The Summer That Took FOREVER
I tried to post this summer, but it got a little crazy. Turns out that taking 10 credits and spending two days a week working in the hospital is kind of time-consuming. But I must post now before the new semester starts! So, for some context. I was on a general medical-surgical floor where most of the patients have things like chronic organ failure (usually kidneys or liver), or post-surgical infections/complications, or a problem that hasn't been figured out yet and they have to have a lot of testing. Most of the patients I've taken care of have been elderly. I have come to appreciate the difficulty of simple things like putting in someone else's dentures, figuring out the best way to help move them to the commode or chair while not strangling them with their oxygen or IV tubing, how to change the bed linens while they're still in bed, how to bathe them while they're still in bed, and how to do lots of other things while they're still in bed. It's hard. And when you don't know how to do it, it is immediately apparent and really awkward. I have spend a LOT of time being awkward. And all of my patients have been very patient and nice to me. One of them even pronounced at the end of the day on Friday that she'd thought I'd be okay after all!

I guess that my experience so far can be broadly lumped into:
Things and People I Have Come To Appreciate, and
Things and People I Have Been Disenchanted With

The Appreciation List:
#1 - CNAs (certified nursing assistants)
Dear lord, I would have no idea what to do about 95% of the time without the CNAs. I didn't really understand what everybody on a hospital floor actually does until now. It depends on the facility, but CNAs usually take care of most of the immediate, non-medication patient needs. The bathing, the toileting, the moving and repositioning, the ambulating, the linen changes, keeping track of the patient's intake and output, taking them to appointments elsewhere in the hospital, and just generally working to help the patient be more comfortable. And they each have up to 8 patients. Nurses on our floor usually have 4-5. It is a LOT of work. It makes me wish I'd been a CNA before, because there are so many things I would feel more comfortable doing now.

#2 - PTs (physical therapists)
I have not met a PT yet that I didn't love. I guess when your job is to be positive and supportive and motivational but still honest and stubborn, you have to be kind of an amazing person. All of the ones I have met have been funny and helpful and just generally the kind of people you want to be around. They are awesome.

#3 - Nurses
That I'd be lost without the nurses kind of goes without saying. They have all been easy to work with and don't usually hesitate to ask me if I want to try something (or at least watch them do something) whenever there is a learning opportunity. But one of them in particular has gone out of her way to check in with me about how I'm doing, to thank me for my help, and to include me whenever possible. She's so nice, I kind of wanted to cry.

The Disenchantment List
#1 - The discharge/scheduling process
To be fair, I still don't really understand how this works. And clearly, neither do the patients. The physicians are usually in the patient's room for a few minutes each day, but that is pretty much it. Some of them are better than others at spelling out what is the next step in the plan for the patient's care, and what needs to happen before they can be discharged. But this is never written down for the patient as far as I know, and most of the patients aren't updated in a timely manner as to their test results, or changes in their diet, or the scheduling of procedures. Honestly, it would make me crazy if I were a patient. And it makes it really hard to care for them if, for example, you find out that someone is going to be discharged in 45 minutes when you've just given them medication to control their dangerously high blood pressure that requires you to monitor them for at least the next 30 minutes, plus they're nauseous and they have no prescription for an anti-nausea med so you have to spend at least part of the next 45 minutes trying to track down their doctor so you can give them something before they leave so they don't puke in the car on the way to the nursing home. For example.

#2 - Physician/nurse communcation
Honestly, this has been the most depressing part of the whole summer for me. Physician-nurse communication doesn't work as a rule, as far as I can tell. When it does work, it's because a specific individual went out of their way to make it work. There are hardly any systemic incentives or disincentives that make successful communication more likely. And it seems that they've tried several things, like having the nurses and physicians carry cell phones to take out the pager/call-back step. But, for example, there is no way for a nurse to know when the physician will be in a room, so nurses often aren't there for the physician-patient interactions. Which is unfortunate because patients will often have questions later about what their doctor said and if the nurse wasn't in the room and the physician didn't find the nurse at some point, which doesn't happen that often, the nurses can't answer the patient's questions. And I've been surprised how much the basic pathophysiology that even I know can be useful. It's not that I probably wouldn't understand what the physician was saying - it's that I wasn't in the room to hear it. And although the division between nurses and physicians isn't so strictly along gender lines anymore, that seems sometimes like a superficial distinction. I have felt just as invisible and excluded in a room of doctors as I have in a room full of weight-lifting dude wrestlers at the gym. It is weird.

(By the way, after visiting my new local gym, I also think that there should be women-only rooms/times for weight-lifting. Does this make me lame? I don't care - I don't want to fight with the whole stinking wrestling team so that I can lift weights for 10 minutes. Call me a weenie - I am not that assertive or motivated. Plus, I don't really need all the unnecessary grunting that working out with a room full of dudes usually entails.)

Okay, I don't want to end with a bunch of negativity, seeing as how I'm going to start a new semester and I'm generally pretty excited about it. I have reached the conclusion, though, that I want to continue on with the schooling after this and eventually become a nurse practitioner. I'll have more autonomy and I think I'll be more useful in non-hospital settings.

Up for this fall: rotations in neuropsych, geriatric nursing, and neo-natal nursery!