nursing seminar

I teamed up with two other nurses this week, "K" and "M" to hold a 3 day seminar to teach nursing instructors what they need for their nursing students in their clinicals. It was quite the eye opener! "K" started by giving an introduction to the expectations. They have to show up for their clinicals, or they will be out of a job. Period. Sounds silly to have to say? Well, several of the instructors never show up, so the students drink a bit of tea, then leave. They then graduate and start working in the hospital with no clue of what to do. We would like to stop this practice, so she also gave some expectations for the students. If they don't meet those expectations, they don't graduate!

I then gave a lesson on "Comfort measures". These range from fluffing pillows (yes, some nurses still do that) to getting the patient to do deep breathing , coughing, and leg exercises to prevent pneumonia and blood clots. They had no idea that patients on bedrest were at risk for these things. I also said that a patient should get up and walk ASAP after surgery, and they thought I was crazy (they still think you need to wait 24 hours...a practice that is not long ago in our past). So they couldn't believe that I had surgery this summer, and walked out of the hospital less than two hours later!

The next day, I gave a lesson on assessment (many new things there!), and "M" gave a lesson on medication math. The assessment went well, and I had found this great program on "lung sounds" on the internet, and because I am an aid worker, they gave me a 30% discount! So we got to hear a lot of crazy sounds. They were upset that I didn't have any heart sounds to listen to. I told them, that they had enough new and important stuff to learn, and that if they heard anything different than lub-dub, they should tell the doctor.

Here is where it went crazy. "M" introduced them to medication math. What the doctor orders is not necessarily how the drug is supplied, so you have to do some calculations to figure out the correct dose. For example, the doctor may order 15 mg of something, but it comes in a bottle labeled 30mg/ml. So, you have to give 1/2 ml. That is an easy one. They aren't always that easy. These nursing instructors are the creme of the crop, some with 20 years experience, and they had never calculated a dose! They draw medicine up into a syringe and just give it without knowing how much of the drug is actually in it! Oh dear.

Then, we went on to drip rates for IVs. That was even worse. They just eyeball it and give a little or a lot (no kidding). That is dangerous for an adult, it is lethal for children. In the States, though we learn how to do a drip rate, we have machines now that do it for you. here they have nothing mechanical at all, so it is up to the nurse. When a patient gets up to go to the bathroom, they shut their own IV, then open it back up when they get back to bed, and usually, they open it all the way up and get flooded with fluid! So crazy.

So, we have decided to have another "mini" seminar just for medication math for these poor instructors.

The instructors were eager to learn though, and that was very heartening. The students come back to school jsut after New Year (which is March 21 here!) So, we will have our work cut out for us!