NursingZen

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.

In response to my post last week, a classmate offers a slightly different take on this quarter. It also seems that s/he had different information. (Thanks for chiming in, fellow MEPN!)

In response to question #1: There has been a lot of misinformation passed around, especially when word travels so quickly. We were informed that the search for CI’s began last March, NOT during the Christmas holidays. The CI’s that were hired either went on maternity leave or flaked out at the last minute. No one could’ve predicted that it would come to a head like this. It is an unfortunate situation, but our wonderful professor, superstar that she is, has worked around the clock and pulled strings so that all of us (regardless of our clinical placement) can get some inpatient peds experience.

As for question #3: We were also told the peds course was not designed for every student to be on the floor every Thursday and Friday. That would make it physically impossible because we would be tripping over each other. The observations at the day care centers, the community health clinic, in urgent care, etc. are not “distractions.” They’re intended to provide us with a holistic view of peds nursing, giving us a sense of taking care of children in different states of health.

Keep in mind that this course is only 6 weeks long (and we’re at the half-way mark). There is only so much you can learn even if you were to be on the floor every Thursday and Friday. Let’s try to stay positive.

A fellow MEPN, who is in Group B, has started a blog about his own journey, with particular focus on ethical issues. I like. (And wish I had the same diligence to write as he does.) Read The One Year Nurse.

On Monday I joined a meeting of frustrated students to write a letter to the school with concrete suggestions about how our Thursdays and Fridays could be put to good use if clinical instructors are not found by the end of the week. We came up with great ideas, such as having optional lectures by a variety of guest speakers who we wanted to hear from (pediatric nurses, advance practice nurses specializing in pediatric diabetes and other conditions, Pediatric Advanced Life Support training, social workers, caregivers of sick children, etc.). We requested a meeting with the powers that be by Wednesday, since we felt time was quickly slipping away.

The letter was well received by the rest of the class, and we sent it off with some hope, a dash of relief for taking some kind of action, and more than a bit of skepticism. We quickly received a reply that didn’t surprise any of us. It read something like: Thank you for the great ideas … your patience is appreciated … Next step plans will follow in the days to follow …

But to their credit, slowly over the next couple days we received news that a few more people would have a rotation through a hospital this week. A couple new CIs had been pulled in. With every announcement, every one of us clamored for an opportunity to see a sick child—and to learn.

Finally, some nursing…
Yesterday I had the opportunity to shadow a Home Health Nurse on a home visit to a newly discharged newborn and mom. The purpose is to check the mom for hemorrhage, infection, and stable vital signs; see how she’s lactating and bonding with her baby; assess her mood; and check her meds. For the baby, the nurse wants to make sure the weight is stable, assess the level of jaundice, and do a complete head to toe assessment. Michelle, the nurse, had worked in Labor & Delivery for about 20 years and had become a certified lactation consultant. Unfortunately she had only one assignment that day, but the upside was that we could spend more time with the family.

The mother was breastfeeding when we arrived (surprise!). The parents were in their early 30s. The baby girl, just four days old, shocked me by how small she was, and how deafening her cry was. She was a full term baby but she weighed 6 pounds so her “newborn” socks and beanie hat kept falling off her (hee hee!).

I could tell the parents were happy but very anxious. They were worried that their baby was feeding every single hour throughout the day and night. Could it be that the mom’s breast milk was not nutritious enough? They had a list of questions for Michelle. Here was where I love the role of the nurse. As she conducted her physical assessments on mom and baby, Michelle answered their questions with ease, confidence, and humor. The parents needed to hear that everything that was happening was normal, that their baby was healthy and strong, and that they were being good, attentive parents.

I finally got to place my stethoscope on a child, and was thrilled by the speed of the baby’s heart and the soft, slight breath sounds. I also palpated her head and inspected her spine. When I touched the baby with my suddenly huge (and cold) hands, I grimaced to myself: Wow, I feel like a real live ogre.

We spent two hours with the family. Time is what Michelle says she loves most about doing home health. Her parting words to the new parents were: Try to be gentle with yourselves.

Week 1
Winter quarter started Wednesday, January 3. Family & Child Nursing is our main course, and it lasts only 6 weeks because we will then have Psychiatric nursing. Our Pediatric clinical rotations were scheduled to begin this first Thursday & Friday, but at the last minute we were told that some of us had the week off and some were observing healthy kids at daycare centers instead. Still in vacation mode, many of us were relieved to not have to jump right back into back-to-back 12-hour shifts. We thought our professor was being kind to us.

Week 2
The Family & Child Nursing readings and lectures are well under way. Because the course is 6 weeks, it’s going to fly by. Med-Surg is our foundation, but we’re now learning about how pediatric health conditions and nursing interventions differ from adults. Child development informs everything. It’s a refreshing way to look at nursing. As I read the text, I’m intermittently excited for the challenge of working with kids and their parents, and also worried about seeing very sick children. The thought of sticking a needle or a foley into a child pains me. But the professor, also a Pediatric nurse practitioner, is an empathetic and enthusiastic teacher. She makes me excited to apply what we’re hearing in lecture to real patients. For days I’ve been mentally prepping myself for clinicals. I go to Whole Foods to buy a bottle of herbal sleep aid pills.

Suddenly at the end of lecture, three administrators come in to our class unannounced and begin talking. At first I’m utterly confused. I feel like I* just joined a conversation that had been going on, instead of them joining us. For 2 minutes they talk in circles about how they’re trying very hard to ‘figure out’ our clinical rotations.

And then it dawns on each of us: they are still trying to hire Clinical Instructors (CIs) and until they find six CIs, none of us will have clinicals at our designated sites! Whoa!!

A classmate interrupts and lays it out in plain terms, and the administrators concede the truth: They have been searching for CIs since December but they can’t find anyone because of the “terrible nursing teacher crisis.” They have been putting off telling us the real situation until it got to a critical point. They joke that our professor has been “great at distracting” us with daycare and other hospital observations while they look for CIs.

Nursing teacher shortage? Understood. But I’m stunned by how we got where we are:

1) Why didn’t MEPN have Clinical Instructors hired and ready to go from months before this quarter? Why were they looking for CIs during the Christmas holidays? (A classmate saw a job posting on Craigslist.org over the holidays.)

2) Why wasn’t MEPN transparent about the situation from the beginning? I’m inclined to believe that the staff is trying their best to deliver what the program promised us, but it’s hard to not feel like I’m being misled when they’re not upfront and straightforward.

3) What does this mean for our qualification for the Board of Registered Nursing license? What if we are required to have a certain number of clinical hours in Pediatrics? (Looking into this.)

Some people are annoyed, some are ambivalent, many are angry, especially partners and family members. I feel badly for classmates who are specializing in Pediatrics. Some suffered through 12 weeks of Med Surg with an eye on this quarter. I’m disappointed because I was looking forward to the challenge of peds nursing, because who knows — though the thought of nursing sick kids scares the crap out of me right now, an in-depth clinical experience might change my mind and make me realize that I’d love to work in this area! I was all set to ride the highs and lows of peds nursing and to write about my Growth and awesome, beautiful, painful, rewarding, fun times! I really do not like writing about this other crap. Unfortunately, this crap has gotten in the way of those experiences.

I’m sure the staff is working furiously on damage control, or else this will all be hugely embarrassing. Let’s see what happens next week, Week 3.

Winter quarter started last week right after New Year’s Day. I was still a little hungover in class after a raucous time at a house in the woods with friends. (I highly recommend getting out of town for New Year’s Eve, getting a space with your friends, and not spinning in circles asking each other: ‘So what are you doing for NYE?’)

I have a lot of juicy news about this quarter (Family & Child Nursing and Sociocultural Issues), but I know a few readers have MEPN interviews coming up really soon, so on the off chance that you read this before your interview, I want to answer a burning question: “For MEPN interviews, what do you think they like to see in students?”

I alluded to this issue in a post under Things I wish I knew:

• Don’t overthink the admissions process or your application. It seems like there’s no one tie that binds all of us. Sometimes we seem totally random. Everyone is different. For example, some people had hardly a clue about the nursing profession, while others did a lot of work in public health or health care. Some people dreamed of being a nurse and advanced practice nurse for years, while others decided to try nursing two months before the application deadline.

How do you like my non-answer? “Totally random.” Well, all right, despite the randomness, if I had to pick out some threads, I’d say that my classmates have had enriching life and/or work experiences, a desire to help people, and confidence (and I don’t mean in a Russell Crowe kind of way. Many classmates have a quiet confidence that comes through if you take time to talk and listen to them).

Some classmates at the interview stage had little volunteer experience and no clue about what a nurse practitioner or clinical nurse specialist does. I admit, I was a little surprised by this because a) isn’t community service important? and b) shouldn’t one have a good idea what nurses and advanced practice nurses do before going into the profession?

More concrete insight into the interview process:

• Wear what makes you feel comfortable and confident. No need to wear a suit if you dread that type of thing. One-third of my classmates during my interview day wore suits, but the rest were dressy casual (if not way too casual).
• Read this guy’s summary about the process in 2005. Nothing changed for me, except the number of applicants, interviewees, and available spots.

When I had my interview with a nursing supervisor, I thought I bombed it. She hardly smiled and kept hitting me with the same type of question and comment over and over again:

• Nursing is hard.
• We need nurses who want to be professionals.
• Nurses need to be able to speak up and stand up for themselves and their patients. Can you do that?
• There are two types of nurses: those who are there to punch the clock and those who are leaders.
• Nursing is hard.

I felt like she was trying to ‘break’ me. Needless to say, I wasn’t too optimistic after this interview. But in retrospect, I believe she was simply trying to be upfront and honest about the profession, so that I could be upfront and honest with myself about whether I really wanted to stick my neck into it. I’m now more than halfway done with MEPN, and I don’t have any regrets. Good luck! Please share your interview experiences at this blog if you can.

Apologies for flaking out for so long! My winter break wasn’t as much of a vacation as I had hoped for. But I did manage to read a few interesting books: The Alchemist, The Kite Runner, The Beginner’s Guide to Insight Meditation, and The Good Heart - A Buddhist Perspective on the Teachings of Jesus - His Holiness the Dalai Lama.

Arinna Weisman and Jean Smith’s The Beginner’s Guide to Insight Meditation helped answered some of my burning questions about Buddhism, such as do Buddhists have to believe in reincarnation? (Many don’t.) Are all Buddhists vegetarian? (No. Buddhists in Tibet and Japan often eat meat.) The writers also resonated with me by acknowledging that it’s not important to categorize or label oneself as a Buddhist because it may not necessarily be a true reflection of whether the person lives by Buddhist thought. Many people don’t call themselves Buddhist, yet they practice “awareness and awakening.” I could get carried away by spiritual talk, but I’ll just say that striving for awareness and awakening has been enriching my whole nursing experience and making the MEPN bubble a lot easier to live in.

An update to Things I wish I knew

Wow, you better sit down for this one. During lunch today my clinical mates and I flopped into armchairs in the lounge and looked at one another with wide eyes and goofy grins.

“I feel like a real nurse this week! Can you believe it??” we blubbered to one another.

Something special happened this week–our second to last week–a period that MEPN calls the “integrative Med-Surg experience.” (Other schools call this the “capstone” period.)

We were tired as ever, but somehow euphoric. The excitement is largely because we can taste The End of our Med-Surg clinicals, but it’s also because we’re functioning and identifying as real nurses.

Prior to this week, we were allowed and encouraged to “pre-lab” (research) on two patients the day before clinicals to prepare ourselves. We also took lunch whenever we felt like it, in addition to taking a 1- to sometimes 2-hour break for “post-conference” with our clinical group, to talk, gripe, snack, chill…

For the integrative experience, however, we arrive in the morning as real RNs do, figure out who our two to three patients will be, and hit the floor running. Our clinical instructor is no longer milling around to quiz us. Our precepting nurse is still ultimately responsible for our patients (and depending on the nurse’s personality and attitude, you can have little or a lot of independence), but we’re to do absolutely everything we can for two to three patients, in addition to making phone calls, directing nursing assistants, and taking care of all necessary administrative tasks. We schedule lunch as regular RNs do and we have no break-time with our clinical group. We’re involved from beginning to end, whether the end be 7:30 p.m. (on a good day) or 8:30 p.m. (as it was for me yesterday).

Prior to this week my clinical group had already transitioned to arriving the morning of clinicals to prepare for our patients (instead of a day earlier), so by this week we didn’t think anything would be very different for us. We were wrong!

Now that we’re charged with being on our own (not having to report to our clinical instructor) and now that we don’t have the respite of our afternoon group meeting to talk about our day and provide support, our sense of responsibility has–unbelievably–quadrupled. Suddenly my clinical mates and I became so wrapped up in our patients that we didn’t have time to stop and chat with one another like we used to. This week we didn’t even take breaks like we used to. I suppose this is partly what made me feel like a “real nurse.” But lest I get too caught up in this feeling, my clinical instructor told me today that we have to fight tooth and nail to keep from developing these habits. She charged my group with taking breaks together next week.

One classmate put it perfectly: “Today I got so caught up in tracking my patient’s I’s and O’s (input and output) that I stopped and said: “Hold on a minute! What about MY I’s and O’s? I have to start tracking my own!” (or else suffer dehydration and UTIs).

The sentiments in this entry are:
- There is sunlight at the end of the tunnel. Some of us might even be able to feel the sun on our skin.
- I can finally say: “This quarter has been hard but we learned a lot. I would do it again–but I’m glad I don’t have to.”
- I’m glad as all hell that I’m not in Schedule B–they’ve still got Med Surg coming up.
- I must keep enjoying the privilege we have as students to goof off just a little…so as not to get UTIs.

Next week will be bittersweet: I’ll be sad to say goodbye to the nurses I’ve gotten to know, but I’ll be ecstatic to close this chapter of MEPN and discover other aspects of what it is to be a nurse.

Sleet, rain, snow, and –6 degrees.

When I woke up yesterday morning and looked outside, the sight made me catch my breath. I hadn’t thought about snowfall in a long time. I touched the cold windowpane and remembered snowfalls when I was a kid on the east coast: how excited I was to wake up to the sound of the radiator whistling and clanking and see nothing but pristine whiteness outside; how I pressed my forehead to the window so that snowflakes filled my field of vision; and how the snow seemed to soundproof my neighborhood from the normal cacophony of people and traffic…

Today: stark, blustery, and still beautiful after some snow melted nearby. Reminds me of Poland in the Decalogue movies.

No, I’m not in San Francisco anymore. This past week I traveled far to see an aging grandma. I’ve had a little bit of time to reflect on my nursing school experience, but not as much as I’d like. I’ve finished with lecture and have only 4 more days of clinicals before a 3-week winter break, so essentially, I’ve already started my winter break. I’ll definitely write more about school and answer your questions over the next couple weeks. Happy winter to everyone.

This is what San Francisco looked like before I left for Thanksgiving last week; this is also my bike path to school: