Tear Jerker

In one of my classes today we watched the movie "Wit" with Emma Thompson. Apparently it was a Broadway play for several years and then was made into a movie by HBO in 2001. I tend to not cry in public - could be the Marine in me - but this movie had everyone in the class sniffling and then just out and out bawling.

I am glad we watched it and would suggest it to any new or seasoned healthcare provider but I wish I had been warned about its serious emotional aspects. Make sure you are somewhere you can cry and have plenty of tissues!


http://www.hbo.com/films/wit/synopsis.html

Ick

Ok, I gagged for only the 2nd time in my nursing student career. Yesterday I had a COPD patient in the ICU. He was mostly there but I had a little bit of difficulty understanding him because he did not have his teeth in and where I live people have accents which make them difficult to understand even when they have their teeth. We did his meds to include one that had to be mixed in orange juice because it tastes nasty. I was helping him get cleaned up and he mumbles something and points at his mouth. I thought he was going to through up so I get the basin and he hocks up some nasty sputum. Now, vomit - no problem, diarrhea - no problem, blood - no problem, amputated limbs - no problem, oozing wounds - no problem, inside parts on the outside - no problem, sputum - BIG PROBLEM. I just can't do it. It grosses me out to the point of gagging. I could never be a respiratory therapist or work in a respiratory unit.

Other icky thing for this week - we had a liver failure patient who was a train wreck and probably circling the drain. His blood chemistries were way, way out of whack. So, of course he gets prescribed Kayexalate and Lactulose via his NG tube since he is on a vent. My preceptor decides that I need to taste both of these (they are liquids) so I know when my patients ask me what they taste like. I taste them - not too bad. I wouldn't want a cupful of either, but you could get them down. But when you mix the two together in a plastic cup so you can draw it up in a big ol' syringe to push it down the NG tube - they are the color of watery mud. Also, fortunately for me but big time unfortunate for the night shift - this all occurred at about 1830 or so - just in time for shift change at 1900. Sorry guys!!!! If you don't know what these two meds do - say thank you because it means you have never had to take them and you have also never had to clean up the result!

The ICU

So, I have done two shifts in the ICU for my new clinical rotation. I love my preceptor so far. She looks like a little elf - short spikey hair, little tiny person, she even has pointy ears! She is very nice, upbeat, not burntout and realistic. It is very nice to see someone who loves her job and doesn't talk down to patients.

On the second day, I had my own patient. She was an advanced Alzheimer's patient with a fractured hip. She had had it repaired and was in the ICU because she had had some arrhythmias in the PACU. Anyway, she was out of control. She would be nice and fine one minute and then she was mean and nasty the next minute. She kept pinching me, she spit at the NA, and she tried to hit one of the other nurses. So, towards the end of my 12 hour shift, my patient was back in bed and she did not have the restraints on since she had been relatively cooperative for the past few hours. I look in there and she has her hands under the blanket in the general area of her Foley catheter. I run in there and she is yelling at me to stop hurting her, I pulled back the blanket and find her YANKING AT HER CATHETER. She wasn't bleeding yet, but she was getting close! I go to pry her fingers from the catheter and she grabs both of my hands and will not let go. I called for my preceptor who comes in laughing and we managed to get her to let go and get the restraints back on. It was a crazy 12 hours and reinforced my desire to work in the ED where my patients come and go within the same day!!!

Don't get me started on the Kayexalate enema I had to give.......

New Clinical Assignment

Well, my 6 weeks in the ED are over and I will now spend 6 weeks in the ICU. I am not happy to be leaving the ED, but I am happier to be going to the ICU instead of the surgical floor as was originally planned. Not that I have an issue with the surgical floor, it is just that I spent a whole summer on medicine/surgical floors and I have had enough of it. I know that it is not what I want to do - heck I already took a job in an ED for after I graduate.

I will miss "theme days" in the ED - you know things like "boil on my buttocks day" or "kidney stone day" or "random laceration day" - anytime we got more than 2 of the same complaint (other than kids with upper respiratory issues or runny noses) it turned into a theme day.

I will miss joking around with the PA's in the ED. They were a good group of guys and their students were hilarious - talk about clueless! But you could talk them into just about anything - even helping you give a soap suds enema. Hey, they need to know what they are asking the nurses to do for their patients!

I will miss my preceptor who ate constantly but never seemed to gain any weight. And the fact that she always made me give the Toradol shots to the patients with elephant tough skin.

I will miss the patients who come in complaining of nausea and vomiting for a week and immediately ask for something to eat - from the hospital cafeteria. Believe me, that is definitely not going to help! Or the middle age men who come in with chest pain and want to go smoke a cigarette while they wait for their labs to come back. And the crack users who come in with chest pain but they don't do drugs.

In all honesty, I am in serious nursing school burnout. My "Give a sh!t" level has dropped to an all time low. I just want to graduate, take my boards and get to work. We have a series of interdisciplinary sessions with the other health affairs students at my university coming up in the next couple of weeks. I'm sure that my bitterness will not be evident at all as I deal with 2nd year medical students and dental students and social work students. We had a patient safety seminar with the 4th year medical students last week and it was all I could do to not strangle one of my arrogant group members.

So that has been my beef over the past couple of weeks. I have spent 2 years in nursing school hearing about how much it sucks to be a nurse right now because of the shortage and I will be overworked and underappreciated from day one. Well you know what? Since this is the only nursing world I will probably know (I don't see an end to the shortage anytime soon - self licking ice cream cone - people quit because there is a shortage and working conditions suck faster than they can be replaced thereby perpetuating the shortage) shouldn't I go into it with a positive attitude and with optimism? Shouldn't I be looking forward to my first job as a challenge and not a burden? Shouldn't I be excited about working hard, not already dreading it and wishing it were easier? If I am always going to have 6-7 patients, shouldn't I get used to that from the beginning and not just constantly wish that it were easier? That isn't to say that we shouldn't push for more nurses and better nurse to patient ratios and better work environments and more pay and better benefits - but lets not start off on a bad foot with our CHOSEN profession.

Ok, enough of a rant - and now back to my Spring Break!

Oh yeah - one more thing - I hate wearing all white scrubs. I only have to do this for 6 more weeks and then I am going to burn my white scrubs since my new job does not require them. At least the hospital I am in now has some real old school nurses who still wear the skirts and hose so I don't stick out quite so much as I did in the unversity teaching hospital.