Saturday, July 10, 2010

Patient Contact

I just had my first day of clinicals in OB. That was wicked awesome.

I was assigned to the postpartum floor. The patients there are moms who have recently given birth and aren't up to going home yet. In this hospital, a mom who's had a Caesarian section generally stays there for three or four days, and others are there for one or two.

Nurses start the day by taking report from the night shift and being assigned to patients. As a student I technically have one patient. I'm responsible for knowing just about everything in her chart: her history, current problems, medications, allergies, pain level, needs for the day, and anything else that might be relevant to her care. I can of course reference her chart when necessary, but life's a lot easier if I read it ahead of time.

A full-fledged nurse is also assigned to my patient. She's there partly to make sure I don't screw up and compromise the patient's care, and to handle things I am not allowed to do solo. But she's also there to instruct me in how to work and think like a nurse.

(I also get teaching from my clinical instructor. She is a nurse associated with my school, not with the hospital, and her whole job is to be our teacher. However there are several of us students, we're not all in the same place, and she's only one person, so I only get to see her every so often.)

My patient was in reasonably good shape and had a great outlook. She had reasons for still being in the hospital, of course, but I didn't have to spend every minute in her room. This allowed me to follow my primary nurse around and help her with other patients. I have to say that the nurse I was assigned to was awesome. She kept asking if I'd like to do some procedure-- like remove a foley catheter, or take out an IV-- so of course I always answered yes!

I think the highlight of my day had to be giving an injection. That's one of the simplest skills to learn, but the idea is contrary to some normal concepts of safety. The instant before I did it, I had to stop and look at the nurse for reassurance, because my brain insisted that sticking sharp metal into a live human was Not A Normal Thing. But she gave me a nod, and I went ahead and did it just like in practice.

The patient I was vaccinating did not like needles. She couldn't even look at the syringe in my hand. But after it was done, she told me it didn't hurt like she expected; in fact she barely felt it. I said, "Thanks! Now I can tell you that this was my first time ever."

There were some other cool procedural things too. I got to remove foley catheters on two patients, remove IVs on two patients, and pass out oral medications. I also recorded vital signs, assessed an incision, and did a "fundus check," which means feeling the woman's belly to make sure her uterus is contracting and shrinking as it's supposed to after delivery.

On top of that, I spent a bunch of time running every errand that needed doing. I refilled a lot of ice water jugs. I handed out towels, ran lunch trays, and stocked some cabinets. I manned the phones at the nurse's station, to the surprise of everyone who called and heard a male voice. This all was new enough to me that it was still interesting and didn't feel like scut work.

A second nursing student was also assigned to postpartum, doing the same stuff at the same time in a different set of rooms. Between the two of us I think we made things easier for the nurses and the tech, rather than making extra work for them.

The other members of our clinical group were assigned to other parts of OB: either in the nursery with the babies, or in labor & delivery. Two of those students got to scrub in to the operating room and observe a Caesarian section! I'm a little envious of that, but hopefully I'll get to see both a C-section and a "regular" birth before the semester ends.

Next week I will be assigned to labor & delivery. Over there I will mostly be watching, because even licensed nurses don't get to deliver babies, but hopefully it will be as fun and interesting as this week was.