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The third semester was getting to work in the OB/GYN and pediatric units at the same local hospital, with some rotations in a much larger place with a NICU and also had high risk OB patients. Amazingly, I liked these two areas the least. I never got to see a vaginal birth in nursing school. All of my patients had complications and had to have C-sections. I was taking care of a postpartum patient on Sept 11th when someone gasped whose mother in law had called to tell them that a “kamakazi pilot had flown a plane into the World Trade Center”. I remember hanging out in the nurses’ lounge and watching all of the things unfold that day in there and on patient’s televisions. It was just awful. Our instructor’s daughter was a flight attendant in New York. Our instructor had a complete nervous breakdown that day (not knowing if her daughter had been killed or not—which thankfully she was fine), and she never returned to teaching. That was her last day with the school.
There were a few babies there born on that day. It will not be one we forget anytime soon.
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.
We finally got to give medications through the IV, in addition to starting IV lines. My first patient that I started an IV on was a forty year old man who had Diabetes Type I, and numerous complications from it. I can still see his face grimacing from such pain. His kidneys had failed from diabetic nephropathy, his lower limbs had experienced diabetic neuropathy, renal hypertension, and he peripheral vascular disease with NUMEROUS arterial ulcerations that had become ridden with gangrene. It was just awful. He was a very sweet man, but looked like he had lived a very hard life.
His current IV line was old and he needed a new one. In addition, he had just gotten an order for surgery to amputate both legs below the knees. I had to put in a really big IV since he was going to surgery and it was not going to be easy. But I managed to strike oil with the first try (and I’m sure this poor patient was happy too). I went in later to give an IV push antibiotic and ended up sticking myself with the needle (this was before hospitals had gone to primarily needleless systems. I rushed out of the room and began to cry. I was so upset. Now I get embarrassed thinking about all of my ramblings about how I had waited until I was married to have sex, and now I was gonna contract Aids and hepatitis anyway from a freaking patient. Living right did me no good at all!! I had no evidence that this patient had any diseases other than the non-communicable ones that I listed above. But really, the guys looked like he had probably gotten around. A lot. It wasn’t like I had been stuck with a needle from some little 80 year old grandmother (not that they couldn’t have anything either). But I just knew right then and there that I was going to die.
So, down to the Emergency Room we went and they drew a bunch of blood to run mine for HIV, hepatitis, etc. Of course, my was negative. But they were going to have to ask for the patient’s consent to test him, which he thankfully gave. I was so worried all week that I would periodically call his hospital room just to hear his voice to see if he was alive. Of course I’d hang up immediately. I know that was horrible of me, but I was so scared that he had something and was going to die and I needed to know his status – at least I thought I did. Anyway, all of his tests came back negative also. Boy, that was a stressful time!
The following week, the same patient was there in the hospital after having his bilateral amputations of the lower legs. I got to do an entire teaching session on “Phantom Pains” while my instructor watched and listened. He was so excited to know that it was normal for him to still feel pain in his lower legs and feet even though they weren’t there anymore!! He understood then that part of the nerve was left, and yet severed, so it was confused. He even smiled.
That poor man. I came back the third week and he was somebody else’s patient, but was going to have to have both upper limbs amputated as well. He would be only a torso. He was clearly getting depressed. Completely understandable. He had a young daughter and was divorced. I never saw him after that clinical. I have a feeling he probably passed away soon after as he continued to deteriorate.
I have to admit though, when asked in an interview who my most interesting patient was, he came to mind.
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 occasionally think about this one resident in the nursing home that I did my clinicals at. I remember coming in the door each week and hearing her CONTINUOUSLY mutter (very loudly) “Oh me, oh me, oh me, oh me, oh me” and would keep going. Stopping only long enough to get a breath to continue saying that. For some reason I liked her. She held a baby doll and kept talking about her baby that died. I have no idea if this were actually something that had happened to her a long time ago, or she had just gotten confused and convinced herself of this. At any rate, she would speak as if the baby doll were a real baby and she had to take care of it. Any conversations with her were short and revolved around this doll. I never saw any family come and visit her while I was there (but I was only there two days a week). I wonder if she is still alive today.
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
