Keep an eye out 'four' me...

Today was a great day...because I'm moving on to level Four, the last of the levels! I got an 86 on my final and an 87 overall so I'm very happy with how this semester went!


I was at the final review today and was talking to some fellow classmates about our inability to describe this semester! I think the best description we came up with was, "phenomenal". It seems like ages ago that I was deep throat suctioning my patient and doing my PICC line dressing changes. It seems like a lifetime ago that we were sitting in on our OB seminars! 


What's even more mind blowing is that one year ago I was shaking in my boots counting down the days until I started nursing school! One short year ago I wasn't the person that I am today. I was naive, timid, frightened, and unsure of what I was getting myself into. However, along the way,  I've gained confidence, knowledge, wisdom, strength, and amazing friends!!!


So what is one to do while I'm on my four week summer break?! I'm going to go to Florida to see my big sister and little nephews and brother-in-law! WOOT! Keep an eye out 'four' me on the waves! I will also have to find some time to study for the CCT exam that we get to take at the beginning of each semester! :) 


You know, finishing each level is amazing, but what's even better than passing yourself is hearing about and seeing all of your friends move on to the next level! I'm overwhelmed with excitement, pride, and joy each and every time I hear that one of my friends has made it through the semester! I've said it before and I'll keep saying it...nursing isn't about one person doing better than another...it's about becoming a team, uniting, sharing knowledge and wisdom with one another, and helping each other stay above water! 


I'm excited for next semester to see what it will bring. It's rumored that we won't have our preceptorship (where we're the real nurse with a full patient load and do all the care for the patients). They say that there aren't enough spots to place our enormous group...but they're hopeful that they'll be able to work something out. We shall see what this last chapter brings...until then...I'll leave another funny comic with you all about preceptors! Hahahaha...hope you enjoy!

Is it really the end?

So what can I say other than, "is it really the end?"...Last week I finished off clinicals and listened to my last lecture. On Friday I had my 3 HESI exams. I can't remember if I've talked about HESI before, but each semester we've had to take these exams. They're said to be NCLEX prep exams and predictors for how we will do when it comes to taking our state boards. In the past two semesters these exams have counted as grades, but since there were 3 this time they didn't count as a grade! The exams were on mother/baby, mental health, and pharmacology. I was most nervous about pharmacology but rocked it, so I was extremely happy about that! 


Tomorrow is my final for level 3!!!!!! HOLY SMOKES! I can't even describe this semester. It has been a fun, exciting, eye opening, and all around awesome experience. I loved my clinicals, I loved my level 3 coordinator...and there was very little drama. It was a very smooth semester and I loved it...but I shouldn't speak too soon seeing as how I still have to make it through the final! 


But before I go I just wanted to share with you all a cartoon that I found!!! Thanks to my rockstar med-surge instructor I became a pro at getting those pesky, unflickable bubbles out of a syringe...you just gotta let it know who the boss is!! :)

Gives a whole new meaning to being objective...

"Just keep your head low and don't say anything"
"She's unreal...and it's absolutely terrifying"
"Just do your homework"
"Don't be dumb"
"Be respectful, don't say anything that you don't know what you're talking about or can't back up"
"She's scary...it's scary...it's hard...people cried..a lot!"

These are things that students were saying about their experience in mental health and their comments about the instructor. Going into mental health, as I have mentioned before, has such a negative connotation to it. There's such a stigma attached to mental health and even going in as a nursing student I was still having a hard time letting go of that stigma, well, that was until now...

So here's my journey through mental health...day one...we were all sitting in the main lobby of the hospital waiting for her to show up and we're all discussing what we think it will be like, pondering what might happen, deciding who we thought the student would be that she would "pick on" etc.  And then she arrived. It was quickly made clear that we are in no way, whatsoever, to question her. For example she told us to all go put the new parking permits that she had for us in our cars. Someone else, however, decided to say, "There are other students that need parking permits, why don't we just give them to them." to which she replied, "Do not question me. I know what I'm talking about. Unless your parking permit says exactly what mine say then you are to go put these in your car." ......Needless to say we told the student that was 'talking back' to just shut up and do what she says and not questions her! It took a while for some students to learn not to question her authority or to question if she was right or wrong....but once everyone realized that she knew what she was talking about and was there to be a resource for us things started to be a little more smooth!!! :)

At UNMH they do ECT (electroconvulsive therapy) on patients that suffer from depression. Our instructor sent several of us down each day so that we all got a chance to see how that happens (I'll talk more about that in a bit). So she sent the students that had a background in mental health to ECT and then the rest of us went to the in-patient part of the hospital.

Prior to "letting us loose" to go speak with patients our instructor took some time to ask us all what our fears were. Those included, but wasn't limited to: being afraid of what to say to the patient, being afraid of "setting them off", being afraid of the unknown and how the patients would act....the list was endless. So we were reminded first and foremost that every patient that is "committed", so to speak, is there for one of three reasons; they're a risk to themselves, a risk to others, or grave passive neglect. It's not easy to be hospitalized on an in-patient mental health unit. Secondly, we were reminded that any question we had for them has already been asked and they're essential questions. We were also reminded to never go in the patients room, if the patient started to get agitated we were told to tell them ,"thanks for your time" and walk away. We were prepared and given information to prepare us as much as possible. I think it made some of us feel a little more intimidated and a little less sure of ourselves and what our experience was going to be...but ready or not...here we went...

Now, in this rotation we don't perform any hands-on care with the patient, no giving meds, no doing head-to-toes. It's simply a chance to watch how things are done, talk with the patients and hear their story, watch and listen in on their group therapies (including art and dance therapy). We were given two things to try and find out with each patient that we spoke with. We had to decide if they were there with a cognitive or mood disorder and why they were admitted (e.g. risk to self, risk to others, grave passive neglect).

My first day I was sent to the geriatric ward. There I had the chance to talk with three different patients. One was there for risk to self, another was there for grave passive neglect...and the other I couldn't quite figure out! :) I had the chance to participate in dance therapy...which was a very humbling experience for me and all of my fellow nursing students. It was an extremely emotional day, to say the least, and an eye opening experience. We were encouraged to try and increase our objectivity and the way that we looked at our patients....something I'm still working on and learning about! I got home and had a massive migrane, I cried, tried to take a nap, but couldn't, got dressed to go for a walk, but never made it out the door. It was a really hard day!

Day two...was a little better. I was still intimidated but feeling not as hopeless. First thing I got to go to ECT! That was a really amazing experience. Somewhere in the back of my mind I still imagined ECT as being a patient tied down on a board, with huge electrodes stuck to their head and just a weird, terrifying experience. It was completely opposite. For those of you who don't know ECT is used for patients that suffer from severe depression, schizophrenia, and in some cases, mania. It's used as a last result for these patients when their medication just sin't working any more. The patient is put under a short-acting anesthetic, they're given a muscle relaxant so that their body doesn't convulse while experience the seizure. A blood pressure cuff is blown up on the patient's foot so that the muscle relaxant can't reach those few muscles that way you're able to watch the seizure and count how long it lasts. Once the patient is completely asleep the doctor then puts the electrode on the top of the head which causes a seizure to go from head to toe. The seizures I saw lasted about 20-40 seconds. Once they've had the seizure the patient slowly begins to wake up and they're then taken back to their room! The procedure itself is only about 10 minutes. It's very fast...and not nearly as traumatic as I had imagined.

After ECT I spent the rest of my day in art therapy. Essentially they set up several large tables, put lots of paper around them and have all kinds of paint, chalk, pencils etc. The patients are let out of their wards and allowed to come out and express their emotions on paper. There was a professional musician there playing the cello, so it was a very soothing, relaxing, enjoyable set-up. I had the chance to speak with a couple patients...one was in the middle of a hallucination, one was delusional...and it was so heartbreaking. So you can guess how things were when I got home..I had a a huge migrane, I cried...and so on and so forth!

The other two days got better! It was still an extremely emotional experience, but I was learning more about these patients. They aren't there because they're bad people, and they're not there because they're awful people....they're there because they have a real sickness and they have real problems that need to be treated and need to get under control. This experience really gives a whole new meaning to being objective and being open to see things with a new perspective.

All-in-all...mental health was an exciting experience. I had a phenomenal instructor that did an amazing job at teaching us about mental health disorders and how to increase our objectivity when working with patients. She taught us how to better use the tools that we already had in our toolbox! I think I can speak for my fellow students by saying that we all left these clinicals with a greater sense of confidence in our abilities to interact with our patients that are going through a mental health crisis. I can say that it takes an amazing person to be able to work every single day in the mental health unit...and that person is not me!

So there you go....that was my mental health rotation!!!

I turned to mush by the end of the day

This semester is just flying by I feel like I have no time to spare anywhere along the way! I already had my three weeks in my OB rotation and I'm half way through my mental health rotation too!! So let us catch up:

My OB rotation was so different from what I expected. In ways I felt like it was a let down and in other ways I learned a lot about myself. However, before I get ahead of myself, let me tell you how this rotation works...There are so many different aspects to OB. People just assume that it's only labor and delivery, but there's also mother/baby, the nursery, OB specialty (high risk) care, OB operation room, OB triage etc. We had a chance to kind of rotate as much as possible through these different units in the six days that we were there. 

My first day I was in the specialty care unit. That's where they have women that need close monitoring during their pregnancy. That can include (but is not limited to) women that have preeclampsia, heart disease, kidney problems, cancer...the list is endless. That floor was boring. Just saying...maybe it was just because there wasn't much for me to do, but I don't know if that's the floor for me. You just go and ask each mom, "Are you having contractions? Do you have any vaginal discharge? Have you been feeling the baby move?" and that's about the extent of your assessment. Then they have someone come in and do a non-stress test on the baby's heart rate. So first day was kind of a bust. 

Second day my instructor sent me to labor and delivery thinking that would make up for the boring day on the specialty care floor. So I was extremely excited for the chance to finally get into the field that I'm wanting to go in. The nurse I was with was phenomenal, but my patient was not progressing. She had been on pitocin for several hours and nothing was happening and she wasn't having any change. She already had an epidural so she couldn't get up and walk around to try and help get things going so they decided to strip her membranes, stop the pit for 4 hours to give her uterus a chance to relax and to allow the pit to completely clear out of her body and then after 4 hours they were going to work it back up and hit it hardcore! Unfortunately for me, after her four hours were up I only had one more hour on the floor, so I again, didn't get to see anything. There was a mom that was delivering down the hall, but another CNM student was already in there (and let me just say at UNMH which is a teaching hospital your room ends up being filled with residents, attendings, students, and family). So since it was so full they said I couldn't be in there. So I stood outside the door and listened to the mother. I could hear by the sound/tone in her voice when she was crowning, you could tell when she was doing a good job at pushing, and then there's one huge yell and then the cry of a baby. Even though I didn't get to see anything it was still fun being with an amazing nurse, and getting to listen in on someone else's experience! 

Day three I got to go and be on the mother-baby unit. That's where momma and baby go after the delivery and stay until they're discharged (baring no complications and that baby isn't in the NICU). I was with the charge nurse that day so I didn't get to see anything too exciting. Something that's crazy about that unit is that you have 4 rooms, but 8 patients. Because you're having to assess both mother and baby and provide education, make sure mom is doing okay feeding baby...basically the needs on that unit are endless. 

Day four I was in the nursery. I got to give IM (hepatitis B) injections to baby, do the PKU (heel pricks), and hold babies. I also got to watch a circumcision, which surprisingly, wasn't as traumatic as I thought it would. For those of you mom's out there...baby hardly even cried. The only time he cried is when they're tugging on the foreskins and that's not really because it hurts (since they're numbed up), but more because they feel the pressure of them tugging. When he got the snip there wasn't even the slightest cry...so there you have it! :) Something sad about the nursery (or just OB for that matter) is how much drug abuse you see. Especially with  UNMH being the hospital that takes anybody and everybody you just see anything and everything. There are constantly babies in the nursery that are going through withdrawal. They come out and some of the babies are put on methadone and then tapered off. There were moms that would come in to delivery that had just shot up with heroine before coming in. There are moms that are treated with methadone throughout their pregnancy and the baby will come out and need to be tapered off. Methadone is an opioid pain reliever and is used to treat withdrawal symptoms in people addicted to heroin or other narcotic drugs that cause a "high" associated with drug addiction. So you have babies that come out and they get scored and based on their score they may or may not need methadone to help them with their withdrawal. 

What does a methadone/withdrawaling baby look like? It's very sad, but they have tremors, an extremely high-pitched cry, rapid breathing, poor sucking, yawning, stuffy nose, sneezing, they have raw chins from itching their chin, they sweat. It's just a very sad situation and picture. For me, that was the hardest part of this rotation. It's so hard to see women come in that way and it's terrible to see infants who have no control over their situation come into this world already addicted to a drug. For me that was so hard to see and I found myself with this anger that surprised even me. I had to remind myself that I didn't know what that woman was going through and I had to remain objective to her situation, but at the same time you can't help but just cringe at the thought of her having a child. 

While we're on the lows of OB I also just want to mention how sad it is to see children having babies. I saw an age range from 13-40 years. I would say that over half of the population having babies are under 17 years old. It breaks my heart to see girls that haven't even lived, that don't even know what it is to be a kid having babies. It breaks my heart and it just blows my mind the thought of someone my baby sisters age having a baby. One of the younger mothers said, "so it's like okay if I like put the baby in the shower right? Like the baby will be okay in the shower?" That's another thing that just makes me cringe just at the thought of these children having babies. 

So nursery had its ups and its downs...on the upside I got to hold babies for hours...I turned to mush by the end of the day. There's nothing like having a newborn on your chest and having them fall asleep as you rock with them. Their tiny little hands and tiny little feet...it's all you can do to not just squeeze the living day light out of them! By the end of that shift I was going to have a baby for everyone in the world...

Quick side note on the PKU...it's all about making gravity work for you and being patient. Wait until there's a huge drop and just let it drip onto the paper. Otherwise you're milking that baby's leg and trying to get them to bleed and fill in the circle, but all you gotta do is gently hold that leg/foot and let gravity work its magic. 

 

Day five I was back to labor and delivery to try and see some babies be born, and I was lucky enough to see two deliveries. One was completely natural and the other momma had an epidural. For both mom's it was their first babies but neither pushed for more than 30 minutes. I was hoping to see the delivery of twins, but her labor wasn't progressing and they were starting her up on pitocin...I would have stayed if I could have, but I couldn't, so I didn't! But let me just tell you there's something awesome about experiencing and being part of a woman's delivery. It's such an awesome and natural thing. There's so much raw emotion that goes into it. Watching the different phases that the mother (and father) go through..there's just no words to describe it. The smell of the delivery room is like nothing that can be described. You just walk into a room and you know...you can feel, hear, and smell it. All your senses are involved and it's such an emotional and simply amazing thing to be able to witness and help a woman through. I'll be honest though the nursing aspect of labor and delivery is cool. I like it, but I'd much rather be the one getting dirty and delivering the baby...just saying...nurse midwife sounds like fun to me! 

Day six was more of a reflection day. We went over a case study that we had to do, we talked about the experience and what we thought about OB overall. And that was about it...that was my OB rotation in a nutshell.