mission accomplished

I got out of the semester with an A, and two B+s. Not bad! I'm satisfied, for sure, although how I got away with it I'm not sure. A lot of luck.

So I'm taking a much-needed break from the nursing world, just for a couple weeks. And then it's NCLEX study time, community health and a statistics class for grad school.

sometimes I just don't get it

I got my collection of papers back from my prof. She is a really tough grader, especially when most papers are opinion-papers, and she gave me an 88. Which is all fine and dandy... but. (You heard the 'but' coming from a mile away.)

I had to write a paper about my 'my future role in nursing' which included my future career goals. I put that I want to go into nurse-midwifery, and geriatrics. She wrote 'this is incongruous'. Yes, maybe it is, but... that's what I want to do, and those are my goals! You can't take off points for that!

And I said I wanted to be a part of a team working for women's health. She said 'midwifery is not women's health'. Since when is giving birth unrelated to a woman's health? Especially if you are assisting her to do it in a manner that she finds most comfortable and suitable to her? Or if you are providing her with safe, affordable, quality care? That's not part of women's health???

What-EVER!

you might be a nurse if...

...You can drink a pot of coffee and still go to sleep in the morning.

...You think it is acceptable to use "penis" and "vagina" in a normal conversation.

...You know the phone numbers of every late night food delivery place in town by heart.

...You´ve ever been telling work stories in a restaurant and had someone at another table throw-up.

...You refer to motorcyclists as organ donors.

...You believe Tylenol, Advil, or Excedrin provides a large part of your daily calorie intake requirements.

...You´ve ever had a patient with a nose ring, a brow ring and twelve earrings say, "I´m afraid of shots."

...You have to leave the patient before you begin to laugh uncontrollably.

...You believe a good tape job will fix anything.

wee update

I got an A in my med-surg clinical. A 98 for final performance. After all of our differences, my instructor said I did wonderful, excellent, just where I should be... so what the heck was I so worried about this whole time?!?

Just one exam left, in two weeks' time. Time to get back to karate and making money!

my next great adventure

Here I am, still a semester away from graduation, and already I've got my sights set on grad school. I would love to go directly into nurse-midwifery, but it's looking more and more like that dream will have to be put on hold for a while. I can't get in to labor and delivery until I've done a year on another floor, and I can't apply to the program until I do a year in L&D. And basically, I want to get going sooner than that. So I'm thinking of applying to U of M's nurse practitioner in gerontology program for winter '09. All I need to do is take a basic statistics course next semester, and my GPA is high enough that I don't have to take the GREs. And by the time I enroll, I'll have my first six months of 'real nursing' under my belt, at least.

I plan to take the program pretty slow, probably four years instead of two. It's intense, and I have to work and make money as well. It's amazing to think that at this time next year I'll be starting out my training as a nurse practitioner! Insane. But I guess right now I need to focus on finals, taking the NCLEX, and getting hired on the telemetry unit where I work as a new grad.

Everything is going swimmingly in nursing student world. I give a group presentation today, and then I just have one final exam and some computerized testing to do. I really did it, survived this crazy-ass semester. I knew I was nuts to do all of this in one term, but I also knew I'd be so happy to have it all over and done with. And I am!!!

I've gotta get through this

I slogged through another 12 hour NICU day on Wednesday. I'm given no responsibility, and since my preceptor doesn't take any patients, I just sort of float here and there, helping people. I spent the majority of the day helping an older nurse with the 'feeders and growers'. Meaning- I fed and changed babies all day. The frustration of just 'hanging out' somewhere, coming from clinicals where I had my own group of patients and all the responsibility I could want, almost got me in tears. The sheer monotony of it. I supposedly have one day left, but whether I will actually go or not, I don't know.

The good news is, my preceptor gave me an 'A'. I guess I was a good cart stocker.

weeeee are the champions

Today was the last day of clinicals for me. I will have a community health clinical next semester, but one very important thing stands out about the end of this one: I will never have to wear these green scrubs again!!! I threw them out. I'm so done with that color.

taking out my frustrations

I suppose I have been sounding quite negative in my recent posts. Besides the fact that I do use this blog for my share of ranting and raving, I am just frustrated by the fact that my 100 hour preceptorship was not the learning opportunity I envisioned it to be. It has been a frustrating experience, but also eye-opening. Truth be told, I do have a firmer grasp on what it's like to be a NICU nurse, and what kind of nurse I do NOT want to be in the future.

I am so happy and excited to be finishing this semester. It's been tough, because as my confidence in my nursing abilities take hold, my patience with those above me slowly dissolves. But I know they are trying to give me the best guidance they know how, and it's impossible to meet the individual needs of every single nursing student.

When I graduate in April, and pass my NCLEX, I know it will only be a starting off point in my career. Another beginning. Because I know I am fated for grad school and big work and big ideas after that. I still cling to my desire to be a midwife, but I also hope to be a geriatric clinical nurse specialist. I know it's a lot, but hey, I've got a lifetime. And there's so much to do! I want to work in Nepal, too, improving healthcare on a global level as well.

I have really big dreams and I know that this BSN is the first step down a long road. I take the nursing profession very seriously, as it has the potential to improve healthcare and re-define quality of care in every community. I want to be a part of that. I want to live my professional life boldly, never ceasing to learn or grow, always striving to better myself and the way in which I affect those around me for the better.

My last boss, and one of my nursing mentors, gave me a quote for a gift last christmas. The last line of it says "To know even one life has breathed easier because you have lived, this is to have succeeded!"

keeping my mouth shut

I really, really try to get along with my NICU preceptor. And when that fails, I try to try. But honestly, she makes me nuts!!! She putters around and gets excited about things like stocking and little 'extra' projects for the unit. I mean, she's giddy about them. We were there for 12 hours and never had a patient. What the? I mean, does the unit seriously want to pay her to be there for 12 hours checking the crash cart and shit? And then, get this, she tells me that she doesn't like to let me do a lot because she'll get in trouble if I make a mistake. I'm like... "but... um... that's why we're students, right? So we can make mistakes with someone knowledgeable to guide us through it?" She was like "oh... I guess so". Geez. Great teacher here.

She does stuff, like education and family communication, without ever giving me the chance to do it. She's treating me like I'm a freshman or sophomore. Hello, I'm going to be a nurse in 5 months! And I can do it! But she doesn't even let me try. I wish I even thought she was a good nurse, but there's been times when I wanted to take something out of her hands myself and just do it. I just... grrrr. I will have to consider this a lesson in working under someone I deem totally not worthy. Teaching is an important responsibility, not something you do in order to have a little assistant to type your files and stock your carts.

Oh yes, one more thing. She told me she talks fast to people because in nursing school she would do that so that the teachers wouldn't understand her, and think she was just smart. This, apparently, worked for her at one time but now she does it with everyone, including the parents of the babies, and doesn't bother to explain what she's saying. And it's so obvious she's using it to cover up!

But I did see another vag delivery today. It is amazing, utterly amazing, how a woman's body, her genitals, stretch and open for the child. You would never guess it could do that just by looking at it. The mother was amazing, and her body was amazing.

the light at the end

Yesterday during my medsurg clinical I felt like I was walking on eggshells. And, amazingly, none of them broke. I wasn't criticized for anything and even told "good job" by the instructor. Hallelujia! And the best part is, next week we are leaving early, and the week after is the last day. Thank you god.

It's like the end is almost in sight. Almost. But I've got to really lean into the wind and get through the month. It's hard, I'm exhausted, I want to slit my wrists, but hey... I'm going to survive. I'm halfway through!

work, sleep, work, sleep

My med-surg instructor and I continue to have 'conflicts'. Tuesday, once again, she found a way to criticize me for something NOT MY FAULT. The RN checked a blood glucose result before I did, and now suddenly I'm the nurse slacker who doesn't realize the importance of insulin coverage. Hello! It's not as if I can walk around stalking the tech, or hover over the flowsheet every minute waiting for the number. The nurse happened to get it before me. But she doesn't see it that way- and she went off on a rant to our whole group about the importance of getting the blood glucose result before our nurse. I was flippin' mad, let me tell you.

Then she followed me around all day watching me hang IVs and criticizing me for not having the right stuff in my pockets. She makes me so nervous, I'm bound to screw something up. And after every clinical, I feel like I'm not going to be a good nurse. But the nurses and patients tell me I'm wonderful, and that's my only saving grace.

And my Essentials prof told me I'm smart like her, and since I think she is incredibly intelligent and a nurse who really stands up for her profession, I took that as a very high compliment.

In NICU news, my preceptor put me with another nurse for the day, thank god! She still made me stock carts, although I did a half-ass job at it because I get so mad. The staff nurse who took me was an excellent, thorough teacher and I learned more from her in 8 hours than I do from my official preceptor in 36. I could try to talk to this preceptor about our 'differences', but unfortunately I don't feel like she's the type to have a reality-based discussion with. It seems like she's on some other planet and I'm trying to work through this with her long-distance.

I have a crazy week ahead of me, with my grandma's surgery and some Nepali holidays going on this weekend. I have a care map due and a big exam for my crazy med-surg instructor, and then there's the usual NCLEX quiz and clinical write-up to complete. No rest for the weary, that's for sure.

Interesting patients this week: A 28-year-old male gun shot wound victim with a fractured tibia. According to the social work eval, he has 7 children by 4 women. Nice as could be though. A baby born at 23 weeks gestation on bipap who desats and brady's every five minutes. For this I learned how to use the bag and mask, just in case. I have never seen such a little person (1 and a half pounds) with such a big personality! Her miniature little hands always flailing when you do something she doesn't like... so cute, so tiny, so sad. And finally, a 70-year-old male below-the-knee amputee back to have an above-the-knee amputation on the same leg, all because he didn't follow his diabetic regimen. Huge wound that totally dehisced on the stump, with a wound vac.

ready to NOT be a student

I'm really tired of being a student nurse. I don't want people following me, criticizing my every move, making me nervous, giving me extra work. I want to take good care of my patients. I will ask questions when I need to, seek out help when I need to. Nowadays my preceptors and instructors are just screwing things up for me and making it impossible to do my job.

By the way, my med-surg instructor is, as we speak, READING powerpoint slides to us. This is her way of lecturing? What a boring, stupid waste of my time. I can read. Powerpoint should be BANNED from the curriculum.

And my last complaint for the week, is that my preceptor in the NICU makes me crazy! She has me stocking and organizing drawers for hours. On top of that, when I asked her if I could do a heel stick, she said 'no'. Then when I asked if I could have my own patient next time, with supervision, she said 'no' again. No??? This is supposedly my shot at being a real nurse with supervision! And she's making me stock carts! I was so mad, I can't even tell you. When she would ask me to do something, she never explained what she meant. She would document vitals and do all kinds of things without even telling me she'd done them, so I'd go to do it and it would already be done. So frustrating. I just want to quit that clinical, even though I love NICU nursing. A different, younger nurse helped me with some paperwork, and she was so good at helping me, and explaining things.

Ugh, I'm so ready to be done with all of this. Only my essentials class seems like an actual contribution to my education.

plowing through

I've made it through half of this semester. But it really doesn't make me feel better, because the worst half is yet to come. For example, I have only completed 24 of 100 clinical hours in the NICU. We have two more exams, peer reviews of papers and our final draft due in med-surge, four more papers in essentials, a mock-interview, a care map, and a teaching presentation due in clinical. Things are going to get a whole lot worse before they get better.

Our clinical group was in an uproar last week because our instructor gave us all grades in the 77-84 range for midterms. She didn't really say why either, when I asked she just started talking in circles. Oh well. My grade was an 80, because she wanted more out of my reflection papers.

Sometimes I feel like it's hard to be a good nurse when we have all of this other stuff due in a clinical. And I'm supposed to focus on my three patients when I have papers and SOAP notes and everything else hanging over my head?

I left Essentials class last night really thinking about the politics of nursing. The fact that 1 in 4 women voters is a nurse, that is just astounding. We could have a lot of political power, as the biggest group of healthcare professionals in this country. And yet, we're too busy tearing each other down (or just surviving our day) to use that power.

By the way, I got in trouble twice in my med-surg lecture. The first time because the letter H came off of my keyboard and I was busy trying to re-attach it, and the second time because I pointed something out on my computer screen to a neighbor. Nevermind that it WAS about something to do with the lecture. Sheesh.

overworked and overwhelmed

Sometimes I think I really was crazy to take on this much work. I mean, two clinicals is a full job right there, and then there's real work and class assignments on top of it. There are moments when I think I don't even want to do this anymore, but I know it's not really that. It's just that I don't have a lot of time to take care of myself.

I have felt like a big loser this week. I missed my classes Monday because I wasn't back from Virginia yet. I did send my paper and stuff to a classmate to turn in, but still. My essentials class paper was due and I didn't do it, and I missed the quiz in there too. Then last night I slept through my karate class. And today I called in to my NICU clinical, which I also had to do Wednesday because I couldn't get time off of work.

And if you add it all up, Tuesday through Sunday I was scheduled for 62 hours of working on a floor. I really didn't think I could handle that. It's just... way way too much. So now I've got it down to 50 hours and I'm still worried about being able to handle it. And turn in a late paper. And study for a quiz. Am I superwoman? No. So I'm trying not to be really hard on myself. But it's harder than it would seem.

Sleep is my most precious commodity right now. And there's never enough of it to get me through. I don't know how people go and go on only 6 or 7 hours per night. I need at least 9 or I'm totally useless.

I hope next week is better.

thinking about critical thinking

I am really beginning to look forward to my essentials class. I dreaded it at first, quite intimidated by my professor, but I have come to see her as somewhat of a heroine to the profession of nursing, never backing down or averting her eyes when she sees something gone wrong. Sitting in her class, suddenly my whole liberal arts education starts to make sense. The whole point of being educated by way of a bachelor's degree, rather than an ADN, starts to flicker like a lightbulb, suddenly illuminating what was dark.

See, they were right when they told us that we could learn the technical skills anytime, that what we were here to learn how to be was a group of critical thinkers, team players, negotiators, managers, leaders, revolutionaries of a little-respected but desperately needed profession. And it was this that had almost entirely passed me by- but I get it now. And I want it, too. I was so consumed with how to set up an IV, how to pass the next test, how to please the grumpy instructor... I didn't understand what made our education any different than any other kind of nursing education, except its duration.

But I want it now. I see it as if I've gained a whole new pair of eyes... I want to be a leader in nursing. I'm not talking about being a charge nurse or a nurse managaer or whatever. Not that I won't do those things, but what I'm talking about is bigger than that. I want to be an instrument of change, however small, in the unit, in the hospital, and mostly to the profession of nursing in general.

We are the largest employed group of healthcare workers, we are the patient advocates, we are the last line of defense when everything has slipped through every other crack. We have the ability to see the patient as a whole, not just as a diagnosis. We are the center, the hub of the wheel that the patient's care spins around. And we are largely invisible for it. We turn on each other and we turn on ourselves. We eat our young. We gossip and we fight. We are regarded as trained robots made for carrying out doctor's orders. We are looked at as sex objects, as servants, as people who weren't smart enough to be doctors. We are a women-dominated profession, and like other women-dominated professions (teachers, for example) we are understaffed, overworked, undervalued, and underpaid for what we do.

The nursing shortage is coming, looming on the horizon and it's going to split our healthcare system down its middle, but the general population by large doesn't know or doesn't understand it at all, because they don't know or understand the role that nurses play in their healthcare.

Anyway, all of this stems from, in large part, this particular instructor's class. I spent the first few weeks whining that it wasn't fair that we had to go to class every week, instead of every other week like the other section, but I now see it as a privilege because by brute force this professor has shaken us up and made us think about the world we are entering in to, and the way we may contribute to its improvement or further its demise.

I've also been thinking a lot about what to do with my future in nursing. I'd like to work post-op in an abortion clinic, but not permanently. I'd also like to do midwifery in Nepal, contributing to some sort of women's health program. What the next few years hold for me, though, is a question mark. Work on the telemetry unit for more experience? Stay in the NICU and try to reach L&D as soon as possible? All will be revealed in time.

baby nursing

I did my first two clinicals at the NICU in a nearby hospital. I really don't like this hospital, not just because it's Catholic, but for a bunch of little reasons. Like the internet bans certain websites, like yahoo, because apparently we're to be babysat in our free time. It's just the whole attitude of the hospital, the feel of it, that I don't like I guess. I do like getting to wear the surgical scrubs, because it means I don't have to do my own laundry.

NICU nursing is fun. But sometimes I wonder if I'm really doing all that I'm capable of doing. I know that I'm capable of being compassionate towards those who may not be easy to deal with. But babies? Always easy to deal with. They don't argue with you, they can't fight you on anything. Not that it's not a noble job, I just have the feeling that I'm not making as much of a difference as I'm capable of making. Nevertheless, it's easy work, and enjoyable, and gives me a connection to labor and delivery. I saw my first vag delivery and it was amazing, truly amazing and I can't wait to be in that area. I am really interested in women's health, along with the baby's, so that's why I wouldn't stay in NICU.

I learn a lot in NICU though, since it is an ICU. I saw them put in a chest tube for pneumothorax, I see a lot of chest x-rays and abdominal x-rays, I am getting interested in rescusitation techniques.

My preceptor though... oh lordy. She is something else. She's always very sweet and pleasant, but she and I have two very different nursing styles. I asked her what she looks for in her student nurse, and she said organizational skills, remembering things after being shown just once, getting things done on time. I asked her 'what about critical thinking, initiative, leadership, things like that?' Her answer blew me away. She said she's more of a technical nurse, and although she admires people who can do critical thinking, she doesn't care about it. What???? Seriously? I mean, that's what separates nurses from medical assistants, right? That we don't just take orders, and get them done on time, but that we can think about what we're doing and understand the outcomes and effects of our actions. She doesn't care about critical thinking? Then she has no business being a nurse.

Not only that, but she likes things done about a half hour early. I'm sorry, but if I'm supposed to give a feeding at 5, I give the feeding at 5. Giving it at 4:30 just throws the whole thing off and makes the documentation wrong. Unless I use my critical thinking to prioritize care, and I have to give the feed a little early or maybe a little late, depending on other emerging factors.

I just don't think this preceptor really has her head on straight. She is really focused on little things like making sure the crash card is organized, organizing the employee schedule, things like that. Which is why she likes to be a charge nurse, she likes the busy work. Personally I think they should always make her charge nurse, since she seems to like that stuff, and let the other nurses who are better at critical thinking handle the patients.

The first day our baby weighed only half a kg, like 1 lb 1 oz, he was born at 24 weeks gestation. Incredibly small and fetus-like. I just thought... maybe we are playing god here, maybe we shouldn't be trying to keep this tiny little thing alive. Those are the thoughts in my head sometimes when I looked at him, but if it was my kid I'm sure I'd want us to try.

biting my tongue

Sometimes I'm ready to kill people at work. The other techs really try to baby me, I suppose because I'm new, but I just want to get rid of them already and just work. Today I made a mistake and gave someone NPO too many ice chips. Ok it happens, I didn't see it on the sheet. I documented it, I told someone, what else can I do? And then my 'preceptor' today, if you can call her that, went on and on and on about how terrible it was because the poor nurse got in trouble by the physician. So... what's the point in crying about it now? It's done. I don't need a long lecture about it. And when putting in a catheter, the 18 french wouldn't go in. She insisted on trying and grabbed the catheter. With unsterile gloves, she contaminated not only my sterile field but the actual tubing about to go inside the guy. And could she get it in? No. I've probably cathed about as many people as she has and I really don't need my hand being held, especially by someone who doesn't know what she's doing. Obviously. And then there's "did you get chem sticks done? Did you do vitals?" Yes mom. I did my homework and cleaned my room. Gawd.

God get me off of this orientation schedule please.

Then I heard a nurse yelling in another room "oh my god, I told my tech to get you out of bed, why didn't she do it???" How about asking me first before spouting off to the patient? He refused, actually, when I went in to do it so I did something else instead. Was I supposed to wrestle him out of bed and into the chair? Jeez you know? And she called me 'dahling' in her French accent all day, which was actually kind of funny.

And finally I've developed a small crush on a very gay-looking nurse and I sometimes, like at lunch, purposely sit near her, and sometimes I purposely avoid her. I guess work just isn't interesting enough without some entertainment.

getting used to things

I'm getting used to the routine at work. And I'm finding that the best plan of action, as far as socialization, is to make friends with the nurses. I could hardly care what the other techs think of me.

We had an accident victim who I've taken care of since she was admitted to our floor. She started out not being able to move or speak, but now she's able to get up to a chair and talk to us. Even so, today when we were alone she said to me "I'm not gonna make it." I said all of the normal stuff, 'you're doing great, you're going to get better, you're already so much better...' and she just shook her head sadly and said no. But after I talked to her for a while she put her hand on my cheek. It was just, one of 'those moments', those moments that make you feel like you're actually making a difference.

aaahhhh my feet

Thanks to new Nike Air walking shoes and a pair of ted hose, my feet are no longer killing me after work. Thank you god. And thank you grandma!!!

I'm now functioning as a tech independently. And as always, it's like walking a tight rope with all these other techs and nurses who talk talk talk about each other. I don't like to get involved in all of that he said she said crap.

come out come out wherever you are

Today a patient asked me if I was gay and I said yes, and she said she was too, and launched into a long story about her first partner dying in a car crash with their 10-year-old son, and having to come out to her parents that same day. And then she told me just to be happy, to never care about what others think about me because it's irrelevant. I nearly cried.

I like evening shifts SO much more than morning shifts. Seriously, I'm a much happier person later in the day. And it's not as crazy hectic in the evening, I even had time to check email and study for a minute.

learning about ECGs

My new hobby is trying to learn how to read ECGs. It's not coming naturally to me, let me tell you that. But at least I can pick out the really deadly patterns, like V tach.

By the way, what on earth is the difference between cardioversion and defibrillation? Especially if both are synchronized?

more clinicals

I went to the NICU and met with my preceptor. She seems ok but secretly I'm not crazy about her. But I will do my best and hopefully it'll be fine. She works all 12s and hopefully I'll be able to squeeze in enough of them to get close 100 hours. I guess that would be 8.

Also, I'm getting pretty good at the tech thing on the cardio/thoracic unit. I had a really fun preceptor the other day which made the day go by. It's just answering the lights, I/Os, vitals, and baths. Oh and bedmaking, which I really hate. Anyway I think I'll like the job so that's what's important. Oh, and the money!

My feet were really killing me though. I hear the secret is embolic hose, so I will try to get some of those, and better shoes. When I actually have money, of course.

getting started

Yesterday was my first clinical on the ortho/trauma unit. We shadowed a nurse and got familiar with the unit, but we didn't have our own patients. The unit is super-friendly towards students and I felt really welcome there. My nurse even *gasp* washed her hands before and after every patient! Miracle of miracles. My clinical instructor, who is also the lecturer, is very reasonable as well. I think I will enjoy this one.

I am terrified of my Essentials professor. She really can make us squirm in our chairs and doesn't mind doing it. I spend the whole class period frantically trying to think of an answer she'll approve of, rather than the real answer. For this clinical I was placed in NICU at the hospital I did my OB rotation in before. So at least I've been to that unit and enjoyed it. I was jealous that a few other people got L&D though... why not me? Anyway my preceptor works three 12s a week and she's going to be off for 10 days, which does not bode well for me and getting all my hours in.

And lastly, my first day on the cardio/thoracic floor was supposed to be today (this is the only place I actually get paid) but once there I had the chills and started vomiting. So they sent me home. Honestly, how embarrassing. Let's hope tomorrow goes better shall we?

level four nursing

So after a long hiatus it is back to the grind. I am now a level four nursing student, as well as a new tech on a cardio thoracic floor. I have a med-surg clinical on an ortho-trauma floor and another clinical that hasn't been assigned yet, but my request was for 1) Labor/Delivery 2)Postpartum or 3)NICU. So in any case I'm hoping to be around babies and do something a little different than on my other two sites.

And exactly how I'm going to manage two classes, two clinicals, and work? I don't know. Because I'm supposed to work 32 hours at the hospital, the med-surg clinical 8 hours a week, and the other clinical 100 hours before the semester's end. That's 12.5 hours per week. Add 2 karate classes, and things like eating, bathing, and sleeping, and that's pretty much going to be my life. I'm already bumming about having to cut down on my karate by one day.

So far I have just been in central nursing orientation at the hospital. It's the same orientation I went through as a nursing extern, so needless to say I'm quite bored. AND I had to take yet another CPR course. It was through the hospital, but the one I had through Red Cross was much better. In fact one nurse failed the hospital one, she missed 7 questions. If you haven't been certified recently through somewhere else, I think this two hour mini review would be inadequate for anyone.

I've met a few nice people, including some new nurses who will be on my floor. That's nice because I've heard a few really scary things from someone in my clinical who works there too. Like, the nurses abuse the aides and take advantage of them, they never schedule her for hours, etc. I'm just hoping it's different for me.

From now on I'll probably be venting in here a lot, so as not to bore readers of my regular 'touchy feely' journal to death with medical details. Anyway, I think this is really going to be the semester that makes me into a 'real' nurse. It's really going to push me to grow and challenge me to learn as much as I can.

ICU not for me

Today I spent the day in an ICU, the one with the highest mortality rate in the hospital rate actually. It took only an hour for me to decide that I don't want to end up in an ICU. This shocked the ICU nurses, who I must say, really really love the kind of nurses they are. But me- my favorite part of nursing is interacting with the patient, teaching them, getting feedback from them... on this unit, patients are hovering near death, the nurse is keeping them alive through brute force. The nurses seem jaded to the suffering, the pain of the family. They keep their patients heavily sedated and on lots of pain pills, which is the only humane thing to do, but I felt that the nursing in this situation was much different. Technical skills are of the utmost importance as the nurse must sometimes balance ten to twelve drips, ventilators, dialysis machines, etc. Nurses also have more independence, and the docs who come around depend on their opinion and expertise.

What they do is amazing, and I have nothing but respect for it, but I don't want to spend my life in that kind of nursing. If I did end of life care, I would want to be in hospice, helping people who have made the decision to die do so as comfortably as possible. In the ICU there is a desperation, the feeling that these patients should not be here, like this, they are gone from the process and now it is the health care team operating their body and the family praying praying praying for them to pull through.

So anyway, the other nurses simply couldn't understand why I would want to be any other kind of nurse. To them, OBS unit sounds dreadfully boring. If they have to answer a call light they think it's time for more sedation. They said to me 'oh you're one of those people who like to talk to their patients'. They said they didn't think they could teach patients. It was just very different. I thought of my old boss and her love for people. I felt proud that I think I'm just like her.

this one's a keeper

My patient today was so sweet. She spoke a little English, was from Hong Kong, and told me repeatedly I was "so beautiful". I was like hey, that's nice, we'll keep you. She also kept telling me I was very smart and very kind. I wish we had more patients like that! It was a busy, busy day and I was very glad because that meant that the time flew by.

I ran into another extern on the way to my car. We chit chatted about how much we've learned and where we'll work when we finish. That was good for me, to touch base with someone else in my shoes.

I've applied to several jobs at this hospital, hopefully I will hear from them before I leave for overseas. If not, well, I will find something to pay the bills when I get back.

funny things I've done

1. Retrieved a wheelchair for a discharged patient... except the wheelchair I grabbed was not a hospital wheelchair, but a personal wheelchair that someone had parked nearby!

2. Spilled Morphine, twice. All because I end up in a fighting match with the carpujets and always lose.

3. Let an IV run out onto the floor. I was wondering why it sounded like there was a fountain running in the room...

4. Wondered how on earth to retrieve a retracted penis so that I could hold it up for catheterization. I have done many females, this was my first time with a male and they sent me in there on my own. Once I got it in, it just kept going and going. I thought, well, this is unpleasant.

5. Thrown away countless carpujets because I thought they were disposable. Guess what, they're not.

6. Injected air SubQ because I forgot to prime the heparin carpujet. No one knows this but me. (And now all of you.)

7. Asked many, many times if a patient wanted something for pain, and they had to remind me that they had a PCA. Oops... oh yeah!

8. Searched all over for an incision site when the procedure required none.

I'm sure there was more but that's all I can think of right now. Could be worse, right?

days gone by

I know I have been lax about this particular blog. The Observation Unit is not really the most exciting place to be. We had a really slow week last week in which I discovered Jigsaw.com and tetris online. I've also been reading a lot at work. But really I have improved drastically on med administration and admin/discharge procedures. I'm pretty much independent now.

Today I had a 17 year old patient because the children's hospital was full. She was glad to have me, as the other nurses were a bit stodgy. For example, I told her sister to go ahead and use the other bay's bed, and the older nurse had a fit. Oh well! She was a funny girl: wanted a picture of her in the hospital bed on myspace, and wanted to take the hospital gown home with her. Sure, I said, just stuff it in your bag. She was a good one but I've had a couple patients who I really wanted to smack. This is why I should be working with old people! I have the patience of the gods with them, but for crabby adults I have none.

Every now and again I sleep over at the hospital and stumble back in at 7am with sleep still in my eyes. Only two more weeks of this day-in-day-out kind of work schedule.

I'm now on a quest to get a job with the hospital after I return from Nepal. I need one, as of right now the money sitting in my bank account has to last me indefinitely.

the long haul

I did my first 12 hour shift on Wednesday. Wow, I was really tired by the time it was over, especially because I spent the night at Laxmi's and slept so lightly. But it was good- my first patient was receiving blood. That was a good experience for me. But my preceptor had a drug seeker... she yelled and swore and had the whole place in an uproar for a while. Finally, she agreed to be discharged. I thought we might get to pull the secret 'yellow card' out, but no.

Today I was going to work 7-3 but my preceptors weren't there and I didn't want to work with Sandy because she looks mean and grumpy. No thanks, it's hard enough being new without someone totally annoyed with you on top of everything.

During my half hour break, I went outside. It was 88 degrees, but I would never have known what it was like outside from the unit as there are no windows. I sat out in the 'garden' area and read. That was nice but over top soon. I felt like I wanted to sleep, but I was afraid a nap would make me sleepier than before.

My preceptor, J, is nice. One good thing is that the preceptors volunteered for this, so they aren't annoyed with having a student.

here we go again

My first day on the floor at the observation unit went pretty smoothly. In fact, my preceptor and I didn't even get a patient for the first four hours. We showed me around a little, we chit-chatted, checked email, etc. Not thrilling exactly but I guess I could be complaining about working my ass off on the first day instead.

I have two preceptors and they both seem very nice. For the most part, we worked out my schedule and it's ok I guess. Some Saturdays afterall, but not all of them. I think working 40 hours is going to take quite a bit of getting used to though. And by the time I'm used to it, I'll be done!

So both of my patients today were thyroidectomies. I learned the ins and outs of admitting, documenting, and assessing for this unit. I think I will enjoy it.

a few weeks gone by

Well a few weeks have passed and I'm happy to report that my Med-surg professor bumped my C+ up to a B-. I love her even more.

I've started my externship, or at least completed one week of orientation. The coordinators are very nice and my preceptor also seemed nice. I start actually working the floor Monday morning, so until then there isn't too much to say. Except that when I had to poke my own finger to demonstrate that I knew how to use the glucometers, I whined like a baby. That hurts! It left a bruise on my finger for 2 days!

The best news is that my unit, the Observation Unit, doesn't operate on weekends, holidays, or overnight. I'm basically on the best unit one could be on, as far as schedules go. I will write about the unit on Monday.

ends and beginnings

My level 3 year is finally finished. I didn't do as well on my finals as I'd hoped. Especially in Med-surg where I only got an 80, and needed a good A on the test for a B in the class. It looks like now it may be a C+. I got A-s in both clinicals though and I was happy with that.

At least it's all over with. Now I can turn my mind to the nursing externship, and all of the nervousness that goes along with that. Today is my last day at my old job. From now on when I say work, I will mean nursing work.

criminal activities

Monday I went to work happily looking forward to my 11 days off afterward. However, it was not to be, because it was discovered that one of my co-workers, a full-timer, has been helping her self to a few residents' vicodin, and leaving a clear trail for the nurses to follow. Needless to say, she was fired the next day and the nurses were left kissing everyone else's ass, including mine. So ok, I volunteered to work today and tomorrow for them, but I'm not terribly happy about it. I will be making call-in pay though, so I guess I will have to let that comfort me. Plus the good-esteem of future work references.

Tuesday we all had breakfast together, with our instructor at this cute little diner near the hospital. It wasn't too bad. She is a total crab during clinical but ok outside of it. Plus, she gave me my grade: An A-, and 'good job' comment to boot. Didn't see that coming! So I was feeling a little friendlier towards her as well.

So this weekend is study-for-finals marathon weekend. I can't wait to get this semester over with!

classes with the kiddies

My last psych clinical was a joke. I literally surfed the web for Nepali websites. I also read a bit about Borderline Personality Disorder, if that counts as 'work'. And I finished my last assignment for the clinical.

Wednesday my friend and I were sitting in Med-surg, rolling our eyes over the gaggle of girls in the front row squealing and giggling over a picture of something pornographic on someone's cell phone. I don't get it... don't they have cable? Haven't they seen naked people before?

Tomorrow morning is my only ATI test for the semester, in psych. These are computerized multiple choice tests that are supposed to measure our level of skill in different areas. Really, they measure how well the school of nursing is teaching us. Oh, and we have to pay almost $50 per test.

the end is in sight

Yesterday was my last day on the floor in my med-surg clinical. My instructor was even crabbier than usual but luckily not to me. How could she have been? I did nothing all day! Patient #1 was NPO and patient #2 went out to X-ray. Boring, very boring. I spent most of the day wandering around, reading my Nepali book when my instructor wasn't around, pestering the floor nurses with questions, or visiting the medical library to check my email.

Yesterday I forgot about meeting with my psych group. I feel terrible!!! We are doing a presentation on some sort of treatment for depression using magnets. I just forgot about them. I did write it down... just didn't remember to look at my planner. Brilliant, isn't it?

see new things

This morning I had to get up very early to go and see ECT. My lecture professor was there, that lunatic, she tried to quiz me on things and took me down to ECT herself. When I saw my clinical instructor I practically ran to her, like "save me! save me!" I was observing with some med students, I'm guessing first year students because they didn't seem to know much at all and they didn't seem to have a clue who I was. At first they assumed I was a med student, until I said I was a third year. Then they just got confused. My instructors always poo-poo the med students, roll their eyes at them, and dismiss them completely. I think I'm developing the same attitude.

Anyway, watching a seizure induction was interesting and the doctor had a habit of explaining everything to us, as well as quizzing us regularly. I enjoyed looking at the EKG strips. Still, it was still a little startling to watch the pt's body reactions. They are supposedly paralyzed except for one foot, but the anesthesia produces body movements that look like a seizure.

I forgot to mention that on Tuesday I watched a PICC line placed for the first time. It was a very difficult placement because the patient's arm was so swollen. They tried to place it in three different veins, I can't even remember which one ended up working. The cool thing was watching them find the vein and place the needle on the ultrasound. I held the patient's hand the whole time, not just to keep her from going over the sterile field but also because the lidocaine they used on her arm stung her every time. The amount of blood coming out, however, resulted in me gripping her hand instead.

Today we had our GI lecture in medsurg, and it always makes me laugh at how interesting nurses and nursing students always find bowels and stools. I think we could've talked about it forever.

back to norms

Today's medsurg clinical was a flop for me. I could just do nothing right in my instructor's eyes. And then, afterwards, she heard that I have an externship and said "why, do you want to work at that hospital?" Like it's the worst possible choice of hospitals, and not one of the best in the country. I said yes, and I want to get into their grad program there to be a nurse-midwife. She said 'oh I used to want to be a nurse-midwife. Where are going to get a job? Have you thought about that? There aren't many nurse-midwife jobs around here.' Fine. Dash all of my hopes and dreams. She's not even accurate, maybe nurse-midwives didn't have a big job market in the 70s when she was getting started, but I've seen a ton of job openings at the hospitals around here. OOOOHHHH she pisses me off!

Everything about that clinical just makes me mad. Only one more, and then in two weeks we are meeting and 'going out for breakfast'. That's great, much better than clinical, but why am I being forced to socialize with her? I'd much rather sleep in.

Tomorrow morning it's up at 6:30am, drive to the hospital, search out parking, watch ECT for a half hour, and come home and go back to bed. What a waste of time! I'm so, so ready for this semester to be over.

nearing the end

I finally finished my research paper, yes almost three weeks late. 'The Confusion about Nipple Confusion'. And it is just that... a bunch of confusion. Health professionals can't seem to agree on whether or not it exists, thus my paper.

Clinical today was fine, for me anyway. I guess it was someone else's turn to get picked on. Except for the massive loose stool in the bedpan that smelled like death itself. So gross, so gross. I kept thinking 'where the HELL is my aide????'

I score again

My research exam ended up a 93, although I thought for sure it was going to be worse because I wasn't sure about a lot of the questions. In fact, I'd say at least 11 questions had nothing to do with any of the material I studied, but I just happened to know the answer or guess right. At the end of the exam my professor said to me, "You haven't been to class much lately, have you?" I said, "I only missed last week, and you were gone the week before." She said, "oh, I guess you're just so small I didn't notice you." Gee, thanks.

I also got an A on all of my mind maps, which is 10% of my grade. Now if I could just finish that paper that's 8 days late... at least it's only worth 10 points.

Also, in medsurg the BSN coordinators really pissed everyone off by deciding that from next semester on they will be assigning everyone's classes. As in we don't get to choose which classes to register for anymore. Hello, high school! Then they passed out our class assignments for next fall and winter. There were a whole lot of unhappy people, let me tell you. I was given Community Health Nursing and Nursing Essentials in the fall, and Medsurg Nursing II in the winter. I had originally planned to do community in the winter and Medsurg in the fall, but I guess it's ok. The important thing is doing my Essentials class in the fall because it's 100 hours of nursing on the floor with a preceptor. And I'm praying to get an L&D placement.

another day of blah blah blah

Today my two patients were completely easy. Only one minor blip on the radar when a blood sugar dipped below 60. And of course, my instructor tried to blame me for it. She said it had to do with me not giving him Renagel as he was eating his lunch, instead of right after. Now, Renagel is for decreasing phosphate levels in end stage renal disease, I have yet to figure out how it affects blood sugar. But I will be researching it so stay tuned! I'm pretty much convinced she was just looking for a way to blame me, but I will give her the(very small) benefit of the doubt and research it. Bah. She is always so grumpy.

Also the nurse manager complained that we weren't answering call lights. Well, what actually happened is that a bathroom light was on, I answered it, didn't turn the light off, but got the student nurse to go in there to collect a stool specimen. I told the nurse manager that that was why the light was on. But she still went and carried on to our instructor who had a fit about it later. Jeez. I should've turned off the light from the start: lesson learned.

Otherwise my day was so easy that I took my half hour lunch break. I didn't eat lunch, I went to the big lounge on the ground floor and napped. Then I got some homework done while I was there. Jeesh.

researching research

This week is devoted to my research class. I must turn in my paper, study for the test, and do about 4 mindmaps. Bah! I hate this class. And our professor... don't even get me started! She is so snappy. As if all of this crap isn't hard enough. This must be the most boring and pointless class ever... ok maybe not pointless, because knowing how to get information is always important, but still! A few classes or projects could probably do the trick.

I was pretty useless at my psych clinical last night. My patient was an 11 year old whose dad beats her. And her problem is anger control. Well, yeah! I'd be pretty freakin' mad if I was getting beat by my dad and my mom could care less. I didn't even really interview her. I only have one interpersonal recall left and all of my mental status assessments are done. I went into the resource room and read some books. Whatever. I just want this semester to be over. Maybe my senioritis is starting in, or maybe it's just wanting to move on to new things.

Whoo!

I got a 90 on the test in the med-surg class I was failing. I say 'was', people! Go me! I might actually get a B in this class.

rotting flesh

This morning one of my patients needed a dressing change for a stage 4 pressure ulcer over sacroiliac prominence. She was very obese, and it took five of us to do it. Imagine our horror when we peeled off the dressing and discovered not only a 5-6 in deep crater over her entire backside, but that the wounds were completely filled with stool and necrotic tissue. Some genius dressed the wound over the rectum.

I have never seen such a pressure ulcer in my life. Even once we cleaned the stool out, my cat could have fit into the crater. The smell of necrotic tissue and gangrene was overwhelming, her roommate started to complain. The worst part is that she is only 62, A&Ox1, and on Hospice. So sad. I have a tough stomach, and normally I like wounds, blood, gore... but this was a bit much even for me.

I think I did really well today with my organization. Besides that dressing change, I had a PEG tube, blood sugars/insulins, and IV meds. I love having two patients though, the time flies by.

our own little worlds

Tonight at my psych clinical my patient, a 10-year-old boy, told me about the private world he slips into as he twirls his baton. In this world everything is wonderful, he meets celebrities, he gets along with his brother, etc. Without the baton, he can't slip into that world and he experiences great anxiety. He twirls the thing all day long. I chose to work with him because I think I totally get it... the magic baton, the portal into a world far better than this one will ever be.

Interesting point that a nurse made today: Her patient claims to be hearing the voice of God. She says she is religious and believes that God speaks to people, and yet at what point does this become an "auditory hallucination"? Good question. I mean, if you claim to really believe that God speaks to people, that he commands them to do sometimes very irrational things, that he impregnates virgins... how do you become a psych nurse? Here you are, drugging up all of God's potential messiahs, calling their visions hallucinations, calling their claim of connectedness to God grandiousity. If Christianity requires blind faith in the illogical, belief in prophets and messengers, and acceptance of scientifically impossible stories of virgin births and visions of the appocolypse... I would say get thee out of psych nursing because it sure seems like a conflict of belief and practice to me.

I must choose between my medsurg test and my research paper, considering the remaining time I have this week. Medsurg test wins out, so I will just take the late points on my paper. Priorities, priorities, and aren't they always telling us to have realistic goals?

it really is rocket science

Why does financial aid have to be so hard? Every semester I go through this. This year it's even worse. Now it's my mother who has to have her credit checked, for some unknown reason. The things that Sallie Mae and your 'educational institution' require of us... I don't ask, I just do it. But it makes about as much sense to me as if they told me to eat a banana while doing a headstand. Ok... I'll try. So I'm still waiting for financial aid to come through for last semester, let alone this one.

I talked to my med-surg instructor today. She has to be the nicest, most reasonable instructor I've ever had and here I am practically failing her class! I am determined to better on the next test, which I told her, which means I'd better do better. I have a paper due on Wednesday as well, and with my crazy (and in my opinion, stupid) work schedule this week, it's going to be quite difficult. On the other hand, if they get mad at me for studying... oh well! I'm leaving in April!!! Goodbye boring, old job of 3 1/2 years. It's been real and I'm soooo ready to go to a "real" medical institution. Or at least a place where everyone isn't out to get me because I'm one of those "smart, book-reading, ej-ucated" people. You can keep your assisted living and your politics, I'm moving on to bigger and better problems.

Tomorrow my goal is just to wake up early enough to study a little. I did buy some groceries today so that is something remarkable. And the cats are having a party because I changed their litter. Blame it on nursing school that I've become such a slacker with the housework!

welcome to my life

Welcome to the life of a nursing student! Yes it is my life, it has taken over my life. My semester has been even crazier than usual. I didn't think it was possible, but life always proves you wrong. Today I was forced to end my sessions with my personal trainer, to conserve energy for studying. This is because I failed my first test in med-surg and must, must, must do better next wednesday on the second test!

Yesterday was the first time I had two patients in medsurg, and I enjoyed being busier. The time went by faster, at least. It was my first time with a patient with a PEG tube. My instructor came in with me the first time, but she tends to impatiently do everything too fast without explaining. So the second time I went in with a crushed Prevacid and Plavix for the tube, I drew up the residual. No residual... hmmm, strange, I thought. But maybe not strange, I'm not so sure if there's supposed to be residual or not. So I went back to the diluted meds, tried to suck it up into the syringe... Nothing is going in! Why, you ask? Well, because I had left the syringe cap on. So I took it off, checked the residual again (10 cc this time), drew up the diluted meds, put it in, took the syringe out and... gush, fluid all over the place! No, I wasn't supposed to clamp it, he was on a continual feed. The answer was simple: Gravity. I should have held the tube up high, instead of down low where everything in the stomach would flow out through the tube.

Live and learn.

I wish that instructor wasn't so crabby. I overheard her telling a nurse that she knows she's being harsh to us, but she's "having a helluva day, and everyone else should too". Geesh. She even made me feel nervous giving insulin, which I do all the time at work.

Here I am in my research class, 'watching a video'. What would I do without my laptop???