Jump to content

Topics About 'Lessons Learned'.

These are topics that staff believe are closely related. If you want to search all posts for a phrase or term please use the Search feature.

Found 3 results

  1. Happily Retired

    Lessons Learned

    Believe it or not, nursing students, there IS life after nursing school, and what a ride you’re about to have! Yes, there will be bumps and maybe even a small crash or two along the way, but what an amazing career path you have chosen - or perhaps the nursing career has chosen you! Speaking to you as a retired nurse, it’s pretty easy to look back and see what worked and what didn’t; but you sure don’t have that luxury when you’re in the middle of care plans and med passes and dressing changes and cramming for the NCLEX; you live in the moment and do the best you can just to get by one more day. But let me give you this note of encouragement: If I did it, so can you!! I didn’t even start nursing school until I was well into my 30s; I was 40 when I graduated. While I was in school I had two small sons, one still in diapers; I was in school three days a week; worked part-time on my off days; worked at the hospital at the end of the day after classes. I had to drive over forty miles to get to school. (Oh goodness, this sounds like an old parent telling about walking uphill to school barefooted every day in the snow every day of the year! It wasn’t quite that bad!) Every single day I wanted to quit. I would get nauseated when I pulled into the hospital parking lot for clinicals. The ONLY reason I kept on going was that if I quit, I had to immediately start paying back my student loans, which seemed as much as the national debt. It was no picnic. There were days I hated school; I dreaded showing up for class; I dreaded showing up at the hospital for my shift as a nurse tech. I was falling short as a mom and wife; I was falling short as a student; I was falling short of the goals I had set for myself to be a caring and competent nurse. But after a quick cup of strong black coffee in the student union with my study group, I was revised and rejuvenated and ready to tackle the world, at least for one more day, one more class, one more care plan. I strongly urge you to join a study group, a support group; it makes all the difference in the world if you are with the right people. It’s so easy to suffer from self-defeat if you don’t have a good support system from those who understand exactly what your life as a student nurse involves. Utilize every opportunity that your instructors make possible for you; as much as you might be hesitant about some of the more invasive procedures, I promise you that the more you do now, the better equipped you’ll be when you do get that hard-earned diploma in your hand. You can then walk into your new job with a pocket full of self-confidence on your first day. Your best source of knowledge is your patient. Listen carefully to what they tell you, but listen even more carefully to what they don’t say. Many times you will play the role of detective. The CNAs can probably tell you more about the patients than the doctors; the CNAs are an invaluable resource and you will be wise to treat them with all the caring and dignity they so deserve, for theirs is the hardest job, yet they cheerfully show up because they love their patients. Learn that lesson. And that math for meds class that you hate? Learn it inside out, for not only will you learn to calculate drip rates, but you will also learn a level of critical thinking that might save a patient’s life. If you can apply everything you learn in anatomy and physiology to med-surg, you will be equipped to confidently formulate a care plan that will ensure quality care for your patient. You won’t get many chances to prove to the doctors that you know your stuff; so know your stuff. Don’t just memorize information for the sake of passing a test; keep in mind that the information you have in front of you while in school will be information that you will build on the rest of your nursing career. Nursing school is merely the springboard of the rest of your education as a medical professional, for you will learn every single day on the job. The first nurse manager I worked under had a rule that we would celebrate our mistakes, even though that celebration more than likely always ended up with an incident report for something as simple as dropping a pill on the floor. But I can promise you that when you acknowledge - and celebrate - your mistakes, you will likely never make that same mistake again. You celebrate because it is a passage to becoming a better nurse. Someday you will look back and see the reason for every care plan you had to write up, every med card you were required to prepare. Your instructors are not being overly hard on you; they are preparing you for just a glimpse of the reality of life as a licensed nurse. Be very proud of that hard-earned license and never ever put it in jeopardy. Your job, your calling as a nurse, is one of the noblest professions. Congratulations on a job well done! Written by Joy Mathis Chadwick, RN (Retired)
  2. Meagan

    A Letter to my Hospice Patient

    To the Patient I’ll Never Forget When we first met, it was my third year of nursing. I was young and excited to start my new job in the clinic. You were in your 80's, and had been through a lot - Heart Disease, Chronic Kidney Disease, Dialysis, and now CHF. By the time we met, you had been coming to the clinic for several years. I heard nothing but wonderful sentiments about your kindness and resilience from my coworkers. I had only known you for 6 months before you surprised me – you wanted to transition to hospice. I remember that day very clearly. We had been working very hard to keep your CHF under control, but we knew it wasn’t enough. You were more short of breath with minimal activity, had more swelling to your legs, and developed reoccurring ascites for which you required numerous abdominal paracentesis. You went to see the renal specialist and cardiologist – and hadn’t received good news – there was nothing else they could do. You see, at that time, I had been a nurse for about three years and my experience came from a busy Telemetry unit. I had taken care of and helped to transition many hospice patients, but they hadn’t walked out of the hospital to go home. They were usually very ill, and after lengthy conversations with family and physicians, they were transitioned down to the inpatient hospice unit. As a nurse, my experience was actually caring for the hospice patient. What I didn’t have experience doing was initiating the hospice transition. You were my first. And, after you passed away, I realized I had learned some of the most valuable lessons in my nursing career. I learned to slow down. When you work in the hospital, you’re always in “save” mode. You’re on high alert for the slightest change, because if you don’t catch it, it could spell disaster or even death for your patient. You’re ready at the slightest change to race down the hall and put to work those ACLS skills you worked so hard to learn. You’re ready to be the best patient advocate you can be to save their life. But I didn’t work on the unit any more. I worked in a clinic with a patient population consisting of the chronically ill. It dawned on me when you chose hospice that it was okay to slow down. I learned it was okay to use my clinical judgement as a nurse to initiate those difficult conversations with my patients and take a more holistic approach. I learned that hospice does not mean “giving up.” When we talked about hospice and your thoughts on starting the process, you told me with such conviction that you were ready. You had been through “save” mode many times. You had been stuck countless times for IV’s or labs, had numerous abdominal paracentesis’, and had already been through dialysis. By this time, you didn’t want any more doctors office visits, trips to the hospital or any invasive procedures. I remember you telling me that you felt so blessed to have made it this far, and that resonated with me. I learned what dignity truly means. By definition dignity is, “the state or quality of being worthy of honor or respect.” After you passed away, it was hard for me to see that empty chair every week. But, what I realized was that you had given yourself and your family a gift. There are times in our nursing careers when we see patients who can’t make these decisions for themselves. Sometimes they don’t have advanced directives in place, or they have family members that just can’t agree. I respected your family’s commitment to your wishes, as this is something I don’t think we get to experience often enough. Although many years have passed, I will never forget the conversations we had, and the lessons I learned as a new nurse. I think about that day often and I thank you for helping to shape my nursing career. Fellow Nurses, have you had similar experiences that changed your nursing practice? What was your greatest take-away?
  3. Working in a Geriatric Psychiatric Hospital, a lot of our patients are awake at night which requires the staff to do a lot of interactions with them to help promote sleep. This particular night, my lady was awake at the beginning of my shift, loudly talking and pacing in her room; unsafely preventing her roommate from sleeping. We questioned her as to what was wrong and what could we do for her, we were unable to pinpoint what was wrong therefore a staff member was assigned to stay with her until she calmed herself or went to sleep, Unfortunately, this did not work. She was adamant that she wanted to walk up and down the hall. We decided that maybe this may relieve some of her anxiety. Due to her unsteady gait, we applied a gait belt as it is recommended by PT or all patients that may have unsteady gaits or difficulty transferring. The belts are applied around the patients' waist while the staff js positioned close near the patient so they are able to grasp the belt if needed as a means to provide safety for the patient. After applying the gait belt she let out a piercing scream and began to cry...... her reaction stunned us all causing an instant pause. Tearfully she pleaded for us to take the belt off and began telling us how as a child her father would beat her with a belt then use the belt to tie her to a boiler while he played cards and drank with his friends.... it made her feel just like a dog. We immediately removed the belt and walked her to her bedroom. She continued to cry repeating over and over how she could not believe this is happening again. After assisting her to bed we sat with her for a while, looking up at us but not focusing on us, she began to say how much she loved her father but could not understand why he did this to her. She recalled her mother telling her how her fathers' drinking was the reason he did these things and he did not mean to do it. Listening to her story saddened all of us. There was not a dry eye in the room after her revelation. She looked at each of us and proceeded to tell us how she thought she had gotten over it and really she felt she should have but when we put the belt around her it brought back those painful memories she thought she had long ago tried to forget. Noticeably calmer now, as she lay in her bed just as we about to leave her side speaking in a soft voice, she wanted us to know that it was not our fault she failed to tell anyone what had happened to her.... it was just too painful but next time please listen when someone is trying to tell you something. Even though we were not aware of the traumatic experience she had, we should have realized that something was wrong. We must not only take the time to listen but listen with empathy and compassion using all of our senses to be able to individualize patient situations as they arise. She was referred to our Psychologist who scheduled weekly counseling sessions. All staff were alerted to the non use of a gait belt for her. This was one lesson well learned and will forever have an impact on us. As for my self, I will never forget this incident and it has encouraged me to look at my patients differently. I will from now on ask more questions, pay more attention to changes in behavior and focus on body language. There are times that small things are overlooked when you are very busy and or dealing with difficult patients. That saying "One size fits all" when it comes to Psychiatric nursing should be "One size does not fit all". Phyllis