Living The Dream

So technically my capstone hasn’t started yet. But I have a really good feeling about this experience after meeting with my preceptor (“C”) this morning.

For one, she loves to teach. She appreciates what it’s like to be a newbie and doesn’t turn up her nose when nursing students make silly mistakes. I told her the story about taking a patient’s pulse with my thumb (big no no, seeing as your thumb has a pulse of its own) on my first day of peds, because I was so nervous.  She just laughed and told me about a new nurse who forgot to put the blood pressure cuff on the patient and couldn’t figure out why the reading was so off.  That made me feel so much better!

I mentioned earlier that there was some confusion about whether I would be in the clinic or on the inpatient unit. I WILL be inpatient, which I actually prefer as far as developing my skills (and nurturing a possible job offer if all goes well). We are going to see if I can shadow another nurse in the clinic a couple of times, just to see what it’s like. But I’m much more likely to get hired onto a unit than a clinic right out of nursing school, so making those connections is going to be critical.

C also has big plans and high expectations for me, which is a good thing! Before the end of my rotation, she wants me to be comfortable with a standard patient load (3).  We’ll technically share the assignments, but she wants me taking the lead on all three and delegating to her. During my orientation shift, we’ll be doing a lot of skills practice – accessing ports on “Chester” the training torso , playing with the IV pump, calculating meds, etc. She’s even going to let me practice blood draws and IV starts on her!

We discussed my interest in peds end of life care, and we decided to focus on developing my knowledge base in this area. She’s going to see if I can sit in on some consults with the palliative care team (with the families’ permission of course).  It was so refreshing to tell someone my goals and NOT have them look at me funny. When I explained why I wanted to do peds hospice, she said it was “beautiful.”

Which brings me to yet another reason I really like her. We get along famously so far. Our meeting this morning lasted almost three hours, although neither of us noticed.  It was so comfortable and I felt that she respected me as a person, rather than viewing me as an ignorant student. She’s still my teacher but it’s helpful to know that she thinks I have something to contribute too!

Orientation is a week from today and then I jump in headfirst the next morning. Let’s get this party started!

Have Mercy!

Pardon the pun, but this show deserves the bad humor anyway.

After frustrating encounters with HawthoRNe all summer, I was holding out hope for the third of three nursing shows this year: NBC’s Mercy.

I think my hopes have been dashed. It’s a bad sign when you actually look forward to the commercials.

Chloe (Michelle Trachtenberg), Veronica (Taylor Schilling), and Sonia (Jaime Lee Kirchner).

I will admit to (apparently) unrealistic expectations that medical dramas be somewhat realistic. But c’mon, when a supposed physician calls heparin a “blood thinner,” you have to cringe a little. For the love of a basic medical education, heparin (and warfarin, for that matter) are NOT blood thinners, they are anticoagulants. Do your research, writer’s room!

And the chest compressions Nurse Veronica did were a little pathetic. You’re not gonna do much for a coding patient when your elbows are bent and you’re 10 feet away from the gurney.

But alas, I accept the fact that medical shows will never capture real health care providers’ knowledge and abilities. It is fiction, after all.

My issue with Mercy has much more to do with the cultural stereotypes it portrays. In true form, here are a few of my biggest pet peeves about this show…

1) Yet again, the doctors come off as either a) abusive jackasses or b) incompetent newbies. Whatever happened to intelligent physicians who collaborate with nurses? I know there are still some jerks and/or idiots out there, but is it really that terrible?

2) One of the main characters (Sonia) is a social climber determined to escape from her lot in life by dating lawyers and swearing to get out of Newark. The supporting characters reinforce the stereotype of blue-collar families drinking heavily and frequenting dive bars, where there is almost always a fist fight.

3) Sonia also views nursing as “just a job,” which is the first stop on the road to total burnout. And disheartening for those of us who are just starting out.

3) The new nurse (Chloe) shows up in cartoon scrubs and seems completely clueless.  She can’t figure out that her patient has an air embolus, even when he’s hooked up to a pulse oximeter that shows his oxygen levels at 79%!!! Instead of bagging him, she screams for help. Even worse, she just got her Master’s degree and was top of her class, so her clinical stumbles paint higher education for nurses in a very negative light.

4) The experienced nurses only minimally tolerate Chloe, being completely inhospitable when she first shows up and declaring after a few days that “this is the first time [we] didn’t want to kill you”. I’ll be posting later this semester about the whole concept of “nurses eating their young,” but this show reinforces that dangerous idea.

5) The main character (Veronica) is completely messed up and recently returned from Iraq. Her story reminds me so much of Dr. Hunt from Grey’s Anatomy, it’s scary. How about a little originality when you sketch your characters?

Yes, I had my issues with HawthoRNe but I’ll take the clever writing and authentic acting of Jada Pinkett Smith any day over this drivel.

I’m giving it one more week to even attempt redemption, but at this point survey says “Two thumbs down”.

I’m not the only one who feels this way either.

One Step Closer…

…to actually beginning capstone!

Today was a painfully long class at the hospital about their electronic charting system. As bored as I was, I was also grateful that they force us to do this. Much better than trial by fire, which has been the norm in previous clinical rotations. I’m realizing how many EHR (electronic health records) systems there are out there!

Should be hearing more details about my preceptor any day now. Then the fun really begins!

Study Guru

My NCLEX study plan officially began today. I’ve been doing some content review here and there before now, but this was really the kickoff of the hardcore launch. I’ve contemplated posting the calendar on the blog but I don’t know if it would actually be helpful to anyone. As I told my friend Katie, this is a “hardcore nerd” personal learning plan. But if you’d like to see a copy, feel free to contact me and I’d be happy to share it.

Today’s goal was to watch the first part of Hurst Online’s “Fluids and Electrolytes” lecture. Most of the videos are of Marlene Hurst (the founder herself) doing the lectures, and she is a hoot! Combine a deep Southern accent with a crazy sense of humor, and I was in stitches! At least I’m having some fun while I torture myself.

I told S this evening that if I stick to the plan and don’t pass the NCLEX on the first go, I’m not supposed to be a nurse. I was being facetious of course, but part of me would be devastated if I worked as hard as I plan to and don’t get that license. I honestly don’t know what else I could do to prepare. I’m attacking this thing from all sides:

• Strategy: How to eliminate answer choices and get to the heart of what the question is asking
• Content: The core information I need to know to get through the test
• Test Knowledge: By reading the NCLEX Test Plan, taking the NCSBN’s NCLEX Tutorial ahead of time, and understanding how a computerized test operates, I will feel a little less anxious about the mysterious exam.
• Practice, Practice, Practice: CD-ROM tests, and practice tests, and questions galore, oh my! I need to familiarize myself with NCLEX-style questions.
• Utilizing “Free Time”: My flashcards (electronic and paper version) go with me wherever I go. If I’m in a waiting room, I can whip those puppies out and go to town.

But I also know that if I stick to the plan, then I will walk into that testing center feeling confident that I DO know this and I CAN do this.

Right??????

Clear!

Today was our pulmonary embolism simulation and it was a REALLY good learning experience because we had to do a lot!

We started out with a “patient” who had a pretty uncomplicated situation – post-op cholecystectomy (gall bladder surgery) – who took off her SCDs in the middle of the night, which is a no-no when you’re a non-ambulatory postop patient. SCDs are Sequential Compression Devices that you might be familiar with if you’ve ever had surgery – they are wrapped around your calves and inflate/deflate in cycles to keep your blood circulating and prevent the formation of clots.

As we expected and knew would happen, our patient started showing symptoms of a pulmonary embolism – shortness of breath, chest pain, decreased oxygen saturation levels, anxiety, etc. So we had to call the physician about a change of status, implement all of the new “orders” as a result of our report (stat labs, scheduling a pulmonary angiogram and starting a 12-lead ECG) and calculate and hang meds.  Then we had to call the doctor back with lab results and reassure the patient, who then became unresponsive.

The funniest/most confusing part was when we realized she was unresponsive and we needed to call a code. We all kept waiting for someone else to take charge for a few seconds and then simultaneously exclaimed “Code!”, then broke into a fit of giggles. Hey, we were nervous!  I ended up actually calling the “Code 99″ through the phone, and then our job was to do basic life support until the code team arrived. A team of 1 – our instructor – but she acted as the leader and we were the code team. One person managed the airway and checked pulses, two switched off on chest compressions, and I got to push meds (epinephrine and amiodarone) and man the defibrillator.  What an adrenaline rush!

After several minutes of interventions, the team leader called it and our mannequin “died”. Mostly because there was no one in the sim control room to tweak the computer and return our patient to consciousness.

By the end we were sweaty and flushed and exhilarated! It’s one thing to practice chest-compressions on a torso in CPR class, but it’s entirely another to go through the whole process of a code. (And I’m sure even moreso with actual people.) But it was important to practice the process and understand what we as nurses/nursing students may need to do in such a situation.

And with that, I’m exhausted. Tomorrow is the first day of our capstone seminar and we will be finding out more details about clinicals. It sounds as if I’ll be in a pediatric hematology/oncology clinic and infusion center!!!!!! Not at the exact location where I decided that peds day treatment was my first choice, but the same type of setting. I will DEFINITELY take it!

Done and Done

I signed up for Hurst Review’s online program today and I am feeling good about my decision, despite the steep price tag. They do offer their review in a 4-day class if you can find one locally, but it was $50 more. I’m actually thinking that watching the lectures by Marlene Hurst, the founder of the program, will be to my benefit, as will my ability to view said lectures from anywhere I can get online.

I’m tackling the NCLEX from multiple angles. Kaplan is helping a lot with strategies to solve specific types of questions. Saunders will give me practice in answering many many many NCLEX-type questions. And Hurst is going to help me hone in on content.

This test is funny. It makes me anxious even though I’ve done really well in school (especially after I read an article today about how nursing students who do well academically are actually a high-risk group for failing…ugh!).

Although I feel confident overall, I’m doing everything I can to pass this puppy on the first go-round. There’s no substitute for thorough preparation! The harder I work for the next three months, the better I’ll feel. And when it comes to my future, you can’t ask for anything more than that.

Back In the Saddle

Or should I say, back in the sim lab?

We are allowed to get up to 15 capstone hours by preparing for and participating in group simulations in the learning resource center – 5 hours per simulation. Although the sim lab has caused some anxiety in the past, I figured it was a good way to get back into the swing of things before our clinicals start. So four of us signed up to care for a “patient” with a pneumothorax (collapsed lung).

I must say it was the most fun I have ever had in a simulation. The director did the teaching and also played the part of a doctor putting in a chest tube, and we learned so much from her! Two of us went in and did the initial assessment, received lab values and CT results indicating the pnemothorax, and called the physician with an update. Then the next pair came in for “change of shift” and assisted with the chest tube insertion, while my partner and I sat in the control room to play the patient’s voice and control the cameras to get a close-up view of the procedure. So cool!

Since it wasn’t graded or recorded, we could just relax and practice the skills we’ve learned over the past year, get patient and helpful feedback and just feel confident in scrubs again! I really appreciate that they’re taking the time to let us do this. My research group over the summer studied the effects of simulations on student confidence, and anecdotally I can say that I much prefer doing it this way, rather than a graded individual test.

So I have two simulations to go. This coming Thursday we’ll be facing a patient with a pulmonary embolism and they’re going to have the mannequin “arrest” so that we can go through the motions of a code. Since I was involved in a code in peds and felt like a bumbling fool, this will be exceedingly helpful in showing me what I can and should be doing as a nurse.  CPR and First Aid are important classes, but it’s applying what you learn is a whole different ballgame.

Then we get a burn patient on October 15. Not something I expect (or wish) to see in my own practice, but I thought it would be a valuable experience, just in case.

We have our first capstone seminar next Friday…cross your fingers that we get our clinical assignments. We’re all going crazy with anticipation!

My New Best Friend

I am an avid reader of many other blogs, but I hadn’t routinely been following my favorites because it is a drag remembering each individual blog address to check.  Even though bookmarking the addresses saves a step, it is still a waste of time to sift through all of your bookmarks, especially if there are no new posts since the last time I went there.

Enter Google Reader.  Why did I just now learn of this miraculous tool?  Google Reader allows you to enter the addresses of all the blogs you like to routinely check, thus creating a subscription to each site.  Then you just click over to Google Reader and all of the sites with new posts are highlighted in bold.  You can even read the posts right there.  All you need is a Google account, which is a snap to set up if you don’t already have one.

What it looks like.

It’s basically the same thing as using an RSS feed to subscribe to a site, but the beauty is that all of your subscriptions are in one place.

What a genius way to track your favorite bloggers.

Nursing Voices

I must say that I am STOKED about this semester so far! Today featured our first of four comprehensive review classes.  We spent a lot of time talking about our personal learning plans and starting to prepare for the NCLEX.  I also found out a key piece of information that gave me some peace of mind: I can take the NCLEX anywhere a testing center is available, instead of only having to take it in the state where I intend to be licensed (since it’s a national test and my state will already have my paperwork stating my intent to be licensed there).  I had been afraid that I wouldn’t get my eligibility paperwork until I was home for Christmas, and therefore would either have to fly back or wait til January, neither of which were very exciting prospects.  This means if I get my eligibility at the end of exams (mid-December), I can go home for the holidays and schedule the NCLEX from wherever I am!

We also had our first day of Leadership, which I think is going to be an amazing class.  Our professor is also Dean of the nursing school’s graduate program, and this course signals a transition between our pre-licensure content and our graduate-level studies that begin next year.  She is using a non-traditional “transformational learning” model – basically we all know we’ll get an A in the class as long as we work together.  None of our written or group work will be quantified with a grade, and we are responsible for holding each other accountable in our group projects.  If we succeed in working as a team, we all get A’s!  Very helpful in preparing for the real world of nursing and working with others! The most intriguing assignment is a forum our class will be presenting to the entire campus on health care reform.  We’ll be going over Obama’s plan, dissenting ideas, historical/social/political background, and the perspective of the nursing profession.  VERY interesting and very helpful for all of us in understanding this debate ourselves.  I originally volunteered to be in the group researching Obama’s proposal, but our professor asked me to switch to the group examining recommendations/opinions among nurses.  She actually recommended particular group assignments to quite a few people, which I think is a positive….it shows that she’s been paying attention to our performance and goals along the way, and is aware of our individual strengths and interests.

Let’s get this party started!

Fall Is In the Air

Well, not quite.  It’s still pretty warm.  But here goes fall semester anyway…

It’s crazy to think that I’m a mere three months away from completing the pre-licensure part of this program.  This term will feature a lot less class time, a lot more clinical time, and a whole lot of independent study.  Here’s the schedule breakdown:

• Leadership/Health Policy: The big feature of this class will be a campus-wide forum on health care reform, which we are responsible for researching, organizing and presenting.  I’m SUPER excited about this project because I love discussing politics and I need to learn more about this mess anyway.  We’ll also be spending a lot of time on learning about our leadership and communication styles…very helpful for when we begin working on our Clinical Nurse Leader coursework next summer.
• Practicum: The famous capstone!  165+ hours in a clinical setting (you’ll know as soon as I do), 15 hours of simulation time to prep, and a seminar to cap it all off.  The seminar will help us process the clinical experience, debrief about challenges we face, and address our anxieties about becoming a professional nurse.  We also have a paper or presentation due at the end of the semester on an ethical or advocacy issue of our choice.
• Comprehensive Review: Only meets four times, but I think it will turn out to be a very important class.  We’ll get help coming up with a personal learning plan to study for the ATI Comprehensive Predictor and NCLEX, complete paperwork to apply for licensure (whoopee!), and practice for those blasted oral comps (more on those another time).

So there you have it.  A lot less reading- and writing-intensive than previous semesters, I really believe that this fall will be what we make of it.  I still can’t believe how far we’ve come!