1feistymama, CNA 6,646 Views
Joined: Sep 14, '09;
Posts: 167 (49% Liked)
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I'm doing my preceptorship in Hospice (my 1st choice). Up until now, all of my clinical experience has been in a hospital and I've gotten pretty comfortable with assessments, charting, med passes, etc in the hospital setting. The last two weeks of my med/surg rotation (before preceptorship), I was taking my nurses full loads and they were answering occasional call lights but I did most of the work. I felt like a nurse, like "I can do this".
Now, I find myself using all paper (no computers), the paper charts (3" thick or more) are at the office while we're out in the field, I feel unorganized with all of this paper shuffling and kind of lost without the patient's history readily at my fingertips. I didn't realize how convenient it was to see all of the previous charting so you can say "yea, his condition is the same" or "no, it's definitely changed" or "I see they gave him XYZ and that could be the cause of his problem". How nice it was to have lab values and now we're relying solely on symptoms.
Each time we walk out of a patient's home, I share my assessment and thoughts with my preceptor. She usually agrees with me, but then she brings up things she noticed about the patient (things I didn't pick up on) and I feel totally inadequate. For example, one patient had a sudden change of LOC along with a fever. We all thought infection, likely UTI since that's common. The preceptor asked me what I thought of his breathing. I told her breaths were shallow, on the slower side, and listening to the lungs, there didn't seem to be a lot of gas exchange. She agreed and thought that perhaps he was also having some CO2 toxicity and instructed the family to put his CPAP on until he showed signs of improvement. As soon as she said it, I'm thinking, "duh, why didn't I think of that? We had a lecture on that." There have been other smaller things, but this was the biggie that I felt like, I wouldn't have been what the pt needed at that time.
Going into our preceptorship rotations, our instructors cautioned us to set realistic expectations for ourselves. They reminded us, we are students and won't know everything. But, I can't help wanting so desperately to be everything my patients need and knowing I'm failing. I just don't know enough.
Anyone else feel like they just aren't enough? Any experienced nurses who remember having these feelings and grew past it? Do these feelings resurface anytime you move to a new dept or nursing function?
"we trust that she is in good hands, call us when she passes"
In my case, I got out before he hit me. He was to the point of hitting everything else around me, but not me....yet. He nearly put his fist through the wall once and his steering wheel was warped from him pounding on it any time he got mad. It takes a lot of pounding over a considerable length of time to warp a steering wheel made of steel (old school, full-size van). Clearly, his rage issues started far before me.
I remember thinking if he hit me, I'd know for sure it was abuse and it'd be easy to walk away but since it was verbal, it wasn't quite as clear. After being out of the situation, able to look back as an outsider, it is so glaringly obvious that it was only a matter of time until it escalated to that point. When you're IN the relationship, the blinders go up and you tell yourself it isn't as bad as people think. Wrong.....it is that bad.
You are worthy of a loving, caring relationship with a person who builds you up rather than tears you down. Right that down and read it over and over until you start to believe it.
Question. Is the NCLEX as horrible as I am making it seem in my head? Are they anything close to hurst/ati/saunders practice tests? I take it Tuesday and I just hope I am imagining the NCLEX to be a million times harder than it actually is? Anybody?
Meantime, there are still new threads posted constantly, screaming "IS THIS THE GOOD POPUP????"
I was helping a colleague reposition her recently extubated post op CABG x 3 patient when the woman began to complain and curse angrily at all her chest tubes. She was angry and did not want " all these (choice curse word) tubes" because they hurt and they got in her way. She had a history of smoking, obesity, HTN, DM....the usual cardiac arrest package. I don't know what came over me but I was in able to bite my tongue! I simple stated to her, "You are here because of you! You did this to yourself! You came to us to save your life and that's exactly what we did! So you remember that every time you get angry about having all these, in your words, (choice curse word) tubes!". Surprisingly I didn't get pulled into the managers office. In fact, after that, the patient was extremely appreciative. Do we really have to be that way for people to come outside do themselves and own up to what they do?
I am trying to say this while causing as little offense as possible. In the last few years I have read a number of posts by a) pre-nursing students b) new/recent grads, who express how disappointed they are to find that a) nurses do not value intellectual inquiry and that b) their research/critical inquiry abilities i.e. referring to various studies, etc., are not valued by the nursing school environment/classmates/instructors, and that they expect they may have to continue on to become an APRN or try very hard to find a niche in nursing where they can use their critical thinking abilities. I would like to ask pre-nursing students, students, and new/recent grads to hold your opinions about how much intellectualism and critical thinking is utilized in the profession until you have participated in it. Participating means practicing as a nurse. Nursing school takes you to the beginning of nursing practice; the beginning of the journey. Did you learn about the Nursing Process in nursing school? You will be using the Nursing Process, the nurse's critical thinking process, for the rest of your career. Practicing as a nurse will give you more opportunities to use critical thinking and research than you will ever dream of.
I realize today that some students do not get as many clinical opportunities as students did in the past, but it seems to me that I am hearing people speaking who have graduated from nursing school and seem to have no student clinical experience at all, who appear to be speaking from a completely idealistic point of view. Of course nursing practice is evidence based practice - this isn't new, as the experienced nurses on this site will tell you. You will find research incorporated in nursing policies and procedures and in the standards of practice. Please, hold off on your comments about how nursing falls/may fall short as an intellectual field when you haven't even begun your practice. There are so many different specialties in nursing, opportunities for specialty certification, and nursing and medicine are constantly changing. Just trying to keep up with the changes is a huge undertaking in itself. It boggles my mind when I hear people who are new to the field say they feel they fear their intellectual abilities will not be sufficiently challenged in nursing. If that is the case, it is one's own fault, not the fault of the profession.
It's nice to read a story with a happy ending. Thanks for sharing.
T-Bird - my OB asked, with all 3 pregnancies, if I felt safe but she specifically sent my husband out of the room before asking me.
I as in an abusive relationship as a teenager. Fortunately, I was still living at home so didn't have to worry about finding a place to live but it starts out verbal and they are exceptionally talented at making you believe horrible things about yourself. I was a fairly confident teenager but in 3 months' time, he had me believing I was worthless and no one would ever love me other than him. I seriously considered going back to him but instead, I found a stubborn streak and figured being alone was better. There were other flings after him and about a year after him, I found my husband. We've been blissfully happy ever since - nearly 20 years now.
I don't think anyone truly understands what it's like to be on the receiving end of abuse unless they, too, have experienced it. They don't understand how degraded and unworthy you feel and how scary it is to attempt to leave the situation. You get brainwashed into believing that you will fail if you try to leave and then he'll be even angrier when you return to him and things will be worse than they already are. It's vicious, really. I agree, we need more than just shelters, we need life coaches that'll assist these ladies every step of the way.
I was in a paediatric ward and had come in at 7AM for the hand over and at 11AM I had just come back from my break which wasn't even that long and two parents of a child who had come in were standing around so naturally I approached them and asked if I could help them. They began telling me that they had been "standing here for ages" so I politely told them that I am sorry they had to wait and had just come from my break but I was more than happy to help them to which they sarcastically responded "oh, so they have breaks now when they should be doing their job". Now I'm more than happy to cut short a break or delay one entirely if it means that someone needs my help but since there was an entire wall between me and them during the time I was away, it was a bit difficult to know they were there since I'd left my x-ray vision down in radiography. I just don't understand sometimes how patients and their families can expect us to give quality care and then have a go at us without taking into consideration the length of our shifts and how many shifts we've had to do in a row that week. I wouldn't change what I do for the world but some people just don't understand
I would have kicked Milton out. Dog killer/abusive husband. He'd be lucky that's all I did. Screw the survey.
Wow, Ruby! My jaw dropped further and further with each story!
lpn2B2016 - I think this one made all of us sob and look forward to starting school. Congratulations on starting in January!!! I start my RN this August so we should be graduating around the same time.
I read this article several months ago and yet it enters my mind often.
I've only attended 1 orientation meeting so far in my program (there are a total of 8 orientation meetings this Spring and then school officially starts this Fall). The Nursing Dean informed us we will have lecture tests and then we will have ATI tests. ATI tests take questions directly from the NCLEX. The reason they give you NCLEX questions is so you are already familiar with them when you sit for the official NCLEX and you're more likely to pass when it counts. Our program has a 95%+ pass rate every semester. We have to pay $500 for ATI access (for the 2 year program). There are pre-tests, review material, and then final tests in each area of study. The tests are set up in the same format as the NCLEX so we are essentially preparing for this for 2 years.
While you may have been ill-informed initially, adding NCLEX questions to your tests actually benefits you in the long run. Buy the Lipincott book and start studying. Perhaps speak with those who did well and ask them their study strategies so you can do the same.
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