Sunday, September 30, 2007

I've Got A Bad Case of Lovin' You

Here is some nursing school gossip that you didn't hear from me, okay?

One of my classmates is getting a divorce because her husband is pressuring her to quit nursing school because, get this: he is afraid that once she's a nurse, she'll dump him and marry a doctor.

Holy 1953, Batman. You mean, once she gets out of the house, has her own money and *GASP* unchaperoned access to men she won't be able to control herself? There's no time to waste! Take away her credit cards, her driver's license, her right to vote, her brain, put a skirt on her and wipe that make-up off her face. What's that? A packet of birth control pills! Here, get rid of 'em, quick. If we let this woman control if and when she gets pregnant she'll be screwing everyone left and right. All birth control pills do is turn women into whores.*

*My very own grandmother said this to me.

We're a long way from Seneca Falls and I don't mean to get up on my feminist soapbox, but WTF? If I wanted to marry a doctor, why would I bother with nursing school? Couldn't I just join a country club or a medical society? Couldn't I ask my friends and family to introduce me around? Couldn't I go to E-Harmony.com?

I usually have an issue with medical TV shows, not because of the accuracy or lack of it, but the unreality of being able to stand around and BS with my peeps. That and I cannot fathom a hospital being okay with already overburdended staff taking care of dogs, chimps and Bambi. But lately I've noticed they've got one thing right. Doctors don't date nurses; they date other doctors. So really, if I want to improve my chances of hooking up with McDreamy, wouldn't it better if I went to medical school? "Ah my darling, listen closely and you'll hear my heart; even closer and you'll hear the Kreb's cycle."

Obviously the issue is more about him and how his own insecurities about himself. He thinks he isn't good enough for her, and makes her suffer for it. It doesn't matter what she does; he'll always try keeping her one step behind him, one level below him. I think she should dump him for being a Neanderthal. Everyone knows that they shouldn't interbreed with Cro-Magnons anyway.

I suppose it still happens that women do try and snag a doctor. I guess it's the money and all; but nowadays most women have their own money. They don't have to marry a doctor to get it. As I see it, the benefit of marrying a doctor for his money is that he's never home. While he's out on-call I could watch whatever I want on television and have a cold hot dog and some Tang for dinner. You have to work on Christmas AGAIN! That's okay. I can sit around in my pajamas all day and watch movies. Besides I can't stand your parents anyway.

But by far the best reason I heard for this being a ridiculous idea came from our clinical instructor. She listened to my classmate's frustration and obvious pain over being accused of wanting to marry a doctor. She let out a small chuckle and said "has he SEEN some of these doctors?"

Saturday, September 29, 2007

A Cute Abdomen

This is exactly why I want to work in surgery.

Oh sure, there's the sit-down-once-in-a-while appeal, but the suspense of trying to figure out what is going on with a sick person gets my juices flowing.

I can't get enough of this stuff.

Friday, September 28, 2007

It's Not Brain Surgery

But today it was.

I got to spend my clinical day in the operating room and got to see an actual brain surgery. The doctor was good enough to hold the brain hemispheres apart enough for me to see the optic nerve and communicating arteries. Oh yeah. That completely rocked!

It was a day of relying in communicating with mostly eye contact, since everything from the nose down was covered. Good thing I did my eyebrows before I left for clinicals this morning.

Ever since I have entertained the notion of being a nurse, I thought I would like to work in the OR. Working in the OR has several characteristics that I like.

1. The circulating nurse spends a lot of time on the computer and on the phone. For an office refugee like me, that's a natural transition.
2. It's freezing in there. I'm hot all the time, so the frigid atmosphere agrees with me.
3. Doctors like to listen to music while they operate. I like to listen to music while they operate. That's a win-win.
4. There are cool instruments to play with.
5. The patient is asleep.
6. The patient's family is in the waiting room.

The nurse plays two basic roles in the OR - scrub nurse and circulating nurse. The scrub nurse works in the sterile area with the doctor, sets up the table with all the instruments the doctor will need for a case, and then passes instruments back and forth and deals with used equipment that the doctor no longer needs. Nurses don't get to be in the scrub role very much anymore. Hospitals have found it cheaper to hire scrub techs for the job instead.

The circulating nurse sets up the room, tests the equipment to make sure it's working, monitors the room to make sure no one breaks into the sterile field, and basically runs errands so that people who are already in the sterile field can stay there. So after anywhere from a few minutes to an hour before the case, there is lots of frenzied activity getting things ready for the operation. Once the surgery starts, things quiet down and everyone gets down to business.

Notice that she's sitting down.

I love it.

I'm very much taken with the work environment, and I think work environment has a lot to do with how well you like your job. I'm trying to be realistic. I don't want to wind up quitting nursing after I've put so much time and effort into my education. Every time I ever go to the OR, it feels like such a good fit for me. This feeling never changes no matter how many times I go.

As for the patient being asleep and the family in the waiting room, I don't want to sound mean, but in my short time in nursing school I have found the most difficult thing to deal with in the nursing role is patient's families. There are difficult patients from time to time, but difficult family members outnumber difficult patients 10 to 1. Many times the patient and I are getting along just fine. He or she is clean, fed, medicated and comfortable. Next thing I know a family member comes in demanding that we "DO SOMETHING" for their family member who was perfectly content last time I checked.

Inside I feel myself screaming "let me do my freakin' job, okay?" I can do a fine job taking care of someone, making sure they are safe, that they are getting the right medication in the right dose at the right time, that they are clean, dry and pain free all without you giving me the hairy eyeball, telling me stories about how you got someone fired for not doing something the way you wanted it done. What is going through a person's mind when they threaten a nurse or student like that? If you're trying to impress me or earn my respect, you're failing in a spectactular fashion.

Over the summer I was taking care of a man who had knee surgery. I did my usual thing - check him top to toe, bathed him, made sure he was not in pain, made sure he was eating okay, had enough blankets, had fresh ice water in his pitcher and had everything he needed within reach. About an hour later I went in to check on him and half a dozen family members were swarming around the bed. One of them snarled at me "turn down the thermostat. It's too hot in here." There was no polite request, for example "can you please turn down the thermostat." No. This was an ugly demand. To top it off, she was standing within arm's reach of the thermostat. She could have turned it down herself if she would just bend at the waist. After being struck (momentarily) speechless I said "Oh, didn't the thermostat worked when you tried turning it down?" Her mouth feel open and an "uh" was uttered. Then I turned to the patient and asked "Is it too hot in here for you?" The patient said "No, I'm fine." So I said "let me know if there is anything I can do for YOU." and left the room.

Again, the media doesn't help. They regurgitate stories about how x-number of people were killed by medication errors, or how hospital infections are spread by unwashed hands. True and true, I don't deny it. What the media doesn't talk about is how nurses are given too many patients to take care of safely, and then they're pressured to not work any overtime. Naturally people compensate by taking shortcuts and unfornately this also leads to mistakes. I can appreciate you being there to make sure your family gets good care. But jeez. Can you at least be polite while you're there?

In the OR I can knuckle down and work. I like the role that OR nurses play - patient advocate. We are there to be the advocate for the patient when they are the most vulnerable of all - unconscious. In the OR it would be my job to make sure everything is correct - that they are doing the right surgery, that he is given the right medication, that he is positioned in such a way that his circulation won't be cut off, that no one who hasn't properly scrubbed goes near him. I like the feeling of responsibility that comes with that. But I feel better knowing I can do whatever I can for the person in that state without someone standing over me, making unreasonable demands over nit-picky details - like making sure the sun doesn't get in their eyes.

If your family member is in my care in the OR, I guarantee they will get the best possible care.I will do everything in my power to make sure they are safe and they'll come back to you pretty much all in one piece, even though a piece or two might be missing.

Everything will be fine as long as you don't ask me to turn down the thermostat.

Wednesday, September 26, 2007

A Little Ditty About Jack and Diane*

*not their real names

"I like doing things at the last minute. I like the challenge of having deadlines. That way it forces me to work harder." Diane said to me one day.

"It doesn't matter if I study 2 hours or 10 hours. I get the same result," says Jack "so I don't waste my time studying too long. I just do a couple of hours the night before the test."

Last year Jack and Diane were amongst my favorite classmates. We got along well and shared quite a few laughs. This year they're getting on my nerves.

Last year I was in on a group project with Jack. Diane was in a different group. Jack has great confidence, which is both his strength and his weakness. Jack decided he was the leader of the group and he was going to control everything. We had to choose a patient, research everything about the patient, create a care plan and do a presentation to the class. As we got down to analyzing the information about the patient and compared it to Jack's presentation, the other group members and I noticed a big, gaping omission on the project. I pointed it out to Jack. "Yeah, yeah, yeah, I got it, I got it." He said. Still the information didn't appear on the project. Another student tried. "I know, I know. I saw that but I don't think it's that important." he protests. I even went so far as finding a brochure that pointed out the very thing we were trying to make him understand. Still no luck. Finally when we got our grade for the project - we got the lowest grade in the class. You guessed it. We lost major points for not addressing the very thing we told Jack was missing from the project.

Meanwhile Diane's group was grumbling to us about her penchant for last-minute work. She didn't turn in her portion of the project until 11 p.m. the night before the project was due. This meant that the other group members had to stay up all night incorporating her information into the project.

Oh, in case I didn't mention it, I hate group projects with a purple passion.

Meanwhile we took our midcurricular HESI exam. Jack and Diane both failed. I knocked it over the fence. Jack said "well I think the reason you did so well was because you happened to get questions in areas you're good at." Huh? Wouldn't be because I spent more than 2 hours studying each subject, would it? Naw, that couldn't be it.

Three weeks ago we were assigned our first group project of the year. I wasn't in class that morning (I have a really good excuse; honest!)and I guess there was a little tiff between Jack and some other folks who wanted me in their group. Jack cornered me later and told me he drafted me into his group and just knew I'd be thrilled, and oh by the way, Diane is in the group too. My heart sank. I went to the other group and said "I don't want to be in his group. Help me out!" Their eyes lit up. "Please be in our group with us. We were so mad at him for saying you would be in his group without even asking you." Somehow I managed to convince Jack that the other group asked me first and I thought I told him. He was furious but I stayed calm, keeping in mind that I really do like him as a friend, but don't want to work with him on anything of any importance. I kept it friendly and acted as if nothing changed, and pretty soon he got over it.

Every week we have lab homework. We are given a certain number of questions we have to answer before class, and if we show up without them we get a zero for the day. I always start on homework the minute it's in my hand because I'm old and it takes me longer to do stuff. Besides, it always ends up being more difficult than I thought, and I like having extra time to look stuff up if I can't find the answer in my book, or online, or in the notes, or some other god forsaken place that they have cleverly hidden the answer. Week before last, I overheard Diane telling someone that she didn't do her questions and got a zero. "I guess I learned my lesson, huh? Gigglegigglegiggle."

We have lab after class once a week with an hour break for lunch in between. Last week fter class I was heading to my car to get my lab stuff when I bumped into Jack walking back from his car. He was waving his homework paper around in the air and said "Hey, did you get all the answers to the homework? I can't find them all. Oh well, I guess we'll sit down in the cafeteria before lab and swap answers."

Uh, I think not.

I hid out in the library during lunch, then snuck up the back stairs to the lab. As I rounded the corner I see Diane furiously copying Jack's crap-ass homework answers that he pulled out of his ass at the last minute.

Wait until the last minute? Only spend 2 hours studying? My ass! I'm going to have to hide from these two the rest of the year

Tuesday, September 25, 2007

We Want You As the New Recruit


A big surprise you get when you go to nursing school is that there are rules......lots of them. They are given to you in orientation and they're as long as your arm. Sometimes it feels like we've been drafted into the military. For adult learners, um, non-traditional students, er, okay old farts like me, it has been a long time since anyone has told us what to wear, how to behave, where to stand or how to talk. The good news is that for those of us who have been on this planet awhile, we have learned that rules are a part of life. Some are good. Some are worthless. The trick is finding out which rules can be gotten around without a problem, and which ones can be violated at your own peril.

There is a level of discipline needed in nursing school that is a bit overwhelming. For example, for clinicals there is a dress code.
I'm philosophical about the rule. Maybe I'm just too old to waste energy on rebellion, but more than that, I understand why they have this rule. I figure that reason they have the rule in the first place is because someone somewhere doesn't have the sense enough to know how to do the right thing. One day, many years before I got into school, someone showed up for clinicals not wearing the right uniform, wearing purple polka-dot undewear under white pants, popping their gum, reeking of cigarettes and B.O., sporting a tattoo down their arm that says "Born to Be Wild". This won't do much to put a patient at ease or to develop trust. I don't know about you, but if this person was coming at me ready to shove a Foley catheter in my wee-wee, I'd have a heart attack.

The path to nursing school is paved with pre-regs. We spend lots of time in classes in the sciences, math, English and so on. Some classes have attendance policies and some don't. Most of the time when we're mixed in with the wet-behind-the-ears youngsters, the rules for turning in assignments are pretty relaxed. I suppose this is to keep the helicopter parents out of the professor's hair. "Trevor can't turn in his homework because his alarm didn't go off today? No problem. He can turn it tomorrow. Oh, he can't turn it in tomorrow because he's going on vacation and won't be back until next week? Okay, well just have him turn it in whenever he gets around to it."

This won't fly in nursing school. It requires a different level of discipline that some students are acustomed to - and not just generation Y. People of all ages, if they've never undergone a challenge this intense, sometimes fall down and never get back up. See the point is to get us to make the transition from "employee" to "professional." Nursing school isn't just job training. It's a transformation. Sometimes students don't understand that the way you do things in high school and community college won't go over well in nursing school or in the hospital. There are deadlines. There is pressure.
There are tired, hungry cranky nurses waiting to go home and they need you to show up on time so they can. Turning in homework on time is a way of driving the point home that things need to be done on time, and if they aren't; there are consequences. The point is to get you to develop some integrity; to be able to do the right thing because you're supposed to without someone standing over you to make sure you do it.

As nurses we will be taking care of people who are vulnerable. The people we take care of, their families the agencies that employees us and the state board of nursing need to know that you can be trusted to not cause harm to this person. They need to trust that we won't steal from them, molest them, refuse care because of differences in opinion or take advantage of them somehow when no one is watching. How can they trust you to hold yourself to that high standard if you can't get your homework done on time? If you cheated your way through pre-regs - fuhgedaboutit! You won't last long in nursing school. First of all, your classmates will be working their butts off too hard to let you scam their work. Secondly if you never learned how to think, you'll be lost very quickly.

At first I was frustrated with students who couldn't step up and do what was asked. This problem took care of itself fast enough. Students who can't conform to the rules don't make if far. The rules aren't there to irritate you. The rules are to get you ready for what's ahead. There are greater expectations and bigger responsibilities. A person's life is in your hands.

Sunday, September 23, 2007

Doctor, Lawyer, Indian Chief

When you were a kid, did you want to be a nurse when you grew up?

Me neither.

I've noticed that most people think that a person is born to be a nurse. I suppose there are some people who have an innate need to nurture and care for others. These people are co-dependent, not nurses.

When I talk to people and they find out I'm a nursing student, several things happen.

A. They want to talk about their last hospital experience - in vivid detail.
B. They ask for medical advice - then promptly argue about it.
C. If they're nurses they tell me I'm crazy.
D. If they want to go to nursing school, they first tell me they're in nursing school, then later confess they're working on pre-regs. Trying to go to nursing school and actually going to nursing school are two completely different things.
E. They tell me I'm an angel.

The last one really amuses me. In my entire life no one has ever said I'm an angel. Oh, I've been called many descriptive and off-color things, but never an angel. I'm not a person who is all-giving, all-loving and concerned about the welfare of others. I'm not known for committing random acts of kindness. Not that I don't care about people at all; just not that much.

I would like to put the idea out there that nursing is a career choice; that people can make an intellectual decision to go into nursing. If you didn't want to be a nurse ever since you were a little girl (or boy) that doesn't mean you can't change your mind later.

There are lots of careers out there that people don't even know about until they get into college, or get into a job and find out there are other things to do in their field. No one thinks it odd that a computer programmer or a widget welder didn't dream about that profession from the time they were little kids. Why not nursing?

My view is that if a person goes into nursing because they want to take care of people, they are trying to get their own caregiving needs met and the focus isn't on the patient. They're looking for a pat on the back or other emotional reward. Another downside to this view is that the person who has a need to take care of others is going to get their hearts broken. Patient's are a very ungrateful lot, and it's getting worse as hospitals are trying to market themselves as hotels. In the short time I've dealt with patients, they couldn't care less that they've been yanked from the brink of death. All they want is their meals hot and on time, fuzz-free cable and someone to make them a fresh pot of coffee. Do you want me to pull the car around for you too?

Even though I didn't go into nursing looking to fullfill a need, I was still shocked by this attitude. Fortunately I was able to keep going and stay focused on my reason for going into nursing - because I love medicine. It doesn't mean that only one kind of person can be a nurse. It doesn't mean that only people who can suffer inwardly and silentely can do the job - although it helps.

For the people who don't get past the shock, I'm disappointed and sad. Nursing is such an all-encompassing field that anyone can find a good fit somewhere. Depending on your personality, there is a nursing job that will be a good fit. Some of my classmates got disillusioned during clinicals and quit. I wish they could have held on long enough to see that nursing isn't just what we do in clinicals. If they held on they would see that the places we spend time in clinicals got more and more interesting. They would have found out that what you thought you'd like to do, you really actually hate, and thing you thought you'd never do end up being the thing that you love.

There are lots of places a person can work. There are different specialities, patient populations, age groups, working environments, and so on. The job can vary a great deal from one hospital to another, and even one unit to another. There are nursing jobs where you don't have to work with people at all if you don't want to. Don't like kids? Work in orthopedics. Can't stand the sight of blood? Work in hospice. Hate wearing scrubs and prefer heels and hose? Become a drug rep.

I'm sizing up jobs based on the working conditions. For example, I always thought I'd like working in the OR best because I'm fascinated by it, but even more than that I don't have to deal with providing concierge service all day because the patients are asleep. Then I went to NICU and fell in love with that too because of the practicality of the job. No running back and forth down the hall. My patients are no more than a few feet away, and I won't be acting as concierge because they can't talk. I can't imagine quitting after all the time and effort I put into my education. If I don't like what I'm doing, I can easily go someplace else.

I wouldn't have all those choices available to me if I had chosen to become an Indian chief.

Saturday, September 22, 2007

A Student-itis

Yesterday during our clinical conference our instructor discussed our assisgnments that we turned in the week before. Some of my classmates didn't do very well. One person confided in me that she got a C on hers and she felt so bad she went into the ladies room and cried.

This is an example of what I call "A Student-itis." That is a student with straight A's and gets a B and feels like she is a complete failure.

This phenomenon happens because nursing school is so competitive now that people who get accepted usually have the best grades and highest test scores of the huge pool of people competing to get in. If you are an average person, like me, getting accepted means you have to knuckle down and work extra super hard to get your grades up and do well on the entrance exam. At any rate the majority of my classmates have a 4.0 GPA. I don't, but I managed to make it in because our school has a point system, and I put my effort into getting high grades and test scores in areas that would get me the most points.

Another part of the phenomenon is the nature of nursing school. It's not like anything else a person could do. I've had debates with people who insist that nursing school is just like any other kind of college. It's not. One of my instructors worked as a legal nurse. She has a law degree and said that nursing school was much harder than law school. All our faculty have master's degrees, and many of them have said that going to graduate school was a breeze compared to nursing school.

A lot of nursing students start nursing school with plans of keeping their 4.0 GPA. Then comes the first test and they quickly find out that it's next to impossible. I said NEXT TO impossible; some students manage to do it, but they are serious freaks of nature. The average student is doing well if they can keep a C average. The super-achievers wind up getting their hearts broken and their confidence shaken when they don't do as well as they expected. Even though the faculty tells them that this is okay, many of them beat themselves up - hard - because their grades slip.

Some recover and manage to either get their grades back up, or learn to accept the lower grade. I think the ones who accept it go on to succeed because they've learned to ease up on themselves. They suck it up and move on to the next thing. Dwelling on the bad grade, wondering where you went wrong, arguing with the instructor about the test takes precious time and energy away from studying for the next test. It helps to talk to actual nurses who've been there. They say that no one will ever check out your GPA when you look for a job. The fact that you graduated and got your license is enough for the hospital to know that you are smart enough and safe enough to be a nurse. If a person can focus on just getting through and letting go of the goal of having straight A's, then nursing school isn't quite so harrowing.

A couple of years ago I started nursing school at a different school than the one I'm in now. I was quickly bounced out by a bad math grade, and it was devastating. Somehow I managed to find the courage and keep trying. It took another 3 years before I got in to a different school, but I got in and lived to tell the tale. I was pretty stressed out at first, wondering if I would go through that again. Eventually I settled down and learned to put my energy where it would do the most good.

The bonus for me having this experience is that I got comfortable with failure. I still stress out from time to time, and I feel a little down when I don't do well, but that's only when I know I didn't try hard enough. If I know I did everything I possibly could to get ready for the test; that I read the material, took good notes, reviewed the material before the test, then I let up on myself. I know that there isn't anything more I could possibly do.

Even if I don't know everything on the test, there is one thing I know for sure. Now that I am in nursing school I know there is no such thing as a stupid nurse.

Friday, September 21, 2007

Nursing school 101

I'm going to tell you something about nursing school you may or may not know. Nursing school has three parts to it. The first part is fundamentals which is reading a text, listening to a lecture, taking notes and being tested on the material. The second portion is lab where we practice sticking needles and tubes into orifices on a dummy. That way we can fumble, giggle and drop things in front of our classmates first instead of in front of a real person. The third portion is clinicals where the idea is to combine what we learned in class with what we practiced in lab and do it in the hospital on real people. The idea is to find a patient who has the disease you talked about in class, and needs to have an orifice poked that you practiced in class that week.

I'm explaining this because many of my classmates said they didn't really understand how nursing school works. I had a loose idea, but I confess I didn't know either. We were surprised to find out that it was more than just readin', writin' and taking tests. I had a classmate last year who is a real brain. She had a 4.0 GPA, could get 100 on any test you put in front of her. Once we got to the hospital She lost it. A few weeks later she dropped out of nursing school.

Today was clinicals. I'm always stressed out on clinical day. It's nerve wracking because, as a classmate put it, "it's like starting a new job every day for two years." You have to hit the floor running - picking a patient or three, looking up the medication you'll be giving them, getting report from the nurse who took care of the patient during the night, and planning what kind of care you will be doing that day - even though you don't really know what you're doing.

What makes it so stressful is that we can't just jump in and start working. We have to collaborate with the nurse, figure who is going to do what, and then dealing with the insecurity of not knowing what you're doing. Even harder than that is not letting the patient see that you are nervous and unsure. It takes almost as much effort to pretend you know how to do something you've never done before as it does to actually DO the new thing you've never done before. When a student does something for the first time - say, a dressing change - the instructor has to be there to observe.

Waiting for the instructor to show up on the unit is another layer of stress. Care has to be done in a certain time frame. Once we figure out what we're going to do for the day we have to call the instructor to come watch. Sometimes they're too busy and can't get to you, and the stress ratches up a notch as you wait for the instructor. Then if the instructor doesn't make it, you then have to tell the nurse you can't do the care after all and they have to do it. This is stressful for the nurse, finding time to do something she thought the student was going to do.

Fortunately I have an instructor who is a real sweetheart. It also helps that now, in my second year of school, it is expected that we already have enough experience to work on our own, and the instructor doesn't hover as much.

First year was worse. Since we had never done anything ever, the instructor put us through a little gauntlet I like to call "stand and deliver". The instructor comes to the floor and starts asking questions. What meds is she taking? What's it for? How does it work? What are the side effects? What do you need to know to give the med safely? What are the labs? If the lab is abnormal, why is it abnormal? At the time I hated it, but looking back on it I realize it taught me a lot. Getting ready to stand and deliver means spending a couple of hours looking up everything - the meds, the labs, the disease, any tests that are being done, how they're done and why.

Eventually I got pretty good at knowing what the instructor would ask and being ready for her when she got there. I noticed that once I had that covered the instructor wouldn't hover as much and would leave me alone. I guess she figured that I had a grip on what I was supposed to be doing and didn't need to be watched as carefully. That meant she would go and put pressure on someone else who wasn't getting it. Since then I've noticed that if an instructor is riding someone pretty hard, there's usually a good reason.

It also was a huge help that I spent the summer in the LVN program. I got 12 extra weeks of clinical experience and got the hang of handling several things at once, and that was the most difficult thing I've ever done in nursing school. I also got better at thinking on my feet and prioritizing my day. I learned to be efficient about getting and giving information. I learned to comb through information, pick out the most important facts, and reporting the most critical stuff to my instructor or the nurse I work with.

The stress still lingers though. I had a good day today and almost got to start an IV. But I'm exhausted and my brain hurts. Tomorrow is dialysis day. It's a relief to go to work, doing skills I'm good at, working with people with whom I am familiar, and patients that I've seen over and over for the past 2 years.

I never thought I would hear myself say that.

Thursday, September 20, 2007

Gonna Dress You Up In My Love

"I don't know what I did to deserve this. I must have done something really terrible in my past life. Maybe I invented culottes." Murphy Brown

Like a lot of people my age, I carry a forward head posture. When I think about it, which is about once every 5 years, I'll try and sit up straight, pull my shoulders back and pull my stomach in. The result of this posture means my stomach sticks out......a lot. And it's not just the posture doing it; I'm fat. I have a big basketball sitting where my waistline used to be.

I can't conceal it very well but I do what I can to not draw attention to it. I try to choose clothing that is cut wider in the shoulders and hips to make it look like I have some kind of shape. I do this out of consideration for my classmates so that my great basketball in full bloom won't block their view of the 22-year-old hotties walking around campus.

I have a doppelganger in my class. People say we look exactly alike. Experience has borne this out. One day my professor handed me something and went back to lecturing. About 10 minutes later she walked over to my doppelganger and asked for the thing back that she had given to me. So it's real. Our personalities, however, are nothing alike. She is more of the homeroom mother, second grade teacher, Vacation Bible school volunteer type. She bakes cookies for the nurses at our clinical sites. When it's a classmate's birthday she passes around birthday cards for everyone to sign. Me, I'm the bitchy, cynical, sarcastic, wise-cracking, gossipy, self-centered type. If I bake cookies it's because I have a craving for cookies.

She is a very nice person; a pillar of virtue even, thoughtful and sweet. But she does something that I hope makes it easy for someone to tell us apart from miles away. She wears elastic-waist pants......with a T-shirt......tucked into the elastic-waist pants.

Remember, she is my doppelganger, which is not really a twin, but we look exactly alike. That means she has forward head posture and a big basketball in front too. Tucking a white T-shirt into dark green pants with an elastic waistband is saying HEY! LOOK AT MY BASTKETBALL. YOO HOO. RIGHT HERE!

I won't even go into the culottes and skorts that she wears with running shoes and footies.

Then I noticed that the phenomenon is spreading. Yesterday I saw 3 other middle-aged women with forward head posture and basketballs in front wearing their shirts tucked into their pants. Over the past few weeks I've seen, I don't know, 5 women over 40 wearing culottes with Birkenstocks and socks to match their shirt. Okay, fashion faux pax. One should wear socks to match their slacks, not their shirts. Oh dear.

Did I miss fashion day in 1977 or something? When was it ever okay for anyone from my generation to wear shirts tucked into an elastic waist? I remember during the 80's when oxford shirts tucked into slacks were big, and I have to admit I'm a huge fan of that look. If it ever comes back I might even consider losing 50 pounds so I could pull it off.

Nevermind. No I won't.

Long ago I made the decision to grow old gracefully. I promised myself that I would not attempt to wear clothes that are meant for people 20 years younger than me. So far it's not a problem. This abomination that is the the babydoll, that makes one look like you're walking around in your nightgown is easy enough for me to avoid.

I'm no sex kitten, I don't have a strong sense of style and I haven't shopped for anything new in a while, but culottes? Skorts? T-shirts tucked into elastic waists? What happened? When does a person wake up one day and say "I'm going to go out and buy the ugliest thing I can find and make myself look 20 years older?"

I hope that if I ever get the urge to wear a skort, or if I tuck my shirt into my elastic waistband, that someone who cares about me will pull me aside and say ever so gently..........

"You're not wearing THAT are you?"

Glossary

ADN - associate degree nursing; usually a two-year program that meets the requirements for taking the RN licensing exam.
ACLS - Advanced cardiac life support. Providing rescue care beyond basic CPR that includes starting IVs, giving medication and using a cardioverter to shock the patient. Certification is good for 2 years. The class has to be repeated to become certified again.
ATT - authority to test; awarded to a student who has graduated from an accredited vocational nursing program. This allows the student to work as a graduate nurse while waiting to take (or pass) a licensing board examination
BSN - bachelor of science in nursing, usually a four-year program that meets the requirements for taking the RN licensing exam.
dialysis - artificial removal of waste products from the blood when the kidneys fail.
fistula - an abnormal connection or passageway between organs or vessels that normally do not connect. An AV fistula is a vein and artery sewn together which makes blood flow faster through the vein making it thicker. Dialysis is then given through this passageway.
Foley catheter - a thin sterile tube inserted through the urether and into the bladder that is left in place to drain urine from the body and collects the urine in a bag. Different from a straight catheter which is inserted into the bladder to drain and then immediately removed.
HESI - Health Education Systems Inc; a test given by nursing schools to evaluate a student's strengths and weaknesses, and to assess their preparedness to take the NCLEX, or a way of keeping a student from graduating and thereby inflating the schools' graduates' NCLEX pass rate; depending on how you look at it.
LVN - licensed vocational nurse; often known as an LPN or licensed practical nurse; a graduate of a diploma or certificate program of 9 months to a year that meets the requirements for taking the LPN/LVN licensing exam.
MSN - master of science in nursing; an advanced degree of usually two years beyond a bachelor's degree; one whom must be addressed as "master" at all times -NAH! Just kidding.
NCLEX - National Council Licensure Examination, formerly known as the state board examination. The exam a graduate nurse must take, and pass, before being issued a license to practice nursing.
OB - Obstetrics; dealing pregnant mothers and unborn babies.
RN - registered nurse; one who has holds a license to practice nursing

Wednesday, September 19, 2007

It's Here

I got it today! My ATT is here.

I take my board exam on October 8, 2007. Some two weeks after that I will no longer be license pending.

My employer is even more excited about this than me.

I mentioned before that I work as a dialysis technician. Most dialysis patients begin their life on dialysis with a central venous catheter. Eventually they'll have surgery to put another kind of access in their arm, either a graft or a fistula. Some never have the surgery and have their catheters forever.

Lately our clinic has gotten a lot of new patients.....so that means lots, oodles, tons, an embarrassment of catheters. On the days when we have catheter patients the 2 or 3 nurses we have in the clinic run themselves ragged hooking up all the catheter patients while we techs stand helplessly nearby and wait. Once I have my license I can join in the fun, and help out with the catheter patients.

For now the cake ban has been suspended.

I Always Feel Like Somebody's Watching Me

The mental health unit of school is winding down. Boy I thought I knew everything there was to know about crazy people. Turns out the crazy people I know personally aren't really crazy; they're just assholes

Now that I think it over, a good many of the people I know probably suffer from some kind or other personality disorder. Just about every geek I know could be fit the description of a schizoid personality - detached from social relationships, uncomfortable in social situations, and more involved with things than with people. Wow, that would even describe me except I'm really not into "things" all that much, unless one considers useless information one of those "things".

This description sort of jumped out at me. This is a passage from my psych nursing book about paranoid personality disorder. It reads as follows. "A person with this disorder possesses shallow emotions, and shows a pattern of disregard for and the violation of the rights of others. They exploit relationships for their own gain and don't give regard to the needs of their partner, but only care about what they get from the relationship and how it will serve them. Those of the paranoid type constantly analyze the actions of others. They are rigid in their view of the world and think others are plotting against them. They have frequent conflicts with authority and are quick to attack. They are deeply suspicioius of their life partner and want to remain in control at all times.

They can pretend a role to suit their needs and can be very charming in order to get what they want. They show a tendency toward impulsivity and are unable to consider the ethical and legal consequences of their behavior."

I didn't jump to conclusions. The conclusion rose up and swallowed me.

Monday, September 17, 2007

What Did Tornadoes Sound Like Before Freight Trains Were Invented?

About 20 or so years ago I had a friend who, every time I saw her, had something else wrong with her. There was always some physical malady bothering her and keeping her from enjoying life to the fullest. She had gone through an entire list of stuff happening to her from bowel problems, to gallbladder trouble, to endometriosis until one day she told me she had TMJ

She was speaking about the diease tempormandibular joint syndrome, which would actually be TMJS, but I'm saving annoying English and grammar for another post. In medical terminology TMJ refers to just the joint, hence the J.

But I digress.

At that time I had never heard of TMJ. I was, and always have been, interested in medicine, so I was instantly fascinated and wanted to know more. Since the Internet wasn't around much, or not to the typical person like me, I had to find out more on my own. I hadn't even made it to the library before I saw an article about TMJ in a ladies magazine - Redbook, Ladies Home Journal, something like that. Turns out it is fairly common and lots of people have it and the treatment is fairly simple.

What is interesting to me now about this malady is that this was the first time I experienced a phenomenon that I now see all the time. There is a new disease discovered or brought to the public's attention and suddenly everyone has it. I remember when everyone had hypoglycemia, then it was carpal tunnel syndrome, then chronic fatigue syndrome, then dysautonomia, then sleep apnea, and now restless leg syndrome.

I know there are people who really do suffer from these conditions, and for those people I have a great deal of compassion. It just seems to me that there are a lot of people who have these complaints and really don't have anything wrong with them, but want to use the disease a way of drawing attention to themselves or to get out doing stuff they don't want to do.

In nursing school we are talking about mental illness. This week we talked about somatoform disorders. These are disorders for which there is no physical evidence of illness. Some of the disorders cause actual physical pain and other symptoms for the patient. Others are completely manufactured by the patient to get out of having to do things they don't want to do, to get money via lawsuits or disability, or because they enjoy the sick role and want attention. This called malingering and it's different from other disorders in that the patient knows they don't have anything wrong with them, and the goal of being "sick" is personal gain.

It happened again the other day. When I was at the psych hospital an adorable, tow-headed, blue-eyed lad of 19 years told me he didn't sleep the other night because he had restless leg syndrome. Restless leg syndrome? Son, you are all of 19. Most people with this disorder develop it in middle age, so go sit down and do your homeowrk. Five years ago nobody had restless leg syndrome because it hadn't been invented yet. Now everyone has it.

My question is what did you have before there was TMJ? Did you just have a headache or an odd clicking noise in your jaw? Before there was restless leg syndrome were you just amped up on Red Bull or going through the manic phase of your bipolar disorder?

It's not just malingering that motivates people into having sexy new diseases. I blame TV as well. Now that it has become legal for pharmaceutical companies to advertise on television, it has done so much to make people believe they are ill and must have the sexy new drug they saw on TV. It works the way advertising works - create a need, tell people they are flawed in some way and then sell them the solution to their problem. The transition for using this technique to sell drugs is seamless.

There was an episode of Scrubs recently where two of the characters are sitting on the couch watching television. The dialog pauses and the newscaster is telling of an outbreak of a new bacteria in the city. The two doctors sit upright and scream NOOOOOOOOOOOOOOO!!! In the next scene the hospital is being overrun by people who think they have this new bacteria.


People are already overly hysterical about everything anyway. Again, I blame the media for this. The media takes a simple fact and presents it with earnestness and anxiety to make it seem like it's a horrible problem, when it's something normal and natural. For example, giardia. Now that is one unattractive parasite and what it does to you will make you feel not at all sexy. You will have cramps, bloating, gas and frequent, watery diarrhea and there is simply no way to sex that up. So let's say in your part of the country there are typically 10 cases of giardia a year. It's not such a big deal. That might be a pretty good number now that we have sanitation and water treatment plants. The number was probably much higher 100 years ago, but we don't know because maybe statistics weren't kept in your part of the country 100 years ago.

So the media gets hold of this number and screams OH MY GOD!!!!!! THERE WERE 10 CASES OF GIARDIA REPORTED LAST YEAR!!!!!! IS THE HEALTH DEPARTMENT DOING ENOUGH TO PROTECT YOUR FAMILY!!!!!?

I never hear of anyone using giardia as an excuse for getting out doing things they don't want to do. No one ever claims they have West Nile virus, or luekemia, or multiple sclerosis. No. Those are not sexy diseases.

And what of all the sexy diseases of the past? Why doesn't anyone have the dropsy anymore? Or the ague? Or the consumption? Because now they have edema, fever and chills, and tuberculosis and it doesn't sound nearly as exotic or interesting. All of these old disease aren't as sexy anymore, or maybe the newer diseases are sexier, easier to have, harder to diagnose, and just bad enough to get you out of going to work or school but not bad enough to disfigure you are cause you horrible discomfort.

What horrible disease lurk on the horizon? I can't write about it anymore because I've developed a terrible case of texting thumb and I have to go lie down on the couch for the rest of evening. I might even have to take a few days off work until I feel better.

Saturday, September 15, 2007

Why My License is Pending

Over the summer I took a course that would allow me to sit for the board exam to get my LVN license.

It was hell on a half shell, but worth it. I learned a lot. It gave me the chance to see how it feels to do actual nursing. By that I mean I had several patients at a time and did all their care. I learned to multi-task and prioritize. These are things we don't get to do in the ADN program. In the summer program I did all the care AND the procedures as well as giving meds. In the ADN clinicals the focus seems to be more about learning individual tasks and not as much learning how to deal with multiple things at once....or at least not yet.

Before I start meandering onto other points and musings about this experience, I want to talk about why I bring this up.

The last day of class as we were eating our graduation cake, someone put her name and phone number on the board for us to copy down in case we are not able to get our authority to test, or ATT. For some reason I had a dumb-ass attack and didn't write the number down. Now some 6 weeks later my classmates have all gotten their ATTs and I have not gotten mine. The simple solution would be to call the person who wrote her name and number on the board. Naw, that would be too much like being responsible. I have a real jones for cake and I think I got sidetracked. That's the best excuse I can come up with.

This week has been a nightmare trying to figure out who that person is and how to contact her. I've left several messages for the secretary, er, administrative assistant for the nursing program asking her to call me back with this person's name and phone number. She hasn't called. I had to deal with this person when I signed up for the summer program and, to put it mildly, she has the social skills of a doorknob. I don't expect to get anywhere with her.

I resorted to calling a few names in the staff directory and seeing what happens. Finally someone called me Friday evening. She said she had a pretty good idea who I was supposed to talk to and would send her an e-mail for me. That was a relief.

This has been bugging me to the point of distraction. I have been losing stuff; important stuff. I lost an assignment last week. This week I went to lab on the wrong day. Today at work a co-worker asked me to take care of something for her while she want to lunch and I totally spaced about it and didn't do it. I'm not usually like this. I'm pretty good at handling details and multi-tasking. I'm fairly responsible with the occasional lapse in judgment, but overall I can be trusted to handle important things.

I just want to get this over with so I can get on with life. I want to get the LVN perspective out of my head so I can continue on with the RN perspective. It's harrowing to try and juggle them both. Ever since I got the call back last night I have felt slightly less moody than before so that's a positive. I was able to settle down and look over some math stuff that I have to know before I take the our first test for the semester. Still, I plan to drive over to the college on Monday and find some actual people to talk to, but not the doorknob if I can help it. Hopefully I'll see a familiar face and we'll find a solution to my problem.


Meanwhile I made a promise to myself that if I have something important to take care, I'll make sure I'm not within 10 feet of a cake.

Friday, September 14, 2007

Got to Keep the Loonies On the Path

Today was our psych rotation. We did this last year and I was a little nervous, mostly because I didn't know what to expect. This year I wasn't nervous at all since I'd already been there and seen some actual psych patients before.

Our society treats mental illness as something to be feared or laughed at. I tend to look at it as any other medical condition. It is treatable and the patient has the potential to be able to function well enough to work, have relationships and take care of themselves. I think the public's view of mental illness is that these people are doing it to themselves somehow. Their behavior is judged as being bad or scary. I see it as this is how the disease presents itself and the person who has it is not to be blamed for it.

I also find it interesting that most people are looking for a reason for a person to have a mental illness. There are many theories about why people develop mental illness, but I think for the most part looking into the source isn't very productive. I think time is better spent figuring out what to do about the disease once it's here. We can't change the past. It is good to have information about a person's past to better understand things, but from what I've seen so far it really doesn't do much to plan the patient's care. Leave the naval gazing to the scientists. As practitioners we should do as much as we can to treat people with the tools and knowledge we have available to us now.

This attitude carries over into how the insurance industry and government pay for mental health services - which is to say very poorly or not at all. If society took this situation more seriously and realized that many things are treatable, the patient's would be so much better off. Instead, mental health is still the red-headed stepchild of health care and it's a horrible, horrible oversight.

It's a vicious cycle. A person becomes unstable for whatever reason and winds up in the psych unit or hospital. They get on meds and their behavior levels out. Then because they can only stay a little while, often before their meds start showing any signs of working, the person is released from the hospital and don't get the support they need to keep getting their treatment. They go off their meds for many reasons; finances, side effects, the belief that they aren't doing them any good, then their abnormal behavior returns and they're back in the hospital.

But I don't want to get off on a tangent about our crippled health care system. That would take forever. I also can't educate the public as much as I would like. All I can do is educate people one at a time.

Maybe I'm still in the throes of nursing school hubris and I believe we can fix anything, but I don't think so. I try to look at things realistically, or at the very least scientifically. I'm old enough to be jaded about almost everything anyway, so I don't feel that I am indulging in magical thinking. What I really believe is that I am living in an interesting time in history where we have the potential to do so much, but beaurocracy and short-sightedness have us in a bind. I wonder if we will look back this time 20 or 30 years from now and wonder why we didn't do more with what we have?

Could I work as a psych nurse? It wouldn't be my first choice, but I could easily do that. The worse part of the job for me would be to have to constantly confront my own issues and keep from having my buttons pushed. It would be exhausting to constantly ward off the manipulation, verbal abuse and possible violence from the patients. Over time it would take its toll I suppose. I would also feel constantly frustrated knowing that we could do more for these people than we actually do.

If I couldn't find a job in a hospital, in an OR, in a NICU or some other area that interests me more, I would consider a stint in a psych hospital.

I'm tired and need a nap. I have to work tomorrow and 4 a.m. is such a sucky time to have to get up in the morning, not to metion the 10 hours of being on my feet. For now though I need the money and I want to keep my dialysis skills up. Oh, for those of you who don't know me, I work as a dialysis technician to pay bills while I'm in nursing school.

More musings about nursing school will follow. I just need to chill for a while.

Thursday, September 13, 2007

Pros and Cons of Nursing School in Midlife

Pros
1. We take school more seriously, so we turn in our assigments on time, arrive to class prepared, and have no excuses for not getting things done.
2. We're closer to death so we're more focused on the goal of finishing and don't want to waste time changing majors.
3. Many of us have already been to college or have degrees. We know the drill.
4. We've had several relationships in the past. If someone delivers the ultimatum that comes in the form of "it's me or nursing school", the choice is easy.
5. We're closer to our professors' ages and so we get their jokes.
6. We've seen lots of people naked so we're not as freaked out at seeing our patients naked.
7. We can pass a drug test. If we're still alive it means we gave up drugs years ago.
8. If we have children, they are probably grown and out of the house. If they aren't out of the house we're not responsible for their daily care and feeding. They can pour their milk over their own cereal just fine.
9. This is probably not our first career, so we have an idea about adapting to a new culture. We don't expect that nursing will be our dream job. We recognize that it won't be perfect and are less likely to have our hearts broken once we get our first nursing job.
10. We have a thicker skin. Mean nurses don't bother us. We can ignore snarky comments and rolling eyeballs and focus on why we're here - to learn.
11. We don't care how Britney Spears bombed at the VMA awards. Well, maybe a litte.
12. We don't get out much and there isn't anything to watch on TV anyway, so studying isn't a problem.
13. We're better at handling money. There might be a bank account or retirement fund that we use for school. If we have to get student loans we won't squander it on beer and pot. Advil, maybe. Preparation H, maybe. But not street drugs.
14. We do well on the psych portion of our class because the longer you're in the world, the better your chances of meeting people who have issues. Who knew that the manipulative, deadbeat, clingy lover from your past would serve as a test case for your group project?

Cons
1. It is difficult to be a beginner at this age. We're used to being experts or at the very least adequate at what we do. It's difficult and sometimes devastating when we try something new and mess up. Hopefully we get over it.
2. We may be older than our professors and don't cotton well to autocratic leadership from people who are the same age as our children.
3. We don't have as much energy and so have to plan our activities carefully to avoid getting overly tired. If we over do it, we have to allow ourselves time to recover.
4. We have to work harder to learn new information so have to devote more to time to studying. This is not a problem because there's nothing on TV and we are way over trying to keep on the latest music group or fashion trend.
5. It's a bitch being on your feet for several hours at a time during clinicals. Fortunately this prepares us for being on our feet when we're nurses.
6. Reading glasses and bifocals are a must for reading teeny tiny drug labels. We just have to make sure we remember to have them with us when we leave the house.
7. We're set in our ways. We have a hard time adapting to new ways of thinking and doing. Sometimes we are presented with information that contradicts what we learned 20 or so years ago. The challenge is keeping an open mind and realize that the world is always changing, and remember to answer the test question with the new information and not the old.
8. We have to sit in front because we can't hear the lecture.
9. Many of us have spent our lives trying to avoid learning computers. Now that everything is computerized we have to figure things out at the busiest time in our lives. Our younger classmates grew up with computers and it's not a big deal for them. For older students, learning new technology is one other task to add to our already overloaded schedule.
10. It's easier to forget things - assignments, watches, keys, stethoscope, eyeglasses.
11. There is no way we can skimp on sleep. No pulling all-night study sessions.

Welcome to my Blog

Here we stand at the middle of life wondering what the hell happened.

Nobody told me that at 22 my life would disappear and I would wake up at 46 wondering where my life went.

I woke up at 46 and found myself beginning my second year of nursing school.

So I'm 50 pounds heavier than when I fell asleep. So what if my face is saggier, my teeth aren't as white and I have to wear reading glasses to make toast? I like myself a whole lot more than I did when I was 22. I don't have the same self-conscious feeling about myself. Mostly I realize I don't have a lot of time left. I can't mess around. I need to finish my education so I can enjoy a few years of having enough money to make life bearable before I have to retire.

There are lots of blogs for nursing students. This theme of this blog is the challenges of nursing school that are unique to those of us in middle age. Fortunately there aren't a lot, but they're funny. I would venture to say we have an edge over those youngsters. But the issues are different and complex, and only another middle aged nursing student would understand.

So welcome to my blog. I hope you enjoy what I have to say. I hope it will bring you comfort when you feel no one understands what you're going through. I hope it makes you laugh on those days when all you want to do is cry. I hope you will see yourself in my experiences and know that you're not the only one crazy enough to do this.