undergrad RN

National Informatics Project!

2011-11-28T23:16:00.001-07:00

I'm writing from an airplane, on my way to Toronto to present at the CASN Informatics Stakeholders Symposium. This is a project I've been working on with the Informatics Task Force since this past summer. Basically, CASN is the body that determines and evaluates the national curriculum to be taught in undergraduate nursing programs. Over the past few years, they've seen a need for graduates to improve their comfort level and expertise with sourcing and applying knowledge. Of course, this has increasingly come to mean databases, web content, and digitally available reference material, with a healthy skepticism to determine which information is trustworthy. So while workplaces may be excited to get we new graduates in because of our general comfort level with technology, they are finding that we aren't as sharp on information literacy as we should be.

Enter informatics competencies.

This task force I'm working with is developing resources for faculty to learn more about informatics, and specifically, how to incorporate these competencies into their teaching plans. The idea is that there will not be any one "informatics course", but rather that information literacy strategies will be reinforced throughout the full degree program.

I was invited to represent students on the task force because of my portfolio with CNSA. As the Informatics Officer, I've found that the opportunities to get involved with new and exciting projects just seem to fall into my lap these days. On my first teleconference with the task force, I was blown away by the expert knowledge by the other people on the team, and mind boggled when they nominated me to chair the team. Probably just because no one else wanted to do it! But they said it would be a good experience for me and they were right.

So tomorrow I am supposed to lead a small group of stakeholders, which includes a few other students from CNSA, in a discussion around some of the documents we've developed in partnership with our consultants.

Regrettably, it comes in the middle of the busiest week of my semester... Orientation for my preceptorship was today, and I have 2 finals and a presentation on Friday. Wish me luck.... :)

xoxo ugrn

One flu (vaccine) over the cuckoo's nest

2011-11-09T19:23:00.000-07:00

I'm about halfway through my nth shift delivering flu shots to the masses. Although it is monotonous at times, I've actually found it to be a pretty good experience. I work casual hours which means I can pick up shifts as I like, and I can even cancel a shift if I get too bogged down in school work. I've met all kinds of people, and gotten semi-decent at small talk. I've also developed a mighty smooth IM technique!

Things I've learned from flu clinics: I have absolutely no desire to work with children. Even if the kids are behaving perfectly appropriately for their ages, I find them stressful. Let's not forget the parents who try to convince me that their 7 year old sniveling kid will sit still by himself for the shot.... Not falling for that one again!

I actually find the flu clinic kind of an enjoyable escape from emergency. After the first week, most sites have been VERY quiet. My stress level right now is about -10. After my high-stress city job and a summer in emergency, I almost feel guilty that they pay me to do this....... Alllllllmost :) my favorite part about this is that no one treats me like "a student" here. I'm a member of the staff, I do my own thing unless I have a question. I can make normal conversation with the nurses, for probably the first time ever. It's great.

In other news, it's about 3.5 weeks away from the end of the semester! this semester has been RIDICULOUS. I was walking to school this morning in the pitch black cold and I thought to myself.... Man, 4 years is a long time. I've been standing on this same sidewalk waiting for this same light to change in this same crappy weather holding a coffee from the same Tim's since 2008.

The workload has been a steady insane pace for the last 2 months, and it's shifting into overdrive for the rest of this month. I have 2 more group presentations, 3 more papers, and a bunch of quizzes and minor assignments to complete by December 2. I also have to finish my oncology nursing certificate by the end of November, except that's impossible so I will have to extend it until January.

BUT. And here's the big but.

I have my preceptorship placement confirmed!

I am going to Oncology!

I am so excited!!! The cancer care center here is huge and highly respected. I also had such a good experience with the oncology nurses that I met at the CANO conference in Halifax. With any luck, I will knock their socks off, and be offered a full time line after I am done my preceptorship hours. :)

Assuming I like it there, of course. But I am feeling very, very positive about it.

Honestly, after some months away from full time emergency, I'm starting to wonder if there's a better fit for me. I mean, emerg is AWESOME experience and I can't say enough about the expert knowledge there. The nurses are mostly super kind and helpful. I will absolutely stay there on a casual basis. But, something's missing.....

.... The kind of relationship building that you get with inpatients. The chance to see the results of your hard work. The possibility of being on a first name basis with your client in a real kind of way. The opportunity to really, really talk about health promotion with your clients, the kind of deep talk that happens at 0-dark-thirty.

I mean, those things do happen in emerg, but rarely. The norm is that I'll round on a patient 2 or 3 times and then they'll be discharged. The ones who come back, our lovely frequent flyers, don't usually come for the witty banter or healing presence of yours truly ;)

I guess it's that some of my classes this semester have struck a chord. Especially in my Chronic Conditions class, we really talk about primary health care, and I want to be more involved with my patients in that kind of way. Obviously inpatient Oncology isn't really the place for that. But it's got a chance for that kind of relationship building, and I see a lot of opportunity for primary health promotion at the community level.

I've got my orientation for the hospital at the end of November, and I'm super pumped. It's for the inpatient-side, so I guess that will be a lot of the really-sickies, palliative care, that kind of thing.

Can't wait! Getting so close to real nursing!

That's So... Meta

2011-09-26T13:34:00.001-06:00

So early in my nursing school adventure, I daydreamed about what the upper-level classes would be like. Well, not really the 400-level courses since they seem kind of dry by title alone: Future Directions of Nursing, Leadership, Bioethics of Health Care. I was so excited about the 2nd and 3rd year stuff. Lab skills, patho, assessment. I remember, shortly after I was accepted into the program, staring at the curriculum and wondering who and what I'd be like once I'd gotten to where I am now. I remember seeing myself in some nebulous idyllic clinical representation, the essence of confidence and expert nursing skills, making effortless profound impacts in the life trajectories of my patients. Hahaha :)

Well, as you know if you've been here or if you've read my blog for any length of time - there's really no such thing as effortless at this stage. I overthink the hell out of every move I make, either before I enter the patient's room, or as I lie awake in bed wondering if I did or said the right thing. My romantic ideas of nursing are muddied further by challenging instructors, complex work-school-life balancing, and learning to navigate coworkers and professional relationships.

Anyway, I guess I'm trying to say that my reality is both laughably departed from what I imagined, and in some ways exactly what I hoped it would be.

So that brings me to this year. These courses which I just viewed as the last necessary steps to my final placement and -at last!- status as Registered Nurse. I thought this semester would be the longest one of my life.

Nothing could be further from the truth.

I LOVE this semester and everything about it. We're already 4 weeks in, with 9 weeks to go before finals. Through divine intervention, or a reasonable facsimile, all of my classes have amazing instructors, including some of my favorites from years past.

The biggest difference this year from previous years is the distinct lack of rote memorization. I don't have any lame keywords to memorize for the final. It's like we spent the last 3 years learning (and forgetting a lot of) that kind of micro-knowledge. My lectures this term are all big-picture discussions. We don't spend so much time convincing each other what nursing's supposed to be (since none of us actually know, anyway). We actually talk about realities of nursing, as seen through our experiences in clinical and as UNEs. Macro stuff like is this congruent with what we imagined? Where is nursing as a profession, and where do we think it should be?

Another thing I love is how empowering my instructors are. They are always reminding us about who the future of nursing is, and how it's up to us to make it into what we think nursing needs to be.

I leave every class with my mental wheels turning. I've been known to jokingly complain to my friends about how META my classes are. Seriously, this semester makes me so happy! I think it's shaping up to be my favorite one out of this whole program.

Right now I'm working on my first paper for this term. It's a review of a pop-lit book on leadership. I'm reviewing the book "Primal Leadership" by Goleman. It's kind of a long-winded project since I have to finish the book before I start the paper (due Friday), and amidst my already packed reading schedule it's been kind of a grind.

In other news, I will be working the flu immunization clinics this year. Orientation for that is on Thursday. I fully expect to be amazing at IM injections by Christmas ;)

Thanks to those who added me on Google+ so far! You rock :D

Yayfriends!

2011-09-23T08:00:00.000-06:00

So you might have noticed that I've set up this blog to have its own (experimental) Google+. If you're down with getting conversational, add me! Please include a non-creepy note so that I know you're a real person and worth saying hello to :) Also, let me know if you're a nurse/student/allied health professional or if you do something else we can talk about! If you're extra not-creepy maybe I'll consider adding you to my real Google+, but that's more of a long term kind of thing <3

A Summary, a Conference, a Project, and an iPad

2011-09-22T14:43:00.001-06:00

I really have to apologize for the dearth of posts lately. I've got no good excuse except for the usual premium on spare time that comes with nursing school. So that aside...

A Summary: I really want to talk about my experience as a UNE (student nurse extern) in the ER over the summer. I freaking LOVED it. On speaking with some of my classmates, it seems that I got pretty lucky in my placement, because my particular ER is small and ultra-inclusive - there simply wasn't enough help to go around, so I was always considered part of the team, and like an extra set of hands. Turns out some other people placed on Med-Surg/postpartum were viewed as subpar RN stand-ins. As student nurses we are mandated to take a smaller patient load and lower acuity than staff nurses - which makes sense. Yet some of the staff nurses took the perspective that the UNE had it easier and so made their jobs harder, where other nurses saw us as a bonus to the existing staff and as lightening the load by taking a patient away from each of the other nurses.

So I am even more grateful that I had such a positive experience this past summer. I was on the unit from May through the beginning of September. My scope was pretty big. There were a few things I couldn't do at all or without RN supervision, and some of my meds needed to be cosigned, but I worked really hard and helped out a lot. I almost never sat down except for a quick charting session. It got to the point where I was starting to anticipate the flow of the ER and what might be done for certain patient presentations. I asked questions and clarified interventions. I saw several urgent presentations and maybe even a couple of emergencies, although I still haven't witnessed a code or done CPR on a human. I made real differences to several patients. I learned how to work as a team, contribute, and COMMUNICATE. I made more money on shift differentials then I ever expected (woo night shift!!) - but, most importantly to me, I gained so much experience in the nursing role and, like, quintupled my comfort level with all the psychomotor skills that made me so nervous in lab. I saw so much this summer.

Some of my coworkers were more difficult than others to really learn from. One in particular struck me as an exceptionally competent nurse, very confident and knowledgeable, but she was like a prickly pear to talk to. I guess like your typical Type A ER nurse (for the record, I'm pretty much a Type B introvert, and I still enjoyed the ER, so don't let anyone tell you otherwise). I got a lot out of shutting up and watching her, but forget asking her any questions, she didn't have time for students. Or so it seemed. And there was the charge nurse who wasn't the best teacher. But the overwhelming majority of my RN/LPN coworkers were super kind and patient with me. They all made such an amazing difference in my practice and I told them so!

Would I recommend Alberta nursing students be a UNE during the summer after 2nd and 3rd year? Unequivocally YES. It's like nursing school on speed. You'll start making sense of the theory in ways you didn't expect. You'll gain the psychomotor skills to actually do lab skills on real patients without your instructor hovering over your shoulder, and while you do those skills you'll start to work patient teaching into your practice. Then in 4th year you'll have real-world examples to back your shit up when you write papers. Or blogs.

A Conference: I was the fortunate recipient of a travel bursary to the CANO annual conference in Halifax, NS. There was supposed to be another student who went, but I never met her.

In a nutshell, Oncology Nurses are seriously knowledgeable. They are also awesome because, from what I experienced at this conference, they are valued as collaborative and worthy team members even by physicians (kind of a hard status to come by, it seems) and are extremely supportive of complementary/alternative medicine (CAM), not so much because of the evidence surrounding CAM but because patients want it and find relief from it, and they need their primary providers to be open and knowledgeable about it too.

The conference was 4 straight days of learning. Corporations sponsored almost all of our meals, and during each meal there was a presentation on some new wonder drug or different approaches to patient care. There were also a multitude of workshops to attend, where nurse researchers would present their latest abstracts and findings.

I had a lot of difficulty integrating myself into the conference because, as specialists, the presentations were operating at a pretty high level of comprehension. The conference attendees were almost all advanced practice nurses - NPs, CNSes, and tons of nurses in research and academia. They would debate different chemotherapy drugs and weigh the pros and cons, and things like that, which was kind of meaningless to me as a student. There was some stuff I did learn a lot about, such as a yummy dinner symposium at which we learned about treating clogged CVADs. I don't remember learning much at all about CVADs in class. The dinner was beef and chicken. The beef was served medium-rare, and pretty pink/fleshy in the middle. It was at that moment the presenter posted some photo examples of blood clots extracted from CVADs. They looked eerily similar to my beef dinner. At which I thought, "Only nurses would be totally cool with watching this as we eat..." mmmmm :)

Another challenge I found was the huge jump, not only in experience, but in age between myself and the other attendees. Being as they were almost all out of bedside nursing (and with the commensurate experience), I'd peg most of them as 40+. Not that there's anything wrong with being 40+. It just didn't give me much to talk about with them. So most of the time I would sit down with a new group of people at a table, introductions would be made, and they would ask me where I worked.... when I would say "Oh, I'm a student".... and the conversation would awkwardly shut down or divert amongst the RNs. It made for kind of a lonely time at the conference although I did meet and network with lots of people. I even met the lady who does the clinical placements for our local Cancer Care centre, where I am hoping to get a placement for my preceptorship.

The CANO BoD contacted me after the conference and wanted to get my perspective as a student attendee. I think I will recommend that they try to designate a "Conference Guide" for future conferences, who can assist the students to really understand the presentations and kind of bring it all together. I think I would have benefited from some kind of debriefing.

On a totally positive note, several of the nurses I sat with were really pleased and happy to help me understand the presentations. I could see that a lot of them were probably involved in teaching. So that was really kind and super helpful. I got a ton of notes from all the presentations, so I might be able to review them once I am practicing and maybe they'll make more sense. :)

A Project: Through my work with CNSA as Informatics Officer, I have been working with CASN and CNA on developing informatics competencies to add to curricula for undergraduate nursing education. I think it's cool that I'm working alongside some heavy hitters in academic and professional spheres on a project that will impact the future of nursing education in Canada. At our teleconference in August, we needed to elect a chairperson for our committee, and some of them suggested that it would be a good experience for me. I think so too, but I really don't know what I'm doing as a chairperson. I told them that if they were patient with me I'd be happy to take on the role. Part of this means I will be presenting our findings to a stakeholders' symposium in Toronto at the end of November. At our last teleconference I discovered who would be considered a stakeholder. I'm super pumped/terrified to meet these people, but wow, what an opportunity.

An iPad: It's no secret here or anywhere else that I have a special fondness in my heart for Apple products. I was one of the original hires to help open the first Apple store in Western Canada (which was a pretty fun day! :). The love is waning a little bit with Apple's continued pricing structure, surging popularity, and militant control of how I enjoy my products, but, on the whole, I still can't beat the user-friendliness of iOS/OSX. Can't argue with the fact that after I convinced 4 of the family members who called me all the time with computer issues, I don't really have to troubleshoot anyone's crap anymore, because it doesn't need troubleshooting.

So when I saw the reading list for this semester, and noticed how much of it was PDF academic articles, I winced and wished there was some way I could read these in a more comfortable manner. I really try to avoid printing anything because I am cheap and scatterbrained. I also hate reading articles on my laptop because of i) the searing pain in my lap once my computer's been on for >20 minutes, and ii) I am way too easily distracted by Spaces.

So I started checking out some different kinds of tablets. Initially I was intrigued by Samsung's Galaxy 10.1 since I might be converted to Android. I certainly am willing. Anyway, after lots of research and playing with tablets at Best Buy, I decided the extra $50 or whatever was worth the negligible decrease in performance/portability/resolution in exchange for an exploding App Store and seamless integration with my existing tech setup.

Anyway, I bought the iPad last Saturday on an extreme trial basis. I had very specific criteria in order for any tablet to be superior to my laptop. I was/am ready to return it if it didn't work for me:

1) It had to be incredibly easy to integrate with my cloud server on Dropbox
2) Accessing and editing documents on Dropbox had to be seamless
3) Accessing and editing PDF articles and class notes had to be comfortable and realistic (nothing too complicated)
4) Google Calendar had to play nice with iCal or an acceptable equivalent
5) There had to be apps out there to make it superior to my browser-based existence
6) OSK is just not realistic for me, so I wanted a great/portable Bluetooth keyboard

Today is day 5, and honestly, I don't know how I got by without it. I LOVE curling up in bed, locking out the rotation, and reading/annotating my PDF articles or even just web browsing or watching Netflix. I am beyond impressed with how most software seem to integrate with Dropbox or other cloud servers.

Right now I have been using Goodreader to read/annotate PDFs, Quickoffice Pro HD to view/edit my Word/Excel docs, and iProcrastinate to manage my workload. Unfortunately iProcrastinate only has an iPhone app at this time, but it syncs up with my Macbook so it's all good. So nice to be able to see what's coming up next between all my classes.

Tomorrow I will try AudioNote especially in my Philosophy class. The prof is very much a talker, and doesn't tend to summarize her points in any logical fashion, so I think recording her lectures and having them timestamped to the notes would be a great thing. We'll see how it goes.

I have been finding a lot of apps that might be suitable to nurse-types, so I was thinking I might do a review of these in the future so you can get a feel for it without shelling out money.

As far as the keyboard setup, I was heavily swayed by NNR's review of ZAGG's keyboard. I checked out Future Shop and found one open box, missing the USB cable. Since I have a few of those anyway, I sashayed up to the sales guy and asked him to "make me a deal" on it complete with flirtatious lashes. He knocked off another $20(!) for me, dropping the price from $100 to $75. Excellent. I love the keyboard, too, although it's good that I don't have man hands, because the keyboard's certainly petite. Together with the iPad, it still weighs roughly 2/3 less than my Macbook, not including the charging cable, and it definitely takes up much less valuable space in my bike pannier.

So altogether, between the cellular data, the apps, the cloud integration, and the ZAGG keyboard, I am quite pleased with my setup. Bonus points for form factor, weight, battery life, and lack of hard disk drive. I will continue evaluating right until Saturday of next week which is the end of the allowable return period.

Anyway, I have been blogging away from yet another new app - Blogsy. I really like it. Even better than I like Blogger's old back end. I used it to write this blog post - I am hoping that the improved mobility will make it easier for me to blog when I have the desire instead of waiting for when I have time at home with my computer.

I guess that about covers everything. For now. :)

It's here! Fourth and final year!!

2011-09-06T22:14:00.002-06:00

I'll keep this short because I was on a weird shift last night at the ER to try and cover the peak times, and then I went to my other job today, and I'm trying to catch up on sleep before my 0800 class tomorrow.

It's crazy to look at my syllabi and see all 400-level courses.

This fall semester is my final lecture-based term; Jan-Feb is my consolidation and then Mar-Apr is my PRECEPTORSHIP!

I put in my preceptorship placement requests yesterday after a lot of serious thought. Basically, after much deliberation and longing to try every specialty but being restricted to only 3 choices, I finally decided on Oncology, Cardiology, and Corrections.

A few that fell on the cutting room floor were PACU, ICU of all types including CCU, public health particularly women's sexual health, and a brief daydream of something extra crazy like OR. I also didn't consider asking for Emergency since I wanted to try something new.

Why not critical care? Although I'm tremendously interested in it, and I KNOW I'd learn a lot, I spent a lot of time reflecting on the criteria to excel in my preceptorship. Some of those things include initiative, the ever-elusive "critical thought", and transitioning to a grad nurse role. I honestly don't think I'd be able to excel in those criteria in ICU. Yeah, a 10-week preceptorship would be an awesome orientation to the floor, but really, it would just be an introduction. In my final preceptorship I'm expected to be a grad nurse. I feel like I'd spend so much time being a fly on the wall, I'd be too afraid to get in and get my hands dirty, so to speak.

The choices I picked are ones that I think have opportunities as a newbie nurse to actually show some initiative and capability as a health care provider.

We had to provide some rationales for our choices, and these were mine:

1. Oncology: My interest in Oncology stems from both the prevalence of cancer diagnoses across all patient populations as well as my family’s experiences with cancer. I feel uniquely prepared for a preceptorship in oncology nursing as I am currently completing the ONDEC course through the Alberta Cancer Board. I am also a student member of the Canadian Association of Nurses in Oncology (CANO) and will be attending the CANO conference** in Halifax this September to learn more from dedicated Oncology Nurses about their specialty. In return for receiving a travel grant, I have agreed to write a journal article for one of CANO’s publications and I am hoping to write about my preceptorship experience and transition from theoretical knowledge into practice as a graduate nurse.

2. Cardiology: I have worked as an undergraduate nurse in the Emergency setting over the past summer. I have tremendously enjoyed working in the ER and have found that one of our major patient populations are either experiencing acute cardiac changes or have a history of cardiac/vascular pathophysiology. Having worked closely with several former Cardiology nurses, I admire their extensive knowledge of this specialty. As I have been invited to stay with the ER after I graduate, getting first-hand experience with this specific population will be extremely educational and give me confidence when working with new-onset cardiac concerns in the ER. My RN coworkers have commented on my willingness to get involved and ask questions to further my understanding, so I believe I could meet the required objectives to excel in this placement.

3. Corrections: My first post-secondary program was in Policing, of which I completed 50% of the course credits. I still have a strong interest in law enforcement although I am geared more towards prevention and rehabilitation rather than apprehension. At the ER we also had several inmates transferred to our facility for treatment. I believe that with my educational background and ability to respect and work with corrections patients without judging their histories, corrections nursing would be a unique opportunity to make a positive impact in an underserved population.

**In other news, as you read, I am going to yet another conference! There are just so many opportunities for students to get involved in Nursing. I have some other projects I'm excited to tell you about. But that post will have to wait until, at least, I get a decent night's sleep :)

WaHOOOOoooOOO FOURTH YEAR!!!!!!

Loss of a Statesman

2011-08-24T08:57:00.001-06:00

Dear Linda Duncan*,

As a nursing student who values social justice and universal health care, I too mourn the loss of Mr. Jack Layton, who championed our cause and the well-being of all Canadian people. Mr. Layton was a true statesman who believed in Canada's legacy and also its future, working tirelessly to achieve his vision for our nation. His final letter is one that we can be proud of as Canadians, irrespective of our political leanings. That he took the time to write such a letter speaks volumes about his character and commitment to Canadians, and the address to young people in particular gives me great hope for our future.

In sadness and solidarity,

Undergrad RN

BScN Student, 4th Year

*Although not my MP, Linda is the MP for the ONLY NDP riding in Alberta. All emails and phone calls are transcribed into his book of condolences.

Check, check, checking out

2011-08-09T16:05:00.005-06:00

So it was SO FREAKING BUSY the other night. The back was stuffed full of sick people and new ones were coming in the door so fast we had two nurses out double-triaging for almost 2 hours. The theme of the night seemed to be chest pains or lacerations secondary to kicking glass/tables/sports equipment.

There were the usual WTF visits, like the mom who ABSOLUTELY had to get her kid "tested" for celiac disease in the middle of the night. At the ER. Where people were practically hanging from the rafters in the waiting room. The urgency? Well, she Googled a new diet and wanted to start him on it the next morning... "Can't I just see the doctor real quick?"

"No. I'm sure the other 25 people in the waiting room would like to see the doctor 'real quick', too." Then, after lipping off the triage nurse, she stormed out. Bye...

Anyway, I had a patient who was recovering from an infected cat bite**. She was on IV therapy q daily and this was to be her last dose.

I pick up the order - Gentamicin 480 mg IV and a PO dose of Cipro.

Go to Pyxis. Look up Gent. Go to withdraw vial.....

.....wait, we only have Gent vials that come in 80 mg/2 mL concentrations?

I check the order again. Yes, 480 mg.

Now, the nurse's cardinal rule in pharmacotherapy is that if you need more than one vial for ANYTHING you're probably doing it wrong. You know, the "thou shalt not overdose the patient into serious complications and probable death" idea. The manufacturers pre-package them in the normal dosages as one step of the safety chain.

I do a quick calc and see that I'd need..... six..... vials of Gent to make the ordered concentration.

I re-check the order and the vial about 500 times. I get an RN to check it. She laughs and says, "Yeah, that's normal for Gent. Don't worry about it!"

Easier said than done. I get to work drawing up the vials and mixing them up in N/S.

Then I go to the patient and start programming the smart pump. Smart pumps have "guardrails" on certain drugs to prevent nurses from accidentally giving unsafe dosages or infusion rates.

So the guardrail pops up with the amount of Gent that I'm planning to infuse. It also pops up with the rate I want to set. The smart pump actually wants me to infuse the 100 mL bag in 30 minutes. I'm all like "screw that, Alaris, you'll run it over an hour!". It's weird that the guardrail cautioned me running the med longer than the time allowed. Usually it's running it too fast that causes phlebitis. But I digress.

So after bypassing 3 red flag safety checks, I was feeling pretty unnerved by the whole experience. I mean, it was only 480 mg of an IV antibiotic, not 48 grams. I was pretty confident that I was giving a safe dosage, and I cleared it with 2 RNs during prep and administration. I also checked my drug guide to verify it was a safe dosage.

Seriously, manufacturers of Gentamicin and Alaris, put guardrails where you need 'em, cuz you just about gave this nursing student apoplexy!

medscape.com

** Who'd've thunk it, but cat bites are among the most common reasons I've seen for people to get cellulitis. Those things just get NASTY! Swelled limbs and purulent drainage. And they usually happen to the nicest people (cat people are usually nice, or nice-crazy, IME). Cute cuddly kitties need to come with a disclaimer.

It's 0430, do you know where your soldier is?

2011-07-30T04:35:00.001-06:00

My first-ever witnessed case of military PTSD tonight. Query attempted suicide on benzos and ETOH. All I can think of is he had no other means to numb the chaos in his mind.

I don't necessarily believe in what the military *does*, but I do support the men and women who stand up for their country in one of the most honorable ways possible and the sacrifice they make in that choice.

But I think the sacrifice goes far beyond a tour of duty and service on the front line. I think that the military completely fails its troops once it's time to re-enter civilian life. In absence of psychological intervention, soldiers turn to any variety of things to numb their thoughts and dreams, and too many of them end up dead.

Thanks for serving your country, here is a sense of manly bravado, zero coping skills and tons of bad shit to deal with. Bye bye now!

Seriously, so sad. I just want to go all "The Cell" on him and hop inside his mind and bring some peace there.

-- from the cellular desk of undergrad RN

Got angry at/for a patient...

2011-07-19T00:35:00.010-06:00

And I'm still troubled by it.

A young woman was brought in by police a self-inflicted laceration. At first it just seemed like your run-of-the-mill angsty teen cutting.

So I brought her in, pulled up a chair, and said..... "start from the beginning".

And she talked, and I listened, and she cried, and I held her hand.

http://www.twloha.com/vision/

Turns out this young mom, just a few weeks postpartum, was beat up by her husband. Lumps and bruises all over her. We had an inservice last term from a nurse who works in a women's shelter who talked about the dangers of strangulation in family violence; she had a big hand-sized bruise across her throat.

"But don't write any of that down," she said. "My hormones got the better of me. I was asking for it."

I told her about her resources and her options, but she didn't want to hear it. She didn't want to acknowledge that her husband laid his hands on her, hurt her, scared her. Hurt her so much that she told me "if he hurt me, why shouldn't I hurt myself?" and she cut herself to cope.

I know family violence happens. I know that women statistically have to ask for help 7 times before they commit to a change... but part of me just wanted to shake her and say "you can do better than him! He CAN'T do that to you!"

I know all that but I still wanted to go and knock him out. I was really upset and talked about it with my fellow students and nurses, but man. I'm really bothered by this one.

At the end of it, I told her that if she EVER felt like she had nowhere safe to go, she could come to our ER and we'd take care of her. She burst into tears. What more could I say?

You need to know that rescue is possible, that freedom is possible, that God is still in the business of redemption. We're seeing it happen. We're seeing lives change as people get the help they need. People sitting across from a counselor for the first time. People stepping into treatment. In desperate moments, people calling a suicide hotline. We know that the first step to recovery is the hardest to take. We want to say here that it's worth it, that your life is worth fighting for, that it's possible to change. - To Write Love On Her Arms

Looks like chicken

2011-06-25T13:26:00.002-06:00

Saw my first compound fracture. The patient was in a looooottt of pain (probably made worse from the psychological aspect of seeing your bones). The proximal interphalangeal joint of the first digit (aka thumb joint) was dislocated and completely out of the skin. There was a very neat horizontal laceration. It just popped right out of there.

I was struck by the whiteness of the bone. Looked like a chicken bone.

http://bareessentialssportsmedicine.com/

The dislocation was reduced, the lac was sutured, and I think the pt was referred to an orthopedic surgeon and/or plastics for follow up.

More tales from the ER...

A nurse's day in the ER

2011-06-21T20:02:00.003-06:00

This is my 7th week in the ER. Adding up the hours, I'm probably at the equivalent of 4/5 weeks if this were a clinical rotation. I don't know how this has gone by so quickly. I only have 9 weeks left before I am finished my UNE position and I'm back in school for my final class-based semester. HOW did this happen? I look back on blog entries from 2 years ago when I was powering through Anatomy and Physiology. I walked into this school only knowing media concepts of nursing, and now I'm a neophyte, not-yet-licenced, practitioner of health care for real live people.

It's a privilege and responsibility that's come with some staggeringly heavy lessons, as well as some of the most inspiring opportunities of my life.

I love nursing.

Now onto the good stuff.

As a pre- and first-year nursing student, all I wanted to read were first-hand accounts of day-to-day nursing. The interesting stuff and the mundane. It was all new. I wanted to know how nurses spent their time, from report until shift change. Stuff that I'd now consider boring to the general universe, I remember as being absolutely fascinating.

Note: I may have obsessed ~~a little~~ a lot over everything about nursing. So this post may bore you normal people. Don't say you haven't been warned..... ;)

In our ER, all the shifts are pretty much the same. The only differences between days, evenings, and nights are the volumes of patients and the amount of sleep you get. For convenience, I'll describe a day shift.

0715: Oncoming nurses arrive. This hospital hires LPNs to cover peak periods at night, and UNEs during the summer (like me!); otherwise all nursing staff are RNs. Oncoming nurses are laden with junk food and Tim Hortons coffee.

0730: We gather at the nursing station for report. The off-going charge nurse gives report to the oncoming charge. She pulls up the electronic ER management program on the computer which shows a map of the ER with names, ages, triage scores, and triage notes for the admitted patients in their respective rooms. She goes over every patient and mentions pertinent details: when and if they've been seen by the MD, lab and x-ray results, precautions, assessment details, and discharge planning. The ER truly is the kind of place you start planning discharge as soon as they are admitted (mostly: how are they planning to get home?)

0745: Report's finished, so we clear out of the room so the off-going nurses can grab their stuff and go home. We gather at the charting station and scan over the charts there. Sticky notes are posted to each of the charts to remind us when the next set of vitals are due, what the last chem strip (aka blood glucose) was, or whether we need to hang a second bolus after the first one's finished. We usually check vitals q2h.

0800: V/S are all caught up and the unit clerk puts up a chart in the rack for Team 1, which is one side of the ER. Team 1 has 3 different nurses, and I float between Teams 1 and 2. So, whoever is on that team (or floating) and happens to be near the rack at that time will take the order, and this time it's me. I grab the chart and put on my MD-handwriting-analysis goggles. I decipher that the patient is to receive 30 mg of Toradol IV. I scan the initial assessment and see that the patient was admitted for back pain. No allergies to NSAIDs. I quickly check the previous orders and see that she has a 1L bolus of normal saline running already. Since I can't give IV push medications, I decide to hang a mini-bag secondary infusion. I check the parenteral manual and see that it can be diluted in 50 mL of N/S and calculate the drip rate. I head over to the Pyxis and pull out a vial of Toradol 30 mg/1 mL, do all my checks (I'm OCD about checks - terrified about med errors). I mix up the bag, label it, and prime the line. I head into the room, explain the med, do my final checks and then hang the mini-bag.

0825: Another order's up. It's a discharge for the patient in room 2 with a tooth abscess. She's to get 2 Percocet tabs now and 5 "to go", which means we send them home with PRN instructions. She's also got a prescription for Keflex and a referral to a social worker, which I interpret to mean that she probably can't afford a dentist. I pull the Percocet and put 5 into an envelope with instructions to take 1-2 tabs every 4-6 hours for pain. I bring the meds and give her our narcotic info sheet to sign. It basically says that they are not to drive or make life-altering decisions under the influence of narcotics. I explain the PRN instructions and give her the Keflex prescription, giving a quick and dirty explanation of the importance of taking all the antibiotics. I discontinue her IV and send her home. I quickly strip the bed, wipe everything down, and put on new sheets for the next person.

0845: So we now have an empty bed with 10 people in the waiting room. Room 2 is a "general use" kind of room (it doesn't have any specialized equipment), so I head to the rack at triage and pick up the next chart. It's a little boy who presented with a temperature of 38.9°C, with a dry cough, sore throat. He was given Tylenol as per the triage fever protocol, so I call him up and reassess his vitals before bringing him back. Temp's down to 37.5 (yay!) and I bring him and his mom into room 2. The little boy is "ILI positive" (influenza-like illness) and I place them on contact and droplet precautions. I chart my preliminary assessment at the bedside - antipyretic medicine effective, skin warm and dry, back of oral cavity is red and child c/o pain on swallowing. Neck nontender on palpation. Immunizations are up to date. Child is voiding regularly. Eating and drinking with no nausea, vomiting, or diarrhea. Mom was concerned because he had a history of febrile seizures and thought she should get him "checked out". Child has no allergies or medications that he takes regularly at home. No previous medical history except for the seizures.

0910: I head to the charting station and complete the chart and nursing notes, and report off to Team 1 on this new admission. There are no new orders so I catch up on reassessments on the admitted patients.

0930: No new orders, no patients to bring back, and the waiting room has 13 people in it. I head up to triage to help reassess those patients still waiting. The computer assigns timers to each of the triage code, so higher-acuity triage scores get flagged for reassessment more frequently. The trouble with reassessments is that people hear their name and think they are going into the back. They don't like returning to the waiting room. Another nurse tells me to call them up as "Mr. Franklin, for REASSESSMENT!" and set expectations from the get go. I get through about 5 reassessments and we are all caught up. I don't like sitting at the reassessment station because it faces the waiting room and I get evil death stares from the patients, and lots of people who think the ER is a turn-based facility and get angry when people go straight back from triage. I have a long history in customer service and it feels very, very good to let the customer know they are not always right.

1030: Break time! I get 30 minutes. I occasionally ride my bike to Tim Hortons for a steeped tea, yum! Before starting in the ER it was hard to convince myself to actually take breaks - too much to do, too much to see. I'm starting to appreciate them now, though ;)

1110: The charge nurse urges me to duck into the trauma room where a young person is getting an I&D on a massive leg hematoma. The MD uses procedural sedation and then incises the top of the wound. He laughingly tells us gawkers to stand clear because we could get hit with the spray. Between much bubbling, gurgling, and massaging, copious amounts of old blood and black clots come popping out of the wound. Amazingly, there is no smell to it. The MD packs it with not one but TWO full bottles of packing. We clean up and I dress the wound. The patient's leg is about half the size. It is amazing what the human body does.

1205: I pull Gravol and morphine to administer IM to a woman who scalded herself with the deep fryer. I am amazed at how quickly I can landmark ventrogluteal injections now. She doesn't even flinch, I'm not sure if that's a compliment to me, or a sign of how much pain she's in.

1235: A young guy is wheeled back from triage, after presenting with a sore head and neck after a MVC at 80 km/h. He was t-boned by a truck that ran a stop sign. He needs an IV started and I get all excited because he's under 30 and a weightlifter.... therefore great veins. I dash into the room with the IV cart. It still takes me forever but I am pleased to hit a vein on the back of his hand with minimal discomfort to him (or me). A senior nurse was waiting to push some morphine and she said she was pleased with my technique. Anytime a nurse with that kind of experience has something kind to say about a nursing-related topic, I always look over my shoulder wondering who they're talking to........

1305: A volunteer is wandering around the department looking bored. As a previous volunteer in this very ER, I know *exactly* how they feel. I make a point of delegating fun-yet-simple tasks to them. Please: Escort patient to x-ray. Make soup and toast for room 10. Clean suture tray from the trauma bay. I like talking with the volunteers because a lot of them aspire to be where I am - on the payroll :)

1340: Reassess vitals, hang new IV solutions, push meds, run ECGs as necessary. As a UNE, I'm like the go-to helper person. I can't do everything that an RN can do but I am an extra pair of hands.

1400: Break time! I have lunch in the break room with some of the newer grad RNs. Several of them were UNEs like I am now, and they came back to work in this ER because they loved it. So do I.

1435: A guy walks in from triage. Chest pain since last night. Patient is a 49 year old male, overweight with a lot of abdominal fat, diaphoretic throughout the night, family history of acute coronary syndrome. I get him into a gown and run an ECG on him. I'm not very good at interpreting rhythms, but even I can see that the time elapse during the QRS wave is loooonggggg. I don't know much but I know bad when I see it. We move him into the trauma/code bay. MD says it looks like an NSTEMI. The RNs begin the heart response protocol and get multiple IV accesses. Someone thrusts a bottle of nitroglycerine at me to hang. I've never hung a bottle before. I poke at it a couple of times and then give it to an RN to show me how it's done. I can, however, prime a N/S line, so I do that while I watch. Once his lines are in, I stand by the chart and write down all the stuff as it's called out - vitals, new line insertions, nitro drip started at 1450, etc.

1525: Oncoming shift has arrived! They pile into the report room.

1530: The unit clerk has booked transport for the NSTEMI to be transferred to a cardiology unit at a major hospital. In the meantime I round on the other patients. It's amazing what a warm blanket will do for someone who feels like they've been waiting too long.

1535: I finish rounding on all of the admitted patients and make sure everyone is looked after before shift change.

1540: Transport arrives. They pack the patient into the EMS stretcher, receive report as they secure him, and roll him out. I clean the room, ready for the next patient.

1545: I head home, and the next shift begins....

Target Practice

2011-06-15T20:18:00.009-06:00

So after my IV Start Lab a couple of weeks ago, I headed to the ER for an evening shift. As a newly "certified" (whatever that means, lol) IV starter - and bedazzled with my official IV Certification Pin (no, I wasn't wearing it, I just think it's hilarious that I now have one) - I was pumped to get my 3 supervised starts in and become proficient at that most intimidating of nursing skills: IV starts.

[mini-rant]
I wish that laypeople would stop using the "IV Experience" as the sum evaluation of their interaction with nurses. How many times have people found out that I'm in nursing school, only to launch into a tirade about their latest hospital stay -

"I had a terrible nurse! She had to poke me with the IV TWICE!", or
"This one nurse was useless, she couldn't get an IV started, so she got another nurse who got it on the first try!", or
"The last time I was here the OTHER nurse had no problem.", or
"The nurse got it in but she must have done something wrong because now I have a BRUUUISE" or,
"My nurse was great. She got the IV started and I barely felt it."

How many other factors are involved here? Location, skill, gauge, hydration, BLIND LUCK? Seriously!
[/rant]

Obviously I'm a little miffed.

So, that shift I picked up a chart and was positively beaming when I saw it was a pt in for IVT who needed a new line put in. So I hustled in there and got all set up, grabbed one of the senior RNs to observe me, got allllll prepped and then....

Tourniquet on.
Examine arms. Nothin'.
Dangle arms. Warm compress to arms. Nothin'.

Except.... the RN peers over my shoulder and points out one tiny thready vein over the patient's knuckle. My very first stick - this could be it! I grab a 22 and try not to sweat onto my patient as I hover the ONC... take aim.... GO GO GO!! And I went. Flash in the chamber and I attempted to thread it and.... nothing! The catheter stopped dead like it hit a wall. Or a knuckle.

Pasting on a smile I deferred poke #2 to the RN. To my relief, though, she also had a lot of trouble finding a good vein - it wasn't just me! That pt took about 5 pokes before we got her with a 24.

That was it for my tries that night.

Sunday morning I'm back in the ER and I told everyone that I was ready to get my 3 starts!!

So the charge RN grabs me at about 1100 to start a line on a guy who was in for severe abd pain. She gives me a 20 and I get to vein hunting. I find a decent one on the back of his hand and prep for the insertion. I am positively STRESSED, though, because the guy was writhing in pain and anxious++ about getting the stick. I'm stressed because he's watching, his wife's watching, and the RN (a very intimidating woman with no real tact filter) was hovering over my shoulder giving very very precise instructions and I just about stroked out from the pressure. I go for the stick and he is actually kicking his feet on the bed. I feel pretty much as bad as can be felt because I can't get the vein. I don't want to be "THAT nurse", the one who fishes the needle around, so I give it about 2 more seconds and I pull the needle out. The RN says she'll take over and she gets a line in. She then yells out and asks one of the RNs to help me do an ECG on him.

That pretty much did it for me. I'm quite confident with ECGs. I do at least 5 of them a shift. So, shellshocked and fighting back my feelings of inadequacy, I "help" the other RN get the leads on him and then bail out of there before I do something embarrassing like cry on my patient.

The charge RN calls me up to the desk - "I need you to document the unsuccessful starts." As I'm standing there, reeling from the overwhelming emotions from the last 15 minutes, she began critiquing my IV attempt. "That's not how WE learned it in school," she says, and I kind of croaked out an answer while trying to keep my cool. She kept critiquing my approach and then one of the newer grad nurses caught my eye with sympathy and that pretty much did it. Yup, I started sniffling, and then a wee tear escaped my eye, and then the emotional dam burst and I got all kinds of upset.

The charge kind of gave me a side hug and told me I'd get it next time, and to go sit down in the back and collect myself. So I went, to try and pull myself together.

But I wasn't upset that I didn't get the IV. It wasn't that at all. It was this overwhelming sensation of being completely UNETHICAL - here I was, barely a full day out of the IV lab with a mere 2 starts on my young male lab partner with great veins, and essentially PRACTICING on patients. Really, that's what it was (and is). I don't know what I'm doing, so I'm practicing on human beings, and it HURTS them, and that's what bothers me most of all. I am hurting people in my attempts to learn. I am more okay with it hurting AND a successful start, but to hurt people like that and to miss the vein.... wow, I hate that so much.

Don't get me wrong. I do completely understand that the only way to learn this skill (and any nursing skill, really, but this is kind of the Big Deal) is by practicing on anybody and everybody. Nobody was born knowing how to thread an 18 into a capillary (I jest ;) but it just really bothers me that my learning is coming at the expense of someone's well-being. More or less. You know what I mean?

I just wish there was a way to get real experience without real people. Those dummy arms are a joke. They help you get the psychomotor action of retracting the needle and applying Tegaderm but that's about it. The "skin" is riddled with holes, the "veins" are rigid and approximately the size of fire hoses, and there is no traction required.

So I was quite emotional from all of these thoughts, plus the incident with the charge, plus another incident that morning where I'd sent a female pt to xray before her preg results had come back (not entirely my fault, plus what the hell does BRV mean, but I still felt awful and had these pictures in my mind of a 17 year old boy with severe deformities because I'd sent his mom to xray without realizing he existed). The results were negative. But still.

Nursing is a tough job. Emotionally tough. There really aren't that many jobs in the world where if you made a mistake, any mistake, someone is instantly and often severely affected. Even if you had no idea you were making a mistake (like how I did not think to check the chart for other orders before I took the pt to xray), BAD THINGS can happen. And they can happen to good people, be they patients or healthcare providers.

Anyway. After all of this went down, all I wanted was for 1530 to come so I could go home and forget this day ever happened.

I was charting when someone tapped me on the shoulder. I turned around to see Michelle, one of the younger nurses on the unit. I'd been buddied with her before and found her to be kind, knowledgeable, and pleasant to be around. She beckoned me into the clean utility room and gave me a great big hug.

"I understand how you're feeling today. We've all been there. But you can do this! You CAN start an IV! You WILL start an IV! And you will be good at it! In fact, it is my personal mission to get you an IV start before I go on holidays."

We discussed my technique and what I was doing wrong. Michelle thought I was blowing the veins by going in at too steep an angle. "But school said we should enter at 45 degrees until we hit the vein, then drop down to 15 degrees to thread it?"

"Forget that!" she laughed, "I almost ALWAYS go in at a low angle, especially those superficial veins."

It was pretty close to the end of the shift so I didn't think that would happen. However, 1500 rolled around and Michelle was waving a chart at me from across the unit. "Do you want to try?" she asked excitedly, "it's an 80 year old man!" She handed me a 20.

Wow. A 20 gauge in 80 year old veins. And with my 6-inch-tall confidence and emotional lability.

"You can do it!"

I walk in the room and find the guy there with his wife. Michelle is right behind me. She's offered to smoothly swoop in if things don't look like they are going well.

Tourniquet on.
Examine arms.

HOLY SMOKES there are ropes of blue up this guy's arms. I feel like I could thread a gauge the size of my pinky in there. Confidence surges briefly. Here we go....

Patient starts muttering that he hates needles. Wife tells him to suck it up.

I aim the needle at 45 degrees, catch myself, and drop it down to 20 or less. One, two, three, POKE! GO GO! I hit the vein right away. I remember to push the needle in a tiny bit more and then thread the catheter, which slips right in. We draw the labs. The vials shoot full of red. We hook up the line and run the bolus, which drips rapidly in the chamber. It was a good one!!!! :D :D I have to stop myself from beaming at this guy and dancing out of the room because I am SO glad that I got my first IV on a real patient on the same day as my bad experience.

So Michelle, although you'll probably never read this, THANK YOU.

For the record, I've had more failed attempts than successful ones, but I've now started 5 IVs, and all the ones I started I got on the first poke. It's getting easier, especially now that I can start them independently. I remember a post I was reading on allnurses to help me get better at IV initiation. One nurse said that when she was working, she told everyone that she got the first 2 pokes on every patient to come in the doors. She didn't shy away from the scary ones because how else was she going to learn?

Truth.

IV Start Lab

2011-06-04T11:33:00.000-06:00

First we practice on these hole-riddled arms and then on each other! Got my first start on my superkind lab buddy hooray :)

-- from the cellular desk of undergrad RN

Maybe I learned something in Psych after all

2011-05-28T09:43:00.002-06:00

So I had TLC's Untold ER Emergencies (or whatever it's called) going in the background while I cleaned the house yesterday. The case patient had occasional episodes of catatonia and paralysis of a limb. It was a different limb each time. The patient's husband was a super-seekrit military pilot who went away on missions for weeks at a time and he had no contact with his family.

Immediately, sez I, "CONVERSION DISORDER"

25 minutes later, after all the exciting build-up of symptoms and escalating drama...

Yup, it was conversion disorder.

Here I thought I forgot everything from Mental Health!

Speaking of mental health, I summoned every ounce of courage I had and volunteered to do the admission for someone who was suicidal the other day. It was optional for me but one of the nurses encouraged me to go for it.

Even in my Psych rotation I never asked anyone if they were suicidal.

It truly wasn't the difficult conversation I thought it would be. Patient was an older lady, landed immigrant, here for 30 years, her only family was her husband and children. She missed her extended family, missed "back home".

I just kind of winged it but I asked her lots of questions about her mood lability and got her to rate her emotional intensity. Then I asked if she ever thought of hurting herself or anyone else when she felt like her emotions were out of control. She answered in the negative and we moved on in the assessment.

If she'd have answered yes, my next question would have been "do you have a plan?" and we would proceed from there.

Honestly, the hardest part about the question of Are you suicidal? is asking it.

Rapture?

2011-05-25T09:57:00.004-06:00

So last night was super busy, again, only it was more busy than I've ever seen it, and with actually sick people. So as a UNE, my big helper job is to reassess patients in the waiting room as their names come up on the triage screen.

Being at the window facing the waiting room, of course, means that I am that I am the prime target for those asking how long the wait was going to be. I'm still trying to find a way to say "a long time" or "hopefully soon" without actually telling them a TIME because that's when they will be coming up to the window thinking they are going back. And unfortunately the back was full of really sick people who weren't going anywhere.

I call up one girl to the desk for reassessment and she is doubled over in pain, dragging her feet, arms over her tummy. She sits down and I reassess her vitals. Abdo pain is increased since arrival. Feels nauseous. Has not vomited. She had to wait quite a while to get to the back, because of the dearth of beds.

So a while later, I am zipping around cleaning rooms and I walk by hers.....gown on the bed.

"Wha?" I said, possibly out loud. I don't remember her being discharged. I go to the computer and she is still showing as admitted.

Mystified, I go back to the room to make sure she hadn't gone to x-ray or something. Nope, gown on the bed, and hey, is that her IV ripped out? Yes, yes it is.

Has the rapture come and stolen her away? She seemed to be really in pain. I asked a nurse who said she'd gotten a morphine shot and her kids were fighting so she decided to go home. Without being discharged? Okay...

In other news, last night was the night staff started calling me out on mistakes. Which is good, and all, but I felt a little blindsided because they were things no one had previously told me about.

For instance I was asked to bring some people back and I wrote them up for the chart. But I didn't start nursing notes on them because I thought that was done by the nurse on that team. So picture my surprise when I am in the middle of a dressing change and a (fairly intimidating) nurse comes up to me and asks where so-and-so's nursing notes were, because he'd been back for a couple hours and they needed to chart his vitals. Then when she learned I hadn't started them, she walked away saying "bad nurse, bad nurse". Unfortunately there was a little kid also sitting there who then asked her mom what "bad nurse" meant. Umm..

Then the charge saw me and told me I needed to start nursing notes on all the patients I brought back, because so-and-so was a Triage 3 and he was being transferred out, and he hadn't had vitals done in however-long. I think my cheeks were a new shade of red.

Later, I was sitting at the reassessment window and a guy comes in with a kid. I see the kid and he looks pale but alive. Dad says "hey, my kid's having an asthma attack". I pause, at a loss for what to do. No one has told me what to do or who to call if this happens. The triage nurse is busy with another person and the last time I interrupted the triage nurse (a different one) with someone who was worried, she told them to sit down and wait for triage. So I told this dad the same thing - just wait in the chairs and the triage nurse will assess you. The dad kind of glowered at me but they went and sat down. Then the kid got triaged a few minutes later satting at 88% with decreased air entry, tripodding, and in-drawing. Oh my gosh I felt so bad. I talked with some of the nurses about it later and they said that there was a sign for SOB/chest pain to report immediately at the window. The kid was admitted quickly and stayed back for pretty much the rest of my shift. I was also quite humbled because when I looked at the kid briefly, he looked fine to me. I obviously have a lot to see and learn about kids and SOB in general.

Then I was asked to bring another person back who was a ?cardiac patient with history of stroke. I did her ECG, brought her back, put her in the room they told me to, put her on the monitor, wrote up her chart, AND yes I wrote up her nursing notes. Then, a few hours later, a different fairly-intimidating nurse comes up to me and says hey, you need to report off to one of the team members when you bring someone back. What if she crashed and we didn't know what was going on?

So again, I felt like I screwed up without knowing that I was screwing up because this wasn't something that they really emphasized in my buddy shifts.

So I learned last night that it is better to communicate TOO MUCH than NOT ENOUGH. Tell at least 3 people what you're doing, and possibly also the charge nurse. Don't feel bad about interrupting, when necessary, because the alternative is not good.

Lessons learned in the ER.

Friday Night in the ER

2011-05-22T10:26:00.004-06:00

It was 4 in the morning and we'd been steadily bringing patients back all night:

a very large woman with a nasty wet cough satting around 85% on room air (her chest x-ray was almost white)
a frail grandma who had just finished radiation for cancer, who came in at midnight because she couldn't sleep and felt nauseous
a kid who'd been maced (by security?) at an event
a guy with inverted P waves admitted for stabbing chest pain - turns out someone placed the ECG leads wrong, he was fine with some Toradol
a young couple and their weeks-old babe with diarrhea
a gangbanger who punched through glass instead of his girlfriend, but seriously sliced his arm just proximal to the medial epicondoyle - deep lac was about 4 inches long and gaping about 3 inches wide - the police found him by following the trail of blood down the street

It was hopping in the ER. I was running ECGs back-to-back, taking specimens to the lab, and herding someone's 5 children under the age of 10 that she decided to bring with her to the ER without extra supervision. One of the docs left at 0300 so we were down to just one doc until 0600 and of course that's when things started to get hairy. Our nurse at triage decided to hang out in the back and keep an eye on triage using the security cameras, because all of the people with sore throats and vomiting in the waiting room kept shooting her death stares.

We had one lady on cardiac observation, the guy with the inverted P waves taking up our peds trauma bed, and another guy came in about 2 weeks post-CABG with crushing chest pain, tachycardia, and a-fib (tachy a-fib? or is it just that it was reading the extra atrial beats as the actual pulse rate? forgive me, cardiology nurses, for I know not what I don't know!), the gangster with the arm lac woke up from his drunken snooze and started howling, the grandma who couldn't sleep still hadn't been seen, the kid who got maced needed a shower, all 5 of the loose children started getting tired and cranky, and the young couple thought we were ignoring them and kept hovering around the desk with babe in arms.

So despite the madness of those three hours, I rolled with it, because the staff were so awesome to witness. This wasn't their first barn dance. With one swoop, the nurses got the kids cozy with some coloring books, told the young couple that they WOULD BE SEEN but not NOW, got the maced kid into the shower, buried grandma in 5 warm blankets (and lo, she fell asleep!), soothed the gangster back to sleep until he could be seen, and all of a sudden the charge nurse pulled me into the other trauma room and said "watch this".

The guy with a-fib was just signing his consent for conscious sedation and attempted cardioversion. They placed the electrodes sandwich-style on his left chest and back, snowed him with fentanyl and propofol, and set the current. Then the physician gave the go ahead. The nurse called CLEAR and made sure we were all back before pushing the shock button. The guy went rigid and then limp.

"Owwwwww," he groaned, motioning to his chest.

We all watched the rhythm as it settled into normal sinus for a few beats....and then blip, blip, blip-blip-blip his heart rate climbed back up to 140 and we saw the beats become irregular again.

The physician ordered a higher electrical current. ALL CLEAR! Shock given. Normal sinus, and then a-fib.

Again, higher current, shock, normal sinus, and then a-fib.

The physician decided to discontinue the cardioversion and instead just hold the patient until he could be admitted to cardiology in the morning.

A couple of hours later, the new doctor was coming on so I pulled someone out of the waiting room for the first time in hours. I looked in the chart. Sore throat x 3 weeks with slight cough, no fever, nontender palpation of lymph nodes. Came in at 0300 on the Saturday of a long weekend (and waited 3 hours) for....what, exactly? A throat swab and dispo with abx...

And then it was 0700 and the gangster was getting his arm stitched up. I played doctor's helper and held the pt's arm in an awkward superman position, while also running to grab sutures and stuff since, although the doc had the suture cart right there, he had managed to turn it so I couldn't get into it, and he was sterile so away I went. It was worth it though because it was awesome to watch him pull the lips of the lac together and get it sewn up. There was a large vein that had to be tied off. He started in the middle of the lac and guessed where to start sewing. After a couple of false starts he got it evenly joined and worked his way out to either end, and then filled in the gaps. All together I think there were 10 sutures. It was neat to watch him pull the edges together , all the subcutaneous fat kind of popped out and sqooshed all over the place. Once he was done, it looked amazingly clean. Especially considering the amount of blood I'd washed off his arm, and how much had caked onto his pants.

I applied a dressing of adaptic, 2x2s, 4x4s, and cotton wrap. Then the oncoming day nurse told me to go home.... so I did :)

*Pinches self* I can't believe I get paid for this. I LOVE EMERGENCY NURSING!

Captain's Log: First Night Shift

2011-05-13T04:25:00.001-06:00

Captain's Log, 0350, 13 May: Halfway through first night shift, ever. Total census: 1 stable patient held overnight for observation. Studying for Sociology midterm in 5 hours. Feeling good about my risky move to work the night before a test.
-- from the cellular desk of undergrad RN

First day in Emergency Externship

2011-05-05T16:20:00.006-06:00

I am super pleased to report that my first buddy shift on the floor was absolutely awesome. Emergency nursing is like nothing else I have experienced in clinicals. In one shift, I was exposed to so many different presenting complaints and patient populations, it was like my entire clinical rotation on fast forward. Nancy, my precepting buddy nurse (it changes every shift) last night, was really great to work with. She's been at this ER since it opened and has been an emergency nurse since forever. And, importantly, she still loves it. I didn't get the whole burnout vibe at all, from anyone.

So for anyone who hasn't had exposure to emergency nursing before, I will try to elaborate what the flow is like. This particular ER doesn't assign specific patients. They have recently implemented team nursing, so a bunch of nurses will be assigned to a wing and work together to meet the needs of all of those patients. My preceptor was assigned to float between the two teams, as well as cover charge and triage for breaks.

My shift started at 1530 and we took report from the off-going charge. I noticed that the report went very quickly, identifying only the chief complaint and how long they'd been there, and any labs that needed to be drawn.

We toured the unit and she pointed out all of the equipment in the different rooms. I've been volunteering on that unit since November but it was cool to see it through fresh/knowledgeable eyes. There is a minor procedures room, orthopedic casting room, EENT (eyes, ears, nose, throat) exam room, 4 stable beds, 4 fast track beds, 4 monitor/observation beds near the desk, 2 gyne/peds rooms, 2 trauma/resuscitation rooms, 1 reverse isolation/positive pressure room, and 1 secure room with superstrength door and optional camera monitoring.

morganlens.com

After the tour, we got started with the day. Nancy went out to the triage desk to admit the first patient. We had a look at the rack of charts from the triaged patients and it wasn't too busy. She picked a triage level 5, a young guy who got some metal in his eye while welding. We called him from the waiting room and saw that his v/s were taken less than an hour ago so we didn't need to reassess them. We took Eye Guy back to the EENT room and I gave him a Snellen test to assess his bilateral visual acuity. It was cool because he sat in a chair like at the optometrist and I flicked the different letter sizes across the wall in the dark. Not something we learned in clinical (it had been briefly mentioned in lab, I think, in our assessment class in second year), and here I was administering it to my first patient on my first day :) Nancy was very supportive of me doing my own thing to help out instead of just being her shadow and I was glad for her guidance. You know how it is, sometimes you just need that push to go out there and put theory into practice!! There was some talk about administering a Morgan lens, as we learned about in orientation, but I'm not sure what happened with him after all.

Like a lot of you, I think, I have followed a ton of emergency nurse blogs since well before nursing school in 2008, including those of the illustrious Nurse K, Girlvet, and NNR, newer ones like newnurseinthehood and Maha, and newer-to-me torontoemerg. Like you I have uttered many a guffaw and/or facepalm at the stuff people do to end up in the ER at odd hours when other people, such as myself, would much rather be home in bed. I am (pleased? saddened? resigned?) to report that I saw several examples yesterday in one shift alone that amazed me, especially in terms of my rosy nursing school glasses.

My next admission was a young man with throat tattoos (listen, I LOVE tattoos. I have two large ones myself. But I have never seen a throat tattoo that I didn't immediately associate with Tapout) dressed head to toe in Ed Hardy who came to visit us with a migraine. Okay, I've had migraines as a teenager. All I could do, once I got the visual disturbance aura, was get home ASAP so I could lie in bed in dark silence and barf my guts out while praying for it to be over. Seriously, the ED is the LAST place I'd want to have a migraine. This young man did not exhibit any of these symptoms. I'm not sure what he got discharged with, but I think he waited a while.

San Francisco General Hospital

I saw my first conscious sedation, an older man who tripped and fell and dislocated his wrist. It's the first reduction I've ever seen. The physicians snowed him with fentanyl/propofol until he would not react to them touching his eyelids. They then grabbed his little frail old arm and reefed on it until it went back into place with a couple of clicks. One guy held traction down on the wrist while the ortho tech put on a cast. First time I've seen all of those procedures. It was very cool. Initially I was squirming inside because the patient was obviously feeling the pain of the reduction, moaning and grimacing. It kind of flew in the face of everything I've seen so far. One of the nurses caught my expression and said "don't worry, he won't remember it." And he didn't - I walked past his room an hour later and he was sitting up admiring his new cast and chatting amicably with the physician who had been poking him in the eyeballs to check his response.

Another interesting thing was a little boy who had stuck a not-so-little bead up his nose. I have never worked in peds before outside of postpartum and preschool participatory observation for a few days. I had no idea what they would do. The RN grabbed him and wrapped him in a full-size swaddle, pinning first one arm and then the other as they rolled him tightly into a sheet like a little sausage. I helped to hold him still as the physician tried to excavate the bead via suction. No dice, but one of the nurses found a metal tool that bends at the tip when you press the trigger and they threaded that through the bead. Success! I was amazed at how big it was. Wonder how it fit up there in the first place!

A few other things I saw -

The ortho tech showed me how to do a wrist assessment to help decide which carpals were affected, and determine which x-rays to order
Nancy starting IVs so fast she made it look easy, and I was consumed with envy
A roughed-up prisoner who got into quite the scrap (I've never seen someone look that, well, beat up before)
A little baby with a case of Grade A diaper rash
Oozing shingles pustules
An ECG on a woman with a heart condition and chest pain - she was graduated to an observation bed. Her husband peppered me with questions about why she was getting a N/S infusion and why they ordered what tests they did, and, MOST importantly, how long they would have to be there. Apparently there are places more important to be than in the hospital ruling out MI...
Query fish bone stuck somewhere deep in a guy's upper GI, not sure what they did with that one
Nancy also volunteered me to admit a query anaphylaxis reaction. Lady had hives on her tongue and reported throat closure/swelling. I was pleased when my brain suggested I auscultate and listen for evidence of decreased air entry. So I busted out my stethoscope and listened to her perfect breath sounds all the way down to the lower lobes. Nancy approved of this and had me chart it. I think my hand shook a little as I signed my new designation, haha :)

My shift was a total whirlwind. Literally every admission was different from the next. We covered triage for a while and I was a bit taken back by how every sick person coming into the ER was seriously inches away from our faces. Yuck. One of the nurses told a story at lunch about how an angry guy with "back pain" launched himself at her, through the window, when she wouldn't put him back right away. Yeah, past the gray diaphoresing guy reporting crushing chest pain.

I saw way more things in one day that I saw in weeks at clinical. I seriously loved it, every minute. I was also super grateful for the extremely kind staff who were more than happy to show me cool things and ask me tough "thinky" questions.

I can't believe I get paid for this!!! I would have been there for free. Wait, don't tell that to my boss..

Can't wait for my next shift tomorrow :)

1st day on the floor in Emergency

2011-05-04T14:39:00.000-06:00

I am leaving in a little bit to my first buddy shift at the ER! I will report all soon :)

I have also just started taking SOCI 271, Intro to the Family, during the spring session at school, as credit for my senior elective. I am SO THRILLED to report that I have begun my 4th Year courses!!!

(I also love spring session because it's 3-hr lectures, 5 days/week, for 3 weeks. Bliss.)

I think my brain exploded

2011-04-26T17:20:00.002-06:00

Today was my Orientation.

We spent 7 straight hours going through (literally) STACKS and STACKS of HR stuff, paperwork, and all kinds of tips and tricks for assessing different populations and situations. I have 3 stuffed folders and I think I will take some time to organize them into binders because they seriously gave me some of the best reference material I've come across since starting school - and free!

Orientation was provided by the clinical nurse educator, herself a very knowledgeable ER nurse with floor experience in critical care, trauma, and flight nursing. It was like my assessment course and my acute care course plus lots of extra information all rolled into one day. I was on learn overload. I am SO excited to see this all in action.

I also saw educational videos on some kind of contact-looking-thing that fits over the eyeball and hooks up to NS to flush the eye of chemicals or debris, and how to install/use an intraosseous (IO) infusion set. Then I played with the drill. No needle ;)

So my next step is to book my buddy shifts (2 days, 2 evenings, and 2 nights)... and then after that?? I don't know yet. I don't think the unit manager knows yet, either. It seems like a gongshow-kinda place. I think I've been spoiled for the last 5+ years I've been in quiet offices with orderly HR and management processes...

I sent an email to my other job letting them know what days I was free. I shall see what they say. I am looking forward to not working there anymore, but prudent thinking suggests that I will benefit from working so much this summer, and I can quit with a clear conscience and a full bank account for the Fall term.

Procrastinating

2011-04-17T19:12:00.003-06:00

Firstly, THANK YOU for all of the kind words re: my summer placement.

Since Zazzy asked, I'll define UNE - "undergraduate nursing employee" is my province's designation for a 3rd year student nurse; since BSN was made entry-to-practice for RNs in this country, it's how we can get paid experience working in an RN-type role before we graduate.

The UNE position does not fall under the auspices of our regulatory college or union; rather, it is a protected position that is only available to regular-entry BSN third year students (not LPN-RN bridging students, or accelerated BSN students) and it is designed to be temporary (cannot work full-time for more than 3 months, less a day, per UNA guidelines - this is to make sure that a UNE does not take the place of an RN or LPN position).

The UNE takes on a lighter load than an RN, with lower acuity, and is responsible for patient care for anything he or she has been trained to do already in school. For example I can do anything I have done in clinical before - foleys, wound dressings, IMs, bladder scans, etc. Things I have not done before I can watch and learn, such as placing NGs. Things that are outside of my clinical scope I cannot do as a UNE. Such as IV push meds or defibrillation - which is totally okay, I'm in no hurry for that kind of responsibility.... lol

Otherwise I function in my full clinical scope. I can do planning, teaching, skills, and nearly everything an RN would do. I'm not totally sure what I *can't* do, yet, because I think that's probably specific to the type of environment I will be working in. I've never had a rotation in Emerg, or spent any significant time there outside of my volunteer position (which never exposed me to much except where the supplies were, really). It won't be like my med-surg experiences with paging the docs and stuff. I like this particular environment because the nursing station is combined with the physician desks. It will be an excellent opportunity to learn by eavesdropping on everybody, especially because curtains aren't particularly soundproof! :)

So yes, I will be working 0.5 FTE from May through August (that's about 20 hours a week) and mainly evenings and nights. I have never worked overnight before. I've worked late-as-hell (6 PM to 2 AM) and early-as-hell (6 AM to 2 PM) but never crossed that barrier. If you have any tips please share. I am concerned that I will turn into a surly, cheerless, friendless prickle. My plan to also work 3 days per week at my desk job, likely in midmorning-afternoon, kind of hinders the idea of turning full-on vampire. I'm not sure how this will work out. If something has to give, I will stick with Emerg.

Oh! That reminds me. I was going to write up some of the interview questions in case that helps any of you out in the future. I have them scrawled on a notepad somewhere...

At any rate, as per the title of my post, I am technically supposed to be writing a ten-page critique of a research report right now. It's a self-imposed deadline for the research class I'm taking by correspondence. Knowing myself and how I am, I booked the final well before I finished any of the projects, so that I would HAVE to finish it. So now I HAVE to finish it, or fail the course, by Thursday April 28............ but it's only the 17th, and of course you see my temptation :)

Before I get back to the ~~slog~~ excitement of critiquing research, I guess I should also update you about my clinicals, which are (surprise!) still going on until the end of this week.

Yeah! Bet you thought I was done, based on the crappy posting of late...

Nope, I am 4 weeks out of 5 from being finished my Community/Public Health rotation.

Tuesday is our oral report about the agency placement with the preschool kids, and our teaching plan re: toothbrushing and washing hands. Wednesday is our actual presentation to the kids. Thursday is our final evaluation, and Friday is a long weekend, my last before I go back to work.

(For the record, I took a leave of absence from my desk job for the months of March and April in order to focus on clinical, and it was the BEST THING I EVER DID for myself in school. Hands down. Last year my hair was literally falling out. This year I am able to attend my horse-riding classes, work out, make healthy food choices, take on 2 correspondence classes, AND do a decent job on my clinical projects)

In regards to Community Health, well... I have felt like I could fit into every clinical placement I've had so far. Even postpartum which I honestly thought I would hate (thanks CC for helping me consider otherwise :)

But, man, Community Health has absolutely NO appeal to me. It could be that I've worked desk jobs for about 6 years now and I'm numb to the pride I once had about having my very own cubicle. I can't stand office work or office gossip. I hate photocopiers and water coolers and I REALLY hate getting emails from people who don't know what Reply All means. I realize that there is a hands-on component in public health, i.e. when you actually go out and assess babies or teach college kids about STIs or do an immunization clinic for Grade 5 kids.... but that seems to be only 10% of the job. The good 10%, IMO. The other 90% of the time seems to be spent in the office, trying to round up resources and liaise with other people and hammer out meeting times and set up appointments, etc, etc.

Maybe CHN/PHN will be appealing to me when/if I have family responsibilities or am tired of running around all day.... but for now, get me back in the hospital, stat.

I shadowed one day last week in the Hip & Knee Clinic, where people go for pre- and post-surgery teaching and assessment. It was actually a really cool experience, especially given my rotation in Orthopedic Surgery last year. I got to take out some staples and do a dressing change. Compared to the rest of my rotation, it was practically critical care in there! lol!

Okay okay, I'm going to go write a paper now. Honest....

Undergrad RN, UNE

2011-04-14T16:55:00.000-06:00

OH YEAHHHHHHHH

I went in there and blew their minds with my clinical genius!

Okay, I was pretty nervous but very prepared.

FYI - I read a tip about putting baby powder on your hands to prevent clamminess. I suffer from seriously sweaty palms when I am under the microscope so I tried it. It worked very well. No one got grossed out by shaking my hand for a change...

At the end of the interview, they offered me the position, on the condition that I am:

A) not a criminal, and
B) not lying about being a nursing student

So orientation's on April 26 and 27!

Unfortunately the position (like every freakin' position in this province) is only a 0.5 FTE. So I will also be keeping my regular job for another summer. Still, who cares! I get paid to go to clinical! :D

I have been waiting for this opportunity since before I started nursing school. I remember Googling like crazy to learn about what it meant to be a student nurse in this province. I found the UNE position and told myself - that's what I want to do in my 3rd year of school. And here I am!!!

This is a great day!

UNE Interview in T-1.5 Hours

2011-04-14T14:12:00.000-06:00

My interview's at 3:30 this afternoon.

My hair is done. My clothes are pressed. I am wearing my STTI pin for awesomeness.

I am browsing my blog archives to try and remember some of my more influential nursing moments.

..........and I am freaking out!!!

Hehe

2011-04-08T17:10:00.001-06:00

From XKCD, one of the greatest comics ever.

Community health, and a phone call

2011-03-31T17:43:00.002-06:00

So here I am, nearly 2 weeks into my Community/Public Health rotation.

My partner and I went to our assigned community agency for the first time today. It is a small converted house in a poor residential neighborhood that supports a variety of programs including childcare, social work, and drop-in personal growth/social opportunities.

Our big project with this agency is to plan, develop, and implement a handwashing/hygiene presentation for preschoolers and their parents. We will have about 6 days total to come up with the lesson plan and resources. Everything will be documented into a presentation for our peers, since different students are assigned to different agencies.

So while my partner and I were brainstorming ideas for a short presentation on handwashing, my phone rang. I didn't recognize the number, but it looked like my instructor, so I sighed as I reached for my phone and rolled my eyes because she had just called me......

.....until I realized it was the hiring manager for the local Emergency Department!!! Yep, the one I volunteer at :) And the one that is literally across the street from me.

I had applied for a UNE position (Alberta Health Service's position for Undergraduate Nursing Employees on a summer/temp basis) last year as well but I didn't realize how many skills I was lacking. And I went to Thailand - no shocker they didn't hire me! So this year I was really pumped when I sent in my application at the beginning of this month.

My interview is on April 14! So excited.

The core reasons I'm interested in working Emerg over the summer are because (in this particular ED, anyway) of the high degree of collaboration between physicians and nurses, and amongst the nurses themselves, the population will be all ages and sizes and socioeconomic statuses, I will see a high volume of presenting conditions and learn about how to prioritize/plan for them, and I will get to use plenty of skills.

Did I mention I was excited? :)

5 Weeks of Vascular Surgery

2011-03-20T23:15:00.001-06:00

I started this post several times over the past few days. Friday was the last day of my acute care rotation, where I have been stationed on a Vascular Surgery unit.

You may recall that my instructor quit halfway through my rotation due to family issues, and we got a new instructor. Not just any instructor, but my Patho instructor from last year. I wasn't sure how changing instructors halfway through could possibly give either instructor a decent overview on how I did on this rotation. Especially considering how I was raked over the coals at my last evaluation. My confidence was so shaken and it's been nearly a year since my last acute care placement.

Wow. I take back almost everything I said about my Patho instructor last year. It actually pains me to read how harshly I critiqued her. I still remember how it felt, though, to be in her class and be absolutely boggled by how she would jump from one topic to the next without clear linear relationships between disease processes. It made me absolutely crazy and I learned Patho from a textbook because her teaching style didn't resonate with me.

But - as a nurse? As a clinical instructor?

I have been SO privileged to be under her care and direction for the past few weeks.

I even wrote on my course evaluation that she should be promoted to teaching other clinical instructors, she's that good. It's hard to put into words what exactly worked for me, but I'll try, so that one day I can remember what it took to make me feel like I have it in me, somewhere, to become a great nurse:

Greet every student with a warm genuine smile, and a holistic appraisal of who we are and what we want to be. Even if that thing isn't in Nursing.
Collaborate with students and encourage us to use our theoretical knowledge in practice. That knowledge is in there, somewhere - draw it out! Get us talking!
Have high, high expectations for us. Expect that we will be safe, compassionate, knowledgeable caregivers. Have faith in our education. We will rise up to your high expectations and we might even exceed them.
Once the plan of care has been decided, ask us to explain what we're about to do, and then leave us to it. We can and will do a much better job without an instructor breathing down our necks (such as priming TPN lines, choosing appropriate IV med tubing, choosing appropriate needles/syringes and drawing up meds). Follow up after to check our work. We will feel the weight of surveillance float right off our backs.
Get involved in the patient's perspective and demonstrate how easy and spontaneous therapeutic communication can be! Segue seamlessly into those tough questions like suicide risk and spirituality! Show us how it's done!
Give instant feedback. Good and bad.
Treat us like adults. We are.
Be excited for us. Be happy for us. Share in our accomplishments and celebrations. Encourage us liberally.
Be fair, honest, and genuine in your appraisals.
Come with us for a drink after the last evaluation. We all worked hard, dammit! We won't judge you. See #7.

So I hope I'm not sounding too sappy, but I absolutely, 100%, believed in, respected, and wanted her feedback on everything. She is a Great Nurse, and a Great Educator, and an Inspiring Leader, and how many times do you meet someone like that?

I can't tell you how many times former-students-now-RNs would come and find her on our unit, with tears in their eyes, and thank her for her contribution to their lives. Doubtless, I'll be the same way.

"UgRN," she said, reaching for my lapel;

"I wish there was a higher grade to give you than A+. You are caring, skilled, and holistic. This hospital is practically run by former students of mine. In my 15 years of teaching, I have developed an instinct for people who are Going Places. I can honestly say that you are one of them."

She pinned a small angel to my lapel.

"This is to remind you of 3 things.

"One, to remind you to connect to your spirituality if you find yourself in a situation that overwhelms you. If you are doing postmortem care for a recently-passed patient, and they moan as you turn them [I had told her about my possible interest in Oncology]. Connect it back to your spirituality, and I don't care if that's God, Buddha, Mohammed, or the Circle of Life. Once you do that, you will remember who you are and the importance of what you are doing.

"Two, you can be anything and go anywhere in nursing. I don't think you would like it, but you could be in management. You can be a Nurse Practitioner. You can excel at anything you put your mind to.

"Three, if you need me to vouch for you - and I don't care if it's 15 years from now - call me anytime. I might need you to send me your picture. But do that, and I will remember you, and you will have an excellent reference."

She smiled at me with tears in her eyes. I did the same. I have never felt that someone Got Me in the way that my instructor Got Me. She totally understood who I am and where I am coming from. She could see how much I love this work.

I am so very honored that she gave me the angel pin. I am not much of an "angel" person, but the significance of it outshines anything else I may ever get from an instructor. Every time I look down at my uniform, I will smile and remember what she said to me.

In which I reflect on death and dying, and the distinct honor of being there

2011-03-08T11:08:00.001-07:00

This post will be short since I'm posting from my phone.

One of our classmates died a few weeks ago. I didn't know her well but I'd heard she was a cancer survivor.. She then got into NS and busted her ass for 2 years like the rest of us, got married to her highschool sweetheart last summer, and by September she was too sick to come back to school. I heard it was lung ca.

At the time it was sad but I didn't take it to heart. However for the last few days, the universe has conspired to bring hospice, mortality, and the randomness of cancer to the forefront. My classmate died, I had a bad dream about my beloved grandparents (they are mid-80s), and I spent all day Sunday working on my cancer nursing certificate and learning about genetic mutations. Then my class yesterday was about caring for dying patients. Then I found out a family friend was being treated for bone ca.

All the while wondering why her? Why now? Why not me? Why my dad? How is her family? How is her husband dealing with this?

And just wondering.... Man, why am I even considering oncology? This is so hard.

But the more I think about it.... If I can be THAT nurse, the one who took the gentlest, kindest care of your loved one as he/she left this world, who made sure pain was as distant a memory as it could be, who focused as much as possible on comfort and family strength...

If I can be THAT nurse -

What an incredible thing I can do for families who need it so much.

-- from the cellular desk of undergrad RN

"Oh, we don't assign students to him anymore..."

2011-03-02T14:05:00.001-07:00

A quick story because I am heading out to clinical soon -

Patient has been in hospital for several weeks now, post op for a diabetes-related amputation. Side effect is HUGELY swollen genitals with some really awful skin breakdown. Guy is in a lot of pain. He is both needy and withdrawn. He is not handling the patient role very well. He wants his control back.

He's had a student with him for several shifts. Student has the time to be with him constantly. Student talks to him, gets to know him, works to understand and resolve his concerns. Turns out there's a lot of underlying stuff about him that no one knew about. Patient is super grateful for the care. Patient calls student (note - I'm not the student!) an "angel from heaven".

Next shift, staff balks at allowing a student in his room anymore, stating that the 1:1 care of a student is "making them look bad".

What say you?

You can tell when you love something...

2011-02-26T20:24:00.000-07:00

Because working on it consumes your thoughts entirely. I have been working on the CNSA website, forums, and social media pretty much non-stop since I got admin rights. I just LOVE it. I love playing with the code (although, admittedly, I am entirely self-taught and barely know anything), I love improving the site nav and content, and I LOVE seeing the numbers climb after I installed Site Meter Pro.

I had some struggles with the old forum software (phpBB 2.x) and not having access to the database so I could mod the registration page to at least semi-prevent spambot registrations. I ended up manually adding approved posters to a group, and then giving that group permission to post. It's not ideal and I am worried I may have killed the forums, but they were pretty much dead anyway. One page worth of posts in a year...

I sent emails to the CNSA web host, Director Communications, and President of CNSA to try and persuade them to upgrade the entire site platform to vBulletin. From what I've seen, people either love it or hate it, and the people who hate it seem to be developers who are looking for ++intensive modifications, which doesn't affect me. I played with a demo version of the admin panel and I am pleased with vBulletin's community-centric nature. I WANT Regional Executives to be able to upload their own content and maintain a web presence for their community. I want the BoD to maintain blogs and reach out to the members. I want people to visit cnsa.ca and want to BE a member.

I'm also intrigued by the calendar functions, the events manager (hugely important for an organization which exists primarily through conferences), and social networking integration such as Facebook Connect. If we make it easy for our members to get involved and stay involved, they might actually take an interest in it - particularly those members (such as myself) who live in areas where CNSA has no physical presence.

Anyway, Reading Week is drawing to a close and I am scrambling to finish the major adjustments to the website so that, by Monday, I have my head back in the clinicals game ;)

CNSA.ca - tell me what you think

2011-02-23T09:24:00.000-07:00

I got the keys last night to the CNSA.ca website so that I could finally get started in my new role as Informatics Officer. One of the big jobs I see is improving the navigability, content, and transparency of the CNSA website. My term hasn't officially started yet (it begins on April 1) so I am just puttering around until the new Board of Directors begin their terms and I can harass them for additional content.

I would really appreciate if you could take a little mosey over there and tell me what you think about the current website. Be honest and give me some constructive feedback. I won't be offended - I didn't make it :) But I am looking to improve it.

It's a good thing it's Reading Week right now. I get so excited over web projects that I tend to stay up all night working and forget other commitments.... wait, did I feed my bird today?? ;)

Sunset in the city

2011-02-21T17:55:00.001-07:00

-- from the cellular desk of undergrad RN

"So... how's she doing?"

2011-02-20T09:24:00.006-07:00

It was right around 1800 and I was in the middle of spiking new bags of TPN and lipids. I had forgotten the PICC IV adapter and was halfway out the door to grab one when her visitor peeked around the corner.

Before me stood a woman about the same age as Mary, my patient. She held her purse with both hands and peered at me questioningly. I paused and smiled at her, told her she was welcome in the room - Mary was awake for a change and watching TV.

She hesitated and looked at me again, eyes darting briefly between me and the room behind me.

Eyes wide, she asked it:

So... how's she doing?

Whoa, loaded question.

My mind lurched briefly and then started racing. Who are you? What do you get to know? How much do you already know? What do I know? Where's the line supposed to be, and how do I draw it?

Mary was not doing particularly well. She was currently weak but stable. The severe ischemic colitis was a major complication; if it turned gangrenous, the mortality rate could be as high as 50-75%. At this point it was a wait and see game, to determine whether she'd recover some bowel function and be able to live a normal life, or perhaps her bowel might perforate and she would have to be treated for life-threatening peritonitis. Surgery could entail resecting the bowel, or even removing it entirely, and creating an ileostomy. Mary was also experiencing some mental status changes, had pitting edema to one leg, and was becoming increasingly gaunt.

So *I* knew all of this. But I was also acutely aware that this visitor would hang on every word I said, and I would have to be as diplomatic as possible, but there was no time to really think about what I would say because every moment I hesitated she grew ever more concerned. There were also concerns of who was she, and what was she entitled to know. What was I entitled to share? How could I put it?

So, with my heart pounding in my chest, I asked the visitor who she was. Mary's best friend since we were in high school, she told me. We go way back.

'Okay,' my mind raced, 'a friend. Good friends, by the sounds of it.'

I took a deep breath.

"Mary's surgery is healing well, but she has developed a complication with her GI system." Her eyebrows raised and I cringed internally. GI? Who the hell says that?

"Her, uh, bowels are having some problems, and we are, uh, keeping an eye on her." I winced inside. It was extremely hard for me to find the right words that would simultaneously protect Mary's privacy, avoid false reassurance, and also respect the friendship of these two women; made harder still as she watched me, nodding carefully and hanging on every word I said. "She is doing well today and you are welcome to go and visit her."

"So, when will she be able to leave the hospital?"

Good question, I thought, I have no idea either. "When the doctors feel she is strong enough."

"So we are just waiting for her to get strong enough, and then she can leave?"

Yes, if she doesn't perforate and go septic... or lose her bowel function entirely and need major abdominal surgery to create an ileostomy... and if that surgery doesn't develop complications too--
"Pretty much. She should be discharged then."

"Okay, thank you." She smiled at me, and I smiled weakly back at her as she walked into the room and gave Mary a big hug.

I let out a huge exhale. My heart was pounding. They never taught us how to deal with that in school...

Vascular Surgery, Week 2

2011-02-18T11:49:00.006-07:00

Today's evening shift marks my 6th day on the unit (Only? Wow!). It would have been 7 except I had to miss a day for flu-related conditions. This week has been interesting.

I've been assigned one patient for the last few days - a lady in her 70s who presented to Emerg with a big DVT in her leg. A CT found AAA as well as an aneurysm on her common iliac. They decided to remove the clot and repair the aneurysms at the same time, landing her on my unit after some time in Intermediate Care. Turns out she has developed a major complication from the AAA repair, ischemic colitis. They put pictures from the scope into the chart.... that was a sight to see. The colon is pale and there are patches of necrotic tissue. There are what seems like grey perforations in the bowel and a lot of mucousy yellow slough. It's crazy to think that's going on inside her body.

Right now, I think they are managing her symptoms and trying to ride it out and see if the bowel will recover some function. She's on TPN and a couple of antibiotics; pretty much everything else is from pre-existing conditions.

So, she's a pretty sick patient, and it's been a busy few days for me. I have been able to hang IV meds & TPN to my heart's content and provide pretty much total care for her, which I have been enjoying immensely. It's like all the good stuff from 1st and 2nd year, plus being able to do almost everything for my patient, with a cosign of course.

"Can I have a shower today?" she asked, squinting up at me in the afternoon sun.

She had been looking kind of, uh, smarmy and I was elated to hear her awake enough to request a shower. It was a hell of a production. The primary nurse and I (despite my protests - I definitely could have managed, but she wanted to be there too) brought the patient into the shower room along with her smart pump. We cling-wrapped her PICC and peripheral IV. We put bags over the pump. 20 sweaty, humid minutes later, we had her scrubbing under the showerhead, and her relief and sighs of satisfaction made the whole thing absolutely worth it. She said it was the best shower she'd ever had. lol :)

Unfortunately the pleasure of providing her with a much-needed shower was tampered by a very unfortunate mishap involving incontinent ischemic bowel... everywhere...

That makes my Code Tally 0 code blues and 2 code browns. They are smelly but no one dies.

So, after having such a crazy start to my shift, the rest was absolutely slow. My patient slept most of the evening, barely waking up for meds, and then zonking out again.

Finally, after I awoke her for 2200 meds and HS care, she popped back to life and asked me what was on the menu today. "Nothing," I smiled, "you've had quite a day; it's now 10 PM and it's night time."

"Oh. Were [unintelligible]?"

I leaned closer. Come again?

"Were those yard apes here?"

I laughed. Yes. "Your family was here. They watched Ellen."

She shook her head and smiled. She picked up her toothbrush and examined it. I waited patiently, watching her for signs of agnosia. She felt the handle and brought the bristles close to her glasses.

"Modern science!" she proclaimed appreciatively, and then proceeded to brush her teeth.

Just after I set up her sidestream nebulizer, and before I turned off her light, she turned to me and asked.... "So, any chance I can have that shower today?"

Flu or something

2011-02-14T19:47:00.000-07:00

Blargh.

Luckily it hit immediately AFTER my weekly mandatory lecture at school, saving me some BS "make up" assignments. Regrettably I had to miss my riding lesson. I was working on leg yielding last week and maintaining canter leads on a figure 8 (i.e. not allowing geriatric old showhorses to autochange) and I was really looking forward to trying some more.

Right now I am febrile, nauseous, and experiencing some awesome muscle aches. I heard that influenza doesn't really make people nauseous so I am hoping it is not that. Rough timing as I really need to be awesome this week, in order to impress my instructor enough that she provides a decent reference for me in my UNE application due sometime this month.

Buddy shift tomorrow and I am hoping I feel up to it; shift is 1530-2330 so I have some time yet.

Since I am not riding.... next best thing!

Vascular Surgery, Day 2

2011-02-10T17:44:00.001-07:00

Second buddy shift down. I had the same RN to shadow. It was a great day, lots going on!

Tomorrow I am taking my first patient, an older guy with rectal cancer who had a new ileostomy created. It'll be the first ostomy I've cared for. My instructor doubles as an ICU nurse when she's not teaching and expects solid research from us about our patients. I am happy about that - patho doesn't REALLY make sense to me until I see it manifested in a patient.

So LOTS of research to do tonight on ostomy care, cancer disease processes, head to toe assessments, and meds. Sooooo many meds.

Whee!

Day 1: Vascular Surgery, and other stuff

2011-02-09T20:47:00.005-07:00

Yesterday was my orientation onto the new unit, new instructor, new everything. It can be pretty challenging to change gears like we do as we move from one rotation immediately into the next. Especially given the circumstances from the last instructor, I found the adjustment a little difficult, but I think once I hit my stride with my own pt load I will be okay.

I wasn't sure what to expect with this unit, since my last surgery rotation was orthopedics. I think there will be a lot of similarities. Older patient population, multiple comorbidities, people who are more or less paying the price for a lifetime of unhealthy choices. Sure makes me re-evaluate my own healthy habits. There are amputations, bypasses, carotid endarterectomies, a whole plethora of vascular surgeries I don't yet know about, and general surgery.

My precepting nurse today was a new grad herself, class of 2010. I shadowed her and rounded with her on her 4 patients, getting a feel for the unit's flow and routine. I was pleased to see the teamwork dynamic on the unit - an AWESOME change from my maternity rotation, where the floor had some serious politics that they made no attempt to hide. Like the day I had to request a new nurse because mine spent the entire morning griping to me about other nurses and work environment instead of letting me care for my assigned patients - wow, awkward.

It was nice having a newer nurse to shadow today. It helps to give me a visual on where I would like to be when I graduate. Usually, when I shadow really experienced nurses, I get blown away by how much they know and what they know to expect. It can be intimidating when they are connecting dots long before the questions have even formed in my brain!

Today's patients included a middle-aged woman with a brand new ileostomy, a senior who'd had her gangrenous leg amputated, a patient with a gianormous gallstone and pancreatic issues, and a man in his 60s who was about a week post-op from a fem-pop bypass.

The unit is pretty old-school in terms of layout; it is a horseshoe with rooms around the perimeter and the nursing station at the opening. Being oldschool, there isn't really anywhere to chart comfortably or congregate with other students to do research. I got pretty used to that on my last rotation - couldn't go 10 feet without running into a charting station complete with computer and task chair :)

I am feeling good about this rotation EXCEPT my instructor will be leaving in a few weeks and will be replaced by someone, but we don't know who. So my current instructor will be doing my midterm evaluation and then a new instructor will be doing my final. This could play in my favor, as I have time to find my feet and then the new instructor will come in and see me being awesome, or it could go the other way.

I am looking forward to my leave of absence from my job; I will be off March-April so I can focus exclusively on clinical. This will be a first for me and I intend to take full advantage of it in terms of home study and knowing my stuff - I should get another 20-25 hours per week to myself! Unfortunately I will be completely broke for 2 months. :(

In other news, I attended my STTI chapter's executive meeting to offer my assistance with maintaining a web presence via The Circle. This kind of evolved into them asking me to give a presentation at the next meeting to show them how to use it. Ironically, the next item on the meeting agenda was succession planning. IMO, the single best way to recruit my digital generation into any role is to create accessible information and make it easy to become involved. Honestly, the first thing I did when I got invited to STTI was go to the website. Same with CNSA. Same with Alberta Health Services. I am probably a little more gung-ho than the average student in terms of finding information, and a little ballsy when it comes to getting involved, and I think more people would love to get involved if the process of becoming involved was straightforward and clear.

I believe we are at an awkward stage in terms of information accessibility; a lot of the areas in senior management that are responsible for coordinating information grew up in the era of newsletters and paper applications. Information was accessed days or weeks from the initial request in terms of fax or mail or answering machine. What you knew was directly related to who you knew, and "in person" was often a requirement. However, these outdated methods of Finding Out no longer meet our expectations. We want to find information in seconds. This dichotomy is causing tension between old methodology and what we've come to expect from online resources. It's no one's fault, of course, that we are taking our time getting information more freely accessible - healthcare is a little unique in terms of extremely important confidentiality issues. I definitely see a huge potential for information distributed almost exclusively through digital media. There really is no reason to have paper anything (unless you live in Canada and have paid attention to recent events involving Usage-Based Billing). It is my hope that I can do my part through CNSA and STTI Mu Sigma to encourage freely accessible information and improve involvement in these organizations.

By the way - I don't know if I mentioned it, but I was elected into an informatics position on the Board of Directors of CNSA! It is currently an Officer position which reports to Director of Communications, but informatics is a massive role in its own right and I see potential for the position could be expanded to Director of Informatics at the next National Assembly. Obviously it will take a whole lot of work on my part to make that happen. I am really excited about this opportunity. The website is going to improve a lot over the next year. It needs improved navigability, richer content, frequent updates, CNSA projects and involvement, and clear role descriptions for the BoD. There are some lacklustre forums on there which need better organization and spam filtering. There are opportunities for greater integration with CNA's NurseONE (I met the project lead at the conference) and hopefully nursingideas.ca. I have a lot of ideas and am hoping to get together soon with the webmaster to discuss the back end process for the website. My term doesn't officially begin until April 1 so no rush.

Wow, I had a lot more to say than I thought. I am so, so, so excited about all these possibilities. Going to bed with visions of awesome, engaging, easy-to-navigate websites dancing in my head. Second RN-shadowing shift tomorrow!

Time-out for my brain

2011-02-06T15:46:00.005-07:00

So after spending the entire weekend feeling sorry for myself and (involuntarily) lying awake pondering the intricacies of human nature, I feel mostly at peace with the events from Friday. I owe a lot of that to you guys for your support and kind words. Nobody gets it like another nurse does and I felt SO much better after seeing your comments and emails.

To answer the common question - I have decided that I will not pursue the matter against my instructor. I am heading into another full-time clinical rotation on Tuesday (vascular surgery, yay!) -- with a different instructor, thank god -- and I just don't have the fortitude to deal with ongoing illogical bullshit. Even if I did call for some kind of inquiry, it would be my word against hers, and how can you argue with someone like that?

I would prefer to be that person who stood up for the masses and blew the whistle... but my school has a history of blackballing, and I just don't see how I could win. One more year of this and I will be answering only to me: ugrn, RN. And CARNA. :)

I did submit anonymous feedback on my instructor before my evaluation. Our school asks for feedback on all instructors up to the day before final evaluations. I was extremely fair in my assessment and delivery, maybe TOO fair considering how she was with my evaluation, but I think my feedback is more likely to be taken seriously than someone who rants unintelligibly.

My mark isn't terrible. I got a B. I think I deserved much more than that, but it's acceptable. If I escalate my concerns with the ivory tower, it would be a whole lot of BS just for the sake of 'being right'. If my instructor had been someone I looked up to or wanted to emulate, I might care more, but frankly I think her bedside manner stinks. I don't need her to validate my hard work. I didn't then and I don't now.

FYI, because this past couple of posts have been pretty specific about one instructor (she'd obviously know it was about her), I have been carefully monitoring incoming traffic. If I feel like I may have been discovered I will be temporarily pulling down my blog or removing some posts.

Anyway, enough about that. Happy birthday to my blog! It turned 3 on February 3rd. I got it a birthday cake because it has grown so much since that first post. I really have to thank all of my readers for sticking around this long. It blows my mind to think of how far I've come since that day. One more year... one more year... then I will have to change my blog name!

In celebration of my blogiversary, I tweaked my page design a bit. I like it. It's a lot cleaner than the last one, which was the result of the various glare and texture filters in Artisteer being vomited all over the page... I also whipped up a slightly modified header since I discovered the joy of Adobe Illustrator. Anyone else want a shiny logo? I'm having a great time with it, lol. Too bad it costs $1500 for a licence. I have 28 more days to enjoy the trial. :)

For some reason I have been getting a ton of visits from Israel coming to learn about cranial nerves. One of my friends is Israeli. She showed me some pictures of the homeland and I was amazed by how many sexy people live there. Wow. Hello, good looking people, and welcome.

I do have a post coming for the CNSA Conference recap. However I have a date with football, beers, and wings so I will have to catch you up later :) Happy Superbowl Sunday!

The maternity wrap-up Pts 1 & 2

2011-02-04T15:38:00.004-07:00

I originally started this post last night while I got ready for my final clinical evaluation today. Because I am having a total mindfuck of emotions right now, I'll break it into two parts: Part 1 was written last night and Part 2 written now.

Part 1 [Last night]:

Thank you all for your patience while I get back into the groove! I had an a-maz-ing week at the CNSA National Conference, as you can tell by my various phone updates, and I will recap it for you as soon as possible. I came home on Sunday and it has been a total whirlwind since then, which is pretty much my life during clinicals.

@Cartoon Characters: Thank you for your awesome supportive comments. I really appreciate you stopping by to say something! Especially given your career :)

Today marked the last day of my experience in Maternity. I have mixed emotions about it - since my final evaluation is tomorrow, I wanted to really reflect and consolidate my patient experiences before going into my eval. I don't feel especially confident in my instructor's appraisal of me, partly because I have NO IDEA what she thinks of my practice, and mostly because I have found her pretty hard to gauge.

A word about instructors... I think one of the most important traits to have is transparency in your opinion. If you think I did great, please say so. If you think my practice sucks, PLEASE say so. But even more than that, it is so important to have an instructor who is willing to share in my challenges and in my victories. I had a huge win yesterday - I'll explain in a bit - and I wanted to share that with SOMEBODY, and so I turned to my instructor. She gave no opinion at all and just stared at me with a blank face until I trailed off and awkwardly walked away. It didn't diminish my feelings of success because I KNOW that I did well and no one's lack of championing my actions can change that. But it would have been nice to have some external validation as well.

Part 2:

She slid the evaluation towards me.

"Do you have anything you want to say?" She asked, eyes glittering, lips in a tight smile.

My heart was pounding in my chest and tears blurred my vision. I had a lot to say, but I was too overwhelmed to get any words out without falling apart. I scrawled a signature accepting my grade and gathered my books quickly, charging towards the door before I lost control.

I was reeling from the evaluation. It felt like series of accusations. Fails to show professional behavior. Fails to maintain professional-social distance. Does not know what she should know. Incompetent. She told me that she didn't think it would be in my best interest to act as a reference for a undergrad nursing position this summer.

As she read these phrases out to me, it felt like she had to be talking about someone else. Fails to maintain professional distance? What could she possibly mean? I wanted to ask but could not; I didn't want to start an argument that I couldn't win. The grades had already been assigned.

I mulled it over and over, trying to pinpoint a time I may have breached that professional boundary - moreso, trying to imagine a time that she might have actually been around to witness it. The only moment I can think of is where she breached the professional boundary and made an off-color comment to one of my families, jokingly referring to their (first, miraculous) post-term baby as a "peeler" and asking the father if he had any stories about 'The Peelers'. He was mortified ("Uh, no, actually, I am not into that at all....") and so was I.

Incompetent? How could this be? I'll be the first to admit there's a lot I don't know. But I ask. I work within my scope of practice and I ask as I go. I practice safe care, I keep my eyes and ears open, and I study at home to try and learn something for next time.

Nothing made sense. My patients expressed nothing but gratitude for the care they got. I independently assessed a need for breastfeeding support on several of my patients and got them the help they needed. I coached new moms through that initial latch and encouraged them to listen for the swallows of their feeding infants. I intervened on a gagging baby and got him to burp the biggest burp he'd probably ever made in his short life. I talked a young couple through how they felt about their changing from a couple to new parents. I demonstrated initial baths to several proud dads and their cameras. I found twin heart beats for an NST on my first try. I palpated fundi, I provided comfort measures, and I once dug through a bag of nasty post-birth laundry to retrieve a pair of tiny baby socks when everyone told me they were as good as gone. And not once did anyone say anything less than thank you with that look that said they meant it.

About that big 'win' I mentioned earlier - I left the hospital on my second-last day knowing I did good for someone. I had spent the entire day providing postpartum care to a new family stuck up in Caseroom until a Postpartum bed opened.

The mom delivered at about 0600 and was still up in the caseroom at 1230. Baby had been showing early signs of hunger but was also quite sleepy. She was an anxious mom, asking about feeding her baby, and the L&D nurse assigned to her provided very vague answers about how to get started with breastfeeding. I stepped in when the L&D nurse deferred their questions, and they had lots of them, like new parents should. I hunted down a pillow and helped prop her up in bed. I stole some breastfeeding pamphlets from Postpartum and sat down with her for close to an hour of teaching. I coached her on positions, and we finally settled on 'football'. I showed her how to get baby nice and awake, and ready to eat. Eventually, with plenty of teaching, patience, and false starts, mom and I got baby with a solid latch and feeding like a champion.

Elated, I went to find my instructor and show her, and further convince anxious mom that she was doing well. I found my instructor getting her hair trimmed by a service aide in the utility room, but I digress. Instructor came in and saw mom and baby feeding well and applauded mom. A few minutes later, at the desk, my instructor told my assigned RN that mom was successfully feeding babe despite all of the challenges and concerns she had before. The RN was happy and asked my instructor if 'we' did that. My instructor reiterated that mom was successfully feeding babe.

I was honestly crestfallen with that statement. I had, in my mind, been a huge advocate for this family; despite their staying up in the L&D caseroom all day, I made sure that they had the same quality Postpartum care (to the best of my ability) that they would have gotten on that unit. Nobody guided me to make these interventions. I saw the need for them to learn, so I stepped up my game and taught them. It was like opening flood gates: they asked about SIDS risks, carseats, skin-to-skin, jaundice, and the list went on. That family was so thankful and grateful for the time I took to spend with them, helping them transition into the role of new parents. That was the family who left their new baby's tiny socks on the birthing bed when they finally did get transferred to Postpartum - the ones I ran back upstairs and convinced Housekeeping to let me dig through dirty laundry bags to find.

So yes, I *did* do that - in the sense that if I hadn't intervened, that mom and baby might not have had the same outcome. They didn't transfer downstairs for another hour, and shift change wasn't for another 90 minutes after that, and I'd bet my stethoscope that poor baby would be screaming blue murder if he had to wait that long for his first meal. Screaming baby + already anxious mom = anxiety through the roof, and who knows, that anxiety could have shaken them so badly that baby would be on formula by now.

And where was my instructor? Selling me short, and telling me in my final evaluation that I was not knowledgeable and crossing professional boundaries.

To think that I started this clinical terrified that I was going to screw it up. If it wasn't for the incredible response I've received from my patients, peers, and especially the unit staff - who frequently expressed how glad they were to have us, and often gave me a high five or a hug at the end of the shift - I would finish this clinical convinced that I am a shitty nurse. If it wasn't for how I felt going home a few days ago, when I KNEW I'd made a lasting difference with my families, I would doubt myself. But I know I did well. One voice to the contrary can't change that.

One thing did jump out at me at my evaluation. Despite all of the bullshit incompetencies on my final evaluation, there was not one bad thing my instructor could say about the quality of care I gave. There was absolutely nothing wrong with my practice as a nurse. The angles she took to undermine me were personal and nebulous. I really wish I had asked for concrete examples of these incompetencies; I would have liked to hear her try to describe them as specific situations.... but I was just too upset with disbelief to argue the point.

I think of the few times she was around to witness my practical skills - Vitamin K injections, initial baths, newborn assessments. She said I did them fine. I even asked her for critique and she had none.

I think of all the times she was around me as a person, not as her student. Very clipped responses, sarcasm, awkward silences.

And I wonder - what on EARTH had I done to make her dislike me so much that she would want to attack me like this. I still draw a blank. Maybe I reminded her of someone.

The lasting damage has been done. Her appraisal of me as a future RN has been decided, written, and filed away somewhere to inevitably reappear when I want to apply for a cool opportunity at my school. I will not let this define me. I will continue to advocate for my patients and provide them with exemplary care, and I will not let personal grudges EVER get in the way of that.

As my peers told me later while I cried into a cup of coffee, I grew so much through this clinical and I did it without my instructor's guidance. I became a better nurse despite her instruction, not because of it.

Cathy Crowe

2011-01-28T13:47:00.001-07:00

Speaking about passion, power, and politics. What a great speaker!

-- from the cellular desk of undergrad RN

The illustrious Rob Fraser!

2011-01-28T12:24:00.000-07:00

Fellow blogger and all around superstar, you may recognize him from such nursing websites as www.nursingideas.ca

-- from the cellular desk of undergrad RN

Dr. Boychuk-Duchscher

2011-01-28T07:33:00.002-07:00

I love hearing her speak. She is so vibrant and engaging! She is addressing us about the idea of living our professional and personal lives with purpose.
-- from the cellular desk of undergrad RN

We came, we saw, we debated

2011-01-27T11:46:00.004-07:00

Wow, arguing for privately funded/delivered healthcare in a crowd full of nurses (and a model that I don't personally ascribe to) was probably the hardest thing I've done in school. But we went out there, we stirred the pot, we pissed people off, and people gave us death stares- but we defended it with all our hearts and received many congrats from attendees on our convincing arguments. We even earned a shout out from Linda Silas, president of the Canadian Federation of Nurses Unions (CFNU), who said we deserved academic credit for our work!! Wow, it was so intense. I loved it and it terrified me. More updates to follow once I am on my home computer :)

The view from our podium:

-- from the cellular desk of undergrad RN

Tilda Shalof!!!!

2011-01-27T06:36:00.002-07:00

I read her books before I ever started nursing school, and here she is :)
-- from the cellular desk of undergrad RN

So far, they are feeding us

2011-01-26T06:55:00.002-07:00

Noms galore! There are so many people here and it hasn't even officially started yet! We will be rehearsing soon and then later a wine & cheese charity auction. Rumor has it there's an iPad up for grabs.... I was just getting a little thoughtful over how 4 years ago today, nursing school was a pipe dream for me, and here I am now sitting with hundreds of like-minded future nurses in a profession I have become so passionate about. Life is amazing like that, I guess :)
-- from the cellular desk of undergrad RN

En route to CNSA National Conference

2011-01-25T15:13:00.002-07:00

This past weekend was a total whirlwind, finishing up a CFAM assessment on my patient family, getting ready for the Big Debate, and getting absolutely slammed at work due to the huge snowfall we got this month.
I just wanted to check in and say I am still working on that post I mentioned, and OMG I'm in Toronto!!!
Will keep you posted on what the conference is all about. Stay tuned :)
-- from the cellular desk of undergrad RN

Antepartum/L&D

2011-01-20T21:36:00.002-07:00

Antepartum and L&D start tomorrow. Had my L&D orientation today.

I LOVED my last few days on postpartum. LOVED.

There is a post in the works about it; I want it to be thoughtful so I won't rush to finish it tonight.

I am SO tired. Exhausted. Run off my feet yesterday in clinical and then straight to a work shift, and a 5 hour sleep before I had to wake up to finish a 15-page review on fetal heart tracings, and back to the hospital to do it all over again.

Oh, nursing school.

Good night :)

Recap of Week 2 of Postpartum Clinical

2011-01-14T20:20:00.002-07:00

First of all - THANK YOU to all the kind suggestions on counting apical pulses on infants. I started tapping it out and it helped me with the counting. Part of why I was so confused with the heart rate was, I think, because my stethoscope is so good. The Master Cardio picks up every little sound and I was hearing the lubbs AND the dubbs and I was having trouble initially telling them apart. I have got it now, though :) Also, when my instructor watched me do vitals, I saw her write in her little notepad that I was keeping a good count! Thanks again!

Let me see here -

Last Saturday, I was fortunate to attend a prenatal class at the hospital (it didn't feel very fortunate at 7 AM on my only day off, but I digress). The instructor was a PT, which surprised me, because she was so super knowledgeable I had her pegged as a RN/Midwife. It never occurred to me that PT/OT might actually function outside of the Ortho unit. Sorry, PT/OT, I was foolish to doubt you!

It was snowing like crazy here but luckily I made it and all of the expecting couples did too. The class was an excellent recap of pregnancy, labor, delivery, and postpartum. The instructor had some really good suggestions on mobility (PT shines through!) and pain relief. I was impressed to see her put the coaches to work. I always wondered how the dads felt in the delivery room. She gave them all jobs to do and made sure they understood! She provided LOTS of teaching on the pros and cons of epidural and c-sections. She made absolutely no doubt that labour was going to hurt but she also reinforced that she was giving the parents-to-be tools to deal with it too. She kept stating "You aren't SICK, you are HAVING A BABY. So, if the nurses tell you to do something for yourself, it's because you aren't SICK and you CAN!" We could have cheered :) It was a very good class to attend and I was grateful.

On Tuesday, we were back on the unit for another buddy shift (RN shadowing). I was assigned to the nursery, which is on the postpartum unit, and it's where the neonates come to be assessed after delivery before they rejoin their moms in their assigned rooms. The nursery was a very busy place. We had 2 or 3 infants in there all night. They come down from L&D "fresh from the oven", so to speak, and are weighed, measured, given initial assessments, Vitamin K, initial baths, and vital signs taken. I had just arrived in the room when someone parked a bassinet in front of me and told me to take the baby's vitals. Man - that was suuuuuch a gong show, I'm embarrassed to tell you about it.

Quick tangent - I upgraded my watch to the kind that pins on - which has been coming in extremely handy.

So I get the little bundle quasi-naked and get to work counting apical beats. I am excited to use my new pin watch. So there I am, stethoscope on this baby's chest, trying to count the heartbeats and remember which minute I started at and which "ten" I was on (90? 100? Wait, was that 80? I think it was 80). Of course when you take an infant's heart rate, you need to count for the full minute. So I kept having to start my minute over again and 5 minutes later I am proudly waving my notebook around saying I GOT IT!!! So the RN asks me for the vitals and I'm like.... oh.... I was so pumped about getting the HR that I forgot about all the other vitals. So another 5 minutes later I've got the axillary temp and I think I've managed to count resps but that baby kept making little noises and moving so who the hell knows. Then my instructor pops her head in and asks if those were within normal limits for neonatal vitals and I was so out of sorts I couldn't remember and I had to go check. FYI - they were! lol :)

My RN gave me an initial bath demo and then asked me for a return demonstration. The baby she gave me was a 9-10 lb behemoth (he was only 38 weeks! LGA? Um, yep) and, luckily, a total gem to work with. I had him stuck under an arm and he was so good in the bath - by good I mean screaming, but not too much - and omg my arm was getting so tired. Then I tried to get a C-hold around his scapula/neck/head and scrub some vernix with the other but he was so darn big that my hand started cramping. I have to say - washing vernixy baby was not my favorite nursing experience. Combing goopy mommy bits out of baby's hair was rating kind of high on my eeeeeeeuuuuuugggghhhhh scale. However I was very satisfied with the sweet smelling, cuddly result once he was clean and dry.

On Wednesday, I was assigned to my first patient - a mid-20s G5 P3 or something similar who was 3 days post C/S and due to be discharged the following morning. She didn't need much care at all, BUT I actually did get a chance to do some teaching. Probably two of my biggest hurdles to overcome were 1) actually touching and handling a neonate without dropping it, and 2) providing breastfeeding advice to a mom, having never been a mom myself.

This mom kept complaining of feeling engorged even though baby was feeding well. I managed to try some strategies with her including warm and cold compresses, manual expression, and pumping to a comfortable level. She actually listened to my advice, although it didn't work, and never made me feel like I was just some random student trying to tell her how it was (which is what I was worried about). I call that one a success. I am, however, having trouble assessing funduses (fundi?) on larger moms. Anyone have a tip for me?

Then I had my second assignment, Day 1 C/S first time parents. I was SO busy. I managed to do all kinds of things - my first initial bath witnessed by my instructor, infant assessment, Vitamin K injection. My patient family kept me busy too with PIH (pregnancy-induced hypertension) precautions (v/s q4h) and some voiding concerns. I got to d/c a foley, spike a new IV bag (3rd year skill, yippee!) and give teensy handful of meds including a Voltaren suppository, for which my instructor said I did a great job with good confidence(!). I did a full independent newborn assessment in the mother's room, which was scary because she kept asking me questions and she was a pretty intense first-time older mom, and I managed to provide some good teaching on Vitamin K and an overview of the infant assessment and things I am looking for. Then she wanted me to demo a swaddle. I think she was expecting some kind of pro-star super tight baby burrito but all I gave her was taco salad and I think she was a little disappointed, whoops :)

Today we had our first major project of the rotation, providing anticipatory teaching on various subjects and covering them from birth to adolescence. I did it last night, per usual, and was up all hours. My subject was on child learning and education in Alberta. It was an enjoyable topic, but like any project during clinical, effort is proportional to grade and the project was worth 10%, so... *shrug*

As an aside, I am still absolute crap at interpreting written orders. I don't know where physicians learned to use a pen but I don't understand how, if it takes close to the same amount of time to write legibly versus illegibly, this* isn't some kind of real patient care risk. I know it's kind of a laughable quirk for a lot of people, but it could really hurt somebody if they misread it. And I don't mean someone who's been practicing with that doc forever and knows what is ordered. I mean me, as a new RN in a year and change, coming onto a unit for the first time, or a float RN. Who the hell can read these? Don't we think that should matter a *tiny* bit more? Although it'll just be my fault if I fail to follow up with the doc. Because THAT takes so much less effort than just writing a tiny bit more legibly in the first place, right? {/soapbox}

*Add - I know this isn't a particularly bad example of illegible writing. But really, if I were to hand this in as charting, would my instructor call it okay and safe, best practice?

I am really happy with my clinical so far. I don't hate maternity. I don't know if I LOVE it, at least not yet, but it has definitely been a great experience for me. First day off since clinicals started tomorrow... we had a lot of snow fall here so I think it's a perfect day to go tobogganing! Have a great weekend, everyone :)

Welcome to 2011, and welcome to the world, babies!

2011-01-09T17:34:00.003-07:00

Wow, 2011. One year from now, it will be 2012, and I will be entering my final clinical placements. This has simultaneously been the longest and shortest 4 years of my life - mostly in that I haven't spent 4 years doing the same thing before.

I started my L&D rotation a few days ago. Okay, okay - despite how much I thought I would detest the idea of being an L&D nurse, I can see how it might grow on me... :)

We are placed at an inner-city hospital with a really nice new wing created specifically for maternity. It has assessment & induction, antepartum, L&D, postpartum, NICU, and obs surgery all in the same wing. I was surprised and pleased to see the focus on family-centered care. Most of the babies barely leave their moms, except for assessments and initial baths.

Being inner-city, the patient population reflects everything from wealthy, prepared, crunchy granola moms who have read every book on gestation published since 1980, all the way to homeless women with no prenatal care and whose babies are detoxing from street drugs. There are recent immigrants and teenagers and the physically and mentally ill. There are high-risk moms flown in from northern Canada. It is a MUCH more dynamic cross section of life than I expected - really.

On Wednesday, we attended Ye Olde Orientation at my school. It's the same stuff we've heard before. WHMIS videos and fire safety videos, per Alberta Health Services protocol. I then met up with my clinical group and instructor. She has been an L&D nurse for 10+ years (and is still!), which is super exciting, because my last 2 instructors haven't been at the bedside in 20 years.

We had our orientation onto the unit. We are starting on Postpartum. My orientating nurse was great! She was a younger RN and it was nice to be with someone who wasn't quite so practiced at it. Sometimes it is hard to pick up on techniques used by really experienced nurses. She was fun and really wanted to teach me, and with me being the sponge that I am, it was a very productive day.

There was a lot more teaching to be done than I ever expected. Some of the moms would ask question after question, especially just after the pediatricians rounded on them, so we could interpret med speak. Lots of questions about breastfeeding. LOTS of questions about breastfeeding. I have a lot of studying to do to, so I can answer all these questions with any degree of competency :)

We saw a mom who was afraid to supplement her 2 day old 37 weeker because she really wanted to breastfeed her, but her milk wasn't really coming in yet. However little babe was losing weight and was getting more lethargic, and sucking less. I saw my RN smoothly convince this nervous mom that she could supplement the baby without worrying about nipple confusion with just one resourceful remedy - the nurse cut the needle off a butterfly infusion set, leaving just the tubing, and used a 3 mL syringe to draw up some formula, and then she attached the tubing. Mom got baby on the breast and the nurse squeaked the tiny tubing into the corner of baby's mouth. She was then able to supplement the baby while the mom nursed. Baby got 10 mLs+ of formula and sucked with gusto once she realized she was getting the goods. Win-win-win - it was GENIUS. I am still telling everyone about it! I was so impressed! Even better, we taught dad to use the syringe at the next feeding. He really wanted to help and he did great. We worked ourselves out of a job in that room :)

Another mom got really sick. Failed vacuum, baby delivered with forceps, 3rd degree tearing and episiotomy. She spiked a 40° fever and raging infection and was put into an ice bath to bring down her temp (I didn't see any of this, but I heard about it in report). When we rounded on her, she was so, so, so tired and very apathetic about baby. Can't say I blame her. Her peri area looked really angry and the only thing she ever rang for was more ice packs.

Third mom was absent for most of my shift because she was up in the NICU with babies A and B.

We also toured the nursery area and I got to play with my very first baby, the tiny little girl who required supplementation. I listened to her heartbeat. I don't even know how you are supposed to count it....shiza.

Seriously, wrapping babies into a tiny parcel is harder than it looks. They stick their hands and feet all over the place. You swaddle one side and the other side escapes! I hope I get the hang of it, LOL :)

Lots of studying tonight, lecture tomorrow, and back on the unit with my own assignment on Tuesday!

Happy new year, nurses!

2010-12-28T16:58:00.002-07:00

I hope you all had/are having a great holiday! I got to spend some time with my fella's family over Christmas and that was wonderful. They have grandkids so they did the whole Christmas Is Magical thing. I absolutely love Christmas. I'm not really into gifts, exactly - the best part for me is hanging out, enjoying family, and listening to carols.... really! I've decided that next year I will, in lieu of gifts, sponsor a needy family.

I did buy myself something a special something yesterday. I've been wanting one for a long time, now, and I wasn't ready to make the plunge..... until I saw they were on sale for 60% off, and I almost-simultaneously got an email from Skyscape giving me a $50 gift certificate for participating in their scholarship contest. I guess some good came from it after all :)

So, when the planets aligned - I bought a BlackBerry. It's a Curve 8530 - last year's model, I think - hence the sale (see below... like my Link wallpaper? ;)

I know, I know, you can all pick your jaws up off the floor - it's not an iPhone.

Reasons I did not buy an iPhone:

-They are ungodly expensive
-They are slightly less expensive if you choose sell your soul to a carrier on a 3 year contract......and I don't do contracts, anymore
-iPhones will be a nice upgrade from this one when I am ready/employed, unless Android makes me happier with less money
-I still love QWERTY!

So far I am quite pleased with it, except for falling prey to the dreaded Disappearing App World Icon. Luckily, there is a metric TON of BB resources around the interwebs and I was able to get it resolved with a few Googlin's and some wasted time setting up the settings I'd lost.

I'm impressed with the integration with just about everything. I had a Palm about 7 years ago, and I spent ages getting it all set up. Then I let the battery die one day.... losing everything. The BB software sets my mind at ease with the Desktop Manager (for Mac, hooray!) and the syncing and the backups. Lesson learned in syncing more frequently AKA before major un/installs or after extensive setting changes.

This model has WiFi and whatever wireless network Koodo offers. It's not 3G, I don't think, and not superfast, but I am new to the idea of mobile browsing so it works for me.

So far, I've installed apps for both of my banks, Dropbox, KeePass, Facebook, Google Mobile, and Skyscape. I am also SO PLEASED that I can handle my email without being on WiFi or within range of a public computer. It made me twitchy staying over at my boyfriend's house and not being able to instantly access my email. I think I am an email junkie.

I spent quite a bit of time browsing Skyscape trying to decide how to maximize my gift certificate. They also had a deal going that, if I purchased by Dec 31, I would get an additional 25% off. They also suggested I share the link, so here you go: www.skyscape.com/share25off.... offer expires March 31, 2011.

I ended up purchasing a few titles:

They threw in a med calculator and the International Classification of Disease as well.

So far, I am happy with Skyscape. I emailed them a problem with my order last night and they had it resolved by noon. I was NOT thrilled with the installation process, which could use an App World update, because it was hunt-and-peck 24 digit serial numbers to install each title. I'm also not thrilled with the setup of the Skyscape app. For something that I paid for, it sure does spend a lot of time trying to convince me to download other free software.

Anyhow, I am pretty excited to use my BB in clinicals! There is a TON of information in my pocket. The drug guide seems a lot handier than my hard copy - search for drug names and the info is there, no holding books open required. RNotes also has a good mix of L&D resources in it. The med calculator is pretty good too, it has everything from IV infusions to Apgar scoring.

More reviews and from-the-trenches stories of using my BB in clinicals to follow in the new year :)

Best wishes for 2011, everyone!

The Ten Year Rule

2010-12-21T23:16:00.002-07:00

I don't know if I have previously shared one of my guiding life philosophies, but I will now.

(Am I the only person out there with actually-in-words life philosophies? lol)

One of my favorite principles that I use when making tough decisions is my "Ten Year Rule" - hence known as TYR. Meaning, ten years from now, what will I wish I had done?

I've put this guiding principle to use many times in my life, usually to justify spending or saving money, or taking risks on new opportunities, but sometimes to remember the Bigger Picture. I used it when I abruptly left my life in Alberta for the opportunity to live in Ontario, grooming at Millar Brooke. TYR when I had the choice of moving back to Alberta or to Scotland. When I had to decide between pursuing graphic design or upgrading my high school on the off chance I could get into Nursing - TYR.

More recently - using some of my student loan money to go to Thailand? TYR. Scuba certification, bungee jumping, facing my biggest fears. TYR.

Today I faced a dilemma. I have been emailing like a madwoman trying to get clearance from my school to attend the conference in January; trouble being, of course, that it's super close to Christmas break and no one seems to be in the office, and CNSA wants me to book my flight ASAP.

I got a reply from the faculty stating that basically

a) they supported me going, but

b) it was going to screw me in terms of clinical hours and could ultimately affect my grade.

So that's pretty disappointing. It's not like I'm OCD about maxing out my GPA. I'm really not. As long as I get a pleasant 3.3-3.5, I'm a happy girl. Enough for grad school is enough for me. But just the idea of KNOWING that I could be throwing away marks in exchange for the opportunity to attend the conference is pretty tough. I've been thinking hard about it since I found out the news.

Then, today, we had our first teleconference and talked about the presentation. I recognized one of the voices on the line - it was one of the coordinators at the conference I went to in October! He was on the team as well. I was even more excited than before. He is the kind of person who speaks and people listen. I just know he's going great places in Nursing and I'm excited to be on the team with him. Then I realized that if this was the calibre of people on the team, I am even more honored to be a part of it.

Thus, the Ten Year Rule.

Ten years from now, will I be lamenting the loss of a few tenths of a grade point in one class?

Or will I be disappointed that I missed out on an opportunity to present to hundreds of peers and respected leaders of my profession?

With TYR, as always, the choice is obvious.

I am, however, hoping to kiss sufficient ass to make up for my 4 days of clinical absence....

Oh! I found out that I will be going to an inner-city hospital for my L&D rotation with two of my best friends. Orientation on Jan 5!!

Christmas came a little early

2010-12-19T21:03:00.009-07:00

After a FANTASTIC decompression in the sun (and a pretty fantastic sunburn, might I add), a red eye flight, and return to the snowy northern wastes, I checked my email to find the following -

Congratulations,

You have been chosen to be a part of the 2011 CNSA national conference's national team!

Aaaaannnnnnnd cue heart palpitations. There are only 5 of us on the team. For the WHOLE COUNTRY. zomg. I'm pretty sure I'm the only one from Alberta.

So now I realized that I actually will have to roll up my sleeves and make this trip happen, aka booking even more time off work, sending my regrets to the STTI induction, and pleading my case with the school faculty as I would be missing 4 days of L&D clinical*.

And practice, practice, practice what I am going to say, so that awful presentation Will. Not. Be. Repeated.

In front of the likes of 600+ CNSA members, Tilda Shalof, and Jean Watson, no less!!

* I think I sent a pretty compelling argument to the faculty. I may have indicated that the academic nature of the conference should be valid course credit. I also may have indicated that it would be a pretty sweet name drop to my fairly-recently-accredited university.

** I also checked all of my final course grades and found that I kicked ass on my finals. Especially my Nursing/Acutely Ill course, which was the one I really cared about. Booya!

I'm melting...

2010-12-14T19:24:00.003-07:00

Into a puddle of joyful, feel-it-in-ma-bones, weightless BLISS. I am DONE! 3rd year is half over! Partying tonight with some of my ladies and then I am flying out to Puerto Vallarta tomorrow.

Interesting substory - as I was exiting my L&D exam yesterday, I checked my Facebook messages on my phone. Picture my surprise when it read "5 friends have commented on your changed relationship status". Um, wot?

So I investigate further and I see "undergradRN is no longer in a relationship" with a bunch of people commenting WTF... which crosses my mind as well... and at the bottom there is a comment from my boyfriend, with a sadface, asking if he was still going to meet me at the airport tomorrow afternoon in PVR! Luckily he also had an email from me from a few days ago that set that record straight, lol! Seriously, what girlfriend would break up with her guy BEFORE the wonderful holiday anyway ;)

Best I can figure is I got sidejacked via FireSheep. My password is 20 characters of upper, lower, numbers, and symbols, so I'd pay money to whoever managed to crack it.

See you kids next week!!

Picking your specialty...

2010-12-13T09:55:00.003-07:00

As seen on an AllNurses.com post, and apparently poached from a new (to me) blog - Those Emergency Blues:

A) I enjoyed this tremendously and I apparently am best suited as a Wal-Mart greeter

B) Anyone who lists At Your Cervix, NurseXY, and Rob Fraser as a must-read is okay by me

C subsect. 1A) YES, I *do* think children are mostly trolls

C subsect. 1B) I resent studying L&D SOOOOOOooo much that I am blogging instead of cramming for my final in 3 hours and feeling no pain whatsoever

C subsect. 2) Fine, I'm getting back to work, I swears!

Vindicated

2010-12-12T20:33:00.006-07:00

My term paper for Healthy Populations went, as you can see, swimmingly. I am sooooo surprised and pleased! This takes the edge off my final for that class, for sure. I haven't done that well on a paper since first year. Yay!

The paper topic was interesting, too. I wrote about the fairly recent decision to do away with the Canadian Long Form Census, performed in the past by Statistics Canada.

I am feeling perked up for my last 2 finals tomorrow and Tuesday. Then, MEXICO!!!!

I've been studying too long today

2010-12-08T23:29:00.005-07:00

I realized it while I was writing out notes for compartment syndrome.

I got the giggles... which was bad, because I was in the silent study room (and it was actually silent for a change, even with 5 people in there)

And then it got worse. I started crying tears of lol from holding in my giggles to a gentle semi-silent nose laugh, which resulted in me choking on it and making a huge reverberating SNORRRRK sound. I felt the eye daggers fly at me and figured I'd better leave the room to get straightened out. It was just as well because my coffee needed a refill.

For some reason I found my notation of compartment syndrome absolutely and ridiculously hilarious as I transcribed it - using the very same descriptors as the text--

"COMPARTMENT SYNDROME: Occurs when the muscle is swollen and hard on palpation and the pain is deep... throbbing... unrelenting... inside the tight fascia. "

OMG, I might as well be writing some torrid ladyporn romance novel.

I am officially going nuts. Thank you and good night.

Death, taxes, and finals week

2010-12-07T14:00:00.005-07:00

3 things the average student can count on.

I am stressed, major stressed, about these finals because this is the first year there aren't any cut and dry answers. Science is cut and dry. Nursing answers are about priorities, and I am never sure if my priorities are the same as my instructor's.

In that vein I borrowed a bunch of practical knowledge books from the library. You know the ones. Not blue-skying theorizing about pathophysiological processes, but real-world nursing interventions for real-world situations, like RNotes and Medical-Surgical Nursing Made Incredibly Easy . I am hoping these will help me... if not for the test than at least for clinicals which are starting in < one month!!

My first rotation for clinicals is L&D. Yup, I am going to catch a baby. Just kidding. I am actually planning to be that wallflower student who presses up against the door looking terrified. I actually think childbirth might be scarier than my OR follow-through. Some people know they were born for L&D (nyuk)... I can say, with certainty, that I was not. Pleased to meet you, moms of Alberta!

In other news, and because my brain needs a break from school, I was in my jumping lesson yesterday and rode a (low) crossrail and bounce jump** for the first time. The geriatric schoolmaster I am on, Breezy, is absolutely wonderful at flat work. He is light and responsive and forward, and I get a pretty good feel with him on aids, which is good for me because I am pretty new to formal lessons and proper aids. Anyway, I've been lol-riding him over jumps for about 5 or 6 weeks now and he's been very patient with me, until yesterday. When he decided he ABSOLUTELY LOVES JUMPING ZOMG.

Dear sweet Breezy, while I understand you loooooove jumping because it's fking cold outside and you are fresh as all-get-out, rearing and crowhopping and crazy random rollbacks while I'm trying to set up for the fence is REALLY FRUSTRATING. What's even more frustrating is how my instructor (who really doesn't think much of my riding ability) praised me endlessly for sitting that crazy rollback without getting turfed, and putting you in a tight circle and firm WHOA, without losing my head. It's frustrating because I am not that confident in my riding ability to start with and, while I am not afraid of falling off (lord knows it's happened plenty-o-times), the dirt is frozen and my back does NOT want to be laid up for a month again like last time.

It's also frustrating because sitting a naughty horse is the first/only time my instructor had anything decent to say about my riding ability. Well, there's something to be said for being a country girl riding greenbroke horses out in open fields, I guess.

Still, dealing with another horseback-related back injury is sooooo not on my To Do List.

Here's hoping that next week they give me the most bored, I-only-canter-for-food geriatric equine they have next week.

If any of you nurse-types are also horse-types, I would LOVE some advice on Mr. Poppin-Fresh.

**This is a bounce, for the uninitiated - the horse does not stride between jumps, instead it lands and immediately jumps again:

Well, that was fun.

2010-12-01T20:42:00.000-07:00

Diaphoresis++, blurred vision, tachycardia, fearful affect, agitation, alogia....

What are these symptoms related to?

...

...

Public speaking....

Yes, in an entirely safe environment filled with people I know, I completely flipped shit on my part of the presentation.

I don't even know what happened but I couldn't WAIT to get out of there.

Oh, I hope the end of the semester comes soon.

In other news, and except for my performance, the presentation was pretty good. It was for our topic "Poverty and Pregnancy" I bought $5 of McDonald's and $5 of a healthier lunch food. It was a cool comparison. The healthy lunch was a small salmon filet and a side of low fat pasta salad. At McD's I was able to buy a small coffee, a muffin, 2 blueberry pies, and a McDouble burger. Then I highlighted the nutritional and (ginormous) caloric differences between the two lunch options and the importance of patient teaching.

I also found this video which was a total gold mine. Thank you, Google. Again.

13 days until the end of finals and a few days' stay in sunny Mexico... *stares wistfully at calendar*

World News: Stranger than fiction

2010-12-01T09:46:00.003-07:00

Well OBVIOUSLY we have a WHISTLEBLOWER up in Sweden. He's raidin' ya government documents, he's snatchin' yo internal emails, try'na post 'em on WikiLeaks so y'all need to hide ya government officials, hide ya diplomats, and hide ya state secrets, cuz they're releasin' info on errbody up in here.

You don't have to come and confess, cuz Interpol's lookin for you on unrelated sexual assault charges and we gon' find you. Sarah Palin says we will hunt you like Al Qaeda and we gon' FIND you. So you can run and tell THAT, Julian Assange.

Your children strike fear into my very soul...

2010-11-26T12:59:00.002-07:00

I'm pretty sure I will be a terribad peds nurse.

Today our lab focused on the immunizations clinics we will be running during our Community Health rotation in the coming term. We will be giving Hep B series to Grade 5 students.

I quiver in fear - bloodcurdling FEAR - at the thought of being THAT nurse, the one who makes your kid deathly afraid of needles and healthcare providers for the rest of his or her life, or screws them up forever, and they go on to become political leaders with personal vendettas against nurses like me.

As part of lab today we had to come up with some pre-vax teaching for the wee 10 year olds. My group of 4 had some Official Pamphlets on Hep B that was not designed for kids, and we had to present it in a kid-friendly format.

Harder than I thought.

Every time I wondered aloud as to how we could modify the content, my group said "Don't you remember what it was like when you were 10?"

The answer is no, actually, I don't. I don't have a friggin clue how actual informative speeches should be presented to children. Puppets? Skits? Fred Penner? The one thing I do remember about information presented to me at the ripe old age of 10 was that I definitely noticed, and was filled with righteous indignation, if the speaker was treating me like I was younger than 10.

But how to actually achieve that balance? Urrrgh.

The worst part was trying to explain the means of transmission. I looked at the pamphlet and it was the usual. Sex, drugs, rock 'n' roll, son. I would be comfortable presenting these straight facts to people that I am reasonably confident actually KNOW what sex is about. Grade 12, sure. But Grade 5?

It's so weird too because those who know me know I am not a prude by any stretch. I am a sexually comfortable person and very open minded. But just the thought of telling these kids that they should wrap their tools put my stomach in knots. For NO reason! SO weird! I truly have no idea when these kids move from "when two people love each other very much..." to "hey, sex is fun, but watch the Rohypnol!".

Maybe it's one of those things that will make sense one day if/when I have a Grade 5 child of my very own.

Until then, they scare me. Really. Make them stop looking at me.

Oncology - maybe this is it?

2010-11-25T17:47:00.003-07:00

First off - thanks for all of your positive comments on my QQ post. I really just needed to vent about it. I'm still annoyed about it but I'm still alive, so that's a plus. I am suffering a severe case of end-of-semester-itis. This was a long haul - third year is kind of a 'blah' year, IMO. I'm not really close to graduating, and I'm not doing anything for the first time. Still, semester is over in less than 2 weeks and then I am GTFO to Mexico.

Secondly, big shout out to Rob Fraser (RN! congrats!) who probably gave me the best quote ever about STTI:

My philosophy about any professional association, is that it is like a gym membership. You get out what you put in. So take advantage of their resources and the different opportunities for getting involved!

Touche, sir! I just got my STTI pin in the mail today. I can't believe it cost $40. It does, however, give me a certain amount of pride to pin it to my nametag. I haven't heard back yet from my CNSA application. Assuming I am not accepted to that, I will be attending my STTI induction at the end of January.

ANYWAY, to the point of my post. I have spent hours - HOURS - trying to decide what kinda nurse I wanna be when I grow up. I have been strongly leaning towards ICU (even joined CACCN to suss it out)........

....until the last couple of days, in which we have focused on Oncology.

And let me tell you, it's the strangest tug at my heart strings.

I do find it somewhat tragic, of course, but so incredibly filled with hope, and such an amazing release from all the (IMO) pithy doings of functional day-to-day society.

Even when my dad was diagnosed with non-Hodgkin's lymphoma, I didn't get really emotionally overwhelmed about it beyond the day I found out. I thought the oncology atmosphere was quite powerful and charged with positive energy. I didn't break down and cry all the time. I was pretty up-front about my feelings and reflected on them a lot with my Dad.

I wonder if that would make me a good Oncology Nurse.

More musings are required. In the meantime, I am going to watch these.

Any oncology nurses out there, or people touched by cancer, who care to share their experiences with patients or nurses?

Happiness Is...

2010-11-17T09:46:00.004-07:00

Hearing nothing but falling snow and crunching hay.

Pity Party For One

2010-11-17T09:00:00.000-07:00

The 10-page paper received a 10/10 on "matters of style" and did mediocre on everything else.

The instructor's comments included such things as "excellent writing style but missed the point".

The post that went up yesterday about the CNSA conference was typed up last week, while I was still blissfully unaware that my paper earned (?) a B-. I am glad I applied for the national team already because there is no way I'd apply for it now... self-confidence is in a puddle somewhere around my shoes.

I held a pity party for one last night, thankfully distracted by yoga and a dance class.

Amazing how one tiny hitch in the road can bring back all those memories of being the dismal underachiever in high school... Kinda had the rug pulled out from under me, there.

After some self-reflection, I have come to terms with this disappointing mark (it's more that I am disappointed that the mark doesn't reflect the enormous amount of research I did) and have resolved to bust my ass on the final exam.

CNSA National Team? Mebbe

2010-11-16T08:00:00.111-07:00

From my experience at the conference a couple of weeks ago, I discovered there was so much more going on at the student level than I had ever thought. It really is my nature to get involved with everything (one of my clinical instructors described me as a juggler, tossing around so many responsibilities, and turned it into a moral cautionary tale, but I digress). It was only natural, then, for me to want to get involved with CNSA.

I am interested in running for a position as regional director or maybe higher (!) next year, so I was clicking around the CNSA website trying to suss out some kind of information for the next election period. In my hunt, I discovered information pertaining to the National Conference taking place in Hamilton ON next year. Check out those keynote speakers! Tilda Shalof! Jean Watson! Man, I spent the entire summer before nursing school reading Shalof books and being excited about nursing. Not to mention the 5 page essay I wrote on Watson's Theory of Caring a few weeks ago. A-mazing.

Then I realized that there was (yay!) another opportunity for me to attend a conference for free (yay!) if I applied to participate on the CNSA National Team.

From the briefing:

It will be the goal of the 2011 CNSA National Team to explore and debate contemporary issues in nursing and how diversity affects, and may affect, the next generation of nurses.

As nursing students it is never too early to advocate for change and challenge the present and future state of healthcare in Canada – the 2011 CNSA National Team will address the challenges of the contemporary nursing student, how they may be effective in the promotion of change, integration into an “old school” health care culture, and how to effectively manage these diversities.

It is our personal challenge this year to hold a debate on the changing healthcare system and to provide insight into the issue of public versus private healthcare in Canada and the affect it will play on the role of the nurse.

They have assigned a few interesting topics for discussion, and there are some other ones on the table.

Public versus private healthcare in Canada, and what it means to us
How we are different or the same as generations past; i.e. technology, traditions
Some of the barriers we face as nursing students, i.e. stereotypes
How can we maintain or improve the quality of health care and advocate for change as needed
Our diverse opportunities for work and how can we use them to make a difference in the health of our society
Globalization in nursing

I've never met an essay question I didn't like, so this was a fun and interesting spin on my comfort zone. I can write persuasive position statements without too much effort but the very idea of PRESENTING and DEBATING and DEFENDING those - now that's exciting! And ~~a little nervewracking~~ terrifying!

Those of you who have been longtime readers may remember my philosophy on life - if it scares the shit out of you, DO IT. I try to tackle my fears head on. It's the only way to know exactly what you're capable of. This is the philosophy that got me through solo skydiving, scuba diving, BUNGEE JUMPING (my all time greatest fear - the video isn't mine but it's where I jumped), and the various other questionably-risky behaviour I have engaged in with the intention of figuring out just what I'm made of.

I guess what I'm getting at is this is something that I am, yes, passionate and curious about. I want to discover more about the professionalization of nursing and see how I can be involved. However, and I think most would agree, it's a big jump from idly pondering the future of nursing to defending your ideology in a debate in front of hundreds of peers and nursing leaders.

It freaks me out.

Therefore I applied.

The only real downsides to this opportunity being the giant potential for failure, the fact that I will miss some clinical time, and I will also miss my STTI induction ceremony, qq.

Wish me luck... and feel free to pass on your views!

Cranial Nerves

2010-11-14T12:41:00.002-07:00

Ah, Cranial Nerves. Beyond amusing mnemonics, I have trouble remembering which does what, and I found this link while clicking around AN today.

This was probably the most helpful way to remember them that I've run across so far. I wish I had seen this picture while I was still in my assessment class... so I shall post it here for you :)

Full article is here, from americannursetoday.com

Useful videos:

Full-size cranial nerve assessment (we were taught to have the pt smell coffee grounds through each nare to confirm olfactory nerve intact)

Or a shorthand version, probably more useful in the clinical setting:

Sigma Theta Tau

2010-11-08T16:03:00.002-07:00

I got an invite.

After some consideration, I accepted.

There aren't many people from my school who have joined, so far anyway. My thought process ranged from "That seems like kind of an elitist thing to do, especially as an undergrad" to "What harm would it do me to join?".

I decided to join based on the idea of supporting nursing research, the membership/networking perks, and the fact that almost all the faculty at the university are also members. If my desire is to improve nursing through leadership, then it would benefit me to rub shoulders with nursing leaders. But it still feels like Ivy League elitism, or like some spooky cult, what with the whole "Induction Ceremony". In fact it was this post at Allnurses.com which encouraged me to accept. It's a few bucks, for sure, but the opportunity may not be there again until I pursue and qualify through my Master's education.

Wow, 5 years ago, nursing was a pipe dream for me. I thought I was going to work for a computer corporation for the rest of my life.

Now I could be a member of the Nursing Honor Society.

Do you know any STTI members?

What do we want?

2010-11-07T22:00:00.005-07:00

This made me giggle, especially in light of the paper I'm writing this week.

Thanks for the awesome feedback on my conference summary, you guys made me feel like I was heading in the right direction. In fact, last Friday I had a faculty meeting about setting up a big pilot project for our school. I don't want to speak to it too much just yet but it would be very exciting. I met with some 4th year instructors and they gave it a huge thumbs up.

Re: L&D.... thanks to availability heuristics, I now fear for every couple in their reproductive years. If you see a crazed third year nursing student running down the street yelling about folic acid, teratogens, abruptio placentae, or the importance of colostrum... rest assured that the police already know about me and have likely sent the squad car to take me home again.

Sociological Images is a really interesting blog that I found purely by accident and now enjoy regularly. The discourse is particularly engaging and thoughtful. Actually, that's not really something I'm used to - most of the medbloggers out there have a steady supply of Angry Layperson Commenteurs who rage unintelligibly against any post they might make. So it's nice to see comments that are as educational as the post itself.

In other Interesting Things Found While Googling Research Topics, a fun diversion to learn about all kinds of different biases can be found here. Be prepared to win any argument by saying, "Well, sure, but your logic is flawed, due to the ________ fallacy."

You're welcome. ;)

Have a great week everybody!

Also - you're looking at a Couch to 5K graduate! Over the course of my C25K experience, I have run more than 19 hours, totalling 73 miles, and burned approximately 8100 calories (yep, I track every run!). I can run for over 30 minutes without stopping. I don't run very fast, but I run. I do get bored as hell, and I'm looking forward to running out on the trails next spring. BIG thanks to NurseXY for inspiring me to start :) When I looked at the C25K training plan in those first weeks I could never have imagined running (and enjoying it!) like I do now.

Punched in the box

2010-11-03T12:18:00.004-06:00

Another L&D lecture, another class full of wide-eyed stares and quiet gagging.

Dear L&D nurses, I admire your fortitude.

I'm going to point out that "uterus massage" is such a nice, happy, relaxing, soothing term....

AND THEN I AM SHOWN THIS:

Or how about this? A little manual extraction?

I am praying for my own L&D nurse to have tiny, tiny hands...

Mind=blown

2010-10-30T19:12:00.004-06:00

So, the conference just finished up and I am back in the airport. There was an incredible amount of information, discussion, debate, and theorizing about what it means to Be A Nurse in this coming decade and beyond.

I am inspired and grateful for my sponsorship to this event. If they hadn't sent me, I may never have realized the importance and relevance of the Canadian Nursing Students' Association. In fact I am seriously considering running for a position with the Association for my 4th and final year of undergraduate studies.

You know those experiences where your worldview is completely shifted and refocused? That was me today. It was like a camera, which has been zoomed in on my idea of nursing, suddenly zoomed way out to a much larger perspective and made my head spin. I know I'm waxing a little poetic here but there were so many interesting and inspiring topics today. I am SO GLAD I got to participate in it. I really do feel like my nursing potential has been magnified and refocused.

Without going into too much detail just now, because I want to do them justice, I am planning to do a little writeup on each of the sessions as an additional resource for you all to share.

I will say this: I am so influenced by what I read and hear that I don't even realize I'm being influenced. As you all know, I'm really passionate and excited about my chosen field and I have been since the very start. A big part of that passion is filled by my voracious appetite for nursing topics, lectures, stories, and discussion, which I usually fill by checking out allnurses.com. Of course a lot of the discussion revolves around frustrations and dissatisfaction, be it with life or scope of practice or employers or clients or families or other disciplines. These discussions have been subtly negatively impacting my perspective on the reality of nursing. Be warned, people, that your in-the-moment opinions may be a reflection of the content you're exposed to. Consider whether they accurately reflect what you believe to be true.

A LOT of discussion on AN involves debate between whether nursing is a trade or a profession.

Is nursing defined by its skills?

It seems to me that most (and I use this term cautiously, I haven't been psychoanalyzing the threads or anything) of those nurses who feel undervalued and crapped on and not like a real profession believe that nursing is essentially a skilled trade, and that BSN students like myself are subpar clinicians and (I quote) "stand around theorizing instead of working".

To which I challenge - isn't theorizing a HUGE PART of working to my full scope of practice? As a Registered Nurse, working with Licenced Practical Nurses who nearly duplicate my scope, isn't my defining feature SUPPOSED to be that I address patient care from a wide holistic focus which would include taking the time to conceptualize appropriate care?

I've heard this said before and I always dismissed it, but it's true, and it's very much in line with my previous musings - anyone can give a bed bath. Any monkey can pass meds, change linens, insert a catheter, change a dressing aseptically, or do any number of the tasks that I used to think were the defining features of a nurse and ultimately the purpose of my education. My graduating without knowing these things cold will only slow me down until I learn them.

The point of this degree, and I now see this developing in my thought process, is to get me to think. This makes me smile because I remember on one of the very first days in first year, I asked my instructor what the difference was between an RN and an LPN - she said that I would learn how to think. It's important to recognize that LPNs also know how to think, but every single course I've taken in school has developed and engaged my worldview, and it is so much broader than it was even a year ago. So yeah, those extra 2 years actually will make a difference and I say that from my own experience.

Another idea that jumped out at me today was for all of those who say "sure, wait till you get into the real world", while in the same breath acknowledging that nursing today isn't what it was 25 years ago. They rail against the system; the role of the nurse being defined by the physician, the lack of respect, the lack of collaboration, and warn all of us bright eyed naive students that we're going to get eaten alive -

Well, thanks to today's intercollaborative panel, comprised of Medicine, Pharmacy, Social Work, Physiotherapy, Registered Nursing, and Practical Nursing, it hit me that it's not just nursing that is graduating new students. Every single discipline is evolving and acknowledging the scopes of other professions, and those changes are reflected in new grads. The physicians I graduate with today I will be working with tomorrow (theoretically) and it's going to be our ball game. Collaboration is alive and well in our student population and will be alive and well in practice. Eventually, of course.

What I'm trying to say, in a long-winded kind of way, that today I remembered and reinforced that I will be changing tomorrow by my actions, attitudes, advocacy, and values.

I would also like to give a shout-out to Saskatchewan's attitude towards Registered Nurses. For those who don't know, Saskatchewan is the birthplace of single-payer, accessible, universal health care enjoyed by all Canadians. It has a long history of strong nurses and seems to have a lot more respect for healthcare than my home province of Alberta. In fact, Saskatchewan passed the Registered Nurses Act. They have their own act! It protects the title of 'nurse' for RNs only! By comparison, the nurses of Alberta and several other provinces fall under the Healthcare Professions Act. Saskatchewan's nursing speakers prided their profession as compassionate caring and conveyors of change - NOT as skillmonkeys, handmaidens, or tradespeople. When that many people are speaking that passionately about their profession, it's time to listen.

I was also introduced to the unfamiliar practice of Saskatchewan nurses identifying themselves by name and title at every opportunity. For instance, the president of SNSS was introduced as Braden, Nursing Student. One of the speakers was introduced as Barb, Registered Nurse. Everyone did this, every time they introduced themselves to anyone.

A simple act but it highlighted the pride in their title, whatever stage of nursing they were in, every single time they said it.

A fine tradition and one I will be taking with me to the clinical setting. Hello, I'm Undergrad RN, Nursing Student - to whomever may ask.

Anyway I've rambled on and on and if you made it to now I will personally send you a chocolate bar. Look for detailed session synopses coming within the next week or so. Have a great Halloween everyone! I am flying back home within an hour!

In Transit

2010-10-29T11:14:00.000-06:00

I'm now sitting in the airport waiting for my flight out to Saskatoon. I'm SUPER EXCITED! First conference ever! There is so much I want to know:

- ideal career pathing for critical care nurses
- CRNE information
- what the hell nurses should be putting on a resume
- what other student nurses think about

I'm also excited about staying in a hotel tonight. I love hotels. Big wonderful beds with big wonderful pillows and small wonderful sample things and coffee pots and all that jazz. And when you're done you just throw the towels in the tub.

That's actually kind of how I roll at home, but anyway...

Hey, boarding call. Will update soon :)

Sweet!

2010-10-21T08:22:00.005-06:00

Guess who's going on an all-expenses-paid conference trip to sunny Saskatoon?

This girl, right here!

Oh, I have horseshoes up my ass.

I am SO excited about this. I've never been to a conference before. It's next weekend and I will share all.

There are several workshops but the two I am most interested in are Family Centered Care and Nursing the Future. Looks like there are also some perks like a job fair and stuff - not that it will help me much as a 3rd Year but it will help me pick the recruiter's brains and find out some things that could help me land a job in a year and change.

Thank you everyone for your positive vibes. I was reading back through some of my old posts and I am so glad I started this blog. It's really helped to remind me how far I've come.

facepalm

2010-10-20T12:47:00.008-06:00

Overheard in class:

"Why can't I do IV pushes as an RN?"

"You can, you just need the certification. It's a short inservice."

"Well, what's the point of being an RN if I have to get certified after?"

______________________________________

This was one of the students who was profoundly baffled by the concept of IV infusion.

I hate to break it to her but if she resists ANY competency training beyond the basic BScN she's going to find her career path pretty, uh, nonexistent.

I find it interesting how I've moved beyond focusing on specific skills of care and started "big picturing" a LOT more. Is that by design? Is this a Third Year goal? Or am I just so annoyed with how small-minded some of my classmates seem that I am focused on the overall concept of nursing to give myself strength to make it through another round of microcosmical questions?

Or maybe I'm just going about this all wrong.

Fingers Crossed

2010-10-17T18:33:00.000-06:00

Last week was nuts and I got a lot of things done.

I applied for 2 student nurse conferences that my school was sponsoring a student for - one is at the end of the month in Saskatchewan and the other is next June in Texas. The application to the Human Caring conference was tough, I had to write a 5 page academic paper on 'caring' the day after I finished that monstrous paper for my N370 class. I was tired and braindead but hopefully it is a success. Luckily, a lot of the books I had already borrowed for my class paper were also useful for the submission.

I also applied for scholarships from Skyscape and from my school.

Come on, student money! *crosses fingers* I also mentioned on my conference application that I would be interested in sharing the experience "on my blog".... *gasp* I have considered outing myself slightly in the interest of growing my nursing career.

New week, new opportunities? :)

Midterms next week!

Wipes sweat from brow

2010-10-14T17:37:00.002-06:00

24++ hour marathon to complete the most complex term paper I have ever written

......complete.

I was up till 1 AM last night, and awoke at 6 AM to complete Week 7 Day 2 of the C25K program, and then headed to work where I was able to finish proofing it.

It took a total of 4 hours to write the paper and a mere 20 hours to format it.

Nay, I jest, but still! Whew. *grumble* stupid APA 6th edition *grumble*

In case you were wondering, I went with Option A for my topic.

To celebrate? Sushi!

Happy Turkey Day!

2010-10-12T15:14:00.002-06:00

Up here in the Northern Wastelands, we celebrated Turkey Day by eating steak and ham.

In keeping with post-secondary tradition, this holiday has been spent hunched over a pile of books trying to come up with a term paper for my N370 class.

The topics were assigned, and fairly uninteresting to me. So far, I have it narrowed down to 2 topics, which are very similar but *slightly* different:

A) According to King’s theory of Goal Attainment, the nurse and the client interact purposefully to set mutually agreed upon goals (King, 1992). Discuss pertinent barriers and potential strengths to mutual goal setting when a patient/family is coping with an acute alteration in health (of your choosing) and develop appropriate therapeutic nursing measures. Your paper should provide specific examples of nursing care to support your discussion as well as demonstrate a clear understanding of King’s concept of mutual goal setting.

B) Present an argument supporting two (2) strengths and two (2) limitations of the registered nurse utilizing King’s theory of Goal Attainment to guide nursing care in the acute care setting. Support your argument utilizing specific examples of patient/family experiences and nursing care/interventions related to a specific acute health alteration (of your choice).

The health alteration I am choosing is Acute Renal Failure, more recently known as Acute Kidney Injury. Even though there isn't a whole lot of nursing-specific information on it (compared to, say, burns), I have some interest in the topic for a couple of reasons. My g-ma has Type 1 DM and has recently been diagnosed with <30% renal function. Even though hers is more of a chronic renal failure, I need to do an acute illness and I figure there will probably be some similarities that I can draw on for those (ever more frequent) times that my family presses me for medical information. My second reason is that ARF/AKI is seen in about 30% of CCU patients and it has a 50% mortality. If my interest in CCRN continues, it will be a good knowledge resource in the future.

Imogene King was a pretty interesting lady. Never married, she spent her nursing career developing her conceptual theories and she defended them pretty much until she died in 2007. I think.

I'm still not sure what the practical point IS for a nursing theory. It still really, really seems like these Nursing Theorists took some common sense, put it into words, slapped a label on it, and called it a theory. And then it was passed through the ages in nursing school for snurses to cry themselves to sleep over. And then they graduated and made a theory so that they, too, could live on in academia.

Maybe I'm just missing the point. Is there anyone out there who has experience applying models to practice?

Last Friday we had labs again. Yup, still terrified for my eventual L&D rotation. N370 lab was fun, as usual. We were reconstituting meds and piggybacking them onto IV.

My battles with the Alaris pump rage on. I'm sure it's the easiest technology in the world once you get it. I still don't get it, and I blame that on the ABSOLUTELY USELESS simulation that we learned on, and the fact that we 'learned' it in 2008. Before I knew anything about meds or infusions.

So we were learning how to reconstitute powder medications. My lab buddy and I got a handle on that right away. There is a label *ON THE BOTTLE* that says if you add [this much] saline, then you will end up with [this] concentration. Pretty straightforward, no?

Then my lab instructor threw the whole class, save one dyad, for a loop. If you have [this] concentration, how much do you need to draw up to get [dosage in question]?

I.e. if I add 5.6 mL of NS to the bottle, the label tells me that will get me a total of 6 mL at a concentration of 500 mg/mL. How many mL must I draw up to get 2g of the drug?

Derp, 4 mL?

My ENTIRE CLASS was stumped. No really, *stumped*. Then we spent the entire lab going over this (zomg straightforward) concept over and over. I can only facepalm.

Sometimes I wonder if I'm smart enough to be a CCRN. Other times, like this, I feel surprisingly optimistic. ;)

Have a great week all!

Paperwork

2010-10-07T14:17:00.001-06:00

I just returned from filling out a stack of paperwork to begin volunteering at a nearby ED! I need to prove I don't have TB or communicable chronic diseases or a history of robbing banks, and then orientation's on October 21.

As I was leaving, the triage nurse was assessing someone for syncope.

Excited? This girl right here.

Of course, using any real medical skills or providing advice is verboten on pain of lawsuit - the whole point of this endeavour, for me, is to keep my eyes and ears open and to network myself into a UNE position next summer. I'm also planning on being my charming self and being soooooo helpful and curious that the staff nurses can't help but invite me into the room to observe cool stuff.

The plus side of doing all of this paperwork, I'm told, is that once (if?) I'm hired with AHS, I won't have to do it again! Huzzah, starting sooner!

To Ride Zenyatta

2010-10-06T17:49:00.001-06:00

This video would be breathtaking on any horse's back - but Zenyatta? *melt*

Third Year!!

2010-10-04T13:01:00.011-06:00

Yes, it's official! I have made it past the halfway point of my degree. So far it's been a great start; I have been keeping (mostly) on top of my (incredibly massively huge amount of) readings.

My schedule is kind of light this year due to my attempt to do one class by correspondence, which means a no-group-work win, and my advance credit for the elective.

Don't even get me started on the ethics of elective requirements. I don't see why I should be REQUIRED to take Greek Mythology or its ilk. It's a thousand bucks that I'd sooner keep to pay rent with. Post-secondary cash grab, anyone? Is that even a surprise anymore?

Anyhoo, I am taking a mere 3 (!) courses this term:

HLST 354: Healthy Populations

This class is, more or less, HLST 152 all over again! The book is OUTRAGEOUSLY mind numbing. I thought I had a handle on reading dry material. This book is so dry it's practically incendiary. Once you slog through all of the verbosity, though, the content is kind of interesting. Chapter 1, the History of Public Health, will make for some entertaining drunken rambles, I'm sure :)

NURS 370: Nursing Care of the Acutely Ill Across the Lifespan

aka "When Bad Things Happen To Basically Good (if you're a humanist) People"
Unlike 270, this instructor is fun and engaging, and, well, interested in the material

NURS 372: Nursing Care of Families With Young Children

I don't think there's ever been a more potent contraceptive than an Obstetrics/L&D class. EVERY SINGLE DAY I am cringing about Something That Could Happen To A Vagina Near Me.
I don't have any desire to ever be an L&D nurse.**

**This may totally and ironically backfire when I am on my clinical rotation and decide that I have found my calling as an L&D nurse.

I have a paper due immediately following Thanksgiving (this weekend! boo) and another paper, and a group project. No big. I really feel in control this semester, and it's almost midterms! That's a first...

I applied for The Persons Case scholarship on September 30th. I hope to hear good news in December. The scholarship is up to $5000!

N370 & N372 both have 2 hour lab components. The labs are scary fun. N370 is awesome to me because it's getting into the really interesting kinds of care. So far this term we've covered complex wound care including irrigation and packing, chest tube management, and tracheostomy care.

Packing a wound. I thought it looked
uncomfortably vag-like... lol

Needs Moar Suction!

Placenta pillow anybody? It even comes
with some amnion....

N372 scares the shit out of me because I know absolutely NOTHING about kidlets or pregnancy or anything. I am the baby in our family and I don't hang out with moms much/ever. In fact the majority of my exposure to children involves them screaming and me hating their parents. So it's totally and completely new material and that's kind of fun, actually!

So far this term we have learned CFAM and CFIM, genogram mapping, and very basic prenatal care. Last Friday I attempted some Leopold's maneuvers. We had these (epically hilarious) fabric abdomens with a little dolly inside that could be flip-flopped all around to approximate various fetal presentations. I had one I was palpating and was pretty sure it was RSA (right-sacral-anterior). We opened that thing up and I was sooooo wrong. Babies everywhere, be afraid!

C25K, legitimately!

2010-10-03T20:09:00.004-06:00

Hi everybody :)

a) Yes, still here

b) Yes, still in nursing school!

c) Yes, still busy as hell.

I did however have time today to run my very first 5K.

Drofen aka NurseXY inspired me some months ago to try the Couch to 5K program, with great success! I am only on Week 7 of the program; I was able to run most of the 5K with 3(ish?) walking breaks to bring my HR back down from the mid-170s.

Total time: 0:36:15, with an approximate 12:00/mile pace, which would be at least a minute off of my fastest training time and running on the road to boot! (I have an unhealthy attachment to my treadmill at 2% incline)

I miss everyone! I miss blogging! I shall return with some excellent nursing school stories... (or pictures, and those are worth at least 1.5 stories each ;)

Also, I am soon-to-be volunteering in Emerg! Oh, thank goodness. I feel like real nursing skills are missing from my day to day.

I have, however, been creeping all of your blogs. Thanks for the nursing fix. I can't BELIEVE that so many of you are already RNs or nearly there! I have 2 years to go!

/wrists

No, seriously, congratulations. Now hurry up and pick a specialty and write about it so I can make up my mind!

As an aside, I have discovered several unmoderated comments which will be moderated within minutes. Sorry about that... I don't delete any comments except spam ones, but I don't check the older posts as often as I ought.

iTunes U and Podcasting: So much nursing potential!

2010-06-21T17:36:00.010-06:00

While at work over the last few days, I have spent a few hours browsing iTunes U for various Nursing vodcasts. It's really, really fascinating to see how other schools teach their students. For those who don't know, iTunes U provides a medium for educational institutions to post video or audio feeds of their lectures, and they are free to view for anyone who has iTunes (also free). There are lectures on every subject you can think of. I love to just browse different topics and learn. The other day I watched a vodcast about Relativity. For no real reason, just because I could. [Photo Credit]

My school, new as it is, was built as a 'smart' institution with microphone hookups and live feed capabilities in pretty well every classroom. It doesn't currently participate in iTunes U, however. I think my school is concerned over privacy issues and intellectual property. I have this dream that instead of burying their heads in the sand and choosing not to address the promise of global education, our nursing faculty would embrace the accessibility of information and begin to publish some of our classes. (Check out the iTunes U how-to guide!)

I find it very exciting to think of how this technology could be utilized by the nursing community at large. For curious students (or would-be students!) like me, it is an easily accessible look at various aspects of nursing and it can introduce us to all kinds of specialties that we may not have known about. How awesome would it be to browse to a central organization website like the CNA, and be able to find and view lecture classes for specialties that you might be interested in? I am thinking specifically of the CCU certification I am interested in, or other advanced Post-RN coursework available at my university like Advanced Wound Care. You could utilize other schools' lectures to supplement your own - maybe to get a different point of view on difficult concepts, or to expand on something that you found interesting. You could even see how other student nurses in the world are learning.

On a larger scale, this could be utilized as refresher courses for distance learning or a video log of the entire class you took. I, for one, would LOVE a v-library of my lectures. I would pay extra to have a permanent record of the classes I take. I feel like I only ever take away about 30% of the information from any given lecture, because really, there's just way too much information assaulting my neurons at once. And how great would a v-library be for studying??

Imagine being an outpost nurse who is planning a community-scale intervention in diabetes management. Sure, you can spend hours and hours digging up relevant research (and you probably will), but imagine if you could visit the site for The Diabetes Nursing Interest Group and find podcasts for the most up-to-date EBP based on current research.

In short, you could find out how other nurses are nursing, straight from the specialty's organization. They could put out quarterly updates with new information or the latest in EBP.

How is this different from the newsletters or PDF publications that are already sent out, you ask?

The big differences would be accessibility - anyone could view this information, not just the organization and not just nurses (!) - and method of delivery.

Reading through a 37-page PDF is a lot more tedious and abstract than viewing a 10-minute video showing the latest in nursing interventions. How much easier is it to learn when you can actually watch a video of a nurse interacting with a patient, instead of just reading about it? Things that are best shown visually with an accompanying explanation, like new methods for IM injections or crisis interventions.

The possibilities are massive. This could theoretically be on a huge scale, with global involvement. Ideally, having this kind of information available from such reputable sources (CNA, PHAC, and NIH, to name a few) in such an incredibly accessible format - over 200 million iPods sold, worldwide! - could even be utilized to educate and influence public health. Inexpensively... AND "upstream" in that nebulous idea of primary health care.

I believe people are becoming increasingly open to being involved in their own preventive health maintenance (anyone notice how popular the Doctors have become? I laugh every time I see them in their pristine TV scrubs). I think that good, reliable information is hard to come by. Google any medical question and you're going to get 2,000 results from Yahoo! Answers or wrongdiagnosis.com. The world is ripe for reliable information at our fingertips. This kind of health information is mostly an untapped market, IMO. I find this all very very exciting.

I guess what I'm trying to say is that post secondary education and research isn't off in some ivory tower (or imposing brick-and-ivy academia) anymore. You don't have to get periodicals from the library to keep up with the current knowledge base. Any layperson can experience the post-secondary environment for free via one of the most accessible mediums to have ever been invented, short of the Internet itself. The information found there is (presumably) based on the most up-to-date resources available.

While I am waiting for the world to catch up to my ramblings, here are a few nursing-related lecture podcasts on iTunes U that I have subscribed to. I haven't watched them all, yet, but they're pretty much everything that I could find that was published from a School of Nursing. Please leave links to your favorite nursing podcasts in the comments and I'll update them here! Happy watching/listening :)

Acute Adult Nursing
Adult Health III
Clinical Skills for Student Child Health Nurses
College of Nursing Lectures - Video
Diabetes Care
NURS 083A: Pediatric Nursing
Nursing Informatics Program
Nursing Skills: Techniques for Sub Cutaneous and Intra Muscular Injections
Penn Nursing: Care to Change the World
Pharmacology for Future Nurses
Nursing-Psychology 342
The School of Nursing - Art of Bedside Care
The School of Nursing - NCLEX Review
Surgery ICU Rounds Podcast
Yale Health & Medicine

Half a day in the life of an ICU nurse

2010-06-15T15:59:00.007-06:00

A great post brought to you by Raspberry Stethoscope! I have been reading her blog for over 2 years now. She has a zillion great resources for nursing students but she is a staff ICU nurse now in Florida!

http://www.raspberrystethoscope.com/2010/06/what-happens-during-half-of-my-day.html

0612 Begin head to toe assessment: listen to lungs, heart, bowels, check pulses—radial and pedal. If pt alert, ask if they have pain, how they slept, follow-up with concerns. If ventilated and sedated, make note of ventilator settings, suction the patient if needed, tidy up the room (!!), check pupils. Zero any alines, cvp’s, ScVO2 monitors, check alarms on monitor, adjust to personal setting. Check room, make sure ambu bag, enough flushes in the drawers/make sure room is stocked for a code!

0620 if patient or family does not need anything, such as blanket, ice, bed pan, water, etc. then begin to chart assessment on flow sheet (approx 3 pages). Go through chart and if not already done, update special treatment pages, education, graphics for IV access, treatment/plan of care, remove 234234 extra papers that do not belong in the nurse’s chart, reprint patient id stickers.

0630 Onto patient #2… chart 0600 vital signs, including: blood pressure, HR, Rhythm, sats and O2 %, temperature, RASS scale, dump urine for the hour and note milliliters.

0632 Begin head to toe assessment: listen to lungs, heart, bowels, check pulses—radial and pedal. If pt alert, ask if they have pain, how they slept, follow-up with concerns. If ventilated and sedated, make note of ventilator settings, suction the patient if needed, tidy up the room (!!), check pupils. Zero any alines, cvp’s, ScVO2 monitors, check alarms on monitor, adjust to personal setting. Check room, make sure ambu bag, enough flushes in the drawers/make sure room is stocked for a code!

ZOMG

2010-06-15T12:17:00.001-06:00

I got a callback today from the UNE position that I applied for two months ago!! They left me a voicemail acknowledging that it was already well into the summer months for college students and asked if I was still interested. They wanted to shortlist me.

YAY

I called back and told her that I was going away for 3 weeks during the summer but otherwise YES I was still interested, especially in an ongoing basis.

Here's hoping!!!!!

Re: ACCN Certificate

2010-06-15T09:18:00.004-06:00

I fired off an email to the department for the ACCN certificate, asking when I could theoretically begin some of the coursework.

Their reply: "You would need to be in your final Year (4th year) of your Degree program to take the ACCN courses. You would be able to take some of the theory course prior to graduating."

Okay, so I have a year to consider my options. This is good. I have an ICU theory term and clinical rotation in the coming year, so I can make a more informed decision at that point.

A lady at work yesterday saw me reading my latest textbook for my correspondence class. It's dry stuff, but at the same time interesting. The current chapter is examining paradigms and methods of scientific inquiry. It is making me wonder how on earth I'll ever get to the point that I can identify a knowledge deficit and choose to research something real and relevant. This is something I'm going to have to tackle in a Master's program. I guess that's why they want me to have a year's experience in my specialty before applying. But I digress...

She asked me how much longer I had to go in my program. "2 years!" I cheerfully replied, and then we were both a little surprised at how fast the previous 2 years have gone by. A lot of the ladies at my work are very old-school (I am one of the youngest people there, by like 20 years) and they seem to have a real reverence for my being a student nurse. It's a little unnerving. No matter how much I tell them that I actually don't know anything, they want me to shed light on various medical concerns they have - my office has a LOT of medical concerns. In fact I have been clamouring for them to get an AED there specifically because I work with a lot of overweight older adults.

However I was actually able to provide some good information to a co-worker whose dad was in end-stage cancer, receiving palliative care. He lived in another province. She was pretty distressed and didn't want him to die alone in a hospital bed. I told her to inquire about home care nurses in that area. A few months later she told me that home care allowed him to die peacefully in his own home with his own family present, and she was very pleased with the supportive environment. I was glad that I had managed to pick up SOME little tidbits from Med-Surg, lol :)

I'm pleased to report...

2010-06-14T11:28:00.006-06:00

That all of my whining and crying about Stats paid off - I got a B. I have never been so happy to get a B before. I just as easily could have failed that course. I crunched some numbers before I went into the final, in regards to my weighted average. Conservatively, I expected a C. Even ambitious estimates predicted I would get a C+ or B-. I must have ROCKED that final to pull off a B. I am SO THRILLED!

Do you know what this B means?? It's an entrance requirement to the Master's degree. "Must have B in Statistics". So I will NEVER have to take stats AGAIN!!! *promptly forgets about z-scores and regression lines*

I also got a fancy letter in the mail in calligraphy type from the Faculty of Nursing (very professional, thanks) congratulating me on First Class Standing for this past year. Not much to brag about considering all my peers' Facebook statii reading "So-and-so made Dean's List!"...

Oh well. It is a small victory, and mine own.

Now that Stats is over, I am taking a correspondence class (starting July 1, web-based) to cut down some of my lecture time next fall. However summer is officially a break for us and I technically don't HAVE to do any more school work. I just want to. That class appears to be all papers and I'm quite excited to just go at my own pace for a change, however fast or slow that may be. And follow my own schedule. Big party this weekend? Cool, I'll just schedule my final for another time.

Lord help me, I'm a little excited to be cooped up in a musty library surrounded by nursing research, with no deadlines to keep.

I have a big summer planned. It technically already started. I spent a gorgeous sun-soaked weekend with my boyfriend. We went on a beautiful long bike ride through the park trails and splashed in the fountain to cool off. We then headed out to my friend's lake house and had a great party and lots of time with beers in hand, just loving life.

I am leaving on a 3-week trip to Thailand on July 13. We are going to see and do all kinds of things. I just got my updated passport a few weeks ago. Then, when I come back from Thailand, I'm going to be all ready to move into my fabulous new condo. No, I didn't buy a house. I'm renting this one too. But it's at least a million times nicer and better than the one I've been living in since last September. This current one is mousey (REALLY mousey), moldy, gang-infested, and rife with electrical problems. Not to mention the sketchtastic neighborhood. I can hardly wait to move. In fact I just bought a ton of boxes from U-Haul to get started. So on that note... have a great week everybody!

[Photo Credit]

postgrad RN, BScN, MN, CNCC (C)

2010-06-11T20:25:00.006-06:00

I don't know if you guys have looked. I'm SURE you have. I'm sure you're all just as concerned as I am about where the hell you're going to work once you've got that shiny degree on your wall. I'm only halfway done and I'm already panicking!

My *ideal* career path would be a year or two in Med-Surg, while building foundational skills, and then to grow into a CCU nurse. I'm not 100% sure if CCU is ultimately the kind of nurse I'd like to be (who can be that sure, anyway?) but a lot of things about it are appealing to me.

Certainly, one of the best days I've had in clinical was when one of my patients had higher acuity and I had to manage him, his family, and my interactions with the rest of the care team very diplomatically and with as much knowledge as I had. Everything that came up with his care made me ask myself questions. I spent my breaks researching. I loved every second of it, even though it was a very difficult time for him and his family. One of the weird things about nursing, I guess - some of your best days are some of your patients' worst.

My career path has always seemed pretty workable. Get a job in something basic, then specialize, while continuing my education. Ever since I realized that I liked learning, I haven't wanted to stop. Sure, some days I wish I was done school so I could have time to myself and actually have a life, but on the whole I've loved every second of it. Stop at my BScN? Hell no.

Unfortunately, with job prospects dwindling and having heard nothing back from the internship I applied for, I'm starting to actually get a little spooked. Our schools keep churning out new grads and I haven't found a SINGLE RN job posting that didn't require at 1 year experience. In fact I haven't found a single RN posting that was in anything other than a specialty.

The job market tanked in the last two years. One hopes it will float again in the next two.

However, in case it doesn't (or in case any market improvement is only temporary) I am considering pursuing this certification on a part-time basis next year as a senior student. I am hoping it will give me a leg up over the ~150 nurses also graduating with me. There are some theory components but most importantly, there is a 210-hour clinical component.

AKA networking opportunities.

Eventually I want to obtain my Critical Care Nursing certification through the CNA.

Alphabet soup? As long as it brings job security and a paycheck, I don't mind one bit :)

[photo credit]

Oh, Blogger

2010-06-07T16:04:00.003-06:00

I had some things I wanted to talk about today but Blogger was down all afternoon. I flirted with the idea of exporting to Wordpress like so many others did. Then it looked like I would have to pay to host my own domain in order to upload my page design.... not to mention all the other headaches involved with changing blog hosts.

Then I thought some more about the future of undergradRN. This blog's purpose has always been to follow my journey through nursing school and allow me to share resources and connect with you like-minded people. Often it has been a therapeutic diary for me. Sometimes I cobble together some resources that people seem to utilize.

After dreaming a little bigger and then weighing the idea of keeping up a higher-traffic site along with the quasi-terror I have about being outed and no longer anonymous, I decided that I am happy with my little slice of the blogosphere. UndergradRN will continue to be hosted right here at undergradrn.blogspot.com.

That said - shape up, Blogger, or I am shopping elsewhere ;)

deep breath exhale

2010-06-05T20:29:00.004-06:00

This past 6 months (wow...6 months!) since the whirlwind of back-to-back clinical, nonstop patient research, papers, drug profiles, and my actual paid work has made me exhausted (see right!), crazy, happy, angry, frustrated beyond belief, and very nearly completely burned out. I didn't have much left to give to work, or to clinical, to my instructors, or most importantly to my patients from my inner self. I had no time to reflect on lessons I'd learned or to prepare adequately for the next 16 hour day. It was just a feeling of sinking... sinking... sinking... and I'd gasp for breath and paddle harder.

Now that it's over I feel practically weightless. You mean... I can just GO HOME after a full shift at work? GO HOME and NOT research things, not unless I actually want to? I can read for PLEASURE? I can reactivate my Warcraft subscription?

What is this "free time" you speak of? I literally can't remember the last time I just sat around and kept the couch warm.

But it's so profound to take a step back and see the whole picture. To get OFF of the myopic hamster wheel called "How To Fit Everything Into 24 Hours".... to get out of that mindset and actually take a good look at who I am becoming, where I've been, and where I'm going.

This is exactly why I blog.

It's been 8 years since I left high school. 8 years ago, I felt like getting married and having babies was who I was meant to be. I'd earned my diploma, but barely (which was my own fault) and college just seemed out of reach. I toyed with the idea of Nursing but my grades were nowhere close. Still, I checked out a few options including an information night at the University (then-college) which I now attend. I can still remember the feeling of awe and privilege I had, being in that classroom, meeting the Nursing faculty. My heart leapt out of my chest as my sneakers squeaked down the polished halls on that seemingly huge campus. Registrar? Student Services? A bookstore? A cafeteria with actual franchises? Wow! But it was not to be... I dared hope that night about the person I could be, but then firmly squashed that dream by saying "school is not for me".

I went into fulltime/casual home care for 5 years. The more I did it, the more I loved it. I was privileged to meet caring families who were strong advocates for their profoundly disabled relatives. My town was relatively forward-thinking, for small-town agricultural Alberta, and taught me a lot (a LOT) about patient rights and respect, and seeing the patient through the family context (a la McGill Model). Home care challenged me and inspired me to think bigger. To consider new options.

I took some time for myself and travelled, on my own, like Lesley from Glitter Scrubs recently did (welcome back, btw!). I found out SO MUCH about myself and who I am. I worked closely with horses every day. I am not much of a 'New Age'-er but if there is such a thing as a spirit animal, mine has 4 hooves and a big heart. Horses are such sensitive creatures. They respond intuitively to minute changes in your own body language. They mirror your actions (some might say your attitude), and if you learn to be sensitive too, the resulting partnership can blow your mind. They taught me so much about being gentle, deliberate, and conscious of my actions.

In fact, I found that the sensitivity of horses paralleled the sensitivity of the developmentally disabled people I'd come to love in home care. Both were reflections of myself, in a certain way. Both required a careful balance of guidance, understanding, and flexibility from me for a harmonious, growth-focused relationship.

Realizing this, as I spent each evening unwinding by the sea with no one to talk to but the fresh coastal wind and old stone cairns, I knew that in my heart of hearts I was led to care about people and to care for them.

I had this attitude when I was accepted into my first college program - a police officer accreditation diploma. I know who I was and what I wanted. When my favorite professor, a working Staff Sergeant with the municipal police force, said that the Force needed less brawns and more compassion, I jumped for joy inside. Looking around me, however, I saw a batch of barely-graduated-high-school small town attitudes like the one I worked so hard to escape. I was drowning in that toxic environment.

After the whole art school debacle and making the conscious decision to throw caution to the wind and pursue Nursing - my actual heart's desire, all along - it just felt SO RIGHT. Even busting my ass upgrading my marks with would-be nurses failing and dropping out all around me, and the Upgrading Advisor telling me I had a snowball's chance in hell of getting accepted, I relished the odds because it was a struggle for something that was absolutely where I was meant to be.

Two years ago last May, I went to the Spring orientation seminar and crossed the inspiring halls of my newly-built campus for the first time. I can't tell you how that felt. I was excited and terrified and most of all profoundly amazed that I could be so lucky. Privileged - there's that word again.

Well, those of you who have stuck with me since that first blog post in February of 2008 know that nursing school has been a whirlwind with its ups and downs. Most of the time I feel like I can't even catch my breath. Nursing school has pushed my perceived limits of exhaustion, motivation, and passion for learning. Every day that I was made to think harder and more abstractly than I thought I could, I wondered how much more my poor brain could think.

But not once, never once have I doubted my reasons for being there.

I am still, 24 blood-sweat-tears months later, in love with my chosen profession.

Of course, not doubting my reasons for being there isn't quite the same as actively APPRECIATING where I am today. I think my sense of appreciation took a back seat to all-night study sessions and 3 AM paper marathons and 1,000 page textbooks.

So today I give thanks for those times of struggle and bouts of madness as well as the profound moments of patient care that I have been, yes, privileged to experience in the lives of those I have pledged in my heart to care for.

Did that sound sappy? It was honest.

Stats is done!!!

2010-06-04T20:19:00.000-06:00

Wow, I can't believe it. I was up until midnight studying last night. I was using some old practice exams and several of my friends called me up in disbelief because the questions were SO TRICKY!! I finally crashed and then woke up at 4 AM in a panic (after dreaming about variables, yippee) and studied some more. Eventually at 6:30 AM I passed out on my notes for an hour, worked through a few more notes, and then went to write the final.

I was SO STRESSED. I was pale and shaky (not helped by my lack of sleep, I'm sure), and just about in tears before I went in to write the exam. I mellowed out to Aqueous Transmission on repeat while en route to school.

Oddity of the week: While I was walking up to the door, I spotted a strange basket thing on the sidewalk. I got closer to it - it was a baby's carseat. With a baby in it.

I looked around and there was NO ONE in sight.

Just... a baby.

This was about 6 minutes until my test.

I zoomed into the school office and told the bewildered girl that she had to go and do something with the orphan on the sidewalk because OMG I had a final to write.

Last I saw of her, she went out to try and figure out where the baby came from.

The sidewalk was parallel to a small parking dropoff for a daycare so my assumption is someone loaded up the car and forgot the baby...... :S

ANYWAY, I went in to write the exam, and to my IMMENSE RELIEF it wasn't impossible. I mean, it sure as hell wasn't easy. It was still one of the hardest tests I've ever written.... but I was able to answer all of the questions (right or wrong, at least they had an answer!) and I finished in time with about 10 minutes to review my work.

Big shoutout to my amazing man who hooked me up with his copy of the textbook, study solutions guide (infinitely useful!!), and even a full-featured calculator that shaved precious minutes off of my calculations and showed the whole entry line so I could easily double check my inputs!! Better yet when he stayed up till midnight to help me study and offered to come over before work this morning too <3

Immediately after handing it in, I burst into song and we went out to relish the gorgeous afternoon with beers and pub food on a restaurant patio. Management was kind enough to give us a free round of "Crispy Crunch" shots. Tasty!

Gah, stats...

2010-06-03T10:29:00.004-06:00

I'm a pretty good student, I think. I show up to class, I do my projects, I contribute, and I get good grades. I think, on the whole, and unless instructors find my contributions irritating, they like having me around.

That said -

STATISTICS IS KILLING ME!!!!

It's a 5 week course, which I assumed, following the utter exhaustion of clinical this past winter, meant it would be a cakewalk.

This is THE hardest class I have ever taken, and it's not even related to nursing. In fact I don't really think it's applicable at all to nursing, at least not at the depth to which we are learning it. Apparently the faculty agrees as they are phasing out this particular course and creating an 'Applied Statistics' course that teaches students to analyze data using statistics software.

This particular course has me manually crunching numbers utilizing 4 pages of formulas. I am graphing curves, calculating z-scores, difference of means, means of differences, null hypotheses, critical values, confidence intervals, p-values, probabilities, paired differences, regression lines, and chi squares, and losing. my. mind.

I mean, I get it. Nursing does and must rely heavily on research and it's important to understand how that data was analyzed so I can determine whether it's reliable or whatever. But I will NEVER, NEVER, NEVER be given a set of values and asked to determine BY HAND what the margin of error would be for a 10% significance level. Except as the meanest joke ever.

Get a load of these symbols which I am supposed to differentiate between. They all mean something completely different and the same symbols mean different things in different formulas:

A, a, α, B, β, b, C, d, df, E, ∑, ∈, H₀, H₁, k, N, n, σ, p̂, P (A | B), P (x), p-value, ρ, q, R, r², s, S_e², SS_x, t, μ, x̄, x, χ², y, Z

*shudder*

You should see some of the formulas we use. With the simplest calculators you can imagine. This one is particularly spectacular:

I worked hard to ace the midterm and I got a 70. I need 40 on the final to pass the course. C- will give me credit, but the Master's program requires a B in statistics. Which means that unless I ACE this final I will be retaking this course.

Final is tomorrow - it will be over one way or another. Man I hope I never have to see it again. My biggest fear is that I will run out of time on the final like I did on the midterm, and not be able to go back to check my work. I lost a bunch of marks on the midterm due to stupid mistakes that I might have caught on review.

It just takes me soooo long to work through the questions. There were 12 questions in my last assignment. That took me at least 6 hours to do. I have 9 questions on the final, and 3 hours to do them...

Every mark on the final is worth 1/2 a percentage of my final grade. No pressure, right?

AAAaaaahhhhhhhh

je t'aime

2010-05-07T16:44:00.004-06:00

It's been months, although it just feels like yesterday.

Months since you sparked my curiosity, my passion, my desire to get to know you. You seemed so different from me - reserved, shy, understated. So different from what I've been used to. I found it frustrating and intriguing at the same time.

However, that was just on the surface. Underneath that, I found a remarkable sense of humour, a lighthearted joie de vivre, a beautiful, kind, heart of gold, and solid character that did not waver under pressure.

A man whom I can respect. A man who respects me, for all the reasons I want him to.

Last night, the weather was chilly and grey, but it was forgotten in the warm glow of conversation over dinner. Laughing, I told you how I ended up in Scotland and my belief that the Meaning of Life is to create important memories. I said, "in this world, if you aren't loving what you're doing, you are doing it wrong". I talked about how every disappointment in my life seemed to work out to something greater, something incredibly worth all of the hurt. I squeezed your hand meaningfully and smiled.

We talked about travel and life and philosophy. It made me feel good when your eyes sparkled and your dimples showed. I felt, for the first time in a long time, heard, and I knew then that I would miss you like crazy when you left. We only had a few short hours between dinner and this morning when we had to say goodbye.

There didn't seem to be much to say when I was wrapped up in your arms, and I was happy to just be quiet and share the moment with you. We'd kiss, and you'd look into my eyes. I noticed how blue yours were, a different blue than I'd seen before - a kind of aquamarine. We kissed again.

I was about to say something, looking up into your smiling blue eyes, but you said something first.

I'm in love with you.

Suddenly, time stopped. I took a moment to process those words. Did you just say them? Did you mean them, the way I heard them? It was like my mind was swimming through a sweet golden fog. I looked into your eyes again and saw honesty in them. A warm, slow, numbing tingle started in the tips of my toes and spread up from there. I smiled like my face might break in two; a smile echoed by your own.

I wanted so badly to say it back to you but my mind was trapped in that luscious fog, flooded in endorphins, adrenaline, dopamine, and serotonin. I took your hand and placed it on my chest, that you might feel my heart racing. I know yours was, too.

I have heard those words before, from other guys. This time did not compare. Not even close.

It was like my heart grew wings.

Finally, the joy that consumed me subsided just enough to let me speak.

"I love you, too."

Stay safe and see you soon. I'm still going to miss you like crazy.

Nurses = Handmaidens, get used to it!

2010-04-20T18:17:00.003-06:00

Just kidding.

I got some spam email from a company that wants me to advertise their stuff for free. They linked an ebook and I was perusing it with a smirk.

Then I happened upon this golden advice for nurses:

Listen carefully. Sometimes physicians can give orders so quickly and it could be hard to keep up. If you don't understand, make them slow down and go over it, but don't second-guess the doctors. Part of your nursing job involves carrying out the orders of the physician, even if you feel another course of action might be best.

Words from the pros, people. Your professional opinion is worthless. DO NOT QUESTION THE PHYSICIAN.

Now fetch me a cigarette, the chart, and a hot toddy, stat! And pick up my dry cleaning!

Care Plans

2010-04-19T20:33:00.011-06:00

Blech. I've written 3 care plans this year, one for each of my clinical rotations. They are essentially full-sized research papers worth a huge chunk of my final grade.

Care plans are fickle creatures. We never had a proper care-plan-class, which really irritates me. I mean, I had to take English (again) to ostensibly learn how to write papers, but I don't have to take a care plan class to learn how to write care plans? Especially when I have never seen a care plan in my life and said care plan has the same impact on my final grade as any research paper had?

So because the learning curve was kind of steep (last semester we were briefly introduced to the nebulous concept of writing a care plan, and all of a sudden this semester we were told to Write A GOOD One Because It's Worth 30%), I had a lot of self-learning to do. Something I do frequently, it seems...

As part of the framework required to write the care plan, my school assigned the following guidelines:

Patient's age, gender, marital status, religion, allergies, admission date, diet, activity, code status
Current medical diagnoses including pathophysiology
Past medical hx and health problems
Applicable surgical/other procedures and their most common complications
The patient's context of health, including (my personal favorite... lol) ye olde Determinants of Health and the principles of Primary Health Care
The patient's developmental and social hx, including family and their influences on the pt's health
Ordered tests, treatments, and interventions, including agency protocols and policy
Recent diagnostic tests and results
The teaching/learning needs of the pt
How other members of the interdisciplinary team are involved in pt care
Strengths & capacities of the pt
Ordered medications including rationale, classification, side effects, and nursing considerations specific to the patient
And, finally, 3 primary patient needs to address in the care plan. Each must include:

Nursing diagnosis (NANDA stem, etiology, and manifestations)
NOC labels 'SMART' goals (specific, measurable, appropriate [person-centred], realistic, & time limited
Nursing interventions (NIC labels)
Rationale
Evaluation

Of course everything must be cited and referenced in APA (barf) format. Throw in a paper introduction, a patient introduction, and a conclusion of some kind, and you are looking at around 5,000 words. My psych care plan came in closer to 6,000 after including DSM axis information and background info on my patient's diagnoses.

Ah, Health Determinants. My school freakin' LOVES them. The Public Health Agency of Canada has a veritable GOLDMINE of quotable information on each determinant. If you're a Canuck student like me, check it out. Even if you're not, I'm sure there's something quotable there for you as well. Or maybe your own health agency has something similar.

The first care plan I wrote was on the "where's my bag? it has urine in it" patient from Unit 3L. Given how poor of a historian she was (dementia and decreased LOC), I didn't get a lot of her Health Determinant information. That cost me very dearly because according to our care plan rubric I MUST have the information. My instructor told me that I should have called her social worker or nursing home to find out more. I can see the conversation now: Hi, I'm UgRN. I'd like to pump you for information one patient out of your stacked caseload. Right, this information will have no relevance to her patient care because I'm not assigned to her anymore. But I need everything you can tell me in great detail because I am trying to ace this paper. Uh, no thanks.

The second care plan I wrote was on my elective hip surgery patient. Since he was cognitively intact, I was very excited to get a quality health history on him, but he wasn't much for talking. Luckily he asked me if I could email a questionnaire to him. Why, yes! SO much easier to just fire off those questions into cyberspace. He wasn't lengthy in his replies but at least I had something to go on. My instructor gave me bonus points for effort. Unfortunately she docked many marks because my care plan wasn't individualized enough to the patient. Strike two....

The questionnaire I made up was pure genius, though. I think I may use it again. Such gems as:

How would you rate your overall health status, with 1 being “very poor” and 10 being “excellent”?
How much control do you have of your overall health? For instance, do you have access to the food you would like to eat, can you live where you want to, can you buy the medications you need?
Please tell me a little about your children and your family dynamics.
How has your heritage impacted your life as a Canadian? Do you have any cultural preferences?
How have you overcome the bigger obstacles in your life? How did you cope? Did you have people you could rely on?

The THIRD care plan (the one I was up all night doing a week ago) I wrote was on a legally blind patient in my psych rotation. I went to town on this one. I wrote the lengthiest summaries I have ever written and threw everything I could into the Health Determinants section. I then got 4 care plan books, my psych text, and the DSM-IV manual and proceeded to cite the SHIT out of it. Here's an example:

Physical environments. “The physical environment is an important determinant of health. At certain levels of exposure, contaminants in our air, water, food and soil can cause a variety of adverse health effects, including cancer, birth defects, respiratory illness and gastrointestinal ailments (Public Health Agency of Canada, 2003).” Jane has lived in Alberta for her entire life. The urban health regions have a much lower mortality rate for all causes of death for females from 2006 to 2008. Calgary has 419.43 deaths per 100,000 population and Edmonton has 427.59. The mean for Alberta is 443.65 (Alberta Health and Wellness, 2009). Jane’s physical location is positively impacting her health simply by virtue of health accessibility and active living opportunities.

I also got very detailed with my NANDA-specific nursing diagnoses (this was the first of 3):

Priority need. Ineffective coping related to loss of vision, personal vulnerability, perception of inadequate control, impaired adaptive behaviors, and problem solving skills, as evidenced by flat affect, social isolation, inability to meet role expectations, poor self-esteem, uncertainty about choices, and deference in decision-making. Jane’s history of dependent behavior is making it a challenge for her to adjust to life as a visually impaired person. It is easier for her to surrender decision-making responsibility to John and rely on him to perform the roles of partner, guide, and caregiver than to accept her blindness and find ways to manage with it and go on with her life. Jane instead copes by isolating herself and being the passive member of their relationship.

Apparently it paid off, because I scored 18.9/20 on it. I was floored. I NEVER expected that kind of mark on the last paper of the year. Yay, me!

If you struggle as much as I do with writing care plans, I STRONGLY recommend investing in a good care plan book. I really, really like Gulanick & Myers' Nursing Care Plans: Nursing Diagnosis and Intervention. The book was very well rated on Amazon and with good reason. It has the NANDA, NIC and NOC labels for all included care plans as well as oodles of online resources and plenty of interventions and rationales. I am very happy with it. So is everybody who keeps 'borrowing' it every time a care plan comes due. At $40 it has been way more valuable to me than the freakin APA guide I spent an embarrassing amount of money on in first year.

Also keep in mind that your campus library, hospital library, and often hospital unit have really good (and really specific, in the case of on-unit material) references available. That's how I found specifically psychiatric care plans such as the one I used for my 'Ineffective Coping' diagnosis.

Another really good free online source I found is the Care Plan Constructor which I have linked on my Resources list. It's not as detailed as a book would be, but it gives you some more interventions and rationales to cite. It's also faster to navigate than a book, IMO, so it can be really handy to peruse for diagnosis ideas.

If I think of any other good things to add, I will. If you need help with your care plan I'd be happy to try. If you have any questions, fire away!

Group Projects

2010-04-17T20:15:00.001-06:00

Typically, I hate them, because I've never felt like the group did a better job than what I could have done by myself.

I'm working on my last project for the year (!) which is a group presentation with myself and another girl. It has been AWESOME because we had a total mind meld and worked together like magic. We both contributed equally to the project and helped each other completely.

Project, start to finish = 4 hours.

For the first time, I think I *enjoyed* a group project. Don't tell any of my instructors. I have an image to maintain ;)

[/profound]

MI is everywhere

2010-04-15T17:50:00.003-06:00

That's Mental Illness, not myocardial infarction, except those are pretty common too.

One of my oldest, bestest friends, who actually completed half of her nursing after-degree and quit because she hated it, may very well be suffering from major depression. She's one of the most amazing people I know. When she feels like herself, she's funny, SO intelligent, adventurous, and free-spirited.

I spent an hour on the phone with her this afternoon talking about nothing much and then we started talking about her life and where she is with it.

She's not happy or remotely satisfied with her choices and she feels like she's 'running out of time' to pull her shit together. We're the same age. This same conversation has been happening for years. She's opposite of me - where I went globetrotting after high school, she went straight to university and took a degree in something that doesn't interest her, hoping she'd find herself. She still hasn't.

Anyway it started with a regular girlchat and morphed into me using my psych skills on her. She expressed fear and doubt about whether she was ever going to be happy and questioned the validity of seeking medical help. I told her in no uncertain terms that antidepressants and mood stabilizers were just one small piece of overall therapy. They would help her feel well enough to start seeking ways to get more from her life. They would provide the boost.

I then heard her out and repeated parts of her narrative back to her to really emphasize some of the self-defeating thoughts she was having. We then discussed how regular exercise might really help her feel better. I really promoted some of the AMAZING psych programs I've seen while I have been on my clinical rotations.

I finished the conversation with this:

I care about YOU. I could give a shit whether you stay in school for the rest of your life or never step foot in a classroom again. I don't care whether you go be a carpenter or a business executive or a drifter. All I have ever wanted is for you to be happy and it kills me that you haven't found that.

She agreed to seek help.

I still consider her a suicide risk if she doesn't get help soon. If there's nothing else in the world that I learn from nursing, I am grateful that I learned just enough to help my friend feel hope.

Mental health issues are everywhere, people. Don't sleep though your Psych classes.

New Layout

2010-04-12T23:07:00.002-06:00

Hopefully it works. I had a lot of fun designing it and the wonderful iPod-wearing Flo was feeling a little tired up there. The graphic was designed by myself so please don't steal it ;) Let me know if there's anything broken...

I had to remove my blogroll and links until I can get them working again.

Applied!

2010-04-12T12:45:00.003-06:00

I was up since 3 AM this morning finishing my last care plan for this rotation (mental health). It's a very cool specialty and I'll describe it for you in another post.

The big thing on my mind right now? I FINALLY got the last piece of my application today, from the instructor who so frustrated me on Friday.

This is the position I applied for. I *just* sent the email with my completed application package. It's been over 2 years since I went through the process of applying for a new job and it never gets any easier.

This is actually way worse because it's, like, the real me I'm sending out into the great unknown. It's not some crap job I'm getting to tide me over until I'm ready to start my career. This is my first contact with my future employer, assuming they're still hiring RNs when I graduate and pass the boards.

This IS my career.

The fluttering in my chest is just like it was 2 years ago (nearly to the day - just... wow) when I realized what I was getting myself into:

It's the searing excitement in my chest - I am going to Be. A. Nurse. After so long trying to find a place for myself in the healthcare industry, this is it. I am standing at the very beginning of my chosen path and I am so incredibly ready.

Now I just watch and wait and hope I said all the right things.

*stares at the clock*

Staying Positive

2010-04-11T19:03:00.003-06:00

The deadline for my UNE submission has been changed to April 15 (Thursday). I still have a fair shot. I'm getting the form from my instructor tomorrow when I turn in my third and final (!) care plan for this semester.

I'm feeling a lot more positive and relaxed now. I've got a huge emotional investment riding on being accepted into AHS. I'm scared and excited and hopeful.

When people ask me what I do, I am so proud to say I am in nursing school.

Every day I am making a difference to someone and I am so, SO, in love with my profession. I have never had a doubt in the last 2 years that I was making the right choice. Everything that I see and do has been inspiring and challenging to me. Menial tasks like fetching water or changing linens have never bothered me. I have been privileged to help people in their times of medical and emotional need. I am in a trusted position and people listen to me, really listen, when I speak to them. I work hard to hear what they have to say.

It has been a long journey and I'm only halfway there, but this opportunity to begin embracing my chosen role is one that I have been waiting a lifetime for and I am so ready to get started.

Being Negative

2010-04-09T17:29:00.006-06:00

I am applying for an undergrad nurse position. It's a very competitive spot, as you can imagine. I needed several forms to complete including one mandatory reference from school. I think I have a pretty good chance... EXCEPT:

My instructor, who is my reference, agreed to fill out the required form on Tuesday
She lost the form 3 times and I keep reprinting it for her
My school decided YESTERDAY it would put in a new procedure on requesting references
Said reference request has a form required (of course)
I can't get the form because I am at clinical and not at the school, and it's not available online (of course)
I have EVERYTHING ELSE I need for the application including a very thoughtful resume and cover letter that took me hours
My instructor refused my offer of sending her the form as soon as I got home if she'd just give me the completed reference today (Friday)
She stated the earliest she could get it to me was Monday
The posting closes Sunday

I am a firm believer that you can respect policy by either following it to the letter (as my instructor seems to think is best) or by following it in spirit. The form is just my consent to have a reference check. I think me asking (and reprinting the form for her thrice) for the letter is implied consent. Just sayin'

So she knows I'm pissed and she tries to turn it into some kind of fucking life lesson.

"What did you learn today?"

Well, I learned I hate bureaucracy because it completely negates common sense. Seriously, lady, it's not up to you to teach me about Life. I've been dealing with it for almost 26 years, with at least 8 of those years in a professional capacity.

"Just think of all the other students in the same position as you!"

Well, I'm thinking of all the students at the other university who have their completed forms in to the same VERY COMPETITIVE position, because THEIR school didn't fuck it up for them at the last minute.

I am very, very, VERY angry.

She sent me an email saying "be positive". Be positive about what? That you are allowing policy to blind you to the fact that you are preventing me from even taking a shot at this kind of opportunity? Thanks...

Second Rotation: Orthopaedic Surgery on Unit 6R

2010-04-04T23:02:00.013-06:00

I've started this post about 5 times now on different days but kept having to try again later. My days are just sooooo busy. I guess having too few hours in the day is a good thing, given the alternative!

My second rotation started in mid-February just before the Reading Week break (that's our Canuck version of Spring Break... only it's in the winter and less associated with drunken bingeing ;) Man, let me tell you, at the end of my first rotation on Medicine I felt a degree of competency I could hardly believe. The nurses on that unit trusted us to do good work. I assumed all aspects of care for my patients and at the end of the rotation I had three. I was pouring meds independently (although we had to get an RN to cosign narcotics and insulin, and our instructor to cosign Coumadin/Heparin). Basically the only time I saw my instructor was a daily check-in to verify my assignment. I felt very comfortable with my patients and their needs and saw and did a lot.

So I had a certain expectation that I would only be improving on the skills, independence, and decision-making that I had been developing over the past 5 weeks.... well, not exactly.

My instructor for the second rotation was an older nurse who'd had her masters for longer than I've been alive! She had been a nurse manager/administrator for more than a decade. Compare that to 3L where my instructor was maybe 10 years older than me and was still in bedside care in the CCU.

This new instructor had a totally different attitude towards teaching. She considered herself more of a facilitator and did not give concrete expectations about anything. It drove us CRAZY. We'd ask what she needed to directly observe, or what meds we could pour, or what expectations she had for the care plan.

Her answer to everything? "It's not about me. It's about your learning."

Um, thanks. Wait, what?

Anyway it ended up that my I-think-I-can attitude from 3L was completely shot because for the entire 5 weeks she insisted on watching every med poured, every dressing change, every bladder scan, every foley/straight cath/IV line prime/etc, (almost) every assessment, and so on. The real problem with that was that we were split between 2 units she would take FOREVER getting from one unit to the other to observe all of these things.

The big difference between the two rotations, I guess, is that on 3L it felt like we were actually somewhat useful to the unit. Handy to have around.

On 6R we were just a pain in the ass. Because she insisted on watching *everything*, that meant a lot of things had to wait. Sometimes hours. Sometimes those things were meds. Some days I didn't pass 0800 meds until 0930. A lot of times I had to ask my buddy nurse to do things that should be Really Freaking Basic because I didn't have permission from the instructor to do them without her and it was something that was urgent.... perhaps a fresh post-op was at 8/10 pain, or the initial dressing was not holding, or something like that. Boy, did I feel great making excuses all the time for why my patient care seemed so crappy. Luckily the patients were really understanding. The nurses? Not so much. Apparently the charge RN took it to the dean (not sure) of my school saying that it was unethical for patients in pain to wait for morphine because the instructor wanted to see it. Especially because school policy says that all we need is ANY nurse to cosign - RN, LPN, whoever is handy! I totally agreed with the charge's opinion. Complete BS, IMO. No patients should have to suffer in pain for ANY length of time just because they have a student assigned to them.

I will say, though, that as much as the instructor's (ahem) 'teaching' style grated on me, she had really valuable insight into people and behaviors. At my midterm evaluation, I was amazed at all the things she had noticed about me. She had things written down from the first day on the unit. She was incredibly perceptive and it was actually really good to hear what she had to say. She said I was a good nurse and that she would hire me if she were still a unit manager. I was completely honored, given her background.

Well! Venting aside, let me describe the unit :)

I think we usually had 19 beds open. The patient population was mostly 60+ and in for elective hip and knee arthroplasties. MOST of the time they were post-op but we did have a few people come in before their surgeries. WOW, what a difference from Medicine! These patients' average lengths of stay were less than 5 days. We would get a post-op in at about 1400, often still numb from the spinal block, and by 1900 physio would have them up walking. I COULD NOT believe how fast their recoveries were. I guess I still had the perception that there was a certain period of convalescing after a major surgery like that - not so, at least not for joint replacements.

Patient care usually consisted of neurovascular assessments and vitals q shift (depending on how recent their operation had been), hygiene, encouraging mobility, assisting with transfers, pain assessments and interventions, and prophylactic meds like Fragmin. And drains. And dressing changes... omg! Dressing changes! Part of me thinks wound care is SO AWESOME!!

I took a picture of the giant Wall O' Dressing Stuff. That was a HUGE learning curve for me. There are dressings for every type of wound. Occlusive, silver nitrate, hypotonic, absorbent, moist packing, protective, nonadhesive... the list goes on and on. I spent literally hours in here (this is the clean utility room) going through all the bins and researching what type of dressing was best for what type of wound. I absolutely loved it. Most patients with a healthy surgical wound, typically and depending on drainage, got their wound aseptically cleaned and dried with normal saline, a layer of Adaptic to prevent adhesion, Cavilon to protect the surrounding skin, and either gauze and abd pads taped down with the sheet tape or Mepore all-in-one bandages. Sometimes I had to get creative and splice together bandages to fit. My instructor had her own ideas about how I should do it, and I usually followed her advice, but when I started sneakily doing dressing changes on my own I did it my way and it looked (and lasted) much better. My sterile technique is completely second nature now. I worked a sterile field sometimes 2 or more times per shift, and it was often awkward as hell with a huge pile of dressing packages and a tiiiiiny little dressing tray for space... I also got to do a dressing change on a central line. The patient thought I did such a great job, he wrote me a letter of commendation! *sniff*

The drains were also pretty cool! I drained and primed a lot of hemovacs. It's amazing to see just how much post-operative goo can come out of someone. The pic on the right was about 300 mLs, I think, drained only about 4 hours after I had already drained 400. She was a fresh post op and quite the bleeder. It looks like straight blood but it isn't; there are tiny bits of bone in there and lipids and lymph. It's quite the cocktail ;) Strange smell to it, too. It smells very strong and very chemical, like a hair perm might.

6R was all about teamwork. All us students got letters when we orientated, stating the rules of the unit. One of the big ones was that we were to NEVER risk our backs. All lifting and heavy patient care was to be done in teams. I was totally impressed with how well everyone worked together. There was always someone ready to help you. The NAs seemed to be everywhere at once.

One of the NAs was a dear older Brit who used to nurse in England. When she came to Canada, her licence did not transfer, so she chose to work as an NA instead of upgrading to LPN/RN. She said she loved patient care more than anything else a nurse was expected to do, and she was really, really good at it. She appeared at my patient's bedside on the first day and helped me give a bed bath, just because. She then instructed me on how to give a really freaking good bed bath. My pt was just about purring by the time she was done. She said that chances were excellent that if you give really excellent nursing care in the morning, patients would be feeling very content and not likely to ring their callbells for the rest of the day. She also said it was very therapeutic for the family as well to see their loved one comfortable and cared for. I completely appreciated her help all throughout the rotation. She was great. I wish SHE was my instructor...

It was amazing how the whole unit acted as a team. EVERYONE went to report, including the unit clerks, NAs, manager, staff nurses, students...

Really the only 'downer' during my stay on 6R was my instructor's desire to see and do everything even though that wasn't physically possible. I'm a pretty gung-ho student. I keep my eyes and ears open for opportunities and make the most out of my rotations. I really liked the unit itself. It seemed like a great place to work, given the helping atmosphere and the fact that most of the patients were there for elective surgery and WANTED to get better and get the hell out of there so they were very motivated and active in their own recoveries. Don't get me wrong, Medicine had its moments, but Surgery didn't have the same atmosphere most of the time.

The other negative about the unit, and it really wasn't about the unit at all, was regarding one of the patients. I really should call him a resident. Actually, I'll call him Mark ;) He was a 60-something man with some severe congenital cognitive impairments. He yelled inappropriate things and was aggressive and immobile. Apparently he had a fall at his group home, fractured his hip, and was sent to our unit after surgery. This was OVER A YEAR ago. The group home refused to take him back (!) because he was so difficult for the staff to handle. Because no one could find him a place to go, he stayed right there on Orthopaedics, probably one of the most ill-equipped units to have a guy like Mark. Everything was so busy that there was no time to just sit and spend time with him and give him the quality care he needed to reintegrate him back into a group home. He was just strapped into a Broda chair most days. You could hear him yelling obscenities from the other unit, and my heart cringed every time I saw a child pass near his chair with no one to make sure he wasn't going to strike out. The hospital did the best it could by assigning an NA to be with him 1:1 as much as possible... but really, he shouldn't be there. Mark is a perfect example of a guy who just fell through the cracks.

I saw a couple of interesting cases during my last week on the unit:

One pt was a trauma who was flown in from very, very north (~200 km north of the Arctic Circle). He was, like, the embodiment of the Determinants of Health. He was remote, poor, uneducated, male, and Aboriginal. My Foundations in Health class would have had a field day. He had gotten into some kind of snowmobile accident and shattered his tibia. I was trying to do a thorough neurovascular assessment on him (big risk for compartment syndrome - challenging because of the cast he had on his leg), and there was a whole freaking med team in there discussing his surgery, and the surgeon was pushing consent forms in his face, and my primary nurse was attempting a dressing change. He was a pretty neat guy though. He told me about hunting polar bears and seals and carving traditional bows and knives. He had some epically beautiful pictures on his laptop too. Wow. Kinda makes me want to be a Northern nurse................. lol, yeah right. Maybe if they had sun 12 months a year ;)

One of my few sub-60 year old patients was a younger mom with a spindle cell sarcoma in her upper arm. She was in for her second resection to try and remove the tumor. She had gotten a skin graft taken from her ventral thigh, and that was pretty awesome. I couldn't believe how much fluid wept from it. No wonder people with burns are at such a high risk for dehydration! I had to do a dressing change on it because the one done 3 hours prior had already sprung a leak. I ended up putting a medium-sized Tegaderm on it, taping it all around, and then putting a huge Tegaderm over that and taping that all around too to try & seal it up tight. My dressing held quite well actually! She had it on still after I was done my rotation. I was very proud of myself :) I also had a really awesome Nursing Intervention moment. She had her initial dressing on her upper arm for over 5 days. Well, by the end of the 5th day she had a crazy case of the itchies. She looked really uncomfortable. I noticed she had Benadryl ordered for nausea so, with the consent of my instructor, I gave her 50 mg of that. Lo and behold, it worked! Total self high five! No more itching, and she pretty much loved me from then on.

My other Really Cool patient ended up being the guy I wrote my care plan on. I got to go into the OR and follow one person through the entire hospital experience. I got to Same Day Admit at about 0800. The first thing that struck me was how young he looked. Comparatively, I mean. He appeared in his late 60s and he was in for a total hip replacement. Turns out he was actually nearly 80!! He had been very physically active for his entire life and now was getting joint replacements because of the osteoarthritis from his sports-filled past. The guy was seriously the fountain of youth. He lived in the mountains and biked 5km every day. He and his wife were adeptly maintaining their home. He looked decades younger than my own grandfather. No lie.

[Photo Credit]

Wow, the operation!!! That was so cool! He was awake through the procedure. I followed him down from SDA to the operating room where I changed into OR scrubs and a hair net. We wheeled him into the theatre and slid him onto the table, and the anesthetist gave him a spinal block (SO COOL - the catheter was massive!!). The anesthetist threaded the needle between the disks and into the spinal column while the pt was sitting leaning forward. Then they laid him down while he could still move, put in a foley, and proceeded to drape the hell out of him. The surgeon was very particular about pressure points from the catheter tubing and clamps etc, which I approved of. I got to stand about 5 feet away throughout the operation so that was very exciting for me. I wanted to be as "in" the action as they'd let me and if I were any closer I'd have contaminated their sterile field :)

They rolled the pt onto his side and clamped him, so to speak, in that position. Then they cut through his skin and down to the acetabulum. And then, oh my god, the surgeon and the resident grabbed onto the pt's leg and popped the head of the femur out!!! It made this nasty thwwwwwwwOP sound that just hit the pit of my stomach and made it churn. Nothing else in the entire surgery hit me quite like that. Once the femur was out (shudder) the surgeon took a bigass bone saw and cut the head of the femur off. I mean off. He plucked it out of the wound and plopped it onto the instrument table. Mmmmmmmmm ;)

Oh! The instrument table! MASSIVE! I was amazed at how the scrub nurse knew what to get and when. There were about 3 tables pushed together, all covered with sterile drills and bits and screws and saline and cloths, oh my!

It truly was like being at a mechanic's shop. The surgeon and the resident and the product suppliers were all talking about the pt's leg and fitting different-sized cups and heads into him. They were moving his leg all around and using power tools on him. It was kind of surreal.

The thing that really got me, though, was how the OR was not really about the patient at all. At that point he was just a Hip that needed fixing. No one talked to him throughout the procedure and really no one censored their conversation to accommodate him. The scrub nurses and the surgeons were talking about some kind of masochistic x-rated somethings at one point. I kind of thought the surgeon was a dick, actually, but he was kind enough in teaching me various things. He was only a little chauvinistic towards me ;)

They sewed up the pt without putting a drain him because he didn't bleed very much, and then I got to care for him for the rest of the week, and I wrote my care plan on him as well. It was great, actually, for both of us. I think he appreciated knowing that I would be there when he woke up in the morning and I knew all of the ins and outs of his surgery given that I had seen it with my own eyes.

Well I guess I'd better wrap up this rambling. Feels like I've been typing forever!

Summary: I definitely liked my surgery rotation. If there's one phrase to describe me, it is Morphine Fairy. I loved giving people pain medications to control acute moderate-severe pain. I loved seeing them grit their teeth while I prepped them for a sub-Q or IM injection and then watching them drift off to sleep within half an hour. I'm not sure if I'm a med/surg nurse, but I learned a TON. Really, I've enjoyed all of my rotations because I'm the kind of person who goes into an experience with an open mind and a humble, 'teach me' kind of attitude. Not like some of the ice queens in my class, but that's a story for another day. Good night, nurses and nurses to be :)

undergrad RN

National Informatics Project!

One flu (vaccine) over the cuckoo's nest

That's So... Meta

Yayfriends!

A Summary, a Conference, a Project, and an iPad

It's here! Fourth and final year!!

Loss of a Statesman

Check, check, checking out

It's 0430, do you know where your soldier is?

Got angry at/for a patient...

Looks like chicken

A nurse's day in the ER

Target Practice

IV Start Lab

Blogroll Update

Maybe I learned something in Psych after all

Rapture?

Friday Night in the ER

Captain's Log: First Night Shift

First day in Emergency Externship

1st day on the floor in Emergency

I think my brain exploded

Procrastinating

Undergrad RN, UNE

UNE Interview in T-1.5 Hours

Hehe

Community health, and a phone call

5 Weeks of Vascular Surgery

In which I reflect on death and dying, and the distinct honor of being there

"Oh, we don't assign students to him anymore..."

You can tell when you love something...

CNSA.ca - tell me what you think

Sunset in the city

"So... how's she doing?"

Vascular Surgery, Week 2

Flu or something

Vascular Surgery, Day 2

Day 1: Vascular Surgery, and other stuff

Time-out for my brain

The maternity wrap-up Pts 1 & 2

Cathy Crowe

The illustrious Rob Fraser!

Dr. Boychuk-Duchscher

We came, we saw, we debated

Tilda Shalof!!!!

So far, they are feeding us

En route to CNSA National Conference

Antepartum/L&D

Recap of Week 2 of Postpartum Clinical

Welcome to 2011, and welcome to the world, babies!

Happy new year, nurses!

The Ten Year Rule

Christmas came a little early

I'm melting...

Picking your specialty...

Vindicated

I've been studying too long today

Death, taxes, and finals week

Well, that was fun.

World News: Stranger than fiction

Your children strike fear into my very soul...

Oncology - maybe this is it?

Happiness Is...

Pity Party For One

CNSA National Team? Mebbe

Cranial Nerves

Sigma Theta Tau

What do we want?

Punched in the box

Mind=blown

In Transit

Sweet!

*facepalm*

Fingers Crossed

*Wipes sweat from brow*

Happy Turkey Day!

Paperwork

To Ride Zenyatta

Third Year!!

facepalm

Wipes sweat from brow

deep breath exhale