A New Shift.

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.



12 Hours.

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.


Megan S