A Good Nurse
 







Posted on Fri, Jun. 02, 2006


Nursing his new dream
Hospital "boot camp" is a challenge to a young man’s maturity.
By Dawn Fallik
Inquirer Staff Writer

Ryan Sholinsky stood over the sink, trying not to throw up.

It had been five hours since he'd overdosed the woman on Seven-Central. He'd been a nursing student for five weeks, at the hospital less than two.

He'd known, when he quit his job at 25 to go to nursing school, that it would be difficult. But he never thought he'd flame out so fast.

The decision to apply had been easy. Like more than 170 other nursing schools, Thomas Jefferson's had launched an accelerated program, one year instead of two, for applicants with bachelor's degrees. The goal was to ease the nursing shortage, about 8 percent of jobs vacant nationally and more than 11 percent regionally.

Ryan was lured by the promise of a three-day workweek, steady employment, and a starting salary of $50,000, all after just a year's training.

He wasn't worried about doing women's work. With his tattoos and spiked hair, Ryan was among a new breed - about 25 percent of his class was male, compared with 8 percent of nurses nationwide.

There'd been dues to pay. Ryan spent two years slogging through prerequisites in microbiology, statistics and chemistry. But those were easy compared to the FACT program - for Facilitated Academic Coursework Track.

The instructors called it "boot camp." They stripped students of their former selves as bus drivers, flight attendants or homemakers to build them into good nurses - people who could walk into a room, assess a situation in less than 10 seconds, and take action.

Only a month in, Ryan felt overwhelmed. Each semester carried up to 12 credits of pathophysiology, pharmacology and epidemiology. That didn't include the clinicals, working two 12-hour shifts at area hospitals.

The work was intense: standing on his feet for hours, someone hovering over his shoulder at every move.

But he'd hoped that, in a year, he'd be ready to carry the weight of a life in his hands.

More than half of his fellow students received full scholarships from local hospitals, including Jefferson, Methodist and Pennsylvania Hospital, covering the $26,750 tuition. In exchange, students work at those hospitals for up to three years after graduation.

But Ryan was doing it on his own, helped by a loan from his parents. Living in a $600-a-month rented room in a Queen Village house that smelled keenly of dog urine, he kept track of pennies.

He thought he'd make a good nurse. He cared about people. He had quick reflexes. A few years ago he'd saved a stranger from a flipped car - kicking in the window and pulling her out.

He'd been working as a union organizer in Nebraska and was bored by the travel and by the work. He'd met a group of nurses and was struck by how they loved their jobs, loved helping people - and the pay wasn't bad, either.

Once he'd locked on to the idea of becoming a nurse, it just seemed right.

His family was not so sure.

Growing up in Cherry Hill, Ryan had been a wild teenager, and had grown into a sometimes-reckless and thoughtless adult, the kind who drank too much and returned borrowed cars with empty gas tanks.

"When he told me he was going to be a nurse, I was very supportive," his father, Robert, said. "But I didn't know if he would be responsible enough."

At orientation in May, Ryan wasn't so sure himself.

Barely a month later, he was standing over the sink, fighting off the nausea, wondering whether his career had ended before it had begun.

His father was right. He wasn't ready.

The accidental overdose

It had all happened so fast, so easily. Everyone made just one little mistake.

Ryan had arrived at 7, checking the daily responsibility chart on the wall. He was in charge of meds that didn't require a shot. He introduced himself to the charge nurse.

Inside her room, his patient - a middle-age woman - was still groggy from surgery. Her husband sat beside her.

Ryan dispensed the morning meds, including her high-blood-pressure drugs. He checked her vital signs, her blood-oxygen level, her blood sugar. Then he typed the results into the computer.

A few hours later, on his way to lunch, Ryan walked up to the patient's charge nurse.

"I'm going to lunch. I checked her blood sugar and gave out the meds," he said.

She looked at him blankly. What do you mean, you gave them out?

Ryan had checked with his teacher, had checked the computer. But he hadn't checked with the nurse. And she had not checked the computer - and so she administered the meds herself.

The patient had received double the proper dose. The mistake was not fatal, but it was serious, particularly after surgery. If her blood pressure fell too low, she would pass out.

After the mistake was discovered, the charge nurse, the nursing supervisor, Ryan, his nursing instructor and the doctor all went to tell the patient.

They were sorry.

• 

As a registered nurse and a nurse practitioner, Sharon Burke was considered by students to be one of the best instructors at Jefferson College of Health Professions.

But in her four years there, no student had ever overdosed a patient. Not on her watch.

At the school, the incident was discussed among the staff. Burke recommended that no action be taken and that Ryan remain in school. She figured he'd learned a valuable lesson.

The patient was monitored for the rest of the day. She was fine. Everyone was fine.

Except for Ryan. He was not so fine.

Early disappointments

Nursing school had been full of unwelcome surprises. His first day at the hospital, Ryan had helped an older man with a hearing aid and a litany of complaints. A doctor swooped in, brusquely asking questions and cutting off the answers.

As the patient sat, confused and in pain, the doctor lifted the old man's hospital gown.

"I just need to check the catheter size," the doctor said, exposing the patient to anyone walking by the open door.

Ryan was appalled.

Patients deserved better. He wanted to be a nurse like his mentor, Burke. On his day off, he'd asked to follow her on an eight-hour shift in the ER. A rare request, she'd said.

Clearly, the job wasn't cushy. Patients were sicker and there were more of them, to the point where they lay in hallways, with only curtains for privacy.

Most trauma and intensive-care units still had one to two patients per nurse, but on other floors, nurses handled five or six patients over a 12-hour shift.

The physical work took its toll, with hours of standing and reaching and turning increasingly heavier patients.

But for Burke, the emotional aspect was the most important and the toughest to teach. "They have to be able to deal with death, and what they think about death, and for a 25-year-old that's a hard thing to do," she said.

After a decade as a nurse, it could still be hard to handle. On a recent four-hour shift in the Jefferson ED, Burke lost three patients. One was a man who arrived after falling ill on a train platform.

She had just picked up the dead man's cell phone when it rang in her hand. It was his daughter. Burke asked her to come to the hospital. She couldn't tell her why.

After hanging up the phone, she cleaned her patient's body. She put him in a room. Then she covered him with warm blankets so his hands would not be cold when his daughter came to say goodbye.

That's what it meant to her to be a good nurse. It was the kind of care she tried to impart to students. But not everyone got it.

Like Ryan, she thought. Ryan was smart and he was caring. But putting warm blankets on a cold body? That might be beyond his capacity.

'Everything's cool'

Compassion came slowly, but other lessons were easier.

Gastrointestinal patients were the worst as far as body fluids go, and Ryan wasn't sure he could handle the smell.

But José Taroncher, a 53-year-old from Atlantic City with colon cancer, had a colostomy bag that needed changing, and he was Ryan's patient.

In Room 7216, Taroncher lay listless. His stomach felt rigid and swollen to the touch. "How is it usually?" Ryan asked, pressing gently. He didn't want to scare his patient, or offend.

Watched by a student, the main nurse and Burke, Ryan carefully removed the bag, wiped the skin, added the white paste holding the bag to the stomach, attached the ostomy wafer, and secured a clean bag.

If he pretended all this was normal, he thought, then he could fool himself and his patient into thinking that seeing stomach and bowel contents was an everyday thing.

It was dispassionate, but for now, it got the job done. He tossed his blue gloves into the medical waste bin and headed out the door. "Everything's cool," he said to his patient, who nodded off to sleep.

Saving Sierra

Taking care of a patient's basic needs was one thing, but Ryan knew it took more to be a good nurse. Good nurses were connected by more than just IVs and monitors. Ryan wasn't sure how to breach the wall.

The constant demands of school and work didn't help. Plans to visit old friends were canceled to study for tests, hopes to join the school soccer league were laughable; he spent his 26th birthday on a clinical rotation at Jefferson.

Not everyone understood, particularly those who were part of Ryan's past, where 9 p.m. was drinking time - not bedtime. "What part of 'I'm in a really hard program' don't they understand?" he complained to a fellow student over yet another cafeteria lunch.

Months passed. Patients came and went. None died. A few pierced Ryan's armor: the young man blinded in a car crash weeks before his wife gave birth, the 27-year-old pregnant woman who had a stroke.

Then he met Sierra.

She was barely a month old, a small swaddle in her crib on Jeff's pediatric unit. She was the first baby he'd ever held.

Her mother was a heroin addict, and throughout his three-week rotation, Ryan watched Sierra go through weeks of withdrawal, crying and squirming, trying to shed her own skin. The only thing that helped was morphine.

He changed her tiny diapers. He watched her vital signs on the heart monitor. He fed her bottles every three hours.

About 40 of the babies arrived every year, their mothers addicted to anything from heroin to Valium. Unlike the neonatal unit, the pediatric unit had space for a parent to stay in the room. Some never did.

But Sierra's mother came, cuddling and rocking her child.

On his last day at Jefferson, Ryan was down the hall from Sierra's room when her mother yelled, "There's something wrong with my baby!"

The monitors screamed.

Nurses rushed into Sierra's room. She was coding. She'd turned blue. Doctors and nurses worked furiously to revive her. Someone shut her door.

Ryan stood outside, helpless. Minutes passed until, finally, the doctors brought her back. They wondered what had caused her tiny heart to stop.

They found methadone in her system, a drug taken by heroin addicts to help them through withdrawal. Mothers on methadone cannot breast-feed.

Sierra's mother denied giving milk to her child. When Ryan left the rotation at Jefferson, doctors were still trying to figure out what had happened.

A week later, Ryan tapped into the hospital's computer. Sierra had survived. She'd be OK.

But he was so angry at her mother, he could barely contain it. How could she use drugs during her pregnancy and then do this to her child?

"How do you handle it?" he asked a nurse on his neonatal rotation, this one at Cooper in Camden. "How do you care for people who hurt each other, themselves, their babies?"

You just do, the nurse told him. They're here because they're sick, and you're here because you take care of the sick.

The real world

It was barely dawn when Ryan caught the 6:09 PATCO on Locust Street on what looked to be a promisingly warm April day. He had to get to Cooper's coronary-care unit by 7 a.m.

It was less than a month to graduation. Ryan was ready to trade his white student uniform for a nurse's blue scrubs.

He'd been offered jobs at Methodist and Cooper. Passing up a $15,000 sign-on bonus at Methodist, he chose Cooper and a bonus half that size.

The memory of his first rotation and the disrespectful physician lingered. At Cooper, he'd watched as doctors talked easily to nurses, to patients.

He felt at home there.

In July, if he passed his state nursing boards, he would start on the cardiac stepdown unit.

It was a slow day, slower than most, and four of the seven beds on Ryan's unit lay empty.

The two other male nurses on the wing - both younger - joked loudly. One was getting married, and plans for the bachelor party were in full swing, along with laments about impending marital doom.

"She was nagging me to pick up the place, so I picked up her shoes and her coat; it was all hers," the nurse complained.

It made Ryan uncomfortable. The patients could hear them.

At noon, a patient came in, quiet and curled, clutching his chest. He was having a heart attack.

With six other nurses, EMTs and doctors in the room, Ryan stood quietly under the monitor, gloved up, ready to handle the IVs or check vital signs. The other nurses took care of it all.

Ryan was frustrated. He'd soon have to handle up to five patients in a single shift. He wanted the practice, to ask questions now.

But today, the most intense question had been, "Where do you put the empty trays?"

A year ago, Ryan had been learning how to wash a body, shaving a balloon for practice. In her recommendation letter to Cooper, Sharon Burke had written that he had become the kind of nurse she would want taking care of her own family.

A good nurse.

Three hours later, the patient was back in his room, stents inserted to hold open recently unclogged arteries.

As the other nurse checked the sports scores online, Ryan walked back to the patient. He touched his feet; he monitored his pulse.

The man was silent, but Ryan noticed a wince that hadn't been there before.

"Are you in any pain?" Ryan asked. "Tell me where it hurts."

• 

Ryan Sholinsky graduated with a 3.86 grade-point average. He takes the state nursing board exam this month and expects to join Cooper in July.


Contact staff writer Dawn Fallik at 215-854-2795 or dfallik@phillynews.com.