nursing school

Waiting


For the last year ( two, if you count the prereqs) this has been my life, day and night. Some days I was sure someone glued me to the chair. Rose still asked everyday, “do you have studying, mom?” always hoping the answer might be no! I loved it though, I love school, (I know, I’m a nerd; the science was always my favorite part). I even liked taking tests, I like the feeling when I read a question and absolutely know the answer and can explain why, it is a powerful feeling. Then we got to work in the hospital with actual patients, and I was sure I was doing the right thing. I was scared out of my shoes that I wouldn’t know what to do, and often, I didn’t, but the patients always looked to me for help and comfort, and somehow I provided. I went from feeling like and impostor in white scrubs, grateful to be able to empty the bedpan; to gradually being able to manage 3 patients care by myself and having the sense that they are “my” patients by the end of my preceptorship.

Then we graduated a week before classes were over. We still had tests, and shifts, but we walked with our robes and hats and all. It felt great! That’s me in the middle of my new friends. Twenty nine years since my last graduation, this one meant so much, and I appreciated the opportunity so much more this time.

We did a few more presentations, and papers and exams, and then school really was over. We had our pinning ceremony, where we get pinned by another RN as a way of welcoming us into the profession. It was very touching, and we celebrated being done, finally!

Here is my pin, the initials are for Samuel Merritt University, we are the first class to graduate from the University, after 100 years of being a College. That is a lot of nurses! It is inspiring to come from such a long tradition, too bad we didn’t get the little white caps too!

BUT…. the studying wasn’t really over yet. I still had to take the board exam, the NCLEX. So my friend Marti and I kept meeting everyday to study for a couple of hours. We practiced thousands of questions, and quizzed each other, and looked up obscure drugs and diseases. We even spent a couple of days in Tahoe with two other classmates to study away from the distractions of house and family. We really did study, though nobody believes us. Then I spent a day in Yosemite, by myself, hiking and enjoying the scenery before I drove to Fresno to take my test.
I couldn’t have been more ready for this test, we studied all year, reviewed for several weeks, I relaxed for a whole day, got a good night’s sleep the night before, ate a healthy salmon (brain food) lunch and had a latte, and walked into the test center ready to conquer it.
It was the wierdest test I have ever taken. First, they take you one at a time, after you have been photographed, fingerprinted and pockets emptied into the test room. They don’t even let you take a tissue in there, I had to leave my bottle of water and my dark chocolates in a locker outside ( those of you who know me, I always have a couple of dark chocolates on my desk with me when I take a test, for that little boost when my brain wears out!). They sit you down in front of the computer and log you in and let you know that you are being video and audio taped during the test and if you need a break, raise your hand and the proctor will escort you to the bathroom. So, I sit down, a little unnerved by all the security, but ready to get this done. I speed through the little tutorial that takes you through some sample questions and push the button to start the real test. Now I should tell you that we have six hours to answer from 75-265 questions with breaks scheduled at 2 and 3.5 hours. The test is constantly evaluating how you answer each question to determine what the next question will be. It keeps asking questions until it determines that you clearly pass or clearly fail. I was determined to go slowly and carefully read each question a few times, since you can’t go back and change your answers. The first few questions were pretty reasonable and I felt pretty sure I was getting them right, then boom, they got hard, drugs I had never heard of, questions about priorities that I couldn’t rank, and then phwew, a few math questions. I love the math questions, because I know how to do them, they are concrete. It is the question about which patient you would see first that always gets me. Well, I am tooling along, I don’t really keep track of how many questions I am answering, (the last time I looked at the counter, I was on 55). The questions are hard, and I feel like I am guessing on many. I am sure I am not getting most of them right, so I am shocked when the whole computer screen goes black. Oh NO!, there is a power outage! right in the middle of my test! will I have to start over? But no the proctor comes in to escort me out and I realize that the screen went black because I was done! I quickly tell her this can’t be, I am not finished yet, I haven’t answered enough questions! there is no way I am up to 75 yet. Can she check? She smiles and shakes her head, no, there has not been a malfunction and there is no way for her to check the number of questions I answered. In a daze I walk out, put my finger on the fingerprint checker (what, was I going to somehow sneak someone else in to take my place while being videotaped? it is really me walking out now!) I collect my stuff, and see that only and hour and ten minutes have passed since my test started. Well maybe I started a little bit early, since I arrived at the center early, let’s say and hour and 15 minutes. Still that is 75 questions in 75 minutes, there is no way, I was going to go slowly! what happened? Oh no! what if I went so fast that I answered most of the questions wrong and I actually failed! I get in the car to drive the 3 hours home and try to think of who I can call that will make me feel better. Marti; she took the test the day before me and we hadn’t talked yet. Aachhh, I hear the sinking silence on the other end of the phone when I tell her that it took me 75 minutes, she took 2 and a half hours with 2 breaks. I didn’t even get a break. That is bad news, Marti is the speedy smart one. When we studied together she usually had the answer before me. I made some more phone calls looking for reassurance, which was given but I didn’t feel it. Nothing was going to make me feel relieved.

It has been 3 days now and I check the BRN website way to often to be considered sane, and still haven’t seen my name on the list of licensed RNs yet. I did the trick that someone said to try to register to retake the test and if the website won’t let you, then you passed. It wouldn’t let me, but I still don’t feel relieved. SO I AM STILL WAITING! I spent today listing all the hospitals that are within a one day drive of me and checking the job openings on their websites. The job hunt is another story that I will save for another post. In the meantime I am trying to keep busy and WAIT.

a good sign or a bad sign

Well, I took the NCLEX today and walked out of the test feeling pretty nervous. I think the computer shut down after 75 questions (the minimum), I am not sure because the last time I looked at the counter it said 55 and then all of a sudden it shut down. The questions were hard, so either I answered well enough that it moved me to the harder questions and I passed or….. I don’t even want to go there. Now I will keep checking the BRN site to see if my name pops up under RN verification. Next, renewed efforts to land a job in this economy.

Up for air

Here are the first blooms on our roses. They are peaking right now, all of them are blooming at their best. They look good the rest of the summer but never as good as the first bloom. I am always amazed at how stunning they look, I just have to look up from the books and take them in.

Today we had our comprehensive exit exam, 3 hours, 180 multiple guess questions. It was brutal, we all stumbled out of there wondering if we passed or not. We only have to meet the national average which is 72%, it doesn’t seem like it should be so hard to reach. We have 3 chances to take it before graduation, but I sure don’t want to have to repeat it. We all got together afterwards for a beer and tried to remember as many questions as we could to help us study for the next time (if necessary). I have to say that I felt better after that, I don’t know if it was the beer or that I my answers were in line with most everyone else’s, probably the beer. We should get our scores on Monday. Luckily (or not) I have two 12 hour shifts at the hospital and class at 8am on Monday so I will be too busy to fret about the test. It hardly seems like enough time to come up for air before we dive right back into studying. I am beginning to see the light at the end of the tunnel though. We have just 5 more weeks before we are done!
I wanted to show you the finished sweater for my newest niece, Erin.

I finished it a couple of weeks ago, but just got it in the mail yesterday. Good thing she is a tiny baby so it should fit her. Here us the ruffle detail that is on the sleeves and the hem.

Here is the detail on the neckline.
And finally here is the finished sweater.
The yarn is Cabin Fever Cotton Tweed DK 45% cotton, and 55% Acrylic. The pattern is from a Cabin Fever book of top down baby sweaters. The pattern is called Little Tumbler. It was pretty easy and quick. I hope little Erin is cozy in it.
Then I started the next baby sweater for my nursing school classmate that just gave birth last week to a little girl, Olive. Another Cabin Fever pattern called Arabesque. It is the same yarn in red. Here is the beginning of it. The detail is a fake cable, made by slipping a stitch , knitting two and passing the slipped stitch over. I like true cables better, but this is cute.
Got to go, Brian is making a special celebratory dinner, pasta, fish and asparagus, all of my favorite things. I think he is looking forward to the day school is over for me and life returns to “normal”. : )

EBS….*warning* rant follows

This is what you get when you take 48 overachievers and drop them into an intense BSN program that they paid big bucks for.  Add some inexperienced, xxxxxxxxxx instructors, some xxxxxxxxxx clinical instructors, add a few shakes of time crunch, last minute changes and ambiguous details and those overachievers get exploding brain syndrome.  EBS, it is common I tell you.  Clinical manifestations are; argumentative behavior during class, hyperventilation, low O2 perfusion to the brain, buildup of possibly useful but likely trivial facts in the cerebral cortex, sensation of impending doom and grey matter leaking out of ears.  Treatment suggestions; ear plugs during tests, if it is in the powerpoint memorize it, if it is FYI, memorize it, if it is mentioned in lecture, memorize it, if it is mentioned in last minute bulletins, memorize it, but don’t worry about the details.  Oh, and it couldn’t hurt to give oxygen.  If ICP rises to the point where grey matter starts leaking out of other orifices as well, administer final exam, and apply copious amounts of EtOH, take 2 aspirin and turn off all phones.  I think there was something in the notes about limes and coconuts too but I can’t read it due to the grey matter staining my pages.

following my patient through surgery

Wow, today was amazing.  I have a patient that has many issues, recovering from a major abdominal surgery on two weeks ago, and suddenly needed neck surgery.  Somehow the planets lined up just right for me and I was allowed to observe his surgery.  I went with him to pre-op and observed how they handle patients getting ready for surgery. He did not want to cooperate though, he refused the TED hose and didn’t want the intermittent leg inflation machine either both are used to help prevent blood clots from forming in his legs.  He answered all the OR nurse’s history questions though and was consistent in denying his diabetes even though he is on glucose monitoring and insulin injections.   Then I followed the OR nurse like a puppy into the locker room, donned surgical scrubs, booties and cap.  We went into the OR to prepare the room.  I met the anesthesiologist and the OR tech.  Watched them get the sterile field ready, get the gurney set up, count all the sponges, sutures, an other things.  Then I helped wheel my patient into the OR and transfer him to the table.  Since he is obese, this took several of us plus the lift team.  The surgeon came in and the anesthesiologist put him under. They sedated him first, then paralyzed his muscles then intubated him and put him on a ventilator. Everything is monitored, breathing, brain function, heart, blood pressure, temp.  They make sure there will be no breakthrough awareness. Once he was under they put that intermittent leg inflating machine on and arranged his limbs and tilted his head to expose his neck.  The OR nurse cleaned the area with betadine and the surgeon draped him with sterile drapes leaving only the front of his neck exposed.  The anesthesiologist sat at the patient’s head and watched a bank of monitors and adjusted medications.  He could see the patients face under all the drapes but unless he stood up, he could not see the surgery.  I was allowed to stand at arms length from the patient and watch, they explained some things that they were doing, the nurse was very good about telling me what the steps were and what they were watching for and concerned about.  The surgeon pointed out the thyroid and parathyroid as she was going, and called me to step closer to get a good look.  I felt very privileged to be there and didn’t interrupt with many questions.  As she started to cut (after carefully marking his skin) and cauterize the vessels, the OR tech kept handing her instruments and using suction and sponges to mop up the blood and fluid.  He seemed to know what she needed, the surgeon did not have to ask for much.  There was an assistant surgeon that came in to help after the thyroid was exposed.  The OR nurse spent most of the time during the surgery charting at the computer what was going on and getting things like the clean bucket for waste, and step stool for the other surgeon.  They found the mass on my patients parathyroid and were able to excise it from the thyroid pretty cleanly.  The parathyroid and the mass was huge, the pathologist commented that it was the biggest he has seen.  He took it away to analyze it to make sure it was parathyroid tissue that was removed.  Then they had to obtain a blood sample within 10 minutes of removal of the parathyroid to check the PTH level.  That was a challenge.  I got to hold the sheet up for the anesthesiologist to get in to use a foot vein to obtain a sample, while the surgeon tried to get a sample from one of the neck veins in the open part of the neck.  Neither one produced enough blood for the sample, finally the surgeon dug around to get at the internal jugular vein and was able to get plenty.  That got sent off to the lab STAT and they started to close him up after the pathologist confirmed that the tissue was indeed parathyroid tissue.  The assistant surgeon left at this point and the surgeon sewed the subQ tissue first and then the outer skin.  They chatted about their own lives at this point, they no longer had to focus so much on the surgery.  Then they counted everything, on the table and  in the wastebasket to make sure nothing was left in the patient.  After they removed the drapes the OR nurse came over and help the anesthesiologist rouse him.  I guess that once you stop administering the anesthesia, it wears off pretty quickly, although the nurse said he would have no memory of this time period.  My patient was slow to arouse however. He did not respond to commands or seem able to breathe on his own.  He could initiate his breaths but did not take in a deep enough breath to oxygenate his body.  They have criteria the patient has to meet in order to remove the trach tube, one of them is ability to follow commands, and the other is the strength to squeeze the doc’s hands and lift his head up for 5-10 sec. My patient could do neither.  They were also concerned about his blood pressure which was dropping pretty low.  Finally the anesthesiologist decided he should remain on the ventilator in the recovery room until he could breathe better on his own.  So we waited till they got all that equipment ready for him in the recovery room (PACU as it is called at this hospital)  The nurse was pointing out to me that it is much safer for the patient to remain in the OR while on the vent until they were ready because he could crash at any time.  They were all pretty calm considering what seemed to me pretty dire situation for my patient.  When they were ready we wheeled him into the recovery room and a new crew of people swarmed around to work on him.  The respiratory therapist was there to work the ventilator, the anesthesiologist stayed, the recovery nurse started her assessment with the help of a couple of other RNs.  This is where I felt in the way. I didn’t really know what to do and there was a lot of activity right away all around him.  The RT was watching the ventilator to see how deeply my patient was breathing, to determine when they might remove the tube.  The surgeon came in to check on him and examined the wound from his previous surgery (done by another surgeon)  and ended up cleaning it, culturing it and repacking it with gauze.  I watched all this pretty carefully.  Meanwhile the patient was coming around a little more and was agitated about the pain in his abdomen and the tube in his throat.  He wanted it out.  The nurse wanted to give him some pain meds but the anesthesiologist (who was still sitting there) didn’t want him to have any since it would affect his breathing.  But the patient was in pain and agitated so he let him have some, and it helped immediately.  He wanted the tube out though. They drew a blood sample for arterial blood gas test, the RT did this, I understand nurses don’t usually do this procedure.  I got to watch that too, but I couldn’t really tell how you know you are drawing from an artery and not a vein.  He use the patient’s wrist.  The anesthesiologist decided his breathing was getting stronger, (an hour in recovery) and he could be extubated if they put him on the BiPAP machine.  It is a machine that delivers positive pressure to the lungs on inhalation and also a lower pressure on exhalation but through a mask instead of a tube.  However my patient got very upset about this, and waved the machine away as they were bringing it to his bedside. He didn’t want this machine.  The anesthesiologist then decided not to extubate him then.  He just didn’t trust that the patient would be able to maintain his airway and reintubating him after neck surgery would be extremely difficult.  So they ordered an ICU bed for him.  At that point I had to go back to the floor since he would be going to a different unit and I would no longer be able to follow him.  All in all it was a very exiting day for me, although quite a difficult time for my patient.  I wish I could follow up on him to see how he does after a night in ICU.  The report that his PTH levels were decreased was good news but it will be a few days before we hear if the mass was cancerous or not.  I was relieved that I was able to watch the procedures without getting grossed out, or fainting or even feeling sick.  You never know how you will react until you are actually in the situation and I am glad I did fine.  It was actually really fun.  I wonder if I might like working in surgery, who knows.

Tomorrow I have a new patient.  A very young stroke patient just admitted this afternoon.

Study Break or prevention of pressure ulcers

I have been studying all weekend for a test Monday and another one Tuesday. However I did take many breaks.  Yesterday I spent a couple of hours communing with my roses.  They have been quite neglected these last couple of months but they are still producing abundant blooms and making hips like crazy.  I pruned and deadheaded them, got them back into shape.  I got to see how well some of the new bushes we put in last season are really taking off this year, and that there are a couple of bushes that are still looking weak and spindly in spite of the good pruning they got in February.  They may need to go, and make room for some new ones this fall.  One thing about gardening is that you have to be ruthless sometimes, if it doesn’t produce and look good with the level of care I can provide, it gets pulled out and replaced.  I do give them a good long time to come around and produce, but I can’t wait forever.  I took a nice long study break today to wander around the garden and harvest some flowers to brighten up the inside of the house.  Brian has spent a lot of effort this year to grow some of these from seed for our butterfly patch and cutting garden.  When I spend hours in front of the computer and under two gigantic textbooks (each one is 2000 pages) I need to get up and walk around in the fresh air and breathe in the fragrance of flowers.  I picked a whole basket of asters, cosmos, hydrangeas and others that I don’t know the names of and arranged them in vases to set around the house.  I put one on my study table too, so I just need to glance up from my computer screen and see the explosion of color.

We have a big test tomorrow in Managing Care of Adults.  It covers wound care, diabetes, seizures, eye and ear diseases, problems with immobility, and the nursing process.  It really is a huge amount of material.  As I  read about pressure ulcers and look at the slides of how they look at various stages, I beg
in to squirm in my chair and wonder how long it takes for one to form if I am immobilized in front of my books.  I feel my ischial tuberosity press on the thin little pillow on the chair and I quickly leap up and make sure I don’t have any red non-blanching areas forming on my skin!  I also have been so attached to my computer; taking notes, doing online tutorials and quizzes, trading questions and tips with my study group that I dream of having an IV pole with my computer on it to drag around with me wherever I go.  It has become a lifeline feeding me facts, testing my knowledge, and allowing me to reach out to my new friends.  We also have a lab practical on Tuesday; a head to toe assessment in 30 minutes.  I’ll practice that after tomorrows test.
This week we were in the hospital for our clinical rotation taking care of our first patient. My first patient was a very sweet man with cellulitis of the right leg. We spent the first day shadowing the nurse, learning where supplies are, how the medication cart works, what the routine for the day is.  We got our patient and researched all their medications, and their diagnosis.  Then the next day we did the assessment on them, I gave mine a bed bath and changed his bed, gave him his subQ heparin injection, hung some IV’s, counted his I & O’s and spent lots of time talking to him about his family and history.  I also got to observe the placement of a foley catheter on one patient and do the removal of one on another patient!  Wow, a lot of new things for the first couple of days.  I learned a lot just listening to the nurses and watching them deal with the problems that came up. And there were many. We never stopped, and it was hard to take time for lunch except that I was starving!  I loved the whole process.  The patients were willing to have us students work with them and mine even asked if he could come to my graduation! I can see that this is where the major portion of our learning will take place.  It is exciting to see the things we are learning about in the books, right in front of us.  The whole nursing process is beginning to make sense, constant assessment of the patient and trying to come up with ways to make them comfortable at the same time providing what they need for their healing.  I am going to like this job!
Well, back to the books, a little more review before bed.

Adjustment


We are a couple of weeks into the program now and I am already feeling overwhelmed on many levels.
First there is the adjustment for my family. They have been used to having me available to them pretty much 24/7 so this is a drastic change to have me in class 10 hours a day and studying the rest of my waking hours. I can’t rescue them when they forget to take something to school, I can’t drive on field trips, I can’t drop in the classroom to hear their presentations, I can’t even pick them up at the end of the school day; they have to walk home or go to the after-school program. It has been the hardest for Rose, she is 11 and still wants me to be present at everything. Pat and Joe at 18 and 16, are liking the forced independence. And now that Brian is working 50 miles away, he is less available too. I am struggling with this part too, I feel guilty about being pulled away, I miss the hangout time with them. Then there are the logistics to adjust to, arranging rides (thankfully Pat has his license now) scheduling appointments for the few hours I have open, getting dinner on the table, the laundry done and the dog hair vacuumed. Even though the kids have always helped with chores, they are having to be more responsible. I know it is good for them but it is still hard. We set up a dinner schedule for the summer, each of us will make dinner one night a week during the week. We did this before and it worked pretty well. Rose is going to do all the laundry for the summer, (for pay) and Pat is going to do the schlepping of people to and from their activities. Joe is working off his new keyboard purchase by painting the remainder of the exterior of the house. Pat is also getting ready to go off to college in August so he has lots of organizing and sorting of a lifetime of possessions to do and packing.

Then there is the adjustment to the amount of work that is involved in a 1 year nursing program. We are in class many hours both lectures and labs, in a few weeks we will start clinical rotations, we have reading, homework assignments, papers, presentations, and practice to do. I took a few evenings off last week to attend Pat’s senior concert (he played a piano solo and I was so proud) and his senior awards ceremony (he received several) and Rose’s girl scout bridging ceremony and our mother daughter book club. It was worth going to all those events (I can’t give everything up) but I feel like I am already behind in the work. We have already had a test and we have another one tomorrow, they come fast and furious, thankfully I got an A on the first one!
Then the adjustment into our new role as nurses. I feel like we are being initiated into a club or society. There is new vocabulary of course, but there are also new ways of interacting with people. There is a whole socialization aspect to becoming a nurse that I hadn’t really thought about before. Also we are all feeling a little overwhelmed with the responsibility for our patients lives, especially now when we are so new to the work and are feeling pretty incompetent. Of course we are being supervised, but the reality of the seriousness and complexity of the job is beginning to dawn on us.
Well it is back to studying for tomorrow’s exam.

12 months to RN

Well, the party is over. The break was great, filled with projects, and visits with friends, and reading for fun, and weaving and knitting and even getaway. Now it is back to school!

Today was the first day of class at Samuel Merritt’s Nursing program. Forty eight of us from 22- 50ish eagerly showed up to begin this journey. We have come from many different backgrounds to get here, lots of career changes, from teaching, computers, accounting, various businesses, lab work and even a jewelry designer! We began with learning to take vital signs in our Health Assessment class. We were all pretty awkward with the stethoscopes and sphingnometers (to measure blood pressure), hoping that we get smoother at it practicing on each other before we face a real patient. Tomorrow’s class is Introduction to nursing and health care. We will learn about the history and changing roles of nurses in health care. Already we are sobered by the responsibility we will have for our patient’s care and in awe of the trust they will place in us. I hope we will gain the skills and confidence in the next year to go out into the workplace and really care for people.

Inbetween


Doesn’t looking at the ocean just make you happy? It does me. I love the sounds and smell of it too. I spent last weekend in Pescadero with my honey just relaxing. I have a couple months off of school before the nursing program starts; I am packing in as much relaxation and visiting with friends as I can. I have spent the last year or so taking the prerequisites for nursing school and at the end of May I start a 1 year program to earn my BSN. I’ll be at Samuel Merritt College in Oakland and various clinical sites. I can’t wait to get started and I can’t wait to get working. With Pat starting college in the fall and my program we will be up to our eyeballs in debt for a while.

I have been knitting more during this break and I went to Stitches West in February and took classes this time. More about that later. Now I am off to my great nieces first birthday party followed by Pat’s piano recital!

I’m a two college student

SCHOOL ROUTINES
So I didn’t get into the physiology class or microbiology at DVC, but I did just hear that I am enrolled in the physiology class at Samuel Merritt College in Oakland that starts next week. YeeeHaaa! Now I know my schedule finally. I’m at DVC Tuesdays and Thursdays and at Samuel Merritt on Wednesdays. Mondays and Fridays are free for studying. Two colleges at once! how about that. At least now I can sing with the kids at St. Catherine’s every morning, I was sad when I thought I wouldn’t be able to do that. I love starting my day singing. St. Catherine’s started this morning, Rose was very excited, and her best buddy started there today. Now she and Hailey will get to see each other every day even though they are in different grades. It feels good to have a routine to fall into. We love the long days of summer and sleeping in, but Rose was getting bored and she really does function better with a set routine that she can count on. Pat is off at school helping with freshman orientation at Alhambra. They start school next week, we picked up their schedules yesterday, and we had to keep reminding Joe that “school is fun! school is great! we love school!” he isn’t anxious to go back, I guess it takes too much time away from his piano practice.

WHAT WOULD YOU HAVE DONE
Yesterday I was in the line at the coffee shop at DVC which is inside the bookstore, the line was long and there were many students ahead of me. A young man with his hands full of a drink and some snacks walked up to the young student in front of me and said “you know, I could just walk out with this stuff” the door was right there and they had students checking people coming in and out. The boys just laughed and then this boy walked right out the door! nobody stopped him or even noticed (it was crowded and busy) except me! I was saying to the boy in front of me “just because you can, doesn’t mean you should” and “he just did!” The young man in front of me just laughed, I watched the door and that young man stood outside and opened his drink and started enjoying it waiting for his friend in the line. After the one in front of me paid, I nudged him and said to him that he ought to give his friend a hard time for what he just did. I kept thinking that I should have said something to the cashier but I didn’t. I walked past both boys as I walked out but neither of them would meet my gaze, and I didn’t say anything. I already feel like every one’s mother there rather than a student. What would you have done? should I have said something? Why is it so easy for people to just break the law, because they can? I find the whole thing rather discouraging.