Sunday, September 26, 2010

The Blog Is NOT Dead

Good grief where have the last few weeks of my life gone?  Every semester, I had hoped it would get easier and every semester it gets crazier.  The tests are the same, but now we have so many self-reflection projects to incorporate into our analysis of the nursing process and research articles utilizing evidence based practice, not to mention trying to remember how long I can leave a peripheral line in a patients arm, all the while hoping for an order to extend and STOP!!  JUST STOP, I keep telling myself, but I can't.  Every time I turn around it is another new assignment. 

School has now incorporated mandatory attendance for classes that talk about the most exciting things like malpractice and managment theories.  It is like being at the superbowl.  Very exciting!!  NOT!! 

My psych rotation completely blows ass!  I feel most of the patient's are a bunch of sissy bitches that just want to utilize the fact that they drink or beat their families because they can't HTFU and make the necessary choices not to be an asshole.  We have a ton of patients who are "suicidal," but yet they are full codes.  Really?  Do you wanna die or not?  I had one patient who has tried to kill himself more than ten times, yet he refuses to take depacot because his lab results have shown liver toxicity in the past.  Again really?  You can't live without a liver, you wanna die, so why do you care?  In my non-psychiatric opinion, I feel he just wants attention.  I bet if someone were to stick him in the electric chair and threaten to throw the switch he would change his mind about dying.  Needless to say I have little tolerance for this rotation as we don't actually cure or fix these patients.  We take care of them for a few days and try to get them to at least pretend they are sane and then send them back out there until they come back again in a few months.  We also had a disgruntled HIV black male patient who was racist and they wanted one of us to take him.  Hell No!!  All that guy has to do is get pissed off and bite me and then I have HIV too.  As a lowly nursing student, I definitely have the right to refuse to provide care to some people -- him being one of them!

On the flip side oncology is just beyond rockin' right now for me.  I don't care for the 4:50 am wake up calls 2-3 days a week, but the work itself is very rewarding.  My preceptor is awesome.  At first she gave me the most difficult patient (the one with the most problems or needed the most care), but now I am up to two paitents, so she lets me pick which cases I want to deal with.  I usually take the hardest patient and an easy one.  I have definitely had to learn to manage my care on the floor or I would never be able to care for more than one patient at a time.  I felt strange being only a nursing student and delegating to a paid patient care nursing assistant things such as vital signs, intakes and outputs, mobility and feeding instructions, but that is supposedly one of the pitfalls of a new grad -- trying to do everything themselves and not knowing how to delegate, thus resulting in less quality care for the patient, so bossy it is :)  While I feel it is not my job to do those things, it is my responsibility to make sure they are done.  I had a hard time trying to figure out how to tie in all this leadership and management with my patients at first because I was so busy worrying about tasks, such as a head-to-toe assessment and what to look for (e.g. edematous patient, check for crackles in lungs, JVD, capillary refill, tingling or numbness in extremities or immobile, does he have DVT's, is he on heparin, does he use incentive spirometry is he using the deep breath and cough method...oh the list goes on and yet there are probably tons of things I am missing), grabbing a refill of water for a patient, or just plain old utilizing my therapeutic communication skills to listen to the patient's concerns, I had no time to reflect of even sit down to eat lunch on the first two shifts. 

The chemotherapy regiments are about 4-5 days with bags being hung consecutively every 12 hours.  Some require two IV lines such as, Fluoracil and CISplatin because they are incompatible while others need administration of a rescue after, such as Leucovoren, which acts as a toxicity prophylaxis for those given methotrexate.  Cancer is not just cancer on this floor.  It is accompanied by complications such as neutropenic fever, imbalanced nutrition, especially if the cancer is esophageal.  Some of the patients have a corpak because they have dyspahgia and are at a high risk for aspiration.  One patient had radiation on his throat and had very visible blue radiation marks along with what looked like the worst sun burn ever.  He was prescribed aquaphor for his neck and a warm soak to maintain the skin integrity and minimize discomfort. 

My second week we moved from one unit to another.  The nurse manager on our floor is no doubt a leader in a management position.  I was able to observe her interactions with directors, nurses and construction workers as to what the most effective and time saving way to safely move patients who could walk, needed a wheelchair or were completely bedridden.  The nursing managner and the assistant nurse manager spent about thirty minutes developing a floor plan on which patients to move first and which room to assign them to. They split the nursing staff up into teams of those who would be sending the patients and those who would be receiving patients.  I was on the receiving end.  I escorted patients to their new room and plugged in their IVs, put the bed in lowest position and made sure some, but not all the side rails were up, as that is a restraint, unless they do it.  As time wore on our nurse manager felt it wise to take a "time out" and confirm all patients were safe and in their assigned rooms and continuity of care was being maintained.  It was very organized. 

Unfortunately, with all this nursing there is just not enough time to jump on the "train" wagon.  Hopefully, once I get some of these crazy projects off my plate and meetings out of the way I will be able to do a few things in the upcoming weeks.  Either way this is all gonna end in 12 weeks.  I can't believe it.  It seemed just yesterday I started this and to think it's almost over, at least the school part will be.  It looks like I wont be able to take my boards until late January or early February and then I can get a big person job!!!!!!!!!!!!  Holy cow, I am so close I can taste it....mmmmmmmmmm, mmmmmmm, mmmmmmmm :)

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