Medical Training

Here at the Concord campus our vocational nursing students are entering the halfway mark of their module and oh boy, are they happy!  For group 13, this module was their first time in a clinical situation.  Many of the students had never performed real life hands-on care for a patient before.  Over the last five weeks I have seen these students grow with confidence and ability.  Many of the students are finding out that the clinical rotation just doesn’t teach patient care, it also incorporates a good work ethic.  They are learning the value of good communication skills, working with multiple disciplinary teams (physical therapy, dietary, social service, etc) and how to prioritize their assignment.

We are half-way through the module, and it’s time for the six-week evaluations for our LVN students at Gurnick Academy. All faculty and students must participate to follow up on our VN students’ academic progress. This means, the instructors are completing evaluation sheets to establish the academic and practical standing of each student.

What a great idea this is! Each of our nursing students will find out from the teachers, where they are in terms of their grades and overall progress in our LVN program. Some of our students are only at the beginning of their journey, and have a long way ahead of them. This is their first module on the LVN program, and they are trying so hard! Some of the subjects are very new to many of them, but still fun to learn and practice. Practicing using crutches in the Clinical Skills lab, learning about the nursing process in the Fundamentals’ class, and studying for midterms in Anatomy, is not easy, but surely is interesting and involving.  Other students have been on the Nursing program for a while, and now they are half-way through their courses. For these nursing students, it is time to stay focused in their Medical Surgical Nursing and Pharmacology, as well as keep improving their skills in the Clinical Practice rotations.

Half-way through the module, we want to motivate our students to keep up the good work and work on the areas for improvement. This is the time to replenish the connectedness between students and their instructors, and to insure the continuity of high quality education.

Recently I was with a friend who was appalled with he saw someone in scrubs smoking a cigarette.  Since he knew that I taught for a LVN/LPN school, he asked me what type of education a student LVN/LPN receives in regards to the effects of smoking.  Even though a LVN/LPN program includes the effects of smoking and other carcinogens on the cardio-pulmonary and urinary system, education alone is not the only factor in promoting the health of those who want to hold down a LVN/LPN job.  At this point you might be asking, as my friend did, how many nurses do smoke?  According to the 2002 Current Population Survey (CPS) Tobacco Use Supplement, 15% of Registered Nurses smoke; 28% of Licensed Practical Nurses smoke. These are higher rates of smoking than other health care professionals, especially when compared to the rate of physician smokers.

According to the Association of Medical Colleges in the Nursing Times November 26, 2008 article, Health Study Shows Nurses Smoke More than Doctors, 1% of US doctors smoked in 2005.  The good news is that the rate of nurses who smoke is reducing.  In the November 24, 2008 Washington Post article Fewer than 1 in 10 Nurses Now Smoke, The UCLA School of Nursing study found that the rate of smoking among nurses has fallen from 33.2 percent in 1976 to 8.4 percent in 2003.  Unfortunately the November/December edition of Nursing Research states that the death rates of those who presently or those that smoked in the past are still double than that of nonsmokers.

Whether you are thinking about becoming a nurse or already a nurse you become a part of a team of health professionals.  As a team player you can ask for support, especially when it comes to improving your health.   In the Nursing Times November 26, 2008 article, Bob Smith, clinical nurse therapist in smoking cessation at South London and Maudsley NHS Foundation Trust says, “It is absolutely essential that a nurse who is helping a patient quit smoking does not smoke themselves because their help may not appear genuine.” Since stress is a big reason for smoking, student nurses can start on the right track by working together to creatively introduce stress management into their life to promote a healthy life for themselves and their patients.

Eating out at a taco shop can seem mundane until you notice that someone sitting next to you begins to choke and turn blue.  For the lay person without medical training from a LVN/LPN program, the thought of someone choking can be frightening.  One of the many benefits about becoming a LVN/LPN is that all LVN/LPN students must be trained in Cardiopulmonary Resuscitation (CPR).  In addition, healthcare facilities usually require nurses to be recertified in CPR every 2 years to be updated on the latest resuscitation methods.  Just in the last 3 years the amount of chest compressions has increased in ratio to the breaths. Some LVN/LPN schools, such as Gurnick Academy of Medical arts offers CPR training onsite for their nursing students.  Not all CPR courses are the same.  When taking a CPR course find out which CPR guidelines are taught in their program.

To be safe look for CPR certification agencies that follow the recommendations of the American Red Cross and American Heart Association for both CPR and AED techniques.  Just imagine what would happen if in a hospital everyone involved in a “code” received different CPR guidelines; not only that but what if they did not stay current on the latest techniques. Becoming an effective LVN/LPN and working safely in a LVN/LPN job requires receiving the most current information.  This leads us to the next question,“Where does one attend a reputable CPR recertification classes?” It may be tempting to take an online course or a one-hour quick course, but how much will you learn and retain without actually having sufficient practice time doing CPR on mannequins?

Another consideration is to find out if you will be able to practice the Heimlich maneuver, use an automatic external defibrillator (AED), as well as practice CPR on different size mannequins to resemble the adult, child and infant. You might receive training in adult CPR and mistakenly think you are proficient in CPR until you come to the aid of an infant choking or drowning, which requires a different technique.  The BLS Healthcare Provider Course, which is designed to provide the LVN/LPN student and a wide variety of healthcare professionals the ability to provide CPR, use an AED, and relieve choking in a safe, timely and effective manner. Even if you are not yet a nurse, this course can also be taken by nonlicensed healthcare professionals, and can prepare you for a variety of life-threatening emergencies.

Today, I had a great opportunity to meet with the Concord campus faculty of Gurnick Academy of Medical Arts. What a wonderful group they are! I was invited to give a presentation on the effective teaching methods for the didactic and clinical instructors. The meeting was very interactive, as the faculty members started asking questions and making comments, and the excitement of the event was present in the air.

As I was standing in front of this lively, intelligent group, I thought to myself: “What a wonderful idea to have faculty of different campuses interact with each other like this!” If anyone benefits from such interaction, it is our LVN students! It’s true! When working with an accelerated LVN programs, instructors have to work together, presenting a united front, when it comes to developing successful teaching methods and training techniques. Not only we get to “vent” about our problems in teaching, but we also find out the approaches of other teachers to certain challenges. And sometimes, we get to learn something completely unexpected and refreshing, leading to “Aha!” moments of our own, when we move outside of our comfortable boxes and look at what other instructors are doing.

I am proud to be a part of Gurnick Academy, who is promoting such interaction between the VN School faculties. Instructors get to learn from each other, share their concerns, experiences, and expertise with each other, making our LVN school stronger and more successful.

As my LVN students study and fill their mind with new facts and data, they are also being taught how to become more sensitive to their patient during the physical tasks of lifting & transferring patients from a bed to wheelchair and stretcher, as well as pushing wheelchairs and stretchers.  Inside the LVN/LPN schools skill lab the students practice these skills and more while using their classmate and mannequins to substitute as a patient. One of the skills to master is “breaking the patient’s fall.”  The word “break” may sound as if they are breaking their own back to protect the patient, but rest assure that this is a safe technique that the students learn to allow their patient to slide down the student nurse’s leg to the floor, instead of a fatal fall to the floor.

The LVN Nursing students have both clinical instructor and their illustrated textbook with detailed steps to guide them down the safe path.  Along with practicing these steps, they themselves get to experience being a patient who is dependent upon someone else for transferring from one place to another.  Instead of choosing when and having the ability to jump out of bed, sit on a toilet, and freely ambulate down the hallway, the students sit in wheelchair waiting for another student nurse to push them through the handicapped-bathroom doorway and then transfer them onto the toilet.  Don’t worry, even though we want our nursing students to experience being a hospital patient the students keep their clothes on.

Soon after a student nurse experienced being a patient in a wheelchair she stated, “It’s the little things that matter.” She was referring to her classmate’s attentiveness to her as he pushed her in a wheelchair outside and avoided the hot sun, kept an even pace, and not once jeopardized injury to her limbs.  This was her positive experience after she had pushed him around in the wheelchair.  Another example of how valuable being the patient is to learning a skill is when students take turns being lifted/transferred from one hospital bed to another.  I can always tell who has never experienced being the patient before, as their eyes get big and sometimes even let out a scream as they are temporarily air-born during their transfer from one bed to another.  These valuable lessons that heighten one’s awareness require first-hand experience as they cannot be fully taught by a textbook or lecture alone.  Hopefully memories of being the “patient” will carry over to their LVN/LPN job to remind them of the importance of being sensitive to their patient.

Years ago when I became a LVN, I was pleasantly surprised to know that nutrition was one of the required courses to become a LVN/LPN.  Fortunately nutrition is still being taught in LVN/LPN schools with a minimum requirement of 32 theory hours in California.  The significance of good nutrition and health was even conveyed back in the days of Hippocrates (460-370 BC) who was the father of medicine known to say, “Let thy food be thy medicine, and thy medicine be thy food.” Today LVN/LPN students learn about the basic principles of nutrition to create a foundation for learning about the functions of protein, carbohydrates, fats and water.

With this knowledge the LVN/LPN may be the first one to notice that their patient is not eating adequate amounts of protein, which is essential for their patient’s wounds to heal and tissue to grow.  In addition, carbohydrates, such as glucose is essential for the brain to function, as this is the brain’s fuel.  Patients are sometimes not permitted to eat food prior to diagnostic tests and surgery.   This time of fasting can be very dangerous when the lack of food disrupts the blood sugar level and nutrients.  A patient may become disoriented and confused by having their diet withheld too long.  Fortunately for the patient, the nurse acts as a detective by keeping an eye out for all contributing factors that can be managed to prevent further problems with their patient.  Nutritional needs not only vary with different diagnosis, but also throughout the lifespan.

Parts of the LVN clinical training in Module 4 is that LPN licensed practical nursing students are scheduled to participate in various field trips throughout the Bay Area.  There are scheduled field trips to HeadStart, Martin Luther King, Jr. Preschool, Lynn Center, California Medical Facility in Vacaville, John Muir Medical Center and Sonoma Developmental Center.  These scheduled field trips during LVN courses are done to enhance the knowledge and experience of our students and thus better prepare them to be the best nurses they can be.  One of our field trips for Group 11 was to go to the Napa Coroner’s Office to observe an autopsy.

On July 16th Group 11 drove to the Napa Valley eager to have a life altering experience.  Students were anxious with cold, sweaty palms but also excited to experience the unknown.  We were welcomed by the Deputy Sheriff who gave us a nice tour of the facility and told us that there were two autopsies scheduled for that morning: a 25 year-old male and a 58 year-old female.  The Deputy Sheriff was explained that these two cases will be good experience for the students, as they will be able to see a variety of cases in one day.  We were briefed by the Deputy Sheriff as to what to expect and what was expected of us, but nothing could really prepare us for what we saw.

Our Clinical Coordinator, Nancye Maffei, handed out the Personal Protective Equipment (PPE) and instructed us to put it on.   As we put it on, we began to wonder why we needed this level of protection to observe an autopsy.  Nancye told us that during previous autopsies the pathologist allowed students to touch and hold human organs.  Experience from previous classes also taught us that there is the risk of exposure to clothing and skin.

We were told if we could not stand the smell or being that close to a dead body we could always stand behind the glass window in the other room.  As we were guided inside the coroner’s laboratory you could feel the cool breeze and the absolute absence of noise.  As the metal gurney was wheeled in with a closed body bag, reality started to kick in.  When the pathologist opened the zipper of the body bag we could feel the anxious, tense feelings of the students in the room.

The Pathologist (as well as all of the staff) was very accommodating to the Gurnick Academy of Medical Arts LVN students.  As he proceeded the pathologist told us exactly what he was doing.  The experience was very overwhelming to the students but it definitely taught them a lot about human anatomy and physiology.  For most LVN students it was the first time they had seen a human brain, heart, lungs, larynx, stomach, kidney, liver, thyroid, spleen and other organs.  It was an experience we will remember.

When we, the faculty at Gurnick Academy of Medical Arts, tell our students “we are here for you,” we actually mean it. Yes, it’s true, our LVN students have to work very hard toward their degree, and no, we do not “sell” the diplomas for the tuition fees. Our nursing students have to put a lot of work and their time into their studies to get the right to become a Licensed Vocational Nurse. However, when it comes to helping our students achieve their goal in education and becoming a healthcare professional, we stand behind them one hundred percent.

So, when LVN program students express their opinion on assignments given in class and at home, we listen to what they have to say. Everyone has a voice and deserves to be heard and considered. We do want to know, what works for our students, what learning techniques are the most useful in achieving maximum results, and which methods may need to be retired. This way, we get maximum student satisfaction, and yet the highest results in academic success. It is possible to get both: high students satisfaction scores for our school, and high NCLEX scores from our graduates. We push them hard, but we push them wisely. After all, we are here for them primarily. So whatever they have to say, we do listen , and we to hear.