1.05.2008

The story so far...

Hello, I'm PM. I'm a student nurse. I can't tell you where, exactly, for fear of retribution by overzealous administrative types. It's funny, how this reverse-pressure impacts blogging about health care. On the one hand, of course, we have to protect our clients identities. On the other, free exchange of information is vital to the advancement of learning. Even with the proper precautions taken, administrators are likely to object with the purpose of exerting tight control over PR. This sort of counter-current adds a delightful sense of prurience to the whole endeavor, in the same way cultural taboos concerning sexuality lead to increased "kinkiness". I decided to start blogging about my experiences in Nursing largely thanks to TS (other people's emergencies) , whose blog I found on one of the social bookmarking sites (maybe digg or reddit...metafilter? Yeah, that one). A friend of mine is almost through with Paramedic school, and a combination of that and reading TS's blog has me itching to get into an RN to EMT-P bridge program concurrently with graduate school.

I'm about 5 months away from taking the NCLEX and receiving an RN license, along with an associates degree from a community college. Our nursing program has less than 100 people in each of its two classes. I'd estimate our attrition rate to be about 10% per semester, for various reasons including grades, clinical performance, horizontal violence and personal issues. Our ADN program includes many more hours at the bedside than the 4-year university programs. While their students spend the state minimum required hours at the bedside, the students in our program get that many in their first semester, and more than that every semester following. After completing three semesters, I've spent over 350 hours at the bedside in settings that include a small private hospital, a large community hospital, a military ambulatory care center and an antepartal care center. The units I've seen include Medical/Surgical, Orthopedics, Neurology, Hemodialysis, Pediatrics, Telemetry, Coronary Care, Labor/Delivery/Postpartum/Recovery, Neonatal Intensive Care, Emergency, Operating Room, Post-Anesthesia Care and Respiratory. Some were full-on clinical experiences as a nurse (most in terms of hours), most were observation experiences where we're relegated to shadowing and assisting. Not bad for a 2-year program, eh?

Truthfully, I've taken 4 years to get this far. I started out as a Computer Science Engineering student, but that didn't work out so well (spent more time playing trombone in the marching/womens basketball pep band than I did coding software). After failing out of the program twice, I spent a few wasted years at Radioshack, hawking cellphones and satellite dishes at the behest of my corporate overlords. After that, a friend got me a job doing direct care at a group home for the developmentally disabled. That was a blast, and was largely responsible for the path I'm set on now. The clients were all interesting, with multiple diagnoses (out of four, all were autistic, all but one was mentally retarded, none of them that were mentally retarded were to the same degree, none of them were functionally verbal, one of them could sign, all had multiple target behaviors, two had to be restrained routinely), and the nurse who taught us how to administer medication told us that if we liked this line of work, and were good at math and science, we should get nursing licenses and make 5 times the money. Made sense to me! Still does. Unfortunately, that place of employment had some abusive people working for them, and as is the case much of the time when you rock the boat, you get pushed out.

That's when I went back to school and started tending bar. Another fun job, with many similarities to nursing (Administer dangerous substances, evaluate the response, titrate the dosage, provide therapeutic communication, etc). Slightly gunshy about returning to school, I took the general education requirements slowly. The first time I took the nursing entrance exam, I scored in the 99th percentile in all of the real subjects (math, reading, etc), but only in the 60-something'th percentile on the personality test. Since they only took the lowest score, it was back to the drawing board for a year. This actually worked to my advantage, since by the time I was accepted into the nursing program, I had completed all of my co-required courses, leaving me with just the core nursing program to complete. Unfortunately, there was no alternative but to take those courses one semester at a time (no summer sessions), so here I am, three-and-a-half semesters into getting an associates degree.

I've often said I'd like to make a video series in the cinema verite style (think Cops, reality TV, etc) chronicling the multi-faceted weirdness inherent in nursing school, at least in the time and place I've attended so far. Even the faux-documentary style of "The Office" or "Trailerpark Boys" would suffice (and would probably be easier to work out for privacy reasons). There were plenty of experiences on the unit, at the post-clinical conferences, and in the hallways and construction sites that would accommodate us between classes that would have been worthy of recording. Actually, I did record a snippet of one of our assessment labs at the beginning of last semester. It was held in the auditorium due to the mass chaos of construction and renovation.



I intended to record many more videos of this nature, but found my motivation lacking for a number of reasons. The Anatomy and Physiology class I took in the year preceding the nursing program was a life-changing experience. I recorded each lecture obsessively. The instructor had a marvelous non-linear way of describing all of the systems of the body in a way that made it obvious how seemingly unrelated systems are interdependent. We jumped from chapter to chapter of our textbook in a way that might have seemed random and arbitrary if it wasn't prescribed by a syllabus that related all the concepts to each other logically. The degree to which I've been successful in the nursing program so far is largely thanks to that class.

After that experience, the nursing program has been pretty anticlimactic. The clinical part has been amazing, and every faculty member I've seen in the clinical environment has been an amazing teacher. Lectures, unfortunately, are another story. Power-point slide-shows are not an effective way of imparting information. Period. There's evidence to back this up, I'm too lazy to link to it right now. The actual academics involved in this have been insultingly easy. There wasn't really anything that I -wanted- to record until the second year, and even then the times were few and far between (basically, any time the faculty started just talking without referring to powerpoint outlines or slides). The lectures only served as outlines for previously completed reading, but no one reads beforehand so I'm always stuck answering the questions that are asked in class (most of the time I didn't do the reading either, but since I was listening to them instead of taking notes I was able to remember what they said 30 seconds ago and put the information in context, while they were just recording it in the hopes it will make sense to them later). My classmates hate this. A lot.

I started off being well-liked by my classmates but loathed by my instructors, who saw me as detached and arrogant because I never took notes in their class. After explaining to a few of them that I never take notes, preferring to focus my attention on the lecturer instead, most of them warmed up to me, especially after taking over as President of the Student Nurses Association. Here's a protip for those of you just starting out. A good way to win over faculty is to get involved. Donate your time. Besides the pragmatic effects of currying favor, it's a good thing to do anyway. Get out there and network, meet people from the professional organizations and state councils. Even if you're not planning on sticking around in that area, it's a valuable experience. Just studying the material can only get you so far. If you really get involved in the profession, you'll increase your interest, which will make it easier to retain information. Trust me, it works. Spending a couple hours with your local state league for nursing or board of nursing educators is worth a dozen hours sitting in a room reading a book. Conversely, don't date one of your classmates if they're emotionally labile. Enough said.

The second half of nursing school saw a complete reversal of the social profile. I walked on water as far as the faculty were concerned, but my friends among my classmates were few and far between. Can't please everyone, I suppose. My classmates are an interesting bunch, probably a typical profile of nursing students at a community college. Only having been in one class I can't say for sure. They range in age from 18 to the 60s. Some have degrees in microbiology, psychology, sociology, there was even a fellow engineering refugee. Some had never had a full time job, some were on their 3rd or 4th career. Some have children. Some have grandchildren. The usual Nursing stereotypes were in effect, however. Only about 10% of us are male (maybe less now, but that's still double the average), probably that same percentage are non-white, and the average age is probably somewhere between 30 and 40.

As I started to find ways to incorporate skills I acquired in the past through bartending, engineering, selling, trombone, shamanism and dozens of other seemingly unrelated life experiences, I began to marvel at how nursing may be the one discipline that is the "universal recipient" of past experience (perhaps a "universal donor" as well?). One of my classmates who came to nursing from 20+ years in construction brought with her proficiency in organizing a team and delegating responsibility. Another classmate with a full careers worth of sales experience brought with her proficiency in customer service and expectation management. Students with BSs in Bio, Chem, Micro, even Psych come with a head-start on some of the concepts. The former LPNs and CNAs were able to take to clinicals like a duck to water, while the rest of us were trying to figure out how to change the sheets. Even a cashier with no post-secondary education can be a wiz at metrology (calculation of medication dosages). Sadly, many of these people were too hung up on taking on a new role to see that the role, to an extent, can meet them halfway.

My biggest sources of frustration in attempting to acclimate to this new culture are what seem to be severe deficits in information literacy and critical thinking skills in many of my peers and betters. I've taken for granted for many years now that the way most of us have been educated is a way of making sure we don't get TOO smart. See "Dumbing us Down - The Hidden Agenda of Compulsory Education"
for more information. We also have some tools at our disposal to make learning easier, but if even the faculty are deriding them as useless and not using them, how can we expect the students to? Even the limited degree to which it's been implemented represents a major hardship to most of the class (all that "reading" and "clicking"..gosh). I dislike the courseware we're given to use (criminally bad user interface design, buggy infrastructure, sloppy construction), but it's worse than useless if no one's using it. I find myself among a group of people to whom email, message forums and blogging are alien concepts. The limiting factors, I've found, are typing speed and reading speed. Hardly any of these people are readers, or if they do read they read things that aren't very challenging. Additionally, few of them can touch type, and hardly any of them are comfortable using computers.

This makes me slightly nervous for the future of the profession. Things are only going to continue to change more and more rapidly, and without information literacy, lots of people are going to be left in the dust, either as Nurse Technicians, or worse still, leaving the practice entirely. Without information literacy, home-brewed computer applications for keeping track of medication administration and charting can potentially cause more errors than they prevent. Worse of all, without information literacy, people tend to rely on "tribal knowledge" and word of mouth, since it's radically easier for them than keeping current with publications and journals.

This was a lesson that got drilled into me in clinicals..don't take anyone's word for anything. I asked my co-assigned nurse once what sucralfate was, since I had to administer it soon and the instructor was coming. I blindly accepted what she told me, and when I told my instructor that I was about to administer cough syrup instead of a GI-cytoprotective buffer...well, it was bad.

Some of my most memorable stories were stories of times when I made a mistake. Some are of things I've done exceptionally well, of course, but no one likes a braggart, so I tell the stories of mistakes I've made. Maybe that's why I remember them better. I think you learn more from a mistake than a success, anyway (that's held true for Go, at least). Another tip I'll confer to nursing newbies out there is this: wherever your clinical education is taking place, there's probably something similar to a "clinical occurrence", or being written up for getting something wrong you shouldn't have. Don't let this throw your game off. It's there to make you better. A good instructor will present it to you in the way it's meant to be intended, an opportunity to improve your skills with a targeted identification of something you need to brush up on. A poor instructor will use it as an opportunity to wreck your confidence and make you feel bad. My point is that you can't allow the quality of your instructor dictate your progress. No matter how it's presented to you, take a deep breath, remind yourself that you're still a student, and get it right next time.

So...one more semester. Those of us who've made it so far have given up a lot to be here. Some of us have lost spouses during our time here, one or two ended up in a psych facility, the stresses involved seem to have turned most of our lives upside down in one way or another. In the process I lost a fiance, my raison d'etre, the one thing I would have postponed all this for another year for the sake of. In the fallout from that I also lost all of my oldest and dearest friends (partially on purpose..sometimes something bad enough happens that anyone who thinks it's a good thing is no longer your friend, no matter how close). Pinning ceremony will be a bittersweet victory. Although I've reached one of my intermediate destinations, it will be in the absence of all of the people who've made the trip worthwhile this far.

From there, my course is unclear. I'm filling out applications to graduate schools (Accelerated RN to MSN programs), and where I go and what I do will largely depend on which school accepts me. A more arbitrary seed than planning to settle down and start a family, but not by much. I'd like to eventually do Travel Nursing, since I don't have any concrete obligations, I might as well. For now, I want to get into Emergency and ICU. Since I don't have any real prior healthcare experience to speak of, I'm trying to find tech jobs at the local hospitals before I graduate, hoping that the experience will translate into the critical care environment. I'd really be happy working anywhere, to tell you the truth. My goal of becoming a Family NP is mainly centered in the thinking that it will give me the broadest scope of options. You don't need to be a clinical nurse specialist to do research, you don't need to be a clinical educator to teach, and Family NPs can be found in critical care and sub-acute settings, treating the young and old alike. At the moment, at least, I want to do it all, and I won't accept a path that leaves me specialized or limited in some way.

2 comments:

DDx:dx said...

You reflected on the difficulty getting into Nursing vs the rigor in the education/training. I believe this is a universal truth to all "guild" designed fields, and healthcare is rife with them.


http://poemd.blogspot.com/2007/03/guild.html

Nurse Practitioners Save Lives said...

I hope that you do well in school. I agree that Family NP is the smartest, most marketable route to go. I enjoy taking care of all kinds of patients and it definitely is not boring. Thanks for the link! I'll add yours soon.