Tuesday, October 30, 2007

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.

Thursday, October 25, 2007

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.

Monday, October 15, 2007

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.

Sunday, October 14, 2007

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.

Saturday, October 6, 2007

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.

Friday, October 5, 2007

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.