This week I am participating in an International Conference on Technology in Healthcare sponsored by Rutgers University. The innovative and creative new systems are amazing. I have seen small hand held devices that systematically report patient medical record items to you via voice control and then record your clinical notes and documentation from a series of voice prompts that auto-load into a documentation template. Very cool and what a time saver. I also saw the use of smart phones for polling and quizzing students in class and presentations. My friend Betty and I liked this technology so much that we added some sample polls to our presentation for the conference. We also learned about the important simulation study being conducted nationally by the NLN. They doing a multi-phase study of the impact of clinical simulation on nursing student performance both on the NCLEX exam and on the performance of graduate nurses. They are studying schools that are replacing up to 50% of clinical time with case simulations using high fidelity simulators. Betty and I presented another option for simulation and that is the use of unfolding case studies that are interactive and create virtual simulations. Some virtual simulations are animations and others are videos using live actors. After watching a short video, the student is asked a question and depending on how they respond, the program takes them to the next step in the case. This is called branching logic and it follows the clincal reasoning and clinical judgement that students apply to the case. I do not believe that simulations can ever fully replace real life clinical encounters or faculty based learning. Simulation does however offer a wonderful opportunity for students to participate in rare clinical events, to avoid placing patients at risk, and allow for a safe practice and learning experience. A great new educational world is unfolding. Jump in !
The Early Story of Becoming a Nurse
By Diann Martin
From the time I was a very young girl growing up in a suburb of Chicago, all I ever wanted to be was a nurse. My mom was a nurse and I thought she looked wonderful in her white dress, white nylon stockings and shoes and her starched white cap. I could hardly wait to grow up and become a nurse so I could have a real cap like that. Mother was a head nurse and her job always seemed very important to her –almost as important as we were. She was the mother of three children and she was also a remarkable housekeeper, cook, wife and the handy-man at our house. In addition, she had a profession. In the early 1960s, a working suburban wife and mother was rare and raised eyebrows of the neighbors and caused her to be diligent in her supervision of my behavior. Her patients were the frequent topic of discussion at our house and she worried about them, supported their families during the times of stress and worked hard to see that the care that they got under her watch was the very best. The nurses on her unit admired her and viewed her as a mentor. I was proud of her and wanted to be what she was.
Even as a very young child, mother used to take me into St. James Hospital with her around the holidays. I would be dressed up in my very own tiny nurse’s uniform and pass water jugs to the patients on her floor. She took me into the rooms of some favorite patients, or people who were lonely and I sat with them and watched television while she worked. I met a young girl who had broken her neck in a car accident when she tried to run away from home. She was totally paralyzed from the neck down and I remember brushing her hair for her and thinking that she was paying a very high price for short-lived adventure in leaving home. I also sat with the mother of one of my school mates. She was yellow and her stomach was stretched taut with fluid and swelling. The woman was an end-stage alcoholic and would not live to go home again. I read a story to her and thought about my classmate facing life without his mother. I also got a first-hand look at the late effects of heavy drinking. When I was in middle school, one of the most popular boys in our school was a patient on my mom’s floor. His name was Dick Perro and I could not believe that he spent several months in the hospital side by side with MY mother every day. It was mind-boggling to think of her seeing him naked and taking him to the bathroom. I remember feeling very proud when he came to our house to see her about a month after he was discharged from the hospital. I was too embarrassed to go downstairs and even look at him when he came to our door. Looking back on it, I realize that my mom gave me some strategic life lessons through her selective introductions to the world of the sick and injured.
When I turned 15 my mother found a way to occupy my time in the summer by arranging for me to work in the hospital x-ray department as a candy stripper. Better that I spend 40 hours a week “volunteering” than be left at home to get into teenage mischief and cause even more concern among the neighbors. My stint as a candy stripper earned me the respect of the stern Dr. Hyman Love, who was the Department Head of Radiology. Dr. Love was feared throughout the hospital and I remember wincing when I heard his heels clack across the tile floor as he walked into his office suite in the morning. I tried to sink into the woodwork in his presence being a lowly peon in the department, but he knew I was there and either because my work, or my mother’s influence I was offered a job every summer throughout my high school years and into college. As the department lackey, I was trained in every aspect of our work from transporting patients down for x-rays to developing film and working in the office. I worked hard and made sure that my behavior was beyond any admonition that could and would have been passed along to my mother who had a pretty high-profile in the hospital. As an x-ray department aide I saw a wide range of human conditions that are likely foreign to most teenagers. These included sagging hairy butts, dangling breasts, and other body parts too numerous to mention. I realized then that most people look better with some clothes on but I continued my interest in becoming a nurse someday.
When I finished high school I had my heart set on attending Michael Reese Hospital School of Nursing and earning a diploma in nursing. I selected Michael Reese because their cap seemed to me to be the very best. It was small, crepe and neatly folded into a triangle on the back of the head. It looked especially charming on nurses with long hair swept off their necks into a bun. My mother strongly objected to Michael Reese and she made it clear that she and my father would only pay for my education if I got a 4 year bachelor’s degree in nursing. A wise woman and ahead of her time, she sensed that the profession was moving toward higher education. So at 18 I went away all of 30 miles to Loyola University and began my 4 years of college as a nursing student.
Working in a Catholic hospital for all of my early years was great preparation for going to Loyola’s school of nursing. The nursing students were the closest approximation to nuns on campus. Unlike most of the student body, we awoke early and ate breakfast in the cafeteria while everyone else slept. We wore white uniforms covered with maroon pinafores that ill-fitted every figure. The thin students looked like they were in sacks and the fat ones, like me looked like we were packed into sausage casings. The program, particularly the hard science courses like chemistry, biology and physiology were challenging and I often felt that we studied more than even the pre-med biology majors. Off we trundled three mornings a week to clinical at a series of local hospitals. Having been an aide I knew how to take care of patients so I was usually done with caring for the patients assigned to me long before my classmates were. What I loved was getting a chance to learn and practice some care and treatment that real nurses got to do. For example, I learned to irrigate a patient’s bladder catheter with sterile water. It was a big production with sterile gloves a bulb syringe and my teacher, Sr. Ruth leaning over me from behind while I did the whole thing. Picture a turkey baster full of juice waiting to be squeezed on the turkey. There I was with a 50cc bulb syringe ready to squirt saline into the patient’s bladder. Just as I was pushing the fluid in to this elderly man, he emitted a deep sigh and died. I was mortified and learned later that Sr. Ruth knew that death was coming within minutes but she wanted to make sure I had the chance to complete the procedure.
I also remember going to the intensive respiratory care unit at a local hospital. It was 1972 and both the patients and most of staff on this unit were smoking. I was helping my side kick and best friend in nursing school, Kitty Moran with her patient. He was a quadriplegic on a rocking bed. The idea here is that the bed oscillates down so the patient’s diaphragm drops while they breathe in. Then the head of the bed rises when the patient exhales. We had to brush this man’s teeth while trying to follow the rhythmic movement of the bed. I was doing the brushing while Kitty watched. I was horrified when I heard her ask her patient, “So what does it feel like to be paralyzed, do you just feel like a head lying on the pillow?”
Later in that same year of clinical, Kitty came to me frantically while I was bathing my patient. She was taking care of a post-op patient and had given her a morphine shot for pain. The problem was that she was to have discarded or wasted ½ of the syringe before injecting the patient but she forgot to do the wasting. She was also supposed to hold the shot until the patient was fully awake and alert. Kitty however, noting a grimace on the woman’s sleeping face, made the unfortunate decision that it was time for the shot. Panicked we sat by the woman’s bedside for several hours counting her respirations and heartbeat. I was nominated to tell Sr. Ruth about the mistake and Kitty had to call the doctor. Though the dose was actually not putting the patient in any peril, we were too green to know this and we hung on every breath the woman took for the rest of the shift.
My last and one of my most memorable sagas of being a student nurse was my psychiatric nursing rotation on the inpatient locked unit at Hines VA Hospital. Unclear as to what on earth we were there to do for these able-bodied men clad in green pajamas and lounging all over the day room like a scene from One Flew Over the Coco Nest we walks in a huddled group like a gaggle of geese. I felt like a USO girl as we usually spent the day playing cards with the patients who were lucid enough to notice our presence. Half of the patients were on what they called the VA circuit going North in the warmer months and migrating to warmer Southern hospitals in the winter. Many were chronic alcoholics. My patient was a younger Vietnam War vet. His name was Dave and he convinced me within hours of meeting him that he had been inappropriately hospitalized by his wife who was having an affair and wanted him out-of-the-way. After hearing his story I could not wait for the group therapy session where I would take a stand and explain the injustice and he would be set free to leave the place. When the time came, the patients, the head psychiatrist, the nurses and the students all sat down in a circle in the day room for the group session. I waited patiently but anxiously to tell Dave’s story. As I hurriedly stated the case, I saw the nurses and doctor shoot looks across at each other, then without changing the studied expression on his face the psychiatrist said, “Miss Proud thanks for telling us about Dave’s situation. Oh, by the way, has he told YOU about the people in the phone that his wife sent?”
“Why no Doctor, I haven’t heard about them” I answered promptly.
“Dave, could you tell Miss Proud and the other students about the phone people?”
“Sure Doctor”, said Dave. “Well my wife is really out to get me, see and just like I told you, she had me sent here to get me out of the house so she could go bar hopping and sleep with other men. And just to make sure she knows what I am doing all the time, she sent these little green men to watch me. They follow me all around the place. They especially like to listen in when I am on the phone, and then they tell my wife everything I say.”
Needless to say, my psychiatric assessment skills would need some further attention and experience. The incident would come flooding back to me when I my mother came to visit me several years after I graduated and got my first job as nurse at the Rehabilitation Institute of Chicago. I had invited my mom to come to my unit and visit me and we would then go shopping on the gold coast. We took the CTA bus back to my apartment and through some odd synchronicity of time and space, when the bus door opened at the first stop, who should climb onboard but Dave, my psych patient from the VA Hospital. He took the open seat directly in front of my mom and me. He leaned around and noticed me. “Well, if it isn’t Diann, my little student nurse from Loyola. How are you?” He said.
Before I could acknowledge him or say a word, my mom chimed in, “Oh! What a wonderful surprise, you know my daughter.” That led to a short replay of my experience taking care of Dave as part of my student experience. I neglected to mention that he had been a psych patient but as I recall he and my mother shared a long discussion of hospitals, nurses, students and the profession of nursing. Sometimes worlds collide. It always makes for an interesting slice of life.
This week I had a very unique experience in my career as a nurse. I hob-nobbed with Patricia Benner and had a chance to interview her for a video taping session at a National Nursing Educator Summit. She is a hero of mine and her book, From Novice to Expert nailed it in terms of my appreciation of the transition that people in practice disciplines make as they learn more and experience more and develop their abilities. She is a distinguished scholar and likely the most famous or one of a hand full of the most famous nurse leaders in the modern era. She remains very approachable, engaged and well, I guess I would say normal. She told me about her work with wounded vets and high tech transport of soldiers from the battlefields in mobile ICUs. She is studying the impact of this care on the patients and on the nurses. She is not sitting back on her legacy of research and past material but she is right out there creating new knowledge and charting the future of nursing and healthcare. I am lucky enough to have had the chance to chat with her and get her views on the need for scholarship in nursing. I sat near her at a conference session on geonomics and the need for nurses and nurse educators to learn about this field and incorporate the knowledge into our practice. She was taking notes! I really got a boost from meeting her and I consider her involvement her way of paying it forward to other nurses and creating a legacy. Thanks Dr. Benner, for being an inspiration. Diann