Clinicals

I am now half way through my graduate program. And, with that starts clinicals. While I do not feel I know half as much as is necessary to become a midwife, I believe my learning will grow exponentially during my clinical training because I am a hands on learner. I learn by doing - and by doing things wrong... I learn from mistakes.

The program I am completing is designed to have all of our preliminary classes like pathophysiology, research, statistics, ect. done at this point. Now we begin the meat and potatoes as I call it. Classes on women's health and pregnancy and labor... what I really am excited to learn.... All while I'm attending clinicals now, too... So, with all of that going on, I've decided to go part time at my place of employment as of January 1st. It is a challenge financially... But is a blessing to be able to do it. I do not feel overwhelmed. I am completing my course work and my clinical work on time... But, never early. I am always doing work for school... So, I do have doubts whether I would have been able to do this without cutting back at work. In March my clinical hours more than double what they are now.. So, we will see if I will be able to continue working then. I sure hope I can. But am not sure. We will see when we get there, I suppose.

I put a lot of thought into choosing the place I wanted to do my clinicals at. It is a large hospital with several midwives... a two hour drive, one way for me. But, it was what I thought was best for my learning experience... But, when it was time for my clinicals to start, the contract was not worked out between my school and the large hospital. It came down to the very last day... I either had to drop my classes for the term and wait until next term when the contract was able to be worked out or I had to come up with another preceptor willing to take me - one who already had an existing contract with my school. I had been given the name of a clinic that had an existing contract with my school... and I had made telephone calls and sent emails to the clinic... all to no avail...

It was the day before I had to drop my courses and I just couldn't sit and do nothing. So, my dear husband took the day off of work and drove me 3 hours to the clinic in a major city. I prayed several times on the way down and when I walked into the clinic, I know God walked in with me.... Because the nurse practitioner who was working at the clinic that day smiled at me and when I explained who I was and my situation, she was very receptive and willing to help me out. She asked when I started my clinical hours and I said, "This week... well, actually last week. I can be here Thursday." She chuckled and filled out all of the necessary paperwork and faxed it to my school the next day... It was a blessing, indeed.

Well, the clinic I am doing my first rotation at is actually perfect. Our first rotation is focused on "Primary Care." General illnesses like sinusitis, bronchitis, etc. All the things someone may come to an ob appt and say to their midwife, "Oh, by the way, I think I have a sinus infection." And all of the illnesses a midwife has to co-manage because the women is not just pregnant, she is human. For example, asthma, thyroid issues and migraines.

So, It is a walk in clinic in a major city. Anyone can come in with anything.. and believe me, they do! My biggest source of discomfort going into this clinic was working with men. Since I graduated from Nursing school, I went straight to maternity. I've never had to work with men. And, the one ailment I hate dealing with the most is a skin rash. So, guess who was my first patient? A man with a skin rash. God is funny! It was like he was saying... Here you go. Tackle your worst fear first.. then it will be all down hill. :)

I've been really learning a ton! It took me a while to be able to do little things like successfully locating the tympanic membrane.... No, it's not a straight shot in, like I thought! But, I'm progressing and the last day I was there I successfully diagnosed a few patients and even selected the correct medications for them. My preceptor is a good teacher. She asks me questions right in front of the patient. Asks me to tell her what medications would work best on the patient and why. It really puts the pressure on me to know "my stuff." I am glad. This is a great way for me to learn.

So, life is crazy. But, I am ok with that because I have a feeling someone is looking out for me and it will all be over soon!

The Growing Bookshelf

My last final exam for this term is tomorrow. I already have my grade for my finance and economics class: An A. But, I do not have much hope held out for an A in my pathophysiology course. I would have to get every question right on the final to get the A. But, I'm working on accepting my non-A grade. I am too hard on myself. It was a hard course... and between working and my sleep issues... It seems I am chronically fatigued anymore... My studying could have been more than it was. Well, and not to mention today.. the day before the final.. I am here blogging... Can we say procrastination?

I then have a week off - spring break of sorts - Then I start my next term. It has eleven required textbooks. They are doosies, too.. Each one of them looks as if it could be a whole semester in and of itself. William's Obstetrics, Maternal, Fetal, and Neonatal Physiology.... Etc, etc... Really interesting ones, too like Human Labor & Birth and Anatomy & Physiology for midwives.

I am very excited to finally be having a midwifery course: Advanced reproductive dynamics... But I also have two other courses and the many, many books required is a bit daunting.

So, I have a week off to gaze at my mound of books and wonder where to even begin....
One step at a time.

2nd Term: Half Way Done

I’m at the mid-term point in my second term of midwifery school. So, what’s been going on? It is still super demanding. If I am not working, I have a full list of “to-do’s” for graduate school. This week I wrote 2 papers: one on colon cancer and one on budgeting. I also just completed a project on hemolytic anemia of the newborn. I was excited about this project because it was the first project/paper that I was able to pick my own topic. I’ve done loads of papers on topics I struggle to find relevance in for my future practice. But, for this project I got to pick the specific topic. It had to be a disease process and it had to focuse on the pathophysiology of that process. So, I began thinking of diseases that related to my field. Of course I thought about PIH and HELLP. But, those were obvious, I thought. So, I went through out text book and looked at things we covered to give me an idea for my project. I saw the section on blood types… Nothing specific… Just the basics: A blood type contains A antigens and anti-B antibodies, etc. It got me thinking about ABO incompatibilities and Rh incompatibilities between mothers and their fetuses. That’s something I don’t know the exact pathophysiology about. So, I had my topic: hemolytic anemia of the newborn. Something I need to know that I don’t.

So, that project was fun to do. And, the next time I give Rhogam to a woman I will know the exact pahophysiology and the reasoning behind it. I am beginning to enjoy classes a lot more when I can foresee them contributing towards my future practice. Although, all physiologic knowledge is useful… this felt MORE useful… You know?

Anyway, that’s what I’ve been up to lately.

The Respiratory System

My physiology class is systematically taking me through every system of the body and relearning the entire system from a cellular physiological standpoint. Can you say TEDIOUS?

I just finished up 4 days of studying the physiological aspects of the respiratory system. Why is this important to a future midwife you may be asking? Well, I kinda did too, when I began my monumentous journey through all of the material including 2 APA papers on the subject. Well, I am always pleased when I am able to apply the learning I am doing on a practical level for my practice now as a nurse and later as a midwife.

The gem of knowledge I will take away with me from this lecture involves the physiological response to excess interstitial fluid leading to peripheral and pulmonary edema. As a nurse in a high-risk obstetrics department I often take care of patients with PIH and pre-ecclampsia. And, I always knew the importance of assessing for pulmonary edema vigilantly. However, I never knew the complicated and intertwined physiological processes that must happen in a cascade effect in order to produce pulmonary edema.

In a very short form, if interested, please read on:
When the renal system malfunctions by failing to filter sodium and water appropriately, fluid overload occurs. This can result in peripheral and pulmonary edema. Excess fluid volume increases hydrostatic pressure and pushes fluid into the tissues. And, when renal disease is present, there is a decreased production of plasma proteins which results in decreased oncotic pressure of the blood. In the absence of sufficient onconic pressure, the venous system is unable to facilitate enough reabsorption. This can lead to increased peripheral vascular resistance, creating an opposing force to left ventricular output. The result is pulmonary edema (Black & Hawks, 2005, p. 214). Additionally, the lymphatic system is altered as it usually helps to compensate by removing residual fluid from the tissues.

Really, very interesting...

Black, J. M. & Hawks, J. H. (2005). Medical-Surgical nursing: Clinical management for positive outcomes (7^th ed.). St. Louis, MI: Elsevier/Saunders

Today was a struggle

There were a few things adding up to make a difficult day today... The one thing that is hindering me the most at this point is my circadian rhythm. In working night shift half of the week and being off half of the week, my body just gets adjusted to working when all of a sudden I stop and expect my body to readjust to "normal" life. The result is a mess. Even when I'm off, I wake up at 1am and am ready to eat "lunch." I was awake from 1am-4am last night... and could. not. sleep. Then, I cannot stay awake during the day. It just sucks.

So, today, I got up for the day at 7am, after just a couple hours of sleep and had a specific list of things I had to get done for school and my family. Then, what happens? I get a full blown migraine --- Because I didn't sleep! So, I HAD to take time out and take a pill and lay down... So, what happens? I go to sleep! What a mess.

It was about 1pm and I literally said to myself, "If I do not get up, push forward through this headache and do my studying, I will NOT become a midwife." So, with that in my mind, I did it.

I ticked off one thing after another on my "to do" list. I read 2 chapters of bio-statistics... Listened to all of the lectures to go with it. Did the review sheet for the module. And, took the bio-statistics exam and got a 100%.

Then, I went on to make a healthy, good tasting dinner of chicken Parmesan for my family. And, after dinner, I took my daughter out for some needed mother-daughter time.

It may sound like I'm patting myself on the back... But, darn it... It was a hard day, and I struggled through every part of it...

I have to just thank God for the strength and determination he gave me to get off that couch and take the next step. Each step counts. I'm glad that this step is out of the way.

On to tomorrow. and the next day... for the next 2.5 years... Ummm... we'll see.

Biostatistics Underway

I did my first on-line Bio-statistics class module. And, I found it surprisingly manageable! This is due to the fact that last spring I took a 4 credit college, graduate-level statistics course. So, it is fresh in my mind... And, it covered a lot more than what we will cover in this course.

When I was researching which school to attend, both Frontier and University of Cincinnati required an undergraduate statistics course be completed; but, Frontier required one within the past 10 years. And, Frontier also did not require you to re-take statistics at the graduate level if you had one in the last 10 years. If you did not have one in the last 10 years, then you simply had to take a statistics course offered at Frontier. University of Cincinnati both required a statistics course during undergraduate school AND a Bio-statistics course at the master's level.

Since my undergraduate statistics work was over 10 years ago, I decided to be safe and re-take the course while awaiting acceptance into my master's degree program with the thought that if I went to Frontier, then I would not have to take their program (taking it from the University near my home works better because my husband works there and I get a 75% discount)... And, if I decided to go to University of Cincinnati, at least I would be re-freshed on the statistical processes, etc.

Well, I decided to go to University of Cincinnati, and it seems my bet paid off. With my advanced physiology course being SO in depth and difficult, it is refreshing not to have to work my butt off at re-learning statistics!!!

Enjoying an easy course: Bio-statistics... Who would have thought I would be saying that!!

Knee Deep in Physiology

So, the first few days of graduate school have gone by. I was supposed to start on Thursday... But I received a shock MONDAY morning when my online course content was available to me! It took my breath away, literally. I was not ready to start classes until Thursday. I felt utterly unprepared... As if, a mere 3 days would make any difference at all... I felt like I was being cheated out of my last three days on earth.

I can only explain my feelings as being traumatized by my nursing school experience and NOT wanting to re-enter that state of living... Work, School, Clinicals... No sleep... No family time.

But, here I am... I refused to open any books or do any on-line work until THURSDAY, thank you very much... But, now I'm knee deep into Physiology... Tomorrow I will start bio-statistics...

Remember the action potentials? How bout DNA/RNA transcription/translation? The sodium potassium pump? Mitochondria and Endoplasmic Reticulum... Yep, that's my world right now.

I'm striving to connect what I learn to my future as a midwife... so when I find little gems in the midst of advanced physiology that directly connect to childbearing women I get a little thrill.

Today I was able to connect the action of lysosomes to the process of uterine involution after childbirth. Lysosomes act as an intracellular digestive system... and when regression of unneeded or unused tissues is needed, the lysosomes get to work. Another example of this occurs in the mammary glands after lactation has ceased. Tissue dissuse lead to increased lysosome activity.

So, while spening 8 hours today studying advanced physiology I was able to directly relate a small part of what I learned to what I practice.... The whole base knowledge will be needed, I know... But, I love connecting it as I go!

Preparations

My before graduate school preparations are in full swing. These are things that, in my mind, if I get them done, they will enable me to be successful in school. What do they include this time around?

Because I will have next to no time apart from work, clinicals and studying for classes and exams, I am worried about my house work getting done. So, here's how I am handling that:

1) I've given the kids more chores. They already have several chores they do on a daily basis - But, they get paid a monthly allowance for these chores - AND, they are getting older now... So, I've added one more chore per child. I now have no kitty cat duties... the sweeping, scooping and changing of the litter are no longer my responsibility. It's not even my cat... Surely, it was an acceptable thing to ask the kids to take care of their own animal?

2) I've set up an interview with a perspective house cleaning service. They would come into the house and do all of the vacuuming, dusting, wiping of kitchen counters & appliances, cleaning of the light fixtures and ceiling fans, scrubbing the floors and cleaning the bathrooms. If I could get these chores off of my plate, it would be a major relief and free up a lot of time for me to study.

Additionally, I am worried about creating a work space for me to study in. In the past, I have used the kitchen table, my bed or my favorite chair in the living room. But, the drawback to not having a specific study space is that if meal time comes and I am at the table, I have to pack up my current project and move it... and I am generally right in the middle of all of the normal household commotion. So, I have begun looking for a desk - just for my computer and my school books. I would like to put it in a place that is away from the action.. Perhaps my bedroom... But, it gets very cold down in my bedroom in the winter... I'm still working on this.

There is still one thing weighing on my mind: The cooking/grocery shopping. That is a never ending, time-sucking cycle that worries me. My husband can shop if I make him a very specific list... But half of the tings I buy are things I pick up while going through the aisles. And, often after working all night and sleeping all day, I am able to wake up and make dinner and have it on the table by 5:30 when he gets home... But will I be able to spend that time cooking? Or will I have to fit an hour or two of homework/studying in?

That's where I am at. In a frenzy trying to get my life in order - to basically not be here for 2 & 1/2 years. :(

Starting Again

Only a couple of weeks left and I will be starting the last leg of my journey: Graduate School leading to becoming a CNM.

I have nothing but feelings of dread about school at this point. I think I should have some excitement mixed in there... But, NO... Just dread.

I registered yesterday for my first two classes at University of Cincinnati: Advanced Physiology and Biostatistics for evidenced based practice. I'm putting off buying books until I get home from Vacation at the beach.

I took out the largest loan I've had to take out yet for one year of school.

I'm just scared that I may invest this much time, energy and money into something that I am not able to follow through on... I think it's my fear that I am not deserving of my destiny... My dream to become a midwife and this is the last step that I need to complete in order to achieve it...

But, you, dear reader, are not my psychiatrist... I'm just voicing my fears... Normal as they are. They are there; along with the feeling of dread about entering back into the state of being overwhelmed with work + family + school + clinicals = Me at my limits. I do not look forward to going back into that state.

But, our family as a whole has decided this is the best thing for all of us. 2.5 years that, when over, will enrich our lives forever. I'm just going to buckle down and do my best.

Application for Graduate School

Since I've made my decision to go on to graduate school, I've been accumulating the necessary items to send in with my application....and finally, I have everything I need to send in. So, my goal for today and tomorrow is to Put everything together and Mail My Application!!

What all goes into a graduate school application:
- A Completed 12 page application packet
- Copy of my RN license
- Copy of my resume'
- Picture of myself - ACK!!! This has proved difficult to find one I want to send along...
- Three professional references - I am sending 4 for good measure...
- Official transcript from college
- Check for $100
- Answers to the following two prompts:

1- A statement about my desire to become a CNM including personal information about myself and my professional goals as a CNM.
2- A statement describing how I intend to integrate graduate school and its rigorous demands and time commitment into my current family, work and life situation.

Then, place all of this and your life goals and heart's desire into an envelope, stamp it and send it off. Then, Wait.

Good Experiences

There are many things that happen and I think, "Boy, I should write that down because I want to be able to remember that." But, rarely do I... My hubby is good... he has a journal... I don't.. I have one but it rarely gets written in and I am sparse about my posts here...

Like two weeks ago when I finally told my nursing supervisor about my plans to apply to graduate school for my masters in midwifery!! I was so nervous and felt like I would be disappointing her because of all of the training she poured into me fresh out of nursing school to become a fully functional L&D nurse... But, she was genuinely happy for me and truly excited for this opportunity! She said many wonderful things I wish I had written down... Like she said when she met me she knew I had great potential for things beyond a staff nurse... and that she was glad to have had a part of my training... And she just knew I would make a fantastic midwife! She was awesome....

My last night at work is another situation I hope I remember for a long time.... I was kind of in a slump emotionally when I got there... I hadn't slept well that day and was kind of off my A-game.. I was assigned an out-patient rule/out labor. Well, it turned out she was a keeper and was indeed in labor. My mood brightened after that because the expectant couple were super nice and the mother intended to labor actively without medications (My favorite type of patient!).

So, it was a lovely night... she progressed slow and steady... I was able to take my time and get her admission done, IV started, etc... Because she was not in a rush to get an epidural ASAP. She warned me that she "transitions and pushes quickly" so I made sure everything needed for delivery was ready by 6cm.

It was coming close to change of shift time and she was not delivered yet but was close to 8cm... Our unit was short staffed and the charge nurse was calling everyone to ask if they could come help - without any luck... So, having bonded with this lovely couple and feeling like she would deliver soon, I volunteered to stay past change of shift and finish out her labor and recovery.

That's when it got a little tricky. The lady's doctor was scheduled to do 2 back to back cesareans that morning and there I was sitting with a multip who "transitions quickly." I was a little nervous. The doctor checked in on us before and between the cesareans, but I was nervous as all heck. Not nervous particular about the possibility of attending a delivery without a doctor present but nervous about the politics of doing so.... Filling out an incident report...meeting with my supervisor... explaining why I was unable to ensure the Dr. made it in time...etc, etc... Plus, my patient was active during all of this... walking the hallways, etc... at 9cm, pausing and squatting, etc, etc... I almost felt the need to follow her around with some kellys and a cord clamp in my pocket.

I agreed to stay until a certain time and it was nearing that time and she hadn't delivered yet.... So much for "transitioning quickly".... I was then happy because she finally delivered after being stuck in transition for hours one half hour before I had to leave... It was wonderful... It was with my favorite doctor to work with and I was able to be with her from start to finish - at a natural medication free birth.... Something I usually don't get to do since giving up my doula practice to turn RN... I felt like I was in the good-old doula days again!!!

Then, after the delivery the doctor and I were talking and I confided in him that I was going to graduate school to become a CNM. He responded wonderfully as well. He said he used to work with 7 CNMs in another state years ago... and he would love to work with a CNM again but doubts that he would be able to in this area... I sadly agree.. But it was great to be able to talk about it... He said the next delivery I have with him where I've bonded with the patient and feel comfortable he wants me to gown and glove up and do the delivery with him as my guide. Pretty awesome, huh?

The right path

I'm faced with many decision now that I've decided to start graduate school next year. I've pretty much decided on which one I will go to: Frontier Midwifery School in Kentucky... They offer an all distance education program where I will do course work via computer and clinical work with a CNM in my community. Now, I am contemplating what the best course of action is as far as work. I drive an hour North for work now at a hospital that has NO CNMs and quite frankly I don't think ever will. There are other hospitals South and West of me that do have CNMs. I'm fairly certain that the hospital I currently work for will not subsidize my studies because they will not hire me after I graduate as a CNM.... But, there is a possibility of me taking a job at one of the hospitals that does employ CNMs and then they would possibly subsidize my graduate school... and the added benefit would be that I would work and train at the same hospital... If I continue to work in the "North" hospital and train as a CNM "South" or West... My travel time would be incredible.

I think I at least owe it to myself to send my resume out to the other midwife friendly hospitals in my area and see what the possibilities are. I feel loyal to the hospital I am at now... they took me fresh out of nursing school and invested a lot in me already to train me as a L&D nurse... But, in reality, I have to do what is best for my future and that of my family.

Torn.

The Climb

However corny it may be... I love Miley Cirus' song, "The Climb." It is an inspiration for me to enjoy the journey...not just the destination.

Well, recently Mark and I went to Los Angeles California for a conference he had --- and some time away to ponder my next step in my journey. During my time away, I decided that I would take the next step and apply for entrance into graduate school right away with a goal of starting next August and graduating as a CNM two years from then.

I am super excited for the destination...but kind of dreading "The Climb." I know how grueling full time work and full time school is..I've been there - Done that! But it is only two years..... And, I also know how quickly two years can fly by. And, with the prospect of many, many working years ahead of me, I can see no better way to spend them than doing exactly what I KNOW I was born to do: Be a Midwife.

Another deciding factor is that it will be healthy for the children to see me accomplish such an important goal that I set for myself. Showing them that hard work and dedication can bring accomplishment.

Finally, I will be easily making two to three times the amount of money I am making as a nurse. That's just the icing on the cake!

So, Here we go.... AGAIN!!