Brianna McCarthy
Journal Entry #4
February 27, 2011
Pertaining to three 12 hour shifts (2/18, 2/23, 2/26) for a total of 36 hours.
It is difficult to believe precepting is over. It turned out to be a fabulous experience. I now feel like I could really be a nurse. I have gained so much confidence and maturity in my thought process and correlating the diagnosis with my assessments. The first of the three shifts this journal pertains to started with four patients but then one discharged early in the day and the only other patient my preceptor had was not available to me as he was a stem-cell patient. I was disappointed and hoped to get involved with the next admit so that I could get my number back to four but it just so happened that I was busy with a patient when the admit came to the floor and so someone else did the admit paperwork and took that patient. My ninth shift I was dead set on having four patients and ended up having five as I knew one was going to discharge mid-morning and I didn’t want to get in the same boat again. I managed the five fine. My preceptor ended up doing the discharge paperwork which disappointed me but, in reality, I was too caught up in my other patients during the time the patient was trying to be discharged. My last shift I had four patients and end the shift with the same four patients! One I had worked with on my previous shift so that made my interactions with her a bit more meaningful as we already familiar with each other.
I find that I really do enjoy taking the time to try to really talk with a patient, spend an extra 10 or so minutes getting to know them and building that trust. It helps me determine an approach that will work well with their personality. It also helps me assess and report to the next shift something that might make the next nurse find the patient more relatable. This can sometimes mess me up with my time management but usually I take the opportunity to spend some quality time with my patients when I am less busy.
My time management has improved tremendously. My goal for my last day was to be on time with all my medications. That went out the window within the first two hours but I could see how it wasn’t my fault; pharmacy is sometimes behind, doctors write new orders, patients decide they want their pills crushed and it is an extended release and can’t be crushed so a different pill needs to be ordered and sent up. Patient’s leave the floor for dialysis and then the majority of their morning meds aren’t given until after lunchtime. So while I know why I had the goal, as a barometer of my time management, not fulfilling it doesn’t mean my time management is necessarily off target.
I feel comfortable with a four patient case load and I can actually envision being competent to take five with more experience. There were times when I was able to be of help to the other nurses and times when I needed to delegate small tasks to other personnel. I checked in with my preceptor occasionally to see if I was way off mark or missing something major and she would always say “no” that I was doing fine. The nurses on the unit were all very supportive and reminded me that time management takes time to learn; that it is a skill like any other skill in nursing and that practice makes perfect.
By the last couple of shifts, I definitely felt like part of the team. The nurses on this floor are all really nice and encouraging. What is really noticeable to me is that I now feel comfortable with the doctors and don’t shy away from them. I have a voice and a place in this picture of the patient’s care. Something new since my last journal entry is that I started writing notes in the front of the chart pertaining to issues either the patient or I needed clarified. Also, I answered the phone at the front desk if no one else was around. I answered the call light phone as well. So apparently, I can hear on the KMC phone system! If I had a spare moment, I would restock things that I noticed earlier were not there, like syringes or alcohol wipes. Things that I felt would benefit me or the other nurses. The last thing I need is to be out of basic supplies when I am scrambling to organize my care for a patient.
I learned more about how to use the tubing system especially the protocol for ordering blood products. You have to enter a code to retrieve the tube with the blood product in it (it makes a special noise which I don’t hear to alert you to the need to enter the code). I took the opportunity to walk down to pharmacy for items. I walked down to the lab to turn in a special specimen. I watched my preceptor give medication to a patient inside the MRI room. I learned that you have to take EVERYTHING that is metal off - including my hearing aids or else they will be ruined my the magnetic forces. Very cool to see and experience.
Most importantly I realized that there is still a whole lot of stuff to learn and that I will probably never feel like I know enough. But this is ok and how most nurses feel. It doesn’t mean that I can’t be a safe and effective nurse. I love to learn and that is part of what excited me about nursing: that there is ample opportunity to continue to learn and grown in a profession that offers an abundance of different pathways in which to practice.
I think that I will truly enjoy and find beneficial the training program that will, hopefully, be part of my future job. I do best when I have observed how something is done. I am a fast learner and very observant. I know that I have to be careful, methodical and observant when working so that I don’t make mistakes or at least ones that aren’t life threatening.
I appreciate the precepting opportunity and all the work that went into it, on every end involved. I am glad I saw what 12 hour shifts are like and now know that I can handle them just fine. I have a lot less fear and a lot more hope now. If nothing else, this is what I got out of precepting and I think that is huge in and of itself.
