Last day of clinicals

Today was my very last day of my 185 hours of preceptorship and marks the end to nursing school!

It's interesting because I started off my rotation with my preceptor being floated to a stepdown unit and today, I ended the rotation being floated to an oncology medsurg floor. I'm definitely going to miss a lot of people...I used to walk into the lounge to grab a bite to eat and I'd talk to the aides or environmental lady. Some of the nurses were just a pleasure to work with and some I definitely will not miss. It wasn't the best rotation I have ever been through, but I still got something out of it.

I feel like without the Mt Sinai internship I would not want to go into critical care so much because I just saw a gazillion things there that I did not experience at this hospital. The staff there worked SO WELL together and they were COMPETENT as hell. I am still amazed by the intelligence and expertise I saw over the summer internship. Bedside procedures, cool stuff like marsupialization, hardcore coding, trauma wounds and the NYPD being involved, ENT, vascular cases...just a whole slew of things. I dunno, I guess as a student it's really intriguing. There definitely was a cultural variety, a lot of the physicians/nurses/staff could speak Spanish, and many other languages, fluently. Here, at this hospital, the medical staff weren't very welcoming to other cultures and if a patient spoke Spanish, forget it. The staff wouldn't be happy at all.

Something interesting did happen yesterday- a family member of a patient who was slowly but surely recovering in ICU came out frustrated and fed up and said to the doctor "Get off your ass and do the job you get paid to do. Stop bullshittin!" Meanwhile, this doctor wasn't even working on his relative's case yet. WTF. We all just ignored it because we were so shocked. This relative usually abuses hospital visiting hours and so the nurse (it was my patient, so my preceptor really) went into the room and asked him to please leave the unit and that it was past visiting hours and the guy just said "you're fucking full of shit, bullshit, i can do what i want" and my nurse got so angry, she was just yelling at him "You don't talk to a doctor like that! That was very rude and unprofessional. It's past visiting hours and you rarely leave when we ask politely." The guy started to leave, cursing out the place, and shoving chairs into the nurses station, and we threatened to call security. He went downstairs and tried to complain and another doctor who was in the unit when he had his tantrum called him out as disrespectful and to never talk to another physician like that again. Turns out,both doctors he yelled at dropped his relative's case. Oh well. What can ya do.

I'll be working in a hospital still as a patient care associate/nursing assistant up until I take the boards, so it won't be the last time I step into the hospital before becoming an RN. I only have one more day, which is Nursing Pinning, when I have to wear my all white nursing uniform. Exciting!

I am just so excited that I've completed my preceptorship hours and took my two finals earlier this week. I had to present on bloodless medicine Monday night at like 8 pm and of the whole group, I definitely rocked it. I was planning on having my index cards, but those just went out the window when I went up because I had researched the topic enough. I was nervous about the professor asking questions, which he did, but it wasn't really in depth. The pens we gave out were needle syringe pens and the class loved it!

Friday, I have my nursing seminar ethical paper due; I focused my topic on DNR orders, healthcare proxy vs. legal will. I had a patient who was coding overnight and the proxy wanted everything done whereas the patient's legal will stated not to do anything that would support life by artificial means. Fortunately, the issue was cleared up the next day when a DNR order was consented to by the proxy (not so pretty overnight when everyone was like wtf do we do since they followed the proxy over the legal will).

I'm loving life right now and definitely just wanna step back and enjoy everything before I start working as a PCA back at the hospital...but yeah, I'm still in a daze and can't believe it..

It's been a MONTH!

Wow, it's been a while since I've posted. I've been absolutely busy with applying for jobs/nursing fellowships, classes, work, and my preceptorship that this has just been nonexistent on the to-do list as of late.

I had two interviews today for the same health system--one was with corporate then a second was for the manager of the NSICU. The questions were all behavioral and the recruiter asked me to walk her through a complete assessment and then give report on a difficult patient I have had. She also asked a difficult decision I have made in practice and how I have gone above and beyond for a patient. Fortunately, from my summer internship I had a plethora of answers to give her! It was great and she was impressed. Thank god. My last interview was okay, but they didn't want me because I had no experience yet. That one was somethin else--gettin thrown to the staff nurses for a group interview (5 staff nurses, care coordinator, manager vs. me!) after interviewing with the manager. I just wanna graduate, take the boards, PASS, and then deal with jobs.

I have so much to do still before graduation in 14 days!!
-Final Presentation in Med Ethics Mon night- presenting on Jehovah's Witnesses and Bloodless Care
-Final Exam in Weightlifting/Gym class (go figure, it's dumb...)
-3 days of 12.5 hour shifts for preceptorship
-1 journal entry for preceptorship + Clinical Ethical Paper
-Cor (American Dream class) presentation
-End of Preceptorship Seminar

Once I'm done with all this, I have to finally set a schedule to work at the hospital again and study for boards...on that note, I just dropped $335 registering to take the NCLEX. =) Sweet stuff, huh. and I'll be paying $500 monthly for insurance to be covered until I get a job, so yeah...no pressure to pass, huh. Love it.

I have day shift tomorrow in the ICU, so time for bed and hopefully a more interesting, well thought-out update next time. After tomorrow, 2 more days in ICU...how sad.

just a moment to breathe

My week so far:
Sat: went to Tenement museum in NYC for project
Sun: Defensive Driving for Insurance Reduction then Lecture at college for extra credit
Mon: start ICU/CCU preceptorship at hospital, leave early to go to 2 classes which end eventually at 9:30PM
Tues: Preceptorship 7a-7:30p
Wedn: sane enough to take the day off to "Relax" (sleep in and take naps throughout the day) and tell myself that I'll get work done but don't
Thurs: insane enough to call into work to ask to work, because I miss a REAL hospital...I don't really like where I'm doing my ICU preceptorship and I have to do 185 hours of them...
Fri: NCLEX/state board review class all day out east
Today: 7a-7:30p at the crappy hospital. But I was pretty pleased today cause I learned a lot and I have a different preceptor nurse today who actually did things the right way and took time to teach me.

I have done nothing else but spend time in 2 different hospitals, go to college classes, go to nclex reviews, and work... I cannot wait for my vacation towards the end of this month!

The good news is I have 4 job possibilities, 3 in ICU settings at 2 different hospitals offering a position, and 1 on the floor I currently work on. I think I'm gonna apply to Cornell/Columbia Presbyterian... more to pick from :P

time for some reading and sleep..thank god we have the extra hour! I have Sigma Theta Tau induction tomorrow and more work to do!

What a SMALL world!

So I was on-call to work the 7a-3p shift today and the evening manager told me that the night manager would call at around 5 a.m. if they definitely needed me. I barely got any sleep cause I was worried I would miss the call--I'm in and out of sleep seeing the hours roll by and 5 a.m. passes and I thought I was safe, but I knew it wasn't so certain until 7 a.m.--and of course, 6 a.m. comes and I get the phone call to come in.

Once I arrived, I was greeted by a nursing instructor who asked where I went to nursing school so she could get ideas from my school and pair me up with a student. For some reason, she got confused that I hadn't graduated yet and wasn't a nurse, so she definitely could not pair me up...maybe it was just too early for any of us. Anyway, maybe about 2-3 different patients all thought I was the other Filipina nurse, who is 4 years older than me and maybe just shares the same complexion as me, but doesn't have the slightest resemblance. Ah well. The worst was when the nurse educator who I have known for more than 5 years thought I was that other new nurse and asked how I liked the unit so far...I just stared at her seeing if she'd pick it up, but she didn't. I had to remind her it was me.. :(

So I get into a conversation with this nurse educator and lo and behold she knows my good friend in Maryland because her son who goes to the academy dated my good friend's friend. Small freakin world. She thanked me for getting her son interested in USNA and for pointing her in the right direction (I supplied her with Academy pointers and tips from books and links and I was kinda disgruntled years ago when her son got in and I didn't because I had wanted it more than him at the time).

Another crazy thing happened--the nursing instructor's clinical group happened to have a student nurse intern from over the summer at Sinai! It was insane! I waited for Norma to come out of the room cause I knew it was her...I think that just made my day to see a familiar face in the least place you expect. Small small world, again.

Some older man during lunch thought I was a doctor, but when I said no he asked what I did and I explained my lil spiel and he said "Good luck with everything, I know you're going to be a good nurse...just from what I see" haha. He had complained that there was a nursing shortage and the nursing field had a void of good nurses. And on Friday there's a program on about the nursing shortage as it pertains to the NY area on Channel 21/PBS (?) from 8p-9p I think..

Lastly, I love how patients think the hospital should be the Ritz Carlton or something. They complain about the furniture being old (and "falling apart" when it clearly isn't..it just doesn't look so appealing) and they complain about the sheets not being folded the way they individually like, or the thermostat needing to be adjusted every so often. Honestly, if you're complaining that much about furniture and terrible linen, you should go home. Especially when you're showing me how you fold your stuff at home and it's clearly different from hospital style bed making. If we wanted you to stay in the hospital, it'd definitely be like the Ritz Carlton ;)

The end

Today marks the end of my last clinical rotation of undergrad nursing school, which was in the Special Care Unit/ICU. 5 weeks of driving to and from a hospital 40 minutes away all over. Not to mention, psych and peds ICU were thrown in there at different hospitals (each was 1 week respectively--barely enough to learn much from). I'm so glad it's over; I mentioned to my friend as I was leaving the hospital that I will not miss the place or the drive out there. I'm thankful I had a friend to carpool with to make the drive a little more bearable. I earned an A and the professor offered to write me a letter of recommendation. She pulled me aside yesterday for my evaluation and asked if I had a job lined up and if I needed a letter. She took the words right out of my mouth because I was meaning to ask her yesterday so she could give me a letter before it was all over. That was pretty sweet!

I was in the ER today and it was pretty ho-hum, which was great for the staff, though as a student I would have loved to see craziness and trauma.

The rest of the days this week I was in ICU and had a pretty interesting experience

• Airlifts and transfers from out of state hospitals are always fun and interesting or related to a medical professional in transferred-to hospital.

• Walking out of a room and seeing the exact person you need when your patient's ETT (Endotrach tube) comes out is definitely a rarity and my luck.
• Giving a patient meds through an NGT and stepping back to realize that the patient had exsanguinated all over your white nursing shoes and some of the bottom of your all-white nursing uniform is a great feeling (*sarcasm) The IV blunt came out of the pt's IV port (the hospital has the strangest IV port system...very very inefficient though cheap, which is why the hospital likes it)...I've seen numerous problems with the IV system throughout the 5 weeks there.
• Seeing a patient who is well into her elder years and then her daughter and realizing that the 110 y.o. or whatever patient looks so much better than the daughter who can barely walk and needs a nursing assistant to take her around in a wheel chair...go figure.
  
• One of the primary nurses I was paired with was just 25 and had done 5 years in med surg and just transferred to the ICU...she started when she was 21...which will be my story soon. She was a nursing assistant before and had always worked in hospitals prior to becoming an LPN and then an RN. She's in school again for her masters. Very motivating.

I'm lookin forward to tomorrow's nursing seminar to find out who my preceptor is for my mandatory 185 hours. I chose ICU and was placed in a medical center close to me (THANKFULLY!) I mean, I guess it's not as bad as living an hour away from your preceptorship site/hospital and having to do the 12 hours...that really sucks! :(

So hopefully I have a good schedule which will go along well with my classes on Mon/Fri. We'll see...

"I was BORN ready!"

Today was a very interesting, albeit slow day because of the Jewish holiday. I started off in ASU- Ambulatory Surgery Unit. The charge nurse decided to put me with a pt having a bunionectomy and so I followed the pt up to the OR and watched her short and sweet procedure. Feet really aren't my thing and seeing her foot just sliced open and manipulated with a saw and chisel tool was very interesting but at the same time, a little gross. I don't like seeing an entire body part worked on and not covered up, it disturbs me. When I saw the laporascopic hemicolectomy and the small part of the pt's colon (omentum) over his abdomen when they took it out , I was just in awe. I thought it was the craziest-coolest thing ever. When the surgeon did the biopsy and cut open the piece of colon and found the ulcer, I was pretty amazed. For some reason, that stuff really catches my attention and I could watch those surgeries any time. I think it's also because I had a lap appendectomy done, so I wanted to see how they operated on me..

I paid close attention to what the anesthesiologists were doing because I want to eventually go back to school for nurse anesthesia. What went through my mind was 'what the hell do they do but put the patient to sleep?' but then what set in was 'Well, if this guy starts to decompensate, then that anesthesiologist better know what to do! That person better know what drugs to use and how to intubate like it was nothin.' I just feel like I'm a million years from that job (which I really am, I haven't even started working as a nurse yet) and I just hope one day I can intubate someone like it was nobody's business and know what to do in different emergency situations. I want to be as comfortable as these seasoned anesthetists are someday and be there for the patient before procedures to reassure them and be there when he or she wakes up. However, one of the anesthesiologists really ticked me off because he had put the pt under, intubated him, then left the room to talk on the phone. Who the hell is watching the patient's hemodynamic stability and oxygen saturation?

Another funny thing that happened after the surgery was the brief discussion between the medical student and the surgeon:
Surgeon: "Our next case is a right carotid endarterectomy...are you ready for it?"
Med Student: "Oh, I was born ready!"

In my head: "Whoa whoa whoa. Chill out! You're not a surgeon just YET." Sure I'm a nursing student, but when I do things with the nurse, I'm not totally *yes I am the shit* immediately. It takes time to develop skills...but I guess she's going into surgery so it makes sense...it's good they have that cockiness so they're totally confident in their skills
.....Now I'm just trying to justify her comment.

After all that, I figured I was done with the OR for the day and went back to ASU. They then sent me to endoscopy where I watched a routine colonoscopy. The procedure went flawlessly and we removed polyps. The pt prepped his colon really well, thankfully. I heard stories from my clinical colleagues about poor prepping and seeing shit (literally) all over the screen. The pt was alright, it was kinda hard waking him up from anesthesia, but he eventually roused. The anesthesiologist was HILARIOUS as anything. He made jokes about anything and everything that was said. Unfortunately, the pt really left a bad impression on me, but I didn't truly allow it to phase me. He brought up a topic about immigrants and how they should not be in this country and how when they don't speak English it pisses him off. The primary nurse pointed me out to the patient (I was standing next to him on his right hooking him up to the monitors) The nurse went completely berserk and said "Watch what you're saying!!...Oh my god! Behave! Don't say that..." The patient looked over at me and shrugged and said "Well, she shouldn't be here." I just smiled sweetly and walked away. In my mind, I was like alright, later dude. People should realllly be careful of what they're saying to the people who will be taking care of them one day.... I'm not an immigrant but I'm the daughter of two!

After that, I just followed a different nurse around ASU--there were only 2 post-op patients who were walkie-talkies on the floor. This is proof of the day's utter slowness.