Internship Site:​ Kaiser Permanente Westside (Pediatrics)

Profession:​ Medical Assistant

Date:​ September 1st, 2017
Total number of hours:​ 9

Entry #1: ​9 hours (running total-9 hours)

I arrived at the Pediatrician’s office at the Westside Kaiser Hospital in the early morning, and
began by meeting the first medical assistant who I would be following. Her name was Ashley
and she had recently become a Medical Assistant. We started off the day by answering emails
and questions from patients and their parents. Each MA was assigned to a specific Pediatrician,
and helped their patients throughout the day. After about half an hour of prep work, the patients
began coming in. When it was time for their appointment (and Ashley had seen that they had
checked in), she brought them back to update their chart. She began by taking height and weight
for the majority of patients, and then took them back to their room. She took their vitals, and
entered them into their chart. Based on what the patient was in for, she would ask background
questions so that she could accurately reflect the situation in their online chart, as well as to give
their pediatrician a better understanding of what they were coming in to get checked for. We had
a couple of patients who needed vaccinations. For these, we would go to a secure area where the
vaccinations were stored, and would grab all of the needed equipment. Then we would make
sure to grab informational packets for the children/parents if they had any questions. After the
vaccinations the MA would be sure to throw away any medical supplies in a secure medical
waste bin. In between patients Ashley would answer questions and do any needed paperwork.
After a lunch break, I switched to shadowing a different MA. She was very experienced and had
been working as an MA for about 25 years. We did mostly similar things for the rest of the day;
taking vitals, charting, giving vaccines, etc. Through this experience I was able to get a behind
the scenes look at what a Pediatrician’s office is like, all of the work that goes on that the patient
doesn’t know about. Although I don’t want to be a Medical Assistant, there are a lot of
similarities between nurses and MA’s daily tasks. While a Nurse has more hands-on and direct
care of the patient, they also have to take vitals, and fill out paperwork. In the future I will be
able to look back on this experience and remember what MA’s do on a day to day basis so that I
can better work alongside them as an RN.
Internship Site:​ OSU Extension Services--Washington County
Profession:​ Family and Community Health Teacher
Date(s):​ November 9th 2017 and November 21st 2017
Total number of hours:​ 6

Entry #2: ​4 hours​ ​(running total-15)

I arrived at the OSU Extension Office during the afternoon, and met Maureen (the woman who I
would be shadowing). Maureen was a Family and Community Health Teacher and Coordinator.
While she occasionally teaches classes, she spends most of her time organizing the other
teacher’s classes, as well as events. The first thing that we did was to sit down and meet so that I
could get a better understanding of her career. Through this meeting I learned tons of stuff about
nutrition that I have never known before. For one, I had no idea how many different careers there
are within the Nutrition umbrella, and many of them do not require a degree in Nutrition or
Dietetics. Many of the careers are focused around Public, Community, and Family Health (this
would be similar to getting a degree in Human Development and Family Sciences). Another
interesting thing that I took away from our initial meeting is more knowledge about the different
programs that are offered for families who may not be fully educated about healthy and
nutritious foods to eat and how to prepare them. After our meeting, Maureen took me back to her
office and showed me around. When we arrived to her cubicle, she gave me a book to read about
the government’s policy on food and nutrition. She asked me to read some of the book and take
notes on anything that I found interesting. After reading for about an hour she came back and we
discussed the material, Maureen noted that Nutrition is greatly influenced by politics and who is
in office. We ended by me sitting in on a meeting with a man from SNAP which is the
Supplemental Nutrition Assistance Program that assists Oregon families who are need in
nutritional assistance based off of income needs.

Entry #3: ​2 hours (running total-17 hours)

For my last 2 hours of my Internship, I interviewed one of the Nutrition Educators for Family
and Community Health. Ms. Rodriguez explained what her job was like and some of the
constraints that she faces within her job. She primarily speaks Spanish and teaches her classes in
Spanish. She teaches classes on how to properly clean healthy foods like fruits and vegetables.
She also gives out recipes that are budget friendly and teaches them how to make those meals.
Ms. Rodriguez also does outreach in community fairs and markets by doing classes during
Tuesday markets in Hillsboro and also in Forest Grove. Ms. Rodriguez also works with young
adults who have special needs to help them learn how to cook for themselves and others.
Internship Site: ​Kaiser Permanente Sunnyside (Labor and Delivery)
Profession: ​Registered Nurse
Date(s): ​March 17th 2018 and April 4th 2018
Total number of hours: ​24

Entry #4: ​12 hours (running total-29 hours)

The nurse that I was following in Labor and Delivery works night shifts, so Amy (my RN I was
shadowing) and I began at 7 pm on the 17th. Within our first couple of minutes of arriving, we
were assigned to a patient who was 7 cm dilated and was having contractions very close to one
another. Within an hour and half in the room the mother gave birth to a baby girl! Seeing a live
birth for the first time was an incredible experience. I got to learn a lot from the baby nurse as
well, such as APGAR scores, and medicines given after birth. I also had the opportunity to
examine the placenta with the first birth. The midwife or doctor makes sure to place a plastic
covering underneath each mom so that after the birth they can measure fluid/blood loss to see if
the patient will need blood bags. The nurse also must check the mothers abdomen after birth to
make sure that the uterus is contracting properly postpartum. The second birth that I saw in the
night went very fast, as I walked in when the baby had already crowned. This mother had an
epidural so the labor was more controlled by the midwife and nurse. After birth, the midwife
makes sure to check for any tears or rips so that they can either attempt to stop the bleeding or
stitch up the tear. The second patient needed stitches due to a rip down her labia, which I was
able to observe. The third birth that I observed also went very fast because the mom was already
pushing when I arrived. This mother also had a tear, but the doctor was able to get the tear to
stop bleeding on its own since it was fairly minor. This baby also latched on extremely quickly to
breastfeed with his mother (almost right after birth). After the 3rd birth, I was able to follow a
baby nurse into the NICU section to take a look around at the babies in the ward. The NICU
section is made sure to be kept very dark and quiet with minimal simulation. This is because
premature babies are very underdeveloped neurologically, so the NICU tries to imitate what the
experience in the womb would be like so that they can develop properly, which I found
extremely interesting! Throughout this whole shadow, I was being called into rooms right when
a baby would be delivered so that I could witness as many as possible, however my nurse, Amy,
had only had the one mother give birth. After a while, the mother can be taken up to postpartum
ward, which Amy and I did with the first birth that I watched. We transported them upstairs and
gave their new nurse a debrief. During the transport while the mom and dad were getting things
arranged, I was able to hold the baby! Something that is important to do in L&D before
transporting a mom up to postpartum is to make sure that the mom urinates. It is vital for a mom
to empty their bladder after giving birth so that the uterus can properly contract--if it is not
emptied, then the bladder puts pressure against the uterus which weakens it and makes it unable
to contract. This can cause hemorrhaging which, if left untreated, can be fatal. Throughout the
time that the mother gets admitted into triage into all the way through admission into the labor
and delivery rooms, both the mom and babies heart rates are monitored. Sometimes, it can be
difficult to monitor the baby's heart rate because the mom’s heart rate can interfere with the
monitors. When this occurs, sometimes an intrauterine heart monitor is placed on the baby’s
head, and I was able to see this procedure take place on a baby who was in distress. The night
shift was very interesting and steady, while also being on the laid-back side as far as
administrators since there are less that work night shifts.

Entry #5: ​12 hours (running total-41 hours)

My second shadow shift in L&D was a less busy night, as I only saw one birth that evening. The
first patient that Amy had was a mother who was already heavily dilated and was ready to start
pushing within a couple minutes of us being in the room. The patient had an epidural which
affected her pretty heavily; she was unable to move her legs on her own or keep them up in place
either. Because of this, when she needed to push, Amy and her husband would have to hold up
her legs. At one point, Amy allowed me to hold one of her legs in place, which is when the baby
crowned! The baby’s head was outside for a good 10 seconds before the rest of the baby was
able to come out. This was because the baby’s arm/hand had been lifted up and needed to come
back down. It was such an amazing experience to be able to see the baby when it very first
entered into the world and took its first breath. This was a moment that I’ll never forget. I also
was able to watch the baby nurse do her workup for the baby. She took the baby’s height,
weight, chest and head measurements, and administered medications. They typically will give
the baby a Vitamin K shot to help give the baby blood clotting factors since they are born with
next to none. They also will give the baby a Hep B vaccine (which I noticed quite a few parents
opted out of; which Amy said is typical). Lastly, they give the baby a gel on their eyes called
Erythromycin ointment to protect the baby’s eyes from anything that the mom may have
potentially had in her vagina that could transmit diseases, and even just a specific flora that
might not sit well with the baby’s eyes. Since there wasn’t a lot of admitted mothers, I stayed
with Amy for most of the night and was able to watch what she usually does during a shift. She
spent some time charting both in and out of the room, and getting everything prepared to get the
mother moved up to postpartum. While I was in the L&D unit, there was unfortunately a baby
who was born too premature and didn’t make it. The mother had gone into preterm labor. Amy
explained to me that when this happens, they usually try to stitch together the cervix to keep it
from continuing to dilate. Sadly, this procedure was not able to be performed because the cervix
was ruled to be incompetent and would not hold the stitches. Because the baby didn’t have any
lung development, there would have been no way to intubate. While this experience was
extremely somber, it gave me insight to the fact that being a nurse doesn’t always mean good
outcomes. Sadly, sometimes it means that you just have to support those along the way no matter
the outcome. This really showed me the different types of situations that nurses will encounter
with their patients. The next birth that I was able to witness was with a mom who had no
epidural, and was in a lot of pain. Walking into the room, the baby nurse gave me a warning that
it might be intense in there. She gave birth after about 10 minutes of pushing. For the rest of the
night I spent time with Amy charting and discussing patient experiences with her, as well as with
other nurses. The last patient that I saw for the night delivered while I was out of the room, but I
was able to meet and talk with her while she was still in the later stages of labor. Even though the
second shift wasn’t as busy as the first, I had a lot of time to talk one on one with the nurses
about their experiences and was able to spend more time following just Amy.

Internship Site: ​Kaiser Permanente Westside (Emergency Department)

Profession: ​Registered Nurse
Date(s): ​April 11th 2018
Total number of hours: ​9

Entry #6: 8 hours ​(running total- 50 hours)

I arrived at Kaiser Westside at 10:00 am to start my shadow shift. When I arrived in the
emergency ward, there was a lot going on all at once. Patients were coming in on gurneys while
nurses were helping them get into their rooms: I knew it was going to be a busy day. I followed a
nurse named Erin, and I soon learned that about ¾ of the patients that get admitted to the
emergency department are elderly. They can be admitted for an array of reasons, but a significant
amount of the elderly patients she took care of came in either because of pneumonia or
symptoms brought on by pneumonia. Our first patient, however, came in because of seizures.
One thing that I learned is that they are not supposed to give a patient who has been having
seizures anything to eat or drink so they don’t choke on it in case they throw it up during their
seizure. All of the elderly patients that we had for the day (with one exception), came in for
pneumonia. We spent a lot of the day making sure their oxygen levels were good, and
administering antibiotics as well as steroids. I really enjoyed working with the elderly patients,
and it’s something that I would like to spend more time doing, possibly even looking into going
into geriatrics when I become a nurse myself. In the emergency department, there are many
moving factors that have to work together to help the patient. There’s the doctors, and the RN’s,
and the CNA’s, respiratory therapists, psychiatric evaluators, imaging technicians, and many
more. Even though we spent a lot of time bouncing from room to room because it was so busy,
we also spent a lot of time charting. Because the Emergency Department has such a vast array of
care needed, there are a bunch of background questions to ask, and a lot of different options for
symptoms and signs. There was also a lot of repeat patients; ones that doctors and nurses knew
because they had been in so frequently. While some of these were elderly, there was also some
young adult patients that were repeats that my nurse Erin had taken care of before. Overall, I
really enjoyed my shadow experience in the Emergency Department. There was a lot going on,
but being able to experience it all was awesome. I realized how much specific knowledge a nurse
needs to know for their department, and all the extra preparation necessary to be able to handle
specialized patients and situations.
______________________________________________________________________________
GRAND TOTAL: 50 HOURS