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[personal profile] pantshead
The semester is (I'm pretty sure) halfway over.  Or, at least, we've finished our first 6-week clinical rotation.  We have evaluations next week and then we begin the next 6 week rotation.

We only had one day of clinical this week, because our instructor was sick the first day.  Usually on Thursdays we are there from 0700-1500 (ie: 7am to 3pm, and most of us arrive early).  On Fridays we're there from 0700-1200 and then have a post-conference until 1300-ish.  Thursdays are usually more stressful, because the 'normal' rhythm of the morning is

  0600-0700:  Read new orders for each patient, check the medication administration books to find out when they get meds, look up any meds you're not familiar with, find paperwork you'll need (like the doctor's order for parenteral nutrition, which has to be written every day and the contents should be confirmed by every shift), etc...  At 0700 the day nurses arrive.  They get report on each patient from the night nurses.  We can't go in to see a patient until we've gotten report, either at the same time as the day nurse or after s/he's seen the night nurse.  This time of day seems astoundingly inefficient--it often takes until 0745 for everyone to have report
  Meanwhile, the doctors arrive on the floor between 0800 and 0900, which means they want to see the vital signs and nursing assessments from the morning nurses.  We're supposed to complete our assessments (including vital signs; the regular RNs usually have an aide who takes vitals for them) and document them in the computer by 0830.  Some patients also receive medications at 0800, so these have to be given by 0900 (there's a 60 minute +/- window for most meds).  Patients who are diabetic receive insulin with their meals, and breakfast usually arrives on this floor around 0900.  So, diabetic patients need a finger-stick to check their blood sugar around 0845, but then you have to wait to see how much breakfast they eat before drawing up their insulin.

  Meanwhile, at 0900 you can start preparing your medications for 1000.  1000 is the primary time for medications on most floors.  Any medication we give must be checked by our instructor who will also quiz us on the purpose of the medication and make sure we've done any necessary assessments before giving it (like checking the blood pressure before giving a blood pressure med).  If the medication is intravenous, the instructor must be present while we give it, whether we're doing it by 'push' (the new skill we learned a couple of weeks ago) or hanging a bag of the medicine and connecting it to their IV fluid pump.  The instructor can't be in more than one place at once, so it's definitely a challenge to get meds together for multiple patients, even within a 120-minute timeframe!

  We're also responsible for helping patients wash up, changing their linen each day, getting patients up & out of bed, and dealing with anything else that might come up (incontinence, emptying tubes and drains, requests for pain medication, a glass of water, etc...).  Some of those things can really eat up time--and it's not that I don't want to do them, but it's just a challenge do get it all done!  So, theoretically by 1100 the morning has calmed down a bit (or that's finally the time that you can help a patient get bathed), but some patients also have 1200 medications, and many patients have their vital signs taken every 4 hours (so, at 1200), and then finger sticks for lunch must be done around 1245 with insulin coverage to follow.

  The second busiest time for medications seems to be 1400, and then by 1430 we're expected to have tallied up all intake and output for the shift (and entered it into the computer), written a note in the chart about our care that day (this has to be handwritten first and checked by our instructor), and reported off to our RNs so we can leave by 1500.  Throughout the day, we also have to adapt to new orders (which could include getting a newly ordered medication to the patient, or changing the type of IV fluid, or getting the patient ready to go to a procedure).

  On Fridays, we don't do any of the noon medications, vitals, or finger-sticks, so as long as we get through the 1000 med rush, it's a little easier!  This week was the very first week that I've had 3 patients.  Other students have had 3 patients for a couple of weeks, but because I was assigned to be team-leader 2 weeks ago, and was in the ED last week, this was my first day.  It went okay, but could have been better.  I got really tied up in a task at the beginning of the morning and that put me behind...  I'm definitely starting to feel some dread about the approaching end of the semester.  On the one hand, graduation is the goal of these 2 years of hard work!  On the other hand, I feel like I've figured out the role of "student nurse" and soon I'll just be a regular nurse!  All the while, I have to keep saying "I should graduate in May," because we really don't have our final "are-you-ready-to-graduate" evaluations until the last 2 weeks of the semester.  I feel like everything is up in the air until then.  (We just have to keep working hard and trying to improve.)

So, anyway, apart from all that, we started learning about the hematologic (ie: blood) system this week in Theory.  We'll finish that up and do a brief unit on oncology next week.  We also have another simulation next week.   
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