Mrs. Smith is a 94-year-old hard of hearing woman with an advanced case of Alzheimers. Here is what transpired in her room a few weeks ago as I prepared her for transport back to her assisted living home.

Me: "Mrs. Smith you're going home today."

Patient: "I'm going to see Jesus?"

Me (thinking): Oh my word it's true people do see Jesus before they leave this world.

I started checking her breathing pattern, skin color, and O2 sats like a paranoid nursing student thinking that my patient was on her way out when all of a sudden she asked me what I was doing and sat straight up. I then realized she had simply misunderstood me.

Each Friday I walk into the hospital dreading the day ahead but by the end of the shift my attitude has completely changed, I walk out excited for the next Friday. If I'm honest I am very fearful of the unknown and knowing someone's life is essentially in my hand is scary. I must be alert to all kinds of changes in the patient and be ready to care for all kinds of needs. It's scary. I am terrified of failure and not doing my job correctly. But what I have come to realize is that I want to be the best nurse. I want to be exceptionally knowledgeable, attuned to my patient so I catch problems early/as soon as they present, and loving beyond compare. I want all of this not to be "the best" but THE BEST FOR MY PATIENT's SAKE. If someone had to take care of my family members I would want that for them.

I still have a lot to learn and experience and I will never know everything. What I do know is from now on I am going to seek out new experiences and try my hand at new skills even if they are terrifying.

Here are some various stories/lessons from the last few weeks in the hospital...

• Who would have ever guessed that I would give a patient marijuana? Apparently it is balled up in pill form as an appetite stimulator. Ha, go figure that the "munchies" could come in handy...nutrition is vital to a patient's recovery!
• Two things that I have a hard time stomaching - wads of hair (you know like the kind you find in the bathtub drain) and saliva/mucous. I don't know what it is about those things but I instantly want to gag. My more recent patient, Mr. Hill, had a tracheostomy. Naturally they tend to have a lot of secretions that come either out of the trach tube OR if they are fortunate enough they can cough up. The Lord must have really wanted to desensitize me to saliva/mucous because my patient spent the whole shift coughing it up into a mouth basin that I had to hold. Don't get me wrong I felt for this 85-year-old man that could not breathe adequately but when he coughed up phlegm on my arm because he didn't turn his head fast enough for the basin I almost lost my lunch. Being professional of course I just smiled and asked him if he felt better now that his mucous was cleared!
• A sick adult is never to old for a hot compress to make an irritated eye better, a straw for their drink, or a back massage to help their back pain disappear. I often think of the things my mom did for me as a child to make me feel better and apply them to my nursing practice. It's the simple things that make all the difference!
• A confused essentially wheelchair bound patient will try and make a run for it if given the chance. Mrs. Oliver is a 90-year-old woman whose legs cannot move as quickly as her brain anymore but that did not stop her from trying to get out of her wheelchair. Good thing she was sitting on a saddle like contraption that did not allow her to slip/move out of the wheelchair because twice I came back to check on her and she was tapping her feet and leaning forward. As soon as I stepped in the door she would grin and sit back up. She wanted badly to get back in bed - can't say I blame her but she needed the "up in the chair" therapy.
• Getting the hang of diapering an adult is difficult. I still seem to put them on backwards or rip them when trying to situate them under one's hiney. I feel terrible because the patient has to roll back and forth multiple times all exposed before I get it right - they must think I'm an idiot. I'm determined to perfect the diapering process before the end of the semester.

Nursing = team sport

"NO MAN IS AN ISLAND"

This is what our instructors told us during our pre-clinical meeting and it's been playing in my head ever since. I was very hesitant to go into junior year because of all the hype of what you had to do, how little time you had to do it in, and all that you have to know. Three weeks in and you know what I've learned, no man is an island. I don't have to do this on my own. Not only is God holding my hand through this (yes I honestly believe He is holding my hand - leading me to the finish line otherwise I'd be a big baby running in the other direction) but I have my classmates to bounce ideas off of, ask questions, and talk through situations that arise. God didn't design us to be "islands," He gave us each other and I constantly have to remind myself that.

Even though I'm heading into week four I have only had one patient. Mr. Mason cannot talk, is contractured (which means his muscles are stiff so he doesn't move), and is completely reliant on nursing staff to take care of all his needs. It kind of broke my heart to know that when he left the hospital and headed back to his nursing home that he wouldn't be taken care of spectacularly. Because he can't talk or move he is the prime candidate to be over looked. What a humbling experience to bathe another grown human being, to change their soiled diaper, to feed them through a PEG tube (this tube goes directly from outside the abdomen into the stomach), and to physically position him until he is comfortable (guessing of course since he can't really communicate). I often wondered as I was talking to him what he thought of this student nurse that kept waking him up to move him around!

It's hard sometimes as you are smelling the foulest of smells to thank God for the opportunity to be His hands and feet but in the end I know that this is what I'm suppose to be doing.

I have learned that if you want to be a good nurse you will also have to be a bath giver, diaper changer, hair dresser, masseuse, call bell answer, linen changer, dental assistant, counselor, drug dispenser, case breaker, feeder, ear to listen, hand to hold, news breaker, life saver... I never gave nurses the credit they deserve BUT I will from here on out.

*The CNA on our floor just loved on us students all day long. She jumped at any opportunity to share/show us anything "cool." Most of all she loves her patients and is very attentive to their needs (CNA's are also under appreciated especially by the RN's a lot of the time. I hope I will always appreciate my CNA's because they do a lot of the dirty work. AND I MEAN DIRTY!) Well her thing is to take new students down to the morgue. Yes, that is kind of morbid but I hopped right into line to follow her downstairs. When we walked into the morgue I felt like I was in a TV set. I'm not going to lie it was pretty sweet down there. However, the awe of being down there quickly came to a halt when she opened the door to the freezer to show us where we would place our dead patients and we saw a body bag. This wasn't your typical body bag it was one of a child. I know as a nurse we will be faced with death quite often but I was not ready for that. We looked at the record book and sure enough it was a 6 month old baby boy. I could not even begin to process that and wanted to leave to get back to the floor pronto. My heart broke (still breaks) for the family that had to say goodbye to their precious baby. They say you get more accustomed/almost numb to death the more you are around it but at this point in my life (and in experience) I'm just not sure I will ever be numb to death nor do I want to. Death means that someone's somebody is gone from this earth and I want to be sensitive to their grief, not just treat it like another notch on a stick.

Beyond the chart...

(Tyler and I before entering my patient's room for her assessment)

These last few weeks have a been a bit hectic between trying to move into a new apartment, packing to go home, studying for finals, and clinical profiles. It's been go, go, go. I finally have a chance to write a few things about my last two clinical experiences so here it goes.

1. I believe that my professor thought I looked good in yellow, hence why every shift spent at the hospital included a patient on "Contact precautions" which meant I spent the evening putting on and shedding a lovely yellow gown each time I entered and left the room!

2. Miss Hopkins taught me the importance of knowing your patients FULL NAME. I was completely embarrassed when she asked me what her full name was. I knew the initial but I realized that was NOT enough. The person sitting in the bed has not only a story and history but has a name and I should always know it! I would want the person taking care of me to know my name so I should take the extra 30 seconds to make sure I know theirs.

3. Miss Hopkins also taught me that a "nasty" patient with just the right amount of care and listening ear can be a "pleasant" patient. I was not thrilled to find out that once again I had a "nasty" patient. The student on the first shift said "ooo you have room ###, good luck (sarcastically)." I was determined to break her down, ha. Sure enough after responding quickly to her bed pan request, comfortably positioning her ever so often, and just taking five minutes out of my schedule to listen to her hospital experiences I realized she was mean because she had been treated poorly in the past. Not seen as an individual patient with specific needs but rather just room ###. Well lesson learned, everybody is somebody's person and they should be treated accordingly, not seen as just another task in the day. And yes, I did break her down. By the end of the shift she was laughing and calling me "honey."

4. My last patient, Mrs. R, taught me that I should be grateful for a working body that does not suffer pain except for the occasional bumps bruises and cramp. Poor thing was in constant pain and no position was comfortable for her. All I could do was hold her hand and push her hair back (and pray of course!).

 (Here is my clinical group on our last day - its hard to believe sophomore year is over, we're half a nurse as many say!)

(These girls are great)

(Here we are celebrating the end of our time together at dinner!)

Our Own Dr. House

Clinical two is over! Crazy I must admit. This day went much smoother and there was more hands on things to do. When I went to the hospital on Saturday to get my information I was a bit shocked to see that I was assigned Miss A**** yet again. (I must have checked the list ten times to make sure I was reading it correctly.)

I was a bit frustrated but at least my profile wouldn't take me as long! So I got the new information I needed and got out in less than an hour...

Fast forward to Monday afternoon, I showed up to the hospital and my instructor, Mrs. Page, was waiting for us in the lobby. She asked if I would like to do meds with Tyler this week and I kindly agreed (I figured less time with Miss A****, I know my attitude needed a check.)

We reported to the floor at 1445 and I got report from my nurse around 1500. I felt more "at home" this time although I was anticipating giving my first medications. Mrs. Page worked with Tyler and me on the accudose system, which is the computerized medicine dispensing machine. At about 1630 I got the meds out of the machine and carted the C.O.W. (computer on wheels) down the hall towards Miss A****'s room. As I pulled up the medicine screen to scan the patient and the med to make sure they matched my heart about stopped as I realized I would have to give her an insulin shot. Trembling I watched as Miss A**** took the meds and then I talked myself through the injection in my head. As I prepared the insulin Mrs. Page was right beside me reaffirming the steps and telling me I would do fine. All I can remember is pinching Miss A****'s abdomen and hesitating for a moment. In and out it was done! She even said I was a good shot giver, she didn't feel a thing. I was just so relieved! My first shot - the first one in my clinical group!

Before I went into a hyperglycemic state we all made our way to the cafeteria...and thats where the fun began. As we went around the table and invested in each other's lives it felt like a little family! I'm very blessed with a great clinical group - I even have one among me who wants to be a mom first and nurse second (they are rare to come by!), and an instructor who is so helpful at the bedside. She's the perfect mix of crazy, walk you through but with just enough push, loveable nurse instructor. We nicknamed her House because around nine o'clock something goes off in her and she gets a little wild. She sings, laughs at everything, and well looses her mind, ha! She was helping (by sitting in a chair with her leg over the other one talking them through it and asking questions - totally House style) three girls give a patient who was at risk for aspirating medication. She asked one of them to run and get the patient a cup of water. By the time Kati came back the patient had gotten the meds down. So Mrs. Page grabbed the cup, said "Thank You," swigged it and walked out! Later as we were walking across the street to get to our cars she almost ran us over (jokingly of course) but laughed and said "watch out kiddos Dr. House is loose" haha. I will say the relaxed atmosphere she provides gives us the baby steps we need to get our foot in the door and feel comfortable and at ease when in the hospital, where we will spend out life next year!

Highlights:

1. Miss A****'s assessment. She was in a much better mood, I was more thorough, and I even got to understand why she was the way she was. That's what nursing is about - investing in not only the physical condition of the patient but by investing in their life, that is how to make a difference. I LEARNED A BIG LESSON, keep my attitude in check, you never know how God will use you. Even difficult people need to be loved on.

2. Glucose monitoring. I got to do two pricks. I just love doing these. Tyler announced later in the evening that it was "Glucs gone wild" on the floor. Haha, he followed it up by saying "I milked that sucker for minutes straight." I about fell on the floor laughing, he was talking about the patients finger but we all missed that part! Context is key...

3. My first shot! Though I may not remember it all, I feel accomplished and am ready for my next one, any takers????

4.Helping Tyler assess his patient Mrs. B***. Ok this woman was so frail, she was in with a pelvic fracture, but very sweet. She was in her chair when we went in and she wanted to be positioned with the feet up, you know like a recliner. So we pushed the chair back but it would start to go back towards the normal position. Well when the chair would move she would grasp the sides real tight and make this face like she was riding a roller coaster. It was quite comedic, although I felt bad that she was so scared she would fall. 

5. Spending time laughing with my group

I look forward to clinical in two weeks!