No, really - what is your EMERGENCY?

This used to be the journal of a nursing student at a prestigious 4 year university that will still remain unnamed. This is now the journal of a Registered Nurse working in an Emergency Department in a major US city. All names have been changed to protect the stupid and the mean. There is no educational value in this journal, sometimes it will be downright mean and catty - this is where I come to vent!

Friday, September 15, 2006

First exam of the semester - DONE!

Ok, I'm feeling a little bit back into the swing of things now. We had our first exam in Pediatrics and even though I procrastinated the studying until the day before, I still managed to get an A. An A on my school's grading scale is 96-100%. Anyway, I'm pretty happy with that and will be very happy if I can keep it up. Like many of my fellow students, I'm a bit grade obsessed. I think it is because I was not for my first degree and that kind of bit me in the butt later on.

I'm getting very tired of our instructors telling us that grades aren't important, learning the information is. Well, if that were really true then 1. why do we have grades in the first place, and 2. why do we get nasty-grams when our grades fall below 80% or something like that? Now, come-on, who really believes that the grades aren't important?? Now I will admit that we get a bit over-obsessed and should be more realistic, but let's face it, in this day and age, grades are important. They are important if you are going to go on to graduate school (which is encouraged daily) and they are important if you want a highly competitive internship as a new grad. I'm pretty sure that answering a question with, "But I really UNDERSTAND the material" is not going to cut it in an interview. So, for all you nursing professors out there: nursing students think grades are very important and they aren't going to change their mind so just indulge their constant quest for extra points and arguing over every question they get wrong on a test.

Quotes of the week:
1. Man, you have a big pickle. Friend 1 says this to the male cashier in the bookstore.
2. Friend 2: I think I have worms.
Yolanda: You don't have worms.
Friend 2: I think I saw one in my poop yesterday.
Yolanda: You have worms.
Friend 2: Do you think I can just go to the pet store and take the same stuff they give dogs?
Yolanda: I don't think so.
The entire above conversation took place during lunch in the food court area that the hospital and all the health affairs schools share. This prompted a lot of stares; Friend 2 had to then comment loudly that she had spent the summer in Africa. Good call. Friend 2 (I haven't come up with a good nickname for her yet) is also the source of, "I don't want to do labor and delivery anymore, I saw enough vaginas in Kenya." I love our total lack of inhibition regarding conversation topics!

Monday, September 11, 2006

I Lied

Ok, in the last post I said that I thought I might enjoy my Peds clinical. That was a fleeting feeling. I now dread my Peds clinical. I'm not sure what happened, but I have no desire to go back and really just want to get through it. Fortunately, I only have 2 weeks left on the floor before I start my secondary sites. I think these will be slightly more fun for me. I will be going to the Pediatric ICU (PICU), the Neonatal ICU (NICU), Pediatric Surgery, and a Pediatric Diabetes Clinic. The last one I'm not so excited about since I've done diabetes clinics before (seems to be a bit of a theme for me), but I'm sure I will survive. So, not that it was ever in consideration, I will not be a pediatric nurse.

We had an interesting issue come up during my clinical last week. Students are not allowed to give patients medications on their own (for a million good reasons), so you have to either have your clinical preceptor or the RN assigned to your patient with you. Well, I was ready to give some Gentamicin (potent antibiotic, can be toxic to the ears and kidneys) via IV to my patient. I got my clinical instructor and we got the med, I went through the requisite 20 questions about the med, and we went in the room and gave it. No problems, all is well. The next day I have the same patient and the same RN (I don't really like her, but I'm sure she is professional adequate). My preceptor and I go and get the med and get ready to give it. Earlier, the assigned RN had said to me, "You don't have to give it so slow, you can just run it through a 10cc flush." I parroted this back to my preceptor and she says, OK. So we go in and instead of using the piggyback pump (with a syringe) we infuse the Gentamicin into the Y-site on the patients IV line. The pump running on that line was infusing normal saline at 20mL/hr (very slowly, actually slower than the recommended rate for the Gentamicin administration). Well, the assigned RN had a fit and thought we had "pushed" the Gentamicin. This would be very bad and professionally irresponsible. So she calls the pharmacy and they tell her to bolus (one time push) the patient with 200mL of normal saline. So she does it. THROUGH THE SAME LINE!! So, just in case the Gentamicin was running slow enough, she just pushed it all into the patient at a much faster rate. GREAT, GOOD CALL.

All of this led to a conference between the assigned RN, my preceptor, the Charge Nurse (the boss for the shift), and the Nurse Manager for the floor. My preceptor explained what we did, the rationale behind it (did I mention she is a PICU nurse with a master's degree?), and the fact that we actually infused it slower than normal and the bolus ended up infusing it faster. All was well - it was a difference in technique and we won't do it again so as to minimize confusion. Now, I was a little on edge during all of this, but what really pissed me off was that the RN decided it was now OK for her to badmouth my preceptor to me. This is totally inappropriate. It is completely unprofessional to speak badly of a student's preceptor to them. The student-preceptor relationship is very important and the student needs to trust and respect the preceptor. Anyway, if you have a problem with a preceptor, take it up with your charge nurse or nurse manager or the preceptor themselves and let them deal with it, but don't question their abilities in front of the students.

I am still loving my Psych class and cannot wait until clinicals start for that. This week we discussed Schizophrenia and other psychotic diagnoses. Our instructor has an apparently never ending stock of real examples for all of the diagnoses we discuss. It is great, you really come away thinking you understand the material.

One last rant and then it is off to study for a Peds exam and get ready for a 12 hour clinical from hell tomorrow. Every time we get our patient assignments we have to ask them if they mind having a nursing student. Do the doctors ever ask if the patients mind having a medical student? I doubt it. Nursing students have far less impact on your care (in the overall picture) than a medical student; we don't prescribe drugs or order invasive procedures. It isn't like they let us loose with you on our own to poke and prod and medicate willy nilly. In fact, we are highly supervised and you will probably get better care from us than the frazzled RN with 5 other patients that is assigned to you. We don't give meds without clearly demonstrating that we understand everything there is to know about the med and the administration. We don't do any nursing procedures (dressing changes, blood draws, etc.) without supervision. In fact, I did more procedures unsupervised as a Certified Nurse Assistant (put catheters in) two summers ago than I will do as a nursing student now. The biggest benefit - you will probably be our only patient. Your call bell will not be ignored. You want to talk about your dog or kid or whatever? We will listen intently - we have no other purpose than to take care of you!

My request to you: if you go to the hospital and they ask you if you would mind having a nursing student assigned to you, please allow it. It is good for us and good for you! You definitely want us learning our trade while supervised. And if you go to a teaching hospital - one usually affiliated with a university - keep in mind that you will probably encounter a student or two. That is why it is called a TEACHING hospital!