Nursing

Patience

This is nurses week, the internet is swirling with recognition for nurses in the midst of two months of talking about the frontline heroes. It makes me squirm a bit. While it feels good to have a moment to recognize the work we have chosen to do, I don’t feel like a hero.  Before the pandemic put us in the limelight, we were doing the same work, just different dangers and on a different scale.  We have always paid attention to hand washing, wearing masks, isolating patients at risk for infecting others or at risk for becoming infected.  But we face more dangers than infection on a daily basis. We deal with an inordinate number of patients who have poor coping skills and treat us badly for trying to provide care to them. They verbally abuse us,  threaten us and assault us, then accuse us of not caring.  As an ER nurse, I am presented with unknowns with each patient and have to balance protecting myself with making that patient feel like a human being and not a potential threat. I am thrilled when I have a patient that appreciates my care, one who says thank you, or even just doesn’t yell at me.  I think the worst thing someone can accuse me of is not caring. I care so much that I put my health on the line to come to work every day. I care so much that I work at a public facility for lower pay because this patient population needs care.  I care so much that I strive to hear each patient and look into their eyes with reassurance.  I care so much that I risk being wrong or ridiculed when something just doesn’t seem right with that patient and I drag a doctor to the bedside.  I care so much that I want to learn everything I can about this current pandemic so I can answer their questions, so I can keep my family safe, so I can keep working and support my coworkers.  So when a patient screams at me that I just don’t care and storms out of the ER unhappy, I am brought to tears.  I realize that this is an indication of how overwhelmed we all are.  I usually have  a tougher skin at work, and I know the insults are really the patient’s lack of coping skills.  Yet this is how fragile I am.

Our hospital has not been overwhelmed by COVID-19. Nor have other hospitals in SF. The bay area has been successful in flattening the curve and keeping the death toll low.  I watch what is happening in other areas of the country in horror. I read about the experiences of the doctors and nurses in those areas and my heart breaks. I worried at the beginning of all of this what I would do if faced with having to choose which patients to tend to, knowing that others would suffer.  To be honest we were already doing this before the pandemic when our waiting room routinely had 40-50 patients waiting hours to be seen. We always seemed to find room for the ones that were truly at risk of losing life or limb, but others also with genuine complaints had to wait.  I hated telling patients that I could see they were suffering but there were no open beds and another patient  was in worse shape.  As triage nurses we know that some need immediate care and some can wait, and we are skilled in discerning the difference. However as a human being, I also know that all suffering is real suffering and everyone deserves to be heard and receive care.  The hard part was that we couldn’t provide what many of the patients needed, such as warm, dry shelter, regular nutritious food, connection with people that care about them, purpose in life, healing for their trauma that landed them in the place that they are.  In the end they all get seen and cared for if they are willing to wait, though for many a tylenol, a sandwich, a clean shirt and socks, and a bus token is all we can truly offer.  Most of these patients are not coming in right now.  They are scared, they don’t want to get sick, and if they are able to cope a little bit, they stay away.  We are definitely seeing  more suicide attempts, more intoxication with alcohol and drugs, and more peopleunable to cope with the anxiety and depression. I get that, I have resources and coping skills and I also feel it.  This week we are starting to see more accidents and fights which makes me think some people are at the end of their patience with the shelter in place order and are going out anyway.

I think we are coming to an understanding that we have to balance the risks we are willing to take.  The risk of being ill, or infecting others vs the risk of the mental health effects of sheltering and not connecting with people vs the risk of a failing global economy.  As we learn more about how this virus works it becomes clearer that we can emerge from sheltering in a controlled way.  The scientist in me understands that we won’t have herd immunity or a vaccine for quite a long time, and this virus is proving to be very infectious and quite dangerous for anyone with chronic health conditions.  By using a reliable antibody test in a widespread way we can find the people who have likely developed immunity and can safely circulate.  We know how to protect vulnerable people from infection, we have done that for patients in cancer treatment, who have HIV or other immunocompromising conditions. We should be able to shield or shelter the elderly and the ones with chronic health conditions while we slowly have others get back to more social interactions.  It will be a new normal; groups will be small, people will wear a mask, more hands will be washed and attention to cleaning commonly touched surfaces. We will continue to test both for the virus and for the presence of antibodies to understand how this virus is spreading and how we as people are responding.  We will need patience with the medical and scientific community to digest and process the garden hose flow of new data.  We will need patience with our governing leaders to help us organize how to be in society with each other.  We will need patience with each other and our various levels of acceptance and anxiety around the pandemic. And lastly we will need patience with ourselves as we adjust to a new normal and regain some balance.  Breathe, and be grateful for that breath.

helpful links:

https://medium.com/the-atlantic/why-some-people-get-sicker-than-others-f64796b01486

https://medium.com/the-atlantic/the-real-reason-to-wear-a-mask-e6405abbc484

https://www.sfchronicle.com/health/article/Inside-SF-s-main-emergency-room-nurse-faces-15230001.php?fbclid=IwAR3kwSKE3hV6nt7a3CueiQPK7EvOgdE5Iy6guu1IPx8V07zhEm79eRRTSrI

https://www.sfchronicle.com/bayarea/article/Meet-the-Bay-Area-nurses-battling-the-coronavirus-15249110.php?utm_source=facebook.com&utm_medium=referral&utm_content=headlines&utm_campaign=CMS+Sharing+Tools+%28Premium%29&sid=53b750d9fdd5ac3a49000373&fbclid=IwAR1RuuSM4Mscs734Oxeoh_ChfkCJ_jCCCACJkMMKD6ogvDcZbcTXZ8D3Dec

https://www.newyorker.com/magazine/2020/05/04/a-city-nurse?utm_source=nl&utm_brand=tny&utm_mailing=TNY_Daily_043020&utm_campaign=aud-dev&utm_medium=email&bxid=5be9e7f53f92a40469fc3ae5&cndid=50793798&hasha=13a5956591fd5aa41a23502f69f091ae&hashb=f101abd5ae6ae47be38befa1cd0eb35a933b4dec&hashc=655c20833ba25cd38ec12a980262018c7ca486019456e25dee2cd915c778aaae&esrc=bounceX&utm_term=TNY_Daily

https://www.nejm.org/doi/pdf/10.1056/NEJMp2009405?articleTools=true

What We Don’t Know About the Coronavirus — The New Yorker

https://podcasts.apple.com/us/podcast/unlocking-us-with-bren%C3%A9-brown/id1494350511?i=1000470370881

erinbromage.wixsite.com/…/the-risks-know-them-avoid-them

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for the long haul

I had a  night off the other evening and I was walking in the neighborhood in SF looking for coffee, a nightshifter’s perpetual quest, when I heard the sounds of a party.  People were yelling, drums banging, and I was completely confused.  I have gotten used to the quiet in the streets, the feeling that I am alone in the world, even outside.  I wondered, who is partying? in defiance of the distancing? I felt my anger rise at the disrespect, until I started hearing people shouting THANK YOU! and my heart shifted.  I realized this is the 7pm cheer for frontline workers it was the first time I had actually heard it.  I looked up at open windows with people in them clapping and cheering.  I sat down on a nearby stoop and cried, letting the gratitude wash over me.  I have been holding it together for weeks, I heard about the 7pm cheer, but hearing it in person was so encouraging.

These weeks have been exhausting.  while the ER is not seeing as many patients as we usually do the patients we do see have been changing.  There are very few traumas, no commuting= no car accidents,  no bars open= no falls and fights, there are fewer of the traumas of violence that we usually see.  These have been replaced with more people in respiratory distress, and more psych patients.  The virus is moving through the homeless population as well.   These patients come to us when there is nowhere else to go  and they stay with us because the psych ward is full and the shelters won’t take patients until they have a negative test.  There are special accommodations  for the homeless that are positive called COVID hotels but they only take people in the daytime. So we hold psych patients and the homeless as a social service.  This greatly reduces the number of beds available for the actual emergencies.

We have actually sent ER nurses up to the ICU every few hours to help with the turning of patients. The ICU is eerie, everyone in full PPE, talking to each other over the banana phones on speaker through the door to the patient room.  We carefully follow the step by step instructions to turn the patient while minding all the IV tubing carrying life supporting drugs and nutrition, the breathing tube, the feeding tube, the urine catheter and on some patients, the continuous slow dialysis lines. The patients are almost all latino, male and in their 40’s and 50’s.

In SF the curve has been flattened, the hospital can handle the number of patients coming in because the public has followed the recommendation to stay home and distance from each other. It is working for now, slowing the rate of infection and death, and bought us some time to learn how to best treat patients, and how to best prevent the spread.  It buys time to develop a vaccine, though we need a long time for that.

We are beginning to realize that this will be our normal for the months ahead until we come up with a vaccine or a lifesaving treatment. What looked at the beginning to be similar to the flu, has turned out to be so much more infectious and so much more deadly.  What looked like a purely respiratory infection has turned out to have dangerous effects on the heart, kidneys, brain, and blood. It is not easy to predict who is most at risk, though we know the age and chronic health conditions do increase vulnerability, there are deaths among the seemingly young and healthy.  We must stay the course until we learn more.

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Overwhelm

I love the adrenaline rush of working in the emergency room at a level 1 trauma center. I walk through the doors at the beginning of my night shift and enter another world, a world where keen observation precise and clear communication and  quick decisions can save someone’s life. The majority of people leave the ER alive and feeling better, some require follow up, long recoveries and rehab.  Some leave with their lives drastically altered forever.  Some though, never make it. It is part of the reality of where we work.  We witness much tragedy and violence, as well as love, appreciation and healing.  We are with people in some of their most vulnerable moments of their lives. Of course it takes a toll on us, we walk the line between opening our hearts enough to have compassion and keeping emotions in check enough to do our work and keep showing up.  We keep each other motivated, have each other’s backs, share humor, and stories of our lives and families outside of work, cheer each other on and commiserate and vent our frustrations and even share a few tears. We see so much, our hearts break, we breath deeply, maybe cry a little in the med room, and then go see our next patient.  When I walk out the doors in the morning, exhausted, calling “sleep well” and “see you tonight”, I leave that world behind and come home to regular life.  I may share a story or two with my family, but I have learned that most people don’t really want to hear details of how we had to go on lock down again after a gunshot wound was dropped at the door, or how I had to delicately determine if the woman asking me to find her husband, is the wife of the unidentified dead stabbing victim in room 6, or how my patient who had just been beaten and sexually assaulted was being harshly questioned by the police  because she allegedly hit her assailant with a bat. These stories stay inside the ED.  Before the pandemic,  the news didn’t usually cover what we do everyday.  We have been short staffed my entire career, and short of the resources we need to take care of the patients.  We are inundated with patients who are aggressive and violent, have drug addiction and mental health problems, are homeless  and without a way to stay clean and fed let alone take care of their chronic health conditions.   It is the balance of normal life outside the hospital that keeps us going and gives us the resilience to keep doing our work.

This pandemic however has been extremely challenging, in that there is no break when we go home.  The news is full of images of nurses and doctors taking care of Covid19  patients, talk about masks and ventilator shortages, counting of cases and deaths in China, Italy, Seattle, New York.  People are anxious, and concerned for their own health as well as their loved ones.  Social media is teeming with good information, bad information, advice, and some humor. There is no getting away from it. The first several weeks I found myself reading everything, and digging into the research as it was coming out, trying to understand for myself and my practice  and to be able to answer questions for my friends and family.  I quickly became buried in data, and the opinions of all the journalists and public figures.  The anxiety level at work is up as well, our preshift huddles are longer due to the daily changes in protocols as we prepare for the surge of Covid19 positive patients, and the shortages of PPE and equipment. Right now we have enough PPE, we get one mask and gown per shift, it is not ideal; they are supposed to be disposable every time you go in and out of a room. But we have them and we are protected for now. There is a sense of foreboding as we watch the number of cases and deaths go up around the country and wonder how long before our hospital is overwhelmed.  One of my coworkers described it as being in a building with an active shooter, you know they are out there with a loaded gun, you know they are coming through the building room by room and you are just waiting for the S#*$ to hit the fan.  It is going to happen, many more people are going to get sick, they are going to come to the hospital, when will it start?  will we be ready?  Right now it is eerily quiet.  Our regular patients are scared to come in, there are fewer car accidents, bar fights and drunken falls with the stay at home order.  The patients that do come in are real emergencies, today we put 5 patients on ventilators, and our ICU is full.

The rhythm of my days has not changed, I am not home with extra time on my hands. I am not going to lie, I am a little jealous of the people who can work from home, spending time with their families, planting gardens, reading more books, getting projects done, or even meditating more. I miss hanging out with my family. I miss coffee with my friends.  I miss going out to dinner, seeing movies, going to the theater and the opera.

I know I have been exposed to the virus, but I am more worried about bringing it home to my partner or kids, than I am about getting it myself. I have a pretty tough immune system, but my partner does not.  At this point we are not  quarantined from each other at home but it may come to that.  We all handle anxiety in different ways and I have had to learn to be more vocal about what I need to replenish during my time away from the ED.   What helps me is SLEEP!  Walks outside in the sunshine, playing my guitar and singing, watching sappy funny movies, talking on the phone with my friends and my kids. Just seeing my kids on a screen, live, in real time warms my heart and settles the protective mama bear in me.  We are lucky that we have some amazing technology to stay connected in so many ways. For this I am grateful.

Some links if you are interested:

How COVID-19 Actually Spreads (w/Dr. Gloria Hwang)

https://hbr.org/2020/03/that-discomfort-youre-feeling-is-grief

The Four Possible Timelines for Life Returning to Normal

 

stay home stay healthy

We are 10 days into our local stay home order, and a week into our statewide order.  I had to cancel my trip to the midwest to visit my mom, who is elderly and 2 years out from open heart surgery.  She lives alone with my sister nearby and is doing great by the way.  This meant I had 6 nights off before going back to my ED nursing job.  I was faced with a choice; do I pick up extra shifts because our department always operates short staffed even before the pandemic started, or do I take advantage of nights off at home, to rest up and eat well and get outside in the sunlight. I spent time reading the emails from my manager and the hospital administration, I read posts from colleagues about nurses being quarantined, I read about the PPE situation in the department and, the posts from my union rep about actions to take and I realized that this pandemic is going to be a marathon so I decided to take the time off as a gift.  I rarely stay home when I am off from work more than a few nights, we usually travel somewhere, so this time at home feels like a gift.  I have been spending the time doing spring cleaning and reorganizing the kitchen. I am working on a project clearing out 32 years of stored stuff that I have been avoiding for the last 5 years.  I have had time to snuggle on the couch in front of movies, do a little cooking and play my guitar.

I find myself reading studies about SARS trying to understand the truth about what we actually know.  Nursing is my third career and my first one was as a research microbiologist.  I know how to look at data, and read research studies, and I understand infectious diseases and how they spread.  I question every headline and statement I see in the news or on social media, how do they know that? what studies are they basing that statement on?  I follow the CDC, WHO and other data driven websites and make my own conclusions about what the data seems to be telling us.  I try not to post statements that I can’t back up with facts, and I don’t apologize for being a nerdy science type. Because of this background I am usually  calm and don’t freak out at every little thing because I can look beneath the sensationalism and find the facts.  This virus is new however, and we have little history about it’s behavior.  We can extrapolate and predict based on the behavior of similar viruses, we can model systems of transmission and study how to protect ourselves. The truth is, we are not far enough into this pandemic to have the data we need to make some of the decisions we need to make.  It is going to take time and trust in the scientific community (not the political or corporate community) to do the experiments; studying the epidemiology, developing a vaccine, and developing antivirals that can mitigate course of infection and maybe even act prophylactically.  We have not seen anything like this on a global level before.  Other novel infections have been contained in certain locales long enough to develop ways to fight them with vaccines or medication protocols. The time for containment of this virus is long past; we must self isolate, be meticulous with hand washing and take care of our immune systems.

So what is the good in this?  Many people get to spend more time with their families, focused on each other and what is important to them.  We as a community are finding ways to help each other with errands, check ins, and support.  We are all learning more about technology and how we can connect virtually.  There has been an outpouring of music on the internet from artists all over the world.  In the long run our healthcare system will have to improve, as this pandemic is exposing lots of places where we are grossly unprepared for a pandemic or other kinds of disasters.

I tend to look at the world though a healthcare and science lens, and rely on others to take care of the economy.  I don’t have talent or much interest in deeply understanding how the economy works, however, I  have been forced to learn a lot in the last five years  since becoming a single parent and putting a child through college on a single income. I am grateful that I have a good, stable job (that I happen to love) with great benefits. But not all are so lucky. Two of my 3 young adult children are without income right now. I am supporting one and the other is managing on savings and scrambling to create new income streams. It is a scary time for everyone,  and I am quite aware that my family is privileged. My kids will be ok in the long run, they are resourceful, smart and generous, and I am in a place to help them if they need it.

My heart aches for those without safety nets.  Without income, or most of all without people to lean on. I try to end each day with gratitude.

Pandemic

When I came back to my blog last week I had something entirely different in mind to talk about.  However in light of the global health crisis, I want to talk about THE VIRUS.  Yes SARS-CoV-2 that causes COVID-19 disease.  I work as a nurse in an emergency room at the only trauma center in a large west coast city. We are busy on any given day with traumas, strokes, heart attacks, drug overdoses, stab wounds, gunshot wounds, falls, alcohol withdrawals, psychiatric emergencies….. I could go on and on.  Since we are  the county hospital we also take in our share of homeless seeking shelter and sandwiches, patients in custody, and sexual assault cases.  This time of year we are geared up to handle people with the flu and other respiratory infections.

When I first started hearing about this novel virus, I thought, as many did that it was going to play out just like the flu, but maybe just a little worse because it is new and we don’t have a vaccine yet.  We already had a protocol for masking people with coughs and fevers, we assumed that would be enough.  Fast forward to the last couple of weeks as the data started rolling in from around the world showing that this virus is more deadly and likely more contagious than the flu. We watched as China, Italy and Seattle shared their experience and their data.  Each day I would go to work and be briefed on the current status for handling patients and testing, and what we should be doing to protect other patients in the ER and ourselves.  We rearranged triage areas, changed workflow, brushed up on higher level PPE. Every day we were told that the tests are limited, with very strict criteria for testing patients. At first the samples had to be sent to the CDC for testing, then much later we got the capability to test in our state, but still limited quantities. As I write this we are still not testing health care workers in my hospital.  As far as I am aware, though  several nurses are out on quarantine for having been exposed, some have symptoms but since tests are scarce none have been determined to be positive for Covid-19.

Earlier this week all our local counties were asked to shelter in place, and yesterday the governor initiated a statewide order. Only essential workers can go to work and only essential activities are allowed outside the home, such as grocery shopping and medical appointments.  Schools, theaters, restaurants, bars, gyms, all closed.  My days have not changed, no Netflix and chill for me, I am still going to work.  My family has been instructed to wash hands when they walk in the door, and watch for fevers or coughs.  College is online and graduation is cancelled for one of my children, two of them have little or no work. We are a multigenerational household with some concern for bringing the virus home so we are all being vigilant.

It is hard to keep up on all of the data coming out, but it has become clear that two  significant assumptions we made have to be adjusted.  First, a study came out showing the viability of the virus on surfaces and in aerosols. Now that we have more information, actual data that shows the virus behaves more like the SARS-CoV-1 (from 2002) with persistence in aerosols, this information makes me more concerned.  This requires higher level of isolation and precaution similar to that of TB.  If we get a surge of patients testing positive, we are not prepared to maintain that level of isolation on many patients.   Second, we have been thinking that this new virus does not affect young people that much, that they would only suffer mild symptoms.  Two studies have shown this not to be true one from China and one from United Kingdom, while young people (under 60) still have a significantly lower risk of death from Covid-19, many do get hospitalized and some even need intensive care.  What this says to me is that young people still must be careful and not assume they will not get sick.

Some other sobering news came out of UCSF Infectious disease meeting, more than half of the US population will likely get the virus and with a 1% fatality rate that means 1.5 million Americans may die.  We will need 1 million ventilators, we have about 160 thousand.  It is time to mobilize manufacturing in this country as we did for WWII; build ventilators, produce masks, gowns, gloves and sanitizer.  We haven’t seen the likes of this since 1918 with the Spanish flu.

This brings me to being a canary.  Those of us who work with sick patients, are 4 times more likely to get the virus, it is imperative that we have adequate protection.  Enough PPE, support of hospital leadership, cooperation of the population to do their best to shelter in place and minimize the spread of the virus.  We are crazy dedicated to our work and often put caring for our patients before our own safety. I don’t want to face the decision of do I care for my patient or not because I don’t have the necessary PPE.

Every day we learn something new, about the virus and about ourselves in a global state of crisis.  Our lives are changed, our priorities reordered and gratitude for the small things we overlooked becomes our focus.  Stay positive, stay connected (virtually) and remember all of us have an important role  in slowing and eventually halting this pandemic.  Step up and lean in with a smile, check in with people, and if someone is struggling, be present with them through the fear even though we don’t know all the answers. STAY HOME AND WASH YOUR HANDS.

Jennie

PS some links

josh lerner MD

aerosols

Atul Gwande

Larry Brilliant

SF Chronicle on nurses at SFGH

young people

maria shriver

Healthcare


http://www.youtube.com/watch?v=Jng4TnKqy6A

Healthcare reform, the more I read about it the more complicated it seems. I came across this little video that gives a basic explanation. Simple enough, are the facts he includes true? Medicare uses 2-3%, private insurance uses 20%? Notice that he didn’t include education in the examples of essential government run socialized services. Why not? It has a government option for all, paid for by taxes, and a private option for those who choose to pay for it. Some question about how well it works, clearly many are educated well enough, some manage to get excellent educations and some end up falling through the cracks. It is not perfect, but it functions. Health insurance for all is not going to be perfect either, but hopefully it will function. And function well enough that not too many fall through the cracks and more people get what they need. I am about to become part of the public healthcare system as I begin my new job in the county ER, and I hope to provide care for everyone that walks through that door.

New grad ER nurse

I don’t know if I can call myself an ER nurse yet, but today at the end of my interview for an ER position the nurse manager said to me, “I am very impressed with everything you’ve done and what we talked about today. The August group of new hires is full, but we have room in the September group if you would like the position.” My ears did a double take, what! really?! You are willing to take a chance on me? wow, yes! It is a job in the ER in the hospital 6 blocks away from me. What could be better, my dream job! I am definitely doing the happy dance.

Restless

It has been over a month since graduation and I am no closer to landing a job. The current economy has not been good for us new grad nurses this year. Sure, there is a shortage of nurses, and people still need medical care, even in a bad economy. But, what is happening is the nurses that were expected to retire have not, and not only that, they have increased their hours since they need money too. The hospitals don’t want to spend the money to train new nurses when there are plenty of experienced nurses around so they are postponing their new grad training programs, and they don’t hire new grads without these programs. I keep hearing people talk about the baby boomer nurses hanging on to their jobs and I have to stop myself from getting irritated because after all I AM a baby boomer too, and I have no intention of retiring any time soon. Hey, I am just getting started!

I keep applying to jobs, first all over the Bay area and now all over California. I could wallpaper my room with all the rejections letters I have gotten. That is the hard part, I am having a difficult time not getting discouraged by all the rejection letters. I know there is a spot for me out there in a hospital somewhere, I just wish it would show itself soon, ’cause I am restless.

I keep trying to pass the time knitting or reading or doing some other thing that I used to enjoy, but I can’t seem to focus these days. I keep flitting from this project to that project and can hardly pull myself away from the computer waiting for a job posting to come in or a response from one of my applications to show up in my inbox.

I do have a few FO to show you though.
First, here is Olive’s sweater (the red one with the fake cables) I started it in the beginning of May see here. I gave it to my classmate, Trisha on the night of our pinning.

Then I started a sweater for one of Brian’s coworkers baby boy. This one is the same pattern as Erin’s sweater except that I had to adjust the guage because this yarn (Blue Sky Organic Cotton) is much thicker. I love knitting with this yarn, it is so incredible soft. I don’t care for the color much though. I had to rip out this sweater a few times because I failed to adjust the pattern for the thicker yarn, and then I got carried away and knit too many inches before I started the decreases for the raglan sleeves.
I finally finished it the morning I left for Tahoe to study for the NCLEX.

Since then, however I have not been able to concentrate on knitting, or anything else for that matter. So I have been making washcloths and stethoscope covers for my friends, just to keep my hands busy.

Last week, the day I found out that I passed the boards, I decided to uncover my loom and see if I could remember what to do. I had put a blanket over the loom for the entire year so it wouldn’t entice me away from my studying. I knew if I looked at it all the time, I would want to sit down and weave a few rows and knowing me, I wouldn’t tear myself away from it to get back to studying. So I covered it with a blanket and didn’t look at it. Well, when I looked at what I had done I couldn’t believe how beautiful and amazing it is! I had started making some kitchen towels, I think the warp is long enough for 4 towels, but to tell you the truth, I am not sure anymore. I looked at my notes and tried to remember enough to read the treadling pattern. After a good twenty minutes of staring at my notes and staring at the weaving, I figured out what I had been doing and started weaving again. Wow! I finished up the last few inches of the first towel, put in a divider and started the next towel. It will be more yellow than blue. I haven’t sat down to weave again. I am too restless, can’t sit still, can’t knit or weave. I sure hope this is temporary, I need these activities to keep me sane.

It’s official

I tell you, I have checked this site so many times since last Friday that when my name came up I thought it was someone else. But there it is in big bold official letters. I am a registered nurse. Sweet!

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.