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

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

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

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

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

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

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

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

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

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

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

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

WaHOOOOoooOOO FOURTH YEAR!!!!!!

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

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

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

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

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

-- from the cellular desk of undergrad RN

And I'm still troubled by it.

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

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

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

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

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

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

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

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

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

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

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

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.

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

Immediately, sez I, "CONVERSION DISORDER"

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

Yup, it was conversion disorder.

Here I thought I forgot everything from Mental Health!

---

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

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

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

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

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

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

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

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

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

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

From the briefing:

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

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

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

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

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

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

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

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

It freaks me out.

Therefore I applied.

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

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

Overheard in class:

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

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

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

______________________________________


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

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

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

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

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

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

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

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

This is exactly why I blog.

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

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

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

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

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

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

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

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

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

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

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

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

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

Did that sound sappy? It was honest.

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.

That's Mental Illness, not myocardial infarction, except those are pretty common too.

One of my oldest, bestest friends, who actually completed half of her nursing after-degree and quit because she hated it, may very well be suffering from major depression. She's one of the most amazing people I know. When she feels like herself, she's funny, SO intelligent, adventurous, and free-spirited.

I spent an hour on the phone with her this afternoon talking about nothing much and then we started talking about her life and where she is with it.

She's not happy or remotely satisfied with her choices and she feels like she's 'running out of time' to pull her shit together. We're the same age. This same conversation has been happening for years. She's opposite of me - where I went globetrotting after high school, she went straight to university and took a degree in something that doesn't interest her, hoping she'd find herself. She still hasn't.

Anyway it started with a regular girlchat and morphed into me using my psych skills on her. She expressed fear and doubt about whether she was ever going to be happy and questioned the validity of seeking medical help. I told her in no uncertain terms that antidepressants and mood stabilizers were just one small piece of overall therapy. They would help her feel well enough to start seeking ways to get more from her life. They would provide the boost.

I then heard her out and repeated parts of her narrative back to her to really emphasize some of the self-defeating thoughts she was having. We then discussed how regular exercise might really help her feel better. I really promoted some of the AMAZING psych programs I've seen while I have been on my clinical rotations.

I finished the conversation with this:

I care about YOU. I could give a shit whether you stay in school for the rest of your life or never step foot in a classroom again. I don't care whether you go be a carpenter or a business executive or a drifter. All I have ever wanted is for you to be happy and it kills me that you haven't found that.

She agreed to seek help.

I still consider her a suicide risk if she doesn't get help soon. If there's nothing else in the world that I learn from nursing, I am grateful that I learned just enough to help my friend feel hope.

Mental health issues are everywhere, people. Don't sleep though your Psych classes.

I was up since 3 AM this morning finishing my last care plan for this rotation (mental health). It's a very cool specialty and I'll describe it for you in another post.

The big thing on my mind right now? I FINALLY got the last piece of my application today, from the instructor who so frustrated me on Friday.

This is the position I applied for. I *just* sent the email with my completed application package. It's been over 2 years since I went through the process of applying for a new job and it never gets any easier.

This is actually way worse because it's, like, the real me I'm sending out into the great unknown. It's not some crap job I'm getting to tide me over until I'm ready to start my career. This is my first contact with my future employer, assuming they're still hiring RNs when I graduate and pass the boards.

This IS my career.

The fluttering in my chest is just like it was 2 years ago (nearly to the day - just... wow) when I realized what I was getting myself into:

It's the searing excitement in my chest - I am going to Be. A. Nurse. After so long trying to find a place for myself in the healthcare industry, this is it. I am standing at the very beginning of my chosen path and I am so incredibly ready.

Now I just watch and wait and hope I said all the right things.

*stares at the clock*

The deadline for my UNE submission has been changed to April 15 (Thursday). I still have a fair shot. I'm getting the form from my instructor tomorrow when I turn in my third and final (!) care plan for this semester.

I'm feeling a lot more positive and relaxed now. I've got a huge emotional investment riding on being accepted into AHS. I'm scared and excited and hopeful.

When people ask me what I do, I am so proud to say I am in nursing school.

Every day I am making a difference to someone and I am so, SO, in love with my profession. I have never had a doubt in the last 2 years that I was making the right choice. Everything that I see and do has been inspiring and challenging to me. Menial tasks like fetching water or changing linens have never bothered me. I have been privileged to help people in their times of medical and emotional need. I am in a trusted position and people listen to me, really listen, when I speak to them. I work hard to hear what they have to say.

It has been a long journey and I'm only halfway there, but this opportunity to begin embracing my chosen role is one that I have been waiting a lifetime for and I am so ready to get started.

Is it worth it to consider getting a Master's degree in Nursing? Post-grad, I could have it in two years. That's 6 years of nursing school, making me 29 by the time I finish. I want to have babies sometime this decade... lucky me, darling boyfriend is 4 years younger. Sometimes I just pretend I'm the same age as him, so I don't feel quite so much like I've wasted these post-high school years.