On August 12

August 12, 2016: I have a weekday off and I am out to lunch with my kids. I enjoy taking them out for lunch when they are on summer break. I look across the table at my son. He wears a goatee on his chin and the rest of his face has several day stubble of beard. He looks like a man now. His serious brown eyes tell me differently though for they are still the eyes my little boy. I know what’s going on in his head because it’s the same thing that went on in my head 25 years ago. It occurs to me that soon I won’t be able to enter his bedroom at 0530 each morning to kiss his forehead before I leave for work. On this day, August 12, 2016 I know that I have approximately ten days to finish dorm room shopping, help him order his college books and get my emotions in check. He’s leaving for college.

Rewind my life back by twenty five years to August 12, 1991. I was weeks away from my 21st birthday and my mother was preparing for my departure. I couldn’t write about this on August 12, 2016 though. Too many emotions involved. Today I can.

At 0700 we stepped off the elevator onto a medical-surgical floor. The aroma of night time body odor, cheap hospital soap and powdered eggs greeted us for the first time in our lives. I immediately gagged at the odor and wondered if I’d made the right choice. We checked in at the nurses station and got our patient assignment. Our task for the day: to administer a bed bath.  I knocked on my patient’s door and there was no answer so I walked in. My patient was sitting up in bed with a sheet over her head as if she were a dead body covered up. I backed out of the room with eyes wide open to show one of my classmates and get the attention of my instructor. My instructor and I went in the room together. My patient was a little old lady with dementia. My instructor helped me bathe her. This lady incredibly was strong. She was combative and she kicked my ass during that bed bath.  I remember noticing how easy interacting with the patient during the bath seemed for my instructor and hoped that one day I could enter a patient’s room with that much confidence. I never saw that patient again but I’ll never forget her either.

I remember so many firsts during that time of my life. I remember when they taught us how to do the hospital tuck but I was proud because I already knew the hospital tuck way of making beds because me grandmother taught it to me as a little girl. I remember the first patient I became attached to. I remember the first time I saw a baby being born and the first time I realized one of my patients was deteriorating over a period of several days and was going to die. I remember my first cardiac arrest and how scared I was. I remember the first time I saw the cardiac rhythm Atrial Fibrillation on a telemetry monitor. It’s not the most lethal rhythm but a dangerous one if uncontrolled. I remember the first time I suctioned someone through their tracheostomy and how when the patient coughed the “trach cough” that it startled me so badly I jumped. I remember calling my mom at work to tell her that I’d given my first blood transfusion and how she yelled out to her coworkers, “my daughter just gave a blood transfusion today”. I remember my first AIDS patient and how his family turned their backs on him because he was gay and dying of AIDS and that he died alone. I remember hearing helicopters and sirens at all times of the night because I lived in the dorm next to the hospital. I remember the oxford blue shirts, white pants, white socks and shoes we had to wear. By graduation those oxford blue shirts had pit stains on them from all the blood sweat and tears we’d put into this. I remember two nursing instructors that were tough as nails to me because I was a young smart ass and I deserved the torture they put me through.They turned the light bulb on in my head and taught me to look at the bigger picture, the patient as a whole. After that I was ready. I remember after each clinical day in the hospital, I’d hum the MASH theme song to myself because I’d helped people just like those nurses did.

I remember how it felt to hold my nursing pin in my hand for the first time on May 14, 1994, the day I graduated Nursing School. I remember coming home from errands on July 18, 1994. My brother was holding a thin envelope addressed to me from the Missouri Board of Nursing notifying me that I had passed my state boards. I was now a Registered Nurse. I remember sitting for my Board Certified Emergency Nurse exam and having a panic attack because I thought I was going to fail that exam. I passed the exam. I remember walking across the stage on May 28, 2011 to receive my Bachelor of Science in Nursing degree.

I remember August 12, 1991 alright. It was my first day of Nursing School. The day all of the above began for me. Never forget what you’ve earned and what you went through to get it.

 

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The Truth Behind July 1.

Becoming a nurse was by far the hardest thing I’ve ever done in my life. The memorizing and understanding of material and the hours of study and preparing for clinical were grueling. Not to mention the social lives of all student nurses fly right out the window the minute the first course begins. No, I can’t go to your party. I can’t be hungover because I have clinical at 0700. I have to be on top of my game. I’m taking care of someone’s loved one.

My nursing instructors were scary and mean and did not except sub par performance in the classroom or clinical area. I remember two of them in particular. One of them was a retired navy nurse. Tough as nails. The other one reminds me of the female version of Professor Snape from Harry Potter. They were relentless but they had to be that way. They were teaching us to save lives.

One very important thing they taught us is how to provide safe and effective nursing care which ultimately keeps us out of a courtroom. If the nurse receives a physician order that the nurse feels is written incorrectly, wrong or unsafe, the nurse must question the order immediately. Do not pass go. Do not carry the order out. Question the order. Clarify. Call the attending physician. Do whatever you have to do. Just don’t do that order.

Translation: IF the order is wrong and the nurse carries the order out and the patient is injured or has an adverse reaction, the nurse’s ass will fry. I repeat, in a court of law, the nurse’s ass will fry.

As a student nurse, I worked as a Unit Secretary on an acute medicine/telemetry floor throughout school. The things I learned were priceless. Part of my job was  to put physician orders in the computer so the nurses could carry them out. I learned how to interpret a physician’s messy handwriting quickly and I was never afraid to use the hospital computer system and I’m still not afraid to. I learned how to navigate my way through a chart and use the telephone to collaborate with other units. I learned about roles of other health care providers; respiratory therapists, physical therapists, occupational therapists, nurse techs, dieticians and how the unit flows throughout the shift.

I listened too. I listened to what the nurses on the floor said about just about anything. I could never figure out why this one nurse in particular was always on vacation for the first three weeks of July every year. So I finally asked her. Her answer was simple and her message rang loud and clear. “Because July 1 is the day the new interns fresh out of medical school start. It’s chaotic and I don’t want to be around the first few weeks of it”.

July 1 is the day the new interns begin. They’ve graduated medical school and earned the title of MD. They’ve been matched with the hospital that they will do the residency of their specialty at. They are green as could be and now they are being let out into the world of healthcare. Now mind you, interns and residents have to discuss their treatment plan with an attending physician before implementing it but that still puts nurses on high alert during those first few weeks especially on the inpatient units, ICU and Emergency.

Listen to the voice in your head especially on July 1. The one that says there’s something wrong with this order. If the voice in your head says don’t carry the order out and get that intern over here, listen. Don’t carry out that order. You will fry. Also, try not to scare the intern too badly. Not on the first day at least. They are just starting out on their journey of savings lives just like you did.