We had our first exam out of 5 (not including the cumulative final) this week.  It covered chest traumas, heart dysrhythmias, cirrhosis, and hepatits, plus some math questions.  (There are always 3-5 math questions, which are usually guaranteed free points as long as you round the answer correctly and include the correct units.)  I did really well on the exam, which is a nice way to start the semester!  The nature of the questions is getting somewhat more difficult (as they've told us all along would be the case).  For example, a complication that can occur with cirrhosis is the formation of very fragile blood vessels (varicies) in the digestive tract.  These can rupture easily, leading to hemorrhage.  A question from our first semester might have focused on either identifying the phenomenon or basic management (like "don't eat irritating foods").  A question from our second semester might have focused on a medication and teaching the patient what it does (the right answer would be something like "this beta-blocker will lower your heart rate and blood pressure so that the blood isn't putting so much pressure on the vessel.")  One question on this exam was something like "The nurse assesses the effectiveness of metoprolol in controlling varicies by:  a) noting that the pt's blood pressure has decreased, b) making sure the pt takes his pulse each day before taking the mediaction, c) assessing for bloody stool or emesis, d) ...something else I don't remember."  With this question, 'a' is a correct interpretation of what this medication does, and 'b' is something the patient should be taught to do when taking this med (which is a beta-blocker).  But the correct answer is 'c', because it addresses the actual problem that occurs with varicies--they bleed (sometimes profusely) into the GI tract.  If blood is still appearing, the drug isn't solving the problem.  So, on reading this question, we're now expected to automatically know and identify the type and action of the drug, as well as the danger associated with the varicies, and then put these pieces together to evaluate the effectiveness of the drug. 

We didn't have any new theory in class this week, which I think is a little weird, but that's the way they wrote the schedule.  We start to learn about the renal (kidney) system next week, as well as management and delegation.  We also have the first of our mandatory math tests for the semester.  These don't count towards our grade, but we must get 100% or take it again.  If a person fails to get 100% after 3 tries, they have failed the entire semester.  I'm not actually aware of anyone who has had to repeat a semester because of this, but I'm sure it has happened.

We had our second week of clinical this week, which I thought went better than last week!  Our instructor has warned us, though, that she's going to start expecting more and more of us--I think not so much in terms of "more tasks" but "more thought, more assessment, and more problem solving."  The idea is that by the end of the semester, we need to have developed at least a rudimentary amount of "nursing judgement," whereby we identify an abnormal finding, assess all of the pertinent information, and then decide what to do--which might include calling the doctor or NP, but that's not the first step.  So, for example, if a patient suddenly complained of being short of breath after walking a short distance, we'd need to measure their pulse oximetry (that little finger clip with the red light), listen to their lungs, identify whether they were in pain, and check the level of oxygen they are receiving (if they have external oxygen).  Then based on those findings we might decide "the lungs sound okay, but the patient needs to use their inspirex (a device they breathe through that promotes fuller lung expansion), and needs to wear an oxygen bottle when walking around" or "there are some crackles in the lungs where there weren't before.  This could mean fluid is building up.  The patient needs to walk a lot, deep breathe and cough frequently, and use their inspirex."  or (maybe) "I can't hear any breath sounds on the right hand side, and I could earlier.  We need to notify the doctor right away."  But most likely, this is not the case, and the nurse is the one who needs to gather the information to make this call.  Even though this sounds kind of simple, it's definitely a habit we need to actively develop.  In part, this is because for the last 3 semester we've been taught to come to our instructor immediately with any abnormal findings.  This is because we didn't necessarily have the knowledge yet about what these findings might mean.  But by now, we should have the knowledge base to understand/interpret the data we gather when doing our assessment.  (Of course, we still have to let the instructor know!  But we need to come to her with *all* the information, not just "my pt is short of breath.")

You guys!  It's our final semester!....That was pretty much the mood when we all got back to school this week.

Of course, we've all heard a lot of scary things about this semester, so there was a fair amount of anxiety as well!

We did not have clinical this week, and we've been assured that we'll only have 1 patient next week to start out.  However, we are expected to be able to step up our care and our assessments...by the end of the semester, after all, we need to be able to make decisions on our own about patient care. 

Instead of clinical, we had a lot of classroom theory work.  We started by learning about Total Parenteral Nutrition, which is a feeding solution that is given through the vein.  Basically, it's the major nutrients (carbohydrates, amino acids, and fats) in the state they would be after they've been absorbed from the gut.  Medicines, vitamins, and minerals can also be added.  Each bag of the solution is custom mixed each day by the pharmacy, and they're wicked expensive!  (>$1500 each).  It's used for patients who cannot tolerate any absorption through the gut (like metastatic stomach cancer, or obstructed bowel), and also for patients with extreme healing needs (like burn patients, who need a lot of calories to fuel the rebuilding of tissue).

Then we had a review of some concepts about diabetes, and a math class (review of the calculations we already know how to do, and also learning a 'new' calculation--some medications are given in micrograms/kilogram/minute by an IV.  These might be things like blood pressure medicines for unstable patients.

Then we had a 'skill validation,' which we were all expecting to be really intense.  We had prepared several skills, and were told to come to the lab to do them.  Normally, this means an instructor watches you like a hawk and you have to do every last thing perfectly.  However, in this case we just talked through the skills as a group with an instructor, and reviewed the kinds of assessments we'd make for each skill.

Thursday in class we started learning about liver diseases--the viral forms of hepatitis.  We'll learn about cirrhosis on Tuesday.  On Friday (today) we learned about traumatic chest injuries--blunt force trauma, punctures, etc...and the basic mechanisms of internal damage and treatments.  Usually, this involves a chest tube, which is put into the space around the lung to remove air or fluid from this area (where it otherwise prevents the lung from expanding and will cause the lung to collapse).

That was pretty much our week!  Next week, we start clinical!

Almost done!  This was our last full week of classes and Clinical for the semester.  We didn't even have any exams this week!  (With these 8-week long classes, each of which have 4 exams, it's a rare thing.)

Tuesday wound up being my final day of Mental Health clinicial.  I was supposed to go on Wednesday as well, but Tuesday I woke up with moderate vertigo and by Wednesday I decided it wasn't worth driving down to the hospital again.  We can take one 'sick' day per semester pretty easily; any more than that involves all sorts of paperwork.  So, Wednesday I just slept and tried not to move around too much.  The vertigo is crazy and disorienting.  I'm calling it 'moderate' because I can still walk and drive (carefully, and only when I know the roads...), but I'm never free of the sensation that the room is moving.  Even closing my eyes doesn't help.  My gait has changed perceptibly--I usually walk very quickly, and I'd say I'm usually pretty confident about where my feet will fall.  Not now!  Now I have a bit of a stagger, and it's hard to walk in a confined space (like, say, the house) because doing so involves so many quick changes in direction.  Anyway...it's gotten a little better since Tuesday, but it isn't gone.  My doctor attributes it to the cold a couple of weeks ago--inflammation of the ear canals.

So, after sleeping for most of Wednesday, I spent the rest of the time looking up information on designer drugs (like synthetic marijuana and bath salts) for a presentation we needed to give on Thursday in Mental Health.  The presentation was only worth 5% of our grade, so I don't think anyone in our group really cared.  We never even rehearsed it as a group!  However, we did okay and now it's over.  Other group topics--which I thought were more interesting, but my group was really into the designer drugs thing--included PTSD/veteran suicides and historic treatments for mental illnesses--such as strapping the patient into a spinning chair to stir up the blood, and infecting schizophrenic patients with malaria.  [Maybe I was just especially sympathetic on the spinning-chair-thing this week...]

In OB/Maternity, we learned about postpartum complications and spent a short time talking about perinatal losses--which includes everything from a loss of fertility to a stillbirth or neonatal death.  This is a side of OB that we didn't really see during our Clinical--our instructors tried to give us healthy patients with healthy babies so that we could learn what 'normal' looked like.  One student apparently did see a birth during which the baby had to be resuscitated, but as of our class time, the baby was doing okay.  Our last day in OB we learned about women's health promotion...or at least touched on the topic.  Obviously, it could be a whole class or field of practice!

On Friday we had our computer-exam in Mental Health, which means that class is officially done except for my Clinical evalutation with the instructor next week.  Next Tuesday we have our 3rd exam in OB, and then the computer exam in OB on Wednesday.  And then I've signed up to do a Clinical elective like I did over the summer--5 days on a Clinical floor, with no paperwork to do!  I think it will be good for me--we don't get to use a lot of our hands-on skills during the 4 classes I just finished, and I know we're going to need them when we start our final semester.  By the end of that, it will be the 21st and almost Christmas...good grief!

Woohoo for Thanksgiving Break!  And not a moment too soon, apparently, because the seemingly minor headcold I was getting on Monday/Tuesday is now trying really hard to turn into a sinus infection.  Or maybe it'll just keep moving down my trachea and turn into bronchitis.  I would prefer neither of these options.

Anyway, this week I was back in Mental Health clinical, but only for one day.  She gave us the other day "off" in exchange for the support groups that we're visiting.  Our first week of MH we were really just supposed to focus on getting comfortable on the floor talking to patients.  We were supposed to practice things like the Mental Status Exam (which consists of our observations of the patient's affect and thought process, and the patient's answers to 2 questions:  "How are you feeling right now?" and "Are you having any thoughts of hurting yourself or anyone else?") and work through the 'therapeutic relationship' conversation.  We learned about that last year--it's a specific conversation in which the patient identifies a cause of concern, then identifies their thoughts and then feelings about that concern, and then comes up with ideas of how they could solve or reduce the problem.  It's kind of like cognitive-behavioral therapy, I guess.  This week we were supposed to use all of those skills (the MSE and the therapeutic relationship) to talk more in-depth with a patient and then create a big write-up and care-plan targeting one of the patient's issues.  So, we did all that and turned them in on Friday, and then also wrote up our lengthy self-assessments.

Thursday and Friday were lectures as usual (with no exams!).  In Mental Health we learned about schizophrenia--the disease one day, and the medications and treatment the next day.  In Maternity/OB, we learned about complications in the 2nd and 3rd trimesters of pregnancy (such as placenta previa--when the placenta grows over the outlet of the cervix, causes bleeding, and usually necessitates a C-section birth), then moved on to learning about the specific adaptations the newborn goes through in the first few moments and then hours of life.  These are really pretty cool--it's stuff like "the ribs/thorax are compressed by the birth canal, which not only squeezes out a lot of the amniotic fluid, but then causes them to recoil open when the baby's torso is born.  This recoil creates vacuum pressure in the lungs and in the blood vessels surrounding them, so all of a sudden blood starts flowing to the lungs from the heart because now it's suddenly the path of least resistance (which it never was during the pregnancy; most of the blood bypassed the fetal lungs and circulated to the body).  The vacuum pressure also draws in air via the nose, so then oxygen can begin to be exchanged in the lung tissue."  Also, the withdrawal of certain maternal hormones causes other changes to happen, and in relatively short order, a baby which has never survived in the outside world before is ready to do so.

This weekend, as I mentioned last week, friends visited and found themselves an apartment.  We've now pretty much gotten the house ready for PoC's family to visit starting on Wednesday--just one more bed to make up and a last round of cleaning to take care of.  And, I guess, a bunch of food to start making!  So, I'm going to try to be good and drink a whole bunch of fluids and get some homework done in the next two days! 

Onward!  This was my first week on the Mental Health unit, which is a locked floor of a nearby hospital.  The unit can be entered by anyone with a badge, but can only be exited with a key through a double set of locked doors.  This is for the protection of the patients as much as anything else.  I'd say (unscientifically) that about half of the patients we saw had been admitted involuntarily (which means that they said they were thinking of hurting themselves or others--or actually tried to do so; or were unable to care for themselves because of a mental illness).  In NYS, an involuntary admission must be reevaluated after 72 hours.  Many patients also chose to "convert" their admission status to a formal, voluntary status, which means they wrote a petition for more treatment.  The remaining half had been admitted voluntarily to begin with.  Generally, we saw patients with anxiety disorders, depression, and personality disorders.  We saw a couple of patients who were biploar, but none of them were in a manic state (which is really a form of psychosis--the person is completely unaware of the consequences of their actions).  Treatment on this unit focuses on helping the patients get back on their medications, and also on learning and practicing coping skills within the safe setting of the unit.  So, a patient who has angry outbursts can work on finding new ways to respond when provoked...rather than having an outburst at work and losing his job.  Nurses and other staff on the unit (counselors, social workers) give them feedback and support.

Mental Health is interesting--and needed for all nurses, since mental illness affects up to 50% of the population--but I don't think I want to work in the mental health field.  Most of the work we do is simply talking with the patients.  While I recognize that it's important, it's just not something I feel very excited about doing day-in and day-out.  The primary paperwork that we have to turn in for this unit is our Self Reflections, in which we need to write in great detail about how we met each of the school's 8 objectives in this area.  I loathe writing these...and we all heard that this instructor was really harsh on last week's group.  We'll see...

After clinical, I had class as usual on Thursday and Friday.  In the Maternity/OB class, we had our first exam (which went very well), and we've begun learning about the actual process of labor.  Those of us who were already on the labor and delivery floor last week are already a little bit familiar with this, but it wasn't possible to synchronize the lecture content to our clinical days.  In Mental Health we learned about mood disorders and suicide. 

This weekend a friend visited, and we learned he'll be moving to the area.  So, that was a nice surprise!  That's all the news...

Our new rotations have begun!  No clinical this week, but lots of orientation and lectures. 

Tuesday was our orientation day for Maternal/Neonatal care.  We had lecture in the morning, and then met with our clinical instructors and toured the labor and delivery floor of the hospital.  My group will be starting in L&D and then move to the post-partum floor (where mothers and their babies stay for a day or two before discharge).  We start on this floor next week--the hope is that we'll all get to see at least one birth.  Unfortunately by next week we won't have actually covered labor and delivery in lecture, which means we have some extra reading to do this weekend.

Wednesday was our orientation day for Mental Health.  This was a shorter day, because we didn't go tour the clinical unit.  We started learning about some of the statistics regarding mental health (as many as 50% of people will experience some form of mental illness in their lifetime) and also some of the barriers to receiving care (lack of insurance coverage and stigma being two big problems).  We will do clinical for this class, too (I start the week after next).  The clinical takes place on a locked floor of a nearby hospital.  Mostly, we'll just be talking with the patients....and writing about it a lot.  The floor is a locked floor mostly for the protection of the patients (not the protection of 'society').

Thursday and Friday we had lecture in both classes.  Unlike Community health (last rotation), these are both 3 or 3.5-credit classes.  This means 2.33 hours of Maternity lecture each day, and 1.8 hours of Mental Health.  By Friday, the Mental Health lecture seemed sort of interminable...  we were all just tired out!  Unlike last rotation, we don't have quizzes everyday!  And there's only one group project, due at the very end of the semester and not worth very much of our grade!  We do have plenty of other work--including our first exam coming up next week already--and more-detailed write-ups to do from our clinicals.  

In other news, we were excited to hear that PoC's family is hoping to come out here for Thanksgiving.  Still hashing out details, but it would be nice to have them! 

This was only a "kinda" week--I only had classes on Thursday and Friday.  I was mostly good over the weekend (through Wednesday) and did my reading for class, etc.  I also had some time to work in the garden (taking out tomato plants, largely) and get some of the Fall clothes out of the attic.  Super exciting, right?  I also spent most of one afternoon figuring out my homework for the 2nd half of the semester.  The school uses Moodle (an on-line learning/management environment) to give us most of our course information.  I'm not really crazy about Moodle to begin with, but I think my issues have as much to do with the way the instructors use it as with the program itself.  Basically, for each course our assignments are posted under the week number.  The syllabus had a schedule --- "In Week 2, we're covering assessment of the newborn:  Topic 6 and 7."  So then I have to open up the Topic Objectives for each of Topics 6 and 7 to find out what the reading assignment is, and whether anything else is due.  Sometimes the week numbers don't line up between courses--one course doesn't assign a number to Thanksgiving week, and the other one does.  Sometimes the Topic numbers don't align with the actual content listed in the Syllabus.  So, anyway, it took a few hours to go through the Maternal/Newborn and Mental Health courses to figure all of this out, get it into my calendar, and get all the dates and times onto our calendar in the kitchen.

On Thursday we learned about blood disorders (hemophilia, anemia, thalessemia) and neoplastic disorders (ie: cancer).  On Friday we learned about infectious diseases and vaccinations, including a class debate about whether vaccines should be mandated by the government or not.  (The general consensus in our class: no the government shouldn't mandate them, but everyone who can get vaccinated should get vaccinated, and educating patients/families is the best way to help this happen.)

In our Community Health class on Thursday the remaining groups presented their community assessment projects.  I know I was wicked stressed out about this project several weeks ago--I'm so glad we already presented ours and didn't have it hanging over our heads until the end of the semester!  And we got our grades for the project--we scored very near 100%, which was awesome (and relieves my beginning-of-semester fears about failing a 1-credit required class because I was having so much trouble with the quizzes). 

So, that was my week!  It looks cold and drizzly for the weekend here, so I'm glad we got some garden take-out done last weekend.  I have 3 exams next week, so now I'll try to be good and study for them. 

A slightly less exhausting week, but I'm looking forward to sleeping in this weekend!

I had Community/Non-Acute Clinical this week.  As I think I mentioned, we do three of these total.  I had thought we'd have one for each of the 3 weeks of Community clinical on the calender, but as it turned out, some of us have 2 one week (Tuesday and Wednesday) and then a week off some other time.  I had 2 this week--one at an inpatient substance-abuse rehab, and one at an assisted-living agency.

The substance-abuse rehab was interesting, though my preceptor didn't do a very good job of actually teaching me what the nurses do there.  She just sent me off to the sessions that the patients were doing.  Patients usually spend 2-4 weeks there.  They can do detox there (not true for every rehab--some of them you have to already be detoxed before you get there), and then they can start their rehab there.  This facility has a 12-step-based program for alcohol and drugs (and people who are addicted to both).  They treat people age 16 and above--I'd bet that the oldest people I saw were in their 60s or 70s.  It feels, in a way, like the worst summer camp ever--all the staff are really nice and supportive, but at the same time there's a strict dress code, you can't wear too much makeup, you'll get written up if you horse around or don't keep your room clean, you can't bring any means of contact with the outside world, and men and women are not allowed to interact outside of official group sessions.  They eat in the dining room together, but at separate tables on separate sides of the room--staff also eat in the dining room to keep an eye on them.  So, imagine being an adult, for goodness sake, and not only do you know you're in trouble because you've hit rock-bottom with a drug or alcohol addiction, but now you're voluntarily allowing a bunch of other people to tell you how to spend every minute of your day.  I understand that this method is believed to be effective, and I guess it probably is--I heard a lot of stories about patients who felt really out-of-control in their lives (which led to the substance abuse, which then became a self-replicating problem)--maybe it's a relief just to hand over the reins to someone else for a while.  Every moment of the day is scheduled for them, from 6am to lights- out at 10pm.  I attended group lectures/educations sessions, and small-group therapy sessions.  The nurses seem to spend most of their time taking vital signs, assessing withdrawal symptoms, and handing out nicotine lozenges (it's a smoke-free campus). 

The assisted-living organization was also interesting.  It's actually a managed-care organization, which meas that patients receive all of their services (except emergency room visits) through them.  They have their own fleet of doctors, home-care nurses, aides, podiatrists, dentists, optometrists, etc...  If they don't offer a service, then they're required to pay the cost of the service to the provider--so it's in their best interest to offer as many services as possible.  Their goal is to help older people live independently for as long as possible (though "independent" can include 'living in a group home with 24-hour aide service but it isn't technically a nursing home.')  I spend the morning with a home-care nurse, and then the afternoon in their health clinic which is attached to their day center.

On Thursday, my group in the Community class presented our project.  The purpose of these projects was to have us perform an assessment of a part of town (treating that community as the "patient"), and then identify strengths and weaknesses, and use these to come up with a nursing diagnosis.  We then needed to come up with a plan and interventions to address this diagnosis--fortunately, it's a paper project, so we don't need to actually do the plan!  We won't have our grades on the project until the last week of the term...but at least it's turned in and finished! 

On Thursday in pediatrics, we learned about musculoskeletal disorders in children (ranging from fractures to muscular dystrophy).  On Friday, we had our 2nd exam.  I did fine, though not as well as last time! 

Now, weekend!  I'm feeling the urge to clean the house.  I wonder if it will go away if I stall long enough?  Perhaps I should just get on with it...

As I mentioned earlier (I think) every other week we have Pediatrics clinical OR Community clinical.  This was my first week of Community clinical.  This is only a 1-credit class, so we actually only have clinical a total of 3 days.  We are assigned to the sites we visit--they range from in-patient and out-patient substance abuse treatment centers, to the poison control center, to assisted living and visiting nurse organizations, to the outpatient pediatric surgery center, and also the Urgent Care at the local hospital (one of them).  I was assigned to Urgent Care, which turned out to be a fast-paced, very busy day!  Urgent Care is supposed to see patients who have minor colds & fevers, insect bites, maybe sprains and strains (they have a radiology lab for X-rays).  It's a good place to go to get some antibiotics for your kid who has strep and also get a doctor's note explaining why you missed work.  This Urgent Care is actually affiliated with the hospital Emergency Department, which means they can easily transfer a patient who comes in with more severe symptoms.  

What I actually saw at UC was a mix of "what's supposed to happen" and "reality."  There were a lot of kids with fevers, sore throats, nausea, etc...  The structure of the place allows a "family unit" to be examined together in one room, which seems very smart!  These kids got strep tests, antibiotics if needed, and recommendations for fluids and tylenol.  There were a good number of "my foot/knee/arm hurts, I twisted/banged/don't know what I did to it."  These folks got braces/ace bandages, X-rays, referrals to follow up with an orthopedist, and prescriptions for Ibuprofen and (usually) something stronger as well.  There were women (and probably men, but I didn't see any) who came in for STD testing, pelvic exams, and pregnancy tests.  Sometimes they came in with another complaint--"my shoulder hurts, but I also have this weird discharge, could you test me?"  There were a few folks who came in who really didn't belong at UC--kidney stones, which require fairly intensive pain management and also a lot of IV fluids.  Interestingly, one of these was actually treated at UC because the patient's overall condition was more stable.  One was transferred to the ED because the pain was extreme and the patient had a lot of other complicating conditions.  I would imagine this patient was actually admitted to the hospital for a day or two, but I'm not sure.  I didn't see anyone who came in with chest pain, partial paralysis, or anything like that (ie: heart attack or stroke symptoms) but I'm sure it happens!  The patients seemed to be a mix of "I don't have a regular doctor," and "My doctor's office can't see me until next week, but I'm sick now!"  Most patients seemed to have some kind of health insurance (from what I gathered) but NYS has free or very-low-cost insurance for low-income kids, so you'd hope they actually had it! 

It was an interesting place to observe/work (I was actually able to help out) because the RNs have a lot more autonomy there than on the floor of the hospital, it seems.  The place is staffed by RNs, a radiologist, and EMT who does EKGs (heart rhythms) and blood testing, and Nurse Practitioners/Physicians Assistants who are the 'providers' (ie: the people who actually diagnose the medical condition).  The RNs usually see the patient first, and they can follow a series of standing orders to initiate care--such as drawing blood, ordering a urine culture, starting IV fluids, etc....based on the patient's initial complaint and symptoms.  Then the patient is seen by an NP or PA, and is then discharged by an RN with their prescriptions and instructions.  Everything gets documented in the computer, because often the RN who takes in a patient is not the same person who discharges the patient.  Their goal is 90-minute (or less) service, though the day I was there they were very busy and I don't think they always met this goal.

Aside from UC, we learned about genito-urinary diseases and defects in children, and then on Friday we took our first exam.  I think it went pretty well.  We got to go and check our answers against the key right afterwards (having already turned in our ScanTrons) and I don't think I missed many questions!  Woohoo!  We have another exam 2 weeks from now, I think.  It's hard to pack everything into an 8-week quarter! 

My plan for today is to do the rest of my homework for the week so that I can then write the paper for our Community project.  Our homework topics this week are lead-poisoning and Child Abuse.  Nurses are mandated-reporters in NYS (ie: if we suspect abuse of a minor by a person who's supposed to be responsible for that minor, we're required to report it). 

The summer is officially over for me--classes started on the 20th.  I had finished my summer classes on the 8th, so I did have a brief break in-between classes.  The Microbiology instructor turned out to be awesome, which made that class fun and made me feel grateful I'd happened to pick his section (apparently the other two sections running this summer were awful).  The Pharmacology class turned out okay, but I was unimpressed with the level of actual instruction provided.  It was an online class, so I understood that we'd do all of our reading on our own, but the brief on-line lectures were often typo-ridden.  The discussion sections were interesting--they were all devoted to medication errors that have happened to patients--but I wish the instructor would have posted some follow-up (such as "if a patient receives an overdose of _____, then the antidote is _____ and the most important systems to monitor would be respiratory and cardiac."  That's basically the information we were supposed to come up with during the discussions, but since we're all students and this could be life-saving information, I would have preferred an "answer key" at the end of the discussion.  Oh well.  I think online classes might not really be my thing.  I also bought myself a $4 Sociology textbook, read it, and took the CLEP exam which will exempt me from needing to take Sociology this coming Spring.

Mid-summer, I did a Clinical Elective, which is just more time on a clinical floor.  As it happened, I was actually on the same floor I'd been on in the spring, which was nice!  The Electives are a mixed group of students--some had just finished their introductory class, and some were going into their final semester.  (During the year, all the students in our clinical groups are at the same level.)  The awesome thing about the Elective was that there was NO paperwork to turn in!  We still needed to know all of our information (such as medications) but we didn't need to write it up and turn it in.  Hooray!  I might try to do another one this winter break, but I think they'll be very much in demand by then.

So, now my third semester has started.  Since I've now completed my 'Liberal Arts' requirements (see above), I will only be taking Nursing classes this year.  Our third semester is generally referred to as "Specialties," and actually involves 4 separate classes.  We take 2 at a time--I am currently taking Pediatrics and Non-Acute/Community Health.  Pediatrics is a 3.5 credit class, and Community is a 1 credit class, but I feel like Community is going to involve more work.  Each pair of classes meets for 8 weeks and then we'll swap (to Maternity and Mental Health) in mid-October.  Because of the limited timeframe, the workload is a little different, too.  We now have daily homework assignments (which we didn't have last year), daily quizzes (also a new thing), a group project in each class (blech!), and, of course, exams.  The Community group project is 50% of our grade, and involves a presentation and a paper....produced by a group of 6 people.  We'll see how all of that goes!

Our clinical days are Tuesdays and Wednesdays, and each week we do either Pediatrics or Community.  In Pediatrics, we'll be on a surgical floor, so generally we'll have otherwise-healthy kids who are in the hospital following a particular procedure.  We're told that we'll be spending most of our time focusing on Growth and Development--evaluating where each patient is, and helping to find ways to preserve/promote normal Growth and Development while they're in the hospital.  Although we'll provide patient-care, we can't give medications or do other procedures without the RN present (on an adult floor, the RN responsible for the patient is not with us when we give medications, but our instructor does check them).  We're also supposed to be evaluating family structures and seeing how we can help promote health for the family--giving respite to parents, teaching, etc...   Our Community clinicals are only 3 out of the possible 6 days, and we get sent to a different organization each time.  I'll be going to Urgent Care, a substance-abuse rehab, and an assisted-living facility.  These are mostly observational experiences.

Our first week started a little crazily--no Clinical, but 4-6 hours of lecture on Tuesday and Wednesday, followed by our normal lectures on Thursday and Friday.  I did really poorly on the Community quiz for the week, which was frustrating and of course led me to immediately think "I'm going to fail this class!"  which is (I hope!) a ridiculous over-reaction.  I'm looking forward to starting Clinical next week--I have Pediatrics first--but of course am a little nervous as well:  New instructor, new floor so I don't really know where anything is, etc...  One of the great things about having finished my Liberal Arts classes is that I don't have classes on Mondays this semester.  I have plenty of homework, though, and I'm glad of the extra time to do it!