Saturday, January 9, 2010

Lack of experience

More on the ankle wound.
Turns out it was a mixed venous/arterial ulcer. This is a fast-developing wound caused by inadequate blood flow and occurs in the distal part of a lower extremity, i.e. the ankle.
Most people at the nursing home have a tendency to label any break in the skin integrity as a "pressure ulcer." Pressure ulcers are considered bad and irrefutable evidence of neglect. I do not believe this, as the skin is an organ and breaks down just as the heart, kidneys, and lungs do. Becoming upset and blaming people because the skin is decaying is like blaming people for pancreatitis.
When I first saw the wound, I thought about venous and arterial ulcers and thought that could be the cause. Unfortunately, I do not have much experience in properly identifying wounds; extremely unfortunately, most of the other nurses at the home also have little experience in properly identifying wounds. I merely described it; I did not give it a name, which is the correct nursing technique. Nurses do not diagnose. Everyone else ran with the pressure sore theory and started a witch hunt for someone to blame: Did it happen on the night shift? Didn't the aide who showered him three days earlier notice the wound? Who changed his socks that evening- didn't they see the wound? And so on. The man walks and turns himself in the bed, which was our first clue that he probably didn't develop a stage IV pressure wound in a matter of hours.
I feel like I have plateaued in my nursing abilities and skills at the home. I originally sought employment in a nursing home because I enjoy working with the elderly and forming long-term relationships with my patients. I have either mastered or become good at everything I need to do. I'm not saying that I'm an expert and that there is nothing left to learn. It's just that I don't get to see or do a lot of highly skilled activities, such as properly assessing patients. Had I been more experienced and knowledgeable, I feel that I could have properly recognized the wound and guided the administration in properly handling the issue.
I spoke to a man whom I knew growing up. He's now in nursing administration in a hospital. He said that the field is tight for relatively inexperienced nurses such as myself, but that I am not considered a brand-new graduate because nursing home nurses have excellent time management and medication administration skills. He encouraged me to apply at the hospital. I think I will.

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