End of Year Preparations

The semester is flying by. In just 5 short weeks it will be over. So, I'm starting to do some end of the year preparations.

Last year, I volunteered to put together a slide show for our graduating nursing class to show at the pinning ceremony - which seemed so far away... Well, now it is very close at hand. Mark and I just finished it last night. It is beautiful.

A pinning ceremony is in addition to the graduation and is a traditional recognition of the new nurse's journey through nursing school and her beginning of her nursing career. There is actually a nursing pin that someone puts on each graduate during the ceremony . It is a symbolic of service and identifies the nurse with the nursing school she graduated from. The ancestor of the nursing pin is the maltese cross.

Anyway, during the pinning ceremony, at one point, the slide show I created will be shown. It took a whole lot of work... Mostly by my dear husband..... Thank you, Mark! But, it will surely be worth it. It has about 150 pictures of all of us students that were taken throughout our time in nursing school. The songs I chose to put as the background are:

• Whenever you Remember by Carrie Underwood
• Welcome to Wherever you Are by Bon Jovi
• Lean on Me by Bill Withers

At the end, I added a special part that is dedicated to saying, "Thank you" to the special people in our lives who have supported us through this journey. For this I used this song:

• You Raise Me Up by Josh Groban
  

It was so beautiful I had tears in my eyes while watching it the first time... Then I had to watch it about 20 more times to get all of the little "bugs" out of it and I ended up a little immune to the emotional effects of it... But, no doubt by the time the ceremony gets here, I'll be all ready to cry again.

The nice part is that we get to choose one person to "pin us." I chose Mark. He has been so supportive and encouraging throughout this whole process.... I truly couldn't have done it without him and it will be so special to have him there beside me as I put an end to this chapter of my life. I feel like I should get him a pin, too... Though I doubt he would wear it to work everyday! :)

Anyway, I still have to buy my cap and gown and get my papers together to send in for my temporary practice permit, etc., etc.

It's so exciting...these last 5 weeks will, no doubt, fly by (hopefully)!!!

New Nurses

Head Nurse posted some tips for new nurses.

Crying Over 3.3 Points

Ok, so maybe I'm not "crying" over them...but lamenting, none-the-less.

Our last test had very poor results overall: The average grade was not a passing grade. To say the least, there has been a flurry of conversations and complaints around the class since the test. Especially since there are only 3 tests in this particular class, all semester! So, getting a below passing grade on this one, would make it difficult to pull anything respectable out of it.

Luckily, I don't have to worry about that; but I was not please with my own performance. While blaming doesn't solve anything, I have many theories as to contributing factors that may account for the dipping grade point average, overall.

Some factors that need to be addressed, I believe, are:
- There were only 30 questions - on a test that is 1 of only 3 for the semester. Do you realize how much content is covered over a whole semester in a nursing class; then to only have 30 questions per exam... It's ludicrous.

- The instructor lectures in a way that she places equal emphasis on ALL material. Nothing is more important, nothing less. So, what do we study????? Concepts or details? Because there is no possible way one can MEMORIZE everything that is covered. We must pick and choose. I usually go for the forest; not the trees.

- She also provides no study guides or review sessions, like other instructors do. Again, leaving us on our own to figure out what she thinks is important.

- For the first test, there were guest lecturers and the main instructor taught a limited amount of material. Not so for this last test; the main instructor taught all of the material. And, last year in this class, the same test brought the same results: average grade below passing.... See a pattern here?

- Some of the questions are RIDICULOUS!!! One question, in particular,has me upset at its focus on small, insignificant details. The question was strictly a knowledge based question, not concept/application based, which is the level we should be at at this point.

The question literally nit picks down to the centimeter. It asked what you would call a 2 cm, flat, discolored area on the skin. It is a "macule." Well, that is unless it is greater than 1 cm. Then, it is called a "patch."

How ridiculous is that. The difference between a centimeter is worth 3.3 points of my grade????

With the large amount of material covered, it is literally like picking a needle out of hay stack.

Sorry for the griping..... But we're all frustrated and trying really, really hard to make the final push out of here..... I can't imagine getting this far and then not making the cut at the last semester.... Some people are in a really hard place ... and I feel it is being made harder than it needs to be.

Snowy Easter

This Easter day has been very pleasant...I didn't burn dinner or anything (unlike yesterday when anything I touched ended up scorched). There is still about 2 inches of snow on the ground here...so easter egg hunts are all inside.

We dyed eggs, ate a nice ham and potato dinner with homemade carrot cake for dessert. MMMmm. Lance couldn't get over the fact that there are actually real carrots in carrot cake. :) We played board games - scrabble of course.

We went to two worship services this Easter as well. One was a passion play at my mother's church... It was so realistic I had tears in my eyes. Then, Easter Sunday at our own church was particularly nice, as well. The singing was refreshing and the sermon unique.

Here is a youtube clip of one of the songs from the play.


I have several issues with organized religion.... One of the big problems is when people act judgemental and pious. No one is perfect and the only thing worse than not being perfect is when you aren't and you act like you are. Follow?

Where am I going with this? I don't know. But, I was blessed by the worship services I was able to go to this weekend. And, feeling hopeful and more at home in our new church.

Here I will leave you with my ALL time favorite Comic (just remember I'm not a very funny person):

Happy Easter!

The Ranks

Have you ever heard the saying, "Nurses eat their young." I have, and I've been wondering why this is. There's a certain "pecking order" among the nurses that is unspoken and resented by some.

I can't say I've experienced it a lot... But, there is definately tension between the nursing students and the LPNs... Not so much the RNs. I had a particularly difficult LPN to work with last week. She came up to me in the middle of the hall with people all around - using a loud, accusing voice, we had the following conversation:

LPN: You didn't give 16A his insulin?!
Me: He isn't due till 1700.
LPN: Not his scheduled dose, his sliding scale.
Me: He didn't need it. His one touch was 97.
LPN: oh (shuffling papers) ok

And, all night she was breathing down my neck.....making me feel like she was hoping for me to make a mistake.

I couldn't do anything right... according to her. For example, later in the evening, a patient had a temperature that didn't respond to tylenol. So, I was making cool compresses to apply. She comes in all bull-in-a-china-shop-ish.....

LPN: What are you doing?
Me: Making cool compresses for his forehead.
LPN: Well, what you need to do is put that away, dump the water and go get an ice pack.

Ok, so she would prefer to use an ice pack and I would prefer to use a basin w/ ice for washcloths.... Big deal... It's not wrong... it is just different than she would do......

So, back to the question at hand... Why do nurses act this way? After some thought I think the issue comes down to power. They want it, but feel like they don't have it, so they try to exert it in any way possible.

Nurses are in a serving profession...they answer call bells and stop what they are doing to take orders from doctors and execute them... In unfriendly employment environments they are unappreciated, yelled at and mandated to work double shifts.

It is easy to see why this type of profession can lead to burn out and a feeling of powerlessness. This often results in tired nurses taking out their frustration out on the new, green graduates coming on. At least then they have power over someone. And, misery loves company. If they are miserable, you should be too.

This is, obviously, making HUGE generalizations... But, I feel there is a grain of truth here.... Thankfully this does not happen to all nurses. I have met many more positive and helpful nurses than I have bitter and demeaning ones. But, they are out there.

I wonder if this type of thing happens in other professions as well as nursing.

My Secret Goal

I have a secret repulsion for something: poop. I can't stand dealing with other people's poop.

As an OB nurse, I know I may have to deal with the occassional poop-pellet being expelled during pushing and baby's first meconium..... And, I'm fine with that.

What I can't stand is cleaning grown adults with incontinent bowel movements. I realize that they cannot help it...and I truly feel bad for them most of the time. But, I find myself having a secret goal for each clinical day. This goal written in three part "nursing diagnosis format:

"Student Nurse will not have to deal with poop by end of clinical day."

Yesterday that goal was unmet....to the endth degree...... Poop, poop, more poop all day long.... I came home and took a "sterilizing shower" and still felt dirty.

Here's to hoping today will be different. I don't know how general medical nurses do it all the time.....

Pondering

I got a post-card reminder in the mail that it is time for me to re-certify as a birth doula through DONA International. Receiving it has me thinking about my journey into birth, starting as a doula. Also wondering where I will go from here.

I have been a doula for about 5 years. Becoming a doula was my first step on this "slippery slope" childbirth career I'm on. I was taken in by two kind hearted midwives (CNM). They encouraged my growth and provided me with many wonderful experiences.

After certifying with DONA, I yearned for more knowledge. While attending births as a birth doula, I also got certified as a Lamaze Certified Childbirth Educator. This increased my knowledge even more. I got involved in local organizations like La Leche League and PaMILC, devoting time and energy in promoting peaceful births and postpartum experiences for new moms and their babies. I served (and still do) as DONA International's State Representative. And, I've attended every birth conference I could afford to on the east coast during these past 5 years.

My journey and yearning for knowledge lead me to nursing school, as you all know, in order to become an obstetrics nurse: A RN. With this part nearly complete and a job waiting for me in the wings, I am pondering whether I should re-certify as a birth doula.

I have all of the requirements (attended births & CEUs) accumulated. All I would have to do it send in the information. Which I most probably will. However, in looking forward to the future, I've realized the likelihood of me ever serving women as a birth doula again is very low.

This is bitter-sweet. Yes, I've moved on and attained a greater, more in-depth knowledge of childbirth. But, in doing so and in filling a new and different role, one of a RN, I'm leaving my first true love of birth: a doula.

As a RN, I will NOT be there to provide labor support. Nor will I be able to contract out privately as a doula to women as my full-time profession will make my availability for continuous support at a woman's labor nearly impossible.

My path as a doula is coming to an end.

I do hope to weave my experiences, inner wisdom, and knowledge of peaceful birth into the hospital experiences I am about to become a part of - as best I can. And, I know I will always bring with me a belief in the power of birth and its ability to impact women's lives profoudly - whether for good or bad.

I have built a strong support base for my practice as a RN while being a doula, filled with memories of women's empowerment and strength gathered from birth, embraced.

So, while I transition roles, yet again, I am filled with sweet memories, fear of the unknown, and hope for the future births I will be blessed to be a part of.

JBJ

Spring Break is over. It was good. I finished my paper and sent it in. Studied for an upcoming test. Got caught up on my reading. Don't worry... I did fit a little fun in, too!

I went to see Bon Jovi!!

My sister and I went together...we both have a not-so-secret love for Bon Jovi. We took our families who stayed and hung out at the Hilton while we took the subway to the concert. It was awesome.

Here are some pics. We had OK seats... But before the concert, I said to my sister, "What is that ping pong table doing over there?" She laughed and assured me it wasn't a ping pong table; not sure what it was, but it couldn't be that. Anyway, as we talked, we remembered the last time we saw Bon Jovi at this venue he came into the audience and sang on a small stage. That must be it!! We were sure.

So, each time the lights went down we prepared to dart down to the small stage (as it was only about 10 rows down from where we were seated). Then, when Richie took the mic for a solo, we knew what was coming... so, we ever-so-slyly made our way down as close to the mini-stage as we could. Then, towards the end of Richie's song, a stage hand lifted a microphone up onto the stage and we lost it!! It was true... Bon Jovi was going to sing right there in front of us... about 5 people away from us.

So, the pictures where he is wearing a red shirt are the ones from the mini-stage... they are slightly blurry because my sister was taking them as some crazed fan - who shall remain nameless - was shaking her from behind while totally losing it. :)

Do you know what I was thinking as I was that close to Bon Jovi? I was literally thinking, "I'm so close I can see his cephalic vein from here." Total geek-nurse... I know. I'm guilty. But, you will be glad to know he decided to grow back his chest hair....that I also saw first-hand.

Ouch!

Feeling the pain after yesterday's "50 pound-events"..... I'm such a wimp. At least it's my legs and arms hurting and not my back...I guess that means I did it right... comforting.... NOT.

Even More Excited!

I went for my pre-placement physical that I wrote about earlier. It took about 2 hours and wasn't as bad as I had made it out to be in my head. I went to occupational health for a history and physical. Vital signs, head to toe physical exam, questions about every ailment I've ever had and every medication I've taken and am taking. They did a drug screen and urinalysis.

Then I went to Physical Therapy where I watched a video on ergonomics and proper body mechanics. After which I had to return demo the techniques. They gave me a crate with 50 pounds of weights in it (It was a lot heavier than I thought 50 pounds would be!). I had to transfer it from a table to the floor and back again. Then, I had to transfer it from a table to a high shelf and back again. Finally, I had to carry it 40 feet and back again. Then, they tested my grip strength with a machine that I squeezed as hard as I could and it measured how many pounds of pressure I exerted.

At the lab, they took 7 tubes of blood for chem 7, CBC, various titers, etc. And, at human resources I filled out my child abuse and criminal history clearance.

Finally I ended at the maternity department where I met the nurse manager and had a tour of the suite.

I am so excited!!! I was excited before, but after talking with the nurse manager and touring the floor, I'm SO excited. It is a perfect fit for me. It is progressive, both in it's care and options available to patients and in its training and retention of staff.

There are multiple options available for women from the standard epidural to the walking telemetry units available to monitor fetal heart rate while ambulating. There is a jacuzzi tub and birth balls... All of which are actually used... Not stored in a closet somewhere deflated.

The orientation can take up to a year, which is awesome. Another hospital I was interviewing at had a 6 week orientation, then you were on your own. Not good. This hospital has a classroom aspect to the orientation and they rotate you through all of the shifts so you can get adequate exposure to all of the various routines in the hospital. They say you are not off of orientation until you feel confident you can handle ANY situation that walks through the doors. That is how it should be.... I don't want to be out there unsure of myself or a procedure... I value the commitment they show towards education and training.

The nurse manager is young and progressive. Easy to talk to and eager to help. Compared to another one I interviewed with who was a past army nurse whose hand shake almost broke a few of my fingers and who has a very intimidating presence.

The nurse manager talked to me right away today about my interest in teaching Lamaze for them and said there is a need for another Lamaze educator. They offer full 7 week Lamaze classes, a one day refresher course, and hypno-birthing classes.

I took my husband along with me today. His opinion matters a lot to me. We both came out of it thinking there couldn't be a better fit for me than this hospital.

God is Good.

What it Takes (sometimes)

While FINISHING my 27 page paper today, I made a terribly unhealthy, yet yummy study snack to enjoy. For the recipe go here.

Visual

What does it look like to be on spring break this week with a psychiatric nursing paper due on my first day back?

Psych Rotation

With my psych rotation finished I feel like I should post a summary of my experience. I've been putting in off for a few days ... It's hard to put the whole experience into words. The best way to say it is that it was emotional. I went into it thinking I could "fake" my way through it.. You know, go through the necessary motions and write the necessary papers without getting pulled into the situations emotionally. I was very wrong.

I found it nearly impossible to not feel for the patients on a very personal level. I was challenged to move out of my comfort zone and grew because of it. I saw poor, homeless people, and the son of a physician... Mental illness knows no boundaries.

Interestingly enough, I subconsciously chose female patients throughout the rotation. Then, on my last clinical week, the pregnant female patient I had hand-picked and cared for on day #1 was discharged on day #2. And, the only new patient for me to pick up was a male patient - a big, burly, scary-looking truck driver who was brought into the ward by police officers at 3am the night before.

I was very uncomfortable. I attempted to approach him about 3 different times before I was able to summon enough courage to sit down and speak to him. I actually have my son to thank for helping me: he taught me a card trick and I used this simple trick to "break the ice" and build some rapport with him. He laughed at the trick and we talked.

In the end he actually opened up to me and had tears in his eyes. I thank God that he gave me the courage to approach him and the words to comfort him.

This wasn't the only time I left clinicals feeling like I had truly been helpful to one in need, and I am only a student. I can only imagine the fulfillment a psychiatric nurse must be able to have at the end of her career in being able to touch so many lives at such times of need.

But it is not all roses, for sure. There were a few times I actually felt fearful of harm. There were also a few times my eyes filled with tears of anger for the unkind words said to the patients by the very ones who were there to help them.... I'm sure burnout and continuous stress can account for it...But, I had little tolerance for it.

In the end, my experience during my psych rotation is one I am thankful that I had.

"Physical"

My RN job offer is contingent upon me passing a "Pre-placement Physical." No big deal I thought... Say Ahhhh, pee in a cup, sign contract.

Well, I got the call today to schedule said physical and was given the itinerary: Be at Occupational Health at 9:15am, Physical Therapy at 10:15, then go to get labs drawn and finally end up at human resources around noon to file all of the criminal/child abuse clearances,etc.

So, what in the world kind of "physical" is this going to be? 3 hours of what? Seriously if anyone knows what is going to be thrown at me, please let me know. I am now stressed out about something I thought would be a no-brainer.

Should I pull out my kinesiology notes and cram? Will I be demonstrating proper transfer methods? I'm just guessing... What will I have to do at Physical Therapy? Lift 50 pounds without grunting?

Clueless.

A Clue

You know that nursing school has officially taken over your entire life if:

While exercising on your treadmill with Bon Jovi's "Bad Medicine" playing through your iPod, you subconsciously correct Jon's lyric, "...I need a respirator because I'm running out of breath..." Because you know that technically, that is incorrect.... He needs a "Ventilator." Because as a good nursing student you know that the "respirator" he is referring to meerly fills the lungs with air (ventilates); it does nothing to facilitate the exchange of gasses (respirate).

Psych Test

This post doesn't have a lot of substance....just some random thoughts....

I'm heading off to take my first Psych exam. It covers Psychotherapeutic management, nurse-patient relationships, therapeutic communication, anxiety disorders, bipolar disorder, depression, personality disorders, schizophrenia and all of the psychotrophic drugs that control these disorders (anti-depressents, anti-psychotics, anti-manics, various anti-convulsants, anxiolytics, etc.)

Interesting difference: Before my last exam (covering anemias, leukemias, shock, and various other hematological and hemodynamic issues) I felt like even though I studied and studied, there was no way I could study enough. This time I studied Saturday and a tiny bit yesterday, but this morning I haven't looked at a thing and feel very prepared. I spent my morning before the test today exercising and leisurely petting my cat, etc....

I like psychiatric nursing a lot... and if I weren't so drawn to my chosen field of birth, I would most probably do some work in psych. This week is our last week in the psychiatric clinical rotation.

Interview Questions

For future new, graduate nurses, I will list some interview questions I got while interviewing for my RN position after graduation.

Some typical/general interview questions came at me, like:
1) Give me an example of when you had to work in a team. What was your role. How did you handle problems that arose?

2) Name one of your greatest achievements.

3) What are your long-term goals?

Some general nursing questions were asked, like:
1) Why did you decide to be a nurse?

2) What is one bad thing about nursing? & How do you plan on dealing with that?

3) Describe how you would do a wound assessment.

4) Describe for me a time when you had prepared fully for a medical situation only to have the entire situation change and "fall apart." How did you recover and prepare to handle the new situation?

5) What would you do if you had a patient who had a complaint you could not resolve for them?

6) What qualities do you have that make you the right person for this position?

Some very specific nursing scenario questions also came up, like:
1) What would you do if you had a female patient who was accompanied by her husband in the hospital. Because of their religion, the wife was not allowed to make any decisions independently, but she wanted to have a procedure done. Her husband was forbidding the procedure?

And, similarly:
2) What would you do it you had a pediatric patient who needed a procedure done, but the mother was very emotional, crying saying she just cannot have this procedure done to the child.

3) How would you try to convince a pregnant patient who bottle-fed her first baby to breastfeed this baby?

4) What would you do if you were in charge of care for 8 patients and one of them just found out they have terminal cancer. The patient was alone, very upset and crying, but there were 3 other patients who needed your attention right then as well.

And, my favorite one because it took me off guard and made me think a little:
1) Imagine you have a 15 year old come onto your floor in labor. During your admission assessment, you learn that she has had no prenatal care, is mentally challenged, and the pregnancy is a result of a sexual attack. How would your care for this patient be individualized? What things would you do/not do?