12 Hours.

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A lot can happen in 12 hours. It’s crazy to think this is what my life is going to look like, i’ve never learned so much in anything prior to my first 12 hour clinical experience. The mental, physical and emotional high you ride through your shift. As a second year we don’t typically get 12 hours shifts, but because of the disruption to our clinicals we had last term, I was lucky to get three 12 hour shifts and the rest being the regular 8 hours.

It was daunting entering my first shift yesterday. Having spent the week prior in the UK for my Master’s graduation I missed the transition day of having a partner to manage one patients and get acquainted with the unit. I was nervous to be alone with a patient and not be in a familiar environment, but I SURVIVED. I am incredibly grateful to have had a pleasant patient who was understanding and the help of the fellow upper year student nurse who pulled me aside to teach me new things and help keep me on task. I am even more grateful to have had a tutor who believed in my capabilities of managing my own patient and who was there any time I needed them to double check my medications or answer my questions.

Post shift, I must say it is daunting. HOW DO NURSES DO IT? I only had one patient to take care of for the day (my first solo patient ever and first shift in my new hospital) but even just doing a head-to-toe assessment, vitals, charting, and preparing his medications took me until 9am.  Let alone the full-time nurses who have 3-4 patients each and have to have all those tasks done by 9 am so the healthcare team can do rounds. It doesn’t help when most of the patients are in isolation because of the flu/MRSA/VRE and you have to gown up each time you leave and enter their room (better remember everything the first time!). Black. Magic.

It’s crazy how much nurses have to keep on top of things, whether it’s 0800, 1200, 0500 medications, charting (can’t bring papers into isolation room), addressing emergencies that pop up or concerns, dressing wounds, health teaching, meeting with family to talk,  accompanying patients to appointments on different floors, bathing them and other personal hygiene measures, having everything ready for report, keeping on top of new orders/lab results, taking swabs, in some cases feeding patients by hand, getting them up and around, arranging a patient’s day and keeping on top of what goes on (how much they drink and output). It doesn’t seem like much, but when you actually see what goes on behind the scenes it’s baffling. By the end of my shift I was scrambling to chart everything, change dressings, and helping others with tasks like trying to get an IV into a patient who was delirious or finding a manual bed alarm for a patient who almost fell out of bed. I can see why nurses have such a high burnout rate or why moral distress is such a prevalent issue in the field.

I think one of the most important things that i’ve taken out of my Master’s degree is recognizing issues that don’t align with my values and how to slowly start to address them. More importantly i’ve come to realize the need for patient advocacy and my role as a nurse to help patients have their voices heard. I came across a patient yesterday who had a nephrostomy bag in which when I walked into their room during the start of my shift was in a bath basin floating in urine. I had never come across one of these bags, but I knew it wasn’t normal. What made me even more sad was after my assessments I was planning my day of how to get the patient up and out of bed and they mentioned wanting to go for a walk. Seeing the situation as a whole, it made me sick to my stomach to think this individual would have to lug this container of urine because the bag had been leaking, out in public, and not only feel uncomfortable with people watching them but also the fact that it was simply a hazard both physically (ie. slips) and health wise (ie. a super highway for infection). When I brought up my concerns to the overseeing student nurse she stated that in rounds they simply played it down to a behavior issue and blamed the individual for tinkering with it rather than making any effort to find a new bag somewhere else in the hospital. I’m incredibly grateful for my nursing tutor who came in to check on me and believe me when I mentioned that this was not normal and that he needed a new bag ASAP. Even to get a new bag was a mission and a half with one hospital unit complaining it would come out of their budget. Since when has it become acceptable to withhold healthcare from individuals? UTIs are prevalent in the hospital setting and seeing the state of this bag (which had been tapes with wound dressing rather than waterproof tape) was unacceptable. I can’t imagine how the situation would have looked had my tutor not been around to help me advocate for the patient in addressing the situation and scavenging the hospital for a new bag. Thinking of it was someone I loved being the in the patient’s position I would feel disgusted and angry to not have a voice in the care I receive because of my age or health condition (ie. depression, dementia).

Honestly in 12 hours, a lot can change. From patients developing delirium and becoming confused to patients dying. I experienced my first death yesterday and let me tell you it’s nothing as how the television perceives it to be. It’s cold, lonely, and in a way mechanical as in the steps are set out in hospital policy. It’s a strange feeling to look at a patient and see them lifeless especially when you had seen them in a better state the week prior, I mean as a healthcare professional we want all our patients to go home happy and healthy but the reality is some don’t and for many who do go home not at a optimal quality of life. I can’t really explain what the death process is like, but I learned a lot about how I can help make it the best it can be. Simple measures like washing the body, closing the eyes, putting on a pair of briefs and providing privacy are things I can do to help. Visiting the morgue was surreal in it’s blandness, it’s kind of unsettling to think about in that at the end of life you end up alone in a cold fridge waiting to be taken to a funeral home or be released for other measures.

It’s eye opening to how many people are death-phobic, I had a great discussion with a professor today about this phenomenon in nursing and how nursing schools do a poor job at preparing nurses to deal with death. Even within my own group a couple students found the patient’s death hard to deal with. I think nursing schools need to do a better job to improve our own awareness and understanding of the dying and death processes. How we can sort out or feelings from our professional duties and have them work together. I think death in itself is powerful, it’s inevitable, and the only I can do in the process is to respect the being that once filled that body and help transition it to the next phase. I can’t control or stop death (when medical interventions fail or are futile) but I can help by being respectful and giving the individual a respectful send off to the next realm.

I’ll be honest leasing the hospital that night, I now know what it smells likes and I also now appreciate sleep more. Being ‘on’ for 12 hours straight is a lot, but the learning experience I had yesterday was incredible. I didn’t think I would enjoy general medicine, but the variety of patients (age, health conditions, tasks) has been eye opening and a much more enlightening experiencing than my first placement at another local hospital. Honestly, i’m looking forward to my weekly clinical now and how much I will grow as a nurse through the term.

While entering the hospital before the sun rises and leaving long after it sets has it’s downsides, the work nurses do fills my soul, while the smell of hospital fills my hippocampus and nares. There’s nothing that I would change though or that a good night’s sleep, shower, and strong laundry wash cycle can’t fix.

Cheers,

Megan S