2 Down, 14 To Go

Well my S2 semester has begun and I’m slowly starting to wrap my head around the fact that I am, in fact, in school AGAIN and that this is, in fact, my LAST semester.

The first thing that has been hard for me, right off the bat, is of course the early morning wake up calls again and the fact that I know I can’t just come home at night after school and sit and watch TV. Man how I wish I could.

The second thing that’s been hard has been the fact that I’m still continuing to try and exercise and eat right everyday but all I want right now is CHOCOLATE. Hello, stress. Nice of you to show up again. (I will not let this semester de-rail my weight-loss progress!!)

The first couple of weeks have been a whirlwind of information overload and assignments and orientations. We even had a simulation already! Our LAST simulation of nursing school!! It was actually super helpful – more so than any other simulation I’ve completed – and I feel like I REALLY learned a lot from it. We covered topics like IV therapy, oxygen therapy (which masks to use and when/why), as well as giving insulin. Then our simulations covered DKA (diabetic ketoacidosis) and PE (pulmonary embolism).

I met my preceptor last week for my CCI clinical at the VA Emergency Department. She’s awesome and also a former TWU nursing student! I am going to love having clinicals with her…we start next Friday.

I also met my school nurse at the school that I will be attending community clinicals in this semester and she seems super amazing as well. I’m blessed by having great leaders this semester! I start those clinicals next week on Thursdays. My weeks are going to go by SOOOOO fast!

I started applying to hospitals last week and have so far applied to 20 different positions at different hospitals. And then yesterday when I checked my email after finishing up at school I saw that I had an email to schedule an INTERVIEW for this upcoming TUESDAY!!! Already?! I’m so not prepared for this…I’m so not prepared for this…I’m so not prepared for this…

But ready or not I have an interview on Tuesday! It’s for the Emergency Department. I have to put together my portfolios today to have them all ready to go…good thing I already have my references and my letters of recommendation all prepared already! I’ll upload a blog post with my portfolio details a bit later next week.

AND I have a test on Monday in CCI. It’s hard to believe we have a test already and we’ve only completed two weeks of school. 😦 Our instructor assured us that we know the material and that it’s all review for us but it’s still nerve-wracking since the test is worth 25% and I really haven’t even begun to study.

Well that’s all I’ve got for now! Time to go study for my test (with Stars-Wars on in the background…this is serious stuff y’all). Happy weekend!


Adult Health Simulation, Round 2

Yesterday (Friday) I participated in my last simulation for Senior 1. It was the exact same simulation that I participated in as a Junior 1, only this time I was on the other side of the same coin. It was terrifying…especially after hearing stories of my classmates breaking down into tears on Wednesday (some of us went Wednesday, some of us went Friday).

I had nightmares about this simulation on Thursday night. I dreamt that I froze and couldn’t do anything…and then I dreamt that we were notified that the simulation was canceled due to SNOW! That’s how badly I didn’t want to participate. I knew that I would be all by myself (the instructors had released the wrong schedule to us – the schedule that showed us who we’d be paired with and which patient we’d have) and the pressure was intense. Most of my classmates were paired with another S1 and everybody had two J1s. Except for the lucky few of us that they decided would be alone with their J1s. I was told later that they specifically picked the strongest of us to participate on our own (a blessing and a curse!).

So when I got to campus yesterday morning I reviewed some of the paperwork that we had to chart on and steeled my nerves as best I could. I didn’t feel at all prepared but I had to do it so I just had to deal.

The first thing we did was practice with IV pumps for about 45 minutes. This was EXTREMELY helpful to me since I’d never been able to practice on one in simulation OR clinical. So I actually feel like I could work an IV pump for the first time! I had a lot of fun doing it and I think it really helped me calm down.

Then we moved on into the “ER-triage” part of the simulation. This time, instead of being stationed at one patient to get a thorough history and assessment, the S1s were paired off (except me) and rotated amongst the five patients in order to do a quick assessment and move on. We were supposed to be able to get enough information to be able to prioritize the patients afterward. I thought this part was a bit harder than I was anticipating. Completing a “quick” assessment is not an easy thing for me to do, plus I think I was so nervous and scatterbrained that I did not ask all the right questions or get all of the information that I needed.

After the ER we spent a bit of time together as a group prioritizing the patients, and then we moved into the ICU lab in order to take care of our patients for the actual simulation part of it.

I was paired up with two J1s and was given a CHI patient (closed head injury). At this point in the simulation, since everything had been happening in “real time” since Wednesday, my patient had decompensated quite a bit. His GCS (glasgow coma score) was 3 which is usually an indicator of brain death (although it’s not confirmed until other tests have been performed), he was intubated, his ICP was 22 and climbing, and really we were there to make sure his body remained viable.

I really wish we were given more time than 45 minutes in the actually simulation to get things done. I had been told in report that the patient’s ICP was 22 and if it was above 20 for over 5 minutes the physician needed to be called. So the first thing I did was check the patient’s safety equipment, vent settings, IV fluids, and took a quick look at the monitor to make sure that there weren’t any pressing concerns other than his ICP. Then I set about trying to call the physician about his ICP. And after the physician gave me orders to give the ordered Mannitol, it took me FOREVER to give that med! I wasn’t sure how long to IV push the med so I had to call the charge nurse. Well the charge nurse told me it couldn’t be IV push so I had to dilute it and give it IVPB. Then she says “wait, let me double check that,” after I told her the only form we had the Mannitol in was for IVP. Meanwhile the J1s are doing a thorough assessment (thank God) and checking the patient’s blood glucose.

Finally I’m given the go-ahead to give the Mannitol as IVP so I have to draw it up and prepare it, and then give it. Well, while I’m giving it, one of our instructors walks in and goes “that’s enough interventions for now! Time to start cleaning up and preparing for the next shift to come in!”

WHAT?! That wasn’t enough time at all! I didn’t even have time to get anything else done!

At least I didn’t walk out of there crying. I thought I just might. But I really should’ve managed my time better and I should’ve been able to get more done during our shift than just give the Mannitol. Ugh. I’m disappointed in myself.

But hey, that’s the purpose of these simulations, right? Figuring out how to be a nurse and manage time and take care of the patient?

I just hope that next semester when I am (hopefully) following a preceptor around that I will learn very well how to manage time and take care of my patients. I’m ready to be a nurse but I don’t want to feel like I can’t organize well enough for this job!


Adult Simulation Lab

I’m actually not quite sure why it was called an adult simulation lab, considering there were two peds patients in the ICU as well. And I got one of them!

So, I’ll start from the beginning. I was in a group of ten J1s (including myself), and as soon as everyone showed up a clinical instructor came up to us and gave us our paperwork for the day. It included a health history, a report sheet, and an assessment sheet. On the back was “nurse’s notes” where we record our documentation for the things done during our shift.

We were then taken to the ER “triage” area to meet our patients and take their vitals signs and get their health history. My partner and I had a 4 year old little boy whose mother brought him into the ER due to a persistent fever and a cough. Because there were no young children brought in to act as actors in our simulation, we had to ask all of our questions to the mom and she had to give us all the pertinent information on our patient. It was fun! And then after we were finished with getting the vital signs and health history, we sat and talked to the “mom” – a current S2 about to graduate – about nursing school and her tips and tricks to make it through while we waited on the S1 students to make their rounds on the patients in triage.

The S1 students then came in, and made their rounds between the 5 patients in the ER triage. My partner and I were pretty quiet as each student came in and got their assessment information, unless they specifically asked us for information. Some of the S1s talked to us and got information from us, but most of them pretty much ignored us as they came in, asked a few questions, and then left again. So that kind of sucked…hopefully when I’m an S1 and doing this simulation again, I’ll be kind to the J1s. Of course, they were probably pretty nervous themselves, and they DID have a whole ton more work to do than we did, since they had to see each of the 5 patients and we were only assigned one.

Then we (the J1s) were released from the ER triage to go sit down and write out a quick care plan on our patient. My partner and I chose three nursing diagnoses that we felt were pertinent to our patient: risk for hyperthermia, risk for injury, and fluid volume deficit. We wrote out our rationales for why we chose those diagnoses, wrote out the nursing interventions for those diagnoses, and then wrote out what patient education we needed to give. In this case, we needed to give the patient education to the mom about what treatments were being given and why.

Afterward, we were ushered into the “ICU” for the next part of the simulation (we were taken into the high fidelity lab!) and we got report from the current J1s assigned to our patient. Once in the ICU, our poor little man seemed like he’d deteriorated. His blood pressure was super low, even with IV fluids hanging, and he was suspected as having meningitis, even though the lab results hadn’t come back yet. My partner and I did our full assessment on him, I talked to his mom a bit about what was going on and why were were running certain tests, and then a “doctor” came in and got pretty agitated with the S1s who were in there because they hadn’t given certain meds that needed to be given before a lumbar puncture. Woah!

So I went with an S1 to the Pyxis to get meds for the patient, but then we realized that one of the meds we were giving had no administration route specified. So we had to call the charge nurse to figure that out, and then the doctor came back and was demanding that someone give the meds that had been ordered over an hour ago so she could perform the lumbar puncture.

It was chaotic! At one point we had 9 people in one tiny little room, not including the mom and the patient themselves! But it was a great learning experience – especially to learn how to work with others on the healthcare team and how to be quick and proficient at completing orders. I felt like I didn’t do much though – the S1s had way more that they needed to do and I felt like I was just in the way most of the time. I didn’t even get to complete a dressing change on the boy’s wrist because by the time we realized that it needed to be changed, the “doctor” and her two “med students” had come back and were about to do the lumbar puncture. And then it was time for my partner and I to leave…where the heck had the time gone??

So we left the boy in the capable hands of the FOUR S1s that had ended up in the room somehow (lol!) and my partner and I went to our post-conference downstairs to talk to another instructor about what we liked, what we didn’t like, and if it was a good learning experience for us or not. We completed a questionnaire/survey, and then we were free to go! In all, we were there a little over 3.5 hours, but it went by SOOO fast. Insane! I can’t imagine what it’ll be like in a real ICU with more than 1 patient that I’m having to take care of…makes me excited to be in the ICU in upcoming semesters. 🙂

All in all I really enjoyed the experience, and I wish were had more of them in a semester! And I can’t wait until my S1 semester when I get to do that one over again, only as an S1!

Also…now it’s Saturday. You know what that means?? I only have one more pharm quiz, my HESI next week, and then FINALS the week after that and I’ll be DONE DONE DONE!!!