Capstone is our last clinical experience of nursing school. We spend 120 hours following the same nurse, learning to take over their load and see what it is like to have a full patient load and being the nurse for multiple patients.
My capstone, as many of you know was in the Emergency Department. I worked night shift 7pm to 7am. So my schedule was very stressful especially with commuting back and forth from Indy to Elkhart. I have run on little sleep, Starbucks double shot drinks, and lots of prayer.
In the beginning of the semester our very first class our teach had us list our goals for the semester specifically for capstone experience. These were my goals
– become good at IV starts
– become confident with medication administration and knowing my medications
– become good at blood draws
– confidence in readiness to become a nurse and care for multiple patients
If you know me the readiness to become a nurse was not really an issue, I am pretty social so talking to patients is not scary to me at all, I can have a conversation with just about anyone. I have been told that I have a very calming persona to me, that I make others feel calm and relaxed and that they appreciate my care. I have been ready for this for so long! I am so excited that I am almost done with school and I will be taking NCLEX in the next few months!
NCLEX is the state license test that I will take to get my Registered Nurse State License. This is a tough tough exam, it can be anywhere from 75 questions to 200 questions. We have 6 hours to complete it. It depends on how you are doing on how many questions you will get.
Back to my ED experience: I got to start multiple IVs every night and I got very good at them! I can say I am confident in the ability to start an IV. I feel confident with drawing blood from them when I start them and once they are started. I can draw blood from a non IV site as well. I gained so much confidence in skills. I was doing so many things on a regular basis that I got so comfortable doing them. Where before we were doing a skill maybe once a semester and that was it. this semester I started over 50 IVs, I did multiple straight catheters, I did multiple EKGs, I gave hundreds more medications. I saw more emergent problems.
Being in health care we have the lovely HIPPA law so I can’t go into a ton of detail but I can tell you a little bit about the moments that touched me the most.
I rocked a 2 year old to sleep in the ED one night at 3 am while we waited for the child’s mother to get to ED. She just snuggled right up to me and started to fall asleep in my arms.
The kid cases are the ones that stick with me – pediatrics is definitely not where I want to be, it is way to emotional for me! . There was a child who was in foster care and the child was brought in for a check up to see how the child was doing. The child had been through so much, but when doctor and I walked in the room the child was just the happiest little kid ever! The kid has the biggest smile, jumping around, jumped right in my arms and gave me big hug! The doctor was examining the child while I was holding the child and the child was playing with my hair telling me how soft it was and how pretty it was. It just made me smile so much. Here this little child was treated so unfair and here this child was so happy and making me smile when we were in there trying to make sure the child was safe and loved. The care that this child was in when we saw the child was so good, there was a lot of love and care for that child and it made me so happy that someone was willing to step up and care for the child that deserved it.
We had an elderly patient who came in that ended up being admitted that was just the cutest thing ever – of course most older people are. She was arguing with us telling us she needed to break out of the hospital so she could go home to get the soup for the animals. She was so precious. She constantly wanted to get out of bed, unfortunately in the ED we do not have bed alarms so we eventually we put her in a wheelchair and one nurse walked her around the unit singing her Christmas songs. It was the most beautiful thing to see and hear. She sat with us until she was taken up to her room and she rocked a bear. It was so sweet. We sang Christmas carols. It was such a sweet 30 minutes.
The other thing this experience helped me see was how blessed I am. There were so many young men and women coming in to the ED alone. I can’t imagine going along like they did. Even when I got bit by the dog Nick was with me and took me to the hospital, My mom was telling me she would come and my grandparents showed up. I wouldn’t be able to make it to the hospital without a family member beating me there let alone sit there for a few hours without someone. I am very blessed to have the love from my family that I do.
Another thing that was hard was seeing how many sick kids came in and when asked if they were up to date on their shots the parents said no. Kids get sick, it is a fact of life. But, the kids that came in to the ED without vaccinations were a lot more sick than those with vaccines.
I saw multiple people who were brought in due to car accidents who were drinking and it was very hard knowing that they were hurt and someone else was hurt and they could have just said “no” to that one last drink and that accident may not have happened.
Being in the ED I have also paid attention to the things going on with insurance. If you don’t know what I am talking to you I will give you an overview:
Insurance companies want to stop covering visits to the ED when they are non emergent. They are also putting guidelines on what emergency is defined as. I heard that in some cases they are not going to consider a broken bone as a emergency, which is very wrong due to complications that can come about from a broken bone.
So here are the Pros and Cons.
Pros: this is going to cut down on the people who come to the ED for a cold, cramps, things that could be treated at home or could be seen the next day at the family doc for much cheaper.
Cons: This cutting down on ED visits means that people are going to be afraid to go to the ED because if it isn’t an emergency it isn’t going to be covered. So a person having chest pain will try to wait it out and see if it goes away, is really having a heart attack and then ends up dying at home. Or the person having abdominal pain who thinks maybe it is just cramps or a pulled muscle, it ends up being an appendicitis, it bursts and then there is an even bigger problem to deal with.
I am happy to have this experience because I was able to see so many diagnoses that I had heard about all through school but the signs and symptoms were not sticking with me but once I saw my first patient with that diagnosis I can’t get that person and what they looked like out of my head.
I had a young child come in with diabetic ketoacidosis with a blood sure of over 1200. The normal range is 80-100. This young child was so miserable. The mother had been asking the family doctor to check the child for diabetes but she was blown off. This just goes to show how important a mothers intuition is and that being in the health care profession we need to listen to what parents say because they are around their children and they know differences. Sometimes parents may be over protective but in this case, the mother has every right to be asking for her child to be tested for diabetes.
The best part about this experience was that I was at St. Francis which is a Catholic affiliated hospital. I had one patient who was in by herself and was just very emotional with the news she found out. I felt the Big Man upstairs talking to me telling me this was the patient that needed to be prayed with. Regrettably, I tried to ignore it because I did not want to make my patient uncomfortable. But, I felt Him keep bugging me more and more. So I went in to give another dose of medication, she was wiping tears away and I asked her if it would be okay if I kept her in my prayers tonight and the next few days, she began to cry some more. She said yes that would be ok. I asked if she was a prayer and she looked at me and said “Hunny I’ve got kids, of course I am a prayer”. So I said well would you like me to pray for you right now and she looked at me and she said I would really really appreciate that, I feel alone right now and I would just like to feel not so alone. So we prayed. and It was exactly the place I needed to be. It was where God knew I needed to be and it was perfect. I am so grateful for those opportunities. and even more for those pushes from God to just go for it, to step out of my comfort zone and pray.
I am sure as soon as I publish this I will think of more I want to tell you all. So you may see a part 2 pop up here at some point. But for now, it is bed time.
Good night dear friends.
Kenzie Post 