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My second semester was very exciting because we FINALLY got to do clinicals in a real hospital. I had a fantastic instructor who encouraged learning, did not make you feel like an idiot, was kind and gentle, yet expected nothing less than excellence (or at least that you tried your very best). No doubt she was called to be a teacher.
I am honestly having a hard time remembering my first patient in the hospital, but do remember it being the first time that I would have to try and get someone on a bedpan by myself. In the nursing home, we teamed up a lot to work faster. But now, we had to learn to manage our time as well. It took me around an hour to get this poor person on the bedpan, wait for them to finish, and get them off and clean them. And guess what?? It spilled. So, now, after making a bed on a bedridden patient, I had to do it all over again. It was horrible. I kept thinking, “This is NOT what I signed up to do”. It was not until later that I truly learned how important it was to know everything from the ground up about skills and how to care for a patient because I would certainly be training, delegating, and evaluating those who were also going to be doing these things.
I think my most stressful day at clinical in the nursing home was near the end of my rotation. We FINALLY had a resident who needed a catheter changed. She had an indwelling foley catheter and was bedridden. A very nice lady who was more than willing to have students learn at her expense. Our instructor had us huddle together and asked who wanted to change the catheter. Nobody volunteered. Honestly, this was primarily because we were told that if we did a skill improperly, we would possibly fail. So, the obvious choice was just to never perform skills for as long as no one caught on, and then just learn them once we graduated, when we weren’t getting a grade for it. Okay, so this is a rather stupid idea, but it did run through our heads. I mean, wouldn’t it make sense to provide a more conducive environment for learning, rather than one that was motivated only by fear of failing. We were frequently so afraid that we just went blank many times, simply from fear.
There was a lot of opportunity for practice on a dummy in the nursing skills lab. All of your catheter supplies came in this nice kit so it was easy for you to maintain sterile technique and get it all down pat. But let me tell you, it is NOTHING like putting it in a real person. First of all, women are FAR harder to insert a catheter in than a man is. (That is, unless the man has an enlarged prostate and then you continue to meet resistance and the catheter coils within him. Ouch!) So, this one poor girl, we’ll call Hope, was selected. The instructor stated that she’d be back in 15 minutes and asked Hope to review her skills and collect her supplies and they would meet in the room. Hope began frantically reviewing the procedure and then went to the supply room. Poor thing, I was just as overwhelmed as she was. Okay, so you look for “catheter kit”, right? At least that’s what they had in our skills lab. Well, this nursing home was being rather cost effective and decided it was much cheaper to not only use a different company that sold catheter supplies, but to also buy each piece separately. You had to also remember exactly what all was in that so easy and wonderful catheter kit that they didn’t have there. So, you choose what size French catheter you want. You mean there’s a difference? Uhm, maybe the size in the middle? Okay, a 14 french sounds good. (No idea what the difference is between it and the others except it looks a little bigger.) Now, you get to (without wasting) decide how many times you’re going to screw up, so you’ll want to get that many catheters. Now you have to pick out a bag. Do you want a regular foley bag, a leg bag, or a bag with a urometer? Uh, not sure she looked beforehand, so we’ll go with a regular foley bag. Okay, we need sterile gloves, and a few pair in case you mess up. Okay, choose a size. I have no idea what size I wear, and Hope didn’t either, because the kit comes with a one size fits all. Again, she just picked one of the middle range sizes—Hope looked like she had average hands, anyway. Were we forgetting anything? Yes!! We needed some sort of cleanser to clean the lady with before inserting the catheter. They didn’t have those super nice prepackaged betadine swabs like we were used to. We only saw this bottle of betadine that was big enough to put in fifty catheters. Were we allowed to take that into the room? Well, it was all we could find; so we took it. But what were we gonna clean her with? This stumped us. There were none of those gigantic cotton swabs like we’d previously used. Maybe some sterile gauze? Grabbed it and took off.
We met the instructor in the room. She stands there waiting for poor Hope to begin. The lady resident was so sweet and let our entire group of seven students watch as Hope began to shake just opening the packages. She opened them out of order (not being used to doing it this way), the catheter size was incorrect, and the gloves were too small. We were not allowed to take the betadine container into the room because it was now considered “contaminated” and we had to waste it all after using it. Apparently, we were supposed to get a sterile urine specimen container and pour it into that and that could be brought into the room. We forgot a chucks pad to put under her bottom so as not to stain her bed and mattress. What a nightmare!!
Okay, so after correcting all of this, Hope began. One student held a flashlight shining on the woman’s private parts as seven students and one instructor all watched. Uh, where’s the hole? We were all looking at the instructor and Hope wondering what in the hell you do when you can’t find the hole! She had a bladder and uterus that had dropped which severely complicated things. Uh, well, finally she found a hole, so she inserted it. No urine flowed back into the tube. Okay, so was her bladder simply empty, or had she stuck it into the wrong hole? We learned that she had stuck it into her vagina instead. She left it in the wrong hole and began to search for the correct one. So, we remembered this trick where you ask the patient to “bear down” like there gonna pee (praying they don’t pee in your face). When they do, the urethra “winks” at you, and for a brief moment you see it open. Well, it worked!!! We saw it, and poor Hope made a second attempt. She kept pushing it up into her and she struck gold!! Urine, that is. The entire group applauded. It was kind of comical. The poor lady resident was trying to give Hope all kind of tips, but none of them were remotely applicable. But the resident felt she had just given the group the greatest experience of our lives. She was so proud she helped.
That was one heck of an hour on one of our last days. I can still see this scene in my head. 
So, some memorable moments in the nursing home was when my instructor came in to help us give a bath to a rather rowdy resident. This older lady could be downright MEAN. She was confused, and got frustrated easily. When this happened, she could get quite physical. Yeah. So, there we were trying to bathe her when my instructor walked in to lend a hand. The older lady apparently didn’t like my teacher from the time she saw her, so she pinched her on her butt, and my instructor firmly told her that she could not do that. The older lady did not take well to that, so she reached up and slapped my instructor. Really hard. I really didn’t know what to do. I mean, I’d never seen anything like this in my life. I think this was the first slapping I’d witnessed. My instructor was embarrassed, and probably in some stinging pain too. She had a pretty good red handprint on her face for the rest of the day.
Another resident that I had was an older British lady who had osteoporosis. She was so frail and had kyphosis (hump back) really bad. It looked like she was frozen in a position as if she were bent trying to touch her toes. It was just horrible. She cried and cried with pain from the osteoporosis. When we tried to clean her up, we had to get her beautiful Laura Ashley gown off of her. She screamed when we tried to take it off because it hurt her to move so much. She cried out for us to just “cut it off” rather than slip it over her head. I remember somehow getting it off without having to cut it. But this left such an impression on me. I had no idea what a severe case of osteoporosis could be like; such pain and suffering. I WILL remember to drink milk or take calcium supplements!!
As a first semester nursing student, you typically do some rotations within the nursing home. (This is, unless where you live has a lot of clinical space at the hospitals, which was not the case where I was.) The day before the clinical, you must go to the facility and get information on the patient which you are assigned. This can take quite a bit of time depending upon which patient you get. Most of the patients in the nursing home have charts that look like novels, and usually are broken down into more than one continuation of their chart. It’s really hard to find where and when problems originated, which is part of the information you are to collect. After doing this, we would go into the room and say hello and let them know that we would be their student nurse the next day. Okay, so I would probably freak out if I knew I had somebody practicing on me. But these folks LOVED having students. And the staff did too; it really helped them out! The nursing home residents would get extra attention and some interesting conversation for the day. I met some of the most interesting people during my clinical experiences.
Although it was a few clinicals later until I got to give medications, I remember just about freaking out over how many pills these people could take. And then you’d crush them all and mix them up in applesauce, YUK!!! Sometimes you would get residents that would refuse their meds, or spit them out at you. It was totally impossible to know how much of what medication they actually took in and how much they had spit out. This made it extra difficult when we would try to evaluate if a new medication was actually working.
Overall, aside from the smell that you pretty much have to get used to, the nursing home is a pretty good place to work. I can say this from experience as a nurse manager now. But at the time, I swore up and down that I would NEVER EVER in a MILLION YEARS work in a nursing home. Yeah, I’ve done a ton of stuff I said I wouldn’t do. Eating my words……is that how I gained that weight? 
I began this program having almost all of my prerequisites finished. This would make my life a ton easier during the program. I remember the first day: orientation. I saw the second year nursing students walk in and thought “Wow. I wish I were one of them. They are almost done.” In a two year program, they were considered “Seniors”, while we were considered “Freshmen”. I never understood how that worked exactly, being a junior college and all, but whatever. In only one year I would too be a senior nursing student.
I did feel a little bitter about the fact that the majority of the few hours I had accumulated did not get me out of having to take classes. This was because the majority of what I had done at the four year university was primarily theory courses. Like writing papers about Florence Nightengale and such. Honestly, I still don’t like the theory part of it all.
What do I remember most about that first year there? Well, for one thing, my class was definitely a mix of traditional and non-traditional students. It gave us some mother figures, but they were usually, and very sadly, the ones who struggled the most. This was certainly not because they were lacking in intelligence, but rather that they had numerous additional responsibilities like two jobs and three kids in addition to full time school.
This is a tad apart from my nursing course, but I want to share this as well. I had to take a speech class as part of my requirement (and I think they’ve dropped that requirement now). One of the assignments was that we had to give a speech on a country that we were assigned. I don’t really remember what mine was. For some reason, I’m thinking it was Canada. In the high school I went to, sadly, the geography teacher taught us that Canada was part of the United States. What he meant was that it was part of North America. But I’m sure some of my classmates will wander out into the world banking on what he had said was the truth. But everyone in the class was totally confused when this one girl who had been given the assignment of speaking on Austria began talking about the kangaroos and the great barrier reef and crocodiles. Poor thing, it was clear she had thought that Austria was Australia. I tried to maintain my composure but was dying laughing inside. I mean, I could have clearly done the same thing, but I did happen to know the difference. I still laugh about this when I think about it!!
I finished up that first semester of the BSN program with a solid B average in my classes. I started into the second semester when to my delight, I got married and was moving. I think I secretly liked the fact that I had an “excuse” to get out of this particular nursing program. I liked the program, but really, couldn’t the instructors be any nicer than say, Satan?
Okay, so I left that program only to find out that I was NOT in fact moving as I had planned. Great. What to do now? So, I thought, can I possibly get done ANY quicker??? I applied to an Associates Degree Nursing Program where I could receive my two year RN degree. It seemed like a pretty good idea. I went to talk to an advisor who let me skip taking some kind of entrance exam that was required of the other applicants. This was because I had been accepted and successfully completed a full semester of a program with a little bit stiffer requirements than the one I was currently looking into. She also felt sorry for me that my move didn’t work out!
After a few weeks, I finally heard from the program and guess what…I got in!! I was so excited. Another journey would begin.
I have started this blog primarily because there was/is a lack of blogs guiding new nurse practitioners and nurse practitioner students. I hope not only to reflect on some of my past experiences and how I got where I am, but also to share with each of you every step in my experience as a brand new nurse practitioner.
Look for me to update at least 2-3 times a week with what is going on. I truly hope to update even more frequently, but I can at least guarantee that!!
Thank you for reading my blog and I PROMISE my hardest to try and keep you both entertained and informed.
-Kate
