OnTheRoad

Thank you both for replying.

I got a job with a HH agency and have had exactly 1 patient whom I have been seeing for 8 wks. I was supposed to discharge the patient tomorrow because patient really isn't homebound ( functions quite well and brings self to the mall and is hoping she can find some elderly employment to take up her days, as well as being able to drive to appointments, grocery shopping, etc). A week ago patient had an outpatient procedure to have a toenail removed and the office wants me to recert tomorrow for that reason. It is true that her toe could become infected, patient is complying with doctors orders concerning wound care. Is this really a reason to recert? As my training consisted of 2 15 minute assessments ( I have always spent my entire hour with my patient), I was ready to put an end to this professional relationship after closing this case. I am wondering if I should now run and also refuse to do the recert??? Any help from you experienced HH RN's appreciated!

Pinning on Dec 18th here. Or at least I hope so. Over half our class failed our first med surg 2 exam, so every point is needed now. I am thinking positive though :)

How many semesters in are you? Skills present themselves as they present themselves. Personally... I am almost done with my AS and still have not inserted a foley. It isn't that my instructors haven't looked for or I haven't looked for opportunities, there have simply not been any to start during all my clinicals. One day I will start a foley and in the mean time I will do whatever else my instructor or nurses will allow me to. I have been reminded consistently though that almost anyone can be trained to perform a skill... it is the critical thinking and knowledge that makes us nurses. Try to remember that and if you stick with your program... research what instructors teach what clinicals and try to get into ones that will suit you more. Just my two pennies :)

Thank you all so much for your responses. It helps so much just to be able to share and to realize I am not alone. I know I will see many horrible things in my career and there will be I am sure many people I just won't be able to forget. It would have been so much harder to get through this first big one without all of you. Oh and on spongebob... I find I can no longer fall asleep at night unless I put on cartoons. My mind races all night if I don't put something else in there. Noggin is my friend LOL

I graduate in a few months and this week while in ICU I had a new admit that had overdosed on tylenol (like 50 ES tabs). I worked for hours with the nurse and doctor doing one on one care keeping the pt alive and caring for the pt... I won't add all the details. By the time I left for postconference I felt like my head was filled with fuzz. As soon as I got home and was able to be alone I just started crying, and being afraid that I am not cut out to do this job because this affected me so much. Thinking about this and dealing with it alone I am hoping this just means I care and eventually it will get easier. Has anyone dealt with this yet? I just need to share somewhere and here seems a good place. thanks for listening to my rambling:(

I am in your shoes. I have always done well on tests, but my exam today means I basically have to be perfect the rest of this semester and I don't know what happened! I emailed my instructor to ask for a one on one exam review to get some input into what I need to do for this class that is different than the last 2 years, but I am terrified of having to repeat a semester. Instructors told us that 1/3 to 1/2 of the class fails the first exam, but I never thought I would be one of them. (((((((((Hugs))))))))) for you and me!

I graduate in December and I remember like yesterday how nervous I was my first clinical ( can we say ready to pass out?). I am still nervous with each new challenge or situation that comes my way. Reading these posts reminded me that I think I have again begun to get that deer in the headlights look ( when speaking with my instructors). Now that look is based more on "OMG what do they want from me?" rather than on being unsure of myself re patient care. When it comes to patients I have always tried to remind myself that I could be in their shoes and what I would want most to make me feel secure is a smile, compassion, honesty, and for noone to say OOPS! So if you take vitals and can't do it as quickly as you would like etc., remind yourself you are still learning ( your patients know you are a student also). Don't let it add to your anxiety, just do what you need to do and if someone asks a question you don't have an answer for ( be it instructor, patient, staff) tell them you are not sure, but will find the information.:typing

I honestly don't think there is a better way. Depending upon how you are being taught or required to do them or how long you have been doing them will affect how much you learn from them though. When I started out, my goal was perfection and I didn't think I retained much. I got a week to formulate a single care plan (1 or 2 dx)and I would stress over it the entire week and it would be perfection. That is not practical, but unbeknownst to me I was actually learning a little. Then I graduated to prep work (check out my pt the night before and have care plans, pathos of disease, all labs, all meds, etc), when I started it took me at least 5 intense hours to do all this to my perfection standards but dang if I wasn't REALLLY learning and retaining info. Then I started being able to do all this work in 1 or 2 hrs, plus once I got my assessments and interventions and assessments done for the patient I had I would shadow my nurse and found I was coming up with care plans in my head based on assessment info on patients I knew nothing about 2 minutes ago. I never realized I was learning what I was learning, but I have been learning. When I have my RN I am not going to have a week, or a day, or even hours most likely to decide how to best care for my patient. It has to happen now, because their health issues or emergencies are not going to wait for me to check all 50 million reference books I have sitting in my library. Care plan at the most basic level = how will I care for this patient. Think of it this way... Dude can't breathe well (ineffective breathing pattern, impaired gas exchange whatever); what do I watch for assessment wise, labs, what can I do to help him out? OK did that, how did he respond, what helped, what didnt? Gotta use Nanda sure, but you really are just saying " this is the problem, this is how I think I can help the problem"

I don't know if anyone has mentioned this, but in my program we have to go the night before clinicals and gather information about labs and diagnosis (medical) etc. We are not allowed to go near the patient. I usually look at assessment data from the last 24 hrs as well so I can at least have somewhat current data to go on, but I have to formulate my DX and care plans initially based upon only what I have read. After patient care day, we go back and adjust for what we actually saw during our assessments etc. It can be very difficult to formulate correct DX and interventions based on only lab values and md DX, but some of us have to make our best guess at what we MAY be looking at when we actually get access to the patient.

I think for most of us, when we first start writing care plans there seems to be so much emphasis on the diagnosis part of things that many of us fail to simply start basic and look at what is going on with our patient and what we can do to improve their health, comfort, etc. When I started writing care plans I would look through my nanda list first, grab a DX I thought might fit, then look for symptoms and RT... you get the picture. Now I look at symptoms, lab values etc first, find the problems, decide what I need to do to treat the problem or help the situation, then find the dx that matches. I also do not start my care plan till I look up all abnormal labs, medical diagnosis, and medications as they will give me a much better idea of what I am looking at. I think all of this can be a difficult process of learning. Sure it isn't rocket science, but it is a foreign language one needs to learn on the road to RN. If it were as easy as pie (not adpie) then anyone could do it and anyone could be a nurse eh?

The thing about care plans (which I used to hate btw) is that they really do teach you to think critically and to know what to do for your patient and why. You can train just about anyone to do clinical skills, but not everyone that can perform a skill knows why they are doing it. Patients and family members can learn injections, suctioning trachs, administering feedings, caring for wounds, so on and so forth.... so why do they need nurses around? I get really frustrated when I have to spend hours doing prep work and writing care plans for my patients before I even see them and then find out that half of my care plan may not fit because the patient isn't in the condition I expected them to be in. But after spending hours and hours focusing on what I need to do for someone in renal failure, CHF, COPD, Cirrhosis, etc I have really learned some valuable information. When I get to clinical and maybe the patient is better off than I thought they were and I don't need to use all the interventions I had decided on I can adjust my care plan. Next time I have a patient with similar problems My mind immediately starts going to the information I gathered last time that is now thoroughly stuck in my brain and I don't have to work so hard in knowing what to look for and do to care for my patient. I don't know if I am talking in circles, but I hope I made a little bit of sense to you in explaining why careplans are such a necessary evil

We have to look all that up and do all the work, but we are not required to be able to recite things verbatim from memory. We will be required to be able to tell her what is going on with our patient something like " Mr. X is a 70 yr old with peripheral neuropathy admitted due to injury to his left foot. He is scheduled for Below the knee amputation on such and such a day etc" (totally made up) If your instructor is reprimanding students in front of patients, someone needs to be reporting that as it is highly improper among other things.

I personally like being able to refer back to previous lectures whenever I want to, and get right to them without alot of searching through my binder. I bought write on tabs and label them with each body system as we cover it in lecture and insert the powerpoints and my notes. That way I can cross reference to a particular body system say between OB and Patho, or med surg and patho etc.

I asked my instructor the last day of clinical about the care plans. It seems to me that she really doesn't like care plans in general. She really wants our OB clinical section to switch to clinical pathways. Seeing as she has to have us do careplans she wants us to think on our own and has seen too many canned careplans. I ended up doing impaired communication and activity intolerance. The problem I ran into is that most of my interventions could not be fullfilled within this particular hospital setting as there is no interpretor available... period. I am wondering if alot of hospitals have this problem when they have non english speaking patients.