The Days of Richard Simmons with Seniors

Seeing as how I about halfway through the semester, it is a good time to check in and write some stuff down. I think all of us in my program realized that we'd just been hazed when this semester started. The summer semester was much, much harder than this one which made for a nice change, but is also making it difficult to stay as engaged simply because I don't feel like I have to try as hard to keep up in my classes. Sadly, I am feeling like only about half of the time I spend in class is particularly worthwhile right now. There is a lot of review of things that I already know (which is weird, because I don't know very much) and a lot of time spent on concepts like leadership that I don't particularly think you can teach using a lecture format. So, pretty much I want a tuition discount for this semester but I don't think that's really going to work out so I try not to think about it too much. I am just trying to enjoy the free time and make the most of it by doing other things like volunteering with other students to provide some nursing care at a free lunch in a church basement and going to health care conferences and doing storytelling activities with residents with dementia at one of the assisted living facilities near here. And I just got a job as a nursing assistant visiting people in their homes who need help with various activities of daily life. I am really excited about that. It's for an organization that tries to help people stay in their homes as long as possible, so there are several levels of assistance they can offer. I will probably do things ranging from helping to bathe people to helping them clean their homes and go shopping. I wish I'd thought of doing a job like this when I was in high school or college. But that's okay. I seem to realize everything a bit late.

My clinical placements this semester have been pretty interesting. We have three of them. The first one was in a neuropsych floor at a hospital in Iowa City. My current one is at an adult day center in Cedar Rapids. The next one will be back at the hospital in the newborn nursery/mother-baby unit. So, I am getting a pretty brief exposure to a lot of different patient populations. I have been reminded that I really like old people. I've gotten to sing Gene Autry songs with them and do Richard Simmons exercise tapes (Disco Sweat!) and make snowmen out of painted coffee creamer bottles. I am not sure how much I am learning, clinically-speaking, but it is a fun way to spend a day. I liked the neuropsych floor too, though it was hard to feel free to interact with the patients as much because there were locked doors and glass windows surrounding the nursing station. I am not a fan of this arrangement. I think it started because of concerns about nurse safety, but I would be surprised if it actually decreased the number of violent incidents since there are definitely ways to get into the nurses' station if a patient really wanted to. Mostly, I don't like it because it feels weird and the nurses talk about the patients behind their backs a lot more than they would if it was open like a regular unit. But it's a tricky situation with some patients and I could see wanting that boundary if I'd been attacked as a nurse, and it does happen.

There are a lot of tricky things about nursing. There is a movement now for bedside report, which means nurses reporting to each other in front of the patient at the end of a shift, rather than sitting in a room somewhere and giving report to each other without even talking to the patient. I think it's a really good idea because it would include the patient's input which would probably mean much more accurate information and a feeling of empowerment for the patient, both of which can be hard to come by in a hospital. Generally, there just needs to be more communication with patients, especially when it comes to things like discharge plans and long-term care options and living wills. There just seems to be a huge reluctance to really plan for the future with a patient because it's logistically complicated and because it brings up emotionally difficult questions. I would really like to somehow be involved in doing that when I'm a nurse. Managing transitions from hospital to home or from home to assisted living or assisted living to skilled nursing facility or skilled nursing facility to hospice can be very difficult physically and emotionally for patients especially as they get older. I really don't believe enough time is spent helping to get them ready for those changes in the vast majority of cases.

Also, I know I have referred to this before, but did you know that medical students and nursing students typically graduate without having interacted with each other at all? Like, not even for five minutes? This continues to blow my mind. And we act like it is this intractable mystery as to why communication among members of the healthcare "team" continues to suck and continues to result in poor patient outcomes. Could it be because none of us ever EVER has to actually do it before we graduate? There is plenty of fault to go around - physicians don't often respond to pages in a timely manner because they have too many patients and nurses don't often include enough information upfront to give the physicians something to work with - but mostly I blame the institutions of higher learning around this country who can't manage to arrange for one damn class or clinical experience that nursing students and medical students would get to take together. Professionally, we start in completely different places right off the bat. So should everyone really be surprised and dismayed that we don't communicate better and that there is so often tension between doctors and nurses? Ugh. It depresses me. But I know that there are exceptions and there is always potential for change. Besides, if everything was working super well, I'm sure I wouldn't even be interested in being a nurse.