A Factory Full of Nursing Firsts

I have yet to shed more light onto my placement up here in Moose Factory... and seeing that it's been absolutely incredible, I can't keep it from you any longer. I knew that doing my nursing consolidation in a rural setting would bring with it many new challenges and exciting opportunities... but I had no idea just how gracious God would be in providing such a rich and constructive learning experience. The title

summarizes it perfectly - I have been exposed to and involved in the widest range of new nursing skills

(probably too many to count), and I wouldn't change it for the world! I am fortunate to have received permission from both Ryerson and Weeneebayko to share my placement experiences through my blog, so hope you enjoy seeing pictures and reading about what I've been up to at this small-town hospital.

The Weeneebayko General Hospital (WGH) is part of a larger organization - the Weeneebayko Health Authority - which services a total of six communities including Moose Factory (MF), Moosonee, and four coastal sites. "Weeneebayko" is a term used by the Cree people of the James/Hudson Bay lowlands to refer to the waterways that make up their traditional territory. It has been really interesting to witness how the sites are interconnected to each other and to other health care organizations, as well as how nurses practice in the North. The communities outside of Moose Factory are home to clinics that employ nurses who follow clinical practice guidelines established by Health Canada's First Nations and Inuit Health Branch (FNIHB) and most often work in consultation with doctors over the telephone. The ER doctor at the hospital cares for patients in Moose Factory along with answering calls and guiding nurses to provide the appropriate treatment to clients up the coast. When their condition becomes more critical, clients are transported via air ambulance through a company called Ornge - either to the MF hospital or further south (often Timmins or Kingston). Nurses at all sites are very familiar with their roles and limits, knowing when clients are expected to be transported to another location.

Despite having more on-site support than the coastal clinics, it was still a significant adjustment starting placement in the MF hospital. Nurses have many more responsibilities than normal but from what I gather are only better health professionals and stronger clinically because of it. I have enjoyed being kept rather busy most of the time and having the opportunity to repeatedly practice skills I may have otherwise missed out on in the south. Even after a long, tiring night shift I walk out of the hospital doors with a huge smile on my face, thankful for all that I got to do during my shift.

The preceptor that I was assigned to works in the ER and the hospital's inpatient department, which admits patients for general medicine, pre- and post-surgical care, intermediate or "step-down" care, and labour & delivery - all under one roof. One of the top items on my list of things to experience was witnessing a live childbirth... and within several weeks of starting placement I got to watch a baby enter this world and be one of the first ones to care for it. Before that day I had never even held an infant so young. It was one of the best placement experiences I have ever had and I will probably never forget that day. Below is the main WGH birthing room where all the action takes place.

Across the hall is the nursery where I have assessed, washed, dressed, fed, and snuggled a number of newborns... spending time with whom has brought me so much joy. Of course there are some things you need to help with that they don't like so much (there's something about axillary temps, for instance, that babies absolutely hate), but still, it is such an honour to be part of the care received in the first few hours and days of life. The nursery is probably one of my favourite rooms for that very reason.

Apart from labour, delivery, newborn and postpartum care, the inpatient department has also provided exposure to other patient populations and the opportunity to begin taking on a full patient load. Increasing my skills in priority setting and time management has been key to the latter, and I have really enjoyed broadening my involvement in patient care and growing in independence. The majority of my time, however, has been spent in the ER... which is pretty much a completely different ball game. Earlier when I mentioned that northern nursing often involves extended responsibilities, this is where I see that play out the most. For example, rather than having designated technicians, nurses are doing blood draws and ECGs for patients. But I am learning so much because of it and wouldn't want it to be any other way. Below is the main entrance to the ER - for staff, patients and EMS services alike. I get so excited every time I walk through those doors for a shift, never knowing what to expect.

Unpredictability, diversity, and unity are some of the many things I have grown to love about ER nursing. Like I said, it's unpredictable because you never know who and what is coming through the doors... diverse because you care for people of all ages, health states and walks of life... and united because everyone works together as a team to assess and care for the many patients that cycle in and out of the department. Working in the ER of an isolated rural community is also unique from all other clinical settings. At WGH, responsibilities are divided between two RNs - who work together to triage/assess clients, manage patient flow, carry out orders and other nursing interventions, and help organize patient transfers. So you are not assigned to a particular area of the ER like nurses are in the south... you do it all, and you never (maybe rarely) get bored. Thus it's not surprising that I have been learning to remain organized, think critically, plan ahead, take initiative, and stay on top of what needs to be done.

Below is our triage room, complete with all your assessment essentials. This is where we get to do a little investigating into what brought the patient to the ER and determine the level of urgency for medical attention. Like other ERs in Canada, we use the Canadian Triage and Acuity Scale (CTAS), which assigns a numerical value ranging from 1 (most urgent) to 5 (least urgent) to the patient status/presenting complaint to ensure that resources are allocated appropriately. I was fortunate enough to receive CTAS training and certification a few weeks ago, which has helped me to navigate the system. This has been a very unique opportunity as most nurses in the south do not get to start triaging until they have worked at least one or two years in the ER. So this is where for the first time I have triaged a number of patients - from infants up to older adults:

Moving down the hall, passed two examination rooms and the nurses' station is the space you would typically imagine when someone simply says the word ER. Below you can see two bays (each complete with a stretcher, monitoring systems, and other supplies), and there is a third further to the right not visible in this picture. Also across the hall we have an isolation room in case anyone were to present with a communicable disease requiring separation from other patients. The first bay is usually reserved for more critical patients, including those requiring resuscitation. Although I have yet to take part in a code blue, I was also able to receive certification in advanced cardiac life support (ACLS)... which has prepared to provide CPR, insert certain advanced airways, use a manual defibrillator and give a handful of medications among a number of other fancy life-supporting interventions if ever needed. Running mock codes in the ACLS training was a really valuable learning experience and made me even more interested in ER nursing if that's even possible.

Below I included a close up of the second bay because this has happened to be the place where I have gotten to do a handful of other new things. Bay 2 is where I have inserted a nasogastric tube (a tube inserted through the nose and esophagus then into the stomach), monitored several patients

undergoing conscious sedation, and removed a patient's cast with a cast saw (probably one of the coolest things ever - look it up if you don't know what I'm talking about). I'm probably missing a few things, but regardless, you get the point that I've been keeping my hands full. Other new skills that I've really been enjoying are doing blood draws and starting IVs... It's hard to explain but there's something so satisfying in successfully inserting a needle into someone's vein. You may call me crazy, but it's probably just one of the many reasons that I'm meant to be a nurse.

All in all, my northern experience has been more than I could have asked for. Even though there are harder days where I am stretched thin and my heart breaks in response to some of the things I see, I am so thankful to have been accepted into the hospital and given the opportunity to participate in such diverse patient care. This placement has been a huge contributor to building my confidence and excitement for stepping into a new chapter as a soon-to-be new graduate nurse. I can't thank staff and patients enough for welcoming me to the community and allowing me to be one of many who contribute to restoring health in the north... and of course God for giving me the strength and courage to continue moving forward into the unknown.