Weekend II - Clinical - Surgery Floor - Difficult People

Going from the medical side of nursing to the surgery side of nursing was interesting for me because I never differentiated much between the two, but they differ. Keep in mind that I am basing my opinions on two separate weekends of 14 hour days. AM staff is way more grouchy than PMs. Faulty conclusion. Maybe.

In order to give you a five week picture of what we are doing at the hospital I guess I should explain the weekend cycles.

The agency where I am rotating has several units that we are rotating through this cycle. 1) Medical Tower which is basically a step-down telemetry unit from the ICU. There are complex cases and some hospice. Next, 2) is Medical which is the melting pot for a plethora of health problems 3) Surgery, the floor they take you to after you've had it 4) Oncology, the floor where our friends with cancer are admitted, and finally 5) the O.R. where people actually have surgery. Our clinical group is rotating through all these areas. Week one, I started in the medical area, and last weekend I was on the surgery floor.

Surgery is different from medical because the patient populations there are diverse. I had no idea what to expect.

AM Day one, I went over to the nurses station to introduce myself. Huge mistake. The float nurse taking a new admission looked at me like I was piece of rotting meat underneath her shoe. I asked one of the regular, less threatening looking nurses if she could recommend a patient for me to prep on and she recommended the patient the floater was admitting. Of course and great! When people are being admitted, there is little, if any information about them available because the chart is literally being assembled during the admission process. The only thing I could gather from looking upside down at the Kardex the float was writing on, was that the new patient was a 74 year old female and she was being admitted for ORIF Tibia fracture (basically it is an open reduction internal fixation procedure with a scope and meniscus repair.) The float looked up at me and said, "I wouldn't prep on this patient. She's not going to like you because you are a student!" Well...well...well... thus begins my first challenge on the shift and it didn't come from the patient. 'Thanks for the advice, but I'm going to prep on her anyway." The float scowled at me walked away with the chart so I couldn't copy down any more information. Fun. At this point, I made a mental note (Note to self: "Don't bring the box of Truffles for the nursing station until AFTER report).

I walked down the hall, poked my head in the door, foamed in and saw a delightful 74 y/o woman sitting in bed with her knees up like Gidget and her husband sitting on the couch next to her. Humor always works for me so I just dove right in- "Hi, I'm student nurse...I'm going to be taking care of you tonight after your surgery...I can see you had a little trouble on the slopes recently!" Now keep in mind, no one could have prepared me for the response I got.

"Yeah, we were coming off the lift at Mammoth and the wind just kicked my legs out from underneath me...just a stroke of bad luck I guess." Gidget was skiing. Holy cow. I fell in love with her immediately. She was in better shape at her age than I was at 27. To say I was convicted to go back to the gym is an understatement. Her labs told the rest of her story. She was as healthy and fit as anyone 50 years younger than her. She just broke her leg skiing. After getting a good history, I went back to look up her three prophylactic drugs and I prepped.

Well, I knew I was in for a triple care plan weekend because when she got back from the O.R., she didn't even return with a foley. Now that's huzpah. She was discharged before I got in the next day for my AM coffee. I was able to do a few things for her before she went to sleep for the night, like change her and her bed and frequent vitals. She asked me all kinds of questions about my family and refused all her pain meds. "They make me sick" she said... In my mind I thought to myself, 'yeah, kinda like mean old float nurses.'

My second patient I met on AM Day two. Since Gidget went home before the cock crowed, I got dirt bike guy with the ruptured appendix and peritonitis. The charge nurse told me he wasn't going anywhere for the rest of the weekend so I decided to prep on him. He was just back from an early surgery to clean out his gut and he actually looked pretty good. I was able to meet his wife and kids and talk with him a bit before I prepped, so we established some rapport.

Day one with dirt bike man was relatively uneventful. The anesthetic was wearing off and he was walking around the hospital. Day two, the pain set in and I could barely get him out of bed. He went from no drugs to IV morphine. I did a head - toe on him and talked to his wife about limiting his activities. Peritonitis can be very serious. I didn't get to spike his bag because I can't do IVs yet, but I watched/monitored him & kept him comfortable, did his assessments and monitored his drains for signs of infection. I let him listen to his bowel sounds.

As I took primary care of Gidget and Dirt Bike Guy, I also took of the other patients my staff Rn was responsible for. I did the fingersticks and charting, ran a host of errands and completed patient teaching on several clients with family present. I had a little run-in with the staff CNA who didn't particularly care for student nurses. She wrestled the Dynamaps from us and took issue with me taking vitals on one of her patients who was decompensating. The CNA also had a penchant for recording respirations without actually assessing them, (which I took issue with). The only reason I know that she did this was because she did it while I was assessing dirt bike guy. My respiration count was 12. She wrote 20 on her clipboard. She also got mad at me for taking an axillary temp on a patient who was in acute distress with pneumonia. I noticed the patient had oral vitals all morning (she was stroke patient who had no control of her tongue). When I took her axillary temp it was 3 degrees higher than the oral probe. They weren't valid vitals.

The lesson from clinical this weekend on the surgery floor was learning how to deal with difficult people. Luckily my partner and I had two incredible staff RNs mentor us and show us procedural things and organizational techniques that were great learning tools. The nuances of nursing school are learning how to navigate the difficulties because the difficult people are always going to be difficult. They aren't necessarily always going to be the patient though.