While I am studying abroad in Puerto Rico, I have been doing my clinical rotations at the VA Hospital. I have never worked in nor stepped foot in a VA hospital before, so it was interesting to see the difference between the standard public hospital vs. the VA. I have worked on the Medical/Surgical floor and spent a day each at the Emergency Department and Surgical Intensive Care Unit. What’s different about their healthcare system is that at the VA Hospital looks out for their patients even after they’re discharged. For example, on every discharge note, there are appointments in various departments that have already been set for the next six months. They understand that ensuring their safety outside of the hospital will prevent readmission because they are following up on their patients after discharge.
The role of the nurse on the interdisciplinary team is to monitor the patients as well as carry out the treatments that’s included in the patient’s plan of care. Because the nurse interacts more with the patient than anyone else on the interdisciplinary team, the nurse makes a huge difference in helping the patient recover. Most of the time, it’s the nurse who first notices or is first notified of any changes with the patient. They advocate for the patient to physicians or other members of the team because they spend the most time with them. These nurses know exactly what works for the patient and what doesn’t because they see the effects. Therefore, they play an important and necessary role on the interdisciplinary team.
I think the nurse/patient relationship is great at the VA Hospital. Despite having multiple patients, the nurses try their best to make sure that each patient is being taken care of. They advocate and look out for their patients when it comes to their treatment plan or medications. Something different that I noticed between mainland hospitals and the VA hospital is that they take the time to explain everything to their patients, especially their medications. Before even opening the medications, they always explain and ask the patient first, thus allowing the patient to be directly involved in their care.
I have experienced some role modeling by the nurses, both on 4J (Med/Surge floor) and the Emergency Department. The nurses that I shadowed really took me under their wing and taught me so many things about nursing skills and patient care. They showed how to draw blood, give chemotherapy, put in a central line, give medications through a central line and etc. I also saw how much they advocated for their patients and how involved both the nurse and patient were in the plan of care. The nurses at the VA Hospital are great examples of the kind of nurse I want to be like.
Because the patient population consists of mostly elderly males, ranging from ages 60-98 years old, whom served in the Vietnam or Korean War, you see a lot of the same diagnosis, treatments and medications. Some common diagnosis that the patients at the VA Hospital have are Chronic Kidney Disease/Acute Kidney Injury, Hypertension, Diabetes Mellitus, Heart Failure, Benign Prostatic Hypertrophy, Prostate Cancer, Urinary Tract Infections. Some common treatments range from Metoprolol for hypertension, Famotidine and Tamsulosin for benign prostatic hypertrophy, Heparin injections, Insulin, chemotherapy, hemodialysis and etc. For the most part, the veteran patients at the VA Hospital are the same as the patients back home. Most of the veterans obviously spoke Spanish, but there was still a good amount that knew English. I noticed that all the veterans I was assigned to were extremely nice and understanding. Not one of them ever gave me a hard time about doing a head-to-toe assessment on them or not knowing any Spanish. In fact, they were so open to the fact that I was a nursing student and even encouraged me to use them to practice basic nursing skills such as drawing blood. The veterans made me feel more comfortable and less anxious about being in a new environment.
During my med/surge rotation, I noticed how much physical illness affected a patient’s mental health. There were numerous patients who were bedridden due to their diagnosis and comorbidities and needed assistance with their ADLs. For some, this affected their mental health negatively because up until their physical illness, they were doing things independently without any problems. Now, they needed to rely on someone to do simple tasks, which caused some to feel useless. In addition, there were also some patients that had difficulty coping with their diagnosis because instead of accepting their illness, they would deny it or get frustrated with the situation. I also noticed the correlation between physical illness and mental health especially in oncology patients. For some oncology patients, they didn’t let cancer or the painful side effects of chemotherapy dictate their mental health. In fact, I’ve had some patients who managed to smile every day and even make light-hearted jokes, despite their diagnosis. Nevertheless, there were still others that let cancer define their mental well-being through a negative attitude and mood.
I have learned so much at the VA Hospital so far and will definitely integrate them into my practice. One of the things that I will take with me into my practice is making sure that my patients are set with everything before being discharged. As mentioned before, the VA Hospital does a great job in following up on their patients and ensuring that they are fully taken care of after leaving the hospital. Therefore, in the future, I will make sure that before my patients leave the hospital, he or she must have a place to stay, a set treatment plan, a good support system and even something as simple as transportation.
My time so far at the VA Hospital has been unforgettable. I have learned and done things that I never would have been able to back home. It’s a breath of fresh air being in a new environment and definitely a one-of-a-kind experience. However, there is still so much for me to learn as I begin my psych rotation. It will be interesting to interact with veterans dealing with mental illnesses, PTSD, and etc. I will never forget my time at 4J, the medical/surgical floor, and look forward to a new experience on the psych floor.