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

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. :)

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:

1. 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.
2. 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!
3. 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.
4. 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.
5. 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!
6. Give instant feedback. Good and bad.
7. Treat us like adults. We are.
8. Be excited for us. Be happy for us. Share in our accomplishments and celebrations. Encourage us liberally.
9. Be fair, honest, and genuine in your appraisals.
10. 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.

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!

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.

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.

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 :)

*Cough* *wheeze*

That’s me blowing the dust off this URL.

Wow, people, can you believe it’s already almost April? I’m almost halfway to being a registered nurse!

Geez, I think there’s an echo, it’s so empty in here :)

You may be wondering why I took an extended break from blogging. The truth, friends, is that my life is Just That Busy, and blogging was an additional stress that I decided to avoid for a while. So instead of apologizing and making promises for content that I can’t keep, I’ll do a brief summary of this past few months and then I’ll get to the rant that brought me back to my blog. I hope you are all coping well with your equally busy lives :)

The fall term from September to December was probably one of the most intense I’ll face in school, content-wise. The term was packed with classes including Patho, Health Assessment, Nursing 270, Mental Health, and 2 labs per week. There was also Pharm on the table but I was smart in taking it last summer because that was a very memorization-intensive class. In all I was taking 17 credit-hours in the term.

My most enjoyable classes were Health Assessment and Mental Health. HA was very cool because it involved all the classical assessment techniques including inspection, percussion, palpation, and auscultation. Our instructor was a seasoned ER nurse who had a ton of stories to back up all body system assessments. She was especially great because she had that snarky, straight-to-the-point way of talking that made things humorous and memorable. Head-to-toe assessments are still tough for me though; I think that’s one of those things you need years to really master.

Mental Health was also an interesting class. I won’t lie – I really wasn’t sure if I like the idea of being a psych nurse. However the instructor for the course is an AMAZING RN who specialized in mental health. The thing that really got me about her was how intelligent she was. She can talk about anything with anybody and be very clear and direct about it. She can argue circles around you. There was no slacking in her class because she would not be duped by a half-assed effort. She saw right through work that was done the night before – she knew exactly how much effort everyone had put in, and graded you accordingly.

We had to split into teams to do a debate in that class. Would you believe that people were actually clamouring to have me as their partner? Do I strike you as fiesty? lol! The debate was great. Our topic was burnout - nurses' fault or system's fault? Our position was assigned and we had to argue that burnout WAS the fault of the nurse and not the system. Tricky! Everyone said we did a great job though.

Patho was a pain in my ass because I absolutely hated the instructor’s teaching style. Call me too picky but I (still) STRONGLY believe that the instructors I am paying good money to teach me a class should be doing that field as a career. At the very least I want a Biology graduate teaching me a class about biology. Unfortunately I had a super-sweet, absolutely batshit crazy RN teaching Patho. I don’t know why. She wasn’t the expert in anything about Patho and any question just dumbfounded her. She didn’t even design the course. She was teaching one developed by someone else. I am a very linear learner. Show me how one theory leads to another and I will be right there with you. But she was so scatterbrained that she would jump around between body systems and the majority of the class would just stare at her. In all honesty, I didn’t go to her lectures much – they confused the hell out of me. My Patho knowledge was almost completely self-taught from a very, very good textbook** (see below for my advice on textbooks!)

Nursing – oh, boy. This was the second-year “meat and potatoes” class about (you guessed it) nursing. Now, after a lot of time spent on allnurses.com browsing the Student Forum, I think how my school handles the nursing content of nursing school is very different from how other schools do it, particularly those in the US. Other schools have classes geared towards different specialties. Medicine, Orthopaedics, OR, OB, CCU... I think that would be incredibly useful for getting a SOLID base of knowledge for each specialty before rotating into one during clinicals. Unfortunately my school believes that all you need to know about nursing is how to think like a nurse and the rest will just come naturally.

I disagree.

I postulate that in order to think like a nurse, I need to understand where nurses are basing their clinical judgement, and to do that I need to have a solid knowledge base.

Yes, you can teach me about ADPIE and NANDA and NIC and NOC, but all of those things are pretty much meaningless without knowing where patients are supposed to be baselining and what interventions we have available, and – most importantly – WHY we would use them!

So what did we learn in NURS 270? Well, several (SEVERAL) classes on meaningless hippy jargon about the power of caring and crap like that. Pardon my language and perhaps condescending attitude but either you care about people or you don’t – talking about such nebulous concepts as “the power of caring” and different ways of "living the patient experience" is a waste of time for everyone. The people who do care already have the intuition needed, and the people who don’t care aren’t coming to class. Even if they were, it’s not something you can teach in a classroom. I think if someone seems like they can’t or won’t care about a patient, it’s probably better addressed in a one-on-one clinical evaluation. The vast majority of us found all of the exercises to be common sense. IMO, the people who really needed their viewpoint adjusted were skipping class anyway.

We learned absolutely nothing about any of the nursing specialties. No baselines for knowledge, whatsoever... just whatever we gleaned from Patho and Pharm and lab time. I most definitely felt like this inhibited my learning experience in clinicals for this term because I had to learn everything on the fly. Which was in itself a good skill to learn, truthfully.

So, anyway, the Fall term was all classroom time. Some more useful than others. Some instructors I loved, some I loathed. Some great learning opportunities, and a whole lot of self-teaching after class in the library. I definitely learned a lot! More than I would have believed could ever fit in this skull of mine ;)

Well, I think that summarizes the Fall semester. I do have a lot to say about this term as well but I’ll make another post about it.

If you’re a new reader, welcome, and if you’ve stuck with me since my last post... wow, I appreciate you :)

Well, began. 

I've been alive for 8,890 days, give or take. Of these, I can think of probably 100 that stand out significantly.

Today, I can tack on another. Probably almost the best day of my life so far.

Here's the story.

You may recall how a couple of weeks ago, I wrote a paper for my Discipline of Nursing class on the topic of Nursing Education. It wasn't quite a real paper but it was a fleshed out skeleton - outline, summary of the article, introduction, first body paragraph, and conclusion.

Well, my teacher started talking about those today. She was just ranting about how sub-par some of our writing skills are. She had them all in a pile and talked about them for about 15 minutes while we sat in fidgeting in our chairs. 15 minutes, gah!

So anyway, the class average was pretty crappy. 65% or somesuch. There was a huge spread in marks from 48% to 97%. So now we're all feeling REALLY scared. Just hurry up and give us the papers back, lady!

Mine was on top so I got to leave first. I grab the paper with the smiley face and she's like, uh, that one's not yours. Bummer!

So I grab it and I go out side to look and OH MY GOD I GOT 97% ON MY PAPER - THE HIGHEST MARK IN THE SECTION

I was ecstatic. I was shaking. I was speechless, although you'd never know it now! I would never ever have guessed that I would get a mark like that. Might I add, she was not giving those marks away! Some kids failed!

So some of you may remember how I've sometimes waxed poetic about how nice it is to finally be considered an 'achiever' instead of an I'll-take-70% passive slacker. How much I feel like I've accomplished more in the last year than I've ever achieved in high school. Well, I've also said how I feel like the competitiveness of nursing school means that only smart kids get in. So therein lies the source of my giddyness. Of the 'smart kids', I got the highest mark. Me. Too-cool-to-attend-school me. Jeebus, this is a big moment.

Sorry if my enthusiasm is turning your stomach. It's hard to express how stoked I am. I'm actually more excited now than I was when I got accepted.

So anyway, I'll just re-emphasize that this course is my favorite of the semester and my teacher is just awesome (and I'm not just saying that because of today). She's really vibrant and intelligent and loves to teach, that much is clear. She pulled me aside after class and said approximately, "Yours was the last paper out of 80 that I read, and I was so excited that you got it that I had to go and show all the other teachers, and we were all like, 'woo hoo!'" She also thought that I had a 'writing gift*'. Man, I was so honored to hear that from her. Today was just the best day.

At least until clinicals, when I can start actually being a nurse :)

*Probably everyone who reads this blog is like "WTF, writing gift? Have you SEEN how this girl abuses a comma splice?" And for that, all I can say is meh! :P

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 :)

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.

...While watching 101 More Things Removed From The Human Body.

So this week has been craaazy. I completely burned myself out after studying for anatomy, so that I didn't even want to pick up my notes for physiology until the morning of the test. A lot of the information from anatomy also corresponded to physiology though so I didn't feel too bad about it. One of the questions was identical: Which order do body structures go in? Cells, tissues, organs, organ systems, organism. That was an easy one. The rest of it was kind of challenging because it wasn't just regurgitated information, it was applied to different scenarios. I was reasonably sure of my answers on 49/60, and had to rethink the rest before I turned it in.

My group and I did our presentation today on the roles of unions in nursing. I had pretty well finished my Keynote presentation last week, but last night I buckled down and put the finishing touches on it. I had thought I only had a few minor changes to make, but one change led to another, and I ended up putting in another 6+ hours on it! While I was searching for the sources/authors for the media I used, I stumbled upon a great Vodcast that highlighted some of the exact points that our presentation was trying to cover. I embedded a few minutes of it into my Keynote and it worked perfectly... after a few hours of troubleshooting.

Today, I am feeling like a student nurse. Although this semester we are only covering theory (no clinicals), I got a glimpse of Pressure - with a capital P.

Today I only had to go in for one class.

The class seems really interesting. There are about 40 students in it and the professor is a sweet-sounding nurse, possibly in her 50's. The way she talked to the class sounded like we were at a tea party. It was nice though. You have to really listen to be able to hear her.

She covered some of the course content - it sounds heavily theoretical, with discussions surrounding issues like how some people can be health-concious all their life and still die of cancer at age 45, and others can smoke 2 packs a day well into their 90s. Also topics like is it fair for all to pay for unhealthy (obese, smokers, etc) peoples' healthcare and how is that different from people with chronic conditions who don't manage them appropriately (diabetes).

The class seems kind of fun. Heavy subject matter, but I think we can all use a good debate now and then!

I don't have classes again until Monday. That's when the 3-hour lectures begin. I hope I remember my coffee...

This morning my alarm went off at 0630. For many of you I'm sure that's no biggie, but I usually work 3-11 and I was feeling like pond sludge. I haven't been sleeping so well the last couple of nights since I am alone in the apartment and there have been a rash of B&E's with a side of rape in my neighborhood.

The nights have started to get down to freezing so I wore pajamas to bed, but I still refuse to turn on the furnace until the last possible day - have you ever been camping and awaken wanting to never leave your sleeping bag because it gets SO COLD at night? I kinda felt like that!

So I dragged my feet, slothlike, around the house, getting ready for the day. Left all of my textbooks at home - they weigh so much! Poured myself a yummy coffee from my new coffee maker. Then I left for the bus. Of course, I left my coffee on the table. Awesome.

I made the connecting bus to the fancy express one that takes 8 minutes to get to school and it was full! So I had to take another transfer, and ended up getting to class just in time.

This morning it was Discipline of Nursing, from 0800 to 1000. The instructor seems great. She is vibrant and has lots to say. Unfortunately she invited the chair of the program in to give a 30-minute presentation on philosophy. First class on the first day, and we are given a variety of terms including existentialism and humanism. Um, right. The guest speaker had the sweetest little voice that did not command my attention whatsoever and I was falling asleep. I felt bad, but still! Giving a presentation and then telling me that I don't have to learn any of it is basically giving me free license to ignore you completely.

Then I had a 4-hour break until English. My prof seems cute, if that's a word you can assign to someone who holds a PhD..? She's from India and speaks flawless English but sometimes her accent left me a little confused. She also kind of has that totally fluid conversation style that chases tangents every other sentence. This might be a problem, but I shall see.

All in all, a positive first day, and my efforts to outwit my severe introversion have been cautiously successful. Hooray!