Adult Med-Surg....Check.

Well, I finally made it. I passed my cardio unit exam with a (yes, you guessed it) a 76. Somehow I don’t seem to be able to get into that B range in this class. That put me needing 75 points to get a B in the class and only needing 25 to keep my C. Today’s final provided me with 51 points. At least I made an A in clinical. I have to admit that this has been the most difficult semester for me ever. That includes all of my “artistic” training years ago. No matter how much I tried, it just seemed that I could not learn all of the knowledge base I needed to know for the application portions of the exams.

I’ve got my course information for next semester (babies and mommies) and my books are on the way. I have a good nursing teacher friend who is able to provide me with free books for next semester…yea! Now if I could just figure out how to use them to benefit my grade. Any study tips from my readers are more than welcome. I’ll be able to get some of the reading done during the Christmas break.

I am looking forward to five weeks of R&R, Review, and Preparation for the next semester.

-DV

The End is Near

With this semester fast approaching, I look back and have to wonder where the time went. I completed the last of my clinical paperwork a week ago Friday (the day after Thanksgiving) and presented my paper to my clinical group on Thursday. Now that that is done all I have left is one more lecture in my cardiovascular unit followed by the unit exam on Wednesday. Then the biggie....a comprehensive final next Monday. There is still a chance for me to get a B in theory. I'm really hoping that the stars align for me and it works out. However, if not, I'm still in good shape for a C. Yes, it would suck just a little, but I'll be okay with that.

Tuesday is out last day in clinical and our instructor is allowing us to attend observation areas for the day. I have really enjoyed every area that I've been to except respiratory. I'm not too interested in doing that again. Also there will be opportunities for cath lab and wound care that day. Guess I'll have to wait and see where I end up.

I've been pretty stressed out lately with crazy family happenings (always during the holidays) and school, work and the like. I hope that all of this stress will go away after next weeks exams. I have been having some issues with my blood pressure lately. This summer I went to the dentist and they checked it (139/90). I figured it was just because I was in the dentist office for the first time in a while. I went again in October...still high. Then all last month I started checking my BP myself. It hasn't been below 130/90. During the last couple of weeks I've been having mild headaches daily along with fatigue and not sleeping well. I really don't want to have to deal with this type of problem, so I'll see how things go when the semester ends. Unfortunately, both of my parents have a history of hypertension and heart disease so it looks like I'm going to have to be really careful. I'm not even 40 yet and I exercise 3 times a week (typically). Now I could stand to lose a few pounds (15-20) but still, I'm not ready to be a patient. It's probably psychosomatic. Yes, that's it. It's all in my head. At least that's what I'll keep telling myself for another week and a half.

-DV

Recovery

I wasn’t too sure about going to the PACU today. I’ve heard reports from other students that the PACU is pretty boring mostly because of the delay in getting any patients. However, I actually had a very positive experience today. Admittedly, the first hour and a half was slow. The charge nurse told me that I was welcome to study until patients started coming in from surgery. Fortunately, I came prepared with my books and notes from class. After a while I was finally assigned to a nurse for when patients started coming in. I lucked out and got a really good staff nurse who immediately started showing me around and asking me if I had any questions. She was able to explain to me the processes for assigning patients to nurses in the PACU. She also made sure that I was able to have something to do when patients came through like getting them hooked up to the monitors. She was careful to explain all of her charting as well. Our first patient was a port placement, so that wasn’t very tough. He was pretty much fully conscious when he got to us. The story he told us about his brain tumor was very touching. Basically it all happened in the last year and he had to quit work as a highly educated professional. It must be very difficult going through an illness like this. After about thirty minutes we accompanied him to his room and came back to the PACU. A while later our next patient came. This is where things started to become very interesting. He was an open heart surgery patient who had a history of drug abuse. Basically, he came in yelling and continued to yell the entire time I was there. He was calling for his “momma” and yelling that “it hurts, I’m gonna die!” Mind you he was 39 years old and the morphine we were giving him I’m sure wasn’t nearly as effective as what he took out on the streets. Still, he was kind of being a big baby about it. I suppose “Be quiet and suck it up” would not be a very good example of therapeutic communication. I have to admit, I like patients like this. It makes for an interesting day. Maybe I’ll change my mind once I become a real nurse.

-DV

Pee, Pee, Pee

It’s the Tuesday before Thanksgiving. I am really looking forward to my day off. I came in this morning and got report on several patients and was able to pick out two that seemed like they would be good candidates for a student nurse. Patient number one – elderly woman admitted last evening for TIA’s. Patient number two – middle aged Hispanic man admitted last week for abdominal pain and is one day post-op for cholecystectomy. Patient number one had a ton of meds and I forgot my blank med sheets today. Great! Patient number two only had one IVP so I was saved. I was able to administer a couple of early meds to my first patients before she was wheeled off for testing, never to be seen or heard from again (until right before I finished my shift.) While she was away I was able to catch up on her meds for when she returned. That was a blessing; unfortunately, I was never able to administer them to her. I was ready though. My other patient was pretty easy to take care of. I was able to help him walk around the unit once and assisted him to pee three times. That was the extent of my day. While I am sure that helping patients pee is noble in and of itself, it does make for a rather long day when there isn’t much else going on.

I did try to help the guy that was blind and deaf. That’s a sitcom waiting to happen. During report the staff nurse and I were told that he could write on your hand to communicate and that if needed an interpreter could be called. I heard his IV alarm going off and went in to check on it. It looked like he was trying to ask for some help so I let him know I was there by touching his arm. He took my hand and proceeded to write “PRXHG===HATYlQ” (at least that’s what I was able to make out). It is quite possible that I could use some training in tactile spelling. I called the tech in and she was able to make out that he wanted a bath even though he had had one the evening before (so she said).

Later that morning, one of the other staff nurses on my wing said that she had some IV changes later and that I was welcome to do them with her if I wanted. I of course said yes, but ultimately they were done after I had to leave. Also, the “flu shot lady” came around giving vaccines to staff that needed them. The nurse I was with today needed one. I promptly asked if I could give it to her and she promptly declined. She said it wasn’t anything personal, but I’m pretty sure it was.

-DV

OR Rotation

I was really looking forward to spending time in the OR today. Previously, I had observed a laparoscopic PEG tube placement, and that was pretty interesting. Today I observed a chemotherapy port placement and 1 ½ laparoscopic cholecystectomies. (I had to leave for post conference before the second was complete.) I was pretty disappointed during the port placement. Because of the x-ray use I had to be out of the room for much of the procedure. Also, it was a very tight fit for the necessary personnel who needed to be close to the patient, so I was kind of out of luck on this one. Next came the gallbladder removal. I had some idea of what was going to happen due to my previous OR observation. Indeed, the gallbladder is not a bright green color like it is in all of the text books. Having had this same procedure done myself a couple of years ago I was very curious as to how everything really happened. I am always amazed at how “simplistic” surgeries are when I see them. Everyone always thinks that operations are so complex, but really, surgeons are just “fancy people plumbers.” If you look through some basic home repair books and an anatomy textbook, you could probably have a pretty good idea as to what to do, where to go, and what to take out. Seeing as how there were two cholecystectomies today, I thought about asking if I could do the next one…. “See one, do one, teach one” right? Okay, maybe I am being a little simplistic here, but still, it seems pretty basic. Maybe good surgeons just make it look easy.

As far as my observation of the circulating nurse, I am pretty sure that position is not for me. I really like to be a bit more hands on. All of the charting that has to be done just does not sound like fun to me. I would much rather be assisting the physician or doing my own procedures. However, when my assigned RN went to lunch, she was replaced by another RN who said that she had always wanted to be an OR nurse. She started as a scrub tech and went directly into an RN program. She had never worked on med-surg and started after she graduated in the OR. It takes all kinds. I am really glad there are people like her who enjoy that aspect of nursing. As of right now, I am still pretty unsure of where I would like to end up some day.

All in all, today’s observation was a good experience. However, I am hoping for a little more blood on Thursday. Does that make me weird?

-DV

Man Down...

Only 2 hours (lecture) into my cardiovascular section and I'm already behind. It's going to be a long four weeks.

-DV

I failed, but then I didn’t.

This last test over respiratory was a big kick in the seat of my pants. On my previous tests, you may remember that I scored 78% on both. My efforts to make that grade were very substantial. For the second test I studied really, really, really hard; harder than for the first test. For my respiratory test, I decided that maybe I was trying too hard. My grade did not improve and I had no extra time to do anything. My respiratory lectures were going well and I felt like I really understood the information. It was time for a new strategy. I decided to take it a little easier and not try so hard. That didn’t work. Initially, I ended up with a 68%. I was pretty average with the rest of the class from what I understand. I heard several students coming out of the testing center stating that this was the hardest test so far. Many had made 70%. By the time I got home I had decided to go back to studying like I had been and just hope for the best. About an hour after I got home, grades were posted to our online accounts. 74% WooHoo!!! I passed. My decreased efforts only cost me 4 points. Two of the questions were thrown out and two answers were accepted on another question.

I was pretty determined to start studying for cardiovascular ASAP. After looking at the reading assignments and all of the study materials I need to get through before the next test I realized that it will not be possible to make it through every word in the text. After some deliberation I’ve decided on another method of studying that I think will make more sense. It’s really about knowing what to do as a nurse if any of these diseases or medications makes it onto your floor. That will be my focus for the next three weeks. Reading just for readings sake just isn’t cutting it for me. Let’s hope for the best on the next test.

-DV

2:1

Today was my first day with two patients. It was also my first day to take care of patients on the fly without any preparation the day before. Suffice it to say that I was extremely busy this morning after I got report and picked out my two patients. It was nice having the evening before off, but the work it created the next day was a bit daunting. I had all of my med sheets with me and only had to look up three new meds for the patients I had chosen. I felt very lucky. After checking in on my patients I proceeded to look at what I was going to have to take care of for the morning. I had a couple of 0730 meds followed by 0900 meds so I needed to prepare for the first two. I still forget some of the little things like which labs to look up for certain meds. I hope that will come with more practice. The RN that was on my wing was very helpful today though at times I felt a little pressured by her. She would ask if I was ready to give meds 30 min before they were due. I know that is an allowable time, but I felt a little rushed. I am pretty sure that she just wanted to get on with her job too. She would ask me questions about what was going on with the patient as well and what I thought was causing it, what labs to look at, etc. In general she grilled me pretty good at times, but I like that sort of thing. At the time, it is a little unnerving, but it really makes me think about what I am doing. Ultimately, I actually learn something from nurses and instructors like that so I do not mind when that happens.

Overall, the day went by very fast. I was pretty much as prepared as I could be and will try to stay prepared for Thursday when I have to do it again. Little mistakes happened all morning so hopefully Thursday will go smoother. I have to admit, I do not know how RN’s do it with 7-8 patients at a time. Time management is something that apparently has to be learned.

-DV

Spider-Man for a Day

Today I was the "Nurse Manager" for my clinical group. It was also the first day for the clinical group to NOT pick patients the day before actual care. It was quite a sprint for the first couple of hours. After reviewing some of the care plans with my instructor I went upstairs to the floor to check on my peers and see how they were doing. I was not able to find anyone at first. We where an hour into clinical and there was no patient care begin given. I eventually found three of the students in the break room filling out paperwork. While they were getting work done (the work that they were supposed to be doing), I am surprised that they were not near the patient rooms getting this work done. As a RN, we will not be able to get our paperwork done in the convenience of the break room. We will be on the floor getting interrupted by call lights, coworkers, family members and other various situations that arise. I am a proponent of being where you are supposed to be when you need to be there. Occasionally, this does not happen: you go to the restroom, you are helping another person in another room, you are observing other procedures in other rooms or other parts of the hospital, etc. However, for the most part, as a student nurse, you need to be seen by faculty, staff and other students doing the work and being available for patient care, nurse assistance, etc. Basically, you have to make yourself look good in front of others. That was my soapbox. Now I will step down.

On my part, I think that I could have served my peers more today. After seeing the stress that many of them were put under today, I think that I could have offered to assist them more. The leadership position is not about the glory of the title, but it is about serving and being an available reference for others. I have to admit that I did not give everyone in my clinical group the amount of time that they needed. Some I could have given less, others more. I had a very basic understand of the patient needs after visiting with the other students, but to be in that position every day would require a little more diligence on my part to make sure that everyone is receiving appropriate nursing care. Today was about diving in and just seeing what it is really like when you are responsible for more than just yourself. I hope that more opportunities like this come up. I would like to practice my leadership skills a little more in an informal situation. I suppose that these skills do not have to be practiced just in the hospital; they can really be practiced in the classroom, the home or in the community. That reminds me of a really good quote…

“With great power, comes great responsibility.”
Peter Parker
a.k.a. Spider-Man

-DV

Lots of Fluid

I started the day today on a different floor. It was pretty easy to find my way around. I was surprised to find out that there was only one nurse on my wing. When I was on the other floor, there were two nurses on each wing. It does look, however, that there may be fewer rooms per wing on this floor. The nurse I was with today had five patients and was very busy. She did not seem all that interested in showing me the ropes or teaching me about the things she was working on so I was pretty much on my own. At this point in the semester I am not too worried about that, but it is always nice to have someone who knows and cares that you are here to learn. Having been a teacher in a past life, I am sure that I will naturally be able to grab a nursing student and have them learn from me in the future. (At least I hope so.)

My patient today went to radiology to have a paracentesis performed to remove fluid from his abdomen. He had had the procedure performed a few days earlier and the physician removed 4L. I was thinking that there was no way they would remove that much today, but sure enough, they drained another 4L. I cannot imagine carrying around that much extra fluid. That is two 2-liters of soda. I am pretty sure there was more to get as well, but the doctor only ordered 3-4 L of drainage. I was very fortunate that my patient is very nice and easy to talk to. Someday, I am sure that this will not be the case. He has pretty much let himself go during the last 20 or so years. He has not seen a doctor and has ignored major medical problems such as the skin ulcers on his calves. Either he has been very healthy up to this point in his life or he is just waiting for his problems to go away. I have seen many people who ignore health problems. Now that I am entering a healthcare profession I can really see what kinds of problems this causes in the future. Fortunately, my family is coming around to asking me about their health problems. I do not always have answers, but I can tell them that thy need to seek out professional advice. I can usually convince them that following up on health issues will prevent complications later on by telling them about some of the issues I have learned about in my training.

On the lighter side of things, our clinical paperwork has been reduced and I can rejoice. A little extra time studying theory class would certainly be helpful. I still have to prepare for patient care, but the extra work later in the week makes life not quit so daunting. This makes the fact that the end of the semester is not quit in sight yet not as bad.

-DV

Watch Out for Air Bubbles

Today was a very long day. However, it was also very productive. Coming off of the second theory exam the last thing I wanted to do was get up early and go to the hospital. I would have much rather stayed in bed all day. I am sure that I will feel that way many times when I become a fulltime RN. My patient today was a very nice elderly woman in the hospital for a bowel perforation and hiatal hernia. She had had her surgery the night before and was just waking up when the staff nurse and I went in for our assessments. She was having some abdominal pain and we started checking out the PCA. The staff nurse said, “Oh, I like to set up the tubing a little different. Everybody does things differently and I just like things to be a certain way.” After a couple minutes of unhooking and re-hooking the patient up to her TPN, NS, and Morphine we left the room. As soon as we left the room the staff nurse told me what was going on. The lines were full of air and were going directly into the patients veins like that. The staff nurse was obviously upset about what she had just had to do, but she was extremely calm and professional while in the room with the patient. She reported the problem to the nurse manager and documented what she had done. Despite the obvious danger that the patient was in, I am very glad to have witnessed the staff nurse in this situation. It taught me how important it is to assess the lines at the beginning of the shift. It taught me things to watch for when I set up tubing, and it taught me how to act in perilous situations that present themselves while the patient is watching or listening. It is so good to be able to see a really good nurse in action. So many of the nurses I have seen during my clinical times have been mediocre at best and some have been just plain awful. I really hope that when I get a job and a preceptor, that the person training me is like the staff nurse I worked with today.

On a technical note, today I was able to hang my first IVPB. Not a huge deal, but it is one of those things that is kind of fun when you finally get to do it for real. I am beginning to find out (after many years) that I am a kinesthetic learner. I have tried for a very long time to figure out how I learn the best, and now I am pretty sure that actually performing skills is a much better way for me to learn than listening or watching. Once I have done something once or twice, I pretty much have it.

I really hope that my next clinical day goes as well as today. Despite the fact that I was really tired today, I was able to learn a lot while at the same time enjoying what I was doing. Days like today are a good prescription for recovery from days like yesterday.


-DV

Nursing School Tests

For the life of me, I don't know that I'll ever understand test questions in nursing school. "Which one of these four wrong answers is the least wrong?" God help me!

My first test this semester I made a 78%. I had studied my butt off to no avail. I have simply come to the conclusion that the amount of time spent studying for nursing school tests is not directly proportional to the grade that you will receive. So after the last test I decided that I was not going to study nearly as much for the next test because I would probably do just as well. My next test is in about one and a half hours. I studied about 3 times as much for this test. I just couldn't not study. I can only imagine what would happen to my test grade without studying. I'm sure it would end up somewhere in the pits of the negative scale. So here's hoping that the extra time I spent this time around will be worth the effort.

If not I'm not studying for the next one.

-DV


Update: Dammit......78 again!

(Sigh....)

So nursing school has apparently been a little bad for me. I've gained about 15 pounds since starting last spring. Looks like I'm going to have to lay off the donuts for a while. Dammit!

I still run when I can. Lately it's 3 times a week before theory, but eating is a huge problem. Too much junk. Here's the challenge... Run at least 10 miles a week and work up to 100 push-ups in one set. The running is not much of a problem. That's pretty much what I do already. I can pump out about 35 push-ups if I'm fresh.

Ready-set-go!

-DV

Edit: Friday, Oct. 15, 2010. Today I ran 4 miles (that's a total of 10 miles for this week. I also did 95 push-ups in 5 sets) Now if I can just stay away from the Cheezy Poofs!

In One End, In the Other

Today I looked at people from one end to the other, quite literally. The endoscopy lab was pretty interesting. They were very busy when I got up to the floor and didn’t really have time to do anything with me until about 7:15 when the procedures started. Hindsight being what it is, I wish I had been more proactive in admitting patients with one of the RN’s. Not that there was very much to do with admitting patients to the endoscopy lab, but I would have at least observed a couple of lines started. The unit manager was pretty good about keeping me in a room all morning. He first led me to a colonoscopy. I was really surprised at how small the procedure room was. I had always thought that it would something like an operating room, but it was more like a large doctors’ office. I was able to watch the monitor very easily and observe the RN and the physician without any trouble. The doctors were happy to point out any anatomy that I was interested in seeing. Surprisingly I was able to identify most of what I saw. I guess all that studying in A&P paid off. I was also able to observe a couple of EGD’s and EUS’s. During the EUS the physician pointed out the anatomy on the sonogram for me. While I didn’t really “see” the organs he was pointing out, I can see how if you view the sonograms enough you would be able to point out landmarks and visualize the various organs. The thing I really wish would have happened more (in all of my on site training) is narrative of what was going on, what we are seeing, what we are looking for during these procedures. I hope that when I have a job as an RN and I have students around that I am able to teach while I work. I understand that the doctors and nurses are busy, but it doesn’t really take that much effort to take the reigns and help the students learn about what is going on. One of the doctors did this for me during one of the procedures today and it was really helpful. I know that I can ask questions, but sometimes I am not sure what to ask or I am not sure if it is a good time to ask questions. I suppose some people are natural teachers and some are not. As a student, you just have to hope for the best.

Overall, today was productive in that I was able to see many of the diagnostic procedures that I have studied in the texts. It is good to really know what happens now.

First Time in OR

Today I had just gone up to the floor to get report on my patient when I noticed that he was not in his room. I went to the nurses’ station where the two nurses were going over report and they said that he had just gone down to have a PEG tube place. Oh noooooooo. Fortunately, I was allowed to go into the OR and observe. I was given a set of scrubs and then I was taken to the OR where my patient would be having his procedure. The RN I was working with today was very helpful. She took me to the pre-op room where it was VERY busy. I would assume that the morning shift is usually that way. It was interesting to observe everything that was going on. My patient was missing a consent for anesthesia. The RN that was assigned to him during pre-op was busy with another patient and eventually came over to get the consent signed. After all of the consents were signed we took him to the OR where he was treated to a nice mixture of meds to make him very sleepy. It is always amazing to me how fast theses meds work. I no time at all he was being intubated. The procedure was really amazing to me. It always seems like surgery is such a complicated procedure, but really it’s all basic pluming or carpentry. You’re just using more expensive equipment and you’re working on a human. I was surprised at the roll of the RN during the procedure. Mostly, she was charting the whole time. She had to chart all of the pre-op procedures, the staff, the equipment used during the procedure, the meds used, etc. Occasionally she would adjust the CO2 or the lighting, but other than that, she charted. I understand that charting is very important, but I’m pretty sure I am not interested in spending my days charting what other people are doing. After the PEG tube was placed a muscle biopsy had to be performed. That looked like it was going to hurt tomorrow!

After observing the OR today, I have a much better appreciation for what the med-surge floor nurses need to be doing for their patients. I can see how infection would be a really bid deal and how it is important to assess your patient once he/she is back onto the floor. I also have a better appreciation for good shoes. Standing in place all day on a hard floor isn’t easy on the feet!

-DV

I Didn't Pass Out

This morning I was greeted by an elderly woman who really needed to get out of the hospital, so she thought. When I got to the floor and finished report a sitter in one of the patients’ rooms was getting off duty and had to leave for another job. The staff nurses really had no one available to watch the patient and they finally asked me if I could stay with her for while they drew up the meds for her agitation. I was happy to oblige and ended up staying with this patient for about 45 minutes. The only way she would not try and crawl out of the bed was if I was holding her hand. After getting her sedated and the bed monitor turned on she was happily resting, but she still wanted me to hold her hand. I would try and let go, but she would awaken and get very agitated again. Eventually she was so drowsy that she just couldn’t bring herself to try and get out of bed after I let go, but I still stayed with her. Soon after she started resting, her husband came in to visit. He spoke with the staff nurse for a minute and then sat down with his wife. He spoke with me for a few minutes while he sat. Come to find out, he was going to take her to a nursing home after she was released later that day. This couple had been married for nearly years and he had taken care of her by himself for the last several months. She had fallen three times prior to her admission and he was able to catch her. The fourth time caught him off guard and she ended up in the hospital. I cannot imagine what this man had to have been going through. I could tell that he was distraught by the situation, but he was holding himself together very well for the time being.

While I was sitting with the patient, I couldn’t help but notice the resemblance to my grandmother who passed away three years ago. After I met the husband and found out that they had been married for so long, I thought about my wife and how I would feel if we were in the same situation. It is very difficult to keep your professional demeanor when you sympathize with the patients so much. I am curious to learn more about this part of nursing. How should one react to such situations? What is appropriate to say and do for your patients? When does human compassion override facility and professional duties? I think that the only real way to learn this is to be in a facility with experienced nurses who are caring, compassionate, and respected in their positions.

In addition to my early morning experience I was able to be fairly productive with my time today. I completed an assessment on my patient (barely…I forgot my cheat sheet today. I’ll try again on Thursday.), and was able to learn a lot from both staff nurses in my hall. It is really hit or miss with the staff at this hospital. Some are great teachers and others just want to get their job done without some “kid” following them around. What was my greatest achievement today? I was able to dc an indwelling catheter. I was supervised by one of the staff nurses and this time........I DIDN’T PASS OUT. Some thing to be very proud of I’m sure.

-DV

Knee Deep

Geez,

There just aren't enough hours in the day. I wake up early and if I'm lucky it's a MWF and I can go run for half an hour before class. If not, I'm on my way to the hospital for six hours. I find that I am spending about six hours a day studying outside of class and clinical and I am just barely staying caught up. I felt really good about the information I had learned during the first week. There was a lot of A&P review on the GI system. I feel like I know that stuff pretty well. It is the critical thinking that gets in the way. I can tell you where everything is and what it does, but when it comes to making decisions based on that information things get a little cloudy. With that in mind, I have my first exam for the semester on Wednesday. I've been able to put myself into a pretty good position for studying. My reading is not only up to date, but complete for this section. I will not have direct patient care next week in clinical due to my RT rotation, so no care plans are due. I've also completed four case studies that are due on Thursday. So what's the problem? I was called in to work this weekend and next. I've got rehearsals and concerts to get through. Now, I'm certainly not complaining about being able to make a little money, but I really want to do well on this exam. At this point it is just a matter of studying. How many NCLEX questions does it take to make an A on Exam One? 1......2.......3.......? :) I guess we'll see.

Lately, I've been contemplating my future career. I go back and forth on the decision to get a tech job somewhere. I want the experience and the opportunity to get my foot in the door. At the same time, I'm pretty swamped as it is. Also, I still don't know where I want to end up in nursing. After last weeks real life CPR training I can see why a lot of people want to go to the ED. It is pretty exciting working in an environment like that. Occasionally I think about CRNA as a future career. The pay is great of course, but will I enjoy it? I'm looking forward to seeing some of that type of work later this semester. I also think about becoming a nurse practitioner. Before going to nursing school I thought about trying to get into medical school. I still have thoughts about that once in a while, but the amount of schooling required just doesn't fit in with my family life. I really admire the people who are willing to make the sacrifice to go to medical school. It takes a lot of dedication. I'm also the tiniest bit jealous. But I am enjoying my life as it is. Now I've got to go and be the best that I can be. Time to study for about six hours before rehearsal this afternoon.

-DV

P.S. Any readers out there want to share your thoughts? Leave a comment. :)

Oh...you're a male.

Today I was pretty excited about getting to meet the patient that I would be working with this week. I was able to get all of my preliminary work done without any problems. Going in this morning, I met the staff nurse who was nice enough, but not overly concerned that I would be around today. I also met the PCT that was on my hall as well, she was very helpful. While I was getting report the PCT had gone into my patient’s room to answer a call light. A few minutes later she stepped out and asked if someone could help her for a minute. I quickly volunteered and told her that I would be working with that patient today anyway. The PCT said that it was somewhat of a personal issue and that the patient did not like males. Apparently I had picked a patient that was not going to have anything to do with me this week. At least that is the impression I got from the PCT. So, the staff nurse goes in to help her and I am left outside to wait like a good boy. I have to admit that I was a little put out by all of this. I am a pretty likeable guy and I had to deal with this same problem last semester in Foundations. It seems that I may be confronted with this problem for the rest of my career. I was determined to go into the room and make a good impression with the patient. When the ladies finally got out, I went in and proceeded to get to work on my assessment…

I was comfortable getting my assessment done after talking to the patient for a while. I went through about 65% of what I was supposed to do for my head to toe. The other 35% was lost somewhere in my brain. It is going to take a lot more assessments for me to remember everything that needs to be checked. Later my instructor came in and went through an assessment on my patient with me. This was one of the most beneficial things that could have been done for me. Afterword we went into a room and went over the findings and discussed how to go about making sure that a complete assessment was done and how to do it well. This is the first time a clinical instructor has done this with me, and I cannot wait to go back on Thursday to try again. I feel so much more comfortable going into a patient’s room and doing my assessment. I really wish my foundations instructor had done this with me (a few times would have been nice). I would have felt a lot better about things. I also feel more comfortable about bringing in my “cheat sheet” to make sure that I have covered everything.

…by the time I had worked with my patient for a while. We were both comfortable with each other. She was beginning to talk to me about her personal issues regarding her illness when we were interrupted by the PCT for the patient’s bed bath. (There went my process recording, but I digress.) I told the PCT that I would be more than happy to help. Then I explained to my patient that I would only help if she were comfortable with my being there. (This is where I had what I like to call, one of my “Jedi Moments”.) The patient stated, “Well normally I would say don’t bother, but you might be able to help her.” I feel like I had been able to make the patient comfortable with a male nurse(ing student.) I cannot be sure if the PCT was initially uncomfortable with me or if the patient would not have been comfortable with a male nurse or if I was really able to change the patient’s perception. Either way I did what needed to be done today.

It Starts Again

So, I've actually been in class for two weeks now. I'm just getting back to my blog. I've studied more in the last two weeks than ever. It's going to be a crazy ride, but I LIKE IT! Here is my journal entry from today's clinical. Today was the first day to actually take care of patients for this semester. I think you'll find it interesting...

Day one – check. I had most of my pre-clinical work complete, but I was still a little insecure about the quality of the work I had done. Yesterday, I had to use another student’s log on information in order to access my patients chart. I felt rushed because I didn’t want her to have to wait for me too long. I was able to get the basics and went home hoping for the best. I could have been a little more thorough, but I suppose it was enough to get me started. I was very glad that when I got to clinical this morning, my instructor had my log on information for me. Monday will be a lot better now that I’ll be able to spend as much time with my patients chart as I need.

As always, I was a little nervous about going up to the floor today. However, I do think I am getting a little more comfortable “going to work” in the hospital setting. I’m not a total newbie. Because the students are pretty much assigned to different wings on the floor, I am pretty much on my own. That’s a good thing. It forces me to take the initiative in finding help and getting things done. I was able to get report from the staff nurse and I even gave her some information on labs and an endoscopic procedure that had been done the day before. I’m really surprised that she didn’t seem to know about the endoscopy. I was about to check out my patients chart and look for new meds and orders when a code was announced at the other end of the hall; thus started the exciting part of my day. Along with the other students, I went over to check out what was going on. I was really surprised at the organization and cooperation that was going on in a room filled with about 10 people. The nurses were giving chest compressions, calling physicians, calling family members, charting, giving meds. All of this seemed like a carefully timed act. I was standing out of the way watching when one of the nurses asked if there were any student nurses around. My immediate thought was, “Hey, I’m a student nurse….” I walked up to the door and was asked if I wanted to do compressions. “…..SURE!” I gloved up and made my way to the other side of the bed and started. The adrenaline was really pumping. All I could think was to give the compressions at the right speed and force. After a while some of the other students came in and we rotated for another 15 or 20 minutes. Then, it was all over. The physician called the time of death. Afterword there was a huge let down. The other students were visibly upset after the family arrived. I didn’t really feel sad or upset when I went back to work with my patient. It was just something that happens sometimes even when you do everything that you can to help. Tonight when I was able to sit and go over my experience with my wife is when I really felt something. I could feel the emotions begin to well up. The loss of a life, even if it is a complete stranger, is a very difficult thing to observe. I suppose my reaction can be a good sign that I can hold it together when I’m on the job when I need to be professional and giving support to patients and their families. However, I can see how this sort of thing could really be a heavy weight to deal with if you see it on a regular basis.

The rest of the day was pretty slow. :) I am going to review some assessment material this weekend so that I’ll feel more prepared next week. I do NOT feel prepared right now. It’s going to be a long weekend….


-DV

Rest Time

So I finished my summer term and ended up with an A in clinical and a B in theory. Once again, there is just too much information in a short amount of time for me to get the A I wanted in theory.

I am looking forward to some time off from school. I am headed out of town this morning for a few days with my family. I'm sure we will have a good time.

Since I finished my summer term, I've been applying for tech jobs at all of the local hospitals. So far I've come up with nothing. I have to wonder how many people are applying to these jobs. There are so many people like me who want to get into a position like that, yet there really are not that many jobs out there. I was talking to some classmates a few weeks ago who said that they had just been hired and had been applying for positions since March. If this holds true, maybe I'll be able to get something before Christmas.

This fall I'll be taking my Adult semester. I really hope that I can learn a lot. I feel pretty ill-prepared for the nursing world right now. There is so much to learn in order to really be able to help people who are sick. I am amazed at the knowledge that the nurses have that I meet. It makes me wonder if I'm in doing the right thing by going into this field. I have to wonder if I am learning everything that I should be learning. Guess I'll see when I land that first job.

I was surprised to learn that I have been awarded a grant for the fall and spring semesters. Woot! I would not consider myself financially needy, but I'll take the money anyhow. I was thinking that if I applied for financial aid I might be able to come away with a scholarship of some sort or maybe they would offer me student loans. (Student loans are evil BTW) So, the grant was a total surprise. Yes, I'll let the government pay for my education!

On with vacation. When I get back, I'll look into doing some more review in A&P. That can never hurt.

-DV

The Apocalypse

FINALLY!!!!! A patient with some character! WOOT!

Today my rotation sent me to the acute psych unit at the hospital. This is where the patients go to detox, get on their meds, sober up, and come back to reality. I was so glad to finally get to this unit. I was able to get past the three locked doors and into the unit. After finding the charge nurse, she took me on a mini tour of the floor. There was plenty of office space for various physicians, nurses, and meetings. Then I was able to see the patient rooms. I was surprised to see them rooming with other patients; there were 2, 3, or 4 to a room. After the tour, I was just in time to attend the interdisciplinary team meeting. The nurse quickly went over each of the 19 patients and the physicians and social workers took notes. It wasn’t quite what I expected, but it was insightful none-the-less. Then I went to the day room to pick out a patient…

“Gabriel” was a male. He seemed very nice and very open and willing to talk to me. I can only wish that he had been the patient I had spoken with for my process recording. “Gabriel” was an angel sent from God to warn the people of the world that they were evil. He could see the souls of those around him. (I had a good soul, thank-you-very-much.) “Gabriel” went on to talk about some of his grandiose delusions and how he found out who he was only three weeks ago. There was a lot more about his relationship with God and Satan, but there is just too much to put down on paper.

Here’s the thing that really got me. Usually when someone starts making up stories and saying things like this, a person can just tell that it is fiction. You laugh and go on. “Gabriel” IS an angel. He truly believes this. What is difficult to understand is that there is an interwoven mesh of reality and delusion. Much of what he said about people in the world today was based on fact. Some of the statements he made, I would agree with whole heartedly. After a while I was truly captivated by his story. Being a Christian, it was difficult for me not to challenge his theology, but I was good and realized what not to say to him. I really tried to work on my therapeutic communication, and while there were a few blocks, I realized what I had said afterword and tried to stay on track. I feel like I am getting better, but I still have a long way to go.

After lunch I went to look up “Gabriel's” chart to find out what his diagnosis was. Initially he was diagnosed with Bipolar disorder. For a while he was functional and going to school while he was on meds. Then during a matter of a couple of days he crashed. Now he is admitted with schizoaffective disorder. Apparently, the physicians don’t really know what is wrong or what triggered his sudden decompensation. This is the really scary part of nursing for me. What do you do for a person like this? His meds just don’t work anymore. He’s completely delusional and doesn’t seem to be getting better. I spent a lot of time in his chart today trying to find some answers, but came away with almost nothing.

Today was an exciting day in my mental health clinical rotation. However, it was also my last full day for this summer semester. I am really disappointed that I didn’t get to spend more time in the acute setting. This is what I’ve been waiting for all semester and now it’s over. I think it’s a shame that I only get to spend six weeks in a class that is so interesting and relevant to all areas of nursing.

As I mentioned in another blog entry, I’m not sure that I see my self going into mental health. However, I think with more time in the acute care unit I might become more interested in following that path. I have noticed that the staff nurses don’t really do very much. They’re kind of like “Nurse Vending Machines”. They give out the meds when it’s time. They discharge and admit patients while filling out loads of paperwork. There really isn’t very much therapeutic interaction with the patients. I suppose that’s why you would want to go into the practitioner levels of education. If I go into mental health nursing, I’d want to help patients in a more direct manner. I guess only time will tell.

-DV

Go Towards the Light

There is a light at the end of a short tunnel. Today I finished gathering all of the information I needed to complete my clinical assignments. I’ve got pages of care plan notes, notes from a lengthy conversation I had today for my process recording, and now I’ve got to do something with it all. I’ve got to take this information and be able to present it in such a way that others will know exactly what I want them to know. After the previous four weeks, I’ve found that to be much more difficult than it sounds. Also, like the long semesters, as I near the finish line I tend to get ready to rest a bit too soon. I’m ready for summer break. This will be my first semester off in 1 ½ years. Yea! I’ve just got to push toward the end and complete everything the best I know how.

My day today was good and bad. First, this morning was somewhat of a bust. I went onto my unit to find that ALL of the patients were in group meetings. There was nobody on the floor. I went back to the computer room and worked on gathering some more information for my care plan. Fifty minutes later I went back onto the floor to wait in the day room for the patients to come back. Most of them did not come back because they were going bowling. I ended up “shooting the breeze” with the nurses for nearly two hours. One was the regular staff nurse, but she was pretty busy and had no qualms about telling me so. The other was a new staff nurse in training on that floor. We actually talked a lot. The cool thing was that this nurse was a male nurse. He had been in psychiatric nursing for about thirty years and had worked for the state hospital for quite a while. He had a wealth of knowledge and tons of tips for me as well as some very interesting stories. We discussed what it was like being a psych nurse compared to med-surge, career tips, education, etc. I was really glad that he was so open to passing on information to a rookie. One thing he mentioned was that the units I had been on up to this point weren’t “really” psych units. I have to agree. He said that next week, when I move to the acute care unit, I would really get the experience I was looking for.

After lunch I went back to the unit and waited for some unsuspecting person to come into the day room. I had to wait about ten minutes when finally a gentleman come in and sat down with a magazine. I mustered up my courage and went over to him and started up a conversation. He was pretty receptive to me. Our conversation lasted about an hour and a half. Therapeutic communication is difficult for me. I caught myself saying things that were not working to help the patient express his feelings. Occasionally something good would come out, but this is really difficult for me. I don’t mind listening, but making me try and say something worthwhile takes work. Speaking of making me say something worthwhile…

A couple days ago I was “encouraged” to participate more in class – as were many of my other classmates. My brain doesn’t work that way very well. It takes every ounce of energy that I have to muster up questions to ask about presentations. The questions I ask on the spot are generally superficial and don’t seem to bring up important issues. I’d much rather have time to think about questions and ponder what has been presented to me. I suppose that is part of becoming a nurse. Being able to think critically in a short amount of time is very important. I’m going to have to practice that as well.

I hope that my last two days in clinical prove to be very educational. I’m looking forward to practicing my skills more without the looming report deadlines. It’s time to get ready for the big finish. I hope I go out with a bang.

-DV

Life's a B**ch

Today was my first clinical day in the main psych building. I was ready to get out of the outpatient unit. My goal today was to get as much done as I could for my assignments that are due next week. I wasn’t too sure how I would do. I went into the short term unit. Here patients are allowed to come and go from the unit. They are also allowed day passes when merited. I was just a little apprehensive going into the unit for the first time. Fortunately, I was able to fine a patient easily and interview him. My goal with this patient was to conduct my interview so that I would be able to complete my care plan and mental health assessment. After talking to my patient for about an hour, he had to leave for a group meeting.

I must say that I was appalled at what he had to go through. There is no wonder he has problems in life. His main reason for being in the hospital is prescription drug addiction. I am quite surprised that this is his chief problem. His father died while he was a baby, his mother was an alcoholic and a drug abuser, his uncles were no better than his mother. My patient was basically raised by his “loving” grandmother who beat him with water hoses and tree branches. His uncles would make him high from marijuana before he even started kindergarten. He started smoking marijuana when he was in middle school. That also led to alcohol and cocaine/crack abuse later on. His best friends killed themselves and he now has no family in his support group. What kind of sick people do this to their child? It is really disgusting to know that there are people in the world who do this to children.

Considering his background, I’m amazed that he is still alive. He does have hopes of becoming a healthcare worker someday, as he was a medic in the army. I don’t know that he will ever be allowed to enter the profession, but he sure would have an amazing and inspirational story if he did.

I was able to get all of the information that I needed for my assignment. That’s good. I spent much of the remainder of the day working on the care plan.

I was wondering today what my future holds for me. I am really enjoying mental health nursing. The disorders we are studying are really fascinating; however, I’m not sure that I feel truly drawn to this particular field of study within the nursing profession. I thought I would be, but that hasn’t happened yet. Honestly, I feel like I’m just waiting for something to really inspire me. Right now it’s as if I’m simply scratching off the options that I know I don’t want to do and I’ll see what’s left. (Process of elimination.)

Tomorrow I will be on the same unit. I’ll work specifically on my process recording. I’m a little worried about this one because it’s all about therapeutic communication. Today, I noticed that I was asking a lot of closed ended questions. That’s not good. I think I’ll feel better if I go back and review a couple chapters on communication. That will make me feel better…maybe.

Only 1 and ½ weeks left for clinical. It’s going by very fast and I don’t feel like I’m able to learn everything I need to learn. Degrees are funny that way. There is an infinite amount of information to be learned, yet there is a VERY finite amount of time to learn it.

-DV

Third Time’s a Charm

I wasn’t too sure what to expect today in clinical. Today was supposed to be a “Community Integration” session; however, it happened to be the third Tuesday of the month a Patient’s Government meeting was held instead. The Pt's are allowed to manage their activities and leisure space as they wish, so once a month they hold parliamentary procedures to discuss what will happen during the next month. Sounds exciting, right? Zzzzzzzzzzzzzzzzz I suppose it was good to see how the patients are able to interact with each other, but I was really hoping to see more today. I had to really work to try and stay alert during this meeting. I have to admit that after today I’ll be glad to move to a more acute setting in the main hospital.

After the government meeting I was able to interact with the patients before lunch…

Patient No. 1: An old man in a wheelchair.
DV: “Hello, my name is DV. I’m a student nurse. Would you mind if I sat down and spoke with you for a few minutes.”
Patient No. 1: “I DON’T WANT TO BE BOTHERED RIGHT NOW!”
DV: Welllllll okay then, maybe later.
Okay, so maybe he wasn’t the best person to approach since he was quite the complainer during the previous meeting. I really thought he would have an interesting story. Strike one for the student nurse.

Patient No. 2: Middle aged African American man.
DV: “Hello, my name is DV. I’m a student nurse. Would it be alright for me to sit and talk with you for a while?”
Patient No. 2: Yes.
DV: Great. (Reaches over to grab a chair)
Patient No. 2: “I gotta go get my gla%$%^&**&^&*^%$#$” (Stands up and runs away, never to be seen again.)
DV: (Perplexed) Um, okay.
DV: (To Student Nurse #2 who saw the whole thing) “Didn’t he just say it was okay if I sat down with him?”
Nurse #2: “Yes.”
DV: “Did…um…did he just run away from me as fast as he could?”
Nurse #2: “Um, yes.”
DV: “WTF?”
Nurse #2: “Well, DV, you are kind of intimidating.” (Laughs)
DV: (Sarcastically) “Oh, right….”
Strike two for the student nurse.

Patient No. 3: Middle Aged African American male (A different guy of course.)
DV: “Hello, my name is DV. I’m a student nurse. Would it be alright for me to sit and talk with you for a while?”
Patient No. 3: “You’re sitting right here next to me. Might as well.”
DV: Don’t run away okay.
Patient No. 3: Um, okay. You alright kid?
CONVERSATION CONTINUES AD LIBITUM.

Okay, so I embellished the third patient a little, but the first two were dead on. FYI, this does not make me want to walk up to crazy people and just start talking to them. Must…keep…trying….

DV

Study Hall Today

Today’s clinical session was good and bad in various ways. I was pretty pumped up about going into the outpatient site today and talking to patients. I was just going to go in and do it. After arriving on the unit we found out that today was “Community Integration” day. Hmmm, what’s “Community Integration”? As it turns out, it is basically a field trip for the outpatients. They were going to go see a movie. After finding out that the student nurses would not be accompanying the patients on their outing (quite frankly, I wasn’t too keen on that idea anyway) we decided to find someone and interview them real quick so that we would have information to write a care plan. I went into the community room and found a “patient” that I was able to have a brief conversation with. I felt rushed and the setting was not very good. The coordinator of the outing interrupted a couple of times to make general announcements. I’m not sure how well I really did on my interview of this patient, but I did get some basic information from him. This was the extent of my patient interaction today. Yep, it was a bit of a bummer.

After talking to my patient, my colleagues and I went back to the meeting room and proceeded to work on our care plans. In some ways this was a good thing. I needed to get my first care plan turned in for critique and I wasn’t going to have a lot of time when I got home that evening. By the end of the day I was able to get something turned in. It wasn’t my best work because I wasn’t able to really research everything like I would have had I been at home. Nevertheless, I was able to turn something in.

Before lunch we were able to practice our therapeutic communication skills while role playing. This was a real eye-opener for me. I had gone through some of this in my head on occasion and it always seemed so natural. When I was sitting in the hot seat however, it was if my mind just went blank. I couldn’t help but think of Mavis Beacon’s “Typing Tutor” (just go with me here). On this computer typing software there is a game where you are driving a car and every time you make a typing mistake, a bug hits your windshield. By the time I had finished my “therapeutic communication”, I had bugs all over the place – closed-ended questions flying left and right, giving approval, agreeing, changing the subject – all over the place! By the end I finally started getting the hang of it and was able to present some good communication skills. I was apprehensive about doing this at first, but it was a really good learning experience. Hopefully I’ll get better.

Overall today was just okay, but it was productive (just not quite what I had expected). I really hope tomorrow will be better. I need some excitement in this rotation. It would be awesome if I was able to witness just one major meltdown before the end of this semester.

-DV

Testing the Waters vs. Jumping In

Today was the second day of clinical. We took a tour of the mental health unit of the hospital and finished going through most of the CID. I’m not too sure if I was just tired today or if things just didn’t go as well as I had hoped - probably a little of both. I woke up early again this morning and went for another run. I really enjoy waking up early before the rest of the family. It gives me some time to be by myself during the day. I loved the train ride this morning. I was able to get quite a bit of studying done without the frivolous talk of deadbeat husbands, girdles and such. :) (Sometimes it really sucks to be the token male.) I arrived at the hosptial nearly an hour early and went on up to the meeting room just in case it was already open. Nope. Next week I’ll hang in the cafeteria or waiting area when I get there. The air was still out so I knew it was going to be another uncomfortable day. Now that I think about it, maybe that [the heat] just started things off on a downward slope.

I knew that I would be sent out into one of the units today, but I’m not too sure what I expected. Actually, I do know. I expected to be able to test the waters today, and I did. However, we don’t have time for that. As it turns out, in order to get everything done that needs to be done during the next four weeks, I’m going to have to just take a deep breath, jump in and hope that I can swim. I feel like I’m already behind in what I needed to be doing today. My first unit assignment was in the recovery group building. What should have happened is this. I should have gone into a group, identified a patient and followed up with that patient ASAP. I didn’t. Did I think about it? Yep, sure did. Was the opportunity there? Yep, sure was. The thing that comes to mind here is that whole “Self Directed Learner” thing all the faculty have been telling us about. I was too apprehensive after the first meeting to seek out that opportunity to practice my therapeutic communication skills. As it turns out, the patient I had chosen attended both group meetings today. She was there in the building and all I had to do was seek her out. Had I left the first meeting and gone to interact with the patient(s) I could have developed an introductory relationship with at least one of them. During the second meeting I had decided to seek out my “chosen” patient afterword. Wouldn’t you know it; she left the second meeting early. Two things happened when my chosen patient walked out…

1. The outward emotion, “Oh, man, she’s leaving. I didn’t get a chance to talk to her.”
and
2. The inward emotion, “Oh, thank God. Now I don’t have to talk to her.”

I’ve come to the realization that this sort of behavior is fairly typical of me. Maybe that’s normal, maybe not. What I do know is this, if I don’t take the initiative to “practice” my skills, I won’t do well in this class. I have to do things in this particular nursing rotation that are directly contrary to my personality. I am not a social person, but I will have to start pretending pretty soon before I start to sink….. [sigh].

So now, after having spent a couple of hours looking at my patient’s chart, I’ve got all of the necessary, fact finding, theoretical, organizational, research work done. I can tell you what’s wrong with her, what meds she’s taking, her delusional statements, her physical needs, etc. What I don’t have is the necessary information I need to actually help this person. What is that information? It’s her tone of voice.

-DV

The Train Ride

It’s going to be a very fast ride with some ups and downs along the way. Today was my first day of mental health clinica. It started last night when I went to bed early. I rode the train from downtown to the hospital early this morning. Surprisingly, I wasn’t really very apprehensive last night about my first day like I was last semester in foundations. I think that is partially because I knew there would not be any patient interaction, just orientation. I woke up early and went for a run this morning and then came home to get cleaned up and make my way to the train station. I felt really good about taking the train because I had scoped out the parking situation earlier this week. I made it in time and met my associates and we were on our way.

It was my idea to take the train to clinical so that I would have nearly three hours of study time each day. However, with a “study group” you have to be careful because they tend to turn into chat groups. Sure enough, not much studying got done today. Fortunately for me, my peers decided that the train took too long and I’ll be making the trip solo from now on.

I cannot begin to say how excited I am about clinical this semester. After last semester (Foundations), I need some structure. Each assignment was given a due date at the beginning of the semester. I know WHEN to get stuff done. Yea! We went through each assignment and talked about what was expected and how to get it done. Yea! Yea! Organization is our friend. I feel confident that I’ll be able to have my assignments done on time and done effectively. Here’s the only problem with the assignments…they roll around pretty fast. There won’t be any rest for the weary during the next four weeks. Between attending theory class (8 hrs/wk), clinical (16 hrs/wk), 2 group sessions and getting stuff done at home it’s going to be tight getting in enough time to complete these aforementioned assignments. Thanks to my handy, super awesome excel schedule I think I’ll be able to stay on top of things.

Our orientation to the hospital was pretty eye-opening today. The educational instructor is really helpful and wants to see us succeed while we are spending time at the hospital. Their computer charting system is very cool. There’s almost not any reason to have to interact with the patients. It’s all there on the computer for us.  It’s almost too much information. I’m sure it will take a couple of days to figure out what where to find the information that I need for my reports. Hopefully, this will actually make my time with the patients even more beneficial. I’ll already know all of the basics. It’ll just be practicing my therapeutic communication on a real life person.

Speaking of real life people, it looks like I’ll have the opportunity to observe all kinds of group sessions while I’m at the hospital. I wasn’t too sure what the clinical experience would be like during the mental health rotation. Looks like I’ll be doing a lot of listening. I can do that. While there will be several group sessions, I’ll have the opportunity to interact one-on-one with some of the patients as well. That’s the scary part.…especially after reading some their charts today (These people are seriously messed up). I just have to remember that it’s not about me; it’s about the patients…How does that make you feel?...Can you tell me more about that?...Do you see someone over there?...Are you hearing voices?...What are they telling you? The voices in my head are sometimes telling me “What the hell have you gotten yourself into?” and other times they say “Cool!”

Regardless, I think that that at the end of this six week rotation I’ll look back and remember this summer session as one of the best semesters I’ve ever had. It will be an exciting ride for sure.

-DV

First Semester....Check!

Woohoo! I finished my last exam today. My first semester of nursing school is officially over. I ended up with a B in theory and A's in Lab and Clinical. I am okay with that. An A in theory would have been nice, but you take what you can get. I really am amazed at what I've learned this semester. It seems like it went by really fast. I've got a couple of weeks off an then it's on to mental health.

Time to go do something fun......


-DV

Nearly There

I've only got two more tests to take and then I'll be done with my first semester of nursing school. WooHoo!!!! I had two meetings yesterday. Well, I was supposed to have two meetings yesterday. First I make it up to the school first thing yesterday morning for a meeting with my clinical instructor. You know, the one I've had issues with all semester long. She didn't show up. No email. No phone call. No nothing. There were other students who had signed up for a meeting with her as well to go over our final evaluations and sign off on skills that we've performed this semester. The office secretary finally called her and she said that the meetings were moved to next week due to "time constraints". Apparently, she said that she sent an e-mail to everyone, but somehow that e-mail never actually got to any of my classmates. I cannot begin to tell you how glad I'll be when I'm done with this instructor.

My second meeting yesterday was for my Mental Health paperwork that had to be filled out before the summer semester begins. I'm going to a "government" run facility for my clinical this summer and there is apparently a LOT of red tape to get through. I'm looking forward to the experience though. Can't wait!

My family is leaving for the weekend this afternoon and I'll have two full days to study. Yea! I'm not too worried about my theory and skills exams next week. Skills should be fairly easy to begin with and I've already secured a high B in theory (no chance for an A however) and I really just need to review the important concepts.

I keep dreaming of the day when I have a full time RN job. It's going to be so cool!

-DV

I Can See the Light

Well, the end is near. I had my last clinical day on Thursday, and I have only one more week of classes before finals. I am really going to miss my clinicals. I have learned so much by working with nurses and watching them do their thing. I will say that I have learned more from the clinical experience than I have in the skills lab or in theory. I suppose the hands on training works well for me.

I've got one more lecture to attend on Monday as well as one more skills lab to attend on Tuesday. I'll be so relieved when those are over. Then I can start the big push towards finals. Time to start reviewing everything I've learned this semester... It is going to be a long week, but I feel comfortable that I can make a decent grade. When finals are over, I'll have a couple of weeks to hang out and do nothing...NOT. I'm actually looking forward to reviewing my anatomy which is something I've wanted to do all semester, but haven't had sufficient time to crack open another book. I'll also begin to prepare for Mental Health nursing this summer. That starts in June. I've been assigned to a great hospital in a large city. I'm sure I'll see all kinds of things. I've already heard many stories about other nurses mental health rotation.

After my mental health summer classes I'll have some time off before the fall semester begins. I'm looking forward to that in a big way.

I'm off to finish my final online lessons for skills.

-DV

Resetting the Bar

Okay, I finished my 3rd exam today. I did better than before, but there goes my hopes for an A in theory class. Now, we're hoping for a B. I'm not too disappointed, but it would have been nice to pull a 4.0 this semester. I have to wonder if it is even possible for me to make an A in this class. I'm studying my tail off as it is and I just can't seem to get it. Today's grade was an 82. Now that's not terrible, but just thinking about all of the time I've put in makes it seem not quite worth the effort...you know? There is just so much information to try and grasp. I feel like if I were to spend about 12 hrs a day studying, I'd get it. But who has that kind of time. Life steps in sometimes gotta get the kid from school, make dinner, run errands. Oh the days of being a single college student. I thought that when I was getting my first bachelors degree in the arts that I worked hard. NO WAY! Having been on both sides of the road now, I can see that "artists" in training have got life pretty easy. Not that people in the arts don't work hard, it's just very different.

I've got work to get caught up on now; chapters to read, meds to look up and a final to begin getting ready for. Better hop to it.

-DV

Study, Study, Study

I've been reviewing nclex questions for three days now. I have got to do better on my next test this Wednesday. There seems to be something going on inside my brain. Previously, I would work through nclex style questions and average about 40-50%. This time around I'm averaging about 80%. I hope I can do as well on the test. My hopes for an A in theory class are quickly diminishing. I made a 90 on the 1st test and a 76 on the 2nd test. There are only two more test to go and in order to make an A I've got to do EXTREMELY well on them.

After visiting with my instructor and a good friend who teaches nursing at another university, I've found that basically I need to think more about the nursing process and how it relates to the information I am learning. I've adopted the following motto...."If it looks like a nurse, walks like a nurse, and acts like a nurse...." you get the idea. This is much more difficult than it sounds. I need about 48 hours in a day to get comfortable with all of the information I am sifting through. Hopefully some of it will stick. (So glad I don't have to wear the same garb nurses had to wear 50 years ago! My hairy legs wouldn't go well with the knee length skirts.)
Back to the books.

-DV

They like me, they really like me.

I had a really good day in clinical today. My nurse preceptor told me that a patient I had earlier this week who was very particular and somewhat demanding had told her that she was very complimentary of me. YEA! She said that she was very comfortable around me and did not have any problems with me providing her care. Stuff like that always makes you feel good about what you are doing. The thing is, is that I didn't think she was really that demanding or particular. She just wants to be comfortable in an uncomfortable situation. I have to admit that I pretty much see all of my patients in the same way. Once today my preceptor was telling me about a new client that she thought was going to be difficult to take care of. I went in to the patients room with the nurse and admittedly the patient was a little rough around the edges. She stated in a demanding tone that she wanted a bath. While I was a little put by her tone of voice, I could only think about what she must be going through right now. Who knows why she is demanding? After attending to this patient for a short time, I think that with a little more time with her that I could get her on my side as well.

Later today I was able educate a clients family about the importance of wearing protective clothing (gown and gloves) when entering a possibly infectious room. A couple of my peers were with me and they had started the conversation with the family, but the family was obviously not interested in gowning up. When the opportunity came for me to say something, I think my peers were impressed with my ability to convince the family that the protection may be worth the time and effort.

Kudos for me today.

Today was a good day. I hope I have more like this.

-DV

Okay, I'm better now.

I was able to vent a little several days ago. I still feel like my clinical instructor leaves something to be desired, but I have seen some improvement.

Our next test is in a couple of weeks. I'm swamped with the reading and I'm not sure if I'll ever get ahead. As it is, I'm just staying caught up. It's really a shame that I can't spend more time studying the information I am reading. I pretty much just gloss over the info and then try answering the questions. While that does get some of the information into my little brain and helps me pass the exams, it doesn't make me feel any better when I'm going in to see my patients and I am fairly clueless about what is going on with them. I can only hope that my knowledge base will improve with time "on the job".

Looking at the calendar, we've only got about six more weeks left in this semester. It's going by very fast (sometimes). I'll be registering for my mental health theory/clinical in a couple of weeks. Summer classes scare me! There isn't any time to actually learn anything. It's almost just going through the motions during the summer. Get the credit and move on. Formal education ticks me off sometimes. Sometimes I wonder if things wouldn't be better like they were in the olden days when you had a one-on-one mentor to learn a trade. It just seems like I'm doing my best to get a piece of paper and not doing my best to learn. Surely other people feel the same way. Right?

On the bright side of life...I had two really good patients last week. One was an elderly woman who said that I looked like her grandson. She was very sweet. I am pretty sure that if I were taking care of her on a regular basis, we'd have a great relationship. The other patient was a female middle aged school teacher who was very pleasant to be around. I'm very glad to find out that most patients in the hospital I am at are receptive to a male student nurse. I've seen more objections from the staff nurses and students than the patients this semester.

That's it for now. I'm tired. Going to get some shut-eye before I get up and go on a quick run before class tomorrow morning.

-DV

Walking a Thin Line Today

I'm headed in for clinical this morning. My instructor has a "review" today, so we're supposed to be on our best behavior. I hope we get to give an evaluation today because I am ready to vent. I feel like I'm getting the short end of the stick that isn't very long to begin with.

You know what they say, "You get what you pay for."

-DV

2nd Test

AGGGGGGGHHHHHHHHHHHH!

I am so freaking tired of this. The first test I took a few weeks ago I made a 90%. Not too bad. I studied, did all of the reading, answered nclex questions out the wazoo and I made some stupid mistakes, but still got an A on the exam. Today after busting my butt every day, reading, answering nclex questions,reading, doing objectives, reading, working from the online and CD resources I end up with a big fat 72% on my second test. Did I mention that I did all of the reading? WHAT AM I DOING WRONG????????????

There is just too much information to grasp in a short amount of time.

If anyone has suggestions for studying SMARTER not HARDER. Please let me know. I don't know if I can put in any more hours.

Very frustrated with nursing school right now.

-DV

Not a Virgin Anymore

I finally did it.....Yep. I gave my first injection today to a real live person. It seems so technical during the lab practice that we do. I've got a list of about 50 steps to follow during my lab check offs for injections. When you get into the real world, it doesn't really seem that difficult. You still have to take the same precautions, but I suppose it is a little more fluid when you are in the field.

This week in clinical has been pretty exciting. I am always a little nervous the night before clinical, but when I actually get in there and start working, I get so caught up in all of the things I'm doing that the nerves don't really seem to get to me. All is want is for the patients I'm working with to feel better. I'd like to think that that is a good sign that I am going into the right field. In my previous career, the only thing I thought about was about how well I could perform and how what I was doing was going to effect me. I feel really good about thinking about other people and how I can help them. I still get a little nervous about doing some procedures, but it's really a heightened sense of wanting to learn my craft well. I can see how that little bit of nervousness will go away with time and experience.

I've seen so many things that I thought would gross me out, but it really just makes me feel for the patients. I am very glad that my family and I are in pretty good health, and that we are not going through some of the things my patients are going through.

I'm still not too sure about how my clinical instructor is going to turn out, but for the most part I feel like when I'm out with the techs, cna's and rn's that I'm learning what I need to be learning.

I'm looking forward to more time in clinical. :)

-DV

I Have a Lot to Learn

Today was a very busy day in clinical. I have to admit that it was kind of fun too. I was able to keep fairly busy which made the shift go pretty quickly. I learned a lot about trachs today. I fed a woman her breakfast this morning. Unbeknown to me, you are supposed to have a cap on the trach during feeding. The RN in charge didn't set it up like that for me. You see, we haven't covered trach. care in class yet. So I'm trying to feed this poor lady her breakfast and she's choking on half the stuff I give her. Ultimately, she doesn't eat very much anyway. When the RN did try the cap on her, she didn't want it anyway because it was difficult for her to breath. I'm sure that's part of the weening process that my patient hadn't been through anyway. Later this morning, I was able to perform some physical therapy with the PT at my side. That was pretty fun.
Before I left the unit I was given the opportunity to check glucose levels on a couple of patients. I know that if you're a diabetic, that's no big deal, but for me it was one of the highlights of my day.

Finally, just after my shift was over, my clinical instructor gave me permission to stay a while and watch a tracheostomy. It was totally cool! At the same time, it was very humbling. Every day that I learn one new thing, I learn that there are about 100 things that I know absolutely nothing about.

Even after five weeks of constant reading and studying, I feel like I'll never learn all of this. I have a VERY long way to go.

-DV

Keeping Ahead of the Race

As I start the fifth week of nursing school I look back at all that I've learned already. I am feeling fairly confident right now because I seem to be on top of things. It does seem though, that the potential to lose control is always right there. It's kind of like walking along the edge of a cliff. Just the slightest breeze will plunge me to my death.

To recap, I had my first exam last week and made a 90%. That's not too bad, but I wish I had done better. The questions didn't seem as difficult as the examples I had been studying from the book and the website. I could have done better, but I went back and changed answers that I had correct because I started thinking too much. Always go with your gut instinct! The questions in nursing school are quite different than in other subjects. They are mostly application questions. (If you're in nursing school, you know what I'm talking about.) The knowledge has to be there, yes, but what can you do with that knowledge. You are given a situation and you must choose the multiple choice answer that BEST answers the question. Yes there may be 4correct answers, but which one really fits the situation. There may even be more than one answer. I can assure you that this type of questioning provides for some very interesting conversations in my head.

This weekend I was able to finish a teaching project for my clinical. Yes, I am a week ahead on this. Yea for me!!!!! It helped that one of my clinicals was canceled last week for embarrassingly petty reasons. Speaking of clinicals, last week I was able to pick out a patient to start practicing on. Muahahahahhhhhhhhh!!!! So far clinical has been just okay. Mostly because of fact that there is a lack of...(how do I put this in a PC form?) leadership continuity? class management? focused direction? well, something like that. For the most part I am realizing that what I get out of clinicals (at least this semester) will be largely up to my own effort to learn from the people around me in the hospital. Time to take the bull by the horns, so to speak.

In skills lab last week we learned how to measure medications and give injections. VERY FUN! Quite frankly, I'm surprise that they don't hand out protective goggles to all of the newbies handling needles. Some of my classmates are a little scary when handling sharp objects.

Overall things are going well and the semester seems to be speeding by at an alarming rate. It'll be over before I know it.

-DV

Skillz

It's looking like it's going to be a very long semester. While I've really enjoyed every day of nursing school so far, there is just so much to keep up with. At this point I've got seven (7) chapters to read. Some of these chapters make a Stephen King novel look like Dick and Jane. I've also got online modules, videos and tests to try and push through. On average I'd say I've been spending 7 hrs a day (outside of class) studying. I have to admit that I enjoy it. It is so refreshing to be doing something different in my life.

This week we've learned how to take vital signs and give a head to toe assessment. I figured all those years of going into the Dr.'s office that those nurses were just goofing around with all that stuff. My wife has been a pretty good sport about letting me practice on her. However, she did get a little perturbed when I started fondling her breast when I was trying to listen to heart sounds. :) DISCLAIMER: Fondling is NOT proper nursing procedure! I had no idea it was that difficult to monitor blood pressure. You've got to really listen and pay attention. You can't kill somebody with an overinflated cuff can you?

My clinical calculations math is going very well. I actually get it! Yea for me and any future patients I may have. I have a clinical math test that I have to take in a couple of weeks. The requirement for passing is 90%. Hopefully I won't have any problems. Remember all those years of teachers saying that you weren't allowed to use a calculator? Well, as it turns out in real life...YOU CAN!!!!!!! I don't know what all the fuss was about. I'm pretty sure all of those no-calculator-using-fire-breathing math teachers were just out to give everyone a hard time.

I have one more day of clinicals this week and then it's off to work I go for the rest of the weekend. The good thing is that I'll be able to study most of tomorrow in my hotel room. I am also trying to get a study group together. I'm not sure how easy that's going to be, or how effective. I've never had a study group, but I think it could turn out to be a good thing if everyone is in the right mindset. After this weekend I'll have one more clinical day on campus and then it's off to my hospital orientation. Very exciting!

Time to get a move on to class. We've got three hours of video to watch this morning. I wonder if anyone would say anything if I brought popcorn.

-DV

Coming Up for Air

I made it! One week down and 15 more to go for this semester. My first week of nursing school was filled with excitement, doubt, anxiety, wonder and just a touch of external genitalia.

I started the week going to my clinicals. Of course we're not in a real clinical setting right now, but we go to the hospitals in about 2 more weeks. Our instructors walked us through the syllabus and going through some of the things we can expect out of our experiences. Some of the major assignments were discussed as well as the grading procedures. Later in the week we had our library orientation which included signing up for all of the websites we will need to access for the semester. One of the really exciting things about my school is that there is a lot of computer based testing and online facilities that will help us learn the skills we need to learn. In addition the faculty seem to really be a dynamic group of people who are working together to assist us in becoming the best nurses we can be.

I have to admit that all of the introduction stuff can make you want to crawl up in one of those comfy looking hospital beds at the side of the room, but I think each week will prove to be more interesting and fun. We did get into a couple skill however. I can now wash my hands effectively as well as make your bed (with you in it of course), and I can give you a bed bath while remaining completely professional when I find your tattoo that says, "Easy Lovin'"

There was a lot of reading this week and there remains a lot of reading and preparation for next week, but I'm looking forward to it. I am really glad that I made a detailed schedule for myself. It not only includes my class schedule, but my work schedule, study schedule, dinner schedule and play schedule. The instructors tell us that about 30 - 35 hour of preparation out side of all of our classes should be expected. At first I thought that might be a little extreme, but after my first week I'm beginning to think that that is pretty accurate.

Time to go read some more......

-DV

Day One...

Ughhhhh, didn't hardly know there was a 5 AM.

Gonna be a very long first day starting with clinicals followed by lab. That's the first nine hours. Then it's off to study for a couple hours and (wouldn't you know it) a rehearsal tonight. I haven't quit my "day job" yet.

Time to go run, eat breakfast, get dinner in the crock pot for the family, shower, dress and move the herd......

On your mark,
Get set,
GO!

-DV

Christmas in January

This post is about all of the cool stuff you get as a first semester nursing student. It's a little like Christmas, except you have to pay for it all yourself. But still....

As it turns out, there are approximately three feet of books that one needs to own in order to be a first semester nursing student. That's a lot of reading! I am so fortunate that I have a very good friend who is a nurse educator at a local university and she has provided me with the bulk of what is required. I have been able to get about $1200.00 worth of books for about $300.00. WOOT!

I also had to purchase a "Nurse Pack" from the nursing office. It contains all kinds of stuff that really scares me. I'm sure that eventually I'll be comfortable with touching all of that stuff, but right now it all just seems out of place. You have to realize that I'm the guy that used to not like to touch the paper that covered band-aids. It just feels weird. I'm over that now, lest you think I'm insane for choosing this career.

I've ordered my stethoscope and a cool light pen as well. They should be here in a couple of days. I can only imagine that every new nursing student gets their first stethoscope in the mail and give it a good workout for about 30 minutes. It's fun just to listen to stuff; you know, your heart your families hearts, the refrigerator, the wall, the wall of your neighbors apartment, etc...

With all of this new stuff, you need something to carry it in right? Right. I looked around yesterday for the perfect travel-book-bag-rolly-cart-briefcase for all of my stuff. Do you know how expensive some of those things are? The most expensive one I saw yesterday was $300 bucks! Besides that most of those things aren't practical for for all the books I'll have with me. You see, I'll be headed to the library after most classes so I can't just leave my text books at home. I'll have to bring several of them with me. So, the all $300.00 all leather pouch with silver lined pen case just ain't gonna work for me. I ended up getting a backpack with wheels made by "Jeep" at Wally-World for $34.00. It fits all of my books, won't kill my back, and the price was right. I just hope it doesn't crap out after day one.

I bought scrubs just before Christmas. You know, if you've never worn scrubs before, I would suggest to purchase them at a local store until you know your size. I bought large scrub pants at first, got them home and was amazed at how big they were. I ended up returning them and getting the medium size that fit just right. Makes me feel better about my weight though. :) I also ordered my name badges. For the first time in my life, I have letters after my name...."SN". Student Nurse - Lowest of the low I know, but still...letters.

Looks like I'm ready with all of my junk. Now it's time to get busy. With less than a week before my first class, I've got just a bit more reading to do, some "medical math" to start working on, and review of past reading to get done. Today, I'm off to the library for some quality study time.

-DV

I Swept the Porch

When I clean the house and get everything in its place, I feel a great sense of accomplishment. When I go through and get the house clean, one of the last things I like to do is sweep the porch. For some reason that puts closure on things. I can look back and say, "Okay, time to move on now." Yesterday, I "swept the porch" so to speak. All of the Christmas is put away, the house is ready, my last couple of books are on their way, etc. I am finally ready to start studying for nursing school.

After attending orientation I was given reading assignments for the first couple days of classes. There is a lot of reading just for the first two days. During the Christmas break I was able to get started and I've finished about half of the required reading. I can now set aside time to finish up. I am also going to begin working on some "medical math" as well. I don't want anything to sneak up on me during those first couple of weeks.

Already I can see that it would behoove me to brush up on some A&P. I'll begin reviewing that subject as well. Hopefully, I'll find time to spend a few minutes each week reading my A&P book as well as my current nursing texts.

I am very excited and just a bit nervous to get started. Time to get busy!

-DV

You gotta start somewhere...

Well, here we are and here's my story.

It all started back in high school. There were two things I really enjoyed: Band and Biology. I had been in honors science classes until my sophomore year in high school. After I completed my honors biology class, my guidance counselor told me that I would not be allowed to continue in honors science because my math grades were not good enough. (I was making B's in standard algebra classes) Hindsight being 20/20, that conversation really stuck with me in later years. I continued to excel in music and did extremely well in competitions and performances. When it came time to decide what to do with the rest of my life I had things narrowed down pretty well; either go into music education or pre-med. I knew that I really enjoyed biology and that I might enjoy going into medicine, but my math skills would "hold me back". I also loved music and knew that I would do well in that area no matter what. I chose music.

I went to school and after a year and a half decided that I didn't want to teach music but wanted to perform instead. I completed a bachelor's degree majoring in music education (as a fall back) and music performance. I was at the top of my class for five years. I received several scholarships, won performance competitions, etc. I practiced 3-8 hours a day. By the end of five years I was exhausted. I didn't want to practice anymore and was ready to move on. I ended up getting accepted to a well known conservatory for my master's work. I went there for one semester and dropped out. After getting married, a couple years later I finished my master's degree in music performance thinking that I would rekindle my love for practicing and performing. It didn't work. I took many auditions for orchestras around the country while forcing myself to practice. I came close to winning some small positions and actually won some local auditions in the process. Eleven years later and barely making a living the economy went downhill and the little work that I did get went with it.

By now my wife and I had a family and I was constantly complaining about the music business. My wife was behind me 100% when I told her that I wanted to change careers. I looked into other careers in the arts, but was just not interested. There is too much at steak to go into another "subjective" field. I remembered that I had once been interested in medicine, but didn't think I had what it took to make it through at the time. With the practice skills and determination I learned from music I decided to go into health care. I looked into medical school and decided that I wasn't willing to put my family through 7 - 8 years of medical school. I was overjoyed to find out that you could become a RN in only two years.

I started taking A&P just to get me feet wet and see if I would still be interested in biology. I LOVED IT! It was so refreshing and I couldn't wait to take on more science classes. In one year I finished all of my prerequisites for nursing school. I took only one or two classes at a time and made A's in everything. I knew that I was on the right track.

I applied for admission to nursing school for Spring 2010 and was accepted. I start in two weeks. Wish me luck....

-DV