It’s been an incredibly busy term, so I haven’t had much time to keep up with my blog or really not think about anything outside of school. Since i’ve come back from my trip in the UK i’ve felt like I had to hit the ground running trying to keep up with all my work.
I’ve honestly really dreaded this term, moreso for the school aspect. To be honest, I think I say this every term, but really you think you’ve conquered one mountain (the last mountain) in nursing school only to be hit with another 2. That’s literally how nursing school feels like at times.
Pathophysiology has really kicked up a notch and now the midterms are over (I did okay), I still don’t feel like i’m sitting in a great spot walking into a full year cumulative exam. Considering I witnessed a number of people sitting in a similar spot fail pharmacology last term and have to stay back a year. Then on the other hand, I thought microbiology would be an okay course, but after that midterm yesterday i’m honestly starting to feel really discouraged with the whole course. It made me even more angry to hear her blame the students for “reading the questions” in the wrong lens, rather than accepting that maybe she made the exam too hard. I find it highly doubtful that 150 people (half the class on the left of the curve) are really that incompetent considering they made it this far in the program.
I think the only part i’ve really enjoyed about this term has been my clinical. As much as I hated how much the strike disrupted my term last semester, I’m really glad i’ve gotten to experience some 12 hour shifts. As exhausting as they are, they actually go by relatively quickly and it’s a great learning experience to actually spend a whole day on a single patient. I was fortunate enough to get to sit in on an endoscopy and colonoscopy and see what the procedure actually looks like and what the physicians look for and then the role of the surgical nurses and what part they play in the procedure and administering and maintain the anaesthesia. I was super fortunate that my patient was willing to let me use that as a learning experience considering how invasive the procedure is. My group as a whole have got to do some pretty cool things, like watching a toe get amputated (not super jealous considering I hate bones), injections almost every week, VRE swabs, or getting to go down to watch hemodialysis with their patients.
To be honest, I know i’ve mentioned it multiple times but I didn’t think i’d enjoy general medicine as much as I have so far. I know it’s definitely not an area I would want to work long-term post graduation, but it’s honestly been a tremendous learning experience and confidence booster. It’s still hard to get used to how to chart everything because there’s a lot but i’m so grateful for the nurses who have been there to answer my questions or make me think deeper.
I think my favourite shift had to have been last week. My patient was an elderly person who was in for something that had been relatively minor but because of her age impacted her ability to move. As a new nurse it always makes me a bit weary when delirium is mixed in because that increases their falls risk. When I asked how the patient ambulates (aka how do they move or get out of bed), the nurse simple stated that they didn’t. When I inquired further the nurse stated that the “patient was old and didn’t like to be moved and that was their right” and to “not worry about it”. Keep in mind this person had been in bed since they were admitted (ie multiple weeks). I felt very unsettled hearing that considering the importance of trying to at least encourage them to ambulate.
When I went to do my head to toe assessment, they were so pleasant and engaging. I was worried they’d be a bit confused having been woken up but they were quite chatty and I got to learn about their life and children and what it was like growing up in the area considering they have lived a relatively long life. I began to ask how they moved around. They began showing me some small exercises their family members had taught them and how she had a rotating lunch/dinner guest list their sister had made for them. I asked them if they wanted to try to get out of bed and why they had turned down physiotherapy’s assistance. This is when I found out that the physiotherapist that had tried to move them a month ago had tried to do a solo maneuver which hurt the patient and made them scared and that’s why they requested to stop.
It wasn’t until the patient’s grown child came later in the afternoon that we really began talking about the importance of moving and trying to understand why physiotherapy never came back to reassess them. I also brought up how nice it would be for the patient to at least be able to sit in a chair for a few hours a day to get some mobility and a different spot to enjoy her paper. Luckily in the moment, the nurse who reported to me stepped in to check on us since her patient was next door and I asked if it was possible to explain to the family why this issue was never re-addressed with the patient. I also brought up that maybe we could at least get them a geriatric chair to sit in as a start and that maybe we could order a new re-assessment to be done for the patient. While the nurse seemed a little flustered to not be able to explain the whole situation or the details (because they obviously just took the blind advice of others) it was at least a start. No patient should ever be left in bed because it increases the risks of pressure ulcers, DVT, infection (especially in lying supine), loss of muscle, depression, etc. While a patient has every right to decide what to do, as a nurse we have a duty to at least ask every day or explain the importance of moving.
It was evident from my patient showing me their mini expercises and bicycle kicks that they wanted to retain mobility and strength and wanted to get out of bed, but no one ever had asked them what they wanted to do or why they had turned down physiotherapy. Moving a patient alone can be scary for both partners, and it made me angry that no one had really investigated this further but rather played it up to the patient age. The patient shouldn’t have to be in bed for that long, considering they had already developed pressure ulcers on the coccyx and heel.
It wasn’t until I came back from my dinner break and went to check on my patient and perform vitals that I had found that the nurse had brought up her a geriatric chair to use the next day. Seeing the look on their face honestly made my entire day. They were so happy and grateful to be able to attempt to use it tomorrow. While it made me a bit sad to inform her I wouldn’t be her nurse tomorrow when they asked, I knew they’d be in good hands with another student nurse the next day. But to hear a patient actually thank me and say because of my actions I made it happen for them and that they’d think of me when they sat in the chair tomorrow made me incredibly grateful to be in this profession. As silly or small as it sounds, to the patient this was momentous.
But really, the patient shouldn’t have to thank me. I did my job. As a nurse I have a duty to advocate for my patients, and this was just simply that. They deserved more than what they were getting and if it were my loved ones I would expect the same from the nurse caring for them had I not gone into this field. I know nursing can be stressful, tiring, and demanding, but at the same time patient safety should triumph everything. I
t makes me angry when nurses sit around (especially when they have students taking patients off their load) and they sit their on the internet or phone ignoring the call bells because “it’s not their patient”. Yes it can be daunting to go into a room and know nothing about the patient (ie. falls risk, medication allergies), but the LEAST we can do is check what is wrong the patient perhaps they are lonely or scared, confused, and offer a bit of comfort or direction, or perhaps it is something more urgent and serious but can wait a bit. But even in those cases we can at least inform them that we will let their beside nurse know and acknowledge their call for help.
Having lost their independence, knowing they’d never be able to live on their own again and basically losing the ability to walk over night, it was something that meant a lot to them. Just to be able to sit in an actual chair again, even if for a few hours a day.
While I know I won’t get the same patient again tomorrow, I am excited to know I have one more 12 hour shift this term where I can go back and hopefully pull up a chair beside them in their new chair and chat. Being in a hospital room can be pretty boring and dreary but I think it’s kind of cool that while i’m still new I have the time to do these kinds of things and really get to know the patients as a person rather than as a number.
I don’t know what tomorrow will bring but i’m excited to find out when I get back on to the floor tomorrow morning and meet a new face.