Beginning of the End of the Beginning

Yesterday was my first day of the last semester of nursing school. I got to reconnect with some old friends who dropped out two semesters ago, returning with a year of PCA experience under their belts. I got to look around the cramped lecture space to see who made it and who didn't. Attrition this semester seems lower than in the previous semesters. It's the point of no return, I suppose, with only one semester left you might as well just finish.

My clinical cohort is starting with acute psych. After an orientation day on Monday, we'll do 3 weeks of client contacts at a large inpatient psychiatric facility. I think my favorite part of this will be not having to wear the rediculous uniforms they issue us. From what I hear, we'll rotate through geriatric, forensic and peds/adolescents. We won't be passing meds or applying treatments, but we'll be doing assessments, which is always a good time.

Many of my classmates are nervous about psych because they don't feel safe and don't feel that they can reasonably predict the clients' behavior. Others are anxious about it because psychiatric diagnoses give them the heebie-jeebies. I'm looking forward to the psych rotation, I've always found the population interesting. I found working with adults with mental retardation and autism very rewarding in the Unlicensed role, and I think I'd be pretty good at psych nursing. Most of the day's activities were centered around alleviating my classmate's anxiety about psych by playing videos and being spoken to in a generally soothing manner. Then, there was the Show.

At the end of the day, we had a theater group come in to do a series of skits about living with mental illness. I took along a pre-nursing student I'm more than a little sweet on. I didn't know what to expect, at first. From what I heard about them I was expecting adults with MR, maybe that's because that's where my experience lies. The troupe was made up exclusively of adults who have been diagnosed with psychiatric disorders. Most had been hospitalized, most were currently on medication, all were in recovery and had symptoms managed well enough to travel and perform throughout our region. The skits they did were hilarious, touching on subjects like guilt, denial and substance abuse. They sat on stage afterward and answered our questions about their diagnoses and their experiences with the health care system. When asked what aspects of nursing care benefited them the most, the things that came up again and again were respect, listening, and support. We watched a video they produced called "All Better", in which a gentleman with schizophrenia is declared "all better" by his case worker and ejected into the workforce after over a decade of institutionalization. The fact that these plays, musicals and stories were constructed start-to-finish by people with psych Dxs is encouraging and empowering. Although I realize this will narrow down the possibilities concerning my geographical location, I was impressed enough with these people to link to them. http://www.artreachheals.org/. If this sort of thing appeals to you, gentle reader, visit http://www.autistics.org/. There you'll find some powerful writings from people with Autism.

Although I enjoy this population and think I'd be good at psych nursing (probably because I identify with them, having been an inpatient once myself as an adolescent, and still exhibit a lot of the characteristics of asperger's), it's not presently compatible with my intermediate range goals. Maybe some day in the future I'll give psych a whirl, but for now the plan is still to build assessment skills on the general units, maybe dabble in hemodialysis, and eventually get into ED/ICU while going for my Family NP. There are plenty of other things I think I would enjoy doing, like Home Care, but I want to avoid becoming too specialized too early on, and I want to preserve the technical skill I've nurtured so far in school.

Speaking of, the following Friday is my orientation day for acute medical/surgical. I'm pretty excited about this, if a little anxious. I've heard fantastic things about my new clinical instructor, and she's also one of the course coordinators for my last semester. It's an evening shift, which is more compatible with my sleep schedule. The IV pump situation is kind of funny, actually. First semester, I learned how to operate a volumetric pump, but didn't have any opportunities to apply this knowledge. Second semester I was in a hospital that was almost exclusively gravity drip. Third semester I was in that same hospital, but having to figure out on-the-fly how to use ancient peristaltic pumps that we didn't have mock-ups of in the Lab. Now, for my last semester, I'm going back to the volumetric pump. I stopped by the lab and had one of the tutors run me through the pump's operation, just to be sure I got it.

This semester we're also doing a "trends in nursing" class, mostly online, with three seminar days in the lecture hall. In the past this class has involved an lengthy paper, but the paper has been dropped from the syllabus. I'm somewhat cynical about this, it seems as though we're being let off the hook. Most of my classmates are relieved, but I'm annoyed. I just hate it when things get dumbed down. Anyway, this class will involve coming up with 150-200 word responses to questions on the online class' message board. The sample question put up on the screen during orientation was something to the effect of

"given the definition of leadership in the text, what aspects of leadership are most important to you and why?"

We were then told that we had to support our answers with APA style citations. My hand immediately shot up.

"What sources can we use to answer questions that are asking us for our personal opinion of something?" I said, or something to that effect.

The instructor smoothly answered that we could use nursing journals, interviews with nurses, or nursing blogs, to name a few options.

My hand shot up again.

"Can I cite my own nursing blog?"

This stumped them, they all exchanged glances before the first instructor explained that I could, if the content was appropriate, nursing related, and universally accessable.

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