I made it! Today I graduate from the University of Southern Maine with a Bachelor of Science in nursing. It is time to begin vigorously studying for the NCLEX and to find a job. There are so many things that have interested me. Now that I have finished my clinicals I am most drawn toward mental health and neurology.
One of the biggest challenges with nursing is connecting everything together. It’s difficult not to get caught up in the minutiae and consequently missing out on the big picture or other significant details. Throughout nursing school we have been assured that with time and experience, we will move from being task-oriented and routine-focused to seeing everything as an interconnected, fluid process, and being able to anticipate and manage rapidly changing non-routine events. I feel that I’ve gained extensive knowledge and learned valuable skills throughout my lectures and labs. However, until interacting with actual patients in a real clinical environment, I could not fully understand, appreciate, and apply all those concepts. My clinicals significantly increased my understanding and have hopefully prepared me for the complexities of nursing practice. I have included some excerpts from my journals of my various clinicals throughout the nursing program:
General Medical-Surgical, Maine Medical Center: R4
One of my clinical days I was assigned to care for a patient who had become paraplegic after falling off a roof. One of the nurses discovered that he needed to have a digital stimulation/disimpaction. Knowing I was a new nursing student, she didn’t expect me to perform this somewhat awkward procedure, but she asked if I wanted to try it. Without hesitation, I said “Sure.” The other nurses and my fellow nursing students looked at me in surprise (I’d like to think admiration and awe), and perhaps some disgust. I double-gloved, and with the guidance of the nurse, I was able to remove his fecal matter. I think my patient was comfortable with it, because during the procedure he was making business calls on his cell phone. I felt a sense of satisfaction that I jumped right in and was able to successfully perform this task.
Mental Health Nursing, Spring Harbor Hospital
I accompanied the kids from the developmental disabilities unit on a field trip to the YMCA to go swimming. It was nice to be with them outside the hospital in a community setting. KP, a 10-year-old girl diagnosed with autism, had witnessed a very traumatic event about 1 ½ years prior to her admission to Spring Harbor. She has a lot of anxiety about any unfamiliar situations. She was very apprehensive about going into the water in the swimming pool at the YMCA. Several staff members tried to coax her and give her different options to entering the pool. KP would dip her toe, lower her legs, or start to descend the steps; then she would immediately pull out in fear. After about 30 minutes of this, she allowed several people to carefully guide her down into the water. When she stood on the floor of the pool everyone cheered. KP was visibly relieved and excited. It was incredibly rewarding and affecting to see this breakthrough! On the next visit to the pool her anxiety and fear were still visible, but it only took about 5 minutes before she raised the courage to step down into the water–much quicker than her previous encounter. She seemed to need the tight grip of several people in order to feel safe and confident. At one point KP said “OK, this is excellent.” Once again, it was wonderful to see her achieve this little success.
Bayside Community Partnership
I look forward to going to the Preble Street Soup Kitchen to take blood pressures every week for our partnership. I hear many different stories from people of different backgrounds in different circumstances, sadly most of whom are going through difficult times. Although many are interested in having their blood pressures taken, I think they simply appreciate our presence there; to have someone listen and provide support.I always look forward to seeing Gene, a charismatic older gentleman who sits in a chair by the door behind our table every week. He has shared great stories and shown me his amazing sketches. His talent and authenticity are incredibly admirable. It is reassuring to know that Bayside provides so many services to those in less fortunate financial and social circumstances. I have enjoyed working with the community, and I have appreciated the opportunity to interact with many different people who I would not have met otherwise.
Pediatrics, Barbara Bush Children’s Hospital
I accompanied my 11-year-old patient down to interventional radiology for a peripheral line insertion. When she heard music playing in the procedure room, she asked if she could hook her iPod up to the dock with the speakers so she could listen to Justin Bieber, a 17-yr-old Canadian pop singer popular among teens. The radiology staff were happy to comply. My patient enthusiastically began singing along with the songs, and appeared to have every word memorized. As she was going under the anesthesia, her singing was less intense, and she was remembering fewer and fewer words. After she was completely sedated, I think the staff were relieved to have some different background music. I appreciated how this simple thing could affect her disposition, as it was clearly reducing any of her anxiety and apprehension.
Practicum, Scarborough Surgery Center
I went into the operating room one day prepared to observe a vitrectomy (removal of vitreous humor around the macula). When the surgeon invited me over to watch what he was doing, I was surprised to see him cut out the lens and proceed to remove the entire contents of the eye from the socket.This kind of thing doesn’t bother me; however, I was a little unprepared because it wasn’t what I was expecting. It turned out that he was performing an enucleation (removal of entire contents). A prosthetic would be implanted later. He explained “sympathetic ophthalmia” to me, which has been known to follow ocular trauma or intraocular surgery. The injured eye becomes inflamed first, and the other eye follows (i.e., “sympathetically”). This leads to an autoimmune reaction against the exposed ocular antigens in the injured eye as well as the sympathizing eye. The injured eye is removed to prevent this from happening. I later asked the surgeon about it, incorrectly calling it “empathetic” opthalmia. Jokingly he responded that it would be called “apathetic” ophthalmia if the other eye didn’t care.
I earned my CNA certification a few years ago because I thought it would be a good segway into nursing. During the course I had some memorable experiences, such as having a patient handing me her dentures to hold while she vomited, having another patient defecate on my shoe after I’d given her prune juice for her constipation, and watching a restless and confused patient dutifully and enthusiastically fold washcloths I’d given her to keep her occupied. While I was preparing the groin of a patient scheduled for a procedure, I casually held aside his scrotum with my hand. My instructor pulled me aside afterward to tell me I should have used a towel instead of my hand. If my patient was surprised or uncomfortable, he didn’t indicate it. I encountered another patient in the hallway who was fiddling with the cardiac telemetry leads on his chest. He noticed they were not registering on the telemetry screen in the hall and was attempting to fix them. When I asked him what he was doing and told him he needed a nurse to help, he said “I’m taking care of it. Don’t worry—I’m an electrician.”
I work as a nursing unit secretary which includes answering call bells. The best part about my job is when I have the opportunity to do things for the patients myself. We had only one or two patients at a time in my nursing clinicals, which allowed us the opportunity to give them extra time and attention. Once I begin working as a nurse, I know I will miss having that extra patient interaction.
We’re usually removed from the real world of illness and dying. The nurse sees and participates in things that other people are uncomfortable with. Nursing has become more involved with management, intensive care, and administration. As they become more advanced, they become further and further removed from the patients. The reward, however, is in patient care. Nurses lament that there is not time to do the little things for the patients anymore, the things they enjoy most. When the nurse takes on the responsibility of his/her patients, he/she is accountable for them, advocates for them, and forms a connection with them. The challenge for nurses is to find the compassionate moments with the patients. ~Lori Burnell, RN, MSN
One of the things that made an impression on me from the beginning as a nursing student was the fuller definition of medical care: To cure sometimes, to relieve often, and to comfort always. This has has always stuck with me. The health system is oriented toward the cure of disease; we think of medicine primarily in terms of the interventions we can perform. When overwhelmed by the biomedical needs of the patient and complexities of the treatments, it is difficult to attend to the psychosocial needs of the patient and family.
It is important to see the person, rather than the illness. The best doctors and nurses I’ve had were those who took the time to sit down with me and actively listen, made sure I understood everything, and ensured my needs and concerns were being addressed. I could sense their genuine concern as they showed an interest in me, and not just my diagnosis.
I am so thankful for the support of my three wonderful daughters who have been incredibly patient and understanding while I have been so busy with school and work. They frequently tell me I’m going to make a good nurse. I cannot adequately express my gratitude and appreciation for my amazing sweetheart and best friend, Brent. He has pushed, encouraged, and supported me throughout it all; always behind me and beside me. Aside from all the hard work, stress, and unavailability, nursing school has been a positive experience overall. I’m definitely ready for the next chapter in my life. I’m looking forward to having more time to spend with my family and to do other things I enjoy. As for putting a “BSN” after my name…that’s pretty awesome too.
I will end with a limerick I wrote for my high-acuity class (thank you, Su) this final semester:
I’ve learned to work hard without rest.
And exercise before each test.
And vigorous lecture
Show evidence-based practice is best!