Doctor, Doctor Nurse?

The beauty of nursing and one of the reasons I am thrilled about my future is how much you can do with it! As opposed to medicine, where once you pick a specialty and do your residency/fellowship, you’re kind of locked in. Even if realistically you could make a change, you’ve invested so much time and money that the idea of going back to Year One of Residency is enough to make many sick to their stomachs. True, most nurses find their niche, but it’s pretty easy to drift around to several areas that are somewhat related. For example, one of the clinical faculty I met yesterday has worked in the NICU and OB, and floats often to Pediatrics.

Most of you know I have aspirations of becoming a Nurse Practitioner of some kind. And the new expectation is that by 2015, those who wish to enter this track will need to be educated at the doctoral level – they’ve even created the Doctor of Nursing Practice (DNP), a new degree that focuses more on clinical work than research; there is still a Ph.D. for nurse scientists. (See the attached PDF file – Doctoral Preparation for Advanced Practice Nurses – to read more about the AACN’s position on the importance of the doctoral education for advanced practice nurses.) The drawback of becoming an NP is that you do end up specializing into a niche. The benefits are the autonomy and the chance to become a clinical expert in your field.

But then again, I am really digging my research class. I’m one of those dorks who loves searching for articles and writing literature reviews and learning as much as I can about a chosen topic. So the idea of a Ph.D. is becoming more and more appealing to me, especially now that I’ve learned that qualitative research has gained a real foothold in helping the nursing profession better understand the lived experiences of those with health care needs. Since my first degree was in cultural Anthropology, I LOVE qualitative research (although I don’t love transcribing interviews ).

So the thought has occurred to me…why not do both? Who says I can’t be trained in both clinical and research skills at the highest possible level? Especially if it means that I get to be in school for even longer? School is what I do! I could go for the Ph.D. first and let the DNP get more of a foothold in the profession, since it’s so new. Or I could do the DNP after I work for a few years and figure out where I fit best, clinically speaking. Then I could go for my Ph.D. later in life, when I’m tired of being on my feet for 12 hours at a time and my pace is more suited to taxing my brain rather than my body (not that all kinds of nursing aren’t intellectually challenging). To me, that would be the perfect way to spend the latter part of my nursing career – answering all those questions that come up in practice.

Not that I have to decide today…it’s just exciting to know how many options I really do have. For someone who loves a new challenge, it’s just another reason that nursing is perfect for me!

Plastic Children

Today was our Pediatrics skills lab, when we basically re-learned a lot of previously acquired skills, keeping in mind the unique developmental needs of children.  It was actually really fun, although even stranger to interact with child-sized mannikins than it was with grown up-sized ones.  But it was definitely helpful to practice my assessment skills and get back into the groove of things again.

We also got to meet our clinical faculty person, who is a hoot!  I think I’m going to really enjoy this rotation, although there will be a couple of significant differences from my other hospital experience.  For one, we’re not going to be assigned one RN as our clinical instructor, like we were on Med-Surg.  We’ll have a different nurse from week to week and will alternate between the infant/toddler and older kids’ units for the first four weeks, and then focus on the area we enjoy more for the last two.  The second major difference is that at least at our hospital, we’re not going to have access to the Pyxis, which is where you retrieve your meds.  This means that every time we have to get out a med, we have to find a nurse.  And since they won’t know us the way our clinical instructors do, they want to watch us dispense meds every time (on Med-Surg, once they feel comfortable with your skill level, you have a lot of independence).  So that’ll be odd…  But I can understand for safety reasons why they’d want to be particularly careful, since a medication error with a child can be even more serious with an adult (depending on the med).

Next week we attend part of the OB lab, although we don’t have to stay for the whole thing.  I’m just thrilled about the opportunity to work with children, and confirm once and for all if this is where I want to start my nursing career!

Overachievers’ Anonymous

My name is Nurse Teeny and I am an overachiever.

Apparently.

There is a culture that is forming in my program that concerns me to no end.  It is a culture of negativity and criticism.  It is a culture that tells us that when we work hard or succeed, we are going to get teased and ridiculed.  It is a culture that seeks to tear down rather than build up.

One of my recent posts was about negativity and not getting sucked into a potentially endless string of complaints about the experience of nursing school.  And that negativity feeds right into this culture that is so destructive, I can no longer remain silent.

Today in our family nursing class, the instructor pulled up the reference list of a fellow student who had turned hers in a few days early – the due date is Thursday.  The professor was simply showing us (with the student’s permission) what our own reference lists should look like. Someone whispered to the student, “You overachiever.”

I have a habit of finishing exams quickly. I’ve often been the first over the last couple of semesters. That’s not a boastful statement, I just test quickly.  Always have.  But I’ve actually been asked by other classmates to wait 5-10 minutes after I finish before turning my exam in so that I don’t make them feel bad (I actually tried it once and then left when I realized how ridiculous the whole concept was). People have taken bets on how quickly I’ll finish finals, or dared me to purposely be the last one.  And when I’m not the first one, I get teased about how slow I must have been that day.  So I’m damned if I do, and damned if I don’t.  And it’s getting old.  Really old.

When someone does well on a test and others find out, it is often to their detriment.  Rather than be congratulated for a job well done, they get teased for studying for the test too hard, or some other nonsense.  It makes the happiness of succeeding on a test feel bittersweet; it makes me reluctant to discuss how I do on tests and papers because if I do well, then I’m gonna get ridiculed for it.  Whatever happened to a simple and sincere “Congratulations”?  And does it really matter how someone else did on an assignment anyway?

I have no doubt that the teasing and the ribbing is intended to be good-natured on an individual basis.  But that doesn’t make it okay to me, because the cumulative effect of being teased for being successful is to feel bad about being successful.  The cumulative effect of being teased about how much you study is to downplay how hard you are really working in this program.  We all busted our butts to get into nursing school and we’re all busting our butts in our own way to stay here.  Shouldn’t that be recognized and applauded within our community, rather than seen as a negative?  We all have different outlets to deal with our stress, we all have different study habits, and we all have different goals.  Mine happens to be ultimately earning my doctorate, and therefore yes, my grades do matter to me because my GPA will affect my next steps academically.  And regardless of that goal, my own expectation is that I should do the best that I can.  Not in comparison to anyone else, but compared to my own standards for myself.  So if I work my hardest and do the best that I can, and the outcome on a paper or test is favorable, then fabuloso.  I like school, I like being a student, that’s who I am.

I was expressing my frustration about this culture to a professor and she said that the unfortunate reality of nursing is this: when nurses feel threatened, they circle the wagons.  Then they shoot inward.  But she also told me that it’s up to us as future nurses to help change that culture, to lead by example.

So I guess for me, it starts here.

My name is Nurse Teeny and I am an overachiever.

A damn proud one.

Right Up My Alley

Week 1 of the summer term is under our belts. And I’m exhausted but excited! Since it’s the summer semester, they’ve compressed 15 weeks’ worth of work into 12…should be interesting. But the good news is we only have one clinical rotation (as opposed to the usual 2), and the coursework is very different from class to class, so there will be lots of variety.  Not to mention all three classes intrigue me to no end.

Our OB/Peds class is the tough one, content-wise.  The idea of learning care of the pregnant woman, the newborn, and the child (through adolescence) in three months is a bit intimidating.  But I’ve been waiting for this class since before the program started.  Now that we have experienced Med-Surg and have a foundation in our assessment and caregiving skills, I feel ready to tackle the little ones.  I’ll be doing my Peds rotation in June and July over 6 weeks, and also have to spend four clinical hours in a community-based experience, so I’ll be helping out at a lactation clinic in a couple weeks.  So excited to see all those babies!  My biggest fear about the class is that I’ll figure out that I don’t want to do peds nursing after all; then again, I’ve already figured out that there are other areas of nursing I enjoy, so it wouldn’t be the end of the world. At least I get the experience to figure that out now…

Our Family Nursing class is a good complement to OB/Peds – it’s discussion-based (no exams – yay!!), and centers around how health care issues affect the entire family, rather than the individual client.  Since my career background is in family support, I’m loving this!  We have to write a big research paper, but otherwise most of the work occurs in-class.

And then there’s Evidence-Based Research.  There is a big push within nursing to compare our actual practice with published guidelines about what is “best” practice, in order to improve and advance the profession.  The nerd in me loves this concept, and I am especially excited because this is an area where my eventual MSN as a Clinical Nurse Leader (CNL) will play a HUGE role.  Since staff nurses are so overworked already, CNLs are able to work with them by doing the research and providing education.  Research answers the “why’s” of nursing; rather than simply do something because “this is the way it’s always been done,” we empower ourselves by putting literature into practice.  The only drawback of the class is the statistics (ugh!), but our awesome professor assures us that we will learn to love ‘em (?). We also have a group research project, and our group will likely be addressing the question of how to improve nursing student education.

So there you have it…I have to say that I’m pretty pumped about the next few months.  But my brain hurts already!

The Nursing Student’s Mantra

Yesterday a classmate and I got together to do a craft project in honor of a truism we discovered over the past semester:

It is what it is.

Nursing school is hard. Really hard. And there will be moments when the only thing you feel like doing is bashing your head against a wall. Group projects will get dumped on you. You will not learn every possible clinical skill before entering the real world of clinicals. And you will make mistakes. But if you look for the negative in every situation, you will find yourself wasting a lot of energy complaining, energy that you could be devoting elsewhere.

This is not to say that you should be a doormat. If you feel the need to advocate for yourself, by all means do so. But pick your battles.  And be wise about how you approach such situations.  Our class was able to successfully advocate for an instructor change because we made rational arguments and communicated our distress calmly.  And we hadn’t already established a reputation for ourselves as complainers.  But there is a thin line between lobbying and whining.  And when that same instructor tried to helpfully send us an article about the challenges of being second-degree nursing students, several of my classmates became incensed because the opening paragraph contained the word “hostile.” They were offended because they believed that she was passive aggressively calling us hostile.  When a small but vocal minority suggested that maybe she was trying to help us by offering us some information, we were told we were being “too nice” (one person was even called a “suck up”).

So a word to the wise for future nursing students:  These programs are stressful, no matter where you go.  And there will always be opportunities to be negative.  Don’t get sucked in.  Do the best that you can do, work hard, advocate wisely and always remember … it is what it is!