Mariana Ramos 1

Clinical Day 1: Match 22, 2018

First day at clinical at Jackson South Hospital and I was placed in the 2 Tower Medical

Surgical Floor. My preceptor Elsie is very nice, always busy so I am never sitting down. I was

assigned an 87-year-old patient who had spinal cord surgery on C-3 through C-7. My patient has

suffered from back pain for several years and she has a previous spinal cord surgery from L2

through L5. For many years she was perfect, no back pains. Until she had an incident and fell.

Her doctor had told her the only way to fix her new injury to her spinal cord would be surgery.

Even though I was assigned this one patient, I would still help my preceptor with the other five

patients in whatever she needed help in. Since the beginning, the day was busy as it was, and

then we had a code. One of our patients was unresponsive, my nurse had asked another nurse to

help her put in a new IV line, as that nurse did, she found that the patient was unresponsive.

After, we regained consciousness from the patient, the doctor mentioned that the patient might

have had a seizure. The doctor nor the nurses knew what exactly the patient had, but they had an

idea that he had a seizure. Our patient was extremely dehydrated, we couldn’t get that IV line in,

so my nurse got the order in for a mid-line to be done on the patient. I observed as the mid-line

was inserted. This 12-hour shift seemed to fly.

Clinical Day 2: March 23, 2018

Second day of clinical at Jackson South. I was assigned 6 patients. My preceptor Elsie

helped me discharge two patients. Two of our patients were NPO, they all had procedures to be

done. A cardiac cauterization was done, in which I learned after their procedure was done, we

had to release air (15 mL) intermediately from the pressure dressing and observe for any signs of

bleeding. Another patient had a colonoscopy to be done. As we went on with our rounds and
 Mariana Ramos 2

keeping in mind of the pressure dressing. As we walked into the room we found the patient

without a pressure dressing on. The patient had taken it off on his own, we just saw a towel filled

with blood. My nurse told me to run to get the charge nurse, but as I was telling the charge nurse

a doctor over heard and raced to the room. Thankfully nothing happened to the patient, but all

the blood scared us. At the end, the doctor confirmed everything was okay, but talked to the

patient the purpose of the pressure dressing in place. The patient bleeding had stopped but the

patient’s wrist was edematous. That was a scares of the day, and after that we had a new

admission. This day was busy but not as yesterday.

Clinical Day 3: March 29, 2018

Third day at Jackson South. Elsie once again my preceptor; I was assigned the same 87-

year-old patient who had spinal cord surgery on C-3 through C-7. She has not yet been

discharged last week due to difficulty to swallow, and did not pass the gag reflex test. Now she is

being feed through a PEG tube. We had five other patients which had COPD, renal calculi,

Acute Kidney Disease, Hematoma with DM, and finally a patient with stab wounds to the neck,

forehead, and shoulder. The stab wounds interested me the most, but unfortunately there was no

wound care to do nor did I find out what lead to such stab wounds. The patient was ready for

discharge as well. At 11 a.m. I did Accu-Chek for the Diabetic patients. This clinical day was

way slower, than the week before. I annoyed the patients with the question “Is everything okay,

anything I could do for you”, “Would you like more water or ice”. I even helped other RN’s on

the floor. Answered the phone, received calls and delivered messages to the nurses. It was a calm

clinical day.
 Mariana Ramos 3

Clinical Day 4: April 12, 2018

My preceptor Alejandra was extremely kind and also encouraged questions. From the

beginning I noticed she actually liked to teach. She questioned me throughout my entire clinical,

questions that didn’t even pertain to med-surg. She was testing my knowledge. If I got a question

wrong, she would say “no, no, no”, she kind of reminded me of professor Kathy. Without the

slap on the hand of course, which was funny to me. She did make a comment, that she would like

to teach one day. Anyways, this clinical day I was able to give heparin shots, of course do Accu-

Chek. I was allowed to program the pumps for the IV Primary and Secondary bags, under my

nurse supervision. The UAP needed help so I helped him take the vital signs. This clinical day

our patients were mostly elderly, the youngest was 74 years of age. I never fail to have a COPD

patient. The other patients were there for an automobile accident with fractures, pneumothorax

patient, an inmate who would do self-harm in order to get out of jail, and two Alzheimer patients.

One of the Alzheimer patient had pneumonia and another with a concussion. Before I knew it my

clinical day was over, enjoyed this day.

Clinical Day 5: April 13,2018

On this clinical day I had Elsie as a preceptor, assigned with the same patients. The

majority of the patients were ready for discharge. I learned that for some inmate patients, you

don’t really inform them that they are ready for discharge because they would inflict harm onto

themselves, in order to stay more time at the hospital. The patient would literally insert whatever

he could fit into his penis, several small objects. I honestly wanted to find out why would the

patient do such harm to himself, would it be bullying in prison? Elsie mentioned he was a regular
 Mariana Ramos 4

patient. This clinical day was very calm, not much new news, besides giving meds and patient’s

being discharged.

Clinical Day 6: April 19, 2018

Today I had another preceptor Samantha. She was just like Alejandra; she loves to teach.

The only thing Samantha is a floating nurse. She used to work in the emergency room, but got

pregnant so we went on maternity leave. She stepped down from the ER, and became a floater.

She says she misses the fast pace work at the ER but she enjoys being able getting home to her

baby with still energy left in her. Today surprisingly the majority of the patients were from

trauma. A gun shot patient with pneumothorax, acute appendicitis waiting on surgery, a vaginal

laceration patient claimed was accidental, a motorcycle accident with multiple fractures, acute

asthma attack patient, and an Alzheimer’s patient. The majority of these patients were younger

than the usual age I’m used to. The gun shot patient had a clean shot, the bullet had entered

through his anterior chest and came out through the posterior, he developed pneumothorax so he

had a chest tube. The vaginal laceration patient had surgery for her vaginal laceration, she

claimed was accidental. We found out she drove herself to the hospital at the middle of the night

as she bleed. The motorcycle patient even with several fractures seemed to be painless. There are

people that could tolerate pain more than others, and this young patient was definitely one of

them. He was even walking; he was scheduled for surgery on Tuesday but he refused so he’s

having surgery on Friday. This patient had a lot of smoking sessions (Marijuana), he was never

in his room. My nurse said that she once had a patient that would always walk out to smoke and

she tried to prevent the patient from leaving the room, so she called security. She came to find

out that patients had the right to have smoking sessions no matter what they smoked. The
 Mariana Ramos 5

hospital isn’t a prison, so they can’t prevent them from smoking. That was interesting for me to

learn. I even helped the charge nurse take Accu-Chek’s of her patients. Besides that, my day was

very calm. There’s this new change in the hospital, now night shift does morning medications.

We had no medications to pass out besides PRN pain medications and heparin shot. Very calm

clinical day.

Clinical Day 7: April 20, 2018

This clinical day, I had a new preceptor Rose. Due to this new schedule, when to pass out

the medications. Now night shift passes out the medications at 7 a.m., nurses are able to better

assess their patients. Be able to actually speak to their patients, instead of being in a rush in the

mornings. This change just really makes the day way easier. I actually agree with this new

medication administration in the morning. The nurses are also better at documenting. As we were

assessing our last patient who had fractured his pelvis bone, ARNP rushed into the room saying

do not eat. He had just finished eating; they were annoyed because they wanted to do surgery on

him today. Now they were looking at surgery until Tuesday, and today was Friday. It wasn’t my

nurse fault, there was no order on the computer nor did anyone call to inform my nurse not to let

the patient eat. We just kept that patient on pain medication and tried not to disturb that patient at

all. The ARNP mentioned that if he stayed NPO maybe they would be able to book him to the

OR at 4 p.m. if not until Tuesday. Today was mainly discharging patients. From six patients we

ended up with 3 patients and another was getting discharged later on. I helped remove 3 IV’s and

later on as they were discharged I transferred the patient down to the lobby with a wheelchair.

Many would suggest to go down on their own, but my nurse said I had to take them.
 Mariana Ramos 6

Clinical Day 8: April 26, 2018

Last day of clinical. My preceptor was Alejandra. She is just amazing!!! Before, I was

assigned to Alejandra, the charge nurse Rose asked me and Linda to take vital signs. As we

started the UAP stopped us and told us she would rather have us help her pass out water with ice

to every room. There were so many empty rooms, the floor did not have a lot of patients. As we

were finishing up passing the waters, the UAP asked us to check every room to see if gloves

were missing. We were coming to an end and then she asked us to take the O2 stat of the trauma

patients. Linda and I only issue was not telling the UAP no, it’s kind of hard to. Even if we got

annoyed because through all of this I still have not been with my preceptor. Finally, I was able to

be with my preceptor Alejandra. She’s just amazing, I love how she loves to teach her nursing

students. She takes the time to explain things and question me. This day was extremely slow, my

preceptor only had four patients, and later we discharged one patient. Imagine having only three

patients, an easy day, but I enjoyed it.