Wednesday, April 23, 2008

Post HESI Survivor's Guilt

The past few days have been exhausting. After the elation of passing HESI wore off I have felt drained of energy. At first I thought maybe i was feeling a little guilty. I want to celebrate the fact that I passed, but 22 of 60 students didn't pass and I feel terrible about it. I feel traumatized by the whole experience, the preparation leading up to the test and the tension that had built up over time.

So much is at stake. If we don't pass, we can't graduate. We get several chances to try again, but only two chances before graduation and pinning. For a lot of people that means cancelling graduation plans, money wasted on plane tickets, the embarrassment of having to tell your family you didn't pass. To make matters worse some students have internships and jobs lined up that they won't be able to start if they don't graduate.

I didn't know what to do with these feelings. Fortunately another classmate who passed the test opened up to me and it turns out she feels the same way. We talked to other students and several others who passed are feeling the same strange funk.

At the beginning of the semester a classmate came up with a plan to help students succeed. She suggested that the students who pass HESI participate in tutoring sessions for the students who didn't pass.

It turned out to be a terrible idea for several reasons. The students who didn't pass are very embarrassed about it, and they feel humiliated to be in the same room with their classmates who passed. For those of us who passed, we're drained and exhausted. We feel that we just don't have anything left to give. I know that since the day of the test I have had this gnawing sense of responsibility for helping my classmates pass, and I resent it.

Then I have this classmate, the one who calls himself the class nerd, who has patronized me for every HESI I have passed. We have had three exams - one midcurricular exam, the LVN exam and now this one. I did well on all of them and he did not. He always says to me "well the reason you did so well is that you got a lot of questions on topics you're good at." Now I'd heard that the questions are random, but after talking to other classmates, I think we all had pretty much the same questions. I can safely say after taking the HESI three times and scoring more than 100 points beyond passing every time, it's not just the luck of the draw that got me through. It was hard work and staying on top of the material all the way through. There is no magic formula. It's not luck or fate. I hate it when he tries to minimize my accomplishment as a way of justifying his failure.

The other thing that bothers me is that that during our test review that was week before last, I listened to students asking questions and I realized that for many of them, this was not a review. For many of them, it was as if they were seeing the information for the first time.

As much as I would like to help my classmates succeed, I cannot teach them two years' worth of material in an afternoon study session. I'm sorry. Every once in a while during nursing school, a classmate would ask me to help him or her study, or I would be asked to join a study group. I would try and explain my study methods to them and they would always reject what I was trying to tell them or they would argue the information. I personally go straight to nursing interventions, then fill in the rest of the information later. That way if I run out of time to study before the test, I at least got the most critical information covered. I would try and convince them that, hey, you asked me how I do it, I'm telling you, you have to believe me. But okay. Have it your way. We'll go through the Powerpoints item by item if that is what you want to do.

So today in class the passers and failers eyed one another uneasily. The class nerd wouldn't even look at me, wouldn't talk to me. I take this as a sign that maybe somehow he finally gets it. I really did learn something in nursing school, and he's not really the class nerd after all. I know that the failing students have their own stories to tell. I know they have no sympathy for those of us who passed. They would trade places with us in a minute. Nevertheless, our feelings are real and we're doing our best to try and sort them out. We feel guilty as hell and we feel left alone to deal with the aftermath of this experience. We want to honor our committment to help our classmates succeed, but we're all too aware of what little we can actually do about it. I'm trying to choke down this ball of resentment mixed with guilt and it's not going down well at all.

I know the classmate who came up with the tutoring plan had her heart in the right place. I know she wanted us to bond as a class and help each other get through, but unfortunately it didn't turn out the way anybody had hoped. They say the road to hell is paved with good intentions. I never imagined the form of hell it would turn into.

But I'll be okay. It's just a weird place to be.

Monday, April 21, 2008

Acute Dialysis - Day One

It sounds great. Patient nurse ratio 1:1. Bring something to read because you'll be sitting down for four hours.

Four hours? What nursing job lets you sit for four hours straight? Wow. This my dream job. And it pays a whole lot more than any other graduate nurse job I've heard of. Some of the nurses told me that they made six figures last year. Six figures. My first year out of school. Oh man!

I figured sooner or later there would be something about this job that makes is suck bad enough that no one would want to do it. Turns out all the things that are good about it are also the things that make it suck.

Nurse-patient ratio 1:1 means the patient interprets this as meaning you are their personal servant for the day, at their beck and call. "I'm cold. Give me a blanket. Turn off the air conditioner. Give me a drink of water. My oatmeal is too cold. I need another Sweet N Low for my tea." You get the idea.

This also means we have way too much personal time with each other. The following is a sample of the verbal abuse I was treated to by my patient today.

"You aren't taking care of me right. I hope they don't ever let you take care of me again because you are a terrible nurse. You can't do anything right. You aren't very good looking are you? You're pretty fat for a nurse. If I get pneumonia I'm going to sue you. If you don't take me off this machine right now I'm going to call my lawyer. You never listen to anybody. You're just hard-headed and stubborn."

Yeah, yeah, yeah. Here's the phone, you grumpy bastard. Call your lawyer. Bring it!

Luckily I've had about three years' experience dealing with similar bullshit working in a chronic dialysis unit. I found that the best response is act like you're schizophrenic or retarded.

"I'm not good looking on purpose. I get so tired of men asking me out all the time that this works better. Really? I'm fat. Oh, if my weight is interfering with your treatment somehow, let me know what I can do differently so it won't be such a problem for you. If I'm not doing anything right how about if I heat up these pancakes for you? I'm hard-headed. You sound just like my mother. Oh, I can't tell you how many times she has told me that. You know the two of you would have so much fun talking about me. How's that oatmeal? So I was wondering, if you already have pneumonia, how are you going to sue me for giving it to you? I've never heard of this before and I'm wondering how that works."

I finally figured out how to eeeeeeeeeaase my chair back little by little until the dialysis machine was between me and his line of sight. I could still monitor him but he couldn't see me and, well, it's sort of like dealing with a baby. If he can't see you, you don't exist anymore.

Pretty soon his wife came in. A lovely woman, very attractive, every hair in place, dressed beautifully and very attentive to him. And he was a complete bastard to her. She didn't speak English and so he felt free to say ugly things about her to me.

I forgot. People suck.

Then there is the "nurses eat their own" thing. Yep. It's true. Since it was my first day on this unit I had to figure out where things were, how to make unruly equipment do what it is supposed to do, you know, just figuring stuff out. Every time I came out of the room to ask a question, I was met with much eye rolling. Once I stepped out of the room and two nurses were at the nurses' station and I asked a question. Both of them ignored me. I know they heard me. I'm loud. My mother would tell you. Finally a tech walked by and asked if I needed anything. I said "Oh thank God. For a minute there I thought I was invisible since nobody seems to notice me."

Probably not the smartest thing to say, but I'm only working near them, not with them. I could see the nurses huddling up, talking about that "stupid dialysis nurse". Wow. Eighth grade all over again, only without acne and I can smoke in front of anybody I want. And I have a driver's license. And a paycheck. Neat.

But I took the high road. When I left the unit I gave the nurse report on my patient and was all professional and business like. I thanked her for everything and said "I look forward to seeing you next week. I really enjoyed my day." If she thinks I'm crazy maybe she won't poke a stick into my cage.

The other thing that could be a negative is the ominous rumbling of many long hours. Yeah the nurses earn six figures but they earn every single penny. I'm hoping that somehow I can balance those long hours doing things I would usually do with my down time - reading, crossword puzzles, surfing the net on my Blackberry. But I get the feeling that somehow it's not quite going to work out like that.

At any rate, I can't think of any other nursing job that would work for me at this stage in my life. I won't be running up and down the hall, patient to patient, juggling hundreds of life and death details. The next patient who asks me why I'm so incompetent and stupid I'll just say "would you like some fries with that?"

Sunday, April 20, 2008

Nursing School Books

With three weeks to go until the end of nursing school, I have found myself with more time on my hands and, well, more time to goof off. But this is creative goofing off.

I desperately want to purge my office of all nursing school detritus, but I still have an exam and a final to go, so I can't just yet. I have a butt-load of books and I'm sick of looking at them. So as I sit here staring at them, watching my bookshelf groan beneath their collective weight, I got to wondering how much they weigh. Unfortunately I don't have a scale.

I don't own a scale out of principle. I find out how much I weigh once a year when I go to the doctor. That's all I need to know. I don't need to watch myself lose and regain the same five pounds over and over again. I have better things to think about.

Still I have the urge to measure my books. Since I can't weigh them I decided to stack them up and see what that looks like.

Oh I also measured the height of the stack to fullfill my need to quantify my books. The stack is 42 inches high. To the right of the stack is a 16-ounce bottle of Dr. Pepper in case you need some sort of scale. Some fools drag these things to class in their backpacks on wheels. My approach was to find a spot in my house and claim that as my work/study area and leave them alone. This worked well for me. I didn't take a single book to class - maybe once or twice in the beginning. I quickly figured out that all I needed for class was the Powerpoint presentation du jour tucked into a nice plastic folder. Voila! No backache.

So in case you're dying to know what these books are, the following is a list of books that I used during the two years of nursing school. Some of these books were purchased during pre-regs but I used them during the course of nursing school even though they aren't nursing books per se. I have two or three other books that I bought but never used, so they weren't included in the photo.

So here is the list starting from the top of the stack.

1. RN Notes. Myers
2. Nurse's Med Deck - Tenth Edition. Deglin, Vallarand
3. Mosby's Pocket Guide to Basic Skills and Procedures - Sixth Edition. Potter, Perry
4. Mosby's Diagnostic and Laboratory Test Reference - Eighth Edition. Pagana and Pagana.
5. 2008 Edition Nurse's Drug Handbook
6. Stedman's Medical Dictionary for the Health Professional and Nursing - Sixth Edition. Lippincott, Williams, Wilkins
7. Laboratory and Diagnostic Tests with Nursing Implications - Seventh Edition. Kee
8. Success In Practical Vocational Nursing - Fifth edition. Hill, Howlett
9. Nursing Diagnosis Handbook - Seventh Edition. Ackley, Ladwig
10. Live Review Course for NCLEX-RN Examination. Elsevier
11. Advanced Cardiac Life Support Provider Manual. American Heart Association
12. NCLEX-RN Strategies for the RN Licensing Examination - Kaplan
13. Pharmacology and the Nursing Process - Third Edition. Lilley, Auker
14. Introduction to Microbiology - Third Edition. Ingraham, Ingraham
15. Contemporary Psychiatric-Mental Health Nursing. Kneisl, Wilson, Trigoboff.
16. Dosage Calculations - Seventh Edition. Pickar
17. Nutrition and Diet Therapy - Sixth Edition - Cataldo, DeBryne, Whitney
18. Human Anatomy and Physiology - Sixth Edition. Marieb
19. Wong's Essentials of Pediatric Nursing - Seventh Edition. Hockenberry, Wilson, Winkelstein.
20. Clinical Nursing Skills - Sixth Edition. Smith, Duell, Martin
21. Old's Maternal-Newborn Nursing and Women's Health Across the Lifespan - Eighth Edition. Davidson, London, Ladewig
22. Medical Surgical Nursing Volumes I and II - Fifth Edition. Ignatavicious, Workman
23. NCLEX-RN Review- HESI
24. Saunders Comprehensive Review for the NCLEX-RN Examination Fourth Edition - Silvestri
25. Understanding Pathophysiology Third Edition - Huether, McCance
26. Fundamentals of Nursing Sixth Edition - Potter, Perry

I also have the urge to calculate the cost of these books, but I'm all out of goofing off time for today. My rough estimate would be $3,000.

Friday, April 18, 2008

HESI Happiness

I am pleased to report that I passed the HESI exam with flying colors. Passing score is 850. My score - 988.

I have mixed emotions. I'm elated that I was able to pass, but I am devastated that some of my classmates did not. They get another chance in 2 weeks, but it's difficult to try again once your confidence is shaken by not passing in the first place.

I wish I could tell all you future and present students what it takes to pass. I know what worked for me but everyone has to find their own way.

Okay. I'll tell you what I did.

* Stay on top of the material all the way through. If you learn it the first time around, getting ready for HESI is a review. It's not as if you are seeing the information for the first time.

* If you tank on a nursing school exam, be honest with yourself and go back and review the stuff you struggle with. Don't blame it on the test, the teacher, the weather, etc. If you aren't getting it, go back and get it.

* Stick to nursing process. Many of my classmates, even at the end, are still trying to approach the material as being able to define what something is. The test gives you a scenario with several right answers. You have to pick the BEST answer. For me the secret is this. If the question says "symptom, symptom, lab, lab, observation observation" - look for key words that tell you what the situation is. Is it heart failure? Renal failure? Pneumonia? Peripheral neuropathy? Once you establish what the disease in question is, think about what you AS A NURSE will do for this condition. In other words, go to INTERVENTIONS in your mind. Remember all those fugly care plans you had to do? HESI is the reason you had to do them.

* Know the normal labs. If the question gives you a lab result and you don't know if it's normal or not, you're dead in the water. If you know, for example, that the potassium is low, then you know what to do about it.

* Know the meds. Granted there were several medications on the test I'd never heard of, but the medication I had seen before, I knew what it was for, what the side effects are, and what a normal dose would be. So if you can't learn every med, at least know the meds you know backward and forward.

* Know medical tests. Know what an MRI is, an angiography, a barium enema, a CT scan, a hysterosalpinogram. Know if there is contrast dye involved. Know that if someone is allergic to shellfish or iodine, they can't have contrast.

* Have an understanding of the nurse practice act, delegation, legal responsibilities, therapeutic communication and cultural norms. It is tempting in the beginning of nursing school to want to skim over these topics and get to the "important stuff" like heart disease and stroke. Give these things your attention right from the start. It's not a lot of material, but you will see it over and over again. By the time you get to HESI you will have seen it so many times that it will be a no-brainer.

Many of us on the way to nursing school got really clever at figuring out to get the best grades for the least amount of effort. It got us into nursing school, but it hurt us in the long run. Some of us, and include myself, were in for a shock when we got to nursing school and found that there are no shortcuts. Those of us who made it accepted that early on and stopped looking for them.

Now that this ordeal is over I hope to gradually get my life back to what is seemingly normal. I don't have to drag a book with me everywhere I go. I can let go of some bad habits I picked up to cope with the stress. I can think about what I want to do in the abundant spare time I will now have.

And I'll blog some more. Twenty-one days from now when I graduate, I'll have to think of a new theme for my blog. It remains to be seen what direction it will take, but hopefully it will be something entertaining and maybe useful.

I don't know, but what I do know for sure is I'm going to have a spa day to celebrate my success.

Tuesday, April 15, 2008

HESI

The HESI or exit exam is this Friday. I'm trying to look over anything that I'm not quite sure of with just a little bit of time left to do it. It's nerve wracking that we must pass this test to graduate. The good news is we get two tries. If after two tries and don't pass we can remediate over the summer and try again.

I'll write more after I take the test and let you know how it goes.

Twenty-two days to graduation. Hooo-ah.

Thursday, April 10, 2008

Do You Believe in Life After.......Graduation?

As the semester winds down and graduation draws near, I'm finding it more difficult to find things to blog about that are relevant to nursing school. When I began this blog I had an acute interest in things that matter to a nursing student. Now I really couldn't care less. I suppose with a little time and distance I'll feel like blogging about it again. For now though, my mind is filled with thoughts of life after school.

As I look around my messy office I'm already making plans to purge just about everything that relates to nursing school. Some of my classmates have talked about keeping their text books "as a reference", but hell, some of the information is already outdated. What's the point?

As an update to the internship scramble, most of my classmates are settled into one job or another. I myself have taken a new job doing inpatient acute dialysis. I still work for the same company, but instead of working in a clinic and caring for four patients at a time, I'll work in the hospital and drag the machine to the patient. But don't feel sorry for me. The nurse/patient ratio is 1:1 and I get to sit down for the treatment. And read. And do crossword puzzles. And surf the net on my Blackberry. I'm sure there are some miserable details about the job that I hadn't thought of yet, but for now I want to bask in the glow of delusion and marvel at what I feel is the perfect job for me.

My classmates have done such a good job securing jobs that I have to tell this hilarious story on the subject. Our college had a health fair that we were forced asked to volunteer for. As part of the health fair, local hospitals, rehabs and nursing homes set up booths as sort of a job fair - a job fair that was not announced to anyone. So naturally no one showed up with resumes or anything.

One of my classmates was cruising the booths and scamming complimentary pens, Frisbees and candy bars when someone behind a booth began complaining loudly to her about the nursing students. The complainer said "this group of nursing students has the worst attitude of any class of nursing students I've ever seen. Not one student has brought us a resume or asked for a business card." Without missing a beat my classmate said "That's because we all have jobs already."

Oooooh. Snap! Take that, you ornery recruiter.

Tuesday, April 1, 2008

Tune In, Turn On, Clean Out Your Backpack

Remember time capsules? If you don't, I'll tell you it's part of some of the 60's stupidity that people thought would turn out to be the wave of the future, along with communal living and EST. But if you read the Wikipedia entry, there is mention of unintentional time capsules, and it turns out that I have one here in front of me.

Yesterday was my absolute last hospital clinical. I will celebrate this event by dismantling my clinical bag. Join me as I open this capsule and take a peek into 18 very interesting and stressful months of my life.

I remember putting it together thinking ever so carefully about what I might need when I would start hospital clinicals. I remember asking for advice at allnurses.com about what the well-prepared student should include in her pack. Now as I pull it out in reverse I'm laughing at what seemed like a good idea at the time, and nodding with self-knowing at what was really useful.

*RN Notes. Not useful at the time, but very useful as a review for HESI.
*Drug book. If I had it to do over I'd use a Palm Pilot or Blackberry.
*Basic Skills and Procedure Manual that I bought this last semester. I wish I had it first semester because now I don't need it.
* A clinical binder. Somewhat useful. It has folders and pockets for keeping stuff organized.
* Stuff in the folders and pockets in the clinical binder.
-A table of IV compatible drugs. Never used.
-A list of NANDA approved nursing diagnoses. Glanced over once or twice.
-An EKG rhythm strip to practice identifying rhythms. Still can't identify it.
-Pulseless VTACH algorithm. Very useful when I was getting ready for ACLS. Now that I'm certified, who cares?
-A colorful chart of most commonly abused pharmaceutical substances. Never used but might come in handy if I don't pass HESI and need to find some street drugs of my own.
-A Powerpoint presentation given by one of my classmates on Marfan syndrome. Was I even there that day? I don't even remember this.
-Some hastily scribbled post-conference notes. Might come in handy if I could just read my own writing.
-A thick sheaf of looseleaf notebook paper that I thought would be more useful than a wire-bound notebook. What the hell am I going to do with all this looseleaf notebook paper?
-An ominous list of instructions for a community clinical from first semester. Oooo, have your clinical care form with you OR ELSE!!!
-A checklist for my instructor to use when I was checked off for Foley catheter insertion........first semester? Wow. Did I get checked off or not? Will the board of nursing find out?
-A Wong faces pain scale. Lest I ever forget how to use it or I can't remember that 1 is no pain and 10 is the worst.
-Step-by-step instructions for various procedures that if you held a gun to my head I couldn't do correctly and neither could anyone I spent any time in clinicals with.
-Ten photocopied patient care worksheets that I created for when I took care of more than one patient at a time. Those actually came in pretty darn handy. I'll keep those in case I ever work in a hospital again.

This is fun. What else is in here?

A cosmetic bag with two compartments that contain.....
*A penlight. Used, oh, five or six times. Pupils never moved on anyone I ever looked at.
*Bandage scissors. Very useful.
*Pens, pencils, erasers, a small rule, write-on page tabs. All very useful.
*Ear plugs. Very useful for studying in noisy libraries. Before you were born libraries used to be quiet places where people could read in peace, and someone would come from behind the counter and shush you if you didn't whisper. I swear I'm not making it up.
*Batteries for MP3 player. First year I recorded all our lectures. I think I listened to one or two of them. This year I didn't bother.
*Breath mints, travel-sized deodorant, anti-gas tablets - all stuff that shows I care enough about my classmates to not subject them to my BO, bad breath or noxious emissions. Trust me. You get so busy in nursing school that sometimes you forget to put on deodorant before leaving the house.
*Feminine hygiene products because menopause did not visit me this year as I had hoped.
*A stick of Carmex lip balm and a travel-sized bottle of hand lotion. Probably the most-used items in the bag.
*A beaded badge holder necklace that I made myself to match our school uniform. It was completely the wrong length so as when I was putting a Foley in a patient, the ID badge got caught in the bedrail and snapped off. But hey, the necklace didn't break! That's the important thing.
*Band-aids and alcohol prep packs that I probably emptied out of my pockets during post-conference.
*Hemostats. Never used. Now, if I just knew a pothead that could use them.
*Change. Hey! I could buy a candy bar for the pothead!

Also in the bag I find.......
*One blood pressure cuff. Bought that for an assignment the second week of school where I had to interview an elderly person and take their vital signs. I never used it again.
*Candy wrappers. Those aren't mine. I swear!
*Trauma shears. These were part of a lab pack that we used first year and I took them out and put them in my bag when I lost my first pair of bandage scissors. When I overhead some nurses laughing at my trauma shears behind my back, I went out and bought some new bandage scissors and threw those shears to the bottom of the bag.
*A small plastic retractable tape measure. I can't remember what I thought I would use this for. Never used.
*A stethoscope. Oh, I remember the first time we had lab and me and my classmates marching proudly into class with our stethoscopes around our necks, looking all nursey and legit. I remember how the stethoscope was an outward symbol of all the hard work and sacrifice that went into getting ready for nursing school. Yes, it's a powerful symbol and probably the second most-used item in my bag.

*A small spiral-bound notebook to write notes about my patients. Let's see what I have in here. Hmmmm.
-Clinical instructors' cell-phone numbers. I'll keep that for future drunk dialing. Just kidding!! I don't even drink.
-Door codes to the patient nutrition room. Might come in handy. Next time I'm in the hospital visiting a friend I can raid their snack drawer and help myself to coffee.
-Some vital signs. Some lab results.
-Phone numbers for people who might be able to put in a word for me in case I want to work on a certain unit. Naaah.
-A tiny drawing explaining osmosis. Not bad!
-Pick up gift for Tara's baby shower. Shit! That was last year! The kid's probably driving now.

Sure was fun exploring my nursing school time capsule. To summarize, the most useful things to pack in your nursing bag is anything that keeps you odor free, your skin soft and prevents chapped lips. Next is your stethoscope and a little notebook to write cryptic notes that you will laugh at later.

Thank you for attending this time capsule ceremony with me. Refreshments will be served in the back. One slice of cake per customer, please.