Tuesday, May 20, 2008

Nursing School Greatest Hits

I was going to entitle this Sunshine, Lollipops and Rainbows and Everything because I need a little too much happiness around here. I have two more weeks of school left before I finish my second level

(and, no, people tell me that you don't count the week you are currently enmeshed in EVEN if it is Monday (and it isn't Monday it's Tuesday), so this week counts even less. And you don't count finals week. Finals week is like a couple of hours of tests and lots and lots of procrastinating flecked w/ some studying, so, that really doesn't count either. Heck, I'm just going w/ the program here, folks I didn't make these rules.)

I've been such a grouch and I'm so sick and tired of nursing school and all that it means to be a student nurse so I've decided to talk about my favorite things from nursing school. Then I can say (in a I'm-Talking-Myself-Off-A-Ledge sorta way): "See, it's not *all* bad! Cheer up, li'l student nurse. Dust off those crappy care plans, buck that daily lack o' respect, forget your feeble skills and failing confidence and lookee here..."

1. How about those psych ward burritos? Not too bad for psych ward burritos. Every Monday night in my first rotation this year we - my adolescent psych ward buddy and I - got to serve and eat burritos w/ our anorexic and/or psychotic patients. Yum!

2. My peri-op instructor. The most patient instructor in the world. I would never, ever want to be an OR nurse, but it was my one of my favorite clinical rotations because of the instructor. And I loved doing a day in ICU during this rotation. I, pretty much, have never done so many skills in one shift AND my patient, in multiple organ failure and looking really grim (um, yeah, hard not to w/ multiple organ failure) survived to kidney punch one of my fellow students later in the week.

3. My geriatric rotation. Loved telemetry. How reassuring to see those P waves. How lovely when the QRS complexes march out so neatly. How gripping when they don't! How many PVCs do they allow around here, people?! And loved the patients with all of their pathologies and stories. One of my patients had had St Vitus' Dance when she was a kid. Who gets St Vitus' Dance these days? It was just rewarding on so many levels most of the time.

4. My night in Hem-Onc during pediatrics. My pt, a teenager, had a below-knee amputation (BKA) d/t (oh, sorry, the nurse-ese creeps in: that's "due to") cancer and hadn't left his room in a month. I got him down to the special "teen area" and asked him, "Oh, how many times have you been here." and he: "Not often. Uh, never. Uh, this is my first time." He made a t-shirt for his mom, painted it with glitter paint. It was beautiful and careful and I helped hold the stencil and he was proud of it. And then we went around the unit, he in his wheelchair. I decided to make him famous. I introduced him to everyone I knew: pretty much every nursing student and most of the nurses, some of them high-fiving the kid and everyone jovial and happy to see him. By our third time around the unit he was waving like a celebrity and grinning.

5. In L and D my instructor was hoping I'd see a c-section on my last day there. She sent me to a delivery room of a patient who'd been at 10 cm and pushing for the entire night, sure she'd be "sectioned". Half an hour later the patient delivered a little boy vaginally, occiput posterior (that's sunnyside up, or face up to my non-nurse-like readers...a tough way to deliver), while I held a warm cloth at her perineum. Half an hour later I was in the hallway with my nurse and there was a "code stork" announcement. That means someone is about to give birth in the ED or in some non-L and D area. I ran with two nurses to the ED, missed the pt who was screaming in the elevator on her way up to the unit. No one had any idea who this woman was and twenty minutes later, with me holding her leg, she delivered a little girl... occiput posterior! The midwife (same one for the previous delivery) was amazed. Two in a row in under an hour, both sunnyside up!

6. My current clinical group. I'm sick of nursing school, I'm sick of everyone. I'm grumpy as anything and, yet, they're just fabulous! We did a group project together and it went so smoothly and no one cried and we got good reviews and a good grade plus there was a funny video! World's. Loveliest. People.

7. And, finally, TWO WEEKS LEFT.

(those are some of my spring freesias. My garden is having an in-between moment right now (read: my neighbors hate me) eh heh heh. Wait'll I get my hands on those weeds. And how long are we waiting? Yep. TWO WEEKS!!!

Thursday, May 08, 2008

Medical: They Like Me, They Really Like Me

I'm on to my medical rotation (my last) now. It's here at Hometown Hospital. My patient last night pretty much told me when I came to take his vitals and do an assessment, "I don't want you in my room." Um, OK, Am I going to assess you over the phone? By the end of the night this young man clasped one of my hands in both of his hands and was thanking me and asking if I'd be back the next night.

So, my patients like me. Is that a good thing? Is it like the teenager w/ the "cool mom". You know, the mom who doesn't give the kid a curfew and ignores the smell of pot seeping through the floorboards? Maybe I'm being too easy on my patients. Maybe I'm not pushing them to get out of bed often enough or I'm not encouraging them to do enough coughing and deep breathing or I'm bringing them too many graham crackers. Maybe I'm enjoying the "psychosocial" part of the assessment a little too much: "Oh, hm, do you still talk to your brother after that incident?... And you've been doing that job for how long?" Am I chatting?

God, do I love nursing for all the wrong reasons? I feel so lucky to be in this private universe of a person, to learn interesting things about them, to pick away at their lab values and wonder what is going on inside. It's a privilege to get past the taking of vital signs and to try to figure out what is really going on with someone and then to come up with solutions even if it just means moving a pillow. Maybe I like nursing because I'm nose-y and curious.

And then, at Hometown Hospital, half of my group's patients last night had substance abuse problems. Heck, my patient did. And, hm, half of the patients were in a lot of pain including mine. I'm told: Pain is what the patient says it is. And there are laws 'round these parts that we have to treat pain, but there's also a culture in nursing that suspects substance abusers of being "drug seekers". My nurse last night said "I don't want him to become addicted." (I'm taught: when used for pain treatment, very few people become addicted to narcotics) But, you know, substance abusers often have a lower tolerance for pain and maybe they're substance abusers in an effort to self-treat some kind of pain. Is it for me to judge? Well, yeah. My patient wasn't due for anything narcotic and when I offered him some-perhaps less "fun "-drug to help him out he said he didn't want it, so you gotta wonder. Yeah, he's probably a drug seeker, but he's probably in pain, too.

For my maternity rotation I had to follow up on a family after they'd gone home with their babe. I asked the new big sister (she's five) to draw a picture of her and her brother and that's it above. I love the big smile on the baby. It made my week and, phew, that was a tough week. I think a lot of my fellow Nursing School U students are going through similar breakdowns and burn out. I've heard lots of stories of staring off into space with the inability to do anything, other tales of going home and crying and I pass by tired looking familiar faces on campus where we both just barely pick up the chin for a "s'up" and scurry away with too many books in our backpacks and strategies for making it through the next four weeks in our heads. There's the Muscle Through It Strategy, The Countdowners, the I'm-Just-Going-To-Take-It-One-Day-At-A-Time folks...

Saturday, May 03, 2008

Maternity Rotation

When I was pregnant w/ my daughter (my first kid) I made a quilt. It's a bunch of strips of fabric put together in the "log cabin" pattern. When I went into labor I was working on it and I had finished everything but half of the edge. Now, seven and 1/2 years later, you can see that it is pretty tattered (that's a very small section of the quilt there). We sleep under it every night and wash it in the washing machine and treat it like what it is: a blanket to keep us warm. It's special to me but, more importantly, it serves a function.
It does remind me of the hard work of being pregnant and giving birth, though, every time I look at it.

Ever since I decided to go to nursing school I've wanted to be a labor and delivery nurse. And I just finished my labor and delivery rotation and, I have to be honest, it was my least favorite rotation. I don't know if it was because I put so much pressure on myself to do a good job or because I'm really burned out right now or because I've had such high expectations for it, but I'm leaving this rotation feeling crappy about my abilities, feeling lousy about nursing in general and just really fed up w/ being a student. I've done what I can to embrace my student-y role: I've resigned myself to being humble and admitting that I know so little, I've polished my study habits until they are gleaming and precise, I put myself out there and ask questions that no one else wants to, I've taken on a student nurse gov't position, I've made a ton of friends and on and on. But I'm so tired now. I just want to be finished and get a job as a nurse and take care of my family.

I'm not ambitious anymore. I thought: I could be a midwife or an ob/gyn nurse practitioner. Ive always had a passion for women's health issues (ever since I took female physiology and gynecology - "gin fizz" - my first time in college) and I just adore working with children and families, but I'm not going to put up a fight for it. My maternity nursing instructor just wasn't impressed by me. She said, "You're just average. You're not the 'total package'. And you want to go into this field?" She had already approved me to do a preceptorship (that's like an internship for you non-nurse-y readers) in L & D, but I've heard if she doesn't fight for you that you could still not get it when it comes time to finding a preceptor to take you in the specialty. So now I've convinced myself that I'm just an average nurse and I would have hated to have an average nurse help to deliver my kids. It was just such a pivotal moment in my life: the birth of my kids. Now I just want to switch to the regular old, average nurse med-surg preceptorship so I can stop fretting about the whole thing. I'm just so tired. And I'm really feeling sorry for myself.