East magazine Summer 2008 edition
A Day in the Life
A day in their lives
starts before dawn
hey arrive as juniors and leave as nurses and in between are regarded as some of the hardest-working students on campus. “You pretty much have to say goodbye to your social life,” says nursing student Carolina Dimsdale. But there is a sense of pride, too. “I can walk on campus and see other students and think to myself, ‘I gave someone an I.V. and a shot. What did you do today?’” says Hallie Horrocks.
“We learn so much so quickly,” says junior Kelly Baxley. “Before we start clinicals we work with models, and take part in role-playing to see how we will act.” Her classmates are her best friends and they support each other through the stresses of life on the front lines.
Baxley embraces clinicals as a precious chance to learn as much as possible before becoming a nurse. She admits feeling a little shocked at the demands during her first days on the floor but now feels entirely comfortable helping to care for patients during her shift, along with the primary nurse.
Even with her classes, simulation labs and several months of clinical experiences, she says there was no way for her to prepare for the angry alcoholic she met during her behavioral medicine clinical rotation. “That was the most stressful thing I have done.”
Baxley recently worked in the post-operative unit of Pitt County Memorial Hospital, where along with the unit’s staff nurses, she cared for patients who had undergone major surgeries. Her ECU instructor was Beth Bryant ’89 ’01. We tagged along to get an idea of what a typical day of clinicals is like for a nursing student.
Wake-up time. Having showered the night before, Baxley dresses in her trademark ECU-purple scrub uniform, packs lunch, grabs breakfast and leaves by 5:45 a.m.
Baxley arrives at the nurses’ station of the post-op unit at Pitt County Memorial Hospital, where she will spend the next eight hours. Today, her patients are an older man with several health problems, and a woman who had knee surgery the previous day. The man’s complex condition includes diabetes, obesity and high blood pressure. She reviews his computerized chart, carefully studying the long list of medications he’ll need during her shift. She will be responsible for making sure he gets them on time and without complications. “You have to be ready to go from the minute you get there,” she says. “People need attention at all times.”
“Good morning, how are you feeling today?” Kelly says as she walks into the room where a groggy-eyed patient welcomes her as cheerfully as possible, considering that he’s still in pain from a recent back surgery. He does his best to accommodate her requests, shifting his weight so she can check his wound dressing, allowing her to listen to his heart, lungs and bowel sounds. “I bet you’re hungry,” she says with a smile. She will need to check his blood pressure and make sure the tube draining his wound is clean. Later that morning, the patient’s nurse will have Baxley remove the tube, known as a Hemovac.
Baxley checks in on the female patient, who’s wide awake. She declines pain medication. Baxley learns that later in the day she’ll be responsible for helping this patient get out of bed for the first time since her surgery.
Baxley returns to her male patient’s bedside to measure his blood sugar and prepare an insulin injection for him. She has to check with Bryant to confirm the dosage, because it’s a form of insulin she’s not familiar with. They must order additional insulin from the hospital pharmacy.
Breakfast is served.
The night nurse is giving Baxley a report on each patient’s condition, providing additional information about their needs and medications. Doctors’ rounds are beginning. Activity is picking up at the nurses’ station as the day gets under way.
Documentation time. While patients finish eating, Baxley makes a record of the morning’s first assessments.
Mentor time. Baxley has in-depth conversations with the primary nurses. Many of the nurses who work with students are not ECU faculty, but they have an important role in their education. Many take a personal interest in prodding them to learn, explaining medical conditions and even quizzing them afterward.
Baxley reviews the availability of medications. Everything has to be in place from the pharmacy before she distributes in a half hour. Most important, all intravenous medications must be taken from the refrigerator and allowed to warm to room temperature before Baxley hangs the bag, because cold medication can be very painful. Baxley also checks again for medication allergies.
Baxley distributes medication to her patients.
Baxley must remove the male patient’s drainage tube. While the primary nurse watches, she removes the patient’s stitches, dislodges the Hemovac and applies new wound dressing. Removing this kind of device can hurt, so she maintains a calm demeanor. That helps her patient relax, and all goes well.
Lunch. Baxley and her classmates have lunch in the hospital cafeteria. She has brought a sandwich, chips and peaches, her usual menu.
Back on the floor, she checks her patients and prepares for the afternoon duties: helping her female patient walk and discussing the doctor’s discharge orders with the male patient.
The woman who underwent knee replacement is coaxed from the bed to her walker so Kelly can help her complete a lap around the nurse’s station. The patient has an immobilization brace that will protect the knee after she’s discharged.
Baxley documents her female patient’s progress and checks on her male patient.
A second round of medication. Her male patient will be discharged this afternoon, but before he leaves Baxley explains the follow-up procedures, new prescriptions and the signs of problems he should look out for. The instructions were written by the patient’s doctor. It is the first time Kelly has been responsible for the discharge instructions.
The end of her shift in sight, Baxley reports to the primary nurse and retrieves her belongings from the locker room. She and her classmates adjourn to a post-shift conference, where they will discuss the day. At the meeting Bryant answers questions and hears about their challenges, which include dealing with shotgun wounds, complex I.V. medications and patients who “code,” or present a Code Blue, which is called when a seriously ill patient’s condition becomes a life-threatening emergency. “These experiences offer them a protected setting, with a lot of mentors around them, so they can learn more and take on greater responsibilities,” she says.
Baxley arrives home, washes her scrubs and takes an hour-long nap.
Study time. Baxley prepares for upcoming course work, tests and upcoming clinicals.
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