Today, I wrote my final exam. The one that everything else has led up to - my dreams of nursing, the time I wasted believing I could never get into nursing school, the hours and hours and years and tears I've spent upgrading my prerequisites, researching, cramming, and composing term papers in the library. It could all mean nothing if I couldn't deliver the goods on today, of all days.

Many of my readers are American and may not understand the differences between the Canadian Registered Nurse Exam (CRNE) and NCLEX. Ours is a pencil-and-paper exam that focuses a lot more on the "art" of nursing versus specific pathophysiologies and interventions. It is notoriously psychosocial and tricky. Canadian-trained nurses tend to do very well on the exam, with overall pass rates of about 85-95% depending on the year. Foreign-trained nurses have a much lower pass rate and I can understand why. We've spent 4 years getting used to the nursing language used on the exam. If someone has poor English reading comprehension, or they aren't expecting the terminology or technicality, I think it could be very difficult to succeed. And, unlike the NCLEX, those writing the CRNE have only 3 attempts before they must either retake nursing courses or do something else entirely. To make it even more stressful, results arrive by mail after 4-6 weeks. That's a loooooooong wait.

I officially completed all of my degree requirements as of April 30. I finished my final preceptorship in inpatient cancer care. Oncology was a special place to work but I don't think I have the inclination to devote myself to it full-time. Floor nursing is hard, no doubt about it, and exhausting, with insane hours of 5 12's in a row. Then there was the emotionally draining aspect. I gave everything I had to my patients. I would build up a relationship with them and their families, and then they would die. This happened a LOT. There were no happy endings in inpatient care. I didn't see any miracles. I know I did right by my patients and their families, and I gave them the best care I knew how, but all I would do is come home and cry. Everyone tried to help me "reframe" how I felt, but it wasn't that. I know there is a certain honor to being present in someone's final hours. I felt that honor myself. But it doesn't change the fact that you grieve their deaths. In a lot of ways, health care is about the cure, the rehabilitation, the moving forward, and I really needed to see that at least once in my experience, but I didn't. I know some nurses embrace the palliative part of the lifespan. Maybe I will, one day, but not now.

As far as employment, I was hired about 2 months before graduation. I now have a permanent position in the Emergency Department where I worked as a student (undergraduate nursing employee) and could not be happier! I have a GREAT team with an awesome culture and support from a nurse educator who actually knows her stuff and still picks up shifts as a flight nurse.

Back to the CRNE. I've been dreading today for weeks. I simultaneously couldn't wait to get this exam behind me, and couldn't bear the thought of EVERYTHING riding on it.

Although I registered for the exam back when I applied for my temporary practice permit in February, it wasn't really "real" until a couple of days ago when a couple of my nursing pals and I went to the convention center where we would be tested. It is a formidable place with cinder block walls and an eerie/horrible hum from the fluorescent lights. Then my heart shriveled up and ran away.

I studied for the exam, but not intensively - more of an overall refresher for myself about the "usual suspects" in chronic diseases (COPD, DM, CHF, cancer), as well as things outside of my usual practice such as obstetrics and mental health. I found it helpful to just read over powerpoints from my nursing classes. Luckily I still have all of them on my computer :) I did the CNA readiness tests and scored 81-87%. In fact I never scored below a 76%, even on the Mosby practice exams which are much more specific. I sat down the other day and was determined to learn how to interpret ABGs. And I did, even passing a pop quiz from the respiratory therapist working with me the other night! Good thing, too, because I needed that skill :)

Yesterday I just did tons of practice tests and made myself nauseated with anxiety. I finally made myself get down to the barn for a nice, technical dressage lesson and I felt a million times better. Riding has been an important distraction for me for the last couple of years. It's hard to worry about school when you're concentrating on your heels, legs, seat, hands, and everything in between, as well as trying to get that nice round frame on the bit from your otherwise-stroppy schoolhorse, know what I mean? ;)

After I got home, I puttered around and got ready for this morning. I was in bed by 2130 and had some broken sleep until 0530 this morning when I just couldn't sleep anymore. I picked up one of my nursing buddies and we headed down to the convention centre. We arrived for 0700, half an hour early. There was assigned seating, so we were in no panic about that. I'd gotten a heads up about the testing center being a little cold, so I was wearing not one but two wool sweaters, the outer one being an approximation of a wooly mammoth, and I'm glad I did because I was really cozy throughout the test.

It was a very long and grueling (length-wise) test. There are 200 multiple-choice questions and 4 hours to complete them in. Time management is notoriously an issue for test-takers. Many people do not finish within the allotted time.

I found the test to be more than fair, and certainly less difficult than some of the practice tests I did. In the first 50 questions, I was laughing to myself, thinking "this is it? What was I so worried about?" There were definitely a couple of really tricky questions with 4 right answers but only one right priority. On the whole, though, I think my experience in Emergency prepared me for this test extraordinarily well and I flew through it, finishing in just under 3 hours including review.

Not everyone felt this way, of course. Many of my classmates (including my carpooling friend) were in until the time was up, even guessing on the last 5-10 questions. A lot of people thought the test was very hard.

Only time will tell how I really did, and I look forward to being a Registered Nurse by my birthday in mid-July!

I don't know it it's because we had a big going away party for one of my best nursing school friends last night, or if it's the color of my scrubs or what, but seemingly all the patients I've talked to today have chosen to unload their crushing emotional pain on me.

 

Normally I don't mind and can sometimes even help,  and I get it that I am helping just by offering a kind ear and some healing touch, wiping tears, that kind of thing....

 

But I started my shift already mentally fatigued, and everywhere I turn people are telling me that they want to die and hate their lives and have SO MUCH emotional baggage that I just don't feel equipped to deal with. It's like we've got a department full of trauma patients, but instead of broken bones, they've got broken lives. And how am I supposed to be therapeutic at all in an emergency department where I've only got 7 minutes until the next quasi-crisis erupts. I hate feeling like I'm giving them the same rushed lines that they get every time they come in to the ED or walk in clinic.... But I feel stuck.

 

And then there's the emotional exhaustion where I think.... PLEASE stop crying and unloading your life on me. I just don't have the strength to carry both of us. My heart aches for you, and I just want to save you, but I can't fix all your problems in a 2 hour stay in Emergency.

 

Sometimes I know the right thing to say, but a lot of the time I'm thinking..... O fuck. I can't think of a single thing. So I hold hands, I rub shoulders, I sit/stand in silence, I look compassionate.

 

Help me, emergency nurses!!! I need to learn how to let this stuff roll off me, or I feel like I am never going to make it in this specialty.

Yet again, gentle readers, I must apologize for the dearth of posts. This entire fourth and final year of my degree has been ridiculously strenuous. BUT. IT IS ALL WORTH IT. BECAUSE....



YES! I have the most expensive test I'll ever write, and the one that will transform me from mere grad nurse to REGISTERED NURSE!!

In other news I begin my final preceptorship in one short week. This past month I have been in a sort of leadership rotation, paired with a nurse manager at a local hospital, and charged with developing and implementing a massive project. One of my professors called it a "mini Master's," and that is definitely accurate. 40 pages of project research and counting. But I'm not done yet, so I have to get back to that.

I also got my grad photos done on Friday. The photographer was arranged by the grad committee which is purely student-driven. Apparently the faculty were against us getting photos with a nurse's cap - it's not "academic" enough. Well, onerous faculty, the entire academic wardrobe is steeped in history, and the white cap has a long and proud one. There is no question about what degree I graduated with. Everyone knows that I am a nurse.

Plus my entire family squee'd when they saw the pics :) I also wore my STTI honor cords. They looked horrible with the apricot hood for nursing, but what-the-hell-ever, I am one of maybe 5 students who had them.

Wish me luck for the end of this massive project, and I hopefully will have a chance to breathe soon and get back into blogging.

xoxo

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

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

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

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

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

BUT. And here's the big but.

I have my preceptorship placement confirmed!

I am going to Oncology!

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

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

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

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

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

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

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

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