Saturday, June 14, 2008


Nurses eat their young.

But not, like, their actual young, just, like, their professional young.

As a new nurse, who somehow survived the daily mental-ass whooping that is nursing school, I can totally attest to this. For some odd reason, a lot of seasoned nurses will go out of their way to degrade a student nurse. They'll follow you around to nit-pick every flinch you make near a patient -- or worse, they don't follow you at all and wait for you to drown in your own sweat and fear. They'll take each and every opportunity to launch a vicious pop-quiz lightening round on you and make sinister smiles at each other while you fumble through a drug guide or look desperately for the "smart" classmate who always know this stuff. For me, it didn't take so well. Older nurses certainly made their best attempts to eat me, but lets be honest: I'm bitter, sarcastic and don't go down all that easy (insert requisite innuendo here.).

Maybe, for me, it was being older, less intimidate-able or just downright uninterested in some unit nurse's power trip every fall semester. I watched countless fellow students run into a linen closet to cry, turn seven shades of dark red in a nurse's station holding back tears during a verbal assault or sit in their cars after class screaming about how they were never going back. Here's a phrase that could earn some awe from a class of nursing students anywhere: I never cried in nursing school. I shook my fists a lot and raised my voice, but nary a salted tear rolled down my face from August 2005 until May 2007.

But let me clarify: this is not all nurses. And there were plenty of fantastic nurses who gave of themselves and their time to help mold the new litter. I am endlessly proud of be a part of this profession. I just don't know why some of us had to pay in tears and psychotherapy to be a part of it.

Now, as a nurse, and as a nurse who is on the other end of student nurses on the unit, I find myself really going out of my way to ensure they aren't eaten (and we have a few nurses on our unit with grumblie tummies, if you get me). Nursing school was hard enough, man. Getting out of the classroom and textbooks and into the hospital with some real-live-sick-people is supposed to be a relief. It's supposed to be the part you look forward to. The part where you are able to reaffirm to yourself, "Yessss. THIS is what I want to do.."

I love having students follow me, actually. It gives me an opportunity to assure them that they'll be on my side of the bed soon. It surprises me every time at how much I actually have learned in a year on the floor -- and challenges me to teach them in meaningful ways. I look to find interesting things for them to see, encourage real patient interaction, versus wallflowering-it near the door and try to "tie it all together" for them -- without scaring the hell out of them at the lightening pace at which we work, the multi-tasking Xanadu we create and must maintain and the knowledge we have to produce at a moment's notice for a family member or a doctor.

I guess through all of this, someone noticed. And this summer I have been assigned my own nursing student. One girl who I am supposed to mentor all summer. I know, right? Me, mentor someone? I have no business mentoring anybody, let alone someone who will eventually be caring for human life.

I've really be savoring the past two weeks with her. I love sharing my passion for this profession with her -- and best of all, she has the same passion. She's quick to learn and easy to teach. The program that sponsors her summer internship requires that she check off a few boxes in the way of skill-sets. And it's partly my job to ensure that she gets as much exposure to procedures and skills as possible in the next 8 weeks.

Task #1: Drawing blood. The poor thing has to have 50 "sticks" this summer. And sadly for her, we're on a renal unit where ain't nobody got nothin' in the way of veins up in that piece. So, I offered up my healthy, well hydrated vascularization to her pointy needle. (This is gross, I know. More people have shivered at this retelling than have commended my selfless offering of my own arm in the name of education. However, it was the kind nurses during my schooling that offered up their own arms that taught me just how to do it right. I thought I ought to make my own deposit into that karma fund.) Freakily enough, I found myself tying off the tourniquet on my own arm and walking her through the stick. She got it on the first prick. Which, for a nursing student, inspires greatly needed confidence. Beware, patients in renal failure! Ain't no vein too small.

Task #2: Learn to insert an IV. Well, hell, she did such a fine flipping job on the blood draw, why not step it up a notch and have her access that veiny goodness for a more permanent amount of time. This time, however, I brought in other experts to walk her through the process. Suddenly, the experience became a "too many cooks in the kitchen" scenario with nurses and nurse's aides swarming her advising on which spot would be the best to hit. I told her she could try for any vein she wanted ~ which, sadly for me, was the one on the inner part of the arm that hurts the very most to stick. I braved through it -- taking every effort to not make a bad face that would discourage her. Once she stuck me, she had the vein and then missed it, likely going right through it. It just ain't all that easy to insert an IV.

In anycase, I have a more confident, ready to try it student nurse on my hands this summer. And on my arm, I have a nice signature of her first attempt to stick another human being.

Incidentally, this was a very hard picture to take all by one's lonesome. And secondly, based on the looks at the grocery store (which is the only place I have been other than the hospital, and large bruises are common, if not mandatory, for hospital folk) I assume that I look like a woman who sassed her man or else a new IV drug user.

How do you feel about Phlebotomists setting IVs instead of nurses, seeing how phlebos see a lot more veins in their days.
Setting IVs and blood draws are within a nurse's scope of practice. And it's a skill that, if not used, will be lost. Many floor nurses these days rely on techs to set IVs and do the draws, but when they're swamped or if it's an emergency, you need to have that skill for yourself.

We'll get a phleb to the floor once in a blue moon when everyone else has tried to access someone, but it's rare. I can't ever imagine having one full time.
My arm totally looked worse than that after my IV last summer. Does that mean they missed the first time? Not surprising since my IV got put in in a moving vehicle.
Elisabeth's friend Nurse Lindsay here. Kudos to you for precepting a nursing student. I loved precepting when I worked at our local trauma center. I too was one of the rare souls that got through nursing school without crying in clinicals. Too bad we can't share a pint (or 12) about our chosen profession and how shitty old school nurses can be to the newbies. You should've put a TB syringe and a rusty spoon next to your arm in that picture, just for added effect! ;)
i just managed to leave the exact same bruise on a friend

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