Episode Transcript
[00:00:01] Hi, everyone. This is Dawn Klemm, and you are on my podcast, Milkweed and Monarchs. Today I'm going to be speaking with you about the training I received as a hospital corpsman, an associate degree nurse, and ultimately a master prepared nurse.
[00:00:23] As a warning in advance, I am going to be talking about bodily fluids, bodily functions, and female parts. So if this is not a podcast that you want to sit through, I completely understand. You can just skip right over this one and move on to the next one.
[00:00:46] So when I entered into the Navy, I was 19 years old. I made it through boot camp, and then I was stationed in Great Lakes, Illinois, just north of Chicago, and I went through 10 weeks of hospital corpsman training.
[00:01:08] Now, I had never, ever done any type of patient care whatsoever at all. I mean, I don't. I rarely visited somebody in the hospital, and I think I was in the hospital twice. Once for my appendix and once for my tonsils. But I had no real understanding of what it took to be a nurse.
[00:01:32] None, zero, zip.
[00:01:36] So I get up to Great Lakes, and we sat through a lot of classes on just the basics of how to take care of a patient and anatomy and physiology so that we would have a generalized understanding. But we also had a lab back in those days. We didn't have models to practice on. We practiced on each other. That's how it worked. Okay. So one of the first things we had to learn how to do was how to make a bed. We also did not have fitted sheets for the bottom sheet. They were all flat sheets. And we had to learn how to make a really tight corner when. Especially when you have a patient in the bed. Now, because I was so small at that time, I was the patient in the bed 90% of the time being rolled around, lifted up while they're trying to figure out how to make a bed.
[00:02:52] I ultimately had to learn it myself. So I would get out, and then I would take turns with people on how to make that bed. It's not so easy when there's a patient in the bed. Then we learned how to get a patient in and out of bed, how to lift a patient up while they're in bed using a pull pad, as we called it back then, how to ambulate a patient, how to measure intake and output. It's very important to know that.
[00:03:25] And then we started learning about how to deliver medications.
[00:03:31] So there's three types of injections or shots that patients can get.
[00:03:39] One is an intradermal, so that just barely goes underneath your skin. And that's how Most tuberculosis or TB tests are getting given. And you see that little bubble? That's an intradermal. The second one is subcutaneous and that just goes into the layer of subcutaneous fat. Okay. And you'll hear a lot of insulin dependent diabetics say that it's subcutaneous. So that's where that goes. And then the third way is IM or intramuscular. And usually we would try to give that in your arm. Like if you're getting your vaccines, you'll get it in your arm, the deltoid muscle at the shoulder. Or if you're getting pain medicine. A lot of times we give that in the buttocks or the gluteus maximus.
[00:04:34] So who are we giving the shots to?
[00:04:38] We don't have mannequins. Yeah, we're giving shots to each other.
[00:04:44] I'm like, what the heck? I did not sign up for this. Okay. I just remember holding my arm out and getting an IM injection into my deltoid, thinking, what the heck? We use saline. So we had to learn how to draw the saline up with the needle and then inject it into our lab partner's arms.
[00:05:09] It was a whole traumatic experience for me. I definitely liked the classroom a little better. I felt completely out of my element in the lab, but I made it through. And it was only 10 weeks. I mean, that's not a whole lot of training when you think about, we're supposed to be taking care of here, humans, Right?
[00:05:34] And then you. I got to Balboa Naval Hospital and it was all on the job training. So you. I learned so much. I'm telling you, the nurses were fantastic. I would have never, ever made it through without them teaching me things. So a lot of on the job training went on. Now, on the job training was great because we weren't doing it to each other. We were doing it with the patients. And we kind of had the nurse there to help us and show us the right way to do things because they had been properly trained.
[00:06:14] So I make it through the military and I get out and I become an LPN because I'm allowed to challenge the boards after working in as a hospital corpsman for four years. So that was great. But.
[00:06:34] And I would say maybe a corpsman kind of functioned as an lpn. So pretty much at the same level, I ended up working in a doctor's office for Women's Health. And a lot of the patients that we saw were child bearing or maternity. Maternity patients. So I really wasn't given any shots or anything. But I was weighing patients. I learned how to use the Doppler to monitor the heartbeat. I learned how to measure the abdomen for the fundus, where the. If they were growing properly according to the weeks that they were into their pregnancy.
[00:07:20] I learned a lot of things there. And I learned, of course, I was continuing on with vital signs. Vital signs is one of the most important things that we do as a nurse. The temperature, the pulse, the respirations, and the blood pressure. I also learned as an LPN how to listen to lung sounds. So that was good. I think I learned some of that in the military, too. But really, in the military, I was doing more perfunctory things like giving them respiratory treatments and then performing chest compression on their back, which is basically pounding them to see if they can get cough up any phlegm.
[00:08:09] So I was growing and learning new things, but I was still didn't have really the education behind it to understand things.
[00:08:22] Then I went back to college to get my associate degree in nursing.
[00:08:31] Now, you know, I've already worked as an LPN for at least a couple years, and I was in the Navy for four years. So I think I was getting a little cocky at that point, thinking, I know how to do this. I've been doing it for six, seven years now, right? So in nurses training, we had a lab, still the same thing. We didn't have mannequins. So we were doing a lot of practicing on each other. But one of the first things that we had to get checked off on was how to make a bed was we still didn't have the fitted sheets at that point. So. But I was like, oh, I'm an expert at making bed. I've been making beds for years. Guess what? She flunked me in bed making.
[00:09:20] Isn't that awful?
[00:09:23] Yes, she did. She flunked me in bed making. She said that I. And she was a tough one. She said that I did not make the corners tight enough and the patients were going to end up with a messy bed because the sheets were going to loosen up too fast. She called me into her office and she said, you know, you're a cocky little thing. I'm like, oh, my God. Oh, brother, I hope I'm going to be able to make it through these two years. I already flunked bed making, whatever.
[00:09:59] But I managed to, you know, tone down the attitude and start to put my head into learning the correct way to do things. Because really, if you think about it, I didn't learn in the Navy. I just.
[00:10:17] You'd get 10 weeks and then you're thrown into it. So that's really what happened. And I ultimately graduated. I thought I was doing pretty good at that point.
[00:10:33] And then I worked as a nurse for a long time with my associate degree. I worked on a medical surgical floor in Cape Cod and I worked on an orthopedic floor at St. Vincent's Hospital in Worcester, Massachusetts. And then I moved up to Maine and I worked on a kidney transplant floor.
[00:10:59] So I felt like I was pretty comfortable in the nursing role. And part of it came from education, but really a lot of it did come from hands on training. I think I learned a lot.
[00:11:13] So then I start back to graduate school.
[00:11:19] Now that in and of itself was a whole new situation, believe me, a whole new situation.
[00:11:31] And I realized at that point how much I really did not know. And that kind of shocked me. I remember thinking the first time that I had to really understand blood pressure medication.
[00:11:50] I remember as an LPN and then as an associate degree, I ran, I looked, I started to think a little bit differently. But when I got into graduate school, I'm like, oh my Lord. I would just pass the pills because that's what the order was. I didn't really stop and think about it. And I remember thinking, one of my nursing colleagues said to me, well, I've been on blood pressure medication for a long time. I never take my blood pressure to see what it is. I'm like, yeah, that's the problem. We don't take it seriously enough. We're so laissez faire about it. But really you should be monitoring your blood pressure and I should be taking their blood pressure more often, especially when they're sick, because your vital signs can change.
[00:12:45] So I started to think about the patient population completely differently.
[00:12:54] And by now, while I, when I was going to graduate school, I was working with bone marrow transplant patients and oncology patients.
[00:13:08] So bone marrow transplant patients are incredibly sick, incredibly sick. So we've already wiped out their whole entire immune system with chemotherapy and they have nothing to fight infection off. So I started to learn the importance of hand washing there more than anywhere else. I mean, I always wash my hands, but when I worked in oncology, I wash my hands every five minutes. Our hands were raw in the winter because we washed our hands so much up there. If your hands weren't raw, you weren't washing your hands enough. And I would pass that on to you today, that just the simple task of washing your hands can make a big difference between being well and being sick. And that is the truth.
[00:14:04] So I learned a lot working on the oncology floor. We had to actually, before we gave chemotherapy up there, we actually had to do a calculation of the patient's body surface area and then look at the dosage of the chemotherapy in the bag to make sure that it was not going to be toxic to the patient. That's not something that you would think that a nurse would be doing, but it actually was a double check for those patients. The pharmacy checked. What if the pharmacist didn't do it right? Or what if it was a pharmacy technician? So you always have a double check in there. And how am I learning that? That's right on the job? I did not learn that in nursing school anywhere. So there's some things that you learn on the job and there's some things that you do get trained for. I mean, they did enforce to us that washing your hands is very important, but until you're actually working in an area like that, I don't think you pay that much attention.
[00:15:26] The other thing as intake and output is so vital to these patients because they're so sick. So, you know, we would measure intake and output, but were we really accurate? Sometimes, oh, they had a glass of water, put 240 down for 240cc. Well, that's not so great.
[00:15:48] So I learned how to be more precise there. I learned how to really pay more attention to detail. And I don't think that's something that you get actually in nursing school, but I think with on the job training and then going to nursing school, a lot of this stuff gets reinforced and then you're starting to think independently.
[00:16:15] So this was really good for me. It was really good that I was working on a floor like that.
[00:16:23] So I was learning more about even just monitoring vital signs, intake and output, bathing the patient when they, they have a fever. There's a lot of just things on the job that you started to learn and you're putting it all together. So I'm thinking, okay, I'm going to go to graduate school now. And I've had so much training from all these jobs that I've had and I'm starting to put knowledge base education together with functionary nursing. So I'm putting both of them together. I starting to feel pretty good.
[00:17:07] But I'm in my graduate class and the instructor comes in and says, okay, one thing that all of you are going to need to know as a nurse practitioner is how to do a pap smear on a woman.
[00:17:29] I go, what?
[00:17:30] Yes.
[00:17:32] If you're working in an office somewhere, that is going to be one thing that you absolutely have to know how to do.
[00:17:42] Well, what if I don't plan on ever working in an office?
[00:17:46] She says, you need to do it. Everybody's going to learn how to do it.
[00:17:51] So I said, how are we going to do that? We don't have any models and we don't have any mannequins.
[00:17:59] She says, you're going to be doing pap smears on each other. I'm like, what?
[00:18:05] You can't even imagine. You will never know how, first of all, shocked I was, and second of all, how petrified I was that I was gonna have to do a pap smear on my lab partner, who, by the way, was a good friend of mine. But that's a little. That's taking friendship a little far, don't you think? And this is what I'm talking about with nursing, because a lot of it is on the job training. I mean, that's how I learned how to give an enema. Okay. On the job training.
[00:18:43] So there's a lot of things that you just don't realize you have to learn how to do on the job. But in getting a degree for a nurse practitioner, they were going to make us do more hands on before we got into the office practice. So I'm like, oh, my God. She says, I've got the lab all lined up. All of you will be with your partner. I think there were 12 students in our class, and so we were all paired up. And she said, I'll be doing the check on you. You're gonna have to learn how to put the speculum into the patient.
[00:19:29] The speculum is a metal. It's. It's plastic now, but it's metal. It looks like a duck's bill and it goes in flat. And then when you get it inside the vagina, you press on a lever and the lips open up or the. The bill of the duck opens up. And on the side of the speculum, there's a little screw to lock it in place.
[00:20:00] So that if you're going to do a pap smear, you have to stick a swab in there to be able to swab the cervix.
[00:20:11] Okay, I'm sorry, you're getting an anatomy lesson here, but you have to know what the expectation was before I tell you of my very traumatic lab experience.
[00:20:26] First of all, I was not a happy camper about it.
[00:20:32] My lab partner was feeling the same way. I mean, both of us are like, this is Freaking weird. This is so weird. This is what I'm talking about, how we have simulation labs now, and you don't have to do all these kind of procedures on your lab partner. So I went home, and I was thinking about. I'm like, oh, my God. Please, God. I hope to God you help me get through this. This is traumatic to me. So what do you think I did? I called my lab partner up.
[00:21:08] I said, kathy, I want to tell you something right now.
[00:21:12] You better be in the shower tonight. You better be doing a douche. I want that thing buffed and puffed before we get into lab tomorrow. I don't want to smell a thing. She was in hysterics, but, I mean, I just kept thinking of all these things I didn't know. This is not the type of medicine I wanted to go into. And I couldn't believe they were making it us do it.
[00:21:41] But nonetheless, I got to school the next day. We went to the lab.
[00:21:49] My partner said, do you want to go first? I said, yes. Hell, yes, I do. I want to get this over. I have to get this over.
[00:22:01] So she's like, okay. The instructor gave us all instructions. We each had a gooseneck lamp, a little stool to sit on. We had to put the patient's legs and feet in the stirrups, position her on the table, and then we had to insert the speculum. I'm telling you, I was shaking. My poor partner.
[00:22:29] But I get the speculum, and.
[00:22:33] And I push down on the clip so that the. The bill starts to move apart. I've got the light real close, and I pulled the light over close enough so I can look in there. We had goggles on, too. And I look in, and I saw her cervix right away. Okay. So I was very excited because I'm thinking to myself, okay, I've seen her cervix. This is it. I'm gonna get this done. And I' on to my next problem.
[00:23:06] So I go, oh, my God, there it is. I see your cervix.
[00:23:11] She started laughing so hard. Well, I had forgotten to twist the lock because I was so beside myself that I had to do this. So when she started laughing, the muscles in her lower abdomen pushed that speculum out. Actually, it flew out. That's the only way to describe flew out.
[00:23:42] And I was like, oh, my God, I'm gonna flunk. I'm gonna flunk right now.
[00:23:48] She's still laughing, and I am basically crying. I'm like, said, look at the instructor. I'm like, please Please, please, please, please, dear God, I tried so hard to remain calm. You please don't flunk me. I really did see her cervix. She said, you did see your cervix and you are all set, Dawn. But you're gonna have to do it one more time just to demonstrate that you know how to do the full procedure. Can you imagine that? One more time. As if the first time wasn't dramatic enough and my poor friend.
[00:24:31] Anyhow, I did do it again for the second time, and that was the end of it. I was done. And then she did my pap smear or put the speculum in and we were done. And the teacher said we never had to do it again. And I'm like, thank God. Thank you, God. But just think about that. That's how we learned we had to do pap smears on our lab partners. I can't imagine anything more invasive than that. It was terrible.
[00:25:10] We didn't have any men in our class, which was great. What would we have done?
[00:25:15] A cough?
[00:25:17] I don't know. I'm just telling you that this and this was in 2004. So it's not even like it was that long ago. Okay, 20 years. But what about the first 20 years?
[00:25:32] It took them that long to figure out that we need simulation labs. So here in Grand Rapids, Grand Valley State University has a. A absolutely beautiful lab, simulation lab with all the mannequins. You can do all these kind of procedures, including injections. You can put a nasogastric tube down your patient which goes through your nose. You can learn how to do an enema. All the things that it should have been instead of us being guinea pigs for our lab partner. I don't even know how I stayed in nursing. I mean, I love nursing. I'm not going to deny it. And I know I made a big difference in many of my patients lives. And many of my patients gave me so much inspiration that I think it changed me as a person. But the training to get there was incredible. And I can't always say in a very good way.
[00:26:46] I hope you enjoyed my podcast. I know it was a little crazy, but now, you know, some of the things we older nurses suffered through in order to just be an advanced practice nurse or a bachelor's prepared nurse. I mean, it was tough what you had to go through.
[00:27:09] If you have a story that you would like to share, please go on my website and you will see my email dawnmilkmon.com so it's-A W N@milkman M I L K M O N.com and you can send me an email if you're interested in telling your story or you'd like me to tell your story, just let me know what it is and I will definitely reach out to you. I would love that.
[00:27:44] I'm also still selling my merchandise, so I have those canvas bags that say Milkweed and Monarchs on them, and if you're interested in purchasing one of those, you can also go on my website and email me the same way that I just spoke about. Dawn D a W n at Milkman M I l k M o n com. Let me know, send me your address and I'll get it shipped to you right away.
[00:28:18] Until the next time.
