Yesterday was our last day at Methodist for our clinicals! 😦 It’s amazing how fast that time flew by. Wasn’t I just writing about my first clinical experience? And now it’s over for the semester.
Our clinical experience yesterday was a little bit different than previous weeks. For this clinical, we didn’t go up to the hospital the evening before and pick out our patient because we didn’t have any pre-clinical paperwork (and no post-clinical paperwork, either, for that matter). Instead, we arrived yesterday morning with a different plan and different paperwork.
What we were to do was go up to our unit, approach a nurse, and have her assign us a patient and give report on them. Then we needed to look up their chart and get pertinent info on them to fill out our new paperwork (which would be used for SBAR report later), and then we were supposed to take care of our patient as a nurse while simultaneously searching the unit for injections to give.
It was hard getting all that done in only the 4 hours we had on the unit! (We left the unit at 1100 in order to get lunch and go to post-conference early.) And it’s also very weird going in without having any prior knowledge on your patient – just as a nurse does for every shift. I’m glad we got to experience that though.
Aside from getting all the pertinent info on my patient and taking care of them, I also hunted down one patient’s insulin injection (using the flexpen) and then a pneumococcal vaccination for a yet another patient. I was SUPER excited about the pneumovax because it was an intramuscular shot and would be my very first one!
Well my first IM injection didn’t go so well for me. 😦 I educated the patient on the vaccine and why it was needed, prepped their arm with rubbing alcohol, got myself ready, positioned the needle, prepared them with a countdown, and stuck them in the deltoid.
It was horrible.
Giving an injection into muscle is a very different tactile feeling from giving an injection into fat. I’m sure the more of these shots I give it won’t matter to me any more, but this one sucked because I wasn’t prepared for the difference in resistance. The patient winced and moved away, the needle pulled out of their arm, and I was left standing there knowing that I had to do it all over again.
So I had to clean the needle off with an alcohol swab, calmly tell them that I had to try again, and then give it another go. This time it worked and I was able to inject the vaccination, but I felt so bad for them.
Hopefully next time goes so much smoother.
After our shift for the day, we went to post-conference and then we learned how to use SBAR to give report to the “oncoming nurse” for our patient (in other words, we gave report to each other). It was awesome! And also incredibly challenging. You have to have so much information on your patient and be able and ready to report it in a manner that helps the oncoming nurse out and provides for continuity of care for that patient. I can see why many new nurse graduates have a hard time with this part of the job. It took us forever, too…we were there until 1330 giving report when usually we leave the hospital by 1245!
SBAR – Situation, Background, Assessment, and Recommendation. It is a reporting tool used by nurses and doctors in order to concisely and accurately give report to one another on patients. First we give the patient’s situation: their name, age, if they are on any isolation precautions, and their code status. Then we give the patient’s background: why they were admitted to the hospital and what treatments are being done for their diagnosis. Then we give our assessment of the patient: what their vital signs were, any findings in our physical assessment that shifted (either to good or bad) during our shift, what meds were given during our shift, what their plan of care is, and this list could go on and on. Finally, we give our recommendations for the patient: do we think any meds need to be changed? Could the patient’s plan of care be updated? Etc…
It was a great last clinical and I’m already so eager to start next semester’s adult health 1 and woman’s clinicals!!