Tuesday, July 6, 2010

Confidence Please!

Whew! The first day is done and under my belt!! What a day it was! After four hours of sleep the night before, I was seriously praying for some strength to get me through the 14 hours ahead....ok, and an awful lot of coffee!! It was a somewhat "rusty" first day but I think that is expected. We all needed a day to get used to the routine and the facility as well as what is expected of us. Figuring out the organization of the med room, iv room, and clean utility is enough to take a whole day!

My pt was a delight.  She suffered from multiple medical problems. Having dementia, she needed to be re-oriented to the time and place quiet frequently. She was pleasant and simply just wanted someone to be there with her. She had recently been transferred from a SNF and she was extremely malnourished. Her entire body had loss all muscle mass, completely atrophied. Each bony prominence displayed a  pressure ulcer. To me, it's unacceptable. I understand that being malnourished with multiple medical problems puts you at a high risk for decubs.....but covering the whole body? She should have been turned every two hours, heel protectors placed, supported by pillows and checked frequently because an ulcer can go from Stage 1 to unstagable all too quickly in a patient like her. But now she is suffering severe discomfort and having difficulty healing.

Anyways, I think I will sum up the day for you in positives and negatives because there was an awful lot of both!!!

Positive: I was involved in pt care! I've really missed the pt interaction and it felt so good to be working with a live person and not a mannequin!!

Positive: Our facility offers FREE coffee and flavored ( hazelnut AND french vanilla) creamer all day!!! Heavenly?!?! I think so!

Negative: I realized that I lost all confidence as a nurse. In the time between graduating my LVN school and now, it somehow flew out the window and I would love to get it back! Before, I was so sure of myself with med passing, dosage calcs, G-Tube feed changes & meds, and so much more. I walked into my pt's room, looked around, and literally thought, " Holy cow. I've forgotten it all!" I'm really hoping with each clinical day I gain some confidence back!

Positive: My pt had diarrhea. You just re-read to see if it was a positive or negative, huh? Ha! Well let it be true...it was a positive! You see, at the facility there are 20+ pts to one CNA. Meaning....pt care can often be overlooked. I'm glad to have my sweet pt because with frequent bowel incontinence she is prone to more skin breakdown, infection in her sacral ulcer, and simply being uncomfortable. Aside from that, her dignity gets taken away each time as she has to sit in it and just wait for someone to help her out. Would you like that?! Nope. Me either. So, it was pure joy to clean her each time right away while making her feel comfortable and that it was simply not a big deal.

Negative: I didn't get to change her IV. It was due to be changed but my RN I was working under had been off the floor for 3 months and wanted the practice again. I felt a little better though after she blew 3 veins before getting it. The pt was fragile and the veins were hardly visible. It would have been hard for me to start it being so inexperienced.

Positive: I worked with an awesome RN. I couldn't have asked for someone better. She made sure to take the time and explain everything she did. She question me which was scary but good because I do need to know the rationales for everything that is done. She was so great in teaching me lil tricks to save time and a way that wasn't confusing. I feel pretty blessed to have had her.

Negative: I was driving home...to an empty house...and was about to get off the freeway to see my parents and share about my day. But, they are in AZ  so I quickly got out of the turn lane and headed home. I'm going to miss that. Walking in the front door to see them sitting at the table. Joining them and sharing the joys and challenges of the day as they offer support.

Positive: I watched a condom cath put on as well as wound care on bilateral cellulitis of the lower extremities. I know it sounds like nothing but I love the opportunity to see everything no matter how big or small it is.

Negative: I MUST get contacts! I don't know what happened but while watching wound care on a friend's pt I had the most embarressing experience. It was an isolation room, so we all ad a mask on. It's always fun wearing a mask and glasses. Anyways, while assisting with setting up supplies I must have breathed weird because the air shot up out of the mask, fogging up my glasses! I couldn't see a thing! Don't they have defrosters or snap on wipers for moments like this.

Positive: I was able to give patient and family teaching. Since my pt suffers from dementia, she comes in and out of reality, so I was thankful when family stopped by  and I was able to talk with them. My pt hadn't been provided good oral care...at all. She was hesitant to let anyone else provide it for her, stating" My niece will do it when she comes on Sunday." Poor oral hygiene can lead to great complications. So, I was able to instruct the family on daily oral care with swabs because the mouth is a an environment for bacteria to enter and travel....causing cardiac problems is a major concern.

Positive: I felt that even though I lacked confidence and elt a little overwhelmed, I still made a difference in her life that day. I was someone who had the extra time to sit with her, hold her hand, clean her, and simply smile. THat is a positive of being a nursing student. We arent' juggling a handful of patients. We are able to really focus on the ones we have. It's truly a blessing.

Today may not have been picture perfect. It may have been a little rusty and confidence lacking. But it's a learning process and that's why we are here, in school, to learn and grow into fabulous RNs. Let the clinicals continue!!

Untill next time,

A confidence-seeking RN student

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