Chalk it up to Experience. Ch 11

Julie Reyes, DNP, RN

Honestly, the first time I did discharge instructions on my own was a disaster. I don't know why I felt like I was giving a speech in front of 10,000 people, when in reality it was a young mother who needed to know what to do in case her child had any problems with his present illness. I may have overdone it on all of the handouts and education I provided her, from information on breastfeeding support groups to diaper rashes to vaccinations. She seemed a little overwhelmed. I just wanted to make sure she could "handle" taking care of her kid....and though I did educate her on the nausea/vomiting/dehydration topics - the reason for admission- she may have lost all that I taught her when I included education on hand/fist/mouth disease and scabies....

Thus, I learned to stick to the main concern.

I had a toddler in the ED who needed to get two IM injections. I cannot recall why, but I can recall asking another nurse to help me hold him while I gave him the two injections. She asked, "Why don't we tag team and do it at the same time, one in each leg, and we will get someone else to hold?"

I learned to do two things at once.

My patient had been in the hospital for several weeks, and the mother had been the one to mostly care for her during her stay, since the father was working out of town. I would always knock on the door before I entered the room, but rarely waited for an answer. One day the mother said the dad would be coming back into town for the weekend - three days away - and would get to come stay at the hospital with the baby. Later on that day, I went to the room and did my quick knock on the door and entered. Unfortunately, I don't think the scene I walked in on was the baby's daddy and mom together.

I learned to wait for someone to respond to my knock.

Since I was a tech before I became a nurse, I didn't want to overburden our patient care techs when I could do something myself. If I discharged a patient and I had time, I would strip the room and take monitors to the dirty supply room. I would try to take my own vitals, do my own glucose checks, measure my own I's & O's. The techs were always quick to acknowledge the effort since they were always so busy.

I learned how to help others.

When doctors would come to round on their patients, I would update them on the ones I cared for. I followed them in to see the patient so I could be ready to answer all of the parents questions after the doctor left (they never have questions when the doctor is there, for some reason). If my patient began having problems and needed a new order or I needed to discuss any changes in the patient with the doctor, I would call immediately.

I learned the value of good communication.

One little toddler had a shunt revision and was doing well. However, one day she was particularly irritated and the father staying with her was at wits end. I offered to hold her for a while so he could take a breather. I picked her up and put her head on my shoulder. She immediately threw up. All down my back.

I learned to always have an extra pair of scrubs in my locker.

Cathing baby boys is not hard. In fact, I learned that it is not always necessary TO cath a baby boy, because they will usually pee on you once you remove that diaper...and you can catch the urine midstream.

Gaining the trust of parents is crucial. I learned the value of telling parents the truth - if I don't know the answer to their questions, I will tell them and assure them I will do my best to find out what the answer is.

I learned that sometimes you have to advocate for your patient to the parents...especially in times of deciding to withdraw life support.

I learned that some parents need to have a sense of control when their world may seem so out of control. I encourage them to provide as much care as we can safely allow for their child.

I am no longer too timid to tell the parents to take that food out of the room and not eat in front of their child, who is NPO and crying because they want some of the McDonald french fries the parents won't share.

I have learned to rely heavily on the opinion of my coworkers, who may have a suggestion or may have already experienced a situation I am having problems with, to improve my patient's situation. My coworkers are an amazing bunch of brilliant minds, and I am always so glad to have them by my side.

Doing chest compressions will make you sore.

I know we are all taught it during nursing school, and we all double check our meds and administer them by the 5 Rights. However, one day I had an infant and was to hang his IV antibiotics. I received a 60cc syringe in a ziplock bag that was labeled with my infants name. I thought that didn't seem right - just why would I give this much of anything to a newborn? Of course, the med was put in the wrong bag and the syringe label didn't even have my patient's name on it. This med belonged to an older child on a different floor.

I learned to never believe what was labeled on the bag, to ALWAYS scan the syringe label, and to ALWAYS verify right patient, right dose, right time, right patient, right route. I made sure to always check my drug book to make sure I was giving the correct dosage - until I was confident I was giving a dose that was ordered that would be safe for my patient!

During a code, it is very easy to lose track of the time. I was always ready to hand off the drugs to the nurse administering them and sometimes it would seem like we were waiting too long to give the next dose of epi (or whatever was needed). We were usually right on the money, however, thanks to the nurse writing down the times.

I learned the person taking the history during the code may be the most important person.

Depending on the area I was assigned to, I could have 1 or up to 4-5 patients. In the event that a child would take a turn for the worse, I would work with my teammates and pull out all the stops to try to change the course. Things didn't always turn out for the better, and I may still have other patients to care for during my shift.

So, I learned that sometimes, I may have to hold in my tears in until I got home because another patient may need me.

I learned that nursing is an ever changing, dynamic, exciting field, and there were always new evidence emerging, and new ways to provide better care using Best Practice, so I always needed to be reviewing journals in order to provide better care for my patients.

I learned that this is what I was meant to be, and what I love to do more than anything.

What did you learn your first year as a nurse?

Read the preceding chapters:

Go to Nursing School? NEVER!! Ch 1

Culture Shock & Big Girl Panties - Ch 2

Pretzels, Puppies, and Physical Assessment Ch 3

Tales from the Crypt....uh.... I mean Clinicals. Ch 4

Give me a BREAK!!!! Ch 5

RN: Judge and Jury Ch 6

Virtual Reality Ch 7

Avoid Kids at ALL Costs! Ch 8

The End of the Tunnel...Holy Cow - is that LIGHT?! Ch 9