want to go to such a "lame" thing, and it would probably never work. But its a nice thought, in theory.....in a nice cooperative world, it would totally work. And be awesome. Then again in a nice cooperative world, you wouldn't need this, because doctors and nurses would have awesome communication techniques all the time.

Its just that some doctors just don't.....get it. They don't get nurses, don't see nurses as a vital part of their patients care. If you call them, you're bothering them. It makes all the difference. However, a couple shifts ago last week one of my patients doctors came in. After he was done speaking to my patient, I caught him on his way out. I introduced myself, and he introduced himself and what kind of doctor he was (that was helpful). After blahblahblah talking, he made sure to finish the conversation with, "Call anytime for anything you need for him."  I felt like going to give him a super duper handshake or pat on the back or something for being so awesome. Thats how doctors should be! Yes!


The hospitalist I've been working with for four weeks now, has been.....truly amazing. Granted he is quite new himself and is probably trying to just be nice to everyone he meets, but I genuinely think he's just a nice, great, smart doctor. He has been *so* patient with me and me being new. Anything my patients need, I can feel comfortable calling him for anything and it is no problem. Thats the line of communication that is ultimately desired with all (or at least most) of your coworker doctors. Right? Right. Today he went home two hours late, and he looked tired. And all I wanted to do was go give him a huge hug or high five or any of the above, for not only being such a terrific doctor thus far but for treating me as an equal and for being so patient with me. A + for him. But I didn't. Because any of the above actions would be very strange.


What do my fellow nurse readers think? (if I have any?) Do you guys have a luncheon or something similar to get docs and nurses acquainted? How do docs and nurses communicate differently in your hospital? Does it affect patient safety or patient advocacy? Is there something you want to do about that?


:-)


With love, ~ WNB


Do something! Communicate!


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Blast from the Past

Hey!! So, Week three was absolutely insane! As expected....I moved up to 4 patient load. The first day with 4, I went home an hour and a half late. I kept all my patients safe, made no mistakes, but ran the entire shift, and charted none. Thats why I had to stay late, to friggen chart to make up for not charting since 7 am. So, thats definitely something I need to find a "system" for.  I'll have to try a couple things out.

But, the most important lesson of the week, was actually a blast to the past. School!

Ok, I'll explain. This week, the local college of nursing began their clinicals, in our hospital. Well, on day 2 this week I saw them in the hall but didn't really interact with them much.  But they were everywhere! I sort of just tried to avoid them because I already had too much on my plate. But much to my surprise, on day 3, after I got done with my second assessment, I had two nursing students hovering by my little binder. I sort of smiled and said hello, and they said hello but just kept standing there. Then eventually, they told me they needed report. So I was like......"Okay....." and then it was awkward silence. And then, I got it. I asked, with a squeaky voice, "Wait....report from Me?" And they nodded. I was like, seriously? They gave me students to supervise? I mean, I vowed, when I was a student nurse in their shoes, that when I became a real nurse and got my own little students, I would be the nicest, best educator I could possibly be. But seriously, I was three weeks old! Was it even safe to give me students? Apparently someone thought so.

So, I gathered my self, picked my mouth up off the floor, and gave them a report, and delegated them some easy things they could do for the day (assessments, report back to me, communication, vital signs, etc.) They are in their first year so that was pretty much the extent of what they could do. It made me giggle, reminiscing back to me, 3 years ago, in their shoes.

Listening to them give me a "report" back at the end of their "shift", was very....interesting. I of course had spent the day with the same patients, so I was listening to see if their assessment matched up with mine. But their thinking was drastically so very....simplistic. They can't make circles yet, no critical thinking yet. They focus on the obvious. Facts. What they can see. No putting two and two together. No advanced physiology.

But at the end of the day, the student's teacher (who also works in the hospital as one of my ex-bosses) happened to be very nearby and the students told the teacher right in front of me that they both request me as their nurse for the next week again, that I was a very good teacher and made them feel very comfortable, and I really "knew my information". Again, I had to pick my mouth up off the floor. I was shocked.

I found it funny, because really- being so busy all day, just because I have students under me doesn't mean I don't do anything. I'm still completely 100% in charge, working with the doctors, giving the meds (they dont do that yet) and coordinating patient care, and taking care of my other two patients that the students didn't have at all. Complicated enough? Quite.

So all day, the best I could do to keep up with everything and educate them, was to just think all my thoughts out loud, and hopefully they would follow that. And they did! I thought aloud but at the same time, talked in their direction so maybe they would think I was actually educating the right way! But it helped myself more than I thought to think aloud for the students, because as a new nurse myself, it helped me verbalize and think through the reasoning behind my actions. Why was I doing this? How do I do this? Why does the hospital do this? Why is our patient getting this medication? Is it the right dose? It helped my own brain slow down and double check everything because the last thing I want is to mess up in front of a student learning from me!

I got to have a cute little real "educational opportunity" with one of them. My patient was on a med I was not familiar with, and obviously neither was she. The order was written for the patient to have it exactly 30 minutes after breakfast. So thats about 0830. Well, I didn't get in there with it til about 1000 (c'mon not everything is on time when you have four pts on third week with 2 students!). So, it was in my best interest of course to investigate why it had to be that time period after breakfast, and if that rule could be bent. So I taught her how to use a drug book, and we looked up the drug together. It was suggested in this book as well to take it 30 minutes after breakfast, so I decided to give him a little something more to eat and gave the med. By doing this, we actually had the classic educational opportunity of, Why is he on this med? What will it do? What are the side effects? Does he have any? What are we gonna do about that? It really opened their eyes on how to think in circles.


But it was definitely an interesting experience. Being looked up to like that, being looked up to by some students older than me going back to school for nursing. thats impossible- since I'm the nurse, after all, not the student anymore. Its overwhelming to think about.

But, I think I liked it. Maybe I can be a nurse educator one day after all. I always threw that notion out the window- thinking there was no way I would ever make a good teacher, I'm far too spontaneous and erratic. But I pulled it together somehow and made it work. They learned from me. It wasn't a total disaster. Maybe I'll teach in "retirement" (aka social security will be zilch when im 70 and I'll be forced to work).


So, fun! Week 4 starts tomorrow......5 patients. Going to just keep getting crazier and crazier. Just have to take a deep breath and constantly re prioritize, and just keep going. *Breathes*.




With love,


~A Writer in A Nurse's Body



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Just can't help myself...

I'm the kind of girl that sees a wall with a "wet paint" sign on it and then touches the wall to see if it is actually wet.

It usually is.






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