This summer, I was fortunate to have the opportunity to work as a nurse extern at Washington Adventist Hospital (WAH) in Takoma Park, Maryland. First of all, what the heck is an externship? Apparently, an externship is shorter than an internship and provides “experiential learning opportunities” (thanks, Wikipedia). Personally, I think they call them externships so they aren’t confused with medical interns. Perhaps…

I worked on a cardiac step-down unit (patients who require more specialized care than a regular medical/surgical unit, but less intensive monitoring than an ICU). The nurse I worked with was fantastic. She emigrated from China 20 years ago where she was a medical resident. After getting married and having two children, she decided to go to nursing school and has been at WAH for four years. As an extern, I was not allowed to give meds so I did a lot of following my nurse around, taking copious notes, charting patient vitals and asking a million questions. Here are some observations from the unit:

Twelve-hour (usually 13) shifts are no joke.
To be a floor nurse, your back must be in top shape (mine was not, but am working on it). Needless to say, my heating pad and supply of Advil got a really workout. During each shift, I would walk anywhere from 9,000 to 13,000 steps—usually depending on how many times I walked to the lab. (Turns out putting stool and urine samples in the tube messenger system is a definite no-no…) And being at the hospital by 6:45 in the morning is brutal, but three-day weeks rock, so I guess it all evens out.

Nurses have an incredible amount of responsibility.
Nurses are the closest person to each patient and are tasked with relaying info to doctors, therapists, nurse practitioners, physician assistants, charge nurses, patient care technicians, food service employees, housekeepers, not to mention the actual patient and their family members. I realized that a lot of time is spent waiting for doctors to call back, anticipating test results, keeping track of patient turn schedules, giving medications multiple times a day, tracking down medication from the pharmacy, making sure NPO patients do not receive meals, calming a nervous patient, explaining procedures, and the list goes on and on. Charting patient progress usually happens after the 12 hours are over.

Wound care nurses are amazing.

If you see something that interests you, ask to participate.
Washington Adventist’s wound-care nurse was on our floor quite regularly. When she arrived, I would always ask my preceptor if I could spend some time with her as she assessed and treated wounds. A few times, I was invited by her to go to other areas of the hospital to see pressure ulcer healing progress, surgical sites, and even a leaking ostomy in the emergency room. Certainly not for everyone, but I am fascinated by how wounds heal, or don’t heal, for that matter. The one disappointment was that I did not get to see maggot therapy. Not for the faint of heart, but sterile maggots are used to help debride wounds that are antibiotic resistant. Nature at its best… I also got to participate in a hospital-wide skin prevalence study in which we looked at every patient in the hospital and reported the incidence of pressure ulcers.

When someone asks you for help, help them.
Even though I spent the most time with my nurse, I worked closely with the patient care technicians (probably the hardest working folks in the hospital) changing beds, emptying bedpans, cleaning and turning patients, and feeding some who could not feed themselves. (Side note: Working with incontinent patients makes you an expert at changing beds while the patients are still in them.) Patients would also ask for things as I passed by their rooms and I tried to help or at least find the person who could help. Did I help because I was the low man on the totem pole? Not at all. My nurse did it too. I hope to be like her and to never say “That’s not my job” or “That’s not my patient”.

Working in a hospital makes concepts covered in class a whole lot clearer.
Learning about chest pains from a lecture or book is a lot different than actually having a patient with chest pains…Get vitals! Check the telemonitor! Administer oxygen and nitroglycerin! Be prepared to call a rapid response! Alert the physician within 10 minutes!

It’s easy to memorize the different kinds of isolation but it’s entirely different putting on and taking off a gown, gloves and mask every time you enter and exit a patient’s room. Need to change an isolated patient’s bed? You better make sure you bring everything with you or you will be yelling into the hall for someone to bring you what you’re missing or else you’ll be taking everything off, getting the item, and then putting it all back on again.

What’s in that tube?

So if you are in nursing school and get the chance to be a nurse extern, take it. It is a bit like a two-month job interview and a great chance to see what it is really like to work in a hospital. And if you are lucky like me, you will meet dedicated nurses who will inspire you and set the bar high for you. And to learn about what you put (and don’t put) in the messenger tube…