5.30.2008

School visits

Today I met up with one of the nursing faculty from the school I just graduated from. She's been on sabbatical for the past year, on a grant to improve the diversity of the nursing profession. She's doing this by visiting middle schools all across the state to introduce children to the profession, what it does, and what kinds of opportunities there are.

This was fun for me, I enjoy talking to children, and they all had interesting questions. A lot of them wanted to know what kinds of things we had seen, and although I hadn't seen as much as the faculty member (who's a certified emergency nurse as well as a professor), I enjoyed chiming in with my own stories. I have my own stories now! 800+ hours at the bedside later, I can spin yarns about wacky, odd, sad and scary moments as a student nurse.

There was the occasional disruptive or rude child, of course, but surprisingly the videos we brought along turned even those kids around, for the most part. We had some promotional material from the J&J campaign for nursing, as well as an NSNA video. Although some of them started out cracking jokes and disrespecting us, you could tell by the end that they were really interested in what we had to say, as evidenced by expressing interest, asking questions, and a general shift in demeanor.

This was a project I wanted to get our SNA chapter to do a couple semesters ago, but in the end only four of us or so helped out by visiting schools with our professor. At one of the previous NSNA conventions I listened to an interesting presentation about the image of nursing. Most of it irritated me because it contained a lot of complaining about how nursing is portrayed in the media (you don't like it, make your own media!!), but the speaker had some interesting things to say about her experience doing this same thing, visiting the school that her son went to (who became a nursing student) and doing some informal psuedo-scientific research by handing out surveys, finding that, at least in this one classroom, she had probably significantly altered the student's perception of nursing, particularly in terms of gender identity.

So, that's one way to do it. Even still, with our area schools having nursing class sizes of 80 with 1000+ students applying, the problem seems more like there aren't enough nurses willing to take the 40-60% pay cut to become a college professor (all you need in our state is a masters degree in nursing) to satisfy the demand for nursing education, even as the demand for nursing -itself- is through the roof ($3000 sign-on bonuses are the norm around here, I think the military is paying $15,000 nowadays).

Still, I think what we were doing was valuable. If we can recruit and retain more people who are interested in math and science, who have more realistic understandings of what the nursing profession is, hopefully the ratios of ASN/BSN/MSN will normalize a bit more.

5.27.2008

I CAN HAZ INTERVIEW

I stayed up all night so I could call one of our area hospitals to set up an interview. These wacky "morning" hours HR types keep, combined with a listless night of completely failing to get any of the games I downloaded to run on my computer (time for an upgrade or three, it seems) resulted in a sleepless night.

So, I have an interview on Thursday. The hospital is about fourty-five minutes away, which isn't all that bad considering I'm still considering the state mental hospital which is about thirty-five minutes away. Hopefully I can get second-shift, the long drive isn't as bad when I can start later in the day.

There are two hospitals within 15 minutes of me, but for various reasons I highly doubt I'll enter into practice there. The closest one, from what I've seen so far, has a highly toxic culture. I've had some pretty lousy experiences there with the recruiter (who everyone hates, wouldn't give me any feedback on my interview after saying she would, and turned me down for an internship after the clinical instructor of one of my exes [who I've never met] started talkin' shit on me) and one of the APRNs there. All of the interesting people I know who work there are jumping ship to either go to the outpatient clinic or the other nearby hospital. The other nearby hospital soaks up a lot of our school's new grads, but I hear they're full up till october.

Aside from all of that, both of those places prioritize hiring students who've interned with them before, and filled up on new grads before school was even done. I would have loved to work at the hospital I did my last semester of clinicals at, but that one is even tougher to get into, with it's swanky "nurse residency" program and magnet hospital status. 100+ applicants for 15 positions!

So, as is often the case, I'm searching far afield for positions. The hospital I'm interviewing at on Thursday is near the state university I failed out of twice (for computer science in engineering), it's also in an area notorious for heroin (although what area isn't these days), and also near where my brother moved to after he finished his masters in accounting. It's a pretty leisurely drive, with lots of trees, farms and residential zoning, about 50mph limit all the way. I know the route well, since it more or less traces the same route I took when I first left home for college around 9 years ago. Damn, that makes me feel old.

I have a couple of friends working at this hospital, one of them in the emergency department. I doubt I'll start off there, since most of the EDs around here have already picked their new grads, and they need to ensure a safe mix of skills. I'll be happy working on a med/surg unit somewhere.

I still wonder if that's the right thing to do. Everyone tells me there's no substitute for getting that year or two of med/surg right out of school (my last clinical instructor was particularly vehement about this), and I wouldn't dream of doing ED or VNA without that kind of background (or at least a lengthy orientation), but getting that foot in the door with the State seems too good to pass up.

The thing is, though, jumping right into psych right out of school would specialize me (and I want to generalize), and the longer I'm out of that med/surg environment the weaker my grasp on all of the skills I practiced in school will be. Hell, even the amount of time that's passed between my last clinical day and NOW is starting to worry me. The only question I ever have for interviewers is about their orientation. How long is it, how does it work, what does it entail, etc.

The state capital (where I did semesters 2 and 3 of clinicals) is really where some of the best orientations and opportunities are, from what I can tell, but that commute is just brutal. It's not much farther than the hospital I'm interviewing at on Thursday, but it's a much more hectic drive. It really wore me down while I was there, and with gasoline racing towards $5 a gallon, it's really an unreasonable proposition, even with the 37-39mpg I'm getting with the hybrid.

I just have to remind myself that this will only last a year or so. Once I build up my skills and have some good evaluations or performance reviews or whatever the hell nurses get, I'll be able to be a little more selective in where I want to work. In comparing myself to some of my classmates, too, I have to remember that a lot of them got where they did right out of school by virtue of their previous healthcare experience, and I have none to speak of (passing meds in a group home for MR/Autism clients doesn't count, it seems). I feel prepared and all, but not to the degree that, say, someone who's been an LPN in a nursing home or a tech in the ED for years and years is prepared.

I seem to be taking the long way 'round, in whatever I do, I suppose the advantage in this specifically is that I'll be bringing an interdisciplinary mindset to a system that badly needs it, hopefully I'll stay afloat long enough to put it to good use.

First Day on The Job

....in a dream, that is.

I arrived on a unit that was a gestalt of a couple of the med/surg floors I had worked on. There was some kind of reception at the nurses station for the graduate nurses, close examination of the trays revealed some kind of processed meat like salami but thicker and somewhat burnt. I skipped out on the reception and collected my assignment. My assignment in this dream was one patient, in room 72. His diagnosis was some sort of rare condition that caused him to become violently ill when viewing certain wavelengths of light. A 1-patient assignment, with nothing else particularly wrong with him except that problem, an easy assignment for my first day. His family all came to visit him, a ridiculously large number of people, like 10 or so, I found myself trapped in a corner and couldn't move around the room. I asked everyone if they'd like a juice or some tea, and after hearing 4 drink orders I started writing them down. I walked over to the nutrition station to make their drinks, thinking to myself I'll have to make some quip about being the nurse and not the bartender before going over the plan of care with everyone. I put a pot of water on the coffee-maker and found the tea bags in some kind of card-pamphlet, where I found teas specifically designed for nurses. There were two different varieties, which were symbolized with two different pictograms describing their desired effects, along with several paragraphs describing the tea. One of them started out "Nursing is a social sort of technic..." (not technique) and then trailed off in that unstable way print does when you're dreaming (I still manage to read quite a bit in my dreams, I think that's common among speed-readers but I can't be sure).

That's all I can remember, probably because I'm writing this 12 hours or so after the dream occurred.

There were other bits, too, like stealing some sort of watercraft to get to a closed and locked hospital cafeteria that had people in it but wasn't allowing anyone else in. Many of my dreams (and I don't remember them often, maybe two or three times a year) seem to have video-game elements and themes to them, unsurprising since I've been an avid gamer since the age of five or so (and I'm a bit of a snob about it, most of the mass-market games are worthy of contempt).

I'm on a game downloading spree lately, catching up on some of the better-reviewed PC games I've been missing during nursing school (I'm definitely picking up a new console as soon as I get that first sweet, sweet cheque). In this blah sort of limbo between school and employment the games serve as a sort of desperate attempt to stave off the awful-awfuls that my life's been saturated with lately.

5.21.2008

Advice for future nursing students:

Today's my birthday, by the way. I turned twenty-seven.

This post is dedicated to the three people who've abandoned me, saying I'd never become an RN.

Now that I'm done with nursing school, I've been inspired by little heck's post dispensing advice to future student nurses to supply my own.

This isn't a trivial task, since nursing programs can vary wildly even intra-state, so take this with a grain of salt, the product of my own singular experience in one local nursing school.


1. Assess yourself. Nursing school will likely require a number of changes to your daily routine, study habits, intrapersonal relationships and thinking style. In order for these changes to be successful, it's important to "know where you're at" first, and determine what kinds of adjustments will be necessary to succeed. The nursing program I went through was very different from the co-requisite courses that preceded it in that rote learning and memorization were not effective strategies. I never personally applied that strategy myself, I'm just basing this on my observation of my fellows. Starting with a firm foundation in anatomy and physiology will save you a lot of grief later, you can save yourself a lot of tedious re-learning of previous concepts if you come into this with a good understanding of how the body works and what happens when things "go wrong". Nursing school will test your critical thinking abilities and assume that you've already accumulated the required book-knowledge.

2. Get Involved. Nursing school may seem like a mammoth amount of work, and faculty will no doubt try to con you into thinking that you don't have any free time to do anything but eat, breathe and sleep nursing, but don't give in to the hype. Academically, this is most likely to be easier than the classes you took to get in to the program itself. If you're spending 12 hours a week in class and 40 hours a week studying, you're doing it wrong. Getting involved in nursing-related extra-curricular activities is extremely valuable for a number of reasons, whether you're acing your tests or barely scraping by. Getting involved with your local Student Nurse's Association (or, to a lesser extent, your class government) will provide you with a larger context for the journey you're embarking on. It will provide you with leadership experience that will serve you well after graduation. It will help you network with your classmates and with your local and national professional organizations, lending you physical and emotional support on your journey. It will look good on your resume. It will help you gain the respect of the faculty and administrators. It's likely to be a relatively small time commitment with a large payoff. Look past your nose, and lead your fellows, you'll be glad you did. Volunteer your time. It might seem like too much at first, but my Vice President while I was President of your Student Nurse's Association had three kids, a job, girl scouts, and a household to run and she's proof it's possible. You can spare an extra hour or two a week, trust me.

3. Accept support, but don't rely on it. Transitioning into the RN role is probably one of the hardest things anyone has had to do. Determine where your support comes from, and nurture those relationships. You are going to change. No matter what level of experience you already have in the health care delivery system, taking on the RN role involves a massive shift in cognition, and you may find that some of the people closest to you won't be able to deal with your struggle to take on these new patterns of thinking. Hell, YOU might not even be able to deal with it. Don't let lack of support or abandonment deter you from your goals. This is something that you will eventually need to do by yourself. Support from loved ones is a good thing, but you must be prepared for it's absence if you want to see this through. I've seen nursing school wreck a lot of relationships, and I've seen a lot of relationships wreck nursing school. Be prepared.

4. Be wary of your faculty. The sad truth is, it doesn't matter if you do a good job and you know what's going on, if the faculty don't like you, they can make your life miserable. You can save yourself a lot of grief by doing things like getting involved, like I described above, but also by sticking up for yourself. Nursing, particularly nursing education, is a field that is thick with what is called "lateral violence" or "horizontal violence" or "intraprofessional violence". There's a saying that "nurses eat their young". I'm sorry if you had to hear it here first, but that's how it goes. If you want to survive your relationships with your faculty, always tell the truth, get involved as much as possible, and don't be afraid to raise a stink and go to your administrators if you think you're getting a raw deal. Stand up for yourself, and stand up for your classmates. If you can't do that, how can you stand up for your patients?

5. Trust no one. This might sound negative at first, but I think you'll find it sound advice. Don't take anyone's word for anything. Lecturers might talk a good game, but don't accept anything as truth until you've read it in a textbook and cross-referenced it at least twice. Evidence based nursing, that's the way to go. Do you have to give a med in clinicals you've never seen before? Don't ask someone what it does, look it up yourself. Don't take anyone's word on anything. You're the Nurse, you're the professional. You're the one responsible. I don't care if it's the chief of medicine, if you're in doubt, look it up. If you're not sure of the procedure for a tube feeding, look it up. It's your license on the line, not theirs. Instructors will respect you a lot more for saying "I'm not sure, let me look that up" than for trying to BS a response.

6. Don't let them get to you. Most clinical programs have a thing similar to what we call a "clinical occurrence", something like being written up for something you did wrong or something you didn't know at the right time. Take these things for what they are intended, a tool and a guide for what you need to work on, not a punishment for something you did wrong. If your nursing school is worth their salt, they -want- you to succeed, and this is their way of helping you. Don't feel bad, just do it right next time. Don't make the same mistake twice, make new mistakes every time, and accept correction gracefully each time. They're supposed to be helping you. If they aren't, do something about it, even if it means going over their heads. Learn from your mistakes, don't feel bad about them.

7. Know your A and P. I touched on this before, but it bears repeating. Your anatomy and physiology class is the single most important class you'll ever take. Shop around and find the best teacher you can. I was lucky to have the best teacher I've ever had for this course. Your understanding of anatomy and physiology will inform everything you do in nursing school. Gain a solid understanding of this subject and you'll save yourself a lot of grief later.

8. Strive for clinical stability. Feel free to play the field and try out different clinical sites in your first two semesters, but for your last two, make sure you stay in the same place. The end of nursing school focuses more on delegation of responsibility and taking on the role of an independent practitioner. This is much more difficult if you're adjusting to a new clinical site at the same time. More importantly, if you had a clinical preceptor before, don't give it up in your last semester. Going from having a clinical preceptor back to the old method of having a clinical instructor is wildly disorienting, I don't recommend it.

9. Intern, intern, intern. A lot of the most desirable hospitals preferentially hire their student nurse interns, so take on a student nurse internship. The hours you'll spend in the clinical environment as an intern will be equal to nursing school x 1.5 (or 2.5 in the case of some four-year schools), plus you'll have a better shot at getting a good job right out of school. Do an internship. You'll have plenty of time to travel later, trust me.

10. Student Nurse, not Nursing Student. Take pride in what you do. Take on the role of the nurse, informed by the best models you have at your disposal. When you're in the clinical environment, you're not "just" a student, you are responsible for people's lives. Take that seriously and bring your best game. Just because you're a student, doesn't mean what you're doing is any less important.

11. Take responsibility for your own learning. Clinical practicum, by nature, cannot be standardized and is extremely irregular due to the randomness of patient assignments and experiences. If you see an opportunity to do something or even just overhear something that is novel to you, jump on it. On the other hand, don't obsess too much about procedures like foley caths or IM injections, you'll have plenty of opportunities to practice those kinds of things once you're an RN, the object is to practice things that reinforce general concepts, like maintaining asepsis, discharge planning, body mechanics and the like. You'll get plenty of training on specific procedures as you go.

12. Have fun. If this is a chore for you, why are you doing it? It's only going to get harder. If you're not enjoying the work that you're doing, apply your critical thinking skills and determine what's gone wrong. With the right frame of mind, this can be an exciting, fulfilling profession. With the wrong frame of mind, this can be hell on earth. It's easier to adjust your mind than your surroundings. Enjoy yourself, and the rest is easy. You might be faced with instruction and resources that you feel are incompetent and insulting, but if you can fool yourself into thinking they're wise, profound and useful, you'll fill in the gaps yourself. Keep smiling, enjoy yourself, there's no other way.

5.19.2008

Pinning and the Pledge



Yesterday was my pinning ceremony.

It was a nice ceremony, all in all, and 14 out of 20 of the people I distributed tickets to were able to make it. I don't think the speakers were as good as last year's, the keynote speaker merely dished out some career advice that we had been getting drilled into our heads in our Trends in Nursing class anyway, and the school's president ended her short speech with an assertion that she hopes she never has to encounter us in our newfound professional capacity. Since she lives in our community, and it's inevitable that she'll require nursing care at some stage in her life, it requires some charity on my part not to take that as an insult. The class president also gave a speech, and I couldn't help but think that this and the keynote address were given "to us" (the graduates) and not to the assembly at large (which included our friends and family).

The only part that seriously bothered me, however, was the recitation of the nightingale pledge. We all had one version of the pledge in our programs, and then they displayed a -different- version on the overhead projector on the stage. When the class adviser started reading one and we all started reading two different ones, we faltered and went silent. When we all started reading the one printed in the program, I remained silent and stared at the class adviser with an arched eyebrow.

The pledge that the rest of the class read:

"I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician, in his work, and devote myself to the welfare of those committed to my care."

Underneath the print it said "Author Unknown", even though it was written by Lystra Gretter, an instructor of nursing at the old Harper Hospital in Detroit, Michigan. One last lapse in scholarly rigor before we part company, I guess.

Now, I take issue with a lot of things in that pledge, which is why I didn't recite it. Some of the reasons are expounded here.

Up on the projector there was a modernized version of the pledge, which I don't have a copy of, but a quick google search rendered something that seems similar:

"I solemnly pledge myself before God and in the presence of this assembly to faithfully practice my profession of nursing. I will do all in my power to make and maintain the highest standards and practices of my profession.
I will hold in confidence all personal matters committed to my keeping in the practice of my calling. I will assist the physician in his work and will devote myself to the welfare of my patients, my family, and my community.
I will endeavor to fulfill my rights and privileges as a good citizen and take my share of responsibility in promoting the health and welfare of the community.
I will constantly endeavor to increase my knowledge and skills in nursing and to use them wisely. I will zealously seek to nurse those who are ill wherever they may be and whenever they are in need.
I will be active in assisting others in safeguarding and promoting the health and happiness of mankind."

That version was somewhat less objectionable, omit the first half of the first sentence and it's almost completely palatable. Still, I'd argue that it's not our role to "assist" the physician anymore than we're here to "assist" the respiratory therapists or health unit coordinators, we're supposed to be a team, nowadays. Citizenship, also, I think is something very seperate from what we're talking about, and another thing that means different things to different people.


Honestly, though, if the second pledge was read I probably wouldn't have said anything, either. Even though neither version was penned by "flo", it's still called "the nightingale pledge", and I think that's one sorry little bit of history we should be letting go of, if for no other reason than the fact that she was staunchly opposed to including both genders in the profession.

Oh, sure, history is quaint and informative and interesting to reflect on, but the past belongs in the past. We need new models. New traditions. If the anchor of tradition becomes too heavy, then it must be cast off. Sure, nursing is "special", in a lot of ways, but in order to survive it's going to have to become more inclusive and multifaceted. Gone are the days when nurses lept over each other to give a doctor their seat, and long, long gone are the days when nursing implied some kind of special religious or moral piety.

Yes, we have a lot of responsibility as members of -the- most trusted profession, a profession which mediates life and death issues for the most vulnerable...but compare this to lawyering or policing for a moment. Ostensibly they're role is to either help people navigate the intricacies of the legal system (just as nurses help people navigate the medical system) or protect them from harm or loss of property, and yet the police and lawyers are almost universally distrusted to the extent that nurses are trusted. To say that it takes a "special kind of person" to do one of those other two types of jobs must be just as true as it is for nursing, no?

I wouldn't argue that there isn't some value to traditions and ceremonies and pledges of this nature, all through my previous educations I saw the grand traditions of the organizations I joined stripped away in the name of political correctness and legal liability. Even as the leaders of these organizations revised and revisited their traditions to make them safer, voluntary and more universally acceptable and applicable, these traditions were stripped away one after the other. The value in these experiences, I would argue, comes from the same system of responses that post-traumatic stress disorder stems from. Things stick with you when they're imprinted properly (and -really- stick with you when they're imprinted during acute stress).

The traditions need revising, though, as I've already said. If your profession is made up entirely of fourty-five year old protestant white women, you can afford to rock the monoculture. The time for that is done, though. It's time for a change.

5.13.2008

Open Lab

Our nursing program recently held an open lab for anyone who wanted to stop by and visit. I got the impression it was geared mainly towards the newly accepted nursing class, but most of the visitors were elderly members of the community.

We didn't use the lab for much this year, our manditory "lab hours" were mainly spent in extended lecture in one of the lecture rooms instead. The first year we practiced injections, foleys, bed-baths, assessment techniques and all of that good stuff. We have one of this highly vaunted and sought-after "Sim-Man" simulated patients, but I only had one simulated patient experience during my entire stay in the program. I was skeptical of Sim-Man, but the one exersize I did with it paid off immediately, the simulated patient had a fractured hip and was dyspnic, the "solution" to the problem was simply to reposition and prompt to turn-cough and deep-breathe. The very next day I had a similar patient with a similar problem that I resolved in exactly the same way (after assessing for fat embolism and all of those nasty complications of fractures).

But anyway, back to the Open Lab. Most of my time there was monopolized by a single visitor and a conversation I couldn't politely extricate myself from. I wasn't in a hurry to do so, there wasn't anyone else I really needed to interact with, so I leaned against a table and snacked while she basically related to me her life-story.

She spent most of her career in corrections nursing. A few months before retirement, an infectious process resulted in a cognitive disability which robbed her of her pension and placed her on SSI. She had tears in her eyes when she told me of her dashed plans to become a nurse educator and how much she loved to teach. She's also a reiki master and told me some stories about volunteering for our local hospice organization, and some anecdotes about using therapeutic touch modality in the corrections environment to relieve pain and allieviate injury-related periorbital edema.

The main aspect of her cognitive disability was severe short-term memory loss, this was the main reason she couldn't continue to practice nursing. I could hardly tell even after a 30+ minute long conversation. Something I would have guessed that she made a point of telling me was that this memory impairment doesn't affect her ability to practice reiki at all.

What I wanted to tell her, but couldn't figure out the right way to say it, was that in the absence of memory, life becomes a shining thread of coincidence.

5.12.2008

Offense ("you MEN")

We had our final day of agency-mediated NCLEX-RN preparation. There's a number of schemes like this, Kaplan, ERI, HESI and the like. I sat in on a couple of Drexel NCLEX-prep classes and had a general idea of what they were about.

The particular agency we used (ERI) ran a pretty terrible show. The first few days were alright, but the reviews mostly consisted of someone reading a book to us (which we all had) and going through a few questions on the content that was just reviewed. We all held up little cards indicating what we thought the answers are. I abandoned this after the second day, since only the instructor (provided by the agency) could see our cards (since we were all facing the same direction), and I didn't really care whether or not the instructor knew If I had the right answer or not.

Ive had some pretty big issues with the testing package we've been using so far. The questions and answers are light on rationales at the end, and the general consensus of the class was that many of the questions were poorly written, with numerous typos and questionable logic. The practice tests on the intra- and inter- nets were especially bad. Often, the rationales for the correct answer were absent or terse, with no explanation of why the other choices were incorrect.

My lippencott NCLEX review on my cellphone, by contrast, has verbose, complete rationales for each choice, as well as identification of content area and step of the nursing process involved. It also sports a larger bank of questions which are higher in quality.

That's right, I get better NCLEX review on my cellphone.


Insult was added to injury on the last day (today), however. The maternal-child health section was attended by a different instructor, a nurse-midwife. I walked in late, but by the time I got there the class was already up in arms. Not only was she disparaging towards students who didn't know the right answer to some of the questions, she was openly and egregiously sexist, saying things like:

"I know some of you need to review the maternal child health content, especially you MEN",
"MEN always seem to choose the answer that forbids breastfeeding, like it's the source of all evil or something",
"How many of you MEN would want a 4th degree episiotomy laceration, eh?"

I was shocked and offended, to say the least. I scored better on maternal and child health than most of the class. It was the lowest scoring content area for the class as a whole, and I did very well at it. Part of the reason for this was that I was planning on having a family at the time, so I took the content seriously and committed much of it to memory (pro-tip: knowing your presumptive and probable signs of pregnancy is helpful in determining if you're the father of your sweetie's child or not). For someone to suggest that my gender put me at a disadvantage in this content area itself was insulting to me, and the way she put it made it even worse.

I think the disadvantage the XXers in the class had to deal with was their personal experiences with reproductive health, which distracted them from learning the actual content (they figured "hey, I lived it, I don't need to study it further").

I digress. I only sat through two hours of her drivel, towards the end I tapped this message out on my cellphone and forwarded it to the faculty:

***

XXXX- (addressed to new program director, old program director and course coordinators)

Im sitting in ERI review right now, and I've been repeatedly shocked by the nurse midwife conducting the review's repeated offensive sexist "jokes" and generalizations. For example, she said that men always chose the answer that suggests cessation of breastfeeding because they think its the "root of all evil", and asked us "if you gentlemen would like a fourth degree laceration". Other students, not just some of the men, have felt she has been insulting when the class didn't know the content. I have found this an infuriating experience today, since this is content that is important to me (not just for the nclex but in general), and I don't appreciate being disparaged, not individually, but generally. I observed what I considered outlandish examples of sexism just in the two hours or so I've been here so far, another male student sitting next to me told me I missed some "doozies" before I arrived. I don't imagine we have any recourse to this behavior, I just wish to register my discontent and outrage, and that of the students sitting around me.

-pm


***

This person played into a very unfortunate stereotype of LDRP nurses in general, and Nurse Midwife's more specifically. I'd encountered the stereotype that they had a tendency toward being sexist man-haters, but nearly all of the ones I had actually MET have been down-to-earth professionals with open minds and a transcendent calling. I suppose this person is "teaching" rather than practicing for a reason. Wonder what that could be?

5.11.2008

anticipatory grieving

So what accounts for this ennui?

I feel as though I'm as prepared as I can be for the terrifying transition from student nursing to the role of independant practitioner. I realize there's still a long way to go, but it's not exactly like I'll be mourning the loss of the hassles of lectures, homework, and the paradoxes of clinical practice as a student.

Summers (particularly the end of may or the end of april) have taken on a decidely unpleasant role in the pattern of my life. Features of transition and uncertainty dominate, reflection and refraction, hints of renewal dominated by overwhelming loss.

I've come to dread the summer. Seemingly arbitrary forces always seem to come together to make my summers miserable. The allergies and sun (I dislike the sun) are bad enough as it is, but summertime just happens to be the time when all of life's slings and arrows strike their target (me) with unnerving accuracy.

It always comes on through hints and duplicity, through the carelessness of others, through my own apathy and resignation, but most of all from my own hopes and expectations.

I don't like the pattern that's forming.

Winters aren't all that great either.

I have the same desire for stability that you have.

This too, shall pass, of course.

What will? Stability, the desire, or me?

D. All of the above.

5.09.2008

She said to me "you're having a rough year"...

...and I suppose that's true. Another friend of mine died this week. Motorcycle accident. Passenger died as well. He moonlighted as the bouncer at the pub I spend my evenings. I've known him for years, but now that he's gone I can't think of anything to say.

I flipped through the videos taking up space on my camera just now and found some candid video from a couple of nights before the accident. It was eerie to see his face staring back at me from the screen of my laptop.

I suppose one of the disadvantages to having one favored coffee shop and one favored pub is that when people go missing, their absence is acutely felt.

Our pinning ceremony is less than two weeks, and I can't bring myself to summon up any enthusiasm for the prospect, not just because of this, but the events of the past year in general. This is a poor replacement for what I've lost.

5.06.2008

No More Student Nursing

Today was my last shift as a student nurse.

Acadmics are trivial, tests are laughable, this has been the real test.

I could have kept my rotation in the inner-city, an hour away from home at the crack of dawn, and probably had an easier time. This is in spite of the fact that I don't "do" mornings very well and nearly failed out of the program last semester due to lateness.

When the Program Director suggested to me that I switch to an evening shift, I balked, figuring (correctly) the advantages of a familiar environment would outweigh the concordance with my circadian cycle. The director (wisely) dangled in front of me the opprotunity to study under a particular instructor that I've been wanting to work with since day one, an instructor that serves in the role I want to one day occupy (emergency), an instructor who seems much more "with it" than her colleagues.

I knew I could very well have screwed myself for signing up for her rotation, but I did it anyway. This was the trial by fire. She came into this knowing she might have had to bounce my ass back a year, and I knew I might have screwed myself for requesting it, but sometimes I guess you have to go with your gut. My gut told me that this was the best educator I could have hoped for, and if I didn't make it through her rotation, I had no business being an RN.

She passed me. Barely. There's a lot I need to work on, and she gave me some sound career advice: to get my ass into a med/surg orientation instead of taking the state mental hospital job. We'll have to see what happens, who wants to hire me, but I have been on that same page since day one. There's a local hospital that has a kick-ass graduate nurse orientation in emergency that takes them through every unit in the hospital that I'm salivating over, but the state mental hospital is still a viable "plan B".

From now on, my entries will not be submissions to my instructor but the unrestrained words of myself, from me.

Many of you have said that my writing has been too formulaic, too systematic, and I'm hoping that the fact that I'm no longer submitting these posts for a grade will result in a looser, more organic read.

So, let's meet my last two patients as a student nurse (having two with no meds was somewhat anticlimactic after four with meds, but it was a welcome gimme):

Patient X was admitted for respiratory failure secondary to pneumonia. He was intubated for about three days ONE MONTH before I saw him, an occupant of our hospital the whole time. He had a slew of interesting co-morbidities, including COPD with severe restrictions, A-fib, Hep-C and that's just for starters.

His pneumonia was resolving when I met him, and his plan was to get discharged by the weekend. His breath sounds were great. His oral mucosa was dry and the papillae on his tonge were prominant. He continuously requested oral hydration, but he was NPO. Most of my interactions with him were centered around oral hydradtion and debriedment, usually around the time we had to reposition him (q2h).

He was thirsty. His oral mucosa told me he was thirsty, he didn't have to tell me. He was getting jevity via g-tube, and I had to wonder, given the osmolarity of his jevity feedings, how much "fluid" he was actually getting (he wasn't getting any IV fluids).

Oh, he was also a Traumatic Brain Injury Patient, which was why he was total-care. I pride myself on being able to decypher aphasia, and Patient X tested the limits of my ability to do so. I was in every 15 minutes or so to moisten his mouth, and it was never enough. Ironically, my oral-swab excursions produced a greater coughing effort (probably due to small-volume aspiration) than he was able to initiate himself (his coughing efforts were mostly groans).

One of my classmates knew Patient X from a Skilled Nursing Facility and checked up on him often. I wish I could have shown her better how well I was taking care of him...how well I understood his slurred and aphasic speech, the times I made him laugh, the overall quality of the care I was giving him..but all I got were rolled eyes when I cracked jokes to him. I made him laugh a couple of times, and that's worth more to me than..well...anything.

Patient Y was admitted for cellulitis of the lower extremities. She had an interesting cardaic history as well, and I was confused intiially as to whether angina or cellulitis-related pain was responsible for her hospitalization.

I got to use the bariatric bed-weight on her for the first time, an interesting contraption that hooks up to a 'tarp that we fold out underneath her to get her weight similarly to placing her in a hoyer lift.

She drew some strength from her roomate, I kept drawing back the curtain so they could see each other, but someone else kept pulling it shut again. I can't be there all the time, and the supporting relationship these roommates had couldn't be replaced by anything.

I felt so useless not being responsible for any medications. I spent a lot of time helping the other Assistants, doing a lot of hygene and measuring a lot of Intake and Output, and I felt that for my last day I was performing the duties of a tech and not of a Nurse.

I Love the Techs we've been working with this semester, for the most part. The facility I spent this last semester at has retained some dedicated, patient and wise people to perform what seems like the lowest and perfunctory role, but truely is central to the unit's operation. This is obviously true of the Unit Coordinators as well.

I seem to be gravitating towards the private hospitals, or at least the hospitals under a certain size, where it's harder for the slackers to blend it, where everyone depends on one another. I know not every facility can provide an environment like that, but I deeply appreciate all of the environments I've been graced with, small private hospitals and large inner-city hospitals alike.

So where to now?

It seems clear that to shephard my skills I need to take on an intermediate or criticla care orientation as a graduate nurse...but we'll see who hires me. The state mental hospital remains as an alluring "plan B". No matter what happens, I feel that I have a long, fullfilling future in a profession that needs me (AND YOU!) desperately.

...and I will do all that I can to elevate it.

Join me.

5.01.2008

Six Random Facts

I'm usually annoyed by these "meme" things in blogging (mainly due to what I consider abuse of the term), but in the interests of reciprocity I'll play along with my good buddy JackOfHares' acute attack of intarweb trendiness.

Rules of the game:
- Link to the person who tagged you.
- Post these rules on your blog.
- Write six random things about yourself.
- Tag six random people by linking to their blogs.
- Let each of the six know they've been tagged by leaving them a comment (on their blogs).
- Let your tagger know when your entry is up.

Six Random Facts about PM:

1. I play trombone and piano. I won an award for jazz improv in high school and traveled around with a college women's basketball team for the NCAA games. My parents even have a tape with clips of me on ESPN. I've let both instruments slide (excuse the pun) since I left engineering school and took up Nursing, hopefully after I graduate I'll have more time to get back into it. In the meantime I've focused most of my musical attention on electronic noise music and turntablism.

2. I live with my parents. Lame, I know, but having the only room on the ground floor of a nice house with a family I get along with -for free- is a tough deal to pass up (what with the "Economy" and all). The lake in the back-yard doesn't hurt either.

3. I experience really bad Subjective Tinnitus. It's most distracting in a completely silent room, where it's perceived as a deafening roar, thankfully the fans in my computer provide sufficient background noise. Childhood ear infections are probably to blame.

4. I read quickly. It only takes me about a day to read a full-length novel, although non-fiction takes me a bit longer for some reason. I was assessed to have a college-level reading ability in kindergarten, about two years after I started reading. I also type around 90WPM.

5. I've had a computer since I was five years old (#1 was a commadore Vic-20, the second was a 128k RAM macintosh). Although this has had sundry positive effects
(like coding in PERL and Hypercard nearly as soon as I could read), one drawback is that I have the handwriting of a four year-old serial-killer.

6. I can't eat cooked fish. Sushi and sashimi are fine, but cooked fish turns my stomach. It took a long time for me to even be around it without retching. I think getting food poisoning from clam chowder when I was young might have something to do with it.

So, let's see...I tag...

Little Heck (Soon to be Graduate Nurse)
CxLxMxRx (Nursing Student)
Alisha Marie (Unlicensed Supportive and soon-to-be Nursing Student)
Lucid (Search and Rescue)

aaannnd.... that's it. I don't know who else is even reading this. hah.