So, we had to do a group presentation and then facilitate an online discussion. I have been dreading the facilitation portion of this--discussion posts usually take me a few hours to research and write, and the facilitators were supposed to make 4 to 6 posts, and I work all but 2 nights this week and I've been sick for almost 2 weeks now, etc... Also, I have to write a paper for my other class that's due this weekend but I work 12-hour shifts this weekend so I really need to get it done today (ie: between 10am on Thursday and about 4am on Friday). This is the same timeframe in which I need to respond to this dreaded discussion...which suddenly looks a whole lot more appealing vs. the option of writing this stupid paper! I posted 5 discussion posts in about a total of 3.5 hours. At least one of the items is now checked-off-the-list-done!

See also: reorganizing the chest freezer, emptying the litter box, washing all that silverware, folding the laundry, freezing 5+ quarts of turkey soup, and cutting the cat toenails x3 cats.

and here I am.

Welp, I obviously haven't updated this in a good while!  The summer has pretty much gone here; we've taken everything out of the gardens and are just waiting for the leaves to fall so we can cover the garden beds.

Really ( long update about work, and what I'm learning. )

Not really much of a week.  We had our 5th exam, which was our last unit exam.  It covered non-pharmacological treatments, burns, head injuries, and spinal cord injuries.  Like all of our exams, it had some math questions too (sadly, there won't be any of those on the final.  They're usually easy points!).  I did okay on the exam, but wish I'd done a little better.  However, I'm still in very decent shape and I think it's very possible for me to get an A in the class.  It's partly vanity on my part, but I think it's actually valuable--getting to put a GPA of 4.0 on my resume can't hurt when I don't have any prior work experience, right?  I believe I'm the only person in my graduating class to have a 4.0 (fortunately, they don't do valedictorian/salutatorian speeches at graduation--I have no desire to do that!).

We had another computerized exam, which actually went pretty decently.  These are administered by an independent company, so the topics on the exam aren't always things we've specifically learned about in class.  There were a few questions like that on this exam, but not too many.

And...that was the week!  I did spend Thursday morning shadowing an RN on a floor where I had a job interview.  More about that if it pans out...

I worked in the yard a bunch this weekend--it was sunny, and pretty mild out--and thus neglected to update this...

Another week down!  This week we had our 4th exam, which went okay but I didn't do as well as I hoped, and then learned about non-pharmacological pain management--everything from acupuncture to meditation to Reiki.  I have to admit, I'm skeptical that 'energy field' therapies actually work (beyond a placebo effect--which can be very powerful and hey, if it works, great!--and beyond the 'caring presence' effect).  However, hospitals--including the one associated with my school--are incorporating them into the clinical area, and patients can now request and receive these treatments in the hospital.  There is a group of volunteers, many of whom are RNs, that provide the service.  One of my previous clinical instructors is one of the Reiki practitioners, and I must say that she is, in every other way, a very focused, scientific, rational person...but then she said "please don't touch the tips of the essential oil bottles; it will destroy the vibrations."  Sooo, I'm not sure that I will be convinced until I try it myself, and I think I have enough of a scientific bent to say "I won't be convinced until someone does it on me and I'm not aware of what they're doing and it works anyway."

[A non-school-related digression:  My father is in the middle of moving out of the country, and he and a friend have bought a house.  A series of unfortunate events have occurred to the friend in this house--nothing criminal or dangerous, but difficult to deal with nonetheless.  The friend now believes the house is in some way cursed, or has a bad 'aura,' or something like that.  My father is a scientist, and has never professed any religious faith.  In fact, it's something he specifically disavows.  I am a Christian, but a belief in evil spirits, or auras, or anything along those lines has never been personally resonant with me.  But the other day my father and I--both admitted skeptics--had a serious conversation about whether having the aura of the house cleansed would help his friend feel at home there.

What's the point of that note?  I guess, in the paraphrased words of Terry Pratchett, 'it would be a funny world if we were all alike.']

This was our second-to-last week of clinical.  We also had our final simulation, which went pretty well in that we did not kill our 'patients.'  The set-up was that we had two patients who were both at risk of going into shock, and if we didn't catch it quickly enough I think one (or both) would have gone into cardiac arrest.  Then we would have had to do CPR and maybe they still wouldn't have made it.  But, everyone (plastic mannequins and nursing students alike) survived!  

It feels like the weeks just keep getting faster!  We started this week with a simulation on Monday.  This one was about endocrine disorders.  It actually wasn't too difficult--mostly we just had to assess the patient and get the right meds hung.  We have one more simulation left.  Tuesday we continued learning about autoimmune diseases (Myasthenia gravis and Lupus).  Wednesday we began learning about Shock--which is any situation that causes the blood pressure to be so low that the organs don't get enough blood.  This can happen during a heart attack, or hemorrhage, or spinal cord damage that causes the blood vessels to dilate so much that the existing blood doesn't provide enough volume, or because of burns (where lots of fluid is lost through the burnt tissue--even if it's not blood leaking out, the fluid was still needed by the body) etc..  We'll learn more about treating Shock on Tuesday.

Our Bridging class this week featured a trio of three recent graduates sharing their experiences from their first year of practice with us.  It was interesting, but also intimidating--they all talked about having instances where they'd cried because of the way another nurse had treated them, and it took all of them a few months after graduation to find and start work [some of that is because some agencies can't hire you until you've passed your certification exam; it's usually 6 weeks to 2 months before you're allowed to take the exam after graduation].  On the other hand, all of them survived their orientation periods, and seem to like the units they're working on now.

Thursday and Friday were, as usual, devoted to Clinical.  I had 3 patients again this week, and each week I do makes me feel a little more confident about it!  It's not actually a requirement of the program that we be able to manage 3 patients--just 2--but on most floors the nurses have 5-6 patients.  (Of course, most staff nurses don't need to have someone else check all of their medications--just narcotics, chemotherapy, and other high-risk stuff!  This adds a huge amount of time to our day, I think.)

This weekend I worked on one of the computerized exams we have to take for our Bridging class.  Increasingly, I don't like them!  They're written by an outside company, and the whole purpose (I think) is that they're supposed to help us review.  The same company publishes review books--kind of a "Cliff's Notes" (does anyone still use those?) of various nursing topics.  But the exams don't necessarily cover information from the review books, and the answers (which are displayed with 'rationales') often don't include any meaningful rationale.  ie: if you didn't understand the concept before, the rationale provided won't help you understand it now!  Anyway, we're required to do them, and the review books are provided for us (I'm sure we've paid for them in our tuition), but really I'd rather review from the actual textbook.

Okay, back to work.  I'm trying to finish the 2nd written assignment for the Bridging class, but it isn't due until Wednesday and thus my brain does not want to work on it... 

Posted at some delay--Week 9 actually ended last Friday.  This week is Spring Break, which I'm enjoying despite the fact that we get new snowfall every day and it hasn't gotten above 40°.  Mostly, it's just good to have some down-time.  I'm catching up and working ahead on some assignments; I'll study for the exam that we have coming the Tuesday we get back, etc...  I had been hoping to do some gardening-prep, but the weather has prevented any such efforts.  (PoC did mark out some new beds, which was great, and then the snow fell...I'm not digging anything up just yet!)

Anyway, in our Theory class last week we learned about endocrine system disorders.  Specifically, we learned about hyper- and hypo-thyroidism, and adrenal insufficiency/Addison's disease, and adrenal excess/Cushing's disease.  Since the hormones from the adrenal glands and the thyroid affect nearly every cell in the body (indirectly or directly), these are fairly involved disorders.  (For example, if you have adrenal insufficiency, you do not make enough aldosterone (among other hormones).  Aldosterone tells the kidneys to hold on to water and sodium.  Thus, you lose excess water (becoming dehydrated), you lose sodium (which causes neurological problems), you retain too much potassium because you're losing too much salt (potassium affects muscle function, including the heart), etc...)

This was our first week on our new clinical units.  As I mentioned, I'm on an oncology unit now, which a unit I'd been hoping to get some experience on.  The first week went pretty well, though in part that was because I only happened to have one patient (people kept getting discharged and she eventually gave up on finding me a 2nd patient).  This was great because I really got to spend a lot of time with the patient, who was getting ready for discharge after a long stay.  It was also useful academically, because one of our assignments this semester is to do a Teaching Plan.  The idea is that nurses do a lot of teaching for patients all the time, and we're expected to be doing that.  But for this Plan, we need to take a look at everything the patient needs to learn about before being discharged--medications, equipment, treatments, general understanding of their illness, referrals and followup, and diet--and present it all to the patient.  The hospital says "discharge teaching begins at admission,"--ie: we're always working toward the time when the patient will go home, even if there's no date on that yet.  But this patient was actually being discharged, which meant that s/he was very interested in learning about all the things s/he and home-care will need to do.  Having only one patient let me focus on this and have some good discussions.  By the time I wrote it all up, it was about 11 pages single-spaced!  It's graded as pass/fail, so now I just have to hope my instructor accepts it and I will have completed the assignment!

The nearness of the end of school is starting to push its way into my consciousness--I need to start applying for jobs soon; we'll be done with regular clinical at the end of April; I had to order my cap and gown the other day.  At the same time, I know I need to remain focused--we have 4 more exams (and 3 more computerized ones) and then the NCLEX to get through!  And, as usual, I won't feel really good about things until I get my evaluation from my instructor at the end of April. 

The semester is (I'm pretty sure) halfway over.  Or, at least, we've finished our first 6-week clinical rotation.  We have evaluations next week and then we begin the next 6 week rotation.

We only had one day of clinical this week, because our instructor was sick the first day.  Usually on Thursdays we are there from 0700-1500 (ie: 7am to 3pm, and most of us arrive early).  On Fridays we're there from 0700-1200 and then have a post-conference until 1300-ish.  Thursdays are usually more stressful, because the 'normal' rhythm of the morning is

  0600-0700:  Read new orders for each patient, check the medication administration books to find out when they get meds, look up any meds you're not familiar with, find paperwork you'll need (like the doctor's order for parenteral nutrition, which has to be written every day and the contents should be confirmed by every shift), etc...  At 0700 the day nurses arrive.  They get report on each patient from the night nurses.  We can't go in to see a patient until we've gotten report, either at the same time as the day nurse or after s/he's seen the night nurse.  This time of day seems astoundingly inefficient--it often takes until 0745 for everyone to have report
.
  Meanwhile, the doctors arrive on the floor between 0800 and 0900, which means they want to see the vital signs and nursing assessments from the morning nurses.  We're supposed to complete our assessments (including vital signs; the regular RNs usually have an aide who takes vitals for them) and document them in the computer by 0830.  Some patients also receive medications at 0800, so these have to be given by 0900 (there's a 60 minute +/- window for most meds).  Patients who are diabetic receive insulin with their meals, and breakfast usually arrives on this floor around 0900.  So, diabetic patients need a finger-stick to check their blood sugar around 0845, but then you have to wait to see how much breakfast they eat before drawing up their insulin.

  Meanwhile, at 0900 you can start preparing your medications for 1000.  1000 is the primary time for medications on most floors.  Any medication we give must be checked by our instructor who will also quiz us on the purpose of the medication and make sure we've done any necessary assessments before giving it (like checking the blood pressure before giving a blood pressure med).  If the medication is intravenous, the instructor must be present while we give it, whether we're doing it by 'push' (the new skill we learned a couple of weeks ago) or hanging a bag of the medicine and connecting it to their IV fluid pump.  The instructor can't be in more than one place at once, so it's definitely a challenge to get meds together for multiple patients, even within a 120-minute timeframe!

  We're also responsible for helping patients wash up, changing their linen each day, getting patients up & out of bed, and dealing with anything else that might come up (incontinence, emptying tubes and drains, requests for pain medication, a glass of water, etc...).  Some of those things can really eat up time--and it's not that I don't want to do them, but it's just a challenge do get it all done!  So, theoretically by 1100 the morning has calmed down a bit (or that's finally the time that you can help a patient get bathed), but some patients also have 1200 medications, and many patients have their vital signs taken every 4 hours (so, at 1200), and then finger sticks for lunch must be done around 1245 with insulin coverage to follow.

  The second busiest time for medications seems to be 1400, and then by 1430 we're expected to have tallied up all intake and output for the shift (and entered it into the computer), written a note in the chart about our care that day (this has to be handwritten first and checked by our instructor), and reported off to our RNs so we can leave by 1500.  Throughout the day, we also have to adapt to new orders (which could include getting a newly ordered medication to the patient, or changing the type of IV fluid, or getting the patient ready to go to a procedure).

  On Fridays, we don't do any of the noon medications, vitals, or finger-sticks, so as long as we get through the 1000 med rush, it's a little easier!  This week was the very first week that I've had 3 patients.  Other students have had 3 patients for a couple of weeks, but because I was assigned to be team-leader 2 weeks ago, and was in the ED last week, this was my first day.  It went okay, but could have been better.  I got really tied up in a task at the beginning of the morning and that put me behind...  I'm definitely starting to feel some dread about the approaching end of the semester.  On the one hand, graduation is the goal of these 2 years of hard work!  On the other hand, I feel like I've figured out the role of "student nurse" and soon I'll just be a regular nurse!  All the while, I have to keep saying "I should graduate in May," because we really don't have our final "are-you-ready-to-graduate" evaluations until the last 2 weeks of the semester.  I feel like everything is up in the air until then.  (We just have to keep working hard and trying to improve.)

So, anyway, apart from all that, we started learning about the hematologic (ie: blood) system this week in Theory.  We'll finish that up and do a brief unit on oncology next week.  We also have another simulation next week.   

Oof!  Tired out again!  I really can't recall how I ever got through the first semester, when I had more classes and more homework!  I guess we didn't spend as long in Clinical each week.

Anyway, we continued to learn about kidneys and kidney failure this week.  Protect your kidneys, y'all.  They are super-important.  Next week we have an exam that is almost entirely devoted to kidneys (with a little bit of management/delegation and IV Push thrown in).

In our Bridging class, which I realize I've omitted for the last few weeks, we learned about temperaments and management styles.  Basically, we took the Keirsey temperament sorter and then talked about what the letters meant, especially in a teamwork-type setting.  For anyone who is interested, I came out as an IST/FJ.  I've taken Myers-Briggs tests before for various reasons and have usually come out to be an INFJ.  This time I was more strongly and S and a dead tie for T/F.  And a very strong I and J, which will be a surprise to no one.  I did find the descriptions of ISTJ and ISFJ interesting (and reasonably accurate, but I still have a lot of N) mostly because of they both describe the typical response to stressors as "catastrophizing."  Oh, yeah.  I've felt like this is more and more true in the last few years, and I don't know whether it's because of the stress of school and some family/personal stress, or whether--as I get older--I'm just going to be more likely to think of the worst-case scenario for stuff?

In Clinical this week, I was the 'Team Leader' which sounds like an honor (maybe) but is really just a chance to experience trying to keep track of 5 other students and 13 patients!  It wasn't bad, but the Team Leader is more like a resource person/troubleshooter/organizer.  My instructor assigned me to it this week because time management and organization continue to be big issues for me.  Next week I get to spend both days in the emergency department, which I'm looking forward to.

Now, though, dinner and then probably early bedtime.  Getting up at 0430 makes me sleepy....