NursingZen

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:

FYI: My Burning questions? has updates.

Today was my last class of the fall quarter. For the next 4 weeks, except Thanksgiving, I will only have clinicals. Winter break will then be three weeks long. It’s still hard to believe that I won’t be back in lecture until Jan. 2.

The best thing about this quarter was the continuity between Intro to Nursing in the summer and Med Surg in the fall. Having these classes and clinicals back to back have been critical to helping build my confidence, skills and perspective as a student nurse. The continuity also has helped some of us strengthen our rapport with nurses on our units, so much so that many nurses now know us by our names and acknowledge our progress and contributions.

The downside is that some of the teaching continued to be shockingly bad and inappropriate. Since the beginning of MEPN I tried to keep a level head about one of our key instructors. I tried to understand that she simply has a different communication style, personality and background. Unfortunately, she proved time and time again that she truly doesn’t know how to teach nursing to 2nd and 3rd career changers like us and doesn’t know how to communicate with people like us who have had valuable life and work experiences that were not necessarily related to health care. Furthermore, she gave us no direction (or gave wrong direction) about her expectations for exams and assignments and focused on petty details instead of what was really key to our understanding of nursing.

During the summer quarter, many in the class tried to give constructive feedback about her teaching and communication skills, but still nothing changed this quarter. I understand change can take time, but some of us fear that the school might not take our instructor and course evaluations seriously.

It may seem petty of me to focus on one instructor, to let one person have such an impact on my experience, but it’s not something to be belittled. The MEPN curriculum is so compacted and the experience so new and intense that one person makes a bigger impact than in a more normal situation. My hope is for the faculty to listen to our feedback and believe that it comes from our desire to become good nurses and not because we don’t “get it” or because we want to be a pain in the ass.

That’s my venting and I’ll try to leave it at that. Life is good and vacation is coming soon!

I’m reminded time and time again that my life as a Student Nurse affords me the ultimate luxuries: the luxury of having only one or two patients to pour my energy into (i.e. Hello, let me check and empty your pee hat every single hour so I can track all your output) and the luxury of being able to ask stupid questions and make even stupider mistakes (i.e. disconnect an IV tube and fling the end of its sterile tip on to the bed like it was a telephone cord, or offer an NPO patient water and lunch, multiple times).

Because I know the day is quickly coming when I can’t fall back on student privilege, I’ve started keeping track of small successes after each clinical shift. I’m also trying to keep a list of details I missed during my shifts so that I can try to remember them next time.

Here are two small successes:

1) Advocating for a 68-year-old man with a tracheostomy tube

A tracheostomy can be a scary thing when you see—and hear–it the first time. I mean, to put it simply to my non-nurse readers, it’s a hole in a person’s neck (windpipe) with a tube coming out of it to make breathing easier. Hole, tube, neck (and blood because the hole was fresh) are what my mind latched on to when I first saw a “trach” last quarter. When the person breathes you can hear mucus rattling in his throat. When he coughs, the mucus gets squirted out of the tube that is sitting in the hole in his neck.

Last week, with fingers trembling just a little, I inspected my patient’s tracheostomy site. I could tell that the site would need thorough care and cleaning and I noticed that one edge of the neck plate (which holds the tube to the neck) was digging into his skin, causing a red sore on his neck. My nurse and I tried to clean the trach site but she then had to rush off, leaving me feeling mightily unsatisfied about the work we had done.

Throughout the day I kept bugging her about the sore on the patient’s neck, until she suggested that I call the Respiratory Therapist for advice. I called him twice. When he finally came around, he taught me how to properly clean the trach, take out the cannula, and how to reposition the neck plate. He recommended that Aquaphor cream be applied all around the site to protect the skin. When we were done, I was elated! I felt like I had made a tiny difference in this person’s care – and I didn’t even mind that he showed zero appreciation. That’s love, isn’t it?

2) The same patient: a pressure-sore discovery

It was reported to me that the patient had a Stage 1 pressure sore on his sacrum due to his immobility. Depressed, he lies in bed all day with very little movement, which is no good for his skin. (For my non-nurse readers, a pressure sore, also commonly called a bed sore, can go from being red and non-blanchable (stage 1) to total skin and tissue breakdown (stage 4) if it’s not taken care of).

As someone who has been terribly negligent about checking patients’ skin carefully, this time I was determined to do a thorough assessment. With my instructor’s guidance, lo and behold, I found a tiny spot on his butt that was no longer covered with skin. It was the beginning of a Stage 2 sore. If left untreated, and if the patient were to continue to lie on his back, that tiny sore would get worse.

I covered this Stage 2 with cream and a duoderm dressing, diligently turned him in different positions every 2 hours, and hoped for the best for him, because he’d need it: He was going to a nursing home the next day and sad to say, nursing homes = land of bed sores.

1. Fall is here, and it’s beautiful and makes me smile to myself.

2. We’ve hit a mid point: There are only 5 weeks left to the quarter.

3. I’ve been treating MEPN as a break or pause in my real life, as though after I’ve completed the program, I will go back to my regular life. This is a detrimental way to look at my next few years, because I end up looking to the future instead of living in the present. What I need to do is embrace my everyday life now. I need to see MEPN as part of my real life. This means not thinking too far, not rushing or feeling rushed to get my NP license or Master’s, not forsaking time with my friends, and not forgetting my other interests and creative pursuits.

4. It’s going to be weird when I’m working and not surrounded by classmates. It’s even going to be sad and bittersweet. It’s going to feel a little lonely walking amidst strangers again and not running into a familiar face for days at a time.

5. When I’m an RN, Med-Surg is going to be tough without having peers who understand exactly how I’m feeling.

6. The days move so fast that it’s hard to feel like I’m really getting to know anyone, or that anyone’s getting to know me. I hope I’ll have a few close friends who will be a part of my life after MEPN.

This quarter I have most Tuesdays off from school, except 3 days when I go to a different department in the hospital to shadow a nurse to see just how different each unit is. My placements have been extremely valuable for assessing my options and interests:

Week 1: Operating Room
I have a relative who works in the OR and she said the nurses there love it and would never leave, so I went to this observation with great interest.

Oh, is that it? I was fully underwhelmed.

I stood in a cold room and watched one nurse hand tools to the surgeon and watched the “circulating” nurse keep an eye out for problems, remind an MD to put on his mask, and play Solitaire on the computer.

The operation was interesting, of course, but since I’m not trying to be a surgeon, it was kinda moot. (I did, however, like to see how I’d react to blood, flesh and guts! Blood and guts? OK; Cauterized flesh with a little smoke arising from it? Not so OK.)

The OR rotation reinforced for me my love for patient interaction and my aversion to boring, sterile work, therefore, the OR is out.

Week 2: Emergency Department
Now this is more like it! Hustling, bustling, adapting, flying, running, communicating… I could tell my preceptors were loving their job, and better yet, didn’t mind taking me along for the ride. In my 12 hours in the ED my nurse dealt with: a woman trying to come off crack, a woman in respiratory distress, a 10-year-old bipolar boy, and a young woman with multiple personality disorder.

I asked three fairly young nurses how they chose the ED and what they liked about it. They all said they knew they wanted to work in the ED as soon as rotated through it during nursing school. They like seeing a lot of different patients and conditions throughout their day, they get bored by med-surg’s chronic care patients, and they like the fast pace. I also noticed that communication between nurses and MDs in the ED were very different than on the Floor. Somehow more collaborative and respectful. I also found it highly amusing that some of the ER docs reminded me of George Clooney’s character on “ER.” I guess that show got it right on the money.

Man, after this observation I so wanted to be able to imagine myself as an ER nurse! I think there’s definitely a coolness factor with being an ER nurse: It is badass to be able to handle anything that comes your way.

But, alas, this department didn’t click with me 100% either. The ED remains an option, but I’m still searching for the ‘one.’

Week 3: Intensive Cardiac Care
Hmm … The ICC is probably the most disconcerting place I’ve been to so far. The acuity of the patients and their multiple tubes and IV drips were quite intimidating. Each nurse is responsible for 2, maybe 3 patients (vs. 4 or 5 on a med-surg floor)–that’s how critically ill each patient is. But my charming, Irish preceptor quickly put me at ease. She said she likes the ICC because the team works wonderfully together and the management is extremely supportive. A few MEPN new grads have done their step-out year in the ICC, but generally, an intensive care unit is challenging for new grads.

There is an amazing special feature that follows a new grad in the ICU for six months, by the Boston Globe. It is fascinating. It’s the first feature of this kind in the mainstream public media. Its intent was to give the public a really deep, insightful look into the work of nurses. It also scared the crap out of me in a thrilling I-hate-scary-movies-but-I-have-to-watch kind of way. It could inspire you, too. Check it out at: http://boston.com/news/special/nursing/top/

6:17 a.m. Some mornings I wake up and wish I had a regular job. So that I can call in sick. It’s a herculean battle between mind and body.

Yikes!! I’ve missed my pledge to blog once a week. I’ve got to leave for clinicals in 5 minutes, but very quickly these are the two important entries I’ve been crafting in my head:

- The public image of nursing and how nurses are working to change it for the better. I’m on board for this. I’m proud to be a nursing student and nurses are the most hardworking, undervalued professionals I’ve seen.

- The face of nursing school and nursing. Both seem to be dismally underrepresented by ‘minorities,’ while the face of our patients is increasingly diverse. Are schools retaining students of color? (No.) Why aren’t there more professors and nurse leaders of color? What’s being done about this?

Ok, gotta run. Have a good week!

I learn something new every day. For instance, I didn’t know that there’s an aerosol bottle in every patient’s room that can be sprayed to help mask foul smells. When a patient poops into the waterless commode, I have to stand near him/her to make sure s/he doesn’t fall off. For the past two months I just stood there each time, suppressing the urge to run and silently begging for a reprieve. (I’ve got willpower like you’ve never seen before, unless you’re a nurse.) Then one day a nursing assistant took that little spray out of my patient’s closet and turned my life around.

Some laughs:

Morning report
Night nurse to morning nurse: …so Mr. X had xyz and abc, and he had explosive diarrhea this morning.
Me: Ha ha ha!
[Morning & Night nurse: faces blank]
Me: Sorry.

Changing soaked bedsheets with overweight patient in bed
Nurse [whispers]: She has the biggest bladder I’ve ever seen.
Me [feeling the cold urine through my gloves]: Mmhm. Wow.
[Patient farts in our faces while I hold her on her side]
Nurse to patient: Are you done?
[Patient nods]
Me: [Ha ha!]

Giving report to my class
Me: My patient is an 85-year-old male, status post diarrhea. He developed…
Teacher: No, you wouldn’t say status post diarrhea.
Class: Ha ha!

I finally have some time to journal…last week was the toughest week for me since school started. I had my first back-to-back 12-hour shifts that went something like this:

Wednesday: Went to hospital to “pre-lab” a patient, meaning pick a patient to work with during your shift on Thursday. I chose an elderly man admitted for dehydration and a UTI. Upon being treated for dehydration, he became overloaded with fluid and developed acute renal failure. I asked his current nurse if the patient was very complex or was he someone that I could take care of on my own. She said, “Oh, he’s fine. He’s really easy!” Went home and researched everything about the patient’s condition and all his medications.

Thursday: Woke up at 5:30 a.m., biked to the hospital, and had a busy morning putting together all the meds and assessments my patient needed. I thoroughly understood his condition and had pieced together his whole history, complete with lab values to back up the history. At 7 p.m. I reported about the patient to the on-coming night nurse, and left the hospital feeling light as air because I thought I had done my job as well as I could.

Friday: Woke up at 5:30 a.m., biked to the hospital, and started preparing my meds again.

8:00 a.m.: My nurse and I helped the pt. avert a diarrhea disaster in his bed.

8:30 a.m.: I asked my clinical instructor to watch me give the medications. She said: “Sure! Now, tell me about this one. And this one. And what kind of anti-hypertensive drug is this? And is that the right dose? What’s the therapeutic range? What blood pressure is considered hypertension? What are the side effects of this one? And that one? And this one?”

Yesterday I had the details, today I had only the general idea. It wasn’t good enough.

“You’re not ready to give these meds.”

My confidence imploded. She was right. Shame flooded over me. If only she knew how many hours I spent preparing for this patient. If only she saw how prepared I was…yesterday—but that doesn’t matter. What mattered was that I had gotten sloppy already.

I sniffed back tears while I assessed my patient. When I noticed how sick he was–sicker than the day before–my shame grew. When I couldn’t choke back the tears, I snuck into his bathroom to talk myself down.

12 noon: My patient is looking worse. My nurse gives me no guidance, takes no initiative.

3 p.m.: The doctors order an EKG stat because his potassium level is too high.

5 p.m.: He may be transferred to palliative care. We tell his family. They burst out crying. I try to console them.

7 p.m.: I go home mentally and physically exhausted. It boggles my mind how nurses can take care of 4 to 6 patients at a time. I go home and make all sorts of worksheets to help me organize and learn my medications.

I found out later that my patient died the following day.

Lessons Learned: Don’t rely on busy RNs to see things from your perspective. Don’t get overconfident. Don’t be too hard on yourself.