NursingZen

“Our parents are always telling us that we don’t have any special talents, so we need to just work and study hard to get what we want, so when people [counselors, colleges, teachers] tell us we need to talk about how great we are and all our skills and talents, it’s really hard. We don’t believe we’re special and we don’t know how to talk about ourselves like that.” — C.C., 16-year-old Chinese-born American.

C.C. tells me this as I help her rewrite her practice cover letter and resume and figure out what makes her stand out. While searching for RN jobs in this dismal market, I’m also working as a counselor for a 3-week UCSF summer program for underserved high school students who are interested in careers in health care. Like I was, most of them are going to be the first in their family to attend college and most are Asian American.

As C.C. shakes her head dejectedly at her letter, I can’t help thinking: “Ah, the way of the immigrant Chinese parent in America persists through the generations! Dish out loads of “constructive” criticism and stand doggedly by the belief in the “American dream” and in the fact that the dream can be built upon a meritocratic system, and ta-da — your hard work will be recognized and you will get what you want.”

But every savvy American, seemingly many UCSF students, and enlightened Asian Americans know that it’s not that straightforward. Work hard and you will gain knowledge and confidence in yourself. But to get exactly what you want? For that, you have to strategize. You have to (loudly) praise yourself. You have to market yourself. You have to knock down doors. You have to raise your voice. You have to network and make connections. This is what’s real in our society, and this is what I begrudgingly tell C.C., while at the same time empathizing with her…

• Yes, it feels strange to call attention to one’s self.
• Yes, it feels wrong to boast and self-aggrandize.
• Yes, it’s just plain weird to call out something personal like “worked at 7-Eleven to help support family” as something notable to write in a college essay or cover letter.

“‘Work to help parents pay the bills’ – I’m not proud of that, no one wants to do that, but all of a sudden that’s supposed to be amazing?’”

I asked this more than once when I was trying to figure out how to present myself to colleges. As the first in my family to go to college, my parents couldn’t give me advice other than “study hard.” Through pure heresay, street smarts, and a tiny bit of h.s. counseling, I learned that for someone who didn’t have the opportunity to take piano and dance lessons, to do volunteer work in Guatemala, or to attend pre-college programs at Yale, my edge over other college applicants would come from the seemingly mundane. I had to learn to be proud of my experiences, believe that I had something special to offfer, and express it to strangers.

I know it’ll be a long time before many of these students are convinced that anything they’ve done or experienced will be interesting to college admissions officers, scholarship committees, or internship recruiters. Over time they’ll get how to play the game and over time they’re going to find a way to reconcile what they need to do in reality with the values their parents taught them. Over time.

*********

The summer h.s. program ended a couple weeks ago. I had an amazing time supporting the kids and seeing them come in day after day at 8:30 a.m. to soak up knowledge about the sciences, health care, and higher ed. The kids were smart, motivated, spunky, sassy, and they affirmed my growing interest in outreach to underrepresented students in health care. The program culminated in a reception dinner where they made health-related presentations to their parents and friends. They made me teary-eyed with pride … so this is what it feels like to be a teacher or parent!

My schedule: Self-study Monday through Friday, 9 a.m to 5 p.m. over three weeks, give or take a couple hours off. I think the Saunders comprehensive review is basically all I need.

A study break:

Courtesy of Facebook & Nurstoon.com

1.  Plan ahead for sleep management. (How will you fall asleep when anxiety keeps you up till 2 a.m. and you have to leave the house for clinical at  6 a.m.?)

2.  Plan ahead for mental health. (Even if you’re skeptical, try to talk to a Student Health counselor at least once as soon as you start hating on your classmates, MEPN, and/or the world.)

3. Buy compression socks (15 mmHg).

4. Don’t follow the rules. (See my update to Things I wish I knew…).

5. Be flexible. When things get hard, just remind yourself, “What did you expect?” A classmate said this all the time.

… I start posting fun pictures! Recently, my partner put on his headphones and started DJing again after a 2-year hiatus (note the little guy, the #1 dancer at this small daytime party). Slowly but surely I’ll be dancing it up this summer at the many outdoor dance parties in the area.

I’m republishing something a very cool older Filipino male nurse said to me when I was taking pre-requisites for MEPN:

“You can do anything, and everything is worth trying because you never know what you will think or how you will do. Don’t listen to what others say. Don’t let their anxiety or even pragmatism scare you.”

I have one half day of community clinical left. One half.

I finished my last paper last night.

I have an interview this week.

I just turned a year older.

I am so excited for the next phase in my life that I can barely contain myself.

It’s taking everything I have to not insert a flurry of exclamation points throughout this entry.

Just when I had made peace with not working for a while and passing the summer like a kid again,  I got a call for an interview. It’s not the most ideal place, but I just want a chance to be seen and heard. This past week a few friends who were despairing as much as I have landed jobs. Whatever happens, I’m thrilled to start being a nurse (after the NCLEX).

Next week will be a flurry of activities, from graduation to bachelorette party to BBQs. Who says going back to school is no fun?

Projects I have on my list this summer of 2008, almost like when I was 15: reading, writing, sewing, making jewelry, biking, rock climbing, and road trips.

Thank you to you nursing students and nurses who have taken the time to write to me and cheer me up. Yes, I’ll be continuing this blog as a new nurse. I think the stories and experiences will only get more intense!

I’ve been in a funk, but am letting it be. It’s normal and it’ll pass. When former MEPNs told me how “intense” the year would be, I had no clue what they meant. The truth is, the experience is different for everyone. I’ve been extremely blessed — my exhaustion with MEPN didn’t set in until this quarter. Now I feel like I’m running a marathon. It’s going to take all I’ve got to stay motivated these last four weeks.

Contributing to the blues are the fact that student fees might increase next year, a week of groceries today cost $95, and I may have no nursing job in the foreseeable future. The bleakness is exhausting. My body just melts into my bed when I climb in at night, and in the morning, I struggle to go to class. I missed clinicals for the first time this year; I simply woke up one morning, and feeling defeated by the job hunt, said: “Screw it. Where has all the year’s hard work in clinicals gotten me?”

I guess I should back up a bit. What’s been going on these past two months is that many of us have been applying for positions in New Graduate Training Programs at various hospitals in the bay area, which are a requisite for people who have never held an acute care RN job before. Given the purported nursing shortage, the reputation of UCSF, and our own healthy egos, we expected to handedly land an interview and then a job. Some of us had been planning to step out of the nursing program for a year or two before going on to our Master’s studies. Oh, I had it all figured out: graduation in 4 weeks, study for NCLEX for 2 weeks, relax on a tropical island for 2 weeks, start working this summer at my Med Surg clinical site, and give my partner a much-needed break from being the Home-Bringer of Bacon.

Alas, little did I know that my plans would become foiled by… our (imminent) economic recession! An uncertain economy means that more nurses are working full time instead of part time or per diem, more are taking additional shifts, and fewer are choosing to retire or stay home with the kids. Here’s an article about how the recession is affecting nurses.

More good news: The job market for new nurses is especially bleak in San Francisco — ‘the only place in the country that has no nursing shortage’ (in-class communication, Dean of Nursing Kathy Dracup, May 2008)! Apparently wages for nurses are the highest here than anywhere else, so nurses flock to San Francisco, work for a few years, save up loads of cash, and eventually return wherever they came from to buy a home and live the good life (lecture presentation, UCSF Recruiter David Kirk, May 2008). Ah ha — nurses are so smart! Why can’t I want to live in Alabama?

Compounding the problem is San Francisco’s $251 million budget gap this fiscal year. Bearing the brunt of the city’s budget cuts is the public health department, including San Francisco General Hospital, a place that one recruiter claims “LOVES MEPNs.” In fact, the recruiter told us cheerily: ‘Just a couple years ago we took every MEPN who walked in our door!’

A handful of classmates have landed interviews and jobs, but I like to think that their circumstances are not exactly the same as mine so I don’t feel like a total nincompoop. (Can you tell the job hunt has tarnished the self-esteem a tad?) When there are 200-plus applicants for 20 positions in a new grad med-surg program at Kaiser or UCSF … well, those who put on their dancing shoes get the worm. Hmm, 200 applicants for 20 positions is a 10% chance, which makes the challenge of getting accepted into MEPN look like a walk in the park.

I’ve got super-duper skills and experiences and I really, really want to — can’t wait to — start my nursing practice! Can anyone hear me??

Labor & Delivery has got me thinking about my own family planning, and happily so. I couldn’t have said that a year ago, when the thought of having kids and being a parent made me cough and squirm.

A year ago I was surrounded by single friends or committed couples who were happy enough raising their dog. Furthermore, an untraditional and unstable childhood had dampened any interest in giving up the freedom I had found in my 20s.

But since the new year I feel like I’ve turned a corner and entered a space where I can imagine having a kid and being a good parent. I’m sure it helps that for the first time I have peers who are also starting to think seriously about having kids. … It’s strange yet refreshing.

It’s even more refreshing to be in an L&D course where our teacher shamelessly and enthusiastically indoctrinates us with knowledge about pregnancy and birth that you don’t easily learn about from mainstream media or mainstream health care.

When someone mentions pregnancy, labor, and birth, what do you automatically think of? Do you wonder how birth is physically possible for anyone to do? Do you taste fear? Do you imagine an exhausted, sweating woman on her back and people yelling “PUSH!” from all directions? Do you imagine excrutiating pain and a mess of blood and poop? These are some of the associations I used to have with birth.

Then I watched “The Business of Being Born” and met my L&D teacher. Suddenly, a whole new side to the birth process opened up. I was stunned! Transcending the pain was absolute euphoria! An alternative to a medicalized, hospital-based birth was a midwife-assisted home birth! Instead of lying on your back in pain and in fear, you should actually walk, stretch, float, dance, yell, and get massaged!

All these alternatives seemed like a novelty to me … even though most of the world does birth this way. Talk about being ignorant.

But now I feel enlightened, and I just realized that I can go on and on about this. I’ll wrap up by saying that no matter what your feelings or opinions are about labor and birth, start a discussion with yourself and your friends by watching “The Business of Being Born.” It might change your life like it did mine.

Labor & Delivery clinical has been thrilling. I saw two Cesarean sections and assisted with the pre-op and post-recovery of the moms and babies.  I caught the tail-end of a natural, spontaneous vaginal birth in which the baby popped out after 10 minutes of pushing. I swaddled and held a newborn.

Labor & Delivery has also been challenging. A large part of our role as a student is to give the mom mental and emotional support during her labor or C-section. Yet here I am still getting comfortable with simply witnessing labor (especially “crowning” — the moment when the baby’s head pushes through the vagina) and Cesareans, so needless to say, I feel a bit helpless when it comes to providing support. But since it’s basically all we’re allowed to do on the floor (aside from routine procedures, like taking vital signs or giving shots), I suspect I’ll be getting some practice!

March flew by in part because of our three luxurious weeks of spring break. We’ve now returned to our last quarter of MEPN. Amazing. The anxiety and sleeplessness of the first quarter seem like a lifetime ago. The Pediatric and Psych experiences are still palpable, but at 6 (?) and 4 (?) weeks each, they were far too fleeting. Now we’re in Labor & Delivery and Community Health Nursing, which together take up five days of the week.

Despite the schedule, I have a feeling that L&D and Community might be the most enjoyable and interesting for me, thanks to a mindful and passionate L&D professor and a nurturing and laidback community clinical placement. My Community clinical is also a much-needed reality check: After the hands-off experience of Peds and Psych, I’m realizing just how rusty my basic nursing knowledge is. For example, on my first day in Community clinical, I recapped a used needle with my RN preceptor watching. She said: “Never recap a used needle – now I know they taught you that.” In my opinion, she was too nice about it. The next day, an NP watched me as I gave a vaccine shot. I forgot to put on gloves. Right. Basics, baby. Basics. I don’t want to make excuses for my idiocy, but I will: This year has been so fast and so up and down in terms of quality of clinicals and preceptors that I haven’t been able to concretize and hone my knowledge and skills as much as I’d like.

But even though I feel rushed in my preparation as an RN, I’ve seen enough good and bad bedside nursing that I know the kind of nurse I want to be. I’ve seen enough wonderful patients, enough disparity in care, and enough burnt-out nurses that I want to help bring in new energy, a dose of optimism, and high standards. While some of my classmates are looking eagerly toward the Master’s program next fall and to becoming NPs, CNSs, or midwives, I’m planning to develop my practice as a bedside nurse for a year, maybe two, while taking time to finish my Master’s (speciality still to be definitively determined, thanks in part to an interest in too many fields –– to be discussed another time).

I’m not sure when it happened but somewhere along the way the words “my practice” started to mean something to me. Months ago I heard a classmate say, “I want school to be over. I can’t wait to develop my practice,” and my internal reaction was, “Huh? We’ve barely been in school. What practice is she talking about?” But over the last nine months I began to see just how differently each nurse interprets the role and responsibilities of being an RN and how much freedom each New Nurse has to define and shape the kind of RN she wants to be—in other words, how well she understands disease and nursing interventions, how safely and critically she will practice, and how brave, outspoken, present, and compassionate she will be. Dare I say it … I can’t wait for my practice to begin.

Week 3 of Psych clinicals, done. It has been enriching, fun, boring, sad, nerve-wracking, and strange, all within a matter of minutes. You never know what you’re going to get.

Going with the flow
One moment my patient answers all my questions with a smile; the next moment he tells me he’s tired of everyone asking him the same damn questions. One moment a man is pacing the halls, pushing at locked Exit doors, and cursing, and another moment he’s having coffee and alternately smiling and frowning as he tells me how he’s going to burn in hell. One moment a man announces that if he doesn’t get discharged today he’ll kill someone; the next moment he’s willing to play Bingo! if he can win a pad of paper on which he can write about his study of Taoism.

Favorite moments

• Coffee hour on the patio brings everyone out, including the motor-mouth schizophrenic, the depressed, the anxious, the angry, and the fast walker. A garrulous bipolar man takes out his classical guitar and strums old tunes. He sings while the others nod along. The fast walker, a paranoid schizophrenic, belts out “America the Beautiful” with his eyes shut tight and his weathered face tilted toward the sun.
• The nurses’ therapeutic interactions. Although we think they’re few and far between, these interactions have stayed with me: the short Papa-Smurf-(sans-blue)-looking nurse, speaking authoritatively to an angry, towering patient; the nearly retired “mother” nurse, hugging and clearly loving the demented man who sits all day staring at and folding newspapers; and the energetic, idealistic young nurse playing guitar and singing to patients when he’s on his lunch break.
• The nurses’ smiles and sometimes inappropriate jokes. Their lightness isn’t hard to get used to, a far cry from the tension of many Med Surg nurses.
• Playing Bingo! with 8 patients, and not giving up on the ones who first balked at the idea.

Difficult moments

• Encountering the manic patient, who is intrusive, hypersexual, and just plain rude. We avoid him while feeling badly for him.
• Reading about or listening to the patients’ past. They’re survivors of broken homes, war, incest, rape, suicide attempts, and unforgiving religious indoctrination. A couple are perpetrators of rape and violence themselves.
• Trying to talk to an old, confused man whose slow responses, blunted affect, and increasingly soft and shapeless features remind me of a loved one.

Last week was our first half day on a Psychiatric nursing floor. To say my classmates and I felt like fish out of water would be a huge understatement.

To enter this acute psych unit, a nurse has to unlock two doors; he warns us to always check the corners of the doorways for patients who might try to dash out an opened door. As we step on to the unit, a thin sprightly man in a large red T-shirt walks past us at a furious pace and greets us with a hello. We learn he paces miles each day from one end of the unit to the other.

Imagine an ‘L’ shape floor with rooms lining the halls and a large stark but sunny common area in the middle of the floor. The common area is lined with chairs with about 10 people sitting in the chairs. Most of them are directed toward a large-screen TV in the corner, while a few stare straight ahead. We enter the nurse’s station, which they call the fishbowl, and indeed it feels like one when patients press their faces into the window to look at us. It also feels a little like a command center because we can easily look out at all the action in the common area. Well, inaction would be a more apt description.

We spent some of the morning pressing our nurses for a clear idea of what it is they do exactly, what the nursing plans are, and what we could do. We were on “med-surg mode,” which meant we were ready to go, and we were hypervigilant about being scolded for sitting down, chatting, or otherwise not doing much. Med-surg broke us in, alright. At first we couldn’t even sit down and relax for more than 5 minutes. Gradually it became clear that med-surg mode wasn’t Psych mode. Psych nursing is its own thing entirely. I’m still figuring out what it is exactly, but in the meantime we were to try to talk to the patients and assess their condition, watch certain ones while always keeping our back to the wall, and try to engage them with games and crafts. The disorders on this unit range from schizophrenia to major depression and suicidal ideation to alcohol withdrawal.

Taking a deep breathe, I introduced myself to some of the more ‘present’ looking patients and tried to chat. One person was tearful and didn’t want to talk because he was thinking about his wife. Another looked like Spock. He replied slowly with one or two words, then proceeded to stare at me without blinking for some very long minutes. Oh how I fumbled with my hands! I awkwardly placed my hands in my pockets, behind my back, across my chest, and in front of me in a teepee formation, all during just one brief conversation. Hmm. Yes, I think I’ll go now.

Games sounded like a good idea. A nurse assured us at least one or two people would come flocking to us. We found a brand new deluxe Uno set and set up shop at a card table. Oh we had high hopes…but we sat in vain. We tried to rope in some of the more talkative folks, but one gentleman whom we thought held the most promise shook his head and said, “No, no, I can’t even think my way out of a paper bag.”

Mission defeated, we retreated to the fishbowl to gather our wits and read up on the folks we interacted with.  Then it was lunchtime, and the end of our first morning. We vowed to have a better plan tomorrow.

Four weeks of Pediatrics ended last week. I think our Peds professor is the kindest, most fair, and most accessible teacher so far. I feel that if I drop in on her six months from now, she’ll make me feel completely comfortable and welcomed. She’s young and vivacious … I hope she sticks with teaching in the MEPN program.

This week began our Psychiatric-Mental Health Nursing course, which encompasses two full days of lecture and three half-days of clinical. We begin at 7:30 and end by 1 pm, which leaves us some glorious afternoons to do with what we wish.

Prior to the start of Psych, I had apathetic feelings about it. I couldn’t place my finger on why, since I always do my best to be positive and enthusiastic about every new experience. Then in class on Tuesday, something clicked. As the instructor talked more and more about mental illness, depression, schizophrenia, and the stressors and risk factors in people’s lives that precipitate mental disorders, I felt something like quicksand weigh down on me. In no time at all, I began to feel claustrophobic. I had trouble breathing, and then tears started to spill. I had to pinch the bridge of my nose to hold them back.

It dawned on me that I’ve been anxious about Psych because I didn’t want to face the mental illness that has been in my family. I didn’t want to recall that my father was depressed, yet I didn’t recognize it and didn’t do anything to help him. I also didn’t want to be reminded of the fact that another relative is depressed and deteriorating because of Parkinson’s disease, yet I haven’t had the strength or know-how to deal with it. And although I’m writing this down here, I’m not saying I’m ready to face those things head on. I guess I’m writing this because it’s important to me that I acknowledge and make real that this is what’s going on with me this week.

Unexpectedly, Psych might become the most challenging and rewarding class for me this year. Maybe, hopefully, it will help me face my personal issues and equip me with knowledge to help my loved one. I make no promises, but I’m going to try my best to keep an open mind and an open heart.

More later about the first week of Psych clinicals, which has been a mixed bag.

Evidently, after 3 weeks of not having clinicals and a lot of free time on hand, I lost some momentum for blogging. I really appreciate that some of you are still coming back to read and chat with me.

Starting two weeks ago, everyone in the class got assigned clinicals. Some people go for two days a week, others for one. I go for one day of clinicals each week for 3 weeks. My C.I. is new to the role, and a little frazzled, but my group kept kissing her feet for helping out.

As in Med Surg, we follow a nurse and focus on assessing and giving medications for one of her patients. As I followed my nurse on her morning rounds, my first reaction was shock, then sadness. That day none of her patients’ parents were present, so after just a few minutes assessing each child, we left them lying alone in their bed. It’s bad enough to imagine adults lying around bored and lonely, but children … can you imagine them alone for hours at a time? As the morning bustle died down, the nurse and I were able to revisit the babies to cuddle them; the nurses can even put babies who are not on isolation precautions into a car seat and bring them out to the hallway and nurse’s station for more human interaction.

My patient during this first week was a 10 month-old boy with a GI problem. He was also developmentally delayed; at 10 months he still couldn’t sit up. He had a fairly flat affect, but was adorable. Imagine Stewie from Family Guy. I’ll call this kid Stewie, too. Another of my nurse’s patients was a 4 month-old who had been in the hospital since she was born. Because a part of her intestine is non-motile, she has two ostomy bags to drain digested food. I was told that it’s likely she will never be able to eat food.

Aside from feeling nervous about touching these beings that seem so incredibly fragile, the most challenging part of the day was trying not to feel pissed at Stewie’s mother for not being around. My nurse had told me that his mother rarely comes to see him. My initial reaction was to judge her.

Then I found some time to read Stewie’s social and family history, and everything fell into place. His mother is a teenager. She lives in a town far away from the hospital. She works nights at a low-wage job. She can’t afford to travel to the hospital or stay in a motel near the hospital. The father is a substance abuser and is out of the picture.

At only 10 months old, the child is going to be transferred to a pediatric skilled nursing facility for an indefinite time.

Pediatric nursing seems to see the sickest of the sick, as well as children from broken homes and children who have been neglected and maltreated. Pediatric nurses have to be skilled at not only working with kids, but also with their caregivers, and they have to be even more cautious about boundaries. I had suspected that I’m the type to get too emotionally involved with vulnerable children and unfortunately so far I’ve been right.