Student Nurse on the loose...

T-Minus 18 hours and we are meeting in the lobby at our first 10 week rotation for medical surgical nursing I & II. Yes, I expect to look this ridiculous. Toodles and I drove over with Comrade X today and looked around. How fortunate are we that the Comrades have adopted us like papa birds pushing us out of the nest. My wings are barely flapping. I felt like an elephant at the ballet. We went to check out the lobby, cafeteria and med-surg floors. We checked out an empty room, located some of the safety equipment, called a code (just kidding...but the button is blue) and we touched something Comrade didn't want us to, so we got a wrist slap. We foamed in and out of the room and I cleaned up my first spill.

The campus is lovely. The best part about today was realizing that the Comrades have paved this road for us and we are traversing it with less bumps.

We have a four hour orientation at noon and our clinical faculty is going to ease us into our new roles as we begin to prep on our first patient for the weekend. Did I mentioned that I feel like a kid going to kindergarten?

I've been up late studying, trying to familiarize myself on reading and analyzing EKGs. Our second big exam is next week and I'd like to do a little better this time around. I have so many books, I have a rolling library at my fingertips.

In preparation for tomorrow, I went and visited my hairdresser, who butchered me up real nice for the hospital. She took one look at me and knew the stress we've been under. I could see how frown when she said, "Woman...people much dumber than you have done what you are doing, and you're smart, so stop it!" I looked over at Truddles and said, "Did you hear that?" She mumbled, "yeah." Well, in that case, I guess we'll just hum along then.

I didn't get the math score I need to pass meds, so I have to bone up over the weekend to retake that test. I know it had to with some conversion I missed on the dimensional analysis of converted volumes and weights...so back to the drawing board one more time. It's pretty embarrasing, considering that I thought I did OK on that test.

I am ironing my scrubs (LOL) and loading up my clinical prep sheets, stethescope and all my badges (there are so many) and hoping to get some sleep while my mind races tonight. I will look over my cardiac stuff for the exam and hope that tomorrow is everything I hope it will be...easy. May the spirit of Cherry Ames reside with us...what a dork.

I am a Phoenix...a 90.1% would be sweet

We had our first MCA I exam which essentially slammed down any good feelings I had going into this week. I shouldn't complain because I passed the exam. However, I didn't score nearly as high as I wanted to. It seems like very little payback for the work that went into it (we are talking about 9 chapters of medical-surgical nursing with focus on respiratory structure & function/pathophysiology/treatment.) We had a day & half of lecture, the rest was self taught. I think I can speak for my class when I say that the most frustrating part of the process was the inability to decipher how the test would be administered to cover such a broad scope. To prepare for the NCLEX style of testing, I looked at about a 100+ potential NCLEX style test questions for the respiratory system + read the outlining we did in study group and the pathophysiology review we spent hours on. I spent every hour outside class on this. It was an exercise in futility when it came to the exam. I shouldn't complain ~ they keep telling us that if you are passing the exams, you are doing well. Wished I could have slayed it.

Projects...presentations..two more courses...advil...motrin...coffee...fluoroscent lights. Did you know that chronic levels of fluorescent lighting can cause hypovolemia & eventually hypoexmia (this is the environment we live in...) I'd be willing to blame anything at this point.

We had a 4 hour lecture today with a 4 minute bathroom break. I remember eating a small pasta salad outside in the cold because I had to get out of the building to escape the lung damage.

The strategy going into this was putting on a nursing "thinking" cap, eliminating choices that were obviously wrong and then weighing what were potentially two fair correct answers. If you over thought it or psychoanalyzed it too much, you probably guessed wrong. In my case I switched three answers that were correct (which is really a personal trademark of mine) and probably accounts for most of my GRE guffaws.

This is a whole new beast. I am getting clammy...and the synapses are misfiring. We are reading EKGs and all I am remembering today is "snow over tree", "smoke over fire" and how much I love chocolate being close to my heart. (this is a mneumonic for where to place your leads.) I know serum potassium level norms...but angiotensin II seems so far away. I could use a pedicure. I really could use a tune up on my hair. I wonder if the kids have done the laundry that is piling into next year.

Saturday is first rotation for my group. Classmates who started last weekend talked about their patients today without violating any HIPPA rules. I was impressed with how respectful they are when referencing their patients.

The biggest laugh I had this week was seeing Mr. Johnson on a powerpoint presentation. Old Faithful friend. Can't wait to bring your Jamba juice and benedryl. I miss you.

Speaking of beasts, my calculator and I took a medical math test today on which I had to obtain a 90%. I am waiting to click onto blackboard to see the score. I am sure that on this first day of Lent, Ash Wednesday, I could use a Phoenix. A 90.1% would be sweet. My luck tells me it'll be something closer to an 89%

MCA I, Dose calculations & Clinical clarity....yahoo!

I love my MCA I instructor. She is a graduate of my school, is working as a CRNA (is a nurse anesthetist) and is very organized! I think I am getting clarity. We had an intensive skills day last week and surprisingly everything clicked. With the a little practice, I think I have my dose calculation formulas down pat and it's hopeful that the exam for that on Tuesday will go swimmingly. We have to have a 90% pass rate, so I have to be very careful not to make any careless mistakes.

Speaking of med-surg, we met our clinical faculty for SR Hospital last Thursday and I am so happy! We have a great group of classmates, plus an experienced teacher and nurse. I remember trying to take her dose calculation last summer, but having to drop it because of an accelerated statistics course I was taking. Now, instead of having her as an online instructor, I get to work with her three days per week at the hospital.

We have managed to divvy up the work for the next couple of weeks on the theory side, so hopefully when it comes time to do careplans and patho maps, we won't feel so stressed out.

I have no idea what to expect with this first MCA I exam on Wednesday, as I understand the questions are written NCLEX style, which means at least 2-3 of the answers will sound good, but they aren't the right answer...So I will have to bone up on my test taking skills by reviewing the NCLEX book in addition to the numerous chapters we've outlined since last week. We've had MCA I for one week, and have already covered 1/3 of the textbook! It's amazing...the lightning fast paced we are operating at and the amount of retention that is taking place.

I am thinking about switching from caffeine to "Go Girl" drinks. Yahoo!

Do the math

Medical Care of the Adult I started today. We have an instructor who graduated twice from our school who is also a registered nurse anesthetist. Five weeks and another final exam. Another 5 weeks and another final exam. I lost a cartridge of ink printing the summaries we outlined over the weekend. Okay. We are on day 1. There were about 40 chapters somewhere in there. I can't read what I printed. Where are my bifocals?

Today our ND gave us our clinical prep sheets, patient and self assessments and told us to bone up on our math (dose calculations/conversions). I broke out into a sweat and thought for one second that it might be menopause (then I popped back into reality)...the panic has begun. Hot flashes are for home. Diaphoresis is for school. So is sacral tenderness, and borborygmi.

So essentially it breaks out a little something like this: try and follow me now:

Wake up at dawn
Do I wear white or do I wear street?
My bags are packed and ready to go (la la la - sing it might help)
Meet the roadies at carpool/caffeine junction. Swallow caffeine fast. Carpool lane.
Go to lecture/theory...sit for 4 hours..take notes (oops, course not loaded on blackboard yet?...take really good notes) Listen with rapt attention to a lot of important stuff that might save someone's life someday.
Go to the bathroom fast - eat something quick - burp. My stomach hurts. Sacrum is tender, but no sign of a pressure ulcer. Do you have a motrin?
Sit in Lecture for another 4 hours (take really good notes again - when will that be posted?) Tinel's sign positive. Is that carpal tunnel..is that nagging pain my thigh a DVT?

Boss comes in to give us a pep talk. We listen like little puppies to how we will be evaluated for every rotation. I feel no pain. Synapses are firing now.

We must get a S (satisfactory) to survive (70% or higher on exams)and we must complete all these forms in pencil. We must prepare for exams and care plans. We must sleep, (sucker). Read in reverse. Do the math. It amounts to a nap at 4 AM.

Clinical tips:
We must prep every patient night before. If patient gets better, we must prep again for a patient not getting better. If that patient gets better, we must prep again until we have a packet of paper with all kinds of information, drawings and sketches (AKA patho/concept maps) to turn in to our teacher who will either give us
a) a S (this would be good)
b) a MS (this is not good, but acceptable if you have a plan to improve or change)
c) a U (this would be a disaster)and would cost a lot of $$$$$$, mental instability and probably crying. Perhaps it would cause one to take medication. Maybe not, but at least we have Mosby's.

When going to clinical, we should take everything with us, but not take it really. We should leave it in our car, which will be parked at least two football fields away so that if we need it, it will require us to exert a copious amount of Carbon dioxide to retrieve it.

We should report to our charge RN on prep night and ask that important person (who thinks we are ridiculous in our large white uniforms, to help us pick a good patient for our rotations. If that person likes us, I think we would get a patient who might stay longer than 12 hours. If not, go back to Clinical tips above and do not pass go or collect $200, because you have to start all over again. This might require staying up until 4 AM after the PM shift because "under no circumstances are you to report to the next shift without a care plan for a patient - you will be sent home" This is where most us start to feel the effects of diaphoresis. I am fanning myself as I write it. I am faint. I should go to bed now.

Okay. This little thing goes on for three (8 hour shifts) in a row. If you count the prep, it's (4) 8 hour shifts in row, this does not count as theory..this is clinical only because there are 40 chapters somewhere to read too - because you want to get that S...remember? I think somewhere in there, I've signed up for about 450 care plans and maybe a couple dozen papers. I heard that somewhere in this are games, powerpoints and meaningful group interactions; perhaps a project on a big piece of cardboard. Group projects:concentration camps, what do you think? Do the math. Food factors in here somewhere. Trudy fed me a stick of gum - because no one wants halitosis.

In the event, that the staff RN hates you, see your clinical instructor who will most likely give you a MS on your interpersonal skills, which if you look at b) above is really your only option. I think if you do the math, you'll see where this is leading.

You are a smart girl and I know how to deal with smart girls...

You're a smart girl and I know how to deal with smart girls.

James Cagney..in Mister Roberts..was referring to a boy..but in nursing school, for some reason, the trouble makers are all women. Women, who don't like women. Women who want to appear to take down other women, spank down women or just don't plain like women. Modus Operandi tactics primarily being humiliation, ridicule and gossiping.

This can be the case with over zealous TAs, teachers and students. It's ugly on you and a waste of time. That's all I'm gonna say about it.

Full of surprises....N-125

We had final examinations this week, plus a visit to the skilled nursing facility, where were assigned a real patient for a full health assessment. Two surprises occurred in the process of cramming final papers, quizzes and examinations into this week.

We completed a entire textbook, study guide and chapter reviews/NCLEX style questions for this course. We completed a comprehensive skills labs. We prepared a 90 page study guide for Health Assessment and shared it with the class. We practiced our full body assessments on ourselves and our SNF patient. The papers we wrote for ethics and health assessment were extensive and mentally challenging. I was expecting the worst going into the final exam because of two factors:

1) we had a 90 page study guide
2) I had a rather embarrassing lab day the day...being first to go with Sim Bob was frustrating..as I failed to verbalize what I did prior to coming into the exam room...i.e. review his chart etc.

So, with all the anxiety looking over everything we did to prepare for the final exam, we all crammed again all morning...we paired our study guide down to 21 pages. We crammed in the car all the way to school. I prayed to every single one of my patron saints and thanked God for my parents who pray for me everyday to do well in school...and then I grabbed my pencil and placed my binder under the table. Taking three deep breaths, I let go of the stress.

As our professor passed out the exam, she instructed us to put our last name first and our first name last. Our instructor looked at us and said, I looked at the study guide you all prepared and figured out that you already knew everything. Here is your final exam. I turned over the exam and there were 6 simple questions.

The last question on the exam was "What is the most important thing you learned about health assessment in this class? My answer: Health Assessment is the foundation for the entire nursing process and dictates the success of each phase of it. In addition, the teacher of this course is full of surprises.

Comrades X & Y RN, BSN

The Comrades-at-arms of SMC '08 ABSN were distinguishable at their pinning ceremony, not because of their physical height and distinguished good looks, but by the sheer tenacity of their perseverance and accomplishments. Both are entering final careers later in life as male nurses. Both had extraordinary journeys in the 12 month program overcoming obstacles that took them away from their support systems (primarily their wives and families) and they were completely humble and unassuming about what they had accomplished. Within three days of each other, they both passed their licensing boards and are now officially registered nurses with the Board of Registered Nursing. I have learned a lot about what it means to mentor others by watching how X has mentored me into this process. He is the jewel swimming in a sea of sharks. I wouldn't have taken the step to do something this intense, had he not tread the path before me. We were always told the truth about what the program entailed, the demands of it and how it would effect us. We are more patient about the setbacks of being in an accelerated program because we were prepared by those who had suffered through it.

To say they have nursed us through this process is an understatement. Both have willingly given of their time, talents and treasure to help us transition from part-time students to full-time accelerated nursing students. It is easy for me to write about these two guys because they are patently real with people, truly genuine and humble, and will be such an asset to the profession of nursing.

I was thinking about how much my own husband impresses me with his abilities to nurture his students for the last 23 years and what it means to be a male elementary school teacher in a profession primarily dominated by females; and it occurred to me that there are so many men impacting the nursing profession in much the same way. What a refreshing new dynamic. My son, who is fascinated by science and how the human body functions may live in a world of medicine in 20 years where half of the profession is occupied by men. It wouldn't surprise me if this would be a fulfillment of Florence Nightingale's vision for healthcare when she wrote of the men who supported her by sitting side by side on her sofa rendering her support in writing regulations and shaping the social policy of her day. " You say women are more sympathetic than men...I would say they have none!" Obviously she had strong disagreements with the females in her life who saw her work as inconsequential. No doctrine she embraced was embraced by women; they were embraced by men of power who saw her work on the dying fields during the Crimean War as changing the way society viewed efficiency within the military, not to mention her impact on health within the family unit. She shaped society from the smallest unit to the largest. Her views simple, but carved within her soul was the conviction that empathy and excellence is born out unselfishness, humility and hard work

In our class, we have (6) men from various backgrounds. Two of those men have wives who are already nurses. Everything is about balance...and it delights me to think that men are re-shaping the face of the nursing profession for the better.

When the boards were looming over their heads, the Comrades hunkered down, took the Kaplan prep course for the NCLEX and went into attack mode. This journey into the nursing profession is one of the most difficult things any of us have ever done. It requires an enormous amount of sacrifice from our families and takes an emotional toll on the student who wants to enter nursing.

Having good mentors along the way makes all the difference.

The Roadies have successsfully completed month 1, Term 1 and we will be taking final exams next Thursday and Friday. We are all working toward collaborating to help everyone else in the class who is taking this journey with us because as John Donne once penned "no man is an island..." But if I needed a nurse on a desert island, I would hope that Comrades X & Y are on shift ~ I think Flo would be proud of you both.

Congratulations to Robert W. Nutter, RN BSN & Ryan Kapty, RN BSN
You are official.