The Long Overdue Ending

I know I promised to tell you about my NCLEX a couple months ago. I've just been so busy I've hardly had time to write in my regular blog, much less my nursing one! But let us get down to business first. This is what NCLEX was like for me:

Preparations

I purchased the Kaplan Online Complete package for far too much money. The online course was soooo boring, but had some nice ideas and flowcharts and such. The online question bank was the best investment in the package, however. Answering several hundred questions really got my brain into NCLEX mode. I highly recommend the Qbank, but can take or leave the rest of the course.

My classmates went to the Hurst Review. I flipped through their book and listened to their stories after the course was over. Apparently it was hilarious and awesome and useful because the crazy jokes and anecdotes caused all the review points to stick well in your mind. The book was much simpler and digestible than my own Kaplan book, but it lacked the review questions I found so useful. So I recommend the Hurst Review as well, though only if you're able to attend a live class.

On the whole, I recommend you do any review course, period. They help refresh your brain, and statistically those candidates do better. Which kind you pick really depends on your style.

The Exam

I arrived early to the small testing facility. I opened the door to find a gentlemen seated attentively and upright behind a desk. He stared at me as I entered and sat. After I'd arranged myself in the chair, he asked if he could help me. Yes, I explained, I'm taking NCLEX.

"Your authorization to test, please. Thank you. Please take this paper and read it. Let me know when you have finished." He was a very formal guy, whose tone was as crisp as his pristinely ironed shirt. I sat and read the paper. When I came back I had to give him my ID, sign my name, let him scan my finger 5 times, get my photo taken, sign my name again, lock up my things, on and on and on. Finally he gathered my papers, scanned my finger one last time, and walked with me two steps into the hallway.

There was a woman seated in the monitoring station, watching the test takers. Though calling it a monitoring station is a kind of visual understatement. It might be better described as a space pod, since it's sphere of glass looked down upon so many screens I felt certain that touching one of them would surely cause the entire thing to blast off.

She took my ID as well, scanned my fingerprint, activated my test in the computer, and escorted me inside to my terminal. I noted that I was seated at computer #7, and hoped it was a lucky omen.

There were a tiny pair of earplugs before the monitor that I didn't use. I started clicking at the tutorial pretest questions and reading yet more rules and warnings. When the test finally began, it looked exactly like the review books describe them. I didn't feel nervous at that time. I felt like I had a really good chance.

Every time I answered a question and clicked "Next", I checked the counter at the corner of the screen. I've heard people say that they were never more terrified than when the cutoff screen popped up and ended the test. I was actually the opposite. I was terrified when I hit Next on question 75, because if it didn't cut off then that would mean that I still hadn't passed. At least I'd know it was over if it cut off at 75. If I had to keep answering questions after that, I would have been terrified.

Thankfully, it did cut off at 75. They scanned my fingerprint again when I left. As I understand it, they scan your fingerprint if you so much as get up to go pee. I was glad to be out of there.

Results

I didn't check exactly 48 hours later. I spent the day working, then spent the evening at a friend's house soothing his grief over his recent breakup. So when I finally got around to checking the site in the middle of the night, I was somewhat disgruntled when I was greeted with only a few lines of text saying my name, number, and the word PASS.

I blinked heavily. Where were the trumpets??? At the very least couldn't they have included an animated gif? Or perhaps the word "Congratulations"? Make no mistake, I was thrilled. But it seemed almost an anticlimax to these years of struggling and studying. I printed out a screenshot to keep with my other school momentos. And then I went to bed, and didn't dream at all.

Work

I'm now a full time RN in a Cardiac Care Unit, and almost finished with orientation. And I have to say, I love it. I absolutely love it. While I found my experiences as a nurse tech extremely beneficial while in college, I cannot tell you how physically demanding it could be on me sometimes. This job is so much better, and I don't feel like a zombie all the time from having to balance work and school.

CCU is all about bypass patients and other thoracic surgeries, though we get other intensive care patients from time to time. I've been learning so much every day, and feel like I'm almost ready to do the job all by myself. I hope to work back here for a year or more, then perhaps for a while in the ER too before I eventually go back to grad school. What do I want to be? Probably an NP, though I'm not sure yet! I have lots of time to think.

Final Thoughts

This is my last entry, and I will not be posting in this blog anymore. I have to concentrate on my career and starting my new life. I considered writing another blog for a while called "I Am No Longer a Nursing Student"... but realized how silly that statement is. I will always be a student. I feel like I'm growing and learning all the time.

Studying nursing has been good for me in so many ways. Certain parts of my personality were already predisposed to this kind of work, but other parts of me were not at all suited to the task. For example, when I began clinicals I was a very shy person. That might not have come out in my posts so much, but I had a hard time talking to new people. As little as 6 months ago I still had a phobia about calling people on the phone. But by working as a tech and working with my classmates, I've grown past those anxieties and gained a measure of self-confidence. The changes were subtle and slow, but when I look back, I'm amazed at how far I've come.

I think that finding a path in life that both complements and challenges you is precious. I think that, in this culture full of disillusionment, I was lucky that college "worked" for me. It actually helped me in the classical sense by shaping my identity and strengthening my character. Of course, it was tedious and taxing. And in the years before I transferred and changed majors, it was downright depressing. But here I am now, with a degree on my wall and initials after my name. After all of it... after everything... I made it.

You can make it too. Hang in there. <3

Thanks for reading.

Graduation

It was, unquestionably, the longest graduation ceremony I have ever attended. Thankfully it was mine, and I knew every single person who walked across the stage. Otherwise I'd have surely died of boredom.
A picture of the school pin. Right now my pin is sitting in a small box on my shelf, waiting for it's place upon my uniform. And I happen to know what color uniform it will be! Teal! I've secured a job working in a CCU at a local hospital. (CCU mostly handles the fresh bypass patients, but they also catch some other acute complex conditions.) I don't start until September 4th, so I've been spending the last few weeks packing my little sister off to her first year of college, giving my room a long-needed junkpurge, and studying for NCLEX.

But what to say about graduation?

The sheer length of the ceremony, the number of speakers, the pictures, the songs... all of these things gave me a real sense of closure on my undergraduate education. I thought "It's really, finally over. I did it." But it wasn't until we said the nursing pledge that I felt a real sense of pride. After we walked across the stage, we didn't return to our seats, but instead went back into the choir loft (the ceremony was at large local church building). They dimmed the lights and we passed fire from lamp to lamp. Then, when everything was glowing around us, some soft music began to play. One of our instructors led us in recitation, and as we spoke into the wavering flames I could see all of my classmates' pins and eyes shining. It was actually a little spooky, since it felt not only solemn, but sacred. I think I will always hold that moment as a very special memory. Something to comfort me in difficult hours.

There were so many parties afterward.


I was supposed to be at the Hurst Live Review today with the rest of my classmates, but because money is tight at the moment, I was waiting till the last minute to sign up. And then what happened? After weeks of open spots, it finally filled up the day I wanted to register. Dang. So now it looks like my only review option is Kaplan Online. No more live reviews are handy for months and months and months! (Did any of you do Kaplan? Online? I'd greatly appreciate your feedback on it before I buy it later this week.)

So, until I start my job I will continue studying. I will post to let you know how the NCLEX went, but I don't intend to write about my job here since it is somewhat riskier. I am uncertain whether I will keep any other nursing blog after this one... I'll have to see whether it's possible or not. (While I'll no doubt have commentary on my life as a real nurse, I fear HIPAA... and to a lesser extent, workplace politics).

I've been so thankful for the few readers who have kept up with me these last 2 years. I feel like our dialog has been fun, and you have certainly been an encouragement to me at times. I hope I was equally encouraging to you. If you are in school, hang in there. You will make it.

So, I'm through! No longer a nursing student! (Though that isn't really true, I have so much to learn for the rest of my life.) Also, my goal is to begin grad school within 5 years. No, not as a to be a CRNA (Ew!) Probably an NP.

I hope to show you a picture of my license in a few months. Until then, thank you so much for reading.

The Last Week of School

One final down, one to go, and then the graduation ceremony is on Thursday.

What a semester this has been! I have had the opportunity to explore nursing in the community, as well as complete my preceptorship in an ICU. I really enjoyed both experiences--particularly the preceptorship--because I felt like it gave me the opportunity to complete my transition from student to novice nurse.

Here are some of the highlights:

The Magic of Learning

My preceptor met me with a smile the first day. She oriented me to the unit, assessed my general knowledge, supervised my opening notes, etc. But as the day wore on, I noticed she was sneaking candy from her pockets.

"What'cha eating?" I asked.

She looked at me askance. "You're totally into Harry Potter, right?" I put a question mark there, but in reality she spoke the words more like a statement of undeniable fact. Luckily, I was, in fact, a Harry Potter fan. I know for a fact my lot would have been different and dire if I had answered her in the negative.

"Of course..." I said. Whereupon she produced several packages of Bertie Bott's Every Flavor Beans, Bloodpops, Chocolate Frogs, and other Potter candies from her pockets. For the rest of the summer, Potter became a constant default discussion topic in the lulls between my educational experiences. She showed me a book she was reading that speculated on the symbolism behind the Potter series. She showed me the costume she had made for her child for the midnight release party. She held her hands over her ears and yelled "lalalalala" as soon as I mentioned that the book had leaked over the Internet. A true fan. (Or addict?)

I wouldn't say that Harry Potter conversations were the most memorable thing about my preceptorship. I learned so much about the day-to-day routine, policies, procedures, computer charting, teamwork... the experience was invaluable. However, I found it refreshing to be paired with someone who was young and at least as nerdy as I am.

I lamented the fact that she took vacation around the book release date, so I could not see her in the last days of clinicals. My classmate and I brought food for the rest of the staff, but I couldn't let this woman's semester of efforts go unrewarded. I agonized over what kind of Potter trinket would be appropriate for a thank-you gift. I felt certain she'd already have anything that could be bought in a store... so I finally decided on something home-made.

The nearest thing to nurses Harry Potter's world are the lime-cloaked Healers of St. Mungo's Hospital. (And trust me, I wouldn't have known this if she'd not told me about the costume she was sewing). As a gift, I painted a small wooden plaque green with the symbol of the hospital, and emblazoned the words "St. Mungo's Award for Distinguished Healer Mentor" on the front. I left it in her locker for discovery. I hope she likes it.

Memorable Quote of the Semester

"One time a student was working in the ER. And she told us that a woman came in with gonorrhea. She was a prostitute, and she had an ostomy. In fact, she was prostituting the ostomy... and I know none of you are going to forget the concept of 'portal of entry' after that story."

~~~

Alright, that's all I have time for at the moment. One more final to study for. Expect an update after graduation.

CC, Psych, Students, and Looking Forward

Hm, seems I haven't posted at all this semester. That's probably because this semester was insane. I'm in the last leg of the race, so I'll have to gloss over a great part of my experience. But to bring you up to speed, here's the digest version:

Psychiatric Nursing

I had the same teacher for psych clinicals as I did for First Level. I really like her, so that was nice.

Despite this, I have decided psych is not my thing. While meeting really crazy people is interesting, I feel like I'm not busy enough up there. Sitting around and watching people... talking about feelings... ugh. For one, I am naturally pretty empathetic. When we study communication techniques, all I can think is "Duh, this is so obvious", and become quite bored. For another thing, psychiatric medicine isn't going to change any time soon. And if you go into it, you stay there. Your skill set is totally different from every other part of the hospital. The longer you're on the psych unit, the more outdated your general knowledge becomes.

I've learned some interesting things though. Did you know 1 in 100 people is schizophrenic or has schizoid characteristics? That's a devastating statistic. All those homeless dudes, the freaky people wandering the streets with shopping carts and talking to their demons. I've met a lot of those people. I am thankful for that... not many people have the chance in our society. It's really amazing to talk to someone who used to be well-adjusted, then sank into a paranoid, hallucinatory mental illness. What happened to them to make them that way? Sure, genetics is some of it, but we all have the potential to go nuts inside of us. It really makes me aware of my own coping mechanisms. I think I am, if nothing else, more self-aware after being around the mentally ill.

Just shows that everyone has something to teach us. Even people who are 100% positive that they are Jesus Christ.

Critical Care

I have absolutely loved Critical Care. I relish the challenges; everything about it is awesome. I can definitely see myself doing it, and listed all the ICUs as my first choice for preceptor placement.

That said, most of the class is failing Critical Care lecture. (I'm talking consistent class averages of 70%, where 80% is the lowest passing score). It's so bad that they've actually had to provide some additional opportunities for people to bring up their grades. Not bonus points, no, nothing like that. But they've adjusted test scores to omit "bad" questions more than once. That NEVER happens in nursing courses. It's shocking. I'm glad they're adjusting scores, but damn. I hope my friends pass.
Luckily, I was passing before the scores were adjusted. But then, when they gave multiple answers to some questions, my grade shot up to like a 90% (Which is fine by me. Most everyone I talk to is failing with a 78% or so).

My clinical instructor for Critical Care is like a younger and less experienced version of Instructor Fantastic. This is only her second semester of teaching, so she still has some things to learn. She tends to take on too much work and take some things too personally. But overall I think she's going to be a really great asset for that college; smart, passionate, but really dedicated to helping students learn.

I have a lot of respect for teachers who manage to prove they have all three of those characteristics. It's a rare combination, and is the reason I look up to Instructor Fantastic so much. One day I hope to go back to grad school. I hope to have my own chance to make those quiet affirmations about why we nurses must be ethical, excellent, and compassionate. How can we call ourselves moral human beings if we don't carry out our professional honorably? How can we expect anyone to treat us better than we have treated others?
(Of course I wouldn't say it in so many words. No one likes to toss around words like "honor" in casual conversation. But I'd hint at it in the way it has been hinted to me.)

Fatalism

I always get so irritated listening to students complaining after an exam.

I'm lucky in that I've never had a problem with test anxiety. If anything, I have test apathy. I always go into exams cold and leave equally unruffled, even if the test was ridiculously hard. Perhaps I'd worry more if I actually failed exams? But I digress; my point is that I don't feel any particular reason to become unhappy with my instructors after I take a test.

All around me I hear such negativism. Everyone talking about how the teachers are unfair, how they should be teaching differently, how they should mention what would be on the test more specifically. How the teachers should "give them" more points. I usually smile amiably to this and nod, but inside I'm always thinking "Wtf? Give? Your grade is nobody's responsibility except your own. You aren't a victim of fate."

This mentality is even more astounding since we have discussed it explicitly in psych class. Viewing oneself as a victim is an unhealthy way of coping with life. It only makes you depressed and prevents you from fixing your problems. I'm not saying I never get pissed off when I miss a question. But the person I get pissed at is myself for not studying more. Everyone can study more. Everyone can always do something more for a class and making a higher grade. If you think you can't, you're fooling yourself. (Especially if someone else in the class makes a 98%. You at least know it's possible then.)

Anxious to Stay, Anxious to Go

Summer semester starts May 14th and ends in the first week of August. And then that will be it. I will graduate Aaahhh! I have no idea what I'll be doing after that. My boyfriend graduates from UT in December, and I can't figure out what I'll be doing between August and the time he settles into a job. We've been apart for a couple years now, and frankly I'm eager to move to Texas and get on with my life.

At the same time, I don't want to build my life around another person. I want to begin my career and stay in a place long enough to become a strong member of the team. I want to save my money. I want to buy a car that doesn't scream like a dying cat as it wheels down the street. I want to learn and grow and be good at my job. I do not want to start work somewhere and suddenly pack up a few months later to go live in whatever city in which my boyfriend finds employment.

But I also don't want to be apart from the person I love any longer than I have to. I've been waiting such a long time... such a very long time.

I am introspective by nature, so I often question what it means to live a good life and be a worthwhile human being. It is difficult to weigh things like careers, money, love, family, and time while gazing out into my future. I can't say which takes priority right now, which pathway is the wisest.

I can only hope it becomes clearer in the next several months. I have found that having too many possibilities can be just as paralyzing as having none.

Fourth Level!

So. Third level was excellent for my GPA; one B, the rest As. Now it's time for the COOL stuff.

Fourth level focuses on Mental Health, Nursing Research, and Critical Care. I could care less about the first two, but I've been waiting all of college to get to the CC class. It's what I'm interested in and what I care about, so I'm enthusiastic about the semester.

General impressions after the first week:

Nursing research has the potential to be very interesting or very tedious. We basically have to do a big group project the whole semester. I'm trying to think up topics. In the past people have done stuff like studying and working and develop better practices of TB screenings on prison inmates (a population with relatively high TB). I have though of some interesting ideas, but I honestly don't see how they could be studied. Things like "If a student is employed as a Nurse Tech program while in school, does this affect their pass rates on the NCLEX in a positive way?" or even "How does the layout/structure of the nurses' station affect the quality of patient care?" (Is it better open or closed?)
Those kinds of questions can't have a proper control group on this small scale, so I can't compare anything. I'm looking around at work to see what other ideas jump out at me... but otherwise it's been slow going.
I can already see that the total freedom to chose, research, and pace my own study is going to be the most difficult part of the project. Managing time. I'm going to talk my group into meeting 3 hours a week rain or shine.

Orientation for Critical Care was great. I walked into the room only to be immediately handed a stack of ECG strips and taught how to analyze dysrhythmias. We just jumped right in on the first day. And much to my delight, this one class was taught by Instructor Fantastic! She won't be the usual instructor, but I always enjoy listening to her teach. She's smart and funny and loud enough to make things stick in my brain.

Mental Health was... um... interesting.
It's obvious that Instructor Psych knows a lot about taking care of mental health patients. And her anecdotal advice was very good; she'd illustrate principles of communication with really hilarious stories. But she also has some eccentricities that made me laugh. Right off the bat she told us there were definitely ghosts in the local psychiatric hospital. Also, she told us that she swears because we're going to hear it a lot on the mental health floors anyway. "And the first time I say 'fuck', I always get reported upstairs to the Dean!", she laughed. Oh my gosh! All my past instructors have had their eccentricities, but I can tell these lectures are going to be... colorful.

I did get my first level clinical instructor again as my Psych clinical instructor. She's sweet, so I'm glad.

I'll tell you how it goes. If I can find the time to post.

Misuse of Resources

I was always told I could do anything I dreamed. I tested out as a gifted student at an early age and have generally kept the company of "brainy" students my entire life. Many of my classmates and friends have already moved on to graduate study in their various fields, some even to medical school or law school. I am somewhat behind them, and will be completing my undergraduate degree after 11 semesters of study instead of the typical 8. (This is due to a combination nontransferable credits and some initial meandering through majors). Yet I am anticipating my graduation next August with great enthusiasm. I feel like becoming a nurse will be a real accomplishment. Though I'm still somewhat surprised to realize it, it is one of my dreams.

I often speak passionately to others about my calling. But this weekend, while I was visiting extended family and friends, I was somewhat deflated by their questions about my career. "Why aren't you going to medical school?" they'd ask.

I made a bunch of standard arguments, mostly centered around the saying "Doctors cure but nurses care". I explained that my desire is to work with people holistically and individually. I want to be present. And I am far more interested in the human elements of health care than the scientific ones. While doctors can do those things, nursing just feels like the best fit.

But none of these arguments seemed to phase them. They couldn't grasp why I'd become a nurse instead of a doctor when I was obviously bright enough to be the latter. They cited a myriad of reasons it would be better for me--most of which boiled down to a supposedly "superior lifestyle". But the one thing that really stuck with me was the phrase "Just wait, you will always be subject to people who are less than you."

I can't help but be upset by the entire perspective. It feels wrong on so many levels.

For one, I don't think a "smart person" going into nursing should be seen as a waste! If I succeed--and I plan to--it will only do credit to the profession, not discredit me. For another, I don't think money is a good reason to choose any career. And perhaps I am naive, but I haven't exactly found nurses to be totally subject to doctors. Nurses seek to be collaborators in patient care; this is the meaning of professionalism. True, some physicians still try to walk all over supportive staff. But people who work in hospitals know it's far less challenging to work with doctors than it is to work with patients! "Subject to those less than you"? Obviously! (Just not how you'd think!)

It's very discouraging to be told that you are, in essence, misapplying your potential. But the thing I think others are overlooking is the fact that my gifts aren't limited to the deduction logical puzzles or the intuitive grasp of certain subjects. So what if I took a test when I was a child that indicated I had some above-average abilities? I have developed others as an adult that are far more important to a meaningful life. They're the more immeasurable qualities of the heart... they compel me to extend my hand to strangers and to listen with compassion. I may not always succeed, but I am a person who is not only able, but willing!

Surely that means more than the money I could have made or the power I could have held. It's not a lack of ambition that set me on this path. It's because I feel like if I place more value on relationships than the other factors, I can't really go wrong. I will have enough money and responsibility. But I will have an abundance of friendship and respect.

Again, it is totally possible for doctors to be and do all the things I describe in addition to their regular jobs. But for nurses, that thing is their job. I watch them while I work. I see what each professional does. And I don't regret my choice, not even a little. Because I know who and what I am.

Mediocre Impressions

OB and Peds are okay. Upperclassmen always told me it was a "nice break", but I'm neither relieved nor inspired.

I'm a little frustrated; I study for OB and Peds equally but have an A in one and a C in the other. I partially blame the C on the ridiculous lecture format for that course. My instructor spends the first 45 minutes of each class talking about how to study and very little time actually talking about what it is we should be studying. More often than not diseases just... aren't discussed. It's frustrating; so Meredith, Cris, and I have started making up our own chapter outlines every week in an attempt to create USABLE notes. After classes on Thursday, we just park it in the library and don't leave until we finish reviewing everything.

I miss Instructor Incredible's class. At least I learned things in there, and never felt sleepy.

My clinical experiences have been somewhat disappointing as well. I spent several days in Labor and Delivery without seeing a single birth. Then, on my LAST day there I got to witness a C-section. It was horrifying to behold because the epidural... uh... well it wasn't working. That lady was kinda screaming and fighting them. They had to hold her down in order to push general anesthesia meds... but by the time they got her under, the surgeons were already cutting through the uterus. I observed all this while pressed up against the back wall with several other speechless students. Apparently this was a very unusual occurrence, but since it was the only live birth I've ever seen, my perceptions of the process will forever be skewed. This has only confirmed my extreme distaste for labor-type nursing.

Peds is disappointing mostly because I am being held on such a short leash. We aren't even giving meds! I understand the caution with which one must treat kids... but I feel like too much of my time is spent sitting idly by rather than providing care. Also, my patience with children is fairly thin, but my patience with parents is even less substantial.

In short, I'm not having the fabulous time I was used to having. That's probably more my fault than anyone else's. Therefore I'm going to have to work especially hard at observing Instructor Exhausted and Instructor Technology if I'm going to uncover the gems of wisdom I previously found so abundant. In the meantime, I look to my Nurse Tech job as a source of inspiration.

Back to School!

This semester is Peds and OB. I like my instructors sofar (though nobody will take the place of Instructor Fantastic in my heart).

I'm a little pissed off because I'm having to take a statistics class. It's not so bad by itself, but I already took Stat as a math class in Houston. But does the school want that credit? Noooo, they want Psychology Statistics. I've fought and pleaded. I've asked to take a test, but to no avail! Basically I'm paying them money to sit around and re-learn things I've already mastered. On top of that, I find that many nurses are none-to-bright about math, and the pace of study is agonizingly slow compared to the first go-round. Let's hope I don't go crazy. ^_^;;

I'm still working as a tech in the PCU. I'd never really considered PCU as a place to start a nursing career, but it's becoming more appealing all the time. First of all, the patient ratio is lower than Med-Surg, but the patients aren't quite as critical as in the ICU. Secondly, the hospital is interested in "cross-training" people in ICU and ER skills in order to provide more options for "floating" extra staff in times of low census. Thirdly, I like the floor I'm on, and wouldn't mind working with these people in a larger capacity.

I've always been far more interested in critical care than anything else, mostly because I'm not too fond of children or surgery or the like. And I want to be in a place that will challenge me and keep me on my toes. Still keeping my options open, but it looks like this hospital has accomplished it's own goals by recruiting me for this job: getting me comfortable with this facility and reeling me in for employment after graduation.

We'll see how things work out when I graduate. If I don't end up in Texas, I really hope I end up right where I am.

Tomorrow I'm going to spend clinicals in Labor and Delivery. I reaallly hope a baby is born in the time that I am there, because I feel like that would be much more exciting than just hanging out with a woman moaning in labor for 8 hours. o_O

Taken two tests sofar. I actually made an A on the second one! (I'd almost forgotten how it felt to make A's on big tests with this funky grading scale!) My extra preparation is paying off. I'm making time to read the chapters before lecture and staying at least 2 hours afterwards in the library for review. And that works. (Well... except when a question is vague or weird. But that's not my problem.)

I really really want to do well this semester so I can increase those decimals after the 3 in my nursing gpa. I want to be inducted into Sigma Theta Tau! They only take the upper percent of the class, so I don't know what my chances are. If I keep making As though, maybe they'll improve. ^_^

The Only Ones Who Can

"I'll need help getting this one to take a bath. She swears and refuses every time I come in the room."

I agreed to help the other tech with her difficult patient.

The woman in question was slouched in her chair. When the other tech asked if she was ready to bathe yet, the woman swore and pleaded to be put back in bed. The tech looked at me with smug "I told you so" eyes.

The nurse came in and told the patient she had doctor orders to stay in the chair for another 3 hours. The woman yelled and demanded to be put back to bed.

I leaned down to look at the woman. "You look pretty uncomfortable. Here, why don't you let me put your feet up? Here, you dropped your PCA button. Why don't you give it a push? Your gown is all twisted. Why don't you let me put on a fresh one? While we're changing, why don't I wash up under your arms? I'll wash your legs too. We can save the rest for when you get back in bed."

The woman grasped my at arm and said "You're not made for this, honey."
"What do you mean?" I asked.
"You don't walk away."
"I can't walk away until I get you a little more comfortable, can I?"
The woman didn't swear the rest of the shift.

I'm not saying that all problems can be solved by a little extra attention. But if nothing else can be gained from my short little story, I want to impress upon anyone who reads the idea that anger and rudeness in patients is often misdirected pain. Humans aren't naturally mean-spirited; we care too much about what others think of us to be coarse. We want to be thought well of, so we treat people politely. A patient who is less than polite has either been treated poorly, or is hurting.

Spending a few minutes to make a person more comfortable can make all the difference. Sometimes all people need is a sympathetic ear. I have won over more disagreeable people than I can count simply by listening. It works with coworkers. It works with superiors. It works with perfect strangers. The key to solving the problem lies in not taking things personally. It is important--essential!--for nurses and techs to try to approach patients with a firm respect for their inherent worth as individuals. If we can't try to see where they're coming from, we are not fit to serve them.

It frightens me to think of how that woman's day would have gone if I'd not agreed to help bathe her. She was in absolute agony sitting the way she was, and the other tech was too insulted to see how it needed fixing. That's why I think nursing isn't only my calling, but my duty. If there aren't people like me out there to advocate the patient and listen carefully to their needs... who will?

Nothing is worse than a dismissive or judgemental caretaker.

The Importance of Meaningful Work

I've been working as a Nurse Tech for the PCU for over a month now. And I must say that my impressions thusfar have been favorable, both of the hospital as well as the floor. Yet, before I go any further, I want to tell you something very important I have realized these last few weeks:

Working as a tech is an invaluable foundation for your nursing career!! I highly advise all nursing students to take on a part time job as a tech or aide!!

Make no mistake, tech work isn't easy. It's sweaty and gritty and filthy and exhausting. I often spend 10-12 hours a day on my feet (Which was quite an adjustment for me; I had to buy inserts for some new shoes just to keep from having muscle pain. I've lost a few pounds from the walking). But I feel like it is fundamentally important to nursing care. I feel like, if I can do this part, I can do anything.

And honestly, if you aren't prepared to do the "worst parts" of the job, how can you be expected to do a good job at the easier parts?

The thing I love most about my work is the people I get to talk to. Of my few gifts, I feel that reading people and ministering to their emotional hurt is the most important and relevant for my daily life. Sometimes healthcare workers forget to look at a patient holistically. While I am caring for the body, I also place great value on caring for the mind and spirit. It is SO easy to write people off because of their behavior. It's easy to forget that people are human beings, not just diseases. Every time I go in a room, I take time to hear the person's story (because everyone likes to talk about their health). I feel it is making me not only stronger, but kinder.

But beyond direct patient experience, this job has been good for learning more how the hospital works. I am sent from place to place on various errands, and am finding out where things are located and how to get things done. The nurses often pull me into a room to watch procedures, so I'm gaining extra "class time" of a sort. And, lastly, I am making connections that will prove valuable for my future preceptorships and job interviews.

The only real downside is that I wake up early and am often tired at the end of the day. But I'm a somewhat soft person, so I can't complain too much if my body hurts simply because I'm out of shape.

School starts in the middle of August, so I'll keep you updated on how this job works out for me during the new semester ^_^

I Have a Job

Finally got hired as a Student Nurse Tech in a PCU. Won't start for a couple weeks. Waiting for HR to call and schedule a physical with me, so they can be sure I'm not a) diseased b) addicted c) disabled d) insane, etc.

Bummer, I need some money now.

I Need a Job

I've been trying to get a job as a student nurse tech. Unfortunately it's very competitive... because the hospital is located right next to the school. EVERYONE applied.

I interviewed for the ER spot and didn't make it. I have another interview for the PCU, and here's hoping I make that one. Unfortunately the interview isn't until June 5th. Crap, I REALLY want this job. But I feel like half the summer is going to be gone before I get hired anywhere. I'd look other places, but I don't want to commit somewhere only to be called back in.

This is really lame. My scholarship ran out last semester, so I need some serious money before fall.

I'm getting very impatient.

Tips for Nursing School

A lot of people have posted comments or emailed me about their studies.

You guys ask "I am applying to clinicals next semester, what should I do?"
or "I'm about to take class X, is it hard?"
or "How did you know this was what you wanted to do?"
etc...

Well, I've been thinking about what I've learned over the last year and I think it's time I gave you some insider information. Here's a few things I've learned that may or may not help you out in school.

1) If you are thinking about going to nursing school but aren't there yet, volunteer at the hospital. I'm serious, it's not just for old ladies and community organizations. I was privileged enough to volunteer for a couple semesters at Hermann Memorial Hospital in downtown Houston. The place was massive and they had everything imaginable over ten floors in several buildings. I got to wander around all over the place and meet doctors and nurses and therapists of every kind. I got to see what the job was really like. It focused my goals.

Another solution would be to get a part time or summer job working in a hospital, though these are sometimes harder to come by. I have several friends who work as unit clerks or pharmacy techs... good jobs but not nursing jobs. I'm applying for a student nurse tech position for the summer... but I wasn't even eligible for it until I completed 2 semesters of clinicals. For students, hospital jobs can serve to ease your transition into the working world (if you can handle the extra stress). But they might not be the best way to feel out nursing as a potential major.

In any case, you can't really know if you want to do it without spending time in the hospital.

2) Go ahead and buy an NCLEX review book at the beginning of clinicals. Look on Amazon and try to find the one with the highest rating, especially one that has questions sorted out by topic with rationales for the answers. (Also, some instructors pull questions from review books... but that's not why I'm mentioning it.)

The thing about the NCLEX is that it asks you questions based on your ability and adapts to your level. The passing questions are based on synthesis and critical thinking, not recognition and recall. Sure, if you keep answering questions incorrectly the computer will eventually start asking you where the liver is. But you have to answer a minimum number of difficult questions to pass. You can answer every single anatomy question correctly from here to infinity and never meet the minimum requirements.

If you are attending a good nursing school, your instructors will try to format their test questions similarly to the passing NCLEX questions. They won't ask "What is this disease" as much as they will ask "What is the priority thing you need to watch when a person has this disease?" They won't ask "What does this medicine treat?" so much as they will ask "What lab value do you need to monitor when these two medicines are combined?" This principle should hold true for any course, so when you study you should try to think on a higher level than simple fact regurgitation. A review book might help you anticipate the kinds of questions your teacher will ask. Even if you never see the exact questions on your tests... you'll be more prepared for boards upon graduation.

3) Don't study for the grades. I know it sounds ridiculous, but your goal in studying shouldn't be to make A's. Studying isn't a product-oriented activity. It is process-oriented.

What good is school if you only cram enough facts in your head to pass a test? What good is your education if you stay up all night before each exam trying to store just enough info in short term memory to bump your grade up a letter? That kind of behavior was okay for English and Psychology... those things aren't your major. But nursing is something you'll have to do every day for work, and your mistakes won't take the form of typos. They'll take the form of injuries and deaths.

I know it isn't easy to do; we're all busy people. But if you make it your habit to reread the week's notes every day... if you make it your habit to learn and retain a little information each time... you'll gain more than class credit. You'll gain competency. Powerpoint is destroying our ability to take notes and listen actively. Printing out the slide handouts isn't enough.

Okay, so some of school is silly and useless. Something you have to get through before you go out into the real world and learn how things are done. Still, constant efforts really will carry you farther in life than intelligence alone. It becomes a matter of discipline and will.

4) Take time to play. But don't do it all the time. Some days you're just going to have to work hard from sun up to sundown. Just remember to relax on weekends. Take time to exercise. That freshman fifteen wasn't your birth control. It was your metabolism slowing down. Even if you only go for a walk on the weekend, it's better than nothing. Don't drink too much. Try to get off the caffeine and cigarettes. You're going to be a nurse; set a good example. The immediate gratification will cost more in the long run.

~~~
That's enough for now. More tips as I learn them.

One more thing: do you have a nursing/health blog or website? I know a lot of you read me but I haven't gotten around to reading linking you. Just post a comment with your URL, I'll check out your site and add you if I like what you have to say.

A Series of Ridiculous Situations

You want anecdotes? I HAVE anecdotes.

Act I: The Project
I recently completed a final project in pharmacology. We were assigned in groups and given a MAR (med administration record) listing 10 drug orders. From this list alone we had to figure out the patient's many medical diagnoses, develop a plan of care, and uncover the various mistakes, interactions, and risks associated with the given orders.

It was nightmarish to say the least, but we got it done. Everyone ended up arguing over why the person wasn't on Lasix, and whether we should point out the combination of a "-pril" and a "-tan" as a mistake even though we have seen this combo in the hospital before... well anyway I don't want to get into a bunch of jargon. The list of stuff goes on and on. The point was that it was a freaking hard assignment. The good thing is I really feel like my studies this semester prepared me well.

But there was something Pharmacology didn't prepare me for...

Act II: The Standardized Test
Each semester we are expected to pass a series of ATI Exams before moving on the next level. ATI scores don't affect our grade. They just provide benchmarks to gauge our competency and predict our NCLEX scores. I finished up the Fundamentals exam last week and took the Pharmacology one today. You only have to make a 65% to pass (which may seem low until you consider the fact that the national average is only 63%).

I took a few practice tests to warm up. Scored in the high 70s, so I figured I was safe. Even when I missed a question on the practice test, my second choice was usually right. I waited outside the computer lab with confidence...

...until student after student came out looking dismayed. "Failed it by one question" they'd say. Ack! Apparently the class was right on par with the national average. When I finally logged in and began my own test, I had that sinking feeling of impending doom. I had never even heard the names of several of the medications before. I guessed many, MANY times at the answers. The proctor caught my expression and came over to pat me on the back. "Take your time, Heather! Everything will be okay."

I looked up at her sadly as I hit the score button. "I know I did horribly. I was only certain of about 10 of those answers". She glanced down at the screen and made a noise of delight, and my eyes followed hers. I'd made an 80%. Apparently it was one of the highest scores in the class.

After the initial shock my first reaction was anger. "This is stupid!" I said. "There is no way this is an accurate score of my ability! There is no way this will indicate my success rate on the NCLEX! I guessed on almost everything!"
"Maybe you're a really good guesser then. It's impossible to know the effects of all the drugs. You've learned HOW to think about them this semester, so you can apply it to the others."
"No. That's not good enough." I said. And it's true; we're dealing with people's lives here. I need to know what side effects go with these medications. I know I can't expect to learn it all immediately, but damn it, I don't want to make a "good guess" about toxicity symptoms. I want to have time to learn it now. But there isn't time.

She was unphased. "You know best what you need to study. Do that, and don't worry about it."

So I guess I won't worry about it. Still makes me angry though. That test is flawed. A big mistake.

But not as big a mistake as my last story...

Act III: The Shirt
My friend Meredith and her girlfriend Cris have started making tie-dye. Anytime Meredith gets excited over something cool she HAS to share it with people, so on the last day of clinicals Meredith brought her latest tie-dye shirt for our inspection. She described the process of creating the tiny folds just so in order to make the intricate zig-zag pattern across the front. She spent days on it. It was a cool shirt, as tie-dye shirts go. We were all proud.

We took Instructor Sarcastic (also known as Instructor Incredible) out for lunch on the last day of clinicals. We gave her some gifts and a card to let her know we appreciated her teaching. I made her this little picture and all of us signed it:
(Everyone thought it was cute. I might use something like it for SNA shirts next year. What do you think?)

But anyway, back to the story:
Meredith wanted to show off her tie-dyed shirt, so she held it up for our instructor to see. Instructor Incredible smiled with delight. "Oh! Thank you!" she said.

What a sad misunderstanding! I could see Meredith's face fall as she realized that she wasn't getting her shirt back. Everyone at the table got big eyes and looked over at her. No one knew what to say. Of course, it wasn't exactly the best timing on her part. And she has a way of handing things to people that somehow conveys a finality... but still! Her pride and joy, mistakenly gifted away. I don't think she even got to wear it once. Instructor Incredible, on the other hand was thrilled. She pulled it over her head immediately and praised it and profusely.

Meredith has a really sweet heart, she just smiled and said "You're welcome"... and let it go. There will be others, after all. Later, when I asked her how her day was, she looked at me flatly. "I lost a shirt."
"Look on the bright side," the others intoned. "Maybe this will help your clinical grade a little?"

Meredith laughed.

The lesson of all this kids? Study hard, study hard, and keep smiling.

Good luck on your finals everyone!