Learning basic nursing skills...not for the timid!

Most students returning to college for their sophomore year feel a sense of relief. No longer lowly freshman, they know their way around, how things are done, and where to find things.

My sophomore year was actually scarier than my freshman year. As a nursing student in the big university, it would be the first year we would go into the hospital. The thought was both exciting and scary. We stood in the hall in a long line to be measured for our uniforms. Like most nursing student uniforms, we considered ours to be hideous. Blue and white pinstripes, with a huge white placket in the front like a baby bib, but pleated. The dresses weren’t flattering to anyone. How envious we were of the men in our class. They would be able to wear black slacks and a tunic top…pinstriped like our dresses but without the ugly placket.

After measuring day, we were broken up into smaller clinical groups and assigned “lab days”. For those of you who haven’t survived nursing school, student nurses learn how to care for patients in the lab before being let loose on real human patients. Our excitement level was quite high, because once we had learned some things, we would have clinical in the hospital.

And how quickly our excitement fell the first day of lab, when we spent 2 hours learning how to make a bed! Like many hospitals back in those days, Big University Hospital did not have fitted bottom sheets. Flat sheets were used for both top and bottom, and we had to learn how to tightly fold and tuck the bottom sheets so they wouldn’t wrinkle, then place the pads on the bed, correctly put on the top sheet and blanket (NOT forgetting to fold them both in a pleat at the foot of the bed so that the patient would not have the linens tight over his/her feet) and tuck everything in neatly. Oh….and I almost forgot….it took the longest time to learn how to correctly insert a pillow into the pillowcase. One NEVER shoved the pillow into the case and shook it down. To insert the pillow properly, you gather the pillowcase up in one hand, grasping the bottom seam, place the pillow into the case and gently slide the case up over the pillow. And don’t forget to raise the bed to waist height (back in the era of hand-cranked beds) to save your back!

Once we learned to make an empty bed, we were taught how to do it with a patient in the bed. This was much harder and required the assistance of another nurse, who would help the patient lie on their side while you rolled up the dirty linens longitudinally, then placed the clean linens on half of the bed, also longitudinally. Then, the poor patient had to ROLL back over this huge hump of linens. You held the patient, again on their side, while your coworker whisked the dirty linens off the bed, into the hamper, then pulled the clean linens straight and tucked them in. After the bed was neat and tidy, the exhausted patient could roll back onto their back and recover.

After we learned how to make beds, we started clinical in the hospital. We could only perform the skills that we had learned in the lab, so the first day in the hospital was rather unsatisfactory once all the beds were made. And how conspicous we felt in our uniforms. Our white hose was spotless, our white shoes were spotless too. We hung around the nursing station, hoping to be allowed to do something...anything!

Other skills swiftly followed…how to bathe a patient, how to help a patient with personal hygiene activities (shaving, brushing teeth, washing hair). I missed the lesson on bedpans due to illness, and wouldn’t you know that my patient wanted a bedpan the minute I walked into the room? I picked up the heavy metal bedpan and looked at it warily. I had no idea how it should go underneath this 65lb 90 year old lady. I carried it over to the bed and the woman’s daughter helped me turn her onto her side. As I began to slide the bedpan under the patient, the daughter suggested quietly that perhaps I should turn it around; the rounded edges go under the buttocks! I blushed crimson and followed her suggestion. Getting a very full bedpan out from underneath a patient without spilling it was a skill I never acquired. Thank goodness for bed pads (now called Chux…BUH had the old fashioned rubber backed cloth kind)

But the days in the lab I remember most clearly were the days learning to give injections. Yes, just like the stories, we started with oranges, learning how to clean the skin, inject quickly and remove the needle neatly. BUH did have disposable needle sets for the most part, although some units still used the glass syringes. For 2 lab days, we practiced on the oranges, leaving with our hands sticky from juice.

After we became proficient in oranges came the day we all dreaded…practicing injections on each other. That day, we were put in pairs and were to inject each other in the two most common areas for adults—the deltoid (arm) muscle and the gluteal (buttock) muscle. The nursing instructor, sensibly, had the “injectee” lie down on a bed so the “injector” didn’t have to worry about fainting patients. I gave my two injections without too much difficulty. Then it was my turn to be the patient…..

My partner was (and is) a lovely girl, very shy and timid back in those days. The thought of causing pain by giving an injection made her hands tremble so hard she dropped the needle package twice before managing to open it. She gave an excellent deltoid injection and gave a loud sigh of relief. Following directions, I rolled onto my stomach for the second injection. I am very ticklish, and have a hard time with injections for that reason. As my partner cleaned the area for the gluteal injection, I began to giggle. I lay on the bed, shaking with suppressed laughter, as she began the injection. When the needle entered the muscle, I flinched and really began to shake. In a panic, my partner let go of the syringe and needle and backed away, apologizing for hurting me. I continued to laugh, lying on my stomach, with a needle sticking out of my hip until I could control myself enough to ask that someone PLEASE remove the needle! The whole room was exploding with laughter, except for my partner who was in tears at the thought she had hurt me. The instructor walked over, took my partner by the hand and assisted her in completing the injection and finally removing the needle.

This was our last learning lab. We had learned all the basic skills. Other skills would be taught when we began specialty clinicals (Obstetrics, Pediatrics, Psychiatric nursing) but they would build on the basic skills learned. Over time, basic skills become instinctive and an experienced nurse becomes very proficient at them.

I recently ran into my clinical lab partner in the ER at BUH, where I had gone for an injury that would require a tetanus shot. We recognized each other and a large amount of waiting time was beguiled by updating each other on our lives. But when she came into the room to give me the tetanus shot, I requested she give it in my deltoid!