Tuesday, July 30, 2013


I finished my nurse externship last week, an 8 week, paid experience where I basically got to pretend to be an RN (carefully supervised by a real RN of course).

Before summer, we found out our placements. We had been given the option of listing our preference in units, and I listed ICU, Pediatrics, and Oncology. I was then given another option to list even more preferences, and I added Labor and Delivery and ED to the list.

I can tell you where I did not want to be. I did not want to be on a Med/Surg unit.

I realize that for a non-hospital speaking person, Med/Surg doesn't really paint a very complete picture. I use the term so frequently now that I forget that once, not too long ago, I wouldn't have known what it meant either. The easiest way to explain what a Med/Surg unit is is to tell you what it's not. It's not Critical Care/ICU or the monitored step-down units that people sometimes go to after an ICU stay. It's not the Emergency Department or the OR. It's not pediatrics or L&D or mother/infant. It's not psych. It's the decidedly un-glamorous, bread and butter of hospitals, a place people go when they have pneumonia or a kidney infection, when they have a GI bleed or are experiencing weakness or dizziness. It's not specialized and it's not high acuity. And for those reasons, among nursing students at least, it's not exactly desirable for an experience like an externship.

It doesn't have the fast paced excitement of the ED, the critical machine filled high drama of an ICU, the cuddly babies of Mother/Infant. It's not glamorous. It's just where the majority of people go when they need to be in hospital.

And course, if you haven't already guessed, when I got the call about my externship placement, I was told that I would be placed on a Med/Surg unit. The unit also has a few hospice beds, but it's mostly Med/Surg, full of people with UTIs, diverticulitis, unexplained fevers and infections, and a whole host of other "Med/Surg" issues.

I was less than pleased. The majority of our junior year clinicals were Med/Surg. I knew I didn't want to work on a Med/Surg unit after graduation. I was done with it. I didn't feel like it's where I would benefit the most from over a summer there. I resigned myself to it, put on the best attitude and outlook I could, but I was disappointed and deeply envious of the externs I met at orientation who were going to be in the ICU or ED or some other far more exciting sounding unit than mine.

8 weeks later, and I can say definitively that I was more wrong about my outlook on this unit than I have been about almost anything else in nursing school. 8 weeks later, and I can say that I am deeply, deeply grateful for my placement, for where I've been this summer.

Part of it was my preceptor, who was fabulous. She's a tremendous nurse, for starters, the kind of thorough, warm, efficient nurse I hope to be. But she's also the kind of personality I learn best from, someone who is kind and encouraging, who teaches firmly but is nowhere near the drill sergeant/pit bull/stereotypical nurse who eats her young model. I don't learn best when I'm scared and intimated and sure that any second someone is going to yell at me. That's why I didn't go into the military. Well that, my total lack of upper body strength, fear of bullets/bombs, and maybe a few other reasons.

But it was also, to my great surprise, the unit. This place I had dreaded turned out to be one of the best learning experiences of my life, and by far the best learning experience of nursing school so far. I think back to where I was in early June and where I am now, in terms of my confidence and skills and it's shocking. I'm not there yet. I still have a long way to go. But I feel closer in a way I never felt even after an entire semester of clinicals.

I realized something this summer. Med/Surg, that scary phrase that I used to find so unappealing, is the backbone of nursing. There's a reason our year-long junior level class is called Med/Surg in most nursing schools (we call it Adult Nursing Science, just to be fancy). It's the foundation of nursing. It's all the things that can go wrong with the human body, not catastrophically wrong enough to go straight to the ICU, but wrong enough to be in the hospital, enough for patients to be sick and miserable and scared, and in need of someone to care for them. It's young people and old people (okay fine definitely more old people). It's patients who are absolutely nuts, patients who are mean and angry, patients who are wonderful and grateful.

This summer I took care of patients at the end of their lives as well as their families (I realize now that at the end of people's lives, you care for them of course, but at a certain point, near the end, they don't need you anywhere near as much as their families do). I took care of young kids, younger than me, with chronic illnesses, kids who despite the shitty fortune of having to be sick on and off their whole lives and having to face fear the likes of which I cannot understand, were also still kids, 20 somethings who could be silly or sweet or petulant, and who liked to watch Netflix on computers and stockpile snacks in the patient kitchen. I took care of 90 somethings whose minds were taken completely by dementia, who were sometimes sweet and affable and sometimes frighteningly angry and mean (you would be surprised the strength a 90 year old can have). I also took care of 90somethings who looked 20 years younger, who were sharp and bright, and at that age, didn't suffer fools lightly. I've cared for people who within minutes of entering their room would suddenly be sharing these intense, deep memories or feelings, who opened up to me utterly and completely.

I've seen really unfair things, people too young with terminal diseases, and I've also seen infuriating things, people who destroyed their own bodies, who were dying because they were never able to overcome addiction. I've laughed with patients. With others I've tried to hold back my own tears. I've comforted and taught. I've cleaned so many bottoms and changed so many diapers you would not believe. I cannot even begin to emphasize just how much poop I was involved with this summer. Mountains of it. But I also realized, over 8 weeks, that it is nothing for me to change a diaper or sheets. And for someone who is trying to hold onto some dignity, it is so much more for them, to be clean, to be taken care of and not forced to wait because I'm hoping a PCT will do that job for me. Nursing is so much more than changing bedpans and sheets, even though some people may not realize that. But that doesn't mean that changing bedpans and sheets is below a nurse. Those may be "tech" jobs, but they're also nursing jobs, because they are so fundamental to caring for someone, for making sure someone has dignity and a healing environment. I hope to God that no matter what kind of nursing I do, I never feel like I am above that.

They're have been moments this summer that have been infuriating, patients who confuse the word "nurse" with "waitress", and use their call bells over and over again with requests like they want their lunch tray moved or their pillows rearranged, ignorant of the fact that a nurse on a Med/Surg unit has FIVE patients, sometimes more, and that down the hall we might have a patient who can't breathe or who has a stat lab due that could affect their treatment plan. (please if you are in a hospital, please, please, if it's something that can wait, something that is truly not affecting you, please just wait until the nurse comes in your room to ask instead of using that Godforsaken call bell).

Nearly every shift this summer has been hectic and crazy. After 13 hours spent almost entirely on my feet walking from room to room, I sometimes barely had the energy to shower when I got home, much less make dinner. I've had victories (getting an IV is still exciting) and I've also failed at things (missing an IV still stings). I've connected with some patients instantly and wonderfully, while others I've struggled to reach. As a nurse people tend to drop down barriers for you. Whether it's because you have to disimpact them (I'm not going to explain that, if you don't know you don't want to) or if you're just in the room while they're having a family discussion, people tend to be so much more vulnerable around you if you're a nurse. And sometimes that can be painful, like when you witness family members say goodbye to loved ones, and the rawness of it all just feels like too much. But often and usually simultaneously with the pain, it's a privilege, to see people in a way people rarely are with each other.

The whole point of all of this is to say that I'm grateful, in a way I did not expect, for where I've been the last 8 weeks. I was a nursing student who thought I knew what Med/Surg meant, who thought I would learn so much more somewhere more "glamorous" or "exciting" like an ICU or ED. But I can't imagine now spending this summer anywhere else. Even with all the poop, with all the patients who were nuts or who were mean and demanding, with all the insanity and sadness, I'm so thankful for this experience. I'm not a nurse yet. There's so much about it that still scares the crap out of me, so much I still have to learn. But I'm closer. These 8 weeks brought me so much closer, and they made me understand that what's important in a hospital isn't the unit name on the wall. It's the people you work with, the patients, and the care you put into it.
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