Who Will be My First?
Throughout life we build our own individual skill sets.
Often times we are our own guinea pig and learn from our own mistakes. Often
times however, if we build skill sets based on our careers these trial and
errors often affect others.
During nursing school I remember being overwhelmed by the
amount of new procedures that I was being taught. Granted, we had the aide of
models that provided the perfectly accessible orifices, but eventually we had
to perform those procedures on live and anatomically varying people.
Over the past 6 years as an ER nurse I can say that I became
pretty proficient at certain things; IV starts, foleys, colostomy appliances, code
medications, etc. Nurse practitioner school definitely built on these skill
sets but also added new elements.
I had always listened to the heart, but now I was doing it
more thoroughly and diagnostically. I had to become comfortable with more
intimate exams including rectal exams, pelvic exams and prostate exams to name
a few. During our clinical intensive we lacerated and sutured cow tongues and
lanced our homemade lotion abscesses, but my clinical rotations did not afford
me the ability to practice those on live individuals.
Starting off the bat in urgent care I knew that procedures
would be a daily occurrence and to be honest I was looking forward to this. I
was honest during my interview to let them know that I had no experience in
things like digital blocks, suturing or I&Ds on real patients. Show me and
then give me the chance to try it on my own, and I would more than likely
I have learned that you have to be confident in your
perceived ability to perform a task. Without that internal cheerleader, you
often are defeated before you even start. I have seen so many procedures during
my nursing career that I inadvertently engrained some great tips and tricks
into my brain.
A lovely patient became one of my firsts. He had the
unfortunate luck of stepping on a piece of glass while traversing his kitchen
barefoot. In his heel he felt that there was something there bothering him with
each step he took. An x-ray did not show with foreign body but palpation of the
heel elicited a nice pain response. Off I went to numb my first appendage and
go looking for a normally invisible item.
It did not help that he had attempted himself to find said
piece of glass leaving a pitted heel to guess which hole might hold that glassy
treasure. Off I went. Infiltrating a heel with a needle was a little more
difficult than I had anticipated but after that ordeal was accomplished I was
ready to go.
I had seen another ER provider at one time use an 18G needle
to explore a wound first to see if they could come across the change in
texture. Sure enough this worked and I was able to manipulate the glass out
without having to use a scalpel to cut into his heel. I have to say I was
pretty proud of myself and I did end up telling my patient that he was my first
in this endeavor.
Since then I have placed my first sutures, successfully
irrigated cerumen impacted ears, hand expressed abscesses, removed sutures and
seen my first complicated patients who are like those proverbial Pandora boxes.
Each and every day has been a learning experience. I have
learned that I could suture all day long. As I said to my husband, "It is like
arts and crafts on people," putting them back together again. I look forward to
being able to add new files into my file cabinet of skills and of course share
them to all of you!