Precepting a new nurse

My manager asked me to consider precepting new nurses a few weeks ago.  I was a little bit shocked considering I’d only been a nurse for 7 months myself.  I told her that I wasn’t sure that I had enough experience to be a good preceptor.  Her response was “You underestimate myself”.  I told her I still didn’t think I was ready to start training someone right now.  She replied, “Maybe we can revisit this topic at the end of the summer”.  Ugh.  Long story short, she convinced me to take the precepting class so that when I felt comfortable precepting, I could “dive right into it”.

The next week, she asked me to precept a student who is needing to do her 96 hour stint before she graduates.  I reluctantly said ok.  I looked at it as a way to give back to the nursing profession but still had my reservations about being able to help someone become a good nurse.  After all, I’d only been working for 7 months.  I received a packet from this student and it gave me a list of all the things she is supposed to do independently.  Things like assessments, foleys, putting a patient in traction, NGT feedings… Yikes.  No way was I going to let anyone do this unattended on my license.

So I had my first shift w/ her yesterday.  The bummer is that because she’s not a new grad or trainee, I’m expected to take on a full assignment while watching her.  She did ok but I couldn’t gauge how much she knew because she asked no questions throughout the day.  That scared me because that means that a: she knew everything. or b: knew nothing but was scared to say so.  She basically shadowed me because she doesn’t have a password to do any of her own charting.

I have another shift w/ her tomorrow and I think I’m going to just have her shadow me again.  How do preceptors do this??? It’s a nerve wracking thing.  I will let her do procedures but I almost get the impression that students are overly concerned w/ starting IV’s.  I had another student follow me last Tuesday and all she asked was if I’d let her start an IV.  I told her if any of the patients clogged their IV beyond salvation, they could do one.  My patients will not be pin cushions just so a student nurse could practice.  However, if they needed one started, she would be the first to know.  She walked away pretty disappointed w/ me.  LOL…

My student asked me for “sage words of advice”.  I told her to always act as a patient advocate and to remember what my favorite nursing teacher told me.  “Is everyone breathing?  Is anyone bleeding?  If the answer is yes and no then everything will be ok. ”  That always makes me smile and remember to do everything as I prioritize them.

Update on FS.  He can wiggle his toes.  Yeah!!! He and I almost cried when we saw that.  Physical therapy continues to work w/ him and he’s in good spirits.  He still isn’t able to care for himself and rely on us and his family but he’s got one that cares about him.  I always feel bad for those patients that have no one who visits them in the hospital.   The docs have decided to carefully anticoagulate him on coumadin so hopefully he doesn’t have another stroke.

Off to knit the right front of my airy lacy wrap!

A crappy report

I worked the last 2 days and have come home feeling drained both days.  On Monday, I returned to work after 5 days off the unit.  I show up and get report from the night nurses about my patients for the day.  I always dread getting report from one nurse because she always gives crappy reports or there is something wrong w/ the patient that she didn’t fix before I got there.   Before I get report from her, I get a call on my phone that this patient that I’m getting from her has a procedure at 8 am so the transporter is up at 7 am to get him.  Ack… I hate my patients leaving before I get a chance to assess them.  I quickly run in the room, do a quick assessment before he goes.  F.S is a 69 year old male who’s left arm is completely flaccid and numb.  He has clear speech, left ptosis and facial droop, and a left leg that is pretty weak.  His lungs aren’t the greatest but he’s alert and oriented.  Stable so I give the ok for this guy to go down to his procedure.

I get report from the night nurse on F.S.  She tells me that he’s got a flaccid left arm but the left leg drifts.  The right side is intact.  He does indeed have a left facial droop and ptosis and had that since he arrived up from the ER.  What blew my mind was that his heart was beating in a rhythm called atrial fibrillation for the last two days and nothing was being done about it.  Atrial fibrillation is when the heart beats abnormally and the atria which are chambers in the heart quiver.  This type of rhythm is dangerous because clots can form in the heart and get thrown out and cause heart attacks or strokes.  Treatment for a-fib includes drugs that slow the heart down, cardioversion, and anticoagulation.  On our floor anticoagulation is very common.   His CT scan came out negative for a bleed and his carotids are completely blocked on one side and 50% blocked on the other.  She also tells me that he’s able to reposition himself, take his pills w/o difficulty, has a heart healthy diet, and he’s able to toilet himself independently.

I called his neurologist after I see my other patients to ask why F.S. is not anticoagulated.  She tells me that she does not know and that she will come see him after he gets back from his TEE.  Curious, I look in the physician’s progress notes and the neurologist on call during the weekend and the cardiologist both note that he should be on either heparin or coumadin but neither put him on it.

I get  the patient back from his procedure which was a transesophageal echocardiogram (TEE).  A TEE gives the physicians a good look at the heart by sticking a camera down the patient’s throat and using sound waves to get the image.  He comes back from the procedure sedated and I try to arouse him.  He is able to talk to me and move his right side and his left foot.  He says he has dull sensation in the left foot but he can feel me.  After I get him comfortable, give him his morning medications, and take his vital signs, I let him sleep.  I come in to see him about every 15 minutes to assess his heart rate, respiratory status, and blood pressure because he received sedation during the TEE.

At 1145, I come in to do a neuro check on F.S. and find that he has slurred speech, his left foot cannot move at al, he’s completely numb on the left side, and he’s become incontinent.  I put a phone call into his neurologist and she asked me to get a stat CT scan on him.  (For those who are curious, an MRI was contraindicated for him because he has a metallic hip)  His CT showed he had a large stroke in his right middle cerebral artery.  Yikes… this poor guy.  I felt so helpless and I wondered if something had been done about his heart rhythm earlier if this would have happened to him.   His poor wife came to the bedside in the afternoon to find her husband a changed man.  I find out later, that F.S.  had not wanted to have anticoagulation therapy because of the danger of bleeding and he was a jehovah’s witness who did not want blood transfusions.  Now he’s willing to do whatever therapy will help him but the doctors think that anticoagulation would be to risky for him.  Now, this poor guy can’t eat, he’s urinating in the bed, and extremely lethargic b/c of the stroke.

Now… for the crappy report.  The nurse told me a whole bunch of things that were not true.  Like, he had been retaining urine and that he’d been dribbling urine.  She had no idea why he wasn’t on heparin or coumadin or if they were planning on cardioverting him.  She couldn’t tell me why he didn’t have an MRI.  She just made it hard for me to do my job.   I guess I expect that when a patient is there for 2 days before I get there, answers will be available for the common situations that we have on this floor.

So I had him for the past two days… I’m exhausted and will spend the rest of the day studying for a test I have on Saturday.  I knitted in the morning but of course want to do more.  I have one front of the lacy airy wrap done.  One more to go….

“Go team, Go!”

Here’s a few pics that I thought you’d enjoy.

A close up of the buttons I used on a baby sweater.

A full pic of the sweater

My little cheerleader

I finished the baby sweater in December 2006 for my friend Missy’s baby. I hate finishing so much it took me until April 20, 2007 to sew on two buttons. I got the Cottage Creations pattern Common Threads. It’s a very easy quicky no seam sweater which people w/ ADD need in order to turn a WIP to an FO. The yarn is Plymouth Encore which is perfect for a new mom who needs easy care. I hope she likes it.

I’m still working on my Lucky Clover wrap and my airy lacy wrap. I messed up on the front panel and need to frog it back a bit but I just can’t bring myself to do it right now. I’ll save that when I have some good conversation. I’m meeting Susan tomorrow for a knit together. Yeah!!!

Studying again…

You’d think that my studying days would be over when I passed the NCLEX but I have a whole other set of competencies that I have to master in about 2 weeks.  Then I test again in June.  Only after this will I be considered a competent nurse on my floor.  I think nurses need to be extremely educated about all things that can go wrong w/ their patients.  I am just suffering from a bout of procrastination.  I’ve been trying to study all day.  So far, I’ve just skimmed the study guide.

I have to learn the treatments needed for emergency situations for my first test on 4/28.  Things like what to do when you’re pt has chest pain, hypoglycemia, symptomatic hypotension, life threatening dysrhythemias… I have had patients who have become hypoglycemic, hypotensive, and have had CP but no dysrhtymias.  That’s what I’m struggling with.  Guess it’s back to the books to learn my EKG strips!

I have been knitting a bit.  I’m getting sick of the Airy wrap so I’ve been knitting the Lucky Clover wrap.  I’m on the left front.  I love the clover pattern.  It’s so easy to memorize and I love the Petite Manderin yarn.  The back and the right front are done.  Just the left front and the sleeves to go!  I’ll post a pic next time.

Anyways, I have to work tomorrow.  I better get dinner arranged.  Matt is remodeling the kitchen so everything is all unorganized.  We have to order the countertop.  Darn, I had an assignment to do today for our project and I forgot what it was.  Oh well… I’m sure I’ll hear about it when he gets home.

I spent the day at the city dump

Matt and I were demolishing our kitchen today. I snuck away to write this post and check email while he’s taking the sink out of the base. Shhhh… he’d kill me if he knew I wasn’t watching him take it apart. lol… We’re going to put new cabinets in next weekend and are hauling the old crap to the landfill.

The Miramar landfillis a very interesting place. Tons of cars are there dumping their old stuff, discarded plant materials, and recycleable items there. I would think that no one would want to go to the dump but there was actually a line to get in! I was totally in shock. Then you take this winding dirt road to dump your stuff. Then it’s a free for all. I would think that you needed to put your waste in a certain line but people were basically getting in the back of their trucks and just shoving the stuff off. Amazing. I wonder when the landfill is going to be filled.

Yarnzilla is having a 20% sale off everything. I browsed and was soooo tempted. There is Cascade 220 as well as some Mountain Colors that I’m currently salivating over but I decided to be good. I have so much yarn I can pretty much open my own yarn store. So… here’s my chance to enable others. If this post has helped you acquire more yarn for your stash, let me know. I can live vicariously thru you. haha…

Because I’m supposed to be playing Tool Time Girl today, there is no knitting content. Maybe next time.:(

I was rejected:(

I took the trolley this morning from Fashion Valley mall to the Court House so that I could perform my civil obligation of jury duty. I waited several hours to get called to a trial and finally got seated as juror #4. The jury questioning took about 1.5 mind numbing hours and then right before lunch, the lawyers began dismissing people that they were “uncomfortable” with. Guess who got called first? Me!!! I couldn’t believe it. I figured I wouldn’t serve on a trial but to be dismissed first… I almost took it as an insult but then I ran out of there so I could do something more fun.

The 3 hours before getting called weren’t so bad. I met a jury duty buddy, H. She and I had a great conversation and made plans to have lunch together which I scrapped after learning I was dumped from the jury. I knitted the cuff of a sock. I broke my one project rule for today. I figured it would take too much effort to bring the Airy Lacy Wrap so a portable sock seemed much more practical. The security people even let me bring my scary looking addis into the waiting area with no problems. I also read a study guide for a test I have to take in a few weeks.

Since I haven’t posted pics in a while, here’s what Marilyn’s Not So Shrunken Sweater looks like these days.

Blurry pic of the shell button I got from Joanne’s
The crocheted ruffle

A better pic

And me in it.

I just have to sew the buttons on and weave in a few ends. . I was on the hunt for the perfect buttons and was beginning to give up. I went to yarn store after yarn store and couldn’t find any buttons that were worthy of the sweater. The owner of Two Sisters and Ewe in La Mesa suggested Joann’s and I finally got over there yesterday and found these shell buttons. 50+ buttons for $2.99. What a deal! I will never forget that Joann’s has awesome buttons. I’ll try to do the last of the finishing tonight so that I can block it. Yeah!!!

Here’s a pic of my current WIP, the Airy Lacy Wrap from Fitted Knits.

I am at the cabled edge but I messed the cable up. I’ll frog it back to the purl border and restart the cables. I am determined to get the cable right. I don’t know why I’m having trouble with it. I’ve done cables before and this is almost ridiculous that I’m having so much trouble with this. I wonder if there’s an error. hmmm…

Well, enjoy the pics. Susan and Suzanne, let me know if you want to get together on Sunday to knit.