Preceptorship update - Week 2 midweek

The 2nd week of preceptorship is in progress with two more work days this week. My schedule is 12-hours on day shift. A lot has happened and I have learned a lot so far. I'm starting learn who the residents, attendings, clerk staff, and my fellow nursing co-workers are. There is a lot to remember! I know over time I'll get it down.

One thing I noticed while working on the floor is the uniform of military personnel on the ward: ACUs. Here's what an ACU uniform looks like:

From Rangeroutfitters.com

Imagine nursing care in this! Here are some issues I see with this unifrom:

• Sleeves
  It is difficult for infection control to have sleeves as part of nursing care. Hand washing will be the most common annoyance as good hand washing includes washing up to the wrist. It is important to wash the wrists as they can be contaminated with germs while performing care. Sleeves can be contaminated and can be spread from patient to patient when performing care: changing diapers (on adults and infants), foley care, IV insertion, etc.
  Also, these sleeves are just annoying and get in the way of performing care. There are many times where I am trying to establish an IV site, but my sleeves get in the way. They also touch every thing.
• Patches and Badges
  While talking about infection, how often to soldiers change their patches? They cost about $20 to change all the patches, and a lil more with badges. How many nurses/medics clean their patches and badges with a cavi-wipe after their shift? Germs, germs, germs.
  
• Blouse
  Moving around on a medical floor and produce a lot of heat especially on a busy floor. Sweat is produced and odors are present. Nasty, just nasty... I find that taking my blouse off during lengthy procedures such as a bed/bath change, IV access, etc. helps reduce my sweat production and reduces infection control.
  
• Boots
  These are pretty heavy and wearing these for a 12 hour shift can make some sore feet. It would be comfortable to have sneakers (I hate Crocs), but that's not part of the uniform. With a lil bit of money, some more comfortable boots can be purchased, but who wants to spend more money on work?
  

There are some good things I like about the uniform. There are some of them:

• Pockets, pockets, and more pockets!
  There are pockets everywhere on this uniform! They are good for storing IV flushes, alcohol pads, gauzes, and medications. Scrubs don't have a lot of pockets and I'm not a big fan of the fanny-pack.
  
• Pen holder pocket
  Nurses goes through pens like crazy. Someone takes them or they get misplaced when a code occurs. Having a place specifically for pens makes it easier to keep them in line.
  
• Belt
  I use my belt to use my holster for my stethoscope. I don't like keeping it around my neck or in my pocket.
  

The solution:

ACU scrubs Nursejoe.com

Reasons for:

• Sleeveless
• Pockets
• Increased range of motion
• Benificial for infection control

Reasons against:

• $20 extra out of pocket to pay unless issued by CIF or unit
• Cost to standardize throughout MTFs and clinics around world

Note: ACUs are not used in units such as the OR and ICU, but are used generally throughout the hospital.

We will have to see what the future of Army nursing will be like concerning uniforms for military personnel in a healthcare setting.

Preceptorship - Medical floor

I finally start my preceptorship this Monday! For the next six weeks I'll be assigned to the medical floor where I will be paired with a preceptor to help me learn the ropes. After those six weeks I'll be on my own without the help and guidance of nurses nearby.

The clinical rotations that finished this week gave me a good idea about how WAMC runs. My favorite place was the pre-op/holding area for surgery. I was able to practice my vital signs and even start IVs! When was the last time I stuck someone with a needle... Both times I went to this unit I started 10-15 in several hours. Of course not all of my sticks were done in the first try. There were some I had to stick twice and there were some that I or the anesthetist could not stick so we had a very experienced nurse work their magic. I also enjoyed the PACU in which patients are coming out anesthesia and need pain management as well as monitoring for any adverse events.

I'm glad that I will have a regular schedule starting Monday. I miss having 12-hour shifts and getting 2-3 days off from work. It'll be another adjustment, but working days won't throw me off that much.

Tips for success:
- Sign up for classes early: BLS, PALS, ACLS - they fill up fast!
- GRE for Dummies - I recommend it (as I am currently reading it) if you plan on advancing in the field of nursing

Side note:
These ACUs aren't very good for infection control... more thoughts next entry.