Today was another day in the OR with nothing really exciting to report. The only thing "exciting" that happened today was a 17 year old boy came in because he was in a car accident. I hadn't seen a trauma surgery yet and it was very intense. The boy was fine but he fractured his entire face and the surgeon had to reconstruct his facial bones. To access those bones he made long incisions right under each eye and then stitched his eyes shut to hold the other stitches in place. The boy had a breathing tube and a heavy dose of narcotics before surgery so I didn't get to talk to him, but his parents were there and very concerned. I found out the boy had been driving and fell asleep at the wheel and ran into a tree. He wasn't doing anything wrong, he just made a mistake that anyone could make. He did great through surgery and he was taken to the Recovery Room. I happened to walk past his bed when he was waking up and you could tell he was so confused because he kept trying to open his eyes but they were sutured shut. The nurse told him that he just had surgery and he needed to rest, he responded by nodding his head but he kept reaching up to touch his face.
Most patients don't really make me upset because for some reason when you are working it is easier to take the emotions out of the situation. But this guy really pulled at my heartstrings. He just looked way too young to have a breathing tube and stitches all over his face. It really makes you realize how dangerous cars are and how your life can change in an instant. His parents allowed his friends to come see him when he was in the ICU before surgery and apparently one of them said, "Wow, I guess we aren't invincible." I'm sure it was scary for the teenagers to see their friend in a hospital bed with a very injured face and body, but I bet it was a good wake up call for them. He is expected to have a full recovery but I'm sure this experience will stick with him and his parents forever. I know that I will never forget his face.
Monday, July 30, 2012
Sunday, July 29, 2012
First Week in the OR
I can't believe I only have 2 weeks left of my internship. It has been a great experience but I'm ready to get back to into the school routine too. The rest of my week continued pretty much the same as the first day. My mentor "C" and I go from room to room relieving nurses for about 30 minutes so they can go eat. At first I just observed but little by little C let me start to chart, put things on the sterile field, go get supplies, position the patient, etc. It's hard during surgery for her to teach me because if the surgeon asks for something she has to get it immediately, she can't really take the time to explain to me where it is and have me go get it. But, by Friday I had learned where a lot of things were located and how to give it to the surgeon or surgical tech without breaking sterile technique so she allowed me to do it.
This whole week was pretty slow and there were many times during the day when we would sit and wait for a surgery to start or to go relieve someone. I'm sure it will get old after a while but it was kind of nice to not be as stressed and frantic as it was on Women's Speciality and L and D. Also, since we work 11 AM- 7 PM instead of 12 hour shifts, the day goes by really quickly. The only problem is I have to drive to the hospital 2 extra days which is 2 extra hours of driving.
The atmosphere in the OR is very intense and I am surprised by how harshly people talk to one another. For example, I have seen many surgeons be blatantly upset with a nurse or anesthesiologist for not setting up something correctly. At these times I try to stay out of the way because I don't want to get yelled at! I understand why this happens, time is money in the OR and people's lives are truly on the line but I don't know if I would want to work in that sort of environment day after day. I've noticed most of the nurses and other employees in the OR are very tough and I think that you have to have that sort of personality to function in that work setting...so I think I will stick to L and D!
Speaking of Labor and Delivery, I went early to work on Thursday because I needed T to sign a form for me and when I walked into the L and D nurses station she told me her patient was about to deliver and asked if I wanted to come! Obviously I did so I went with her in the room, set up all of the equipment, helped the patient push and 5 minutes later the baby was there! I then was able to be the baby nurse and hang out on the floor for a while! It was a great way to start the day and really affirmed to me that that is the type of nursing I want to get into. Comparing the atmosphere and responsibility of the nurses on L and D to the OR, I know that it is more of a match for me. But I know these next two weeks in the OR will be a valuable experience and will fly by!
This whole week was pretty slow and there were many times during the day when we would sit and wait for a surgery to start or to go relieve someone. I'm sure it will get old after a while but it was kind of nice to not be as stressed and frantic as it was on Women's Speciality and L and D. Also, since we work 11 AM- 7 PM instead of 12 hour shifts, the day goes by really quickly. The only problem is I have to drive to the hospital 2 extra days which is 2 extra hours of driving.
The atmosphere in the OR is very intense and I am surprised by how harshly people talk to one another. For example, I have seen many surgeons be blatantly upset with a nurse or anesthesiologist for not setting up something correctly. At these times I try to stay out of the way because I don't want to get yelled at! I understand why this happens, time is money in the OR and people's lives are truly on the line but I don't know if I would want to work in that sort of environment day after day. I've noticed most of the nurses and other employees in the OR are very tough and I think that you have to have that sort of personality to function in that work setting...so I think I will stick to L and D!
Speaking of Labor and Delivery, I went early to work on Thursday because I needed T to sign a form for me and when I walked into the L and D nurses station she told me her patient was about to deliver and asked if I wanted to come! Obviously I did so I went with her in the room, set up all of the equipment, helped the patient push and 5 minutes later the baby was there! I then was able to be the baby nurse and hang out on the floor for a while! It was a great way to start the day and really affirmed to me that that is the type of nursing I want to get into. Comparing the atmosphere and responsibility of the nurses on L and D to the OR, I know that it is more of a match for me. But I know these next two weeks in the OR will be a valuable experience and will fly by!
Monday, July 23, 2012
First Day in the OR
Today was my first day in the OR and it was pretty much what I expected. I met my mentor "C" and her job is to relieve people for lunch since her shift is 11 AM to 7 PM. So we went around to different operating rooms and asked people if they wanted us to take over. The job of the nurse in the OR is to chart, get supplies for the tech and surgeon and basically just monitor everything that isn't sterile. We spent about thirty minutes on each case and would then rotate to the next room. The OR at the hospital has over 30 rooms so it is very large. It also has the new da Vinci robotic surgeries, a room just for Pediatric Surgery (I like this because it is so much warmer than other rooms!) and a ton of other high tech equipment.
I was able to see a cheek tumor removed, a hysterectomy, a skin graft, chest tubes placed and a mastopexy (breast lift). The day went by really quickly because we moved so quickly from room to room. I think that I will like this rotation because the hours are pretty good (11-7) and it's very fast paced. However, I know that I would not want to be an OR nurse because there is no patient contact! But that's a benefit of this program, I have gotten to see what I love and what I wouldn't want to do!
Thursday, July 19, 2012
Lab Nursing and Male Nurses
The past three days I have experience many different kinds of nursing during our "Clinical Enhancement" week. I remember when I got this internship I was so excited for this week because I would be able to see so many different aspects of nursing and decide which ones I like and which ones I do not like. Tuesday I was in the GI Lab (snore) and then shadowed a Wound and Ostomy Care nurse. The Wound and Ostomy Care nurse was interesting but I don't think I could ever do that as my daily job. If you don't know what an ostomy is, it is an opening in your abdomen (usually) that allows for the elimination of waste products if your body can't eliminate them naturally. You can have one for urine or feces so as you can imagine these things smell and are not appealing to the eye. The most interesting part of the day was when we went to change a colostomy bag (ostomy of the colon) in a patient in the local psychiatric hospital. I don't even have to go into much detail for you to imagine what that experience was like...
Yesterday I was in the Cath Lab all day where they do cardiac catheterizations, place stents, etc. I didn't really connect with any of the nurses there so I didn't have a very good experience. It is fast paced and organized very much like an OR but the nurses have very little responsibility and they seemed bored all day.
Overall, I do not think I would want to be a nurse in a lab like the GI lab or Cath lab. There is very little patient contact and it is very repetitious. I am glad that I was able to see that side of nursing so now I know what I don't want to do!
Today I had a great experience with two different male nurses, one in Radiology and one in Critical Care. I haven't had the chance to work with any male nurses in my clinical experience, especially in OB, so this was something new. I began the day with one of them in Radiology. I thought this was going to be similar to lab nursing so I wasn't expecting much, but so much goes on in Radiology that it was more interesting than I thought. Radiology includes Nuclear Medicine (stress tests, etc.), CT Scans, Pediatric Sedation (to sedate kids for procedures) and Special Services (stent placements, fistula repairs, etc.) The nurse I was with showed me around and quizzed me on different things regarding the procedures and I was surprised by how much I knew (Go Clemson Nursing!). He was very good with all of the patients we had and really seemed to enjoy his job. We even got a free lunch because a vendor came to sell the lab some supplies! My second experience with a male nurse was with a Critical Care Transport Nurse. His job is similar to the PICU Transport Nurse that I was with Monday except he rotates around all of the ER's and ICU's. When he first walked up to introduce himself I was surprised because he was so attractive. I soon learned to find he was not only attractive, but a great nurse. He showed me around the entire Emergency Department which is way bigger than I realized. It includes Adult Emergency, Children's Emergency, Isolation Area for Psych patients, Chest Pain center, Intermediate Care, Urgent Care and Congestive Heart Failure Observation. We took a few patients from the ER up to ICU and helped a few other nurses with procedures. It was a really slow day in the ER but I was able to see some weird, I mean sick, people.
I was so impressed by both of my male nurses today! I wish more guys would choose nursing as a profession! To end this post here are two interesting/funny stories that happened today in the ER...
1. A nurse called my mentor and I over to start an IV on this lady. She was a diabetic and apparently homeless. She had a huge ulcer on her foot and she smelled like a trashcan. I asked her where she was and she looked around and said "Home!"...She had no idea where she was or how she got there. Anyways I went to reach for something and I bumped her. I didn't know she was wearing a wig but it goes flying onto the floor! She has no idea what happened so I just put it back on her head but it was crooked for the rest of the time and my mentor and I couldn't stop laughing because it was just such a ridiculous situation.
2. My mentor and I were trying to start an IV on this guy and he kept telling me how beautiful my name was (Sammy?...) and how pretty I was, etc. Then out of the clear blue sky he tells he me shot and killed someone once. He reallllly knows how to impress a girl.
Yesterday I was in the Cath Lab all day where they do cardiac catheterizations, place stents, etc. I didn't really connect with any of the nurses there so I didn't have a very good experience. It is fast paced and organized very much like an OR but the nurses have very little responsibility and they seemed bored all day.
Overall, I do not think I would want to be a nurse in a lab like the GI lab or Cath lab. There is very little patient contact and it is very repetitious. I am glad that I was able to see that side of nursing so now I know what I don't want to do!
Today I had a great experience with two different male nurses, one in Radiology and one in Critical Care. I haven't had the chance to work with any male nurses in my clinical experience, especially in OB, so this was something new. I began the day with one of them in Radiology. I thought this was going to be similar to lab nursing so I wasn't expecting much, but so much goes on in Radiology that it was more interesting than I thought. Radiology includes Nuclear Medicine (stress tests, etc.), CT Scans, Pediatric Sedation (to sedate kids for procedures) and Special Services (stent placements, fistula repairs, etc.) The nurse I was with showed me around and quizzed me on different things regarding the procedures and I was surprised by how much I knew (Go Clemson Nursing!). He was very good with all of the patients we had and really seemed to enjoy his job. We even got a free lunch because a vendor came to sell the lab some supplies! My second experience with a male nurse was with a Critical Care Transport Nurse. His job is similar to the PICU Transport Nurse that I was with Monday except he rotates around all of the ER's and ICU's. When he first walked up to introduce himself I was surprised because he was so attractive. I soon learned to find he was not only attractive, but a great nurse. He showed me around the entire Emergency Department which is way bigger than I realized. It includes Adult Emergency, Children's Emergency, Isolation Area for Psych patients, Chest Pain center, Intermediate Care, Urgent Care and Congestive Heart Failure Observation. We took a few patients from the ER up to ICU and helped a few other nurses with procedures. It was a really slow day in the ER but I was able to see some weird, I mean sick, people.
I was so impressed by both of my male nurses today! I wish more guys would choose nursing as a profession! To end this post here are two interesting/funny stories that happened today in the ER...
1. A nurse called my mentor and I over to start an IV on this lady. She was a diabetic and apparently homeless. She had a huge ulcer on her foot and she smelled like a trashcan. I asked her where she was and she looked around and said "Home!"...She had no idea where she was or how she got there. Anyways I went to reach for something and I bumped her. I didn't know she was wearing a wig but it goes flying onto the floor! She has no idea what happened so I just put it back on her head but it was crooked for the rest of the time and my mentor and I couldn't stop laughing because it was just such a ridiculous situation.
2. My mentor and I were trying to start an IV on this guy and he kept telling me how beautiful my name was (Sammy?...) and how pretty I was, etc. Then out of the clear blue sky he tells he me shot and killed someone once. He reallllly knows how to impress a girl.
Monday, July 16, 2012
Pediatric ICU
Today I spent the day in the Pediatric Intensive Care Unit (PICU) for my first day of our "clinical enhancement" week. I had such a great experience but it definitely was an emotional day. My mentor "J" is a Transport Nurse in the PICU so she goes on ambulance and helicopter rides to get patients from other hospitals. When she is waiting for a call she helps out the other nurses and does odd jobs around the PICU which seems like a pretty cool job that would never get boring. She was an amazing nurse and really helpful to all of the other nurses. The PICU is pretty cool because the nurses have a small patient load (1-2 at a time) and have a ton of autonomy. They were doing a ton of bedside procedures and monitoring on their patients and the doctors were letting them do it all.
The PICU had patients ranging from 3 months to 17 years old today so I was able to see a wide variety of things. A lot of patients that come in are Non Accidental Trauma's, which is the politically correct way of saying abuse cases. To protect patient identities I won't go into much detail but these young kids had bruises and signs of trauma all over their body that makes you sick to think about. Sadly a lot of these kids that are abused when they are younger become brain dead or mentally delayed so they never really recover. They have to not only deal with the emotional trauma but it truly effects them for the rest of their life. Another thing I was surprised about is that in the PICU they get a lot of teenagers that overdose on drugs or drink too much alcohol. It was strange to see a three month old baby in a room next to a teenager who was on drugs.
To finish off this post I will tell you about the best and worst (AKA most embarrassing) part of my day! The best part was when my mentor was putting an IV in a baby and I was able to hold the baby and keep his arm straight (he was very very strong so this was harder than it sounds) while she did it. I really felt like I was helping her and I was able to comfort the baby while he was being stuck, poked and prodded. The most embarrassing part of my day occurred when J and I went to find some supplies in the NICU (neonatal intensive care unit) and I opened the wrong door and set off the alarm that prevents people from stealing babies in the hospital. Whoops! The NICU nurses didn't think it was as funny as J did because she ended up telling everyone back in the PICU that I tried to steal a baby.
The PICU had patients ranging from 3 months to 17 years old today so I was able to see a wide variety of things. A lot of patients that come in are Non Accidental Trauma's, which is the politically correct way of saying abuse cases. To protect patient identities I won't go into much detail but these young kids had bruises and signs of trauma all over their body that makes you sick to think about. Sadly a lot of these kids that are abused when they are younger become brain dead or mentally delayed so they never really recover. They have to not only deal with the emotional trauma but it truly effects them for the rest of their life. Another thing I was surprised about is that in the PICU they get a lot of teenagers that overdose on drugs or drink too much alcohol. It was strange to see a three month old baby in a room next to a teenager who was on drugs.
To finish off this post I will tell you about the best and worst (AKA most embarrassing) part of my day! The best part was when my mentor was putting an IV in a baby and I was able to hold the baby and keep his arm straight (he was very very strong so this was harder than it sounds) while she did it. I really felt like I was helping her and I was able to comfort the baby while he was being stuck, poked and prodded. The most embarrassing part of my day occurred when J and I went to find some supplies in the NICU (neonatal intensive care unit) and I opened the wrong door and set off the alarm that prevents people from stealing babies in the hospital. Whoops! The NICU nurses didn't think it was as funny as J did because she ended up telling everyone back in the PICU that I tried to steal a baby.
Friday, July 13, 2012
Rapid Response
My last day on Women's Speciality turned out to be a very exciting one...it began with my mentor trying to set me up with a 4 foot 11 chubby doctor...sorry, but no. But that wasn't the exciting part. The beginning of the day was really slow with a low patient number so L sent me down to the CVICU (Cardiovascular Intensive Care Unit) to see some "cool" (this word is relative to your desire to see chest tubes, blood and other bodily fluids) things. A very nice nurse showed me around the unit and was so patient explaining everything to me. She had just come on the shift so she showed me what an ICU nurse does and how they prioritize patient care. Just being in the ICU setting was very intense and I don't know if I could do that kind of nursing! The patients had a least 10 IV fluids running, wires and tubes coming from all kinds of places and they just looked really sick. I was able to watch her take out a chest tube which was really interesting but looked painful for the patient. By the end of my hour with her I felt more comfortable but I think I'll stick to the pregnant people and babies.
The real exciting part of my day came at the very end. L and I had gotten a new admission around 4:30 and she had just had GYN surgery. She had a medication ordered for her and the ordered range was 1-3 mg. They had given her 1 mg and it wasn't having any effect so L decided to try the 3 mg. She was hesitant because she had never given this much before but the patient said she could handle it and the doctor had ordered it so L thought it should be fine. Fifteen minutes after administering the medication via her IV we heard beeping from her room and I went in to check on her. Her pulse was 147, her skin was blue and her eyes were fluttering. Her daughter was at the bedside and said all of a sudden her mom started acting funny and that was when the machine started peeping to indicate her high pulse. I went to get L and we hurried back into the room. At this point the daughter was crying so I did what I was taught to do and calmly took her outside the room and told her we were going to do everything to make sure she would be OK. L called 2 other nurses in the room and a "Rapid Response". Rapid Response is a step below from calling a full code but basically it is designed to help a nurse with a patient in critical condition. A RR will send 2 ICU nurses and a Respiratory Therapist immediately to the floor to help you out. While we waited for them we put the patient on oxygen, moved everything out of the way in case of a code, put cold washcloths on her face and chest and pushed Narcan which is a narcotic drug reversal agent. By the time RR got there she was doing a lot better but was still having trouble keeping her eyes open. We stayed with her for a while until the Narcan kicked in. Fortunately Narcan works very well to reverse the effects of the drug but it also makes all of the pain come back. Our poor patient was so confused what had happened, was all of a sudden in a lot of pain but was afraid to take any medication. We monitored her for the next hour and then before the end of the shift we convinced her to take a 0.5 mg dose to take the edge off.
It was a scary moment and I truly felt bad for the patient and her daughter but it was also a really educational experience for me. I learned to trust your instinct if you sense something is off, even if the doctor ordered it. With pain medication it is important to keep the pain at bay but also to ease the patient up with dosages, especially with narcotic drugs. Also, I learned to not hesitate to call a Rapid Response. This patient obviously needed help even though she was much better by the time she arrived. It is better to be safe than sorry!
Tomorrow I get to go to Labor and Delivery for one more day so I am very excited. Hopefully it will be less exciting than today though!
The real exciting part of my day came at the very end. L and I had gotten a new admission around 4:30 and she had just had GYN surgery. She had a medication ordered for her and the ordered range was 1-3 mg. They had given her 1 mg and it wasn't having any effect so L decided to try the 3 mg. She was hesitant because she had never given this much before but the patient said she could handle it and the doctor had ordered it so L thought it should be fine. Fifteen minutes after administering the medication via her IV we heard beeping from her room and I went in to check on her. Her pulse was 147, her skin was blue and her eyes were fluttering. Her daughter was at the bedside and said all of a sudden her mom started acting funny and that was when the machine started peeping to indicate her high pulse. I went to get L and we hurried back into the room. At this point the daughter was crying so I did what I was taught to do and calmly took her outside the room and told her we were going to do everything to make sure she would be OK. L called 2 other nurses in the room and a "Rapid Response". Rapid Response is a step below from calling a full code but basically it is designed to help a nurse with a patient in critical condition. A RR will send 2 ICU nurses and a Respiratory Therapist immediately to the floor to help you out. While we waited for them we put the patient on oxygen, moved everything out of the way in case of a code, put cold washcloths on her face and chest and pushed Narcan which is a narcotic drug reversal agent. By the time RR got there she was doing a lot better but was still having trouble keeping her eyes open. We stayed with her for a while until the Narcan kicked in. Fortunately Narcan works very well to reverse the effects of the drug but it also makes all of the pain come back. Our poor patient was so confused what had happened, was all of a sudden in a lot of pain but was afraid to take any medication. We monitored her for the next hour and then before the end of the shift we convinced her to take a 0.5 mg dose to take the edge off.
It was a scary moment and I truly felt bad for the patient and her daughter but it was also a really educational experience for me. I learned to trust your instinct if you sense something is off, even if the doctor ordered it. With pain medication it is important to keep the pain at bay but also to ease the patient up with dosages, especially with narcotic drugs. Also, I learned to not hesitate to call a Rapid Response. This patient obviously needed help even though she was much better by the time she arrived. It is better to be safe than sorry!
Tomorrow I get to go to Labor and Delivery for one more day so I am very excited. Hopefully it will be less exciting than today though!
Thursday, July 12, 2012
Back from Vacation
Two nights ago I came back from a wonderful vacation at home to finish up my externship. Since I arranged my schedule to maximize my vacation time I had to work yesterday, tomorrow and the next day. I found out right before I left to come back to Clemson that I would not be able to do my last rotation on Labor and Delivery and would have to be in the OR. I am disappointed but I know I can handle three weeks and I will probably be able some interesting surgeries!
Yesterday was an interesting first day back to work. The twelve hour shift seemed way longer than usual but I'm sure that was due to my relaxing vacation and long travel day the day before. Also, my mentor and I had the first really sick patient that I had seen on this floor and we had to monitor her carefully. This patient had an emergency C-section the night before because she had pre-eclampsia and the only way to help her is to deliver the baby. After delivery she kept bleeding, her vital signs were out of the normal range and she didn't look good at all. We had to carefully monitor her all day as well as take care of three other patients. It was great to see the other nurses step in and help my mentor without a complaint. Our patient ended up being fine and will probably go home tomorrow. It was cool to see someone improve so much just during one shift!
I have one more day on Women's Speciality and I have learned a lot but I'm ready to try something new. On Saturday I get to work for 1 last day on Labor and Delivery because my mentor won't be in on the Saturday that I need to work and she said that I could go to L and D if I wanted! (Obviously I said yes!)
Next week is our "Clinical Enhancement" week where we rotate to different floors in the hospital for 4 days. I just received my schedule and I am really excited about what I am going to do! Monday I will be with the PICU (Pediatric Intensive Care Unit) Transport Nurse. I haven't done anything with Peds yet so I'm excited about this. Tuesday I am with Mobile Care and this means I get to ride around in an ambulance! Wednesday I am in the Cath Lab and to be honest I am not sure what that entails but I will find out. Thursday I am in Radiology for the morning and the Critical Care Transport Nurse in the afternoon. I then get Friday, Saturday and Sunday off and begin in the OR on Monday!
Yesterday was an interesting first day back to work. The twelve hour shift seemed way longer than usual but I'm sure that was due to my relaxing vacation and long travel day the day before. Also, my mentor and I had the first really sick patient that I had seen on this floor and we had to monitor her carefully. This patient had an emergency C-section the night before because she had pre-eclampsia and the only way to help her is to deliver the baby. After delivery she kept bleeding, her vital signs were out of the normal range and she didn't look good at all. We had to carefully monitor her all day as well as take care of three other patients. It was great to see the other nurses step in and help my mentor without a complaint. Our patient ended up being fine and will probably go home tomorrow. It was cool to see someone improve so much just during one shift!
I have one more day on Women's Speciality and I have learned a lot but I'm ready to try something new. On Saturday I get to work for 1 last day on Labor and Delivery because my mentor won't be in on the Saturday that I need to work and she said that I could go to L and D if I wanted! (Obviously I said yes!)
Next week is our "Clinical Enhancement" week where we rotate to different floors in the hospital for 4 days. I just received my schedule and I am really excited about what I am going to do! Monday I will be with the PICU (Pediatric Intensive Care Unit) Transport Nurse. I haven't done anything with Peds yet so I'm excited about this. Tuesday I am with Mobile Care and this means I get to ride around in an ambulance! Wednesday I am in the Cath Lab and to be honest I am not sure what that entails but I will find out. Thursday I am in Radiology for the morning and the Critical Care Transport Nurse in the afternoon. I then get Friday, Saturday and Sunday off and begin in the OR on Monday!
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