My Senior Nursing Experience Paper

Our nursing class has known about having to write this paper since the very first week of nursing school. We were divided into groups and the faculty that led our group read us the nursing experience paper they had chosen, with the writer anonymous of course, to help us foresee the journey we were about to embark upon and give us each a glimpse of the not-so-distant future. So, here I am a senior in the nursing program and writing my own paper. I have thought about this paper, about whom and what I wanted to write about quite often over the last few years. I don't think that I can just narrow it down to one patient or one experience so I would like to share a few, more or less taking a journey with me through my time as a nursing student, as I have learned to "walk in my nursing shoes". On that note I would like to say that many of the patients that I have taken care of or interacted with have touched me and will remain dear to my heart.

One of the first patients that I would have to say touched me was a woman who was bedridden, had a pain pump inserted into her left buttock (which was a not so brilliant idea) which had broken through the skin and created a pressure ulcer that tunneled, two other pressure ulcers that tunneled, insulin-dependent diabetic, with a history of seizures, as well as stroke and a tracheostomy stoma that oozed copious amounts of sputum. Now, it was not very easy to communicate with her because her speech was hard to understand but with a little bit of patience and sign language I was able to figure it out. I had the opportunity to follow her to pre-op, surgery for the pain pump removal, and post-op. I had taken care of her the previous day and, of course as a student nurse, had familiarized myself with her chart. This enabled me to note the fact that she had a long-standing history of seizures. Now, I came back the next day and the nurse that had had her the previous night had noted seizure activity and told the physician that this was a new onset. This opened a whole new area for a neurology consult prior to having surgery for removal of the pain pump. So, with myself knowing that the patient had a history of seizures and knowing that medication for seizures is different if it is new onset versus seizures already being treated with medication I felt that I had to say something. I did, to whomever I could get to listen, but my information fell on deaf ears. I was definitely in a position of "oh she is just a student and couldn't possibly know." Well, I went through the entire procedure from start to finish, still trying to be the patient advocate that I felt I was and finally, feeling like I needed to take action, put my hand on the chart while the resident surgeon was looking through it and I interrupted her and let her know (of course as sweetly and unassuming as I could sound) about the history of seizures. FINALLY, the resident surgeon acknowledged that she was noticing this too. On the floor, once she was brought back to her room from post-op, she started to have apneic breathing (20 second periods of apnea) and really starting to crash. The nurse paged the on-call resident for the ICU who came to assess her for placement. Well, I was TERRIFIED when he came in the room and started asking questions. I thought, Oh My God I am not going to be able to answer everything when, at the same time I was thinking this, I was "spouting off" the information he was asking for. That was my first "real nurse" experience!

Now, here I am a year later, in my final semester of nursing school. I am two weeks before spring break and three weeks before I start my leadership. I go to clinical thinking that I am going to have a "typical" day and get to choose my two patients to take care of. I have my assigned nurse and we are discussing her patients and she tells me to just come with her to the rooms and meet them and then I can choose, after she has told me a brief report on them all. We get to the second room which is the only one "out of the norm" and realize that there is a lot to be done with her. She is a new admit with no IV access who has a cerclage in place but is having an inevitable abortion (spontaneous), and her physician is 20 minutes away and has ordered medication to be given via IV as well as IV fluids. There was not a moment to stop and think about choosing a patient, mine had chosen me. So, from that moment on we hit the floor running and never stopped!

I stuck her twice for an IV and they blew after getting blood return; the instructor got one and it infiltrated, so we called in the best IV sticker who was working and she got it (while she was in the OB room on the table to have her cerclage removed). No sooner did we get her up there and her IV going and she started bleeding heavier and next thing I know the fetus came down. Now, I did not realize that she was at 18 weeks gestation or that this was her third miscarriage so this was a "shock" for me. I had not started my day being prepared emotionally or mentally for this. A gamut of emotions ran through me as I was there with her. I found myself wanting to do what I could to make this experience bearable for her and be supportive in whatever way I could that would benefit her. Well, once the cerclage was removed she started to hemorrhage. The doctor ordered Pitocin and HemAbate stat and I went to the tube system to wait for the HemAbate. When it came I verified the amount that the doctor wanted drawn up and went to the med room to do this. Well, my hands were shaking awful and I was scared to death because I knew how very important this medication was (the Pitocin was already hanging). There was a nurse in the med room and I said to her "Can you please help me?" as I am grabbing the 3 mL syringe and needle to draw up the HemAbate (which was in glass vials and I didn't have much experience with those). I basically verbalized what to do while I was doing it and drew up the medication and got it ready for the IM injection by myself. I suppose I just needed a warm body to "hear" me and be there in case I did need someone. So, I get the medication to the nurse whom I had been working with and she gave it. I was also assisting the physician by handing him supplies that he needed and, with another nursing student from another school who was extremely helpful and the nurse, we all pitched in and were able to stabilize her to take her back to the room. HOWEVER, we needed a stretcher and there was not one on the floor. One of my classmates, who was a tremendous help, went with me floor to floor to find out as quickly as we could. We got the patient on the stretcher and to her room. BUT, the high dose of HemAbate caused diarrhea so not only is she hemorrhaging even through the packing but she is having very hard and heavy bowel movements as well.

In the meantime, at this facility, if the mother wants a memory card with footprints of the baby and a picture, they provide this. I went in and took this beautiful 18-week-old fetus and foot printed him and took his picture. Now, having had three children of my own with their feet printed (toes and all) I wanted to make sure that I did the same thing. I had to weigh him, measure his length, and footprint him and I made SURE that I had his little toes there too. I took the best picture that I could and gave these things to the mother of the patient for later. One of the very hardest things that I had to do was put him back into the bucket to be sent to the morgue. I must have stood there for ages (at least it seemed like it) and I could NOT make my hand put him there. I had to literally tell myself that I was putting up a "veil" so that I could.

Now, with all of this said she had to have a D&C that afternoon. She was still having difficulty with the diarrhea but we made the best out of it that we could. As she was going down to surgery we finished our day. I felt such a plethora of emotions that entire day, up until late that night, and it didn't really hit me hard until then and I was able to just cry. I was angry that that had to happen to her, sad for her loss, scared because of the hemorrhaging, empathetic to how her loss affected her, but really my heart hurt. I wondered if I had done "enough" for her and wondered what I could have done better. Like I said, I was not in the least bit prepared or expecting that kind of day but I made it through it to the next one. Of course, I had the option the next day to not have her as a patient but I felt it important to follow through with her and I am thankful and happy that I did. I was able to discharge her home and this really helped with "closure".

Both of these experiences helped me see some different things about myself as a nurse and realize that sometimes being an advocate or just having your presence there makes a world of difference. I realize that we are all human and feel, just on different levels. I hope that as I walk on into my career as a nurse I will remember these two patients and remember what taking care of them meant to them, as well as myself.