RePosting an old Nursing Post

Sunday, September 23, 2007
Nursing a general malaise
Sometimes, I am not too certain that getting a job in the hospital was a good thing for my nursing school career. Some of the things I've seen, some of the things I've had to do . . . they're heartbreaking things, nauseating things, things that haunt your dreams and linger in your nose and your memory for weeks.

Do I still want to be a nurse?

Nursing school clinicals aren't really anything like working on the floor. You've got one patient, maybe two. You have an instructor watching over you, drilling you on your meds, backing you up on hard calls, and you have other students there just as obsessed with idiocy like finishing your NANDA prep sheets and deciding what your "focus" will be for the shift. We're working right now on the "med-surg lite" wing-- we have walky-talkies, mostly, with a few peds cases thrown in. Gastritis and cellulitis. Kidney stones. Nothing too strenuous. You get to decide on NANDAs like "Knowledge Deficit" and "Pain" and come up with some nice little interventions to address that focus.

When you're working, there's no time to decide a focus. You're thrown in head first, you try hard just to get report, check charts, keep up, keep up, keep up . . . .

I've walked into a room with a nurse and found a dead patient. I've had several of the patients that I've cared for for days on end just . . . die. I read about it in the obituary column, but I can't point to their names and talk about them to my husband, not even to vent the grief I feel about it. I've cleaned out necrotic toe ulcers more times than I care to recall, and the smell of it is permanently stuck inside my sinuses. I've opened up a postop dressing in order to do a dressing change and found an open incision that very nearly made me throw up . . . and then I still had to finish the dressing change, calm and professional. I've had to hold an extremely elderly woman down as we tied her into a posey vest-- she scratched me and fought the whole time as I tried to remain calm and compassionate. And, yes, professional.

It's not that much, really. I haven't done anything hideously traumatic, haven't been in any codes, but it is still a drain.

I can't think of anything else I'd like to do. And sometimes as a student you really feel that glow of "wooo, I was caught up all day, I charted wonderfully, and I got to do theraputic communication and patient education for hours!" It's just that I work on the renal floor, and I don't see that happening in the real world environment, after the students go home and the nursing services decides to send one of our four nurses over to another wing and we're left with three nurses and no CNAs and a wing filled with really ill people. I spend the whole night running just to do all our Accuchecks, to reposition patients, to clean up incontinent patients, to fetch millions of glasses of ice and coffee, to change sheets, to help people walk to the bathroom and back, to do those nasty dressing changes, to place or remove Foleys, and to deal with the delirious patients who think the blood pressure dial is a clock badly broken or the television has to be on channel 42 as they click the nurse call light 42 times. There's no time for charting or communication. I'm lucky to have a minute to smile at someone, to crack a joke, to touch someone's arm and offer a tiny bit of comfort before I have to race off to the next crisis.

I know that staffing at our hospital is really low right now. My boss, the Nursing Manager of the whole floor, is working as a charge nurse several times a week just to make up for some of the shortage. I know we're in a crummy little town in the middle of nowhere and no one wants to move here, no matter how much of a sign-on bonus we throw at them. What I don't know is if it will be like this when we move somewhere else. If we do relocate the Comte to a more northern clime, will I be taking 7, 8, or 9 patients . . . unable to do more than rush through an initial assessment and push some meds on them before it's time to give report again?

I work on weekends on the evening shift . . . perhaps that's part of the problem. But I like working evenings. I figure that when I do graduate, I'll be working 3 12 hour shifts per week, probably including at least one weekend night. I can't imagine working five days a week. After working at the hospital four days a week, I am sick of it, I want nothing more than to go home and curl up on the couch and pretend I never have to go back there again and deal with that stuff.

But I can't imagine quitting now.

Probably, I need to find a different area of the hospital to work in. The renal floor is a horrible floor-- insulin and accuchecks, fluid restrictions and dialysis, people wasted and drained from the slow failure of their organs to sustain them. Most of them have already had something amuputated. The rest are just in the process of getting there. Unhealed ulcers become amputated toes, spread to above the knee amputations, become the patients who we have to lift with machinery. The elderly are heartbreaking to work with-- so much confusion and dementia, so much fear in their delirium. So fragile, so sick, and there isn't anything you can really do to restore them to their former health. Every intervention we do just opens up a new opportunity for infection, every minute they spend in our care increases their risk of dying.

Why did I go into nursing?

What would make me get out?

I don't know.
Posted by Frog Contessa at 10:42 AM 0 comments