The Very Beginning

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In the beginning...

If you are a good/typical first year nursing student, the very first patient you ever care for is a terrifying experience. You are convinced that you are going to kill them by taking their vital signs (puncturing someone's tongue straight through with the thermometer is a possibility), that they are going to think you a fool (if they ask you a question and you don't know the answer!) and if they stop breathing- you don't know who to call or what to do. You have to give yourself a pep talk every time you walk onto the hospital unit, much less walk into the patient's room. You don't know who any of the different personnel walking around are. You have no idea what half of the tubing and equipment around your patient is and you are wondering why the room doesn't quite look like the lab at school. And on top of all of this, you are expected to know normal versus abnormal vital signs, put the pieces together and come up with a mysterious concept called a care plan.

And then came acronyms...

Acronyms and terms are swirling around you like alphabet soup, CHF, COPD, PE, H&P, PA, NP, MD, D-dimer, Core Measures, SCIP measures, sepsis, and c-diff. You laid awake all night before clinical, you got sick when you arrived and you know that your fight or flight response is kicking in. Your hands are sweaty and your mouth is numb and you wonder if you should have listened to your family and went for that business degree. But you didn't, and you are here and you have to make the best of it. You had to take a few tests, pass a few lab practicums before they let you in the hospital and then they had you show up, in a uniform to take care of a real patient.

You start...

So you start. And with all of this knowledge and fear and excitement running around in your head, where do you start?

You start by smiling because it helps you relax. You start by collecting your equipment and then walking in the room. You start by putting into your pockets pens, paper, scissors, a pulse oximeter if you have one, a pen light, and alcohol swabs. You place your stethoscope around your neck and you get a thermometer and a blood pressure cuff. You check your patient assignment on the paper you received with the room number and bed location in front of you. You find out what their name is and who their health care provider is and why they are at the hospital. You knock on the door and enter. And just like that, you become part of another person's life.

The assessment...

What comes next is what I think is the most fascinating part of a nurse's role. The assessment. And it begins the minute you lay eyes on the patient and it continues the entire time that patient is in your care. You introduce yourself, and you may even shake their hand. As you do you are looking at them. Your eyes are always roving the patient and their environment. What does this patient's head look like? The patient's eyes, nose and mouth? How do their lips look? How is their speech? How is their hearing? What is their skin color? What about their breathing? How does their chest look, and their overall body shape? How was their hand grasp? Their skin texture and degree of moisture? How do their lungs sound and their bowels sound? How do their feet look and how are their pulses?

Your eyes follow every line and tube leaving the patient to the place where it ends up. Is it connected to a pump, is it connected to the wall? What are the settings on wherever it ends up? Do they have a catheter? What color is the urine?

As you are entering your patient's personal space, you are asking questions. Questions about their symptoms, how they are feeling, what they want to talk about. You can learn a lot about a person this way and get a handle on what they need and how you can help.

You take their vital signs and carefully record them, comparing how these vital signs compare to the person you are looking at. If the sp02 is 82%, is the patient on oxygen? How much oxygen? Do they look like they are in distress? Are they pursed lip breathing? Are their lips dusky? Always ask yourself how those vital signs compare to what you are seeing from the patient in front of you and how they compare to the reason why the patient came into the hospital.

You can do it...

Before you know it, you have your jumping off place. Your very first assessment. As you excuse yourself from your patient to go get some hygiene items for them, you are mindful that their bed is in a low position and that the call light is within their reach.

That is simply how you begin. With your assessment. All of your care planning and all of your care, your good nursing care, comes from that assessment. As you leave and reenter the room for the rest of the shift, Advice to the Younger Nurse Me ... train your eyes to continuously assess. And after a while, believe me, this assessment will be like second nature to you. And then you can move onto more phases of the nursing process: Diagnosis, planning, implementing and evaluating.

But it all begins with that initial thorough assessment. Start there, and before you know it, you will be well on your way to a successful patient care, a successful nursing school journey and eventually an amazing nursing career!

Every single person on the planet has a story. - Unknown