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.

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.

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*

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.

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!

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

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.

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

Wow, after finishing up that post yesterday, I realized how much I had to talk about! There is a lot so I needed to think about how best to split up my thoughts. This term (since January 4) has been straight clinicals. 5 week rotations at different sites here in the city. So I'll give an overview of my week and then delve into my experience in each rotation afterwards.

So, my week. Wow. I am absolutely INSANE for working as much as I do. My job with the City (and the associated union contract) stipulates that I must work a minimum of 21 hours per week. Unfortunately my clinical rotation hours were all over the map between 0700 and 2300 so I couldn't work during the week. This meant that I worked full 8 hour shifts on Saturday and Sunday and worked another 5 hours on Monday after my lecture time on campus.

This means that I have been working 7 days a week since January with the odd singleton day off every few weeks from clinical schedule adjustments or school holidays.

In order to have some semblance of a day off I chose to work Saturdays from 1800 - 0200 and Sundays from 1600 - 0000 before lecture time at 0800 on Monday. That way I'd at least get the weekend days to myself. However that meant that Friday night was my only "night off" to go out with friends and have a life.

The stress has been eating at me though. I've always been the kind of person who thrives on busting my ass during the week and then utterly recharging on my days off. I haven't been able to do that every week or even every two weeks. I'm gaining weight (like 10 pounds, QQ) and losing my hair, and I wish I was joking about that. It's been falling out all over my head for the past few months and it's way thinner than I've ever seen it. My apartment looks like hell and my car looks like it ate a hurricane, and I've been sweet talking my mom into doing all my laundry. I feel like Marge Simpson in that episode when her hair starts falling out and she goes batshit crazy.

Happily, I am now in the final stretch of this clinical term. I am on the second week out of five in my last rotation and I will be done on April 24! I have never wanted anything as badly as I want to just go back to regular work with regular weekends. I don't even know what I'll do with myself. Sleep? :)

So, to any curious about whether they could pull off fulltime clinicals and a solid work commitment... it was a dumb move. I mean, I'm technically DOING it and I'm still alive, but I hate every second. Clinicals are my time to roll up my sleeves and be excited about nursing! But I'm so exhausted from never getting a rest day that I just can't wait to go home all the time and don't want to put in more than the bare minimum of effort. I haven't done something 'just for me' in months. Hobbies? What are those?

Next year, if I am still with my job with the City (I'm considering picking up a brainless job with no commitment required), I am going to apply for a leave of absence from January to April. Seriously. I can't do both again.

My first rotation was on 3L, an 20-bed medicine unit at a hospital about 40 minutes from my house. My instructor was a younger nurse, maybe in her late 30s. She came from a critical care background which is something that interests me. We were her first clinical group so it was new for both of us! Our schedule rotated 8-hr shifts with days one week and evenings the next. Mondays from 0800-1000 were classroom time at the school, with all students doing that rotation (not just our clinical group). After that we'd head down to the hospital to get our patient assignments for the week and do the research. Typically I'd go through my pt's chart to find out admitting dx, medical hx, health determinant information, plan of care, relevant lab values, interdisciplinary care from OT/PT/dieticians, and I'd copy down the laundry list of medications for research at home or at work.

Monday lecture was a joke. Attendance was mandatory or else we'd have to put in extra time to "make up" the missed lecture. Ridiculous. Our instructor (the same facepalmingly awful instructor from Nursing) claimed that we were not allowed to cover new material so all we did was rehash bitterly boring discussions about caring and stuff. How would I have chosen to spend this time? How about talking with the whole group about their clinical experience? It seems clear to me that the lecture time SHOULD be about getting as much shared information as possible. What did we actually do? Well, one class was spent reviewing some acronyms found in patient charts. Two hours. One class was spent role playing how we'd teach different groups about choking. Another two hours. FML. May I add that I was working until midnight the night before these "lectures"? I determined that it was actually less effort to go to class and space out for two hours versus skipping it and having to show some kind of "research" instead. Sad...

Anyway, about the clinical! The unit was similar to the one I was on in first year, being a med unit. However the hospital had a very different setup and it was positively spacious and well-organized in comparison. At report on the first day we were assigned two to a buddy nurse. It was a way better experience than first year, IMO, because we had the initial OMGAPATIENT freakout out of the way and we could just watch and learn the routine. Wow, were there a lot of meds being dished out. Our nurse, Michelle, had 6 patients with at least 5 pills each. It seemed like by the time she finished passing 0800 meds it was time for the 1000 ones. Sheesh.

We did 2 buddy shifts like that and then we were responsible for one patient from Tuesday through Friday. We did all patient care, charting, and most meds (PO, sub Q, and IM, including all narcotics). In fact the only thing we did not do was IV anything including saline flushes.

Over the 5 weeks I worked my way up to caring for 2 patients. I had some really interesting cases and I thought it was a great experience. I managed to do almost every procedure at least once. The nurses thought I was great because I'm the type to find opportunities for myself. "What's that, a patient in 77-3 needs an intermittent cath? I'll do it!"

A brief summary of my more memorable patients:

• A middle-aged man with CHF, gross edema his lower abdomen & scrotum, pitting edema to his arms and legs, kidney and liver failure. He was one sick guy. It was amazing because I started with him and had to do med teaching for obvious things like potassium supplements (he was on Lasix) and he was really kind and patient. However I was able to observe his very subtle decline and I charted about him "seeming slow to respond to commands" which made me feel silly. Boy was I ever glad because 2 days later he was acutely delirious and he came very close to being transferred to the ICU. I had to do neuro assessments on him q15 and the rapid response team was in and out asking questions. I got to observe his CAT Scan [Photo Credit]. I got a ton of interaction with the physicians and I was very assertive and sure of my observations, and they listened to me. It was a very, very good experience. I felt like a Real Nurse for the whole week. His family asked me many questions and they were very glad I was there to look out for him. I also got to do my first foley on him with the son present (aahh!). In addition this particular patient had phimosis and I wasn't even able to see his urethra. I was kind of shooting blind, so to speak...

• An older lady with dementia who suffered a fall at a nursing home - she had been on the unit for some time and was having a lot of changes in mental status. She would swing from drowsy spells to moments of complete lucidity. Sometimes she would be very confused about what procedures I was doing. She swung at me while I was trying to palpate her abdomen. I asked what the matter was and she yelled "It's not appropriate!!!" Other times though she'd be pleasantly confused. I caught her once trying to get out of bed. I asked her why. "I left a bag around here, somewhere," she told me. I went through the motions of looking around her bed and table and asked her to describe the bag. She looked at me pityingly as if I were a complete moron and said "It's got urine in it!" ..... she meant the foley ..... uh, yep, it's right here.

• Another elderly woman battling depression, awaiting transfer to LTC. Wow, older people and depression... I'd no idea how common it is until I started my psych rotation. She'd just lie in bed and "sleep" the entire day. She'd do the bare minimum and that was it. She was SO hard to engage and part of me just about cried every time I thought about it.

• A 70-something male who was on heparin and had massive nosebleeds. He had foam stuck up his nose the whole week and he was so angry about it. It was up there for ages while the med team decided whether to cauterize or not. He started refusing his heparin. I don't blame him. He was also incredibly constipated and the twice-daily Senokot and Colace weren't doing anything for him. He was the recipient of my first glycerine suppository, he had the world's largest BM, and he was SO HAPPY after that (nose foam and all!), it still makes me smile :)

• A little old lady (seeing a trend here with the ages? lol) who was blind in one eye and deaf in one ear, who's children had all died, who's husband had died, who lost all her family, and had just found out she was terminal with lung cancer. She was incredibly plucky in spite of all she'd lost and she told me, as I was changing her chest tube dressing, how she was born under a lucky star... I don't even know how she managed such a positive outlook. For all her losses, she was hilarious. My classmate was giving her peri care and she burst out with such quips as Hey! be careful with my 'jewel'! and Bedbath, eh? You gonna wash my pussy? An octogenarian... I also got to watch her chest tube insertion. Wow, that was awesome! They aren't gentle at all! An NP put it in. They cut through her chest wall into the pleural space and shoved their fingers in her to make sure it was clear. Then they inserted the tube. Nothing came out so we rolled her onto her back. Woosh! 1.5L of serosang pleural effusion drained within a matter of seconds and we had to clamp it to prevent too much drainage at once. It was remarkable. She was so tiny! Where was all that fluid being stored??

• Another patient who impacted me a lot wasn't technically assigned to me. He was in his 90s and was close to death. There wasn't much to him - he was just a skeleton! One morning, his breath was harsh and rattling. His eyes were so scared. He looked like a man drowning in his own lungs. He was lying in his bed, gasping for breath, with each arm out straight in a white-knuckle grip of the bloodied side rails. 4 hours later, I had the privilege of being at his bedside, with his family, when he died. His chest rose slower and slower and finally did not rise again. The resident checked his apical pulse and pupillary reflex - nothing. When it struck me that he had passed away, I was very thoughtful. I'd never seen a dead person before, much less the transition from life to death. It was very odd for me, and I kept expecting him to breathe suddenly and sit up. I wondered if I should be sad; I wasn't. If anything, I was relieved. He wasn't suffering anymore. It was a very sombre experience but very, very inspiring - the nurses were so respectful of him. They talked to him and addressed him by name as they took off his brief, disconnected his IV, and gave him a final bed bath. I really felt like they upheld the CNA Code of Ethics:
  
  
  

  "When a person receiving care is terminally ill or dying, nurses foster comfort, alleviate suffering, advocate for adequate relief of discomfort and pain and support a dignified and peaceful death. This includes support for the family during and following the death, and care of the person’s body after death."

I'm going to emote a little bit. This might be a little on the not-fun-to-read side, but I'm more writing it for me than for anyone else.

I... am single.

For the first time in 2 years, it's finally irrefutable that the boy I fell head over heels for in December 2006 is not the man of my dreams, and will never be the man of my dreams.

All that talk of engagements and weddings and babies and small town bliss and the future - gone.

I gave it my best shot. I probably gave it more than I should have, and I probably took more emotional battery than a reasonable person would have. But I wanted to have no regrets when it was over, no thoughts that I could have done something differently or said the right thing and saved a beautiful union.

Regrets? I have none.

I know that I am a deeply caring, gracious, intelligent woman and I'm positive that some man out there will want to respect me and honor me, and fight for me if that time ever comes. Someone who doesn't value appearances and money over integrity and respect. Someone who isn't content to let the world come knocking - he goes out and seeks to expand his worldview and challenge his mindset. He examines all sides of a situation and bases his decisions on critical thought. He has a softness in his heart to allow for the unbridled worship of a God greater than he.

More than anything, he's as committed to my well-being and happiness as I am to his.

I've got a lot to offer.

I'm stronger for this, I know I am... but I'm still mourning the loss of a future that will never be.

Well, sometimes.

I really do apologize for the dearth of posts in the last couple of months (wow, has it really been that long?). I was/am still dealing with some personal stuff that I'd rather not air on the interweb but school-wise everything is going very well! We finished off the second semester in mid-April and I did decently, still hopefully in the running for a second year scholarship although I lost my tenuous grip on Dean's list. But I'm okay with that - the semester was intense!

Oh wow, our last class in Physiology was very exciting! Note to future students - do not plan to have a 3 hour class on Friday from 2 to 5. It feels more like a 6 hour class. She was about 6 or 7 months pregnant and I'm sure she was as glad to be done as we were. She was a great prof, really knowledgable, but she had the most unfortunate monotone voice. I ended up being conditioned to fall asleep at the sound of her lecturing :)

The Micro test was the hardest of all the finals. I studied like I'd studied for her previous tests but unfortunately she amped the difficulty like 35% for the final. It was really hard and I came out of there feeling like I'd been punched in the gut. There were short answer questions on there that I didn't see coming and unfortunately a zillion questions on the actions of antimicrobial drugs. Luckily I "diagnosed" the short answer infection correctly as malaria and was able to answer all the related questions semi-correctly. Yup, it was a challenge. Of course, going through the class had me convinced that I either previously or currently was infected with any number of terrible organisms. Like diptheria or rubella! Scarlet fever anyone?

Psych, Communications, and Nursing 175 were just more of the same as last semester. Kind of fluffy, no real hard knowledge required. Nursing was mostly regurgitated factoids from Potter & Perry that anyone who had been awake during clinical should know - what is the proper positioning of the BP cuff? Where can you clamp the Sp02 monitor? Mrs. Brown looks like she's about to keel over, what do you do? And some of the more tricky memorized parts, such as bed positioning and the according names.

I actually enjoyed Communications more than I thought I would. I didn't really learn anything - does anyone actually have moments in those classes where they're like, ohhhh, now I understand human behaviour? The prof was a lot of fun and very spot-on in her statements. She also refused to play politically correct so we got to hear some really good stories about life as a nurse in a hospital and running a nursing home. The best part about that class was that I made some really good friends who have been pretty much awesome in helping me out with my personal life. Heart you guys! To celebrate the (almost) end of the first year, piles of nursing students went out drinking and dancing. We did a lot of fun things together in a week that will forever be known as Nursing Students Gone Wild, Parts 1, 2, and 3. I'd have to recommend that to every student as a way to end the school year! It felt so good, after a month of locked in the library studying for hours, to let go and just be 24 again. Or 19, in most cases :) One night I got a lot of free drinks for a variety of reasons - first, I got socked in the eye by a guy giving his friend a vigorous ILOVEYOUMAN hug, and all my friends ordered him to buy me a drink immediately, and thereafter mostly by guys trying to get with my beautiful, and single, friend Tina from our clinical group. Not that it worked but I appreciated the gesture! ;) We also tried out our nursing student pickup moves. These must be as old as time. We'd tell anyone who would listen that we were first year students and would subsequently impress them with our brachial-pulse-finding skills, and tell them they were experiencing tachycardia. Even if they weren't. More free drinks for Tina and I. There you go, you learned it from UgRN first :)

On May 5th we started our third and final semester of Year 1. It was a condensed Psych 105 class that was the follow up to Psych 104. 3 hours a day, 5 days a week, 3 weeks long. Actually, I just wrote the final exam a week ago.

Boy, do I have a story about this instructor. Maybe it's a requisite that psych instructors need to be batshit crazy - you tell me!

So on the first day I sat in the front because I was kind of late and the class was packed. So I sit within "saliva distance" of this very enunciative man and listened to him regale the class with tales of his residency in gynecology and how NOBODY should go into gynecology as it is clearly the worst field imaginable.

Nursing students present exchange uncomfortable glances.

So, okay. He's a physician who left medicine to pursue psychology. I could see it, and at any rate if he didn't like labia that was his own problem.

Then he proposed that we change the class time from 0900 to 0830 because, and I quote, "the lineup is shorter at Tim Hortons and I'll have a better chance at getting a parking spot." Uh, right. Well I have a problem with that because I work evenings from 2-10 and any half hour in the morning that I get, I'm going to cherish. Also hanging out downtown for yet another half hour before work isn't really appealing. Also I don't drive, I don't give a rip about your parking spot or your coffee, and this just might be the most self-centered thing I've ever heard a prof say.

"Does anyone strongly oppose this change?" (Note use of the words 'STRONGLY oppose'. Because minor opposition will just have to suck it up, princess!)

Nursing students present exchange uncomfortable glances.

Then, suddenly, a hand shoots in the air! A single, stalwart hand that, yes, strongly opposes self-serving suggestions by college professors whom we are paying to listen to!

I look up. OH MY GOD IT'S MY HAND! I turn bright pink but I keep my hand up. He looks at me with contempt and suddenly there's more hands out there. Yes, more evening shift workers who don't want to come in earlier and make their days even longer. Whew!

"Please step outside so we can discuss your excuses, uh, reasons."

We then form in a semicircle of determination while he goes through us, one by one, trying to discredit our reasons for not wanting to change the class time. Because the class time on the roster is the one we signed up for, we say, and because we work late to put ourselves through this class. Not that we should have had to defend ourselves at all. But I was still bright pink from being the Class Dissenter.

"Can't you change your shifts?"

Uh, WHAT? Change our shifts so you can get coffee? The shifts I planned around this class? Can I get a hell no?

Thus was the start to our semester.

More epic tales of Dr. Uncongeniality to follow :)

Well, in case you're wondering, my post from last week is still unresolved. But I am being open and honest with myself for the first time in probably a while and I can feel change in the air. To be honest I've been steering clear of blogging for a bit because I have been doing a whole lot of partying to get my mind off things. However, judging by my traffic counter, not many people are interested in my emoting, so it's back to your regularly scheduled program of UgRN!

It's been a rough few days...

Thank you for posting that review of Fireproof. I decided to rent it on iTunes and it really struck a chord with me. Yes, it appears that men really are capable of being real men all on their own and shouldn't require careful prodding from a woman to do the right thing.

I started to realize that I'm a bit of a pushover and I shouldn't have to take the B.S. that I have been, but I keep taking it hoping that everything will be smoothed over in the end. I need to put a stop to that and start demanding the respect I deserve otherwise I may never get it. Well, I don't know if it will work out or not, but I have to trust that Someone has my best interests in mind.

"A real man needs to be a hero to his wife before he can be to anybody else"

You may have started something big in me. Thanks, I think ;)

It's official. I've been avoiding all of you.

how absolutely lux being off from school could be. I mean, I've looked forward to (and enjoyed) Christmas break before, but I have never felt SO weightless before. It's like I am 50 lbs lighter. Maybe not in dress size (darn!) but certainly in spirit!

A year ago today I got my acceptance into nursing school and what an incredible journey it's been so far. I was really depressed and felt like garbage for several months at the beginning of this year as my job was on the rocks (and I was subsequently laid off along with 1200 other people) and I hated everything. I was practically climbing the walls in frustration. September was the beacon at the end of that very dark tunnel and nursing school has more or less saved me. I didn't like who I was a year ago. I had no motivation to get out of bed, much less make an effort at achieving something. Life held no mystery and nothing was interesting. It was a "live until I die" feeling. Maybe you've been there. It sucked!

Anyway right now I feel awesome. I'm so excited for so many things! In a few weeks I will find out about my placement (OMG I can't wait) and in my Nursing Practice Foundations class we will start doing real practical stuff - putting all that theory into practice! I'll get to learn baths and transfers and bed-making, and perhaps most interestingly I will get to learn vitals and more medicalish applications after the spring break in February. I'm sure the nurses who read this (or maybe even those nursing students who are further ahead than me) are rolling their eyes at me being excited over bed-making. I'm sure I'll feel the same way after I've done two or ten, but from where I'm standing right now, those are going to be the first concrete experiences of my nurse education. Enough with the theory and models and concepts. Time to get my hands dirty!

Er, preferably not dirty dirty. My level of comfort re: nurse-patient skin-to-skin contact is pretty low. A friend of mine had a testicular examination and the doctor didn't wear gloves. That's a little TOO intimate, in my opinion....

As for previous semester, all of my marks are in and I got A- in all my courses. That puts me on the Dean's list for this semester which is an extremely UNEXPECTED surprise! I don't expect this achievement to last for long. I'll be happy with First Class Standing on my degree (above 3.4 GPA I think).

Yay! My research paper-slash-critique on Euthanasia is finished. I'm pretty proud of it. You know when you hit the zone and you just can't type fast enough? That was me.

Because I haven't yet and I said I would. And because I read over my last post and probably everyone who visted today is wondering what the hell I was smoking. I should make a bumper sticker: "yes, you CAN be this tired!"

So on Sunday I was at the U until about 2200, and I came home and died until Monday morning. My Discipline class is the first one of the week and really interesting as usual, this week we talked about ethics. I love a good debate and there were many... i.e. ethical dilemmas, values, conflicts of interest. The best part of that class is how great my instructor is. She really loves to teach and she's really good at class management. Anytime we get off topic she smoothly brings the conversation back to the point, which I love.

After classes on Monday, I spent the rest of the evening cramming for Physiology.

Tuesday morning more of the same, and then I wrote the midterm at 1100. The questions that I knew, I knew very well, but the stuff I didn't know was awful. Specifically andrenergic and cholinergic receptors and their associated info... nicotinic, muscarinic, alpha, beta... WTF. So I was reasonably sure of 80% of the material and I made educated guesses on the rest (a careful deduction process by evaluating all of the answers, and picking the one that sounds most unlike the others)

I need to revise my revision strategies because I just don't have the time to study like I want to. Normally what I like to do is print off a copy of the slides to bring to class, write notes all over it, and then rewrite all of that into my notebook. Handwriting only, because after years at call centers, I have mastered the art of transcribing speech or notes onto the computer without really registering anything in my brain. Handwriting, I remember. So this strategy worked great for the last couple of years when the notes load wasn't so extreme. However, it's just not realistic anymore. By the time I finish rewriting all of the notes, I have a serious handcramp and I don't have time to actually study... hence my not knowing anything about cholinergic or andregenic receptors.

New plan. I am ONLY rewriting things that are on my "key concepts" list that the instructors hand out on the first day. This goes against my instincts since I like to know everything that was in the course but I think I'm going to have to start being more choosy about what I learn.

So, Wednesday afternoon while studying for Anatomy, I followed this strategy and it is working great. I actually remember where the sphenoid bone is. And what it looks like - yeah, sella turcica!

In regards to the presentation from last Thursday, the one on addiction that we got absolutely roasted for in the previously-unannounced critiquing part of the class, we got our mark back. 9/10! I'll take it. I was expecting way worse, from how the critique went.

We watched a bunch more presentations today (yes, I did go to class after all), and I brought an ice cream bar with me as comfort food because it is so frustrating. The instructor *gasp* changed her mind again: now we accentuate the positives and no more than 5 minutes giving feedback. Compared to my group's 15 minutes. I scanned the submitted feedback from the class: "maybe don't go so long", "no hands in pockets or GUM", "don't say 'um' so much", "maybe you should have handouts!". WTF, people, handouts? Are you going to pay for them? Alright, I'm biased, but everyone else's power points sucked ass in comparsion. Stretched clip art, 1000 fonts, not embedding media...

What I'm getting at here in an angry rant is that people made all kinds of great (ahem) comments on our presentation, but their presentations had the same problems if not more. One girl was so nervous I thought she might cry. 'Um' was the word of the day. I may have hand my hands in my pockets but at least I wasn't hiding behind the podium, you know? And I'm just pissed off about this whole thing because the point of the presentation was to MAKE A PRESENTATION ABOUT A HEALTH TOPIC. She didn't give a shit about our content after all our hard work. Her comments were made solely on our presentation skills. It was completely missing the point.

AND, here is my big point, she is fostering a completely negative attitude in the class. Instead of watching peoples' presentation and learning something about health issues, we are ignoring content and just staring at their flaws. Then she pinpoints someone and says "YOU: What could they improve on?" and all it does is make us pissed off at each other.

She is building the eat-your-young attitude. That is SO WRONG.

So I'm trying to formulate a scathing email to the dean but I can't seem to write coherently because I am so angry about it.

Anyway, quick change of topic, I also got my mark back on that awful paper I wrote for English. My strategy appears to be successful - I got one of the highest marks in the class and special mention! My nose is a whole new shade of brown. Also, I picked my English research topic. I'm going to write on euthanasia. If you have any good sources for further reading, let me know :)

My bed, of course.

Instructor takes basic concept and spends 10 minutes elaborating on it, saying the same thing in about 7 different ways.

Receives blank stares of boredom from class.

Interprets blank stares as not understanding the basic concept, continues to fumble with trying to explain it, muddying the point further.

Receives even blanker stares of boredom.

Interprets this, not as class-wide apathy, but as a personal mission for her to pound this basic concept into our heads with a half-hour explication complete with web searches.

Listen, lady, if you're going to just change all of the requisites for the group presentation a week before we present, I'm not going to be very sparing with the criticism.