Clinical practicum as a student nurse-midwife is going very well! As I anticipated, I absolutely LOVE catching babies. I love being able to do full scope triage as a student (as opposed to as the RN at my job, where my hands are tied as to my scope of practice). I enjoy being able to meet the woman, assess the situation, come up with a working diagnosis (or more than one diagnosis), formulate the plan of care and assist her in making decisions.
The more common things I see in triage:
- Urinary tract infection
- Bacterial vaginosis, yeast infections
- Round ligament pain
- Back pain related to the "sway back" of advanced pregnancy
- Muscle spasms (back, legs)
- Early labor or false labor
- Complaints of vaginal bleeding with no evidence of bleeding coming from anywhere (very frustrating for the woman!)
Don't get me wrong, I do enjoy triage. It keeps my mind thinking, especially when you discover something incidentally, and you come up with a diagnosis that has nothing to do with her presenting complaint! (For example: back pain is her chief complaint. Upon arrival, you find her blood pressure alarmingly high, and in the course of assessing her, you find that her lab work indicates she has preeclampsia. The back pain may be normal for pregnancy, but the high BP and abnormal labs sure are not! Bingo! You have just discovered something incidental to her chief complaint that needs addressed.)
On the nursing aspect of my life, I'm finding it easier and easier to handler larger patient assignments, thanks to my ability to juggle multiple patients as a student nurse-midwife. Granted, there is a larger amount of documentation required as the RN vs as the nurse-midwife, so more of my RN time is taken up with documentation. Blech. We really need to find a way to streamline the documentation aspect of nursing so we can actually do *Real Life Nursing Care* (trademark pending). I loathe nursing documentation. It is double and sometimes triple charting, repetitive, and cumbersome. We have to keep up with documentation standards put out by groups that have no clue what nursing really is like. They keep coming up with more and more documentation that we have to do, and less time to actually take care of the patient. Can I get an "Amen", my sister nurses?
I am, without a doubt, looking forward to completion of my education, and graduation as well as passing boards. I am ready to be done on this journey towards midwifery. It has been quite the long journey. I started in December 2008 as a Bridge student at Frontier, attending Frontier Bound. Then I Crossed the Bridge at Bridge Crossing in November 2009. Finally, Clinical Bound this past July 2012. Clinical practicum began two weeks after Clinical Bound.
And here I am. Mid October, full on clinical practicum.
I anticipate completion of clinicals by March 2013, I hope. Then --- practice comp exam. Must pass with an 80% or more. Then, comp exam. Again, must pass with 80% or more. That will give me my very hard earned graduation and MSN degree.
Final step: pass boards. I'm aiming for April 2013.
Ready, set, let's GO!!!
6 comments:
AMEN! I've decided if they keep adding to documentation, that they are going to have to hire nurses to take care of the computer, and nurses to take care of the patients.
I wrote the sex, weight and apgars in four locations in the chart, noted them on the op note, and lastly on the discharge summary. Still got dinged as I forgot to write them in the "Short Surgical Summary" form as well.
Amen! So difficult charting 5 minute push lines, when you are actually trying to...get this...push with the patient!!!
On the triage note...hands down the most devastating triage outcome for me was a patient that came in with repeated reports of back pain. She was sent home twice in one week ( not by me) for r/o labor and UTI. Third visit, she was in my room and 5 minutes later, full out coded. Stat section...baby saved...patient died of a dissecting aortic aneurysm. Obviously that would not have been something we ever would of found in reality, but horrible circumstance!
Oh, a definite AMEN! I am so antediluvian that in my early days as a nursing student it was drilled into me that the DOCTOR was ultimately responsible so the burden of charting fell on him, but by the time I graduated, the principle that a nurse was responsible for her own actions had been established, and the trend toward endless, repetitive, mind-numbing charting was in full flow, not to mention the hated "Nursing Plan". It's much worse now, in the US, I understand. Fortunately there is still a sense of proportion here in Israel [and less malpractice suits] but the burden is considerable, since our official patient/staff ratio is much larger than in the States.
There have been so many changes in nursing since I entered Beth Israel School for Nursing in 1964 that it would take a complete essay to list them all, but IMO everything that has removed us from patient care to "chart care" has been a retrograde step. Surely in this technological age, with voice recognition software, EMRs can be developed which could generate chart entries by simple dictation, which would save huge amounts of time!
Just a note about my personal experience with back pain and pre-e. My chief complaint was upper back pain. Went to a DC thinking I needed an adjustment. He was the one who said my BP was high. After a few weeks he mentioned that it might be my liver. BINGO! Totally made sense. A few days later I was in the hospital with pre-e. Obviously not scientific proof that back pain and pre-e are correlated, but interesting nonetheless.
Amen! I agree with Anonymous about pre- eclampsia. that's what happened with me too.
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