Adventures in Nursing (at Harborview)

This is the third week of my first clinical rotation in a real, live hospital. I've been getting up and stumbling around my little house at 5 in the AM, shivering at the bus stop by 5:40, and go go go! at Harborview Medical Center from 7am until 4 or 5pm. Then a couple buses home, where I collapse. It's utterly exhausting and AWESOME.

In the six shifts that I've been there, here's some of the things I've done (some with the help of preceptors/instructors):

- Worked with patients who speak Spanish only; used phone interpreter on speakerphone as well as using my own rusty Spanish skills.

- Assisted in transferring patients from beds to gurneys and back again.

- Wore gowns, gloves and masks for working with a patient on contact precautions (due to infection with Vancomycin Resistant Enterococci - a bad, bad buggy).

- Gave bed baths and changed Depends and linens with patients in the bed.

- Monitored I&Os (Input & Output - food & liquid go in...you get the idea).

- Helped a teenage girl with a broken leg use a bed pan.

- Removed Foley urinary catheters from both male and female patients.

- Removed peripheral IV lines from patients' hands and arms.

- Gave subcutaneous injections of anticoagulants into patients' abdomens.

- Used the magical Pyxis medication dispensing machine to select meds.

- Gave oral meds.

- Gave IV meds (via syringe) and by hanging an IV bag and connecting it to a pump to allow a steady infusion.

- Discontinued PCA (Patient-Controlled Analgesia) buttons (morphine, Dilaudid, etc.)

- Lots of charting via computers - including meds, vital signs, and nursing progress notes.

- Educated a family member of a patient with a broken bone about the impact of her thyroid medication on bone density and implications for medication management after discharge from the hospital.

- Talked with an adult son who was grieving his mother as she was on Comfort Care (no food or meds besides pain meds).

- Worked with a really cranky RN one day, which made me all the more grateful for the wonderful ones I worked with the rest of the time.

- Worked with patients who needed to be restrained because they were confused/delerious and tried to get out of bed or pull out tubes/lines otherwise.

- Worked with a man with who has a tracheostomy and couldn't speak, so used writing to communicate.

- Used a Yankauer suction tube to clean out the opening of his trach and around it when he coughed up gunk.

- Crushed pills and administered crushed pills and liquid meds via PEG (directly into stomach through abdomen) tube.

- Checked contents of stomach using a syringe in the PEG tube, and checked placement of tube by pushing a bubble of air into the stomach and listening with a stethoscope.

- Assisted with administering EKGs and a bladder scan (ultrasound).

- Gave nebulizer meds - liquid meds that go into device that turns them into a mist that the patient breathes in through a tube.

- Worked with a patient whose husband broke her arm (grrr, DV makes me so angry/frustrated).

- Applying and removing SCDs (Sequential Compression Devices - they are almost like long blood pressure cuffs that wrap around the calves and are hooked to a machine that inflates (and deflates, in a cycle) them in a way that helps push blood back up toward the heart).

- Called a resident MD to change orders on my main patient this week - eep! phones are strangely nerve-wracking at first!

- Worked with a patient with a (big! like the diameter of a quarter!) tube through her chest and into her lung to drain out fluid, which then drains into a special box for measuring it.


So much! While we each have one patient who we are mainly caring for, I was in the rooms of 8 different patients today, helping out with various things. It is just amazing to get to care for people in all these vulnerable situations, and there's so much running around and keeping track of details and charting and technology and.... I'm really excited about this whole nursing gig.