Wednesday, October 24, 2012

Mid-Senior Practicum Reflection

This rotation has been a busy, chaotic, educational, lonely, and frazzled one.

I have never minded working nights. The pay differential is amazing, the evenings are usually more quiet and leave more room for really taking your time and getting to know your patients. However, that is when you are actually working, getting paid, and working your own desired schedule. When I did work nights, I did all three in a row so that I could have days off to myself....and I could be awake during days. Because I am doing three days of clinical and working at least one day a week, that means four nights a week I am doing something, and they aren't all in a row, which means I have to be diligent in keeping on my night schedule. So my "days" off are lonely nights spent watching tv, grocery shopping, and cleaning, much like tonight. However, it has proved a great learning opportunity to me.

The graduate NICU at PSL has allowed me a unique opportunity. Most of my classmates are also in ICU's or ED's, critical care units, on day shift. They are seeing tons of interesting cases/scenarios and taking care of some pretty intense patients. While I take care of a very focused population that experiences very similar situations, marked free of disease other than congenital anomalies, with disease processes that are understood and predictable. The unique aspect is that my preceptor is allowing me to take care of the babies on my own. She is allowing me the opportunity to assume being the nurse and making the experience really into the nursing role for myself. She allows me to critically think and provide my nursing reasoning skills in my care (and of course guides and corrects me when I'm not quite on target with her reasoning). What it is allowing me to do is learn time management, workflow, and clinical reasoning. I'm not seeing tons of interesting stuff, but I'm learning other aspects of nursing such as delegation, time management, critical thinking and reasoning, disease process, prophylactic interventions, physical assessments, etc. It's been an awesome rotation in that aspect. And I'm learning tons.

Contrary to adults, neonates bodies respond the exact opposite of how we learned adults respond to different disease processes or conditions. In that aspect, and in caring for neonates, it's all new territory.

The only problem will be studying for NCLEX, which is all geared towards adult med/surg after this rotation is done. I will have to go back and remember everything in the adult world. I guess it just means I will have to study even harder!! And go through tons of practice questions.

I've had a plethora of babies however. I'm currently up to taking care of 4 babies. I was able to take care of 3 babies all on my own last week. So much so that my preceptor was bored by 10pm and spent two nights playing games on her phone. This week (a week ahead of schedule), she thought me ready to bump up to 4 babies. We walked into a pretty high acuity 4 baby assignment, and while it was incredibly overwhelming, it was an absolutely great experience. We will be shooting to have 4 baby assignments for the rest of our time together over the next five shifts.

I've had respiratory babies, GI babies, cystic fibrosis, ostomies, OG/NG tubes, TPN/lipds, isolettes, open cribs, CF/HF oxygen delivery, and there is one baby who had a foley that I got to observe. All in all I would say I've been able to see quite a bit. I'm doing the initial assessment, cares, lab draws, etc. The only thing I haven't yet tried is starting a PIV, and that's because my only opportunity has been on a baby who is a notoriously hard stick and I'm just not going to do that to a poor little babe who has been nothing but a pin cushion since birth.

I need to get better at interacting with families, and confidence in myself, but I feel like that will come with time. It's a lot to take in and learn all at once. I feel like I'm getting there, slowly but surely. We will see how the next two weeks pan out!!

 This is me, while at work, looking out over the city through the 7A windows at work...while mostly you can see the desk and the reflection of what's behind me, you can also see the dots of the lights on the buildings. I thought it was pretty cool :-)

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