Wednesday, August 22, 2007

What's in the clinical bag?

cross-posted at the SON's new blog, of which I am a contributor! Kay Supreez!

One of my favorite nurse bloggers recently did a post on his toolkit - the bits of debris that he intentionally fills the 85 pockets of his cargo scrubs with. At one point during this summer's rotation, I realized that I needed to learn to either tie sturdier bows with my drawstring pants or carry less stuff.

The clinical bag* for Med-Surg always had this:

*not that I carried an actual bag while I was on the floor this summer during my med-surg rotation. After a couple of weeks of searching desperately for each of these things each Monday night before 7am Tuesday clinicals, I started keeping them all in a little tote. I'd empty my pockets into the tote before throwing the scrubs in the laundry, and then fill the clean scrubs from the tote the next clinical day. I still managed to wash quite a few alcohol swabs.
  • my little notebook. Mine was from the dollar store, about the size of my palm, and fit nicely in my pocket. It had:
my clinical instructor's cell phone number, in case I got eaten by a monster on the way to the hospital and had to call out
my plan for the shift, broken down by hour, written the night before and then edited during report, when I found out that ECT had been cancelled for the day because my patient had a sandwich for breakfast
lists of the questions that I wanted to ask later
abbreviations to ask about - UC? (ulcerative colitis), R/O? (rule out), 2/2? (secondary to).
my patient's meds - what is it, how does it work, why/when/how/how often are they taking it, are they taking the right amount, how will we know if they have taken too much, and how will it react with the other med they're taking? I soon realized that many of my patients were on the same drugs (stool softeners for pts on opioids, magnesium for those with borderline mag levels, proton pump inhibitor to lower gastric acidity, etc) so having the info already written out, ready to read off to my clinical instructor when we pulled meds was really handy!
  • 2 black ink pens - since I invariably lost one during the shift. remind me to tell you the one about the nurse, the checkbook and the rectal thermometer.
  • watch with a second hand. I really resisted this one, and went the whole first semester without one, doing all my evals with the second hand on the clock in the classroom. But then I couldn't count resp rates or take a pulse one morning because my patient's room didn't have a clock and I knew I was going to have to break down and stop by the drug store on the way home and get a $30 watch.
  • penlight, for shining in people's eyes and looking into the cabinets where the canisters of NG tube drainage are kept before you go reaching your hand in!
  • stethoscope, labeled indelibly, of course. It was surprising how many folks laid their stethoscopes down around the unit. The big cargo pants pockets were good to stash mine in, especially when I had a patient on contact precautions and was going to be using the one in the patient's room all day anyway.
  • lip balm. tricky, this one. I always washed my hands before and after putting it on. But the nice minty smell and the familiar ritual of lip balm was really important to me while I was getting acclimated to the unit.
  • tiny bottle of hand sanitizer, rarely used because my unit had three handsinks every two feet.
  • a super compact OB tampon, because, hello! white scrubs!
  • two granola bars. After a week, I realized that I had to bring food that I could eat using sterile technique. I never *felt* like my hands were clean, even knowing that I'd been wearing gloves and washing them constantly. It made me happier to eat things in wrappers.
  • at least 10 of those little alcohol wipes, good for wiping down the earpieces of the afore-mentioned stethoscopes in the contact precautions rooms. for that matter, I put a couple of the big dinner napkins sized individually wrapped alcohol wipes in my pocket when I had patients on contact, because the Dinomaps and glucometers all had to be wiped down as they left the room.
  • I also always had a letter sized piece of paper, like my patient's latest CBC or my write-up from last week, folded lengthwise in my pants pocket, half sticking out. When I took vitals (since I did it the old fashioned way, without the fancy machines), I could write down BP and HR and temp on the back of that paper, using my own leg to bear down. It worked really well, even better when I started writing down the time beside the numbers so that when I got out to the chart and opened up the paper, I could tell the 8am numbers from the noon numbers!


For my Psych rotation this fall, the bag is pretty different. First off, it's actually a bag, and I have no pocket-stuffing to do. We're wearing professional clothes on the unit, and we're not carrying ANYTHING in our pockets. We're also not doing any writing or note taking while with the patients. So, my little notebook stays with my pens in my bag until I can come back to the breakroom every hour or so and make some quick notes. No wallet, and only my car key ring, since I can't lock my bag up, just lock it away from the patients. I never carried my cellphone this summer either, except on a day that I knew something sketchy could happen child-care-wise, and then I kept it in the break room on silent and checked it every hour for missed calls. No stethoscope - I feel pretty confident it would go on the same list with belts and sharp objects. A bigger bottle of hand sanitizer, though, since I'm in an older facility and there's just two easily accessible sinks on the unit that aren't that easily accessible most of the time. Granola bars, lip balm, and tampons still essential, but they all stay in the bag, along with a bottle of water.

There are a thousand differences between med-surg and psych, but the most obvious at the moment is that all the time I spent writing up meds and labs and chief complaints and medical history before I did any patient care for med-surg is now spent after interacting with the patient, writing up our conversations, analyzing for therapeutic communication techniques, writing nursing notes about the shift, looking at the files and finding that things are sometimes quite different from how the patient perceives them. Oh, insight, you are a wily beast! Off to write up my observations from today, before I forget them forever!

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