Nursing students, past and present. Help me with my story!

I need a bit of input from nursing students or those who know can lend me a nursing student’s perspective. I’m writing a murder mystery – just a short story, probably, and unlikely ever to be published – but I’m a perfectionist and would rather avoid some of the bigger pitfalls made by writers who know little about the field into which they are dipping their metaphoric toes.

The story involves a murder that takes place on a university campus. The victim (Paige) is found by her roommate (Angelika), who quickly seeks the assistance of a nursing student (Leticia). What I’d like to get a handle on is how Leticia is going to react to the situation.

First a little background on the character. Leticia grew up in a barrio, and witnessed a lot of gang violence. She realized at an early age that education would be her way out of poverty, and applied herself to her studies with an iron will. While not a prodigy, she worked her way up to the top of her class in school, winning several scholarships. Acting on the helplessness she felt as a child when her brother had been carried home from a gang fight with a fractured skull, she chose nursing as her field. It’s not the greatest fit because she isn’t much of a people person on the outside. Leticia is brusque, a bit gruff, and has no tolerance for whining or petty disagreements – of course this is due to the hardened shell she welded about herself to shut out the pain and ugliness of her childhood. Although standing only 5’1", Leticia has a commanding presence and has a unique talent for silencing a noisy room just by entering it and casting an icy stare about (I knew a nun in high school who had this quality). Once you get past the exterior, though, she’s a kind and caring person, though she has difficulty expressing it.

The setting is a private Catholic university. It’s similar to the one I attended (because that’s what I know of college life) except that the fictional school has a college of nursing, which my school did not. To be quite candid, I know little to nothing about how a nursing college is set up, what the curriculum is like, how early students begin spending time in an actual hospital setting with real patients, etc. This complete ignorance is why I’m putting forth this discussion.

Here is the gist of what I want to know:

A. Supposing that Leticia is a fourth year nursing student, what would her schedule be like? Would she be spending the majority of her time in lectures, studying, or working shifts in a hospital? Is it feasible that a student in her field would also have a job as a “dorm mother?”

B. How much exposure will a fourth year nursing student have had to death? Would her studies at this stage have included working with cadavers? If so, in what capacity – performing actual dissections or just observing? Would she have spent time in an ER in any capacity?

C. The situation: Leticia has been summoned for help by Angelika, who is in such a state that she can only pass on the information that “something has happened to Paige.” She follows Angelika back to their dorm room. Paige is indeed dead, and has been for over thirty minutes. She is lying in a fetal position on her bed, facing towards the wall, wearing only a silk scarf knotted around her neck. The scarf, in combination with a short but stout dowel rod, has been used as a garrote, but the fact that the scarf remains around her neck means that the wounds of strangulation, and therefore the cause of death, are not immediately visible. As a fourth year nursing student, what should be Leticia’s automatic, instinctive reaction? Would she be more likely to recognize this as a case beyond medical assistance (thus preserving the crime scene), or throw herself into attempts to resuscitate the body?

Any insight into these areas would be greatly appreciated. Leticia doesn’t play a huge role in the my story, but I want her reaction to be authentic, as it sets the scene for much of what follows.

My wife became an RN in 2 years. That’s all I have to say.

Not a nurse, but I do know that you don’t “need” a four year degree to become an RN. Many universities have a bachelor’s degree program in nursing, but it appears that one can get a 2 year nursing degree at a community college and pass the exams (which I know little to nothing about). You can get a master’s degree in nursing too (does this help in terms of salary or advancement, such as to charge nurse?)

Since nobody has attempted the OP’s question, I’ll WAG. I would think that Leticia’s exposure to violence would desensitize her, to the point that it would have a lesser effect on her than a random person, as to her, seeing the effects of violence would be “more normal” for her than the average person.

A nursing student wouldn’t be working “shifts” unless they had a job outside of school. Time spent in the hospital as a student is referred to as “clinical” and would be with other students and under the direction of an instructor. There are “rotations” through the various clinical areas of a hospital–peds, med-surg, OR, ICU, etc., and a student really just gets a small taste of what is going on. There would be minimal, if any, contact or experience with death & dying. Nurses don’t dissect cadavers! Anatomy labs generally include dissection of a cat or fetal pig. Sorry, but I wouldn’t trust a nursing student to dump a bedpan unsupervised! Nursing school basically prepares you for taking boards–what you learn on the job is where you really get your training. And you can become a registered nurse (RN) with an associate degree, diploma, or bachelor’s degree. You take the exact same licensing exam. Diploma programs are quite rare now, but were once the standard. Most have now transitioned to the ADN or BSN routes.

You absolutely do not need a master’s degree to be a charge nurse–that position is generally based on experience. Advanced degrees help to the extent that you are in a better position for advancements such as to administration or education, where you don’t have to work as an actual “nurse”;). There are rarely any pay differences (if so they’re minimal) according to degree, in general hospital nursing positions (excluding advanced practice, of course). As I noted previously–all graduates take the same board licensure exam to be called a Registered Nurse. Advanced practice nurses such as Certified Registered Nurse Anesthetists, Nurse Midwives, etc. have training resulting in master’s degrees (or specialized diplomas in years past). There is a move to require these advanced practice nurses to obtain doctorate degrees within the next few years. (sorry to hijack–)

I have been assured that Nurstoons are based on actual nursing situations.

Let’s see…

I did a two yr degree but hopefully this will help you a bit.

I spent most of my last year in the clinical setting and the last three months doing shiftwork.

I had little to no experience with death in nursing school. That’s a pretty individual thing, though - some of my classmates had some exposure. I don’t think anyone attended an autopsy, though.

As far as ER experience went, some people chose ER for their specialty and spent their last three months there, but for the rest, we may have spent a day in the ER, but that’s about it.

Most of her time would be in clinicals, although she may have a class or two a semester. It is probably not feasible for her to be a “dorm mother” or Resident Assistant, due to the variance in clinical hours.

Dissections or in the morgue, most likely not. They may have been given a tour of the hospital morgue, but no classes or such with human dissection. Death, it will depend. Some may see a patient die, others may not encounter it. Usually when someone codes or is in danger of imminent death, the nursing students are not given critical roles to play if they are present and are most likely told to get the hell out of the way so the code team can work.

First instinct would be to check for breathing, airway obstruction and circulation. If the girl has only been dead for 30 minutes, she’s not going to be rigid, but she may be a little cool (depends on the temperature of the room). When she checks for a pulse she may determine that the body is cool and has been dead too long for medical intervention.

exactly!!:d

At my university, we used human cadavers, we actually had a real morgue for the nursing students, containing real human bodies donated to our school.

At the community college next door, they used cats.

Depends on the school.

If she’s done clinical rotations in ER, ICU, or at a nursing home, she will have seen plenty of death.

If she’s in an RN bachelor program, she’s most likely already gotten her Red Cross First Aid certification. Training in that is, when you see a nonresponsive person, you:

  • check the environment for danger (was person electrocuted by downed powerline, etc)
  • tell someone to call for help and tell them to find an AED if one’s available
  • try to get the person to respond. (“Suzy! Suzy! Can you hear me!”)
  • check for breaths
  • if no breath sounds, give two rescue breaths and begin compression

The big variable will be Leticia’s sense of fatality about it. She will surely recognize that Paige is dead. She may even see signs that Paige has been dead for a while - lividity, dried blood or vomit. If she is very fatalistic and emotionally objective, she’ll recognize it for a murder scene and not touch anything. If she has an emotional attachment to Paige or she hasn’t seen violent death (as opposed to death in a medical setting), she may start CPR in an attempt to bring her back.

Pretty much, no one ever gets in trouble for rendering aid. Medical personnel are required by law in most states to give aid in an emergency situation. The ambiguity of whether or not to render aid could supply conflict to the story - is Leticia now a suspect as she destroyed evidence when she started CPR? Does Leticia’s description of the scene before making rescue efforts contradict others’ testimony? Did Leticia “let her die” in her own eyes or the eyes of others if she didn’t start CPR?

Good writing!

Last I heard most medical professions do not bother with something like basic first aid certifications since your training encompasses far more skills and in many cases is contradictory to basic first aid curriculum. Would you tell an EMT not to move an injured person? We used to have a great time with the CPR classes because they demand you go through all the steps like telling someone to “go call 911”, uh, you’re here…

Also IME many of the nursing types are not well versed in environmental threat assessment, plenty of EMT’s and paramedics are not either but they are taught, whereas to firefighters this is a religion.

Depends on the luck of the draw (and the assignment of your instructor). I had my first Code and death in the first semester of my second year, on a Med-Surg floor. It’s a two year program, but I was still 7 or 8 months away from graduation.

Awesomeness. Thanks!

Actually, that sounds like a lot of us…

Busy, busy, busy. No, she would not have the time to be an RA or “dorm mother”.

In my two year program, we may spend one 12 hour day in the ER, depending on what teacher we have. It’s not written into the program, but some teachers send us anyway. Some don’t.

Like I shared above, some students have patients die during Clinicals. Most don’t. If you’ve got a conservative teacher, she’s going to give you fairly healthy patients who are unlikely to expire on your shift. If you have a careless or confident teacher, you may get very sick patients indeed, who may die before lunch.

If it was me, I’d pull off the garrote and try to find a pulse. Yes, that’s probably destroying evidence, but I don’t give a shit. I don’t have the experience to determine if someone’s dead by their palpable body temperature, especially if it’s been only 30 minutes. I’m going to shake her, call her name and rub her sternum hard to see if I can rouse her. I’m going to tell Angelika to call 911 and then I’m going to start CPR. I’m going to keep doing CPR until I’m exhausted, and then I’m going to grab another person and talk them through how to do it until I get my wind back or the paramedics get there. I’m probably also going to tell someone to find an AED, which should be in a hallway somewhere if it’s a semi-public building, and when they take it off the wall, it will very likely signal Emergency Services, whether or not Angelika has found a cell phone signal to call 911. When I get the AED, I’m going to fumble around with it and swear a lot, because it’s almost guaranteed to be a model other than the one I tested on to get my CPR card.

I’m going to be scared shitless the whole time, and probably be silent mostly, but barking orders and sound pissed off to everyone around me. When it’s all over, I’ll probably cry, but I might just be numb and zombified for a bit.

BLS for Healthcare Providers was a prerequisite for my Nursing program.