NursingZen

The first week of the fall quarter has been mellow, great for getting us back into the right mindset. Again, our class of 84 has been split into two groups, Schedule A and B. The exciting aspect of my group, Schedule A, is the two 12-hour back to back Med-Surg days at the hospital, which is from 7 a.m. to 7:30 p.m. We’re supposed to take on more responsibility–instead of ‘helping’ a nurse, we’re going to start off with total care of one patient, then two, then three–and maybe four by December. Holy moley. Very cool.

Aside from the Med-Surg clinicals, we only have class 1-1/2 days and are free the rest of the week.

Schedule B folks reportedly have more relaxed clinicals, because they are doing Pediatrics, Labor & Delivery and Community Health. Many of the students are glad to see other units of the hospital and of nursing, instead of Med-Surg. I’m personally glad to be doing Med-Surg now, because I can continue to build on my relationship with the nursing unit I’d been working at over the summer. It seems like most people are happy with their group and can see the pros and cons of both schedules.

So, the eye-opener of the week is the fact that the illustrious UCSF MEPN program was scrambling to find and hire enough faculty/clinical instructors to accommodate everyone for the fall! Two clinical instructors were out of commission this week, so Schedule A’s clinicals had to be cut down to one day instead of the normal two (this week only). A clinical instructor had to be pulled in last minute as a favor to our full-time instructor! The teaching shortage is very real. Without faculty, schools can’t accept or train all the people that want to be nurses.

I’m really curious about how nursing programs are run at other schools, whether they are also scrambling for faculty, and whether the accelerated ones are just as hectic and crazy as UCSF’s. If there are any readers out there who are in a nursing program, please, please chime in!

Of all the questions/issues that my MEPN friends and I lost sleep over during the first quarter, two of the most disheartening might have been: Is an accelerated nursing program really for me? And, am I crazy, stupid or lazy for feeling this overwhelmed?

Question 1: Is an accelerated nursing program really for me?
I learned over the break that a classmate is dropping out. She wrote an email to the whole class, explaining that she decided a traditional BSN was more suitable for her. I know her email resonated with many of us, either because it was our worst fear or our deepest desire.

Normally a pre-licensure program occurs over two years; MEPN is one year. In creating the one year curriculum, an administrator told us, the school took a hard look at all the types of courses in a normal nursing program and whittled them down to the knowledge and experiences they thought were vital to being a nurse. They also whittled the credits down to the minimum number required by the Board of Registered Nursing. Apparently we’re taking only one credit more than what the BRN requires.

This compressed, bare bones curriculum can be a dream come true for people who want to become a nurse but who are short on time and money for a long program and/or who have already demonstrated their academic competence and maturity in college and on the job. Most of us were probably good students and hard workers in the past, so, in theory, a lot of reading and weekly quizzes are not outside the realm of impossible. I went into the program prepared for the workload and at peace with the fact that I wasn’t going to read everything or get an ‘A’ on every test.

But what I hadn’t anticipated was how we would be skimming the surface of subjects like Pathophysiology and Pharmacology, and how fast… The Pathophysiology class, for instance, was offered in the summer for a mere 10 weeks. It’s a critical piece to understanding our patients’ illnesses but there was no time to do it justice.

Many of us came to realize one or more of the following:

• Either we want a deep understanding of concepts, or we don’t mind skimming the surface.
• Either we like didactic class work, or we live for clinicals.
• Either we find it exciting to run around like headless chickens, or that scares us shitless.
• We can find the time we need for studying, but there’s no time left to process how our identity, language and outlook are changing.

The last point is the most salient for me. Within weeks I was expected to think and talk like a nurse, but after bending time to fit in classes, clinicals, studying and new people, there was nothing left over for processing and bringing everything together. This is a piece of the accelerated program that threw me for a loop. I felt like a whirling dervish–spinning into a nurse but not able to stop to really feel like one.

Within weeks it also became apparent that the way in which pieces of a person’s life come together can make MEPN either wonderful or stressful. I realized that I’ve got it pretty easy:

• My man is 100% behind me, and is keeping me fed and housed.
• I have a 10-minute commute to school.
• I have no responsibilities to kids or parents.
• I don’t have to take out loans, thanks to my dad’s modest pension. He labored for the City of New York Parks & Recreation for 18 years before dying unexpectedly three years ago. Thank you, Ah Ba.

But others are in the opposite situation. I didn’t have a chance to get to know the woman who dropped out, but I know she faced a very long commute to school, which would be enough to make me think twice.

She was also an older woman and a person of color.

I can’t say for sure whether her background had a bearing on her leaving the program, but as a woman of color from a working class family and the first person in my family to go to college and graduate school, I know color, class and culture most definitely inform my experience in MEPN and as a MEPN, as they do in any school and setting. No one seems to want to talk about the color, class and culture of the MEPN class, so I’ll post about this in the near future.

I give the woman props for making her decision. If her situation was like other people’s, she most certainly felt caught in a bind: What are you to do if you arrive at a place after months, maybe years, of dreaming, hard work and agony, and only want to run the other way but feel stuck because you don’t want to have wasted your hard work and/or because you can’t imagine what else you’d do?

And then there’s that feeling that you should feel lucky and privileged and even grateful to have been accepted to UCSF MEPN, because by god, it’s one of the top nursing schools in the country and there were hundreds of other applicants who didn’t get in, so what are you complaining about…&#!$&@?

Again, the decision could have been a piece of cake for this woman, but the agony about whether an accelerated nursing program–and UCSF MEPN–is really the right choice is very real to some students.

The question that bugged me in the beginning was whether I really could be a nurse and whether I really wanted to be a nurse. Fortunately, after a few challenging, life-changing clinical days, I felt I had made the right decision. UCSF MEPN, with all its problems, is the best route for me at this point in my life. But I know that if my circumstances were just a little different, if like in Jenga, one little piece was out of whack, things could easily crumble.

Question 2: Am I crazy, stupid or lazy for feeling this overwhelmed?
I’m going to have to finish this part another time…

Update: Yes, I’m not alone! A classmate just called me and said: “I just got back from L.A., I’m totally out of it and I don’t remember anything. Help!” Tomorrow’s going to be interesting…

The two weeks have flown by and I quite unexpectedly failed to write for NursingZen. I’m sorry. To my utter surprise, when it came to thoughts about MEPN and even nursing, my brain completely, 100 percent, checked out this vacation.

When I tried to reflect on the first quarter of nursing school, especially because I wanted to share the experiences with you, I found to my horror that some memories were fuzzy, like the picture on an old TV, and some felt unreal, like a dream, but on the whole, my mind went blank. I might as well have had amnesia. I felt like the world of MEPN and of the journey to becoming a nurse belonged to someone else entirely.

Fortunately, it has started to come back to me, though not in the best way: The other day I dreamed I was at the hospital and was completely and totally mismanaging the care of all my patients. It was 7 a.m., and I hadn’t a clue who my preceptor was. Then it was 8 a.m., and I was letting a patient walk all over me. Then it was 9 a.m., and I still didn’t know who my patients were. No one would help me. I sensed doom. Then I woke up. Hmm, so those are my deep fears; that’s the real life that I’ve got to get back to. Tomorrow. Joy!

I’ve got one word for the San Francisco Bay area in September: Spectacular. I didn’t want to be any place else for my break. I love how the bay dazzles with sunlight all day, how weeks of 80 degree weather turned my skin the color of caramel, how the winds from the Pacific ocean make my bike rides a breeze and how the colors at the farmers’ markets remind me that it’s actually fall, not summer. My connection to the Bay area is getting stronger!

In the beginning of the break I had a list of goals and projects (nursing school/nursing= obsession with time management), but thankfully, I think, the list flew out the window by day 2. Suddenly I had the kind of summer vacation I wished I had when I was growing up: carefree, with an abundance of new experiences and new people.

(A digression: Summer vacations when I was little were boring and dreary: While my friends went to camp or played on the streets, my evil stepmother kept me captive in my dark railroad apartment and loomed over me, ruler slapping in her hand, as I practiced math problems and was forced to teach her English. Later, summer vacations during college were fraught with stress about making money to support myself =(.)

This time, I had no worries. Every day I secretly thanked the universe–and my man–for the gifts of unemployment and student life (amazing!).

Highlights:

• 12-mile bike ride to Sausalito
  
• Family weekend at the Russian River
  
• Hiking from Mt. Tamalpais to Stinson Beach
• Rock climbing at Mission Cliffs
• 
  Farmers’ market

I’ve created a new Burning questions? page. Feel free to send questions and I’ll try to answer or incorporate them in my posts.

I never thought vacation would be so sweet. I’ve got two weeks of chilling and reflecting. My goals this vacation:

Call friends
Bike
Hike
Meditate
Go to yoga
Take out library books
Blog
Craft presents for friends
Go rock climbing
Swim
Bake

Last week of the summer (first) quarter. I’m responsible for total care of one patient. I think I managed it pretty well…except one day when I was so engrossed in the care of one woman that I forgot to give an antibiotic to another patient. This was a good lesson learned: It’s all too easy to give my all to a patient, but I can’t afford to do that. I need to stay vigilant of the fact that other patients relying on me.

I got to change the dressing of a deep wound abscess. Instead of freaking out about it, I dove right in. I know myself—if I didn’t dive into it, it would’ve built up into this scary concept in my mind. My patient and compassionate clinical instructor guided me through the process…It was like 80 degrees in the room on one of these recent hot San Francisco days. As sweat slowly beaded up on my forehead, I prodded a long Q-tip into a wound on a guy’s back. “Pry deeper,” my instructor told me, because there was “tunneling” beneath the skin that one couldn’t see but that had to be packed with gauze so that it would heal properly. I prodded deeper. And deeper. After determining how far the abscess went, I withdrew the Q-tip and slowly packed in the gauze until the inch-deep wound was filled in. I covered it with the right materials and signed the date, time and my name. There was my first mark.

Last week of the first quarter. I feel like I’ve been in school for 6 months instead of two. My classmates all look at one another and marvel at how far we’ve come. It’s a pretty amazing feeling.

There has been a lot going on (good and not so good) that I’ve been wanting to share (here’s a preview), but unfortunately I’ve been trying to catch up on my class readings. It’s amazing: We’re down to our last two weeks of this first quarter, yet this past weekend was the first weekend in which I felt truly motivated and focused to read! Clinicals have always been exciting and challenging–that’s where I give it my all–but the class instructions? Something had to give, and that was it.

I used to think that I’d been slacking this quarter, but I think I was actually just adapting. I’m finally getting in the groove of reading, studying, and sleeping on schedule. (I think) I’ve accepted that I’m going to get sleepy by 10 p.m. and that on Fridays I’m going to be thrilled about staying home–and sleeping.

During my break I’m going to get deeper into what MEPN has been like. I want to write up information that I would’ve wanted to know as a prospective student. I’ve started with these two ongoing lists: ‘Things I wish I knew about UCSF MEPN‘ and ‘Surprising things about UCSF MEPN.’

Here’s a preview: The rose-tinted glasses have come off. The program has some serious flaws. Sometimes the problems make us feel like we’re stupid, crazy and/or helpless, but since we all feel the same way, we know it’s not us; we’re not crazy. Unfortunately some of us have become apathetic; others have gotten angry. (More to come about this.)

• More surprises at this page.

OK, I admit it: I have a real thing for libraries, especially the one at UCSF.

I walked into it for the first time recently and the hushed quiet made me feel like I had walked into the Grace Cathedral. I felt right at home among the plush couches, loads of free books, esoteric journals, and international newspapers.

But here, it’s the view that takes the cake: Like the rest of the UC buildings, the library is perched atop a hill so steep that even on the second floor you can look out through massive windows at nearly all of San Francisco (makes some sense since UCSF seems to own nearly half the city)!

On this particular day, the fog hung like a curtain in front of the window. I nestled into a seat, propped my legs up, watched the fog swirl around, and took a perfect little nap.

Note to those moving here for MEPN: Bring a down coat. Become one with the mist. Laugh, jump and skip when the sun comes out on random days (and on many days in September and October). Don’t bother with Weather.com, or any weather forecast for that matter.

Interesting fact: UCSF is the second largest employer in San Francisco, after the City of SF.

So far the biggest challenge and greatest anxiety I’ve faced in my first quarter (which is quickly winding down –- 3 more weeks before break) is not the coursework or clinicals; it is going to sleep at a decent hour!

On the days before I’m to be up at 5:30 a.m., my anxiety about falling asleep slowly mounts throughout the day. At night I lie awake for hours thinking about having to fall asleep. I usually sleep only 5 or 6 hours. Next week, the pattern repeats.

But despite the part where I have to get out of bed, I like being up early. When it’s still dark out, I feel like I’m 12 again, waking up in the dead of winter and eating breakfast with my dad before school. I miss him. Now when I walk outside and the streets are just coming alive, I acknowledge the affinity I feel to the stray grey cat, the lone man crouched on the corner, and the workers on the empty bus.

A shift in perspective
Today at the hospital went by really quickly. Instead of wondering when I’d see or get to do something “exciting” (and feeling cheated when my classmates seemed to have more “interesting” patients) it recently dawned on me that everything I’m seeing and doing now is interesting and important. Giving a bed bath or walking with a patient may not make for a great story or for deep reflection, but they’re important because they’re part of what the patient needs for wellness. With this new perspective, everything I did for my patients today was infused with meaning. In particular:

• I spent time talking to an old Japanese woman with astonishingly beautiful skin. She came to the U.S. because she married an American 14 years ago but they since divorced. Before I spoke with her, everyone around me said she was “Japanese-speaking only.” Not true. If they had spent a few extra minutes with her they would’ve found her understanding and speaking English pretty well, only slowly. She just needed time (but time doesn’t seem to exist in hospitals). I chuckled when she asked me, “Why am I here again? I feel fine.”
• I fed breakfast to a 40-year-old black man dying of cancer. Literally dying. He couldn’t move and could barely eat, but he wanted to eat. He had nibbles of hash browns, eggs, bacon and oatmeal. It was a privilege to feed him one of his last meals.

Friday Update: I went into the hospital today thinking that I could see the man again. I was told he passed away last night with his family and friends surrounding him. I can’t stop thinking about the short time I spent with him and how I literally helped with one of his last meals. It rocks me a bit, but I’m glad I was there.

As it turns out, at the end of Week 3 everyone I talked to in the program was in the same boat: Partners felt neglected, couples argued, time seemed to slip away, tensions mounted. I think it’s funny that we all hit the wall–and were scaling it–at the same time.

Unfortunately, some people hit the wall harder than others: They wonder whether they’ll make it another day, whether nursing is for them, whether another program would’ve been better organized, and whether all accelerated programs are as crazy and intense as UCSF’s.

I feel for them. We all worked hard to get to this stage and it can be soul-wrenching to feel like the program may not be what it was cracked up to be, or that nursing may not be what one hoped for or expected. But I hope they don’t leave. We’re just getting started; former MEPNs have said that the first quarter is the toughest because we’re all getting adjusted.

Meanwhile, to my surprise, the anxiety and fear I felt leading up to and during the first two weeks of school have melted away!

Something clicked for me during my second week of clinicals: I like nursing. I really like it.

I like the fast pace, the constant, never-ending learning, the gross stuff, the sad stuff, the teamwork, the blend of social work, science, medicine, sociology, anthropology and psychology…It’s an amazing thing. There’s no field like this. (Yes, tag me “Idealistic” right now.)

And I can just go on and on about my admiration and respect for the nurses I’ve met and seen in action. They make me want to become an excellent nurse–no less.

I’m also relieved to have something to focus on, to be back in school, to have readings, tests and discussions that are applicable to real life, to meet new people. I can’t imagine myself doing anything else right now but be in this program.

Wow, these feelings blow me away. Is it really me who’s talking?

On the Saturday of the end of the second week of school, I was lying in bed wondering why I was so exhausted. Then it hit me: the enormity of what I’d taken on for the MEPN year.

The timeline is staggering when you really think about it:

• By the end of the summer quarter, in August, we’ll be allowed to give medications to patients.
• By the beginning of the fall quarter, in September, we’ll be continuing to shadow a nurse but will be responsible for total care of one patient throughout a 12-hour day.
• By the end of the fall quarter, in December, my instructors said: “We will be stepping aside and watching you take care of four patients.”

One year from now I will be taking the RN licensure exam and applying for jobs.

The following week, Week 3, my man and I got into some arguments. He was frustrated with my preoccupation with school and my inattention to him. Intellectually he understands that we’re in an adjustment period and that we’re going to be on different wavelengths for a little while. I promised to do my best to attain balance.

I can’t decide what I’m looking forward to most:

A) Change the dressing of a Stage 3 or 4 wound

B) Insert a nasogastric feeding tube

C) Change & clean out a colostomy bag

Each week we’re introduced to a set of skills that we’re then let loose to perform in the hospital (with supervision of course). When I first saw a pic of a Stage 4 wound (meaty with bone showing), I thought wounds would be my worst fear. But by the next week, (A) had been upstaged by (B). And then this week… (C) is at least tied with (B). I’ll be actively seeking out these things at clinicals because the fear and anticipation of having to do them is driving me bananas.

A brave classmate offered to let a student practice (B) on him (up the nose, down the throat and into the belly):

I finished my second week of clinicals last week. I shadowed a nurse who was my age and had been working for only eight months. She already seemed jaded and bitter, which made me sad and anxious. She echoed what I’ve heard from every nurse: The first year is the toughest to get through.

It’s been fascinating to see the different personalities and nursing styles. Most of the nurses I’ve observed are very organized and on point, but some handle the stress better than others. I’m realizing that a sense of humor is essential for survival. I’ve been lucky so far to not be with the nurse who yelled at my classmate for spending too long chatting with a patient and another one who talks to her adult patients like they’re kids and does only the minimum she can get away with.

Update on the 56 year old man with very aggressive thyroid cancer: He moved to a more acute wing. I visited him. Since he can’t swallow, he has a feeding tube now and currently he can’t talk. I was overjoyed that he remembered me. He and his wife maintained big smiles and a sense of humor even though his prognosis is bad: 100% of people with his aggressive cancer die; the docs give him 3 months. I left the room teary-eyed.

Soon I’ll post a photo of my horrendous hospital uniform…and nursing shoes that are so-ugly-they’re-trendy (at least in NY!)

For July 4th, I partied as though I didn’t have to be up at 5 a.m for my first day of clinicals at the hospital. Excitement and a hangover woke up my mind at 4:30 a.m. I slowly brought my body out of stasis with three unbearably stiff sun salutations.

6:45 a.m. at the hospital: The buzz around the nurse’s station was the true wake-up call. Until then it hadn’t fully registered in my mind that there were nurses working while I slept, and care was truly being provided 24 hours a day.

I also never realized how many hip, young, good-looking nurses there could be in one place. Dang. Meanwhile, we students looked liked tired lemmings.

The preceptor I was assigned to fit the former description too. She was nice but not sweet, a badass but not a hard-ass. She could be professional one minute, then shoot off a wisecrack or flippant remark another minute. I could tell she wasn’t thrilled to have someone shadowing her for–how did she put it—“the rest of our lives”—but she knew it was important and she took me on seriously and with intention.

Hour 1, 8 a.m.: My preceptor gets organized for her four patients of the day. Night-shift nurses give reports on patients to morning-shift nurses. Good communication and listening are essential.

Hour 2, 9 a.m.: My preceptor helps an obese woman on to her bathroom commode. She then conveniently says, “You can do her blood pressure, right? I have to go do something,” and runs off. While the patient has a long and labored No. 2 in the commode, I tryto take her blood pressure. But the cuff won’t fit properly. I don’t know what to do–Am I supposed to leave her to shit in peace? Stand there and keep her company? Should I leave? Should I keep trying to take her blood pressure?–I probably choose to do the most naive thing possible: I remain in the room and make small talk. While she sat on the john. My rationale is that I should get used to the smell of someone else’s poop sooner than later. In retrospect, though, I’m not sure if there was any “therapeutic” rationale for me to be in that room at that time.

Hour 3, 10 a.m.: My feet and lower back are starting to kill me. I look at the clock and laugh that it’s only 10 a.m.

“My” patients this week were:

• a spunky, 60 year old woman with a deep wound/abscess in her knee. During a dressing change she gladly showed me how deep her wound was by poking a cotton-swab stick right into it; it went in about 3 inches.
• an 80+ year old Chinese woman in palliative care. This means she was no longer being treated for her cancer but was being allowed to die naturally and as comfortably as possible. I talked with her awesome daughter in Chinese.
• a 56-year-old man with very aggressive thyroid cancer. In the 2 days I saw him he went from upbeat and talkative to no longer able to swallow. His wife, his high school sweetheart, was with him the whole time.
• the 30-year-old 400+ pound woman who was going on her 4th week in the hospital, more for psychosocial treatment than medical.