This past November, 16 fellow RNs and I walked into Alexian Brothers Medical Center in Elk Grove Village, Ill., dressed in spotless white uniforms and shoes. We carried with us the tools of our profession — stethoscopes, Kelly clamps, bandage scissors and penlights — along with a slight touch of trepidation and a strong dose of butterflies in our stomachs.
For the next two months, we were neither nursing students nor hospital nursing staff. Instead, we affectionately were referred to as “nurse refreshers,” RNs enrolled in the Current Nursing Practice Update CE Certificate Program at Harper College in Palatine, Ill.
Nurse refresher courses are designed to brush the dust off RNs who have not practiced in a hospital setting for an extended period. The goal is to “make them competitive” with new nursing graduates, said program manager Sue Hughes, RNC, who has headed Harpers refresher course since 2005. “We want to give them bragging rights with nurse recruiters so they can confidently say they can use the Pyxis, computers and Meditech.”
My classmates were women who ranged in age from their 30s to early 60s, with most of us falling somewhere in the middle. We had been out of nursing anywhere from four to 25 years. One classmate and I had been out of patient care the longest — 25 years. But we all had one thing in common: We were taking the course with the goal of finding positions in hospitals or other clinical settings.
I also wanted to see whether I still could cut it at the bedside after having been a nurse editor and writer for the past three decades. Although my clinical skills were rusty, I was well-versed in healthcare and nursing trends, such as the use of rapid response teams and electronic medical records.
Still, one important question remained: Were the clinical skills that once had come so naturally to me still there, buried deep in my gray matter?
‘Lab Barbs watchful eye
The first seven weeks of the course were in the classroom. Our time was spent reviewing the various body systems and the most common diseases and chronic conditions we would encounter in the hospital, and debating nursing-based case studies.
Initially my classmates and I were overwhelmed by the amount of required reading. We also had to obtain physicals, proof of vaccinations and CPR certifications; undergo criminal background checks; and complete the hospitals required online safety programs.
We informally debriefed after classes in the hallways and parking lots. Our anxiety levels skyrocketed when Hughes informed us we needed to pass a simulated medication administration test in the schools simulation hospital.
We learned there now are seven rights of medication administration rather than five, and they needed to be checked three times before we could give the meds to our simulated patients.
At test time, we quaked under the watchful eye of “Lab Barb” — nursing lab coordinator Barb Gawron, RN, MSN — as she observed us behind the simulated hospital rooms one-way mirror and served as the voice of the simulated patient who answered our questions as we went through our necessary checks. Despite our worries, we all passed.
We spent a Saturday in the colleges simulation labs practicing insertion of Foley catheters and nasogastric tubes, conducting physical assessments and reviewing how to care for various peripheral and central lines on simulated patients. In other classes, we reviewed chest tube care, IV pump use and IV line insertion.
These tasks presented challenges for each of us. I encountered difficulty using the safety syringes and giving injections with gloves. This was so foreign to baby boomers such as myself who remember cleaning up blood and urine with our bare hands.
Removing the rust
Finally we were ready to apply what we learned on real patients. Hughes reassured us that once we were in the hospital, the cobwebs would clear and our past nursing instincts, knowledge and skills would resurface. We hoped she was right.
At Alexian Brothers, clinical instructors Judy Singh, RN, Rita Hall, RN, and Kathy Walasinski, RN, gently eased us into clinical practice. We spent the first couple of shifts shadowing nurse preceptors. We then were assigned one patient, along with a preceptor, with the goal of eventually working up to four patients. That number seemed an elusive and maybe even unrealistic goal to many of us.
We quickly found the quality of our learning experience depended on the preceptors assigned to us for the shift. The best preceptors were natural-born teachers. They would explain the rationale for their patient care actions and tell us how they organized themselves at the beginning of a shift or why they reviewed patient lab values. Quite naturally, others were less comfortable as preceptors.
I discovered many things about the hospital setting remain the same: the sounds of patient call lights, the ringing of phones at the nurses station, messy break rooms and the comings and goings of other healthcare personnel. Most significantly, patients and their families still require emotional support and comfort.
I found the human body still responds to illness and injury in the same way, despite the remarkable advancements in medicine and nursing in the past two to three decades. Temperatures, blood pressures and lab values still increase or decrease in response to infections, injuries and medications. Foleys and bedpans still need to be emptied, and the odors of body excrements and fluids still are noxious.
Of course there are amazing differences as well. I noticed that every patient — whether 20 or 90 years old — had a cellphone either in his bed, on his pillow or by his bedstand. Patients are more knowledgeable and assertive about their rights and care.
And, of course, there was the technology to conquer, such as the Pyxis machine and the IV pumps. The fingers of the staff nurses flew across the keys and prompts of both. I often stumbled and sometimes pressed the wrong keys. Speed would come with practice, my preceptors reassured me.
If patients are more knowledgeable and assertive, so are todays nurses. Their focus is no longer on just following physicians orders, but on understanding patients disease processes and anticipating their needs. An array of protocols enables nurses to make decisions regarding treatment, order labs and adjust medications, all without calling physicians.
The downside to nursing independence is less time is spent at the bedside with patients and families and more time is spent in front of a computer. Most of the hands-on care is given by the certified nursing assistants, whose skills also have become more advanced.
Hughes was right. Eventually, the cobwebs cleared, long-unused nursing knowledge resurfaced and our nursing instincts kicked back in. Our band of refresher nurses grew close as we bonded over shared challenges and experiences.
The course ended in December, but we communicate by email and periodically get together for dinner. When together, we give updates on our job searches and share job-hunting tips. But mostly we relish our camaraderie as nurses and the satisfaction of achieving a goal that at one time seemed so intimidating.
As my classmate Jeanne Malter, RN, so aptly said, “It felt good to finish the course. I know I am a good nurse, and now I can go forward with my career.” •
Janet Boivin, RN, BSN, BA, is a freelance writer, former editor at Nurse.com and staff nurse at the Family Health Partnership Clinic in Woodstock, Ill.
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