This afternoon, I finished my second week of clinicals.

What a week.

Thursday night my patient was a very sweet 11-yr old girl who had an appendectomy earlier that morning. Her parents were great, she was great. I spent a lot of my time talking with her parents about what their daughter needed to do before they would let her go home - eat, drink, take oral painkillers, walk around. My favorite part of the night? Getting the questions from the parents and knowing what the answers were. It was another step in my feeling like a bonafide nurse.

Friday night was an entirely different story. When I arrived at the unit, I discovered my patient from the night before had already discharged during the day. So I had to pick a new patient on the spot. I opted to go with my previous patient's roommate, who I had met the night before briefly. If I had only known....

She was a 12-yr old who has been there for 3 months due to being traction after an auto accident. Her parents don't visit often. And she has been isolating herself. So I figured my night would involve just hanging out and keeping her company, trying to get her out of her room to socialize some. If it had only been that easy! This 12-yr old girl tried my patience all night - and she knew she was. She did everything in her power to get me to leave her alone. I knew she was testing me, seeing how much I would take before abandoning her. So I persevered. When we ended up playing cards for a couple hours before I went to dinner, I figured I'd won her over. But when I returned she was back to her behavior from the start of my night. (I now realize it may have been that I decided to leave her for dinner..but that's life). When I went to take her vitals and do an assessment at the end of my shift, she did all she could to avoid it, to interfere. I had to take her blood pressure twice (when she complained about a mark from the cuff, my response was. "Well, if you had let me do it right the first time instead of playing with it, that woudn't have happened"). I had to demand she place the temp probe under her tongue. When I asked her to put the prescribed lotion on her foot, and she refused, my response to her was, "It's ordered by your doctor for now. You can do it, or I can do it. But either way, it's going to get done. You decide".

Yes, my patience (which the mother of the girl in the bed next to my patient complemented me on) had worn out. And the inner parent I didn't know existed emerged. It was a great learning experience, if not a tad exhausting.

The highlight though was my day today. I got to follow a nurse (who is also an instructor) for the day in the Pediatric ICU. I was basically there for an entire shift - 7am to 3pm. And I got to do a lot more than just observe - I gave meds, changed diapers, took vitals, changed IV tubing and fluids, charted, and followed the head ICU doc and residents on their rounds around the unit. I LOVED IT!!! The nurses get only 1 or 2 patients. The kids all have differeing diagnoses (both of the ones I helped with were in for post-cardiac surgery issues). My favorite of the day was the 3-month old with Down's who had just had surgery to correct a coarctation of his aorta. He was adorable. Oh, and he loved me! Every time I approached him, he's turn to stare at me. My nurse and his mother both commented on it. At one point we were all trying to get him to stop crying,the mom rubbing is back, the nurse holding is hand, and me rubbing his head. The two of them stopped and I kept rubbing...and the kid stopped crying. :-)

It's days like today that prove to me that I have made the right choice in career. And, as I have done before, I came home declaring that I had found where I wanted to work. But today it was more obvious for me than other days. Not only did I have a great day on the unit, but I also got a chance to spend time talking with different nurses about their experiences on the unit and at the hospital. I chatted with a nurse who started in Pediatric Oncology (where I will be observing this coming Friday), and nurses who have been there for 3 years as well as 25 years. And I got along great with all of them. It just felt so comfortable being there. I also learned that the nurses at CHO all have to float among all the units (except the ED), no matter which one they work in.

Driving home today from the hospital, the sun shining on me, I thought to myself, "Hmmm. If I was working there, this is the drive home I'd be making each day." and then, "Wow. This is what it's like to find what you were meant to do. Lucky me!".

Now to make sure that for my preceptorship next Spring, I get PICU or NICU.

Today was the first time I got to spend a second day with a client. It was a great experience.

It was nice to walk into the hospital and not only already know what was going on with my patient, but also already have started to build a relationship with her and her parents. It made going into her room and working with her so much easier.

I also learned today that sometimes success as a nurse is achieved in small steps, and the little things can totally make your day. My patient today hadn't been eating or drinking anything. I had tried most of the afternoon. At 4pm she barely took her oral pain meds. By 8pm she still had drank almost nothing. It was getting very frustrating that no matter how hard I tried, she just didn't want to. At 8pm we gave her another dose of Tylenol elixir, and when it went down easily she suddenly was excited to drink. I got her to drink more than she had all day for me - and to eat a small amount of chocolate ice cream. It made my night!!

Watching my instructor interact with my patient, and talking to her about how to work with a child to get them to take meds, I picked up so many tips and techniques. Listening to the RNs at the Nurses Station talk about patients and share info, I learned more new things.

At the end of the shift, I had to sit and wait for my ride/classmate as he talked with our instructor about a bad experience he had in the ED today. As I waited I sat at the Nurses Station, studying for the Peds test I have on Wed morning. At one point the Unit Coordinator asked if i was just hanging out because I like them so much. LOL I said I was wating for my ride, but I also like being there. Her response? Good! :-)

This was a great first week in the Peds unit. Hopefully it will continue next week. The one big challenge I see is not so much working with the kids, but also working with difficult/controlling/neurotic/anxious parents. That will definitely take me time to get used to. 

Just like in Maternity, I am feeling like I am where I'm supposed to be. If this feeling lasts throughout the rest of the semester, I'm going to have to make some decisions about where I really want to work...

There could be worse things to have to worry about.

Ok, so it wasn't that bad. Not at all actually.

Today was my first full day in the hospital for my Pediatric clinical rotation. Going over to the hospital, I was a bit nervous. I didn't have a patient yet (I went early to get one), and it being my first day, I really didn't know what to expect from the nurses and the patients and the instructor.

Well, they all proved to be pretty amazing. My patient had been admitted to the floor after surgery to remove her tonsils and adenoids. She was 6 (almost 7) and totally reminded me of my oldest niece. One of the first things I did was crouch down next to the bed so I was on eye level with her, and tell her I had my tonsils out at 5. Her eyes got big as disks. She was having a hard time talking (due to the swelling from the surgery), but I could imagine her surprise that anyone as old as me could ever have been as young as her. :-)

Most of my day was spent just checking in on her while she slept, and checking in on mom as well. The rest of my time was spent charting and doing a scavenger hunt, helping classmates, and having some great conversations with my clinical instructor. This instructor looks to have the potential to be the BEST INSTRUCTOR I have had yet in clinicals. She is always there, already has given us feedback on our charting, and is always there to answer questions and give us support when we need it. I let her know at the end of the night how much I appreciate it and how I've never had this level of involvement from a clinical instructor.

Then there was my nurse. She let me do my thing, taking care of all the vitals and assessment and charting on my patient. She also appreciated when I pointed out things in the charts I was questioning (missing info, incorrect info). And each time I did, it turned out that I was right to bring it up. :-)

Tomorrow I go back to the same patient (and the same nurse). Which is also a new thing for us - the same patient two days in a row. Which is great because it gives us a chance to build a bond with the patient as well as the family - just like we would if we were nurses on the floor.

The thought of only getting 4 weeks to do this now really points out how much we are going to miss....but at least I get to spend a day in Oncology and another in Pediatric Intensive Care (where she told me that since I'm following another instructor, I might actually get the chance to do more than just observe!!!)

Oh, one of the many conversations I had with my instructor today involved our final semester preceptorships. She basically told me that if I want to do Peds or PICU or NICU that I could do it - all I have to do is be assertive and let it be known that that's where I want to be placed (rather than MedSurg, which holds no appeal to me whatsoever). And she also said that most hospitals tend to hire the students who do their preceptorships there, especially if in a specialty area (and Peds is considered a specialty). YAY!!!

 This week was supposed to mark the beginning of my second round of clinicals for this semester - Pediatrics. Which it did...sort of.

The Monday before Spring Break we had a meeting to prepare us for clinicals and to meet our instructors. At this meeting we had a small bomb dropped on us (it was dropped on the clinical instructors as well) - the school had to pull all clinical groups out of SFGH due to low census numbers (not enough patients for the 10 students) and therefore had to move them to all the other clinical groups. Which is fine..except that my clinical already had 10 people, and now had 13. And Children's Hospital Oakland (CHO) only allows 8 students at a time on the floor. So there was a problem.

And how did the School of Nursing address this problem? They decided to launch their Simulated Lab a semester early...which means I got to spend two days this week in a trailer with 9 other classmates running simulations with a computer and a robot baby. Which could be very cool except this is the SFSU School of Nursing we are talking about here...and they really weren't ready to do this, thus we are their guinea pigs as they develop this program. (Oh, and the husband and wife team are too much...and not in a good way. She's the nurse, he's the techie. And he is one big annoying fuck. Ugh!!)

Also this week was supposed to be two days of Orientation at the hospital itself. But thanks to this new Sim Lab thing, we missed the first day yesterday (we're actually not supposed to go to clinicals AT ALL the weeks we are doing the Sim Lab). But the 4 of us who missed yesterday went over this afternoon for the last day of Orientation.

OH MY GOD!! After 4 hours with the instructor, I am SOOOOOO excited about this clinical. Yes, I will get less time on the unit than I would like, but at the same time I can see that I am going to learn so much. Today she spent over an hour doing something no instructor yet has done - she showed us how to fill out the paperwork, how to properly do all the documentation we need to do. 

And then she handed out the schedule for the semester. Unlike many of my classmates in this clinical, I get to rotate off the unit to do two days of observation, in the two areas I wanted most - Pediatric Intensive Care (PICU) and Pediatric Oncology. Yeah, I know neither is going to be particularly easy, but I do know that after my time in the NICU earlier this semester I had to experience the PICU. And at the same time there is something about Pediatric Oncology that I'm drawn to...as hard as it may be at times, I also know that I will learn so much from the kids and their families. And in both cases, there is something about knowing these children (and their families) need excellent care and attention that appeals to me. Plus the fact that I HATE seeing any child suffer and would do all I could to help fix that.

Stay tuned...