So I would consider myself a pretty tough cookie. I generally roll well with the punches and shrug things off. But I am super duper frustrated with school.
Last week we started our Acute Care Clinical rotation and it was tough. So tough that on my 2nd day, I cried all of the way home and wanted to quit. I know, that's so not like me. Which is exactly why it is so hard. I feel so unprepared to even be in the hospital. I feel like I haven't learned any skills and that I am just plain old lost.
So here is how my crappy ass day went. Our 1st day at the hospital was Thursday. We got oriented to the hospital, out instructors and to the floor that we'd be working on. It was all talk talk talk so it was pretty tiring. After lunch, were assigned our patients for the next "2" days. Awesome. Right away I began the work that I needed to complete. I looked through my patients chart and gathered all of the info that I needed to get familiar with him. I had even begun to think about what I was going to go for a care plan. I went in to meet him and it was all good. He couldn't speak, so I couldn't get any info from him. It was going to be strictly me and the charts, no problem, I could had that. We only had about an hour or so to look at the charts and gather the information. I got the bulk of what I needed, I could get the rest the next day.
Well surprise, surprise....I am the only person out of our group of 6 that's patient left the floor. On Friday morning, I was assigned a new patient, I had to start all over from scratch.
Ok cool, I can handle that. Starting over from scratch, no big deal. Deep breath, dive into the chart. New patient, not as many issues as the last one I had, so its looking good. Strike 2...my new patient has already received AM Care (bed bath, changing the sheets, oral care), my instructor gives me another patient to do that for. I am supposed to gather my supplies and meet her in the room. I feebly attempt to get some info on this patient...I don't even know his name or why he's there. Well she's rushing me because we are on a tight schedule and I go in pretty much blindly. Lucky me (and lucky her I might add), I get paired up to do this AM care with another girl who has absolutely no experience (just like me). Mind you, there are 4 other people in our group who all work in a patient care settings, but that's cool pair up the two "green" girls who have absolutely no idea what they are doing, we will do the best we can. We gather up our stuff and we start our care. Surprise patient is roughly 300 lbs, short of breath, has an NPO (no food) tag on his door. NPO?, I think, why does he have a breakfast tray? I ask the nurse and she says its OK for him to have food.
We do the bath to the best of our abilities. He can't lift his leg for us to soak his feet, he can turn for us to wash his back, he's breathing so heavily I was starting to get nervous. Surprise, we roll him, he has a fecal back and it is leaking all over the place. Argh...now what do we do. We get our instructor and he helps turn him so I can clean him up (now its not pleasant to clean up a person, but it really doesn't bother me). Well i was expecting a bed bath, not to have to use 20 wash clothes to quite literally clean up all of that poop. I definitely wasn't prepared. When the instructor came in she was all disappointed with us. We weren't doing the bath properly, we didn't have the soiled linen bag prepared, we didn't have all of the answers she wanted. Now it was time to change his bed which became another task. I didn't have the bed high enough to use proper body mechanics (but I did, my instructor is like a foot taller than me) , I didn't use proper asepsis (clean technique) and I didn't know how to change a gown with an IV. I KNOW how to change a gown with an IV, but not an IV that is running through an infusion pump. Finally we got out of that guys room. The PCA comes by and reminds me that I need to get rid of the soiled linen. Ooops! I put it in the wrong room. I put it out for the garbage, not for the soiled linen. No biggie, I go garbage picking and put it where it needs to go.
Huge SIGH!!!
Now I can get to MY own patient. I go in to see her, she's totally zonked out. I try to wake her, but she's not responding. I tell her that I need to get get vitals (like she can hear me) and I proceed with getting them. Not too bad. I had to get her temperature under her arm, because she was not awake/alert enough for me to get it orally. While she's sleeping I do my baseline assessment to the best of my ability. I get about 80% of it done, I can get the rest when she's awake. I report to my instructor the vitals and she has me contact the nurse for my patient because she has a fever. I find him and we go in the room. She's still zonked out, but we (actually, he the RN) needed to do a neurological check on her. She shook her arm, poked her in the chest to get her to awake up. After a few very "rough" tries, she was wearily awake. So response to any questions except her name...which was VERY hard to understand. I watch him do the neurocheck and then get pulled away from my patient to go help another student do her AM care on her patient. I reported my vitals to my instructor and got grilled on why I didn't take the temp orally. Duh...I can't get my patient to open her mouth!
Good news, he's not 300 lbs, but he only has one leg, can't talk and can't move his right side. We can handle this. We get our supplies ready and in walks the RN and she needs to do the IV change...do do do do, we wait 15 minutes for then to get all of their stuff done and we can finally begin. It going well, no issues. We are doing a bath like we learned in the lab. But of course, there is a problem...of course there is a problem. He has a brief and its full. I never learned how to change a brief so I have no idea how is the best way to do it. Poor guy has 2 amateurs that have no clue working on him. We undo the brief and we can't get it off, the tape is sticking to his skin. So now we are all concerned about his skin because that one of the biggest issues we've learned about in class. We don't want to pull too hard and tear his skin, but we can't get this sucker off. We HAVE to find SOMEONE that can help us. Hooray, we find a nurse to come to our rescue and help is out. But alas, our troubles aren't over, we start making his bed and we can't get the sheets to go on. Now the patient is getting irritated and we are feeling defeated. We both want to cry. And surprise...here comes our instructor its time for lunch and we need to hurry. I make light of the situation with the patient and tell him that he'll have a story to tell about the two dumb blonde's that can't even make his bed. He smiles and it makes me feel better.
Finally with a lot of muscle, we tug and pull the sheets on and get the bed made. We thank the patient for being so agreeable and we promise not to bug him anymore for a few hours.
Hallelujah....its lunchtime. HUGE SIGH!!!
After lunch its back at it. I need to get vitals again. I go in and my patient is now awake. Poor thing is so confused. I smile at her and ask her if I can get her temperature. She nods her head yes...but I can't get her to open her mouth. I try for 10 minutes asking her and demonstrating what I want her to do, but she's not responding. So I go for the underarm again. I report my finding to my instructor and again I get grilled about the axillary temp reading. Do you think if I could have gotten the temp orally, I would have? Then I could save myself the BS, from you that I am going to have to listen to. She then asks me if I've moved my patient. No...I say, she's been just about comatose all day and you didn't want us to do a transfer without you there. She gives me that disappointed look again, GRRR. So we go into to move her and the patient just keeps saying, Ms., Ms, that hurts, like 50 times. I swear that was the only time I heard her talk all day and clearly for that matter. So as my instructor is pushing and pulling her, she keeps saying how badly it hurts. We roll her so I can see the ulcers she has on her back and she has a full brief. Hallelujah we were in a time crunch, so I just had to tell the PCA. But we didn't end up even turning the patient at all because it hurt her. It was about time for the day to be over and all we had left was post conference.
I cried all the way home, I felt so defeated. I hope it gets better and easier.
