Check out some of our Student Editorials below!
You Have to Learn
Towards the end of my Medical-Surgical clinical rotation at Penn Presbyterian Medical Center on Cupp 5 East—an orthopedic surgery floor with a lot of spillover—I cared for a lovely older patient who had been hospitalized for over a month following complications, infections, T-tube placement, etc. from a Whipple surgery intended to treat her diagnosis of pancreatic adenocarcinoma. The patient was in an immense amount of pain throughout the day. Not to mention that this particular day was her first day being weaned from the PCA or patient controlled analgesia (i.e., they were getting her off IV opioids and switching her to PO opioids). To complicate her case even more, she had a PICC line for long term antibiotics, was hooked up to a wound vac, and had an ostomy bag attached to her abdomen collecting bile/fluid which was hard on her self-image. It’s clear how complex this case was and how much was going on.
Nonetheless, I felt so lucky that this particular patient was so wonderful even with all that she was going through. Despite her intense pain, she let me learn! She wanted me to perform my full physical assessment on her (even though it meant she would have to move around a bit and endure pain). She wanted me to give her all of her medications, including insulin and heparin injections, as well as her IV antibiotics. Although she was exhausted all day, she wanted me to interview her for one of my clinical assignments. She easily could have declined my requests and I gave her the option to “opt out” multiple times throughout the day.
No one has said it better than this particular patient. She kept telling me throughout the day: “Yes, honey, go ahead and do it. You have to learn. This is where you will learn best.”
I was so appreciative of this patient. Even though she was experiencing so much pain, she still wanted me to learn and practice my skills on her! After all, clinical rotations are the best place to learn and each student should take full advantage of this time in the hospital (especially when you have a patient who is so receptive to student nurses). I’m so grateful I was able to care for this patient and learn so much from her case!
Dana Shulman, Penn Nursing Class of 2024
Value from Clinical Experiences
In the spring semester of sophomore year, all Traditional BSN students will complete their first clinical, the maternity and newborn clinical, where we spend time rotating between labor and delivery, post-partum, and NICU floors. Since before I applied to Penn Nursing, I have always known that I wanted to be a pediatric nurse, and always imagined myself in an acute care pediatric setting, like the PICU. So, despite the excitement of starting our first clinical, I was always more excited thinking about junior spring and our pediatric rotation. However, I am so grateful for the opportunity to have spent time on the maternity unit, as it inspired a passion for primary care and caring specifically for the adolescent population.
It was my second day at clinical, and I was assigned to the delivery floor. I was so excited that I may actually see a birth! The nurses on the floor asked me to go introduce myself to my patient for the day, who was a teenage girl accompanied by her mom. I entered the room to introduce myself, and asked the patient if there was anything I could get for her. I tended to anything she needed, whether it was ice chips, a blanket, or the remote control. During this time, I decided to strike up a conversation with the girl and her mother. We talked about everything from pop culture to baby names, and I got to know so much about her in such a short period of time.
Then, all of a sudden, it was like everything I learned in lecture manifested in front of my eyes. The patient stopped our conversation to let me know she felt the urge to pass a bowel movement, which is a key sign that she was about to deliver. I instantly ran to grab a nurse when she told me, and I am so glad I did, because within five minutes of her cervical exam, she was pushing. The nurse midwife moved swiftly once she realized the patient was 10/100%/-2, all while remaining calm and encouraging to the patient. I assisted the delivery by holding her leg and hand while she pushed, which she did not need for long. After six minutes and five pushes, her baby girl was delivered without a single tear of her perineum.
I was particularly moved by this patient, however, not because she was the first birth I witnessed, but because of our earlier conversations. Before she had her baby, I asked what she was excited about, and she answered that she wasn’t super excited – she just wanted to eat raw sushi and sleep on her stomach again. Her entire life had clearly been changed by this, and I felt horrible that she was not excited about welcoming a new baby. That being said, I was also moved by the level of family support this young mother had. Her mom was her support person, and kept reiterating how proud she was through the entire labor and birth process. Her sister, grandmother, and at least ten different friends all immediately called to congratulate the new mom and “Tutu” (the grandmother of the newborn baby). I was relieved and in awe myself, then, when I saw how happy she appeared to have her baby in her arms with all the words of encouragement surrounding her. There was so much love in the patient’s room, and I felt assured that this young mom, who was not very excited about having a baby, had a vast support network.
This experience still has me reflecting almost a year later. I think about this young girl and her circumstances, and how great of a family she had surrounding her to support her as a new mom. I also reflected that not everyone has these same support systems, and that primary care can stand to play a large role in creating these social support networks for similar-aged mothers. Throughout the rest of my time on the floor, I was sure to listen to the social work consults and read through the available pamphlets on the floor. As a young woman entering the nursing field, I feel inspired to enter primary care, with the goal of bringing my newfound passions for women’s health and my newfound knowledge of the available social support systems for adolescents into my practice.
Megan Laubacher, Penn Nursing Class of 2024
Every MedSurg clinical starts out the same way. I arrive at the hospital at 6:30 AM, select my patient, and begin researching their diagnosis. At 7:00 AM, I meet the nurse I am paired with for the day. On one particular busy morning, the nurse I was paired with had five patients to take care of. The nurse was warm and welcoming, and she let me accompany her into each of her patients’ rooms. Her attitude made me eager to start the day.
When I received the report, the night shift nurse described my selected patient as unpleasant and difficult. It has always bothered me when the report includes descriptions like this, before I have even met the patient. When the nurse and I went into the room for the first time, the patient had few words for us, and the nurse let her know that we would have to change the dressings on her leg ulcers later in the day, something that was very painful for her in the past.
When we began to change her dressings, she told us more about her feelings regarding her hospital stay. Her ulcers were very severe, and she had a bad bone infection on both legs. Her doctors advised her to get an amputation or to go on hospice care and to prepare for the end of her life. However, she had extreme doubts about her ability to care for herself if she were to undergo an amputation. She doubted her strength and was unaware of options like prosthetics. My nurse and I described some options to her and intently listened to her worries.
After leaving the room, I was very bothered by this woman’s troubles. Her doctors were rushing her to make a decision that could end her life while she was seemingly uninformed. I advocated for her to acquire educational materials. Additionally, I advocated for her to receive emotional support.
While I am unaware of her current health or her final decision, she taught me skills that I will take with me through the rest of my career.
Alissa Brubaker, Penn Nursing Class of 2024
How Can You Not?
It was a normal day on my favorite unit—an inpatient oncology unit that specialized in liquid oncology. I was completing my summer fellowship and it was my last day. It was 7:15 AM—the busiest time in the hospital, and I was greeting my four patients for the day. Four was the maximum one nurse was allowed to have, so I knew it was going to be a busy day for my preceptor and I. By the fourth patient, I felt like I had some time to relax into my day. I was getting in a groove and I had a few spare minutes so I chatted with my patient. A middle aged woman just a little older than my mom who had a nasty form of leukemia. She was taking chemo like a champ and we chatted about her fuchsia pink nail polish. I took her vitals and everything was normal—easy day I thought to myself.
About 45 minutes later, I came back into the room to bring her some water and the air was drastically different. She was struggling to breathe. Counting her respirations thirty one, thirty two, thirty three—I started to panic even though I’ve been trained for three years for situations like this. You allow yourself five good seconds of panic and then you start to think about what you need to do. I quickly bumped her O2 up, threw a pulse ox on, and sent my preceptor a message to come immediately. I did not feel comfortable leaving the room. My preceptor comes gliding into the room, she covers her concern nicely and again raises the O2. It’s time to elevate to the next level now and as we leave the room I’m quietly shaking in my clogs.
Just this morning, we were joking about fashion, and now she is having a clinical emergency. I slide back into the room as the attending and his entourage arrive, and the conversation takes me back. “Honey, I don’t know how to tell you this, but this could be the end for us.” He speaks succinctly but with overwhelming kindness. She’s spiked a fever and is put on high-flow oxygen—they think she has a bug. This is my first family meeting. My goggles fog up as I try to hold back tears. Her husband asks several questions about hospice and the decision is made. Immediate transition to comfort care. Within hours, her family is flowing in and out like a revolving door (we had a visitor limit because of COVID so the family had to take shifts at the bedside) and all orders are switched to measures to keep her comfortable. Her breathlessness increases and she begins to drift into a gentle sleep. We give her medications to keep her calm as breathing becomes more difficult. I bring her daughters coffee and let them tell stories about their mother. She loved to garden, she liked to play with her grandchildren. She wakes up only briefly and asks for a lemon icee. We were out on my unit but you better believe I tracked down this water ice for her. She ended up passing peacefully at the end of my shift with her two daughters at the bedside.
After an experience like this, people often ask me, “How can you do oncology?” and my answer is “How can you not?” I had the privilege of caring for this woman and her family at the lowest point they had ever experienced. I had the privilege of holding her daughter’s hand and explaining how we were keeping her mom comfortable. It is really hard for lots of people to understand, but the end of life can be just as beautiful as the beginning if you work hard enough. In oncology, this will certainly not be my last patient death, but the goal is to bring people peace when none is around. Even though this was something that I didn’t feel prepared for and I was really scared about, I feel very privileged to be able to uphold the nursing values of caring for the vulnerable and feel so much gratitude for the experience.
Lindsey Krott, Penn Nursing Class of 2021
Nursing Students are Innovators
People are usually confused when I tell them I’m a nursing student passionate about entrepreneurship. The typical question I get is, “Why aren’t you in Wharton then?” I usually just want to roll my eyes, but instead, I respond by saying, “Nurses aren’t just at the bedside, we are CEOs, legislators, researchers, and more.”
Nursing students are one of the most powerful minds for innovation on Penn’s campus. As the frontline provider, we have a vital perspective into healthcare and the many challenges that patients face. Within this perspective comes an opportunity to be innovative and creative. This drives the power nursing students have as innovators and entrepreneurs.
I’ve been fortunate to utilize my nursing lens within the entrepreneurship ecosystem at Penn. Through my entrepreneurial projects outside of clinical and studying for anatomy, I’ve learned a lot - especially about the incredible power nurses have to be innovators. And here are some reasons why:
- With our ability to empathize with people and view situations in holistic ways, nursing students are primed for being incredible entrepreneurs, who like nurses, need to be able to understand problems, empathize with stakeholders, and find solutions.
- Nursing students have a powerful entrepreneurial spirit. We don’t just take orders; rather, we utilize our critical thinking skills to find unique solutions to complex problems.
- Nursing students understand people, and we have seen them, interacted with them, and cared for them in their most vulnerable times.
- Clinical hours provide us a chance to learn clinical skills, but they also provide us the opportunity to investigate challenges and network with healthcare administrators/nurse managers.
- Amid the COVID-19 pandemic, nurses have finally begun receiving the recognition and gratitude they deserve. Now, more than ever, companies such as Johnson & Johnson and Microsoft want to support nurses in their innovative pursuits.
- We handle pressure and stressful situations with composure.
- We are compassionate people and are driven to make an impact.
In a report issued by Penn Nursing and the consultant group BDO, LLP entitled Unleashing Nurse-Led Innovation, leaders surveyed from both clinical and business sectors agreed that nurses have the greatest opportunity to utilize innovation to transform and improve care for patients by 2025 (BDO, LLC, 2019). While innovation and nursing have not always been coupled terms, it is time to realize that entrepreneurship/innovation has been incorporated into nurses’ daily work since the nineteenth century. As nursing students, we cannot underestimate our innovative ability.
You may be asking yourself, “How am I supposed to balance a heavy course load, clinical, and startup?” and trust me, I ask myself that a lot. However, there are incredible resources on-campus to help you so that pursuing your innovative ideas is not such a burden and can be balanced. Resources like the Penn Nursing Innovation Accelerator, designthinkingforhealth.org platform, the Innovation in Health: Foundations of Design Thinking Case Study course (Nursing 357), the Weiss Tech House, VIP-C, and more!
I encourage you to reach out to your professors, ask patients what is wrong with their care experience, interview nurses and managers about what is challenging for them during clinical — We have the power to truly transform healthcare, and it’s time we start speaking up about it.
If you want to learn more about how to participate in innovation/entrepreneurship on campus, feel free to email me at email@example.com.
Anthony Scarpone-Lambert is a Penn Nursing graduate of the Class of 2021. Additionally, he is the Co-Founder and CEO of Lumify Care, a startup currently participating in the VIP-X on-campus accelerator.
Finding the Positives
This summer, I had the unique opportunity of working at Curative Inc., a COVID-19 detection laboratory. At Curative, we provided the community with precise oral fluid tests, maintaining a turnaround time of getting results within 24 hours of arriving at the laboratory. Oral fluid tests reduce pressure on the medical supply chain; the test is performed by the patient — a quick and easy 3 step procedure. 1.) for 2 minutes, swab around the walls of the mouth, under the tongue, and the roof of the mouth 2.) place the swab into the tube 3.) gently swirl the swab.
Each day, I worked with up to 1,000 patient samples, utilizing a single-channel pipette to precisely extract fluid from patient tubes into a 96 well plate. This procedure took extreme stability because of its high possibility of contamination. Through my time at Curative, I was able to perfect my pipetting skills thanks to the high volume of tests I encountered daily. I had the opportunity to learn how to operate the Hamilton Microlab STAR Liquid Handling machinery, an machinery for automatic extraction, tripling output rate. These were skills I never would have never had the chance to develop during nursing school!
This experience taught me persistence; we were constantly working tiring 8 hour shifts, filled with 4:30 am wake ups, back aching work from pipetting all day, and difficult breathing conditions due to wearing N-95 masks the whole shift. However, this was worth our efforts in order to insure patients had their results as soon as possible. Even though I was exhausted, I knew that the work I was doing was helping to aid the current global pandemic - lives were being saved.
During my time at Curative, I was able to witness many milestones. After operating for only 5 months, the company hit one million tests analyzed. Two weeks later, we hit 2 million tests analyzed. I am happy I was able to have the opportunity to be a part of a company and have been inspired working here, as Curative finds new ways to improve, learn, and grow every day in order to slow the spread of COVID-19.
Vanesse Tan, Penn Nursing Class of 2022