Week 3: "Are you guys doctors?" No, I'm a NURSE!!!!!!

I thought I'd approach this entry more or less like a nurse interacting with a patient.  It's somewhat chronological, but it's somewhat topical too.  Why do it this way you ask? Umm, I thought it would be fun, haha.  What you see in quotes is what I have been saying repeatedly for the better part of three weeks.  Now on to Week 3!!!!!!!!!!!!!!

"Hi, my name is Edwyn De La Cruz and I'm an RN Nursing Student at Golden West College.  I'll be helping out your regular nurse!  How are we doing this morning?"

That simple phrase is called our opening act. We say it every time (or some version of it) when we enter a patient's room (currently, every time we practice or get assessed).  The days are ticking down and in about two weeks I'll will have to perform actual patient care.  How I do feel?  I'm excited, but at the same time I've never taken care of a real patient before.  That's scary.

"I'll be performing a head-to-toe physical assessment on you this morning."

"On a scale of 1-10, with 10 being the worst pain you have ever felt, where is you pain level right now and where is it located?"

Wednesday was Physically Assessments assessment day (or maybe I should have said assessment day for Physical Assessments).  This time I didn't go last (thankfully!) and was the first group of people to get assessed.  Each pair role-plays a physical assessment while one of the instructors watches and critiques.  I played nurse first and partner/patient just recently had an abdominal surgery.  When it was my turn to play patient, I had pneumonia.  During the assessment, I assess from top to bottom, look and feeling for any abnormalities.  We ask questions, lots of them, to get an understanding of a patient level of orientation and most importantly if they are in any pain.  Why ask about pain?  Just cuz it wouln't be smart to be moving a patient around when pain level is really high.

Since I'm a male nursing student and the class is predominately female, I'll more than likely be going to care for female patients/classmates.  The nursing instructors have discussed this with all the males in the classroom and stating that I will need a female nurse witnessing anything I do when assessing bikini zones.  As it is protection for the patient, it's really protection for me from unwarranted accusations of sexual harrassment.  When I'm doing a physical assessment, I'm gonna have to get up on all their business.  I understand that has to be extremely uncomfortable for a patient, but at the same time it ain't any better for me.   

As is usually the case, my partner was female.  Luckily, the only time I got up all into their business was during the assessment of the thorax for lung sounds and apical pulse with a stethoscope (so all around the boobs).  All the classmates that I have done a physical assessment on have been cool with me assessing up there (that's good they don't think I'm a weirdo). We did this over clothing, so I couldn't hear anything but the rumbling of clothing, so I just pretended that everything was normal (of course I won't pretend it in real life).

After 15 minutes of assessing the patient, I completed the assessment, forgot a couple things (like lowering the bed, OMG!), but all-in-all did a good job (as the nursing instructor said).  

"That's great to hear you are feeling a lot better this morning!  I'll be administering your 9 o'clock meds!"

We mess up on the research, we kill the patient!

During the first two weeks of school, we watched demostrations about medication administration and got a chance to play around with medications.  The instructors realized that we really haven't practice yet and gave us a chance to learn the in's and outs of administering medication for a majority of the week.  It's not a simple process.

In a nutshell, physicians diagnose patients problems and then write an order for drugs to treat thse problems.  Nurses administer those drugs and makes sure that whatever is ordered won't have an adverse effect on the patient.

Let say I have to administer medication at 0900, I have an hour window (0830 - 0930) to administer those medications.  During that time, I have to research all these drugs, double check the order, hold any drugs that the patient may be allergic to, get the drugs, prepare the drugs, then give the drugs to the patient.  We practice this in lab in small groups, and it took over an hour to get this stuff done.  Definitely will need more practice.  I'm sure it will be a piece of cake by the time I get to the hospital, right?

We also have been learning how to give injections and we have been practicing on our partners arms. Lol, although that would have been fun (to give, but not receive), we have utilize this fake arm/stomach/whatever-body-part-you-wish to inject.  I guess it is supposed to simulate what it would feel like stabbing someone with a needle.  One thing I learned is that the needle goes in like butter.

It was actually quite fun playing with the syringe.  The difficult part is trying to get the bubbles out of liquid in the syringe.  You would think flicking the syringe will get rid of them, but sometimes nothing you do will actually make the bubbles go away.  It is then you relinquish all of hope of getting it to work, push the fluid out and start all over again.

"Kathryn, you gave a us a scare there this morning! Are you feeling better?"
Friday, we were split into 11 groups and went to Golden West Hospital (aka The Skills lab) to simulate the hospital setting as best as possible.  Each group got a patient and we had to take care of this patient for the day.  This is the only time you will ever hear me talk about a patient, since this one isn't really alive (otherwise, it would have violate patient confidentiality).

The beginning of the morning was good, the nurse gave us a report on our patient Kathryn Doyle.  The patient was in for hip surgery because of a fall at home, but otherwise was just a normal healthy 79 year old.  Her catheter needed to be removed, and all normal AM care needed to be performed (Bed bath, change linens, etc.).

She was fine after our morning assessments, so my group left to go document/chart what we did in the computer lab.  Little did we know, the instructors were really trying to simulate a real hospital situation.  As we were documenting, we see our nurse open the door and shout "Bed Alarm on Bed 4".  I was like, "that's my bed, do I leave now?"  Then the nurse scream "don't wait around, drop everything and go." So my group rushes to the scene and finds that our patient is no longer a mannequin and is one of our instructors pretending to be our patient.  Kathryn was beginning to get antsy because she wanted to brush her teeth.  She began moving off the bed and thus the bed alarm sounded.  So we aided our patient to the bathroom (cuz she said please help me to the bathroom).  But as naive nursing students that we are, we forgot that her orders were for assistance to chair only.  Thus, when we started walking her over, she collapsed on the floor (literally our instructor went limp on us).  So we assisted the patient back up, check for any injuries, filled out an incident report, and then went to lunch. I had a turkey sandwich, and chipotle chips and guacamole!

When we came back from lunch we found our patient unresponsive.  We check all the vitals and called a rapid response team to aid Kathryn.

At the end of the day, we learned our patient stroke out under our care and the patient was moved into the stroke unit.  Sad, but just another typical day in the hospital. All in all, an interesting day at Golden West Hospital.

"If you need anything, just press the call-light.  I'll be back a little later to check up on you :)!" 
This statement is part of our closing act.  It basically means call me for an emergency, otherwise I'll probably be back around an hour from now.  It may sound insincere, but if we give you a specific time that we are coming back, you are going to look at the clock waiting for us to come back.

Final Note:  "Are You Guys Doctors?"

On Wednesday, I heard that uttered by a costmetology student sitting next my table.  I was there with a couple other nursing students and I was a little confused.  I was a little bit offended.  I wasn't sure what gave that person the idea that our table of nurses are doctors.  I wasn't sure why this student made the comment in the first place.  Oh yea, LAB COATS! That gave the impression that we were doctors.  I kept thinking to myself that the comment was a little bit odd considering a GWC, a community college would have a medical school (that would be one cheap medical school).  But the reason she made the comment was because she was wearing black scrubs and the student didn't seem to like them because it was hot to wear them. 

It's funny because we just had a lecture on Tuesday that discussed the history and image of nursing.  It has been so ingrained into our heads what a nurse should look like (everyone knows the image of the naughty nurse during halloween).  What jumps out to you is a female in scrubs.  Suddenly, you add on a lab coat, that person become a doctor.  Hell, a male in scrubs already signals a doctor and not a nurse.  But times are changing and the image of nursing continues to change.  So next time you see a health professional in scrubs and a lab coat, ask them what they do!