My Journey into Nursing

When entering the clinical setting everything takes on a completely different meaning. Another person's life depends on the actions and interventions that the healthcare professional in charge of their care makes. Decisions that are made in the clinical setting can have very real consequences for the patient. The person in the bed is someone's mother, father, grandfather, or grandmother. They have a wife, husband, children, grandchildren, and friends that love and depend on them. Until today, all of my CPR and Basic Life Support techniques have been practiced on a dummy in the nursing school lab. There is no adrenaline rush when performing procedures on a dummy. There are no adverse consequences for the dummy if a mistake is made. The student just keeps practicing the procedure until he/she gets it right. These procedures seem quite mundane when performed in the lab. But perfecting them in the lab provides the nursing student with the credentials needed to apply the theories and practices to real-world situations. I am a male nursing student and today begins the first day of my "Emergency Room" clinical rotation.

Today begins the first day of my journey into nursing.

"You. Come with me," the small, but strong woman commands as she leads me down a harshly fluorescent-lit hallway - as if she is the arresting officer leading the suspect away from the crime scene. We pass several small rooms with the shower-like curtains drawn until we arrive at the one that has the number "1" posted above the curtain. She pulls open the curtain and we enter the room.

"I need you to start compressions," she says. Compressions, I think to myself, or did I say it out loud?

"You do know how to do compressions, right?"

"Yes!" Of course I know how to do compressions. I've performed compressions many times in lab, I think to myself. Suddenly, I find myself drifting back to the nursing lab.

"One, two, three, four," I counted out loud.

"No. Count one-and-two-and-three-and-four." The voice came from my nursing

instructor Mrs. Culbertson, Mrs. "C" to her students, who was standing on the opposite side of the bed. "And you need to position your hands a little higher or you could break the tail of the sternum and damage a major organ." I repositioned my hands and began to perform compressions on the dummy again, counting with each downward thrust, "One-and-two-and-three-and-four."

"Position your shoulders over the center of the patient's chest and keep your elbows locked. One fluid movement, like a piston in an engine," she said. Standing around the bed with Mrs. C were my twenty-two classmates. We are required to pass the Basic Life Support and CPR training before we start our clinical rotations in the hospital. Today is "check off" day and we are all very nervous. If we fail our "check off" then we could be dropped from the program. Then I hear the voice of the woman in the room with me.

"Okay. Put on gloves and start compressions while I get an IV access line started," the woman says. While putting on my gloves I hear a monotone voice coming from the intercom system, but can't comprehend any of the words. It's as if I'm in the classroom sitting in the seat next to Charlie Brown. All I hear is, "Waaaah waah waah, waaah waah waah wah."

Shortly after the monotone voice finishes its announcement, a multitude of staff members fill the small room. One of them wheels in a blue metal toolbox-like cart with the words "Crash Cart" written on the top. At that moment I realize that the monotone voice had announced a "Code Blue." The patient is in cardiac arrest and the "Crash Team" is here. I begin compressions.

Within seconds a frenzy of highly organized chaos begins. One nurse begins to ventilate the patient, while another is setting up oxygen and suction devices. One nurse begins attaching defibrillator pads to the patient's chest, while another starts to monitor and maintain vitals. Directly across from me -- on the other side of the patient's bed -- a man is calling out directions to the rest of the staff, as if he is the quarterback running the hurry-up offense during a two-minute drill. He calls out one command, and the physician assistant establishes arterial access through a central line in the patient's neck. Another command and the "Crash Cart" nurse starts to prepare medications, while another nurse administers the drugs. Standing in the doorway, a nurse dictates all of the information in the patient's chart to the man on the other side of the bed and records all of the interventions being performed.

There is a constant flow of staff members entering and leaving the room. They come and go as if they are hockey players entering and leaving the ice while the game action never slows down. Their actions are so well reheorificed that no words are needed. Every member knows their respective responsibilities and carries them out with extreme precision. Suddenly, the man across the room says, "Stop compressions!" I immediately stop and watch as he studies the several monitors above the patient's bed. Again I find myself drifting back to the classroom.

"There are several types of monitors that you will have to know and understand that will alert you to changes in your patient's condition," Mrs. C said. "The goal is to assist in the prevention or treatment of organ dysfunction," she continued. "You will see devices that monitor the patient's temperature, heart rate, blood pressure, and respiratory rate. The electrocardiogram, or ECG, monitors the electrical activity of the heart. The pulse oximeter measures the patient's arterial oxygen saturation. There are machines to monitor cardiac output, arterial blood pressure, and central venous pressure. As a nurse you must be able to accurately interpret the information from these monitors and use it along with your senses of sight, touch, smell and hearing to successfully treat your patient." The sound of the man's voice brings me back to the small room.

"Anything on auscultation," he asks. The "vitals" nurse places a stethoscope on the patient's chest and listens for a few moments.

"Nothing," she replies.

"How long has it been," he asks.

"Thirty-five minutes," the nurse holding the chart answers.

"I am going to call it now," he says. "What time do you have?"

"It's 0635," the vitals nurse replies.

"Zero-six-thirty-five," he states.

"Yes, sir," the "chart" nurse replies.

With that statement the entire crew, with heads hung low, begins to haphazardly exit the room. This highly precise group of people seems to have no sense of direction as they leave this scene. It is evident that none of the team members are willing to admit defeat.

The man across the room asks, "What is your name?" I look up and notice that he is talking to me. What is your name, I think. I look down and notice that my name tag is covered by my lab coat. My lab coat, I think. I'm still wearing my lab coat? Mrs. C is going to be really upset. We're only supposed to wear our lab coats when entering and leaving our clinical sites, not while we are performing patient care.

"My name is Greg," I reply.

Welcome to the emergency room, Greg. I am Dr. Veegas. You can place your personal items in the break room and then join me in room two. I have a patient with a leg wound that I will be suturing. It will be a great opportunity for you to gain some experience in wound care," he says.

"Yes, sir," I reply.

When entering the clinical setting everything takes on a completely different meaning. Another person's life depends on the actions and interventions that the healthcare professional in charge of their care makes. Decisions that are made in the clinical setting can have very real consequences for the patient. The person in the bed is someone's mother, father, grandfather, or grandmother. They have a wife, husband, children, grandchildren, and friends that love and depend on them.

Until today, all of my CPR and Basic Life Support techniques have been practiced on a dummy in the nursing school lab. There is no adrenaline rush when performing procedures on a dummy. There are no adverse consequences for the dummy if a mistake is made. The student just keeps practicing the procedure until he/she gets it right. These procedures seem quite mundane when performed in the lab. But perfecting them in the lab provides the nursing student with the credentials needed to apply the theories and practices to real-world situations. I am a male nursing student and today begins the first day of my "Emergency Room" clinical rotation. Today begins the first day of my journey into nursing.