Style Change

I am changing the style of this Blog. When I started the blog I was undertaking an adventure in the role of a Nurse Refresher Student. I will continue to review the nurse refresher modules but I want to add some personal clinical information. I completed my clinical experience at an Acute Care Hospital on a primarily postoperative surgical unit which included some medical patients. I plan to add information to the reviews that relate my personal experiences on returning to nursing. The RN Refresher experience as a whole was excellent! I did find a job back in research before I finished my first attempt at the practicum. I continued to work with the refresher program to find an opportunity to return and finish the practicum. I am happy to report that I was able to work with my employer in allowing flexible hours so I could complete the Clinical Practicum on the second attempt.

The first   attempt at the Clinical Practicum was a classroom type orientation very much like nursing school. Extra classes were offered in a clinical lab setting. We learned adult assessment, respiratory equipment usage, Intravenous care, wound care, using the PIC system to administering drugs, and practiced CPR on smart Annie dummies.

Annie was connected to monitors and proceeded to get very sick. Annie told us her symptoms and we had to decide how to best treat Annie. Annie proceeded to develop arrhythmias which we had to identify and treat.  We used a mock crash cart to get supplies. Annie had IVs hanging and we administered drugs via the IV lines. We set up for chest tube insertion and set up the drainage system. Annie had some large draining wounds. We set up a wound vac and dressed Annie’s wounds. We did CVP site care and changed IVs. We administered Oxygen therapy via nasal cannulas, mask, and tracheotomy. We suctioned secretions and cleared airways. We listened to heart sounds and breath sounds and learned to identify the different sounds to respond to how to best help Annie. We practiced starting IV on rubber tubing. It was an intense day but I am happy to report that Annie recovered and was resting comfortably when we left. Annie has gotten much more advanced and sophisticated since I first met her in nursing school.

We had another training day where we had our ID badges made. We got parking passes and a tour of the hospital as well as a tour of the floor where we would train. We spent a half day training on the computers. All nursing notes would be entered on the computer. We would get our patient updates from the computer and the staff. No more Kardex systems. We were instructed on patient privacy. We would now use room numbers not names. A room number was a way to attempt to protect patient’s identity. This was a big change from my nursing days. I can remember being reprimanded early in my career for using room numbers instead of a patient’s name. The idea then was that a room number depersonalized a patient and was inconsiderate. How is that for a 180 degree change in thinking?

Our instructor or preceptor was a nursing instructor at the School of Nursing in the University of North Carolina. She also worked in the hospital once a month to keep her skills current. All the refresher students completed the course work and scored 80 % or above on the course work. There were 10 students more or less. Most of the returning nurses worked in Clinical Research type jobs. Some had taken time off to raise families or pursue other career paths. As students found jobs they left the program with the hope of being able to complete the practicum at a later date. Students worked on the floor providing bed baths, linen changes, taking and recording vital signs on the computer systems. Our instructor reviewed everyone’s work and signed off on the effort.

We only worked 6 hours on the floor 3 days a week. Our instructor needed time to sign us off (thank goodness). Weekly, we were provided with handouts on case studies. We read the case studies at home, did the research, and had to be prepared to discuss the case study as well as any related lab and medication pertinent to the case study. The last hour was used for the discussion, review assignments, and questions. We were so tired we could barely drive ourselves home. We thought we were in good shape with walking every day.  We even had yoga and exercise instructors in the group. The reality is that we were on our feet working for 6 hours with no sitting except at lunch. The physical challenge was unbelievable. None of us were up to it. By the second week some were wearing expensive shoes from sporting stores. We all had trouble with ankle swelling. The standing was the hardest part of the practicum. The relentless standing got easier over time but the first 2 weeks were intimidating.

We had a check list of the experiences we needed to complete by the end of the practicum. We reviewed the list to determine what experiences we had acquired and what experiences were still outstanding. We worked with our instructor to get the check off list completed. I was half way through the practicum experience and received my midway evaluation by the time I had to leave.

My second attempt at completing the practicum was with a preceptor. The preceptor was a senior nurse on the floor.  The preceptor was arranged by the refresher program director. I worked out the schedule with my preceptor and my employer. I worked two 12 hour days at the hospital during the week. I worked 8 hour days remotely on the week end for my employer. I did not have any days off for 8 weeks. I was exhausted but it was a good experience. I had “one on one” mentoring experience. I no longer had to complete with other students for limited experiences and my instructor’s time. I got to administer a lot of drugs under supervision. I was not tired when I left the hospital. I often stayed late to give report and help. I was delighted that I could do it all and I was nursing again (even if I did not get paid). In fact I had to pay more to get the second opportunity to finish the practicum.

I am proud that I finished the RN Refresher Program and I can now incorporate my experience by adding personal comments to the module summaries.