Sunday, April 30, 2006

Last day as a student nurse

Today I am embarking on my last official day as a student nurse. From now on in clinical I will be "the nurse." For real. It is so convenient to be able to say, I am sorry I can't help you, I can get your nurse for you.

I bought a few gifts for the unit and for my new preceptor who has been just awesome these past few weeks. I still see the evil nurse preceptor that I had in the beginning. It is weird working alongside of her. This is a continuing theme in nursing. The stressful environment, people snap off each others heads, you get over it and you move on. Recently we had a gathering at my school to celebrate commencement and I realized that every person in the room had said something that I was offended by at some point in time or another. Then I said, "Ah, what the Hell, why not talk to them."

In talking to them I found that some of us had many things in common. One student and I both want to be Family Nurse Practitioners. Don't get me wrong, in the first three years of my schooling, those girls were bitches, but it was only because our school is so competitive and stressful. Now it is all over, and we can just be normal people. I must say, I like everyone a whole lot better.

I am a work in progress. I was really mad at one of my friends because we were supposed to meet up and she blew me off. More than once. Then I saw her and found that she really did forget that we were supposed to meet up and that it was not a punishment for something that I did. For some reason I feel like people are always trying to hurt my feelings. I am a perpertual victim. Starting today I plan on changing my way of thinking.

It looks like I am going to make my goal of graduating with honors. Every time I see one of my advisors they hug and kiss me. They know the Hell I have been through doing this whole program, and of course they have made a lot of money from thirty of us completing the program at $120,000 per student. I'd kiss me too! I can't help but wonder if I cried or complained the whole time I was in the program. Most people have a memory of me crying of being upset. I didn't think I was going to make it. Seriously, every time I turned around my son was in trouble at school, or my daughter had an accident and needed a change of clothes, or something. But now is my big walk. I don't care what anyone else thinks, DiVa made it!

Okay so for the trivial stuff. I don't know what I want to wear for graduation. I don't want to be all fussy, but then I want to look professional and comfortable. I found this really great cotton sundress and sweater that I want to wear. But that is only for one event, I have at least three other events to wardrobe for. Then people are coming in from out of town that I need to entertain. I can't wait until June. I plan on taking the kids on vacation to Universal Studios and the beach in Florida and South Carolina. I will keep you posted on my job search. In the meantime, the DiVa will be enjoying her remaining time as a student while preparing for the licensing exam.

DiVa...a real BSN in a few weeks!

Sunday, April 23, 2006

After three years of nursing school...

I am still doing goofy things.

I was taking care of a patient on Thursday. She was hooked up to a vent, but alert and oriented. She was diagnosed with ovarian cancer, that had spread to her lungs and gave her some serious breathing issues. It was my first real day of having two patients all day and I wanted to be confident and together. So I was a bit nervous.

My preceptor sent me into a room to hang IV meds and I was having a spot of trouble getting things together. I have a really bad habit of talking to myself audibly. Sometimes this dialogue is what helps me organize things in my mind and give myself that much needed encouragement. I said, "Ugh, I don't know what I am doing!" Lo and behold, the patient heard me. I had proceeded to do her care and she started freaking out. She was kicking and trying to make noise and I asked her what was wrong. She wrote a note to me that said "find onebody to hang medicine." I was like, "Huh?" So I said, "Do you want me to get my preceptor?" She said yes. So I sent her into the room and I went to go take care of my other patient. My preceptor came and told me that the patient did not want me taking care of her anymore because I said that I didn't know what I was doing. My feelings were a little hurt. I came in to stop her IV from beeping while my preceptor was at lunch and she freaked out again. I told her that I was just stopping the noise. I was assigned this patient the next day and she still remembered.

I guess I can't say that I don't blame her, I wouldn't want a nurse taking care of me if she didn't know what she were doing either. To my benefit, I only have 40 hours of senior practicum left. That is something to dance about. I met one of my really good friends yesterday for dinner and drinks. It was really good to see him. He was supposed to graduate with our class, but life happened and he had to take a few semesters off. I from experience, nursing school is tough. Especially at our school. There is no mercy. He told me that he was really proud of me for enduring the program with all of my difficulties. I find that it is really hard for me to look back at this accomplishment as something that I should be awestruck about. I want to be so amp'd about doing this great thing I have done, but I am really modest. That isn't very DiVa-like, I know but I don't want to be one of those type of people who are unapproachable and sort of arrogant and aloof. Case in point:

I ran into a nurse that was very influential in my becoming a nurse and it was interesting to say the least. She was driving a white convertible blasting Jay Z. She walked into the gas station and I knew it was her. She had on this flowing white poncho and a walk that could stop traffic. I said hello former nurse practitioner I knew from a while back.(I really didn't say all that, but I can't use her name.) And she said HI! (really loud!). I said, "Do you remember me?" and she said "Yes, I do!" (she really didn't, I bet a million people do this to her all the time.) She might have stopped for a few seconds, but the rest of the time she was talking and walking all around the store gathering items. I remember her having a really vibrant personality, but I don't recall all of the noise and activity and just anxious energy. I imagine that she heard what I said and everything, but I felt like there was huge distance, like I was the little person and she was the big-time RN. I wanted to thank her for inspiring me to try nursing, but all of this facade wouldn't allow me too. I couldn't bring myself to say it. I did manage to tell her that I will be graduating from nursing school in the coming month. She seemed impressed, and gave me a plug to try her area of nursing because "How depressing could it be to catch babies?" Well, I guess it can't be too depressing as long as they are born alive.

I could see that nursing has done her well. She has all the trappings of a person who has financial security and she seems to be happy with her career choice. I want the same things for myself someday, but I don't want to be aloof. I am sure I will find some way to balance my confidence so that it doesn't come across as arrogance. Most importantly, I want to be supportive to other people who are coming along my path. If you need a friend or someone to support you and give you a few words of encouragement, I am here. If you want to ask me a question about nursing school and how I did it, I will tell you. I am opening this blog for Q and A. If you post a question in the comments I will answer it.

Anyway, back to my paper and presentations. I hope everyone who reads this has a great week.

DiVa...can't wait until graduation.

Sunday, April 16, 2006

The DiVa has returned...

I had to take a week or two off. You see, my grandmother passed away. It was not really a huge surprise as my grandmother had been sick for a while. She was the most awesome person in the whole world. She was greatly admired by many people. My grandmother has and will continue to be greatly missed.

We had to take a long drive to the West coast for her funeral because no one had enough money for a plane ticket. I will assure you, that is too long to be in the car with anyone. My parents have been married now for over 30 years. My father has never been involved in the lives of myself and my younger siblings. I sympathize with the fact that he had to provide for all of us, but we still lived in deplorable living conditions. I never had fancy things like my other friends, but I never made a big deal of it because my Grandmother explained to me that it was a part of the sacrifice of being the big sister. My grandmother was a huge source of inspiration in my life. She was my best friend, and when I was 14 years old she moved away. My life would never be the same.

On the road trip, my father made it pretty clear that he has no respect for my mother, and no respect for me and my other siblings. He has always had the money to provide for our family, but chose not to because we didn't do this great "thing" he wanted us to do with the so called family business. I never wanted to be a part of the family business. This was one of the big factors that made me decide to go to school and get my own legacy. My father owns property that some of my brothers and sisters believe will be left to them as a sort of inheritance. I realized a long time ago that either 1) There was no inheritance or 2) If there is one, I won't be getting it. I know that it may sound shallow, but we all believed in this grand story that my father told us about not having to work and living off of the family business. He refused to help me or any of the others get through college. One of my brothers joined the marines as a result. The rest of my siblings have just gone on with their lives. My father can't seem to understand that his presence was needed during our childhood. The whole way down to the west coast, he bitched and moaned about how unappreciated he feels. And the way back home he made condescending remarks about my mother until I decided to tell him enough was enough. Then he had the nerve to threaten to cause physical harm to me because I told him that he should have to pay my mother alimony if they split up. He said she doesn't deserve anything. I wish I could have broke both of his legs.

How do you put that kind of emotional strain on a woman who just lost her mother? It was already a difficult trip because one of my aunts has multiple life insurance policies on my grandmother and it is believed that these policies will be the way that she will buy her new Mercedes Benz. Another of my aunts were threatening to tell everyone where to get off because she felt that she was the only one who cared for my Grandmother. One of my uncles has health problems and the whole family is worried that the strain of my grandmother's death in combination with his crazy teenage children could be too much for his poor heart to bear. I could go on but it is just exhausting. I thought there was going to be a huge fight, but my grandmother's spirit kept everyone in check.

This has been a difficult year for the DiVa. Last fall my godmother died while I traveled abroad, and now my grandmother. Two of my aunts died of cancer in the past year and all while I am trying to finish school. I have wanted to quit so many times, but I can't let them down. These women were powerful influences in my life. In their honor I must find the strength to go on. It is so hard, because every time I hear someone a praise and worship song I feel myself getting misty. I am so behind on my hours for senior practicum. I wanted to be done by now.

DiVa,...Just holding on

Wednesday, April 05, 2006

You know what....?

When my clinical instructor came to visit me the other day at my site, she mentioned something that after a few days of thought rings true to me. The senior clinical is to prepare one to work in the real world of nursing, not learn how to deal with difficult people. It is designed to teach you how to organize your day and coordinate everything learned over the past four years. Since I no longer have the preceptor problem, I have noticed that I can focus on the really important thing. Patient care. So I will devote this entire post to my clinical experiences and patient care activities.

The first time I ever saw a patient with a ventilator and more than one IV pole and tubes in every orifice I thought to myself, I will never be able to take care of a patient with so many things going on at once. Then all of a sudden I had to take care of one. I will admit, it was somewhat intimidating because I was positive that I would attempt to turn the patient and completely extubate him, and I have. I thought OMG I am going to program the levophed pump totally wrong ant the patient is going to have a stroke because I gave too much medicine, which I once almost did. But I liken this nursing thing to having mother's wit.

When I first brought my son home from the hospital I thought it wouldn't be any different than babysitting my younger siblings. It was totally different. I held this baby in my arms for the first time and realized that he was totally vulnerable and dependent on me for all his care. I decided that I wanted to nurse him because I read all the top baby books and read that nursing was the best thing for him. I had a full thickness episiotomy and when my epidural wore off I wanted medication to prevent excruciating pain. The doctor ordered tylenol three and one day after giving birth I was discharged from the hospital.

I realized that three days had passed and I had only nursed my son once. My son was sleeping all the time and my Mom made the suggestion that I stop taking the pain medication. I couldn't sit, I couldn't go to the bathroom. I was miserable, but my baby was nursing again. He and I would spend afternoons gazing into each other's eyes, and before his Dad went to work on day three of my son's life he noticed that the baby was looking kind of strange and was coughing. He said the baby looks like he is choking, and when he turned my son around to me his little face was turning purple. I was terrified. Before I knew it, I had his little body laid across my lap. I quickly grabbed the bulb syringe and suctioned his mouth. I got nothing. Then I suctioned his right nostril and a big gray plug of mucus came out. I looked at him again and just as quickly his color returned and he was back to being a normal yet perfect newborn. In that moment, my son could have died right there in his father's arms. But something clicked inside of me, and in a moment's notice I saved my baby's life.

When I am in clinical, my patients are number one. And in the ICU, you only have two patients, so I take my time and give them a good cleansing bath. I talk to them if they are not sedated. The ventilator has become not so scary. That one time I turned a patient and almost extubated him, I was turning the patient slowly and noticed resistance. Instead of yanking really hard, I decided to look to see what was catching and noticed that the suction catheter got caught. Awesome catch I must say. And the day that I almost set the levophed pump too high I got a message on the pump that said this is "levophed, are you sure you want to do that?" And even when I fixed it I called my preceptor to check it again before I set the pump. It made me feel better just to have a second set of eyes.

As far as the therapeutic relationship, this has never been a problem for me. The only difference is that in the ICU, the likelihood of patient death is a lot higher. A few weeks ago I had a patient who was on a ventilator, but was improving so was put on a high flow mask. I talked to her and she asked me if I could help her with her hair. It was almost time for me to leave, but I was going to stay late and do her hair for her. Nurse preceptor battle ax said I couldn't do it and so I went home. Two weeks later I am in the break room and notice that there is a sympathy card sitting on the table. It was for the patient who asked me to do her hair. I felt so bad. I am so glad to finally have an opportunity to develop this area of my nursing practice even though it is so late in the game.

-DiVa,...The student nurse for only a few more weeks!

Sunday, April 02, 2006

Do what you have to do...

To get where you need to go.

That's what my preceptor said yesterday when some of the other nurses at clinical were commenting on my lack of activity. DiVa is finally having an Aha! moment with this whole prospect of senior practicum. This is supposed to give me a good taste of what it is like to be a nurse...for real! Not just how to write care plans or how to provide nursing care, but how to work with other people who are jack-asses.

In my management class, we had to work in random groups to complete projects. One day I was in a group with almost ALL of the people at my school that I don't like. Amazing how I managed to do what I had to do to get what I needed to get done...which was a completed project and an "A" in management class. In clinical, there have been times where I had to bite my tongue so hard I swear I could taste blood. This week, there was a nurse that was making fun of one of the aides who is an older black lady. When I say older, I mean old enough to be my grandmother. We were in the break room talking about pregnancy cravings and the lady said something about craving starch and drinking three beers a day. Why did she do that?

Most of us who completed OB know that the starch craving is condition is called pica and that it results from a deficiency of certain vitamins and minerals during pregnancy. Eating starch or clay is a cultural thing that is typical in the south and among African Americans. Anyway she was riding this lady until the cows came home about whether or not she received prenatal care, how irresponsible she was and how she probably messed up her kids, who are now well into their forties or almost fifty. In the early sixties, people didn't know about fetal alcohol sydrome. The lady was obviously offended and she got up and left. Did that stop her? Hells no.

So yesterday, this same nurse was getting on my case about me sitting at the nurses station. I had nothing to do. All of my ADL's were done, all of my meds were passed, the patient had been suctioned, all of my patient education was done, vitals...Everything. No one else needed my to do anything, so I decided to look over my notes for my test on Wednesday. Someone was talking about doing the 4pm assessment at three. Since I only have one patient, I thought I could wait until 3:30. It was then that the other nurses advised me that I can do somethings early because when you have two patients in the ICU, anything can happen. I said something like that is good information to know because soon I will be taking two patients and I said that I didn't think I was ready. The same nurse who was harassing the old lady about prenatal care said, "I don't see why not, everytime I see you all you're doing is sitting around."

To my surprise, the other nurses who happened to hear what was said turned around to her and said that what she said was rude and uncalled for. She said, "That is just how I am. In the beginning, people are offended by my directness but later on you'll thank me for it." I will reserve my comments. I asked my new preceptor if she agreed with her statement and her response was basically, "Do what you have to do, to get what you need to get done. Don't be bothered by what anyone says, me included." At first I thought she agreed with what the nurse said. And she must have sensed it because she followed her statement with the fact that all of the other nurses on the floor have been student nurse assistants for at least six months before becoming a nurse and that since I haven't had the same level of experience I can't expect myself to perform at their level. My focus at this time should be to primarily finish my hours. So I guess I had better get ready to go back to clinical...

DiVa...Doing what she has to do, to get what she needs to get done which is graduating from this wretched clinical experience in May.