Nursing State of the Union

nursing state of the union

We have a HESI benchmark exam tomorrow.  This is something that only nursing students have to deal with, so don’t fret if you’ve never heard of it or anything.  Basically they gauge our ability to pass our licensing examination throughout our tenure in the program.  It’s kind of a big deal, and if any student fails to bench they pretty much make our lives a living hell that following semester.  I’ve been doing practice questions in EVOLVE off and on all day, when suddenly….

Benchmark tomorrow

So here I am, trying not to panic.  This blog post is something I’ve had rattling around in my brain for a few days.  Since my study time has been rudely cut short I guess I’ll go ahead and write it now.

Let me start by saying that data is a wonderful thing.  We live in a time where we have more access to data and information than at any other point in history.  This is an amazing achievement.  However, it’s not always presented in a way that’s easily digestible.

With education costs rising and income inequality climbing, there are a lot of people who have some understandable anxiety when it comes to choosing a career path.  The medical sphere is no exception to this.  So let’s look at what the research says about nursing and where it’s headed over the next fifty years.

First, before we go crazy with the nursing stats, we should probably cover two important bits of information in regards to life expectancy/median age and population growth.  My main man Hans Rosling will do a much better job at this than I will, so watch this very short video.

 

 

What I want you to focus on about this video is that population started skyrocketing around 1850-1950.  This was due to a number of factors, not least of which is industrialization and the discovery of penicillin in 1928.  During this time, life expectancy rose dramatically and child mortality saw just as big of a drop.  But compare this information against the earmarked years in this next video and see what you can see.

 

 

Did you catch it?  In case you didn’t here’s the answer: the number of children born per woman didn’t really start decreasing quickly until around 1965.  That means that for almost a hundred years, people were crankin’ out a lot of kids and almost all of them were surviving into adulthood.  They also enjoyed longer lives than had previously ever been seen in human history.

This resulted in the current situation we have in the United States today where the median age is higher than it’s ever been.  We’re finally at a point where less children are being born, but we still have all of these people that were minted in the 40s and 50s.  And there’s a lot of them.  That’s not a bad thing by any means, but it does correlate with my next point rather well.  You can see the increase very easily if you graph it out.  Fortunately we don’t have to, as the US Census Bureau has done it for us already.

 

medianage

The lion’s share of the healthcare resources in this country go towards the older adult population.  That makes sense when you consider the fact that about 80% of people in this age demographic have at least one disease process that requires management.  Over 50% have two chronic conditions.  Average life expectancy is higher than ever.  The older a person lives to be, the more healthcare resources they consume.  Again, this is not a bad thing.  Just a thing.

What this means for our field is that there will be more and more demand for nurses  as the overall population continues to age.  Considering that this trend upwards in median age isn’t supposed to level off until about 2050, I think it’s pretty safe to say that my generation of nursing students has little to worry about in the way of employment opportunities.  In fact, some would argue that the projected increase in demand is already starting to rear its head.

 

The vacancy rate for Registered Nurses continues to rise and currently stands at 7.2%. A year ago, this stood at 6.7%. Thirty-four percent (34.3%) of hospitals reported a RN vacancy rate of “less than 5%”. This is a 5.7 point drop from 2014 and a 25 point decrease from 2012. In 2012, 59.5% of the hospitals indicated a vacancy rate of “less than 5%”. This rightward shift, along with the RN Recruitment Difficulty Index, (see page 7) is a clear indication that the RN labor shortage has returned and is becoming more intense.

The vacancy rate of “5.0% to 7.49%” saw the greatest increase to 25.7% of the respondents. Of significant concern is that 24.2% of all hospitals have a RN vacancy rate higher than 10%. This is up from 4.8% in 2012. As the economy improves, as RNs no longer delay retirement, as RNs reconsider travel nursing, as part time RNs take less shifts and as the demand for RNs increase expect the vacancy rate to further deteriorate.

2015 National Healthcare Retention & RN Staffing Report

 

“But Meg,” you might say.  “There’s quite a bit of negative chatter among nurses and nursing students about how difficult it is to find a job after graduation.  Haven’t nursing graduates had problems finding a job in the past few years?  And if they have, won’t these un/underemployed nurses be available to fill the shortage?   Won’t we still have an overabundance of labor?”

The answer to the first question is ‘yes.’  Even back in 2005 the field was beginning to reach saturation.  The economic crash in 2008 threw every field into a tailspin, and nursing was no exception.  This was particularly hard on nurses who had entered their peak earning years, as they were the first to be targeted for layoffs.  Even those who kept their jobs faced financial hardship as spouses lost 401Ks and were themselves given the boot.  Delayed retirements made life miserable for graduates who were looking to enter the workforce.  These forces finally started to break starting in 2012, and by 2013 the data showed a much better outlook for everybody involved.

The answer to the second question is ‘no.’  We’ll get to that in a minute.

The web is full of snapshots of how hard it is to get a job, but those in-depth looks are only worth so much.  Anecdotes and case studies are great and all, but if you focus exclusively on them, you’ll miss the forest for the trees.  Or the big picture window.  Or…something.  Anyway.  Here’s more data:

 

With respect to job offers for new graduates 4–6 months after the completion of their programs, the survey found this rate to be 88% and 92% for entry-level BSN and MSN graduates, respectively. Once again the survey found little variation based on school type and institutional characteristics. The job offer rate for BSN graduates did vary by region, from 79% for schools in the West to 82% in the North Atlantic to 91% in the Midwest to 92% in the South. Though employment of graduates in the West lags behind the rest of the country, the job offer rate did increase considerably, by 37 percentage points from the time of graduation to the period 4-6 months out of school (42% to 79%). For entry-level MSN program graduates, the job offer rate at 4-6 months post-graduation ranged from 84% in the West to  92% in the South and North Atlantic to 95% in the Midwest.

Employment of New Nurse Graduates and Employer Preferences for Baccalaureate-Prepared Nurses

 

Those numbers are staggering.  Almost 60% of nursing students have a job immediately upon graduation.  They can’t even be called RNs yet, because most graduates don’t sit for the NCLEX until around 90 days after they walk down an aisle wearing a pointy hat.  There are some regional differences, sure.  California is a freakin’ wasteland for new graduates right now which is why the west has such low employment numbers (relatively speaking). But by and large, nursing students are in the 90-somethingth percentile of degrees that lead directly to gainful employment.

Wanna know the kicker?

These numbers are six years old.  They were printed in 2010, just two years after the recession hit.  In the midst of the biggest economic turmoil since the Great Depression, new grad nurses were still employed at a rate of 88% in the first six months following completion of their degrees.  Hundreds of thousands of people have been delaying retirement due to the crash, and still the demand for nursing continued to grow.

Speaking of retirement.  We’ve talked about the median age of the population at large.  Maybe we should look at the median age of practicing RNs?

 

Current and Projected Shortage Indicators

 

Note: this information is also from 2010.

In case you were wondering, there are about 3.1 million nurses in the United States.  That means that we’re probably going to turn over at least 30% of the entire nursing labor force within in the next ten years.  That’s a scary, scary number.

Normally employment trends tend to follow population trends, but nursing is a special case.  Remember that as age goes up, so does healthcare demand.  More people reaching retirement age just means that we need even more nurses.  And with a third of our workforce being lopped right off the top, we’re going to need as many as we can possibly get.  In fact, the demand for nursing labor will be higher than it’s ever been in the history of the profession.  That counts the ramp-up to World War II.  Even if every single nurse who’s practicing today worked until they literally fell over dead on their units, we’d still need more nurses to meet the increase in demand.

We think that the population will level off by 2050ish in the States.  In fact, the stage is already set for this to occur.  There are about 1.9 billion children in the world today.  In 2050, there will still be around 1.9 billion children due to decreasing birth rates.  This phenomenon is called “peak child,” and it spells the end of population growth the likes of which we’ve seen for the last two hundred years.  For nurses, this means that our field could see the bubble burst somewhere between 2060-2080.  What goes up must come down after all.

But I’ll be long retired by then, so it’s not really my issue.  Maybe some other blogger can crunch the data for you if you still care by then.  I’m just here today to say one thing:

 

dont-panic.jpg

 

There will be a job for you once you graduate.  Well…there will be a job for about 93% of you.  The other 7% can still live in their mom’s basement.  Somebody has to live up to our generation’s stereotype anyway.

Hearing None of It

hearing loss

It’s no secret that I have difficulty hearing.  Normally it’s the third or fourth thing I tell somebody when we first meet.  The conversation usually goes something like this:

“Hello.  My name is Meg.  I’m a student nurse and a bookbinder.  Also, I can’t hear very well, so can you please face me when you’re speaking?”

Hearing loss runs in my family.  Visiting my grandparents a few months back was like looking into my future.  He has difficulties hearing voices more than anything else.  My mother is the same way, although hers is a little wider in terms of the frequencies she can’t detect.  My cousins on her side all have varying degrees of loss, with Stanley displaying the worst.  They sent him to a school for the deaf as a child even though he could hear at that point just so he would learn sign language early.  They’d suspected that he’d lose 90% of his hearing by age 35.

On top of these hereditary risk factors, I suffered from numerous repeated ear infections as a child.  I was prescribed multiple medications that are ototoxic – chemically damaging to the auditory nerve.  And then in my youth I decided to play the drums.  It’s hard to figure out which one of these variables caused the most damage, but they’ve all undoubtedly contributed in some form or another.

People are very understanding by and large.  Very rarely does somebody get frustrated with me when I ask them to repeat themselves six times in an hour.  Michael has never, not once snapped at me when I ask him to walk into the room I’m in to speak to me.  He’s never lost his patience with me.  Or at least he hadn’t…until last Saturday.

I’ve been noticing an increase in my tinnitus and a decrease in my hearing acuity over the past year or two.  Mostly, I brushed it off as my imagination.  Maybe I just didn’t want to admit it.  Maybe I was trying to deny it.  I don’t really know.

So when I heard him say something off the cuff and uncharacteristically cruel, I crumpled inside.  It only took about five minutes to figure out that what I’d heard wasn’t at all what he’d said, but by then he was angry that I didn’t immediately discount it as my terrible hearing to begin with.

And he’s right.  He would never, ever have said what I thought I heard.  But when my ears failed to transmit the sound, my brain filled in the gaps.  This is a cognitive compensatory mechanism for those suffering from a deficit in sensory perception.  I tried to explain it, but he’s an engineer.  He doesn’t study in my realm.  He was offended, and I can’t blame him for that anymore than he can blame me for not being able to hear his deeper voice clearly.

misunderstanding

What this situation did was force me to say it out loud as I explained the physiologic process to him.  I had to admit that this cognitive compensation was taking place in my brain at all…and that it highlighted a highly disturbing fact that I’d tried to ignore up until then.

The ability to effectively communicate is critical to nurses.  We’re on the front lines of patient care every day.  We’re the first to speak to patients when they arrive and the last to speak to them when they leave.  They direct their concerns and questions to us.  Auscultation of lung, bowel, and heart sounds are cardinal functions that we must perform.  Although hospitals are moving away from them, verbal orders from physician to nurse still frequently occur on the floor.  We must be able to hear alarms and make out what our coworkers are saying in an inherently noisy environment.  Somebody with hearing impairment would already have noticeable difficulties with any of these tasks without a high ambient noise level.  When it’s present, the effects of hearing loss are magnified.

When communication challenges occur, 82% of nurses report a ‘high to very high’ impact on their ability to work efficiently, and 92% of nurses report that lapses in communication affect patient safety.  Furthermore, The Joint Commission has identified ineffective communication as the single largest cause of sentinel events for the last ten years running.  Sentinel events are situations in which patient harm has occurred but should have been prevented.  They’re the massive fuck-ups of the nursing world, and they often result in tragic, avoidable patient deaths.

Hearing loss is not a condition that’s covered by the Americans with Disabilities Act.  Furthermore, the American Nurses Association has no set policy on how to handle RNs with hearing difficulties.  There is little that can be done for hearing loss from a medical standpoint; hearing aids are just about the only effective therapy, and they present a whole host of different problems in and of themselves.

confused

I find myself very troubled about this all of a sudden.  Surely I’m not the only nursing student who’s ever faced this situation.  17% of people under 40 suffer from mild to moderate hearing loss.  It’s unlikely that none of them ever studied nursing.  But it is concerning that this issue of mine might very well impact a patient’s health one day.  I don’t really know how to internalize that yet.

 

 

Unexpected Firsts

Sad nurse

There comes a time in any student’s education where theory begins to slowly morph into practical application.  Typically that happens around junior year, but it’s an incremental process for most fields of study.  I say ‘most’ because there are some areas where the transition happens all at once.

Nursing is one of those areas.  We spend almost three years learning anatomy, pharmacology, nursing fundamentals and proper health assessment skills.  We even get some hands on time with simulations involving our peers or, if we’re lucky, weird medical mannequins.  But mannequins don’t randomly vomit on your shoes, and they don’t suddenly collapse or swing at you when you try to stand them up.  Other students are (for the most part) perfectly healthy, and they give us the opportunity to assess nothing more than normal baseline values.  These learning exercises present us with the best-case, least complicated scenarios possible.

That’s never how it works in the real world.  Ever.  And that fact becomes quickly apparent the moment a baby nurse sets foot on a hospital floor for the first clinical assignment.

I’m not going to say that I was terrified last Thursday when I walked onto Med/Surg for the first time, but I was certainly nervous.  I was concerned that I was going to be completely steamrolled by an angry family member.  I expected to face situations that I didn’t know how to handle, and I fully anticipated that my assigned nurse might get a little exasperated with me.  I hoped that he or she would be an overflowing fount of nurturing patience, but I knew it wasn’t exceedingly likely or anything.  Still, I counted on most of the flack to be launched from patients…not my preceptor.

Spoiler alert: I was very, very wrong.

When my clinical instructor tried to introduce me to my assigned floor nurse, she practically sprouted horns and growled.  She literally threw her hands up and started shouting.

“What do you mean I have a student today?!  I’m not taking a student.  This is ridiculous.”  She looked pointedly at me and directed her ire in my direction next.  “I can’t babysit a student.  I’ve been a PACU nurse for 18 years and I’m relatively new to this floor.  I don’t want to do this!”

I wanted to sink into my shoes.  Am I that terrible?  Is it so unbearable to let me take vitals and follow her around?  My peers on the same floor had been assigned to nurses with less seniority than a year without complaints.  As she shouted for the charge nurse to come over and back her up, I found myself unable to say a single word.

I wanted to retort that she must have developed her nursing skills in utero instead of following a preceptor like the rest of us mere mortals.  Clearly she never needed clinical experiences, so it’s completely understandable that she had zero empathy towards the already apprehensive and timid first-timer standing before her.  Normally standing up for myself isn’t an issue of mine, but this time?   I let her walk all over me.  We were on her turf, and I was the outsider in the room.

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I ended up getting floated to Respiratory Therapy for the day.  It wasn’t exactly a waste, but it wasn’t what I was there for either.  I got to watch RRTs do things that I will rarely or never do in the hospital setting, and while I was thankful towards them for taking on a misplaced student, it was aggravating to be robbed of a chance to build my skills.  Our clinical opportunities are limited.  Simulations and videos can’t replace the experience of actually caring for a patient.  Nursing education is a full contact sport…and I had essentially been benched.

The age old adage says that nurses eat their young.  I expected to face it sooner or later, but I didn’t think it would be on day 2.  I also never thought I would allow myself to be eaten so easily.

Mark my words: it’ll never happen again.

A Procrastinator’s Guide to Passing with Flying Colors

procrastinate

This one’s for the chronic procrastinators out there.  My people!  Welcome!

When you have six classes and all of them are hard as hell, you’re bound to have some assignments or tasks that you just don’t want to do.  I can never get over that hump.  Maybe my self control is just terrible in comparison to others, but if I sit down and try to force myself through an assignment that I don’t have the desire to complete, I end up half-assing it and hating every minute.  And when I don’t put forth my fabled 90% effort, my grades tend to be lower.

So, what’s a persistent “Meh, I’ll Do It Later” type to do?  How do you manage this type of behavior and still maintain good performance in a high intensity program?  Well, my friends…I’ve found a way.  Despite what every guidance counselor has ever told you, it’s totally possible to be a successful procrastinator.  I’m not saying it’s ideal or anything, but when you’re irreparably stuck in this personality type like I am, you’re forced to work with what you’ve got.


Step 1: Be Organized

Just take my word for it: you cannot pull this kind of study strategy off unless you are hyper organized.  The hang-up is that procrastinators also tend to be woefully helter-skelter too, so you’re going to have to pick one or the other.  Sorry.

The biggiest piece of this puzzle is that you need to know exactly when everything is due.  For you working stiffs, that translates to “you need to know exactly when your deadlines are.”  Get a desk calendar and write everything in bright red Sharpie if you have to.  In order to be a successful procrastinator and push things off until the last minute, you need to know where the last minute actually lives.

Organization goes far deeper than a list of dates, though.  You need to be able to quickly locate your resources and efficiently put them to use.  The invariable Type-A crowd will spend 8 hours on a paper that you can whip out in 1.5 if you really put your mind to it.  You see, they merely adopted stress.  You were born in it.  Molded by it.  You never completed an assignment before midnight until you were already a man.  That kind of frenzied efficiency is a powerful tool to be utilized…but make it easier on yourself by laying your workbench out meticulously in advance.


Step 2: Screw Around Wisely

screwing around

The key to successful procrastination is to have a very clear idea of what you absolutely despise more than anything else.  Do you hate doing laundry more than the fires of Hades?  Maybe mowing the lawn makes you want to punt kittens.  Inevitably you’ll have one class or task that makes you want to scream more than every other activity.  If you’re a student, it’s better if that thing is non-schoolwork related, so dig deep for that chore that you absolutely cannot stand.

For me, it’s cleaning bathrooms and/or doing the dishes.  Man…I hate that shit.  In fact, I hate it so much that I’d rather sit at my desk and do my utterly boring, totally useless Clinical Informatics coursework than stick my hands in a toilet to clean it.  I mean…I’d rather run my hair through a pasta machine than do those things too, and homework is infinitely more pleasant than that scenario.

I’ve found that as long as I can procrastinate something I hate with something I hate moderately less, I’m able to find the motivation to get my stuff done.  Is that self-deception?  Maybe.  Personally, I consider it to be more along the lines of “screwing around wisely.”  But it works for me, so give it a try.  You might find it surprisingly effective.


Step 3: Make Pavlov Proud

Establish a way to reward yourself when you do manage to finish something.  If you don’t feel any sense of accomplishment after you complete a required task, then you’re less likely to move onto the next thing you need to do, and more likely to say “fuck this” and go play Halo 4 instead.

For me, I do this through lists.  If I break every assignment down into teeny tiny parts like so, that means I get to cross things off about every 2.6 milliseconds.  It shows me verifiable evidence of progress, and for some reason I get a sort of gleeful satisfaction from striking through a line item.  Few people are as nerdy as I am, so you’ll probably have to find something else.

Try chocolate.


So there you go.  If you’ve been trying to shake off your procrastinator personality for decades and you’ve never been successfully able to do so, it might be time to just embrace it.  Personally, I think it can make you a ballin’ multitasker if you manage it efficiently.

Try employing these steps and see what it gets you.  And if you have anything to add after you try it, drop me a comment.  I’d love to hear about how it went.

Beware the Rollie Backpacks

On the first day of class in pretty much any course ever, the moment a middle aged woman pulling a wheeled bag walks in I immediately cringe.  Why?  Because I know that she’s going to consume most of the class resources.  She’s going to interrupt the instructor, challenge him or her on stupid points, and generally be a nuisance to the rest of us.  Most egregiously, she’s going to shoehorn lengthy anecdotes from her boring middle class life into the discussion at every possible juncture.

Today, I found myself gritting my teeth as our resident class mommy interjected for the sixteenth time within an hour.  When we got to the twentieth, a scene from my favorite movie came to mind.

Most of the time, how we’d like to react to a situation is completely different than how we’re allowed to react.

Strategies for Studying

Visit allwallpapersfree.blogspot.com

If there’s one thing I’ve learned in my first month as a brand new student nurse, it’s that having an effective study strategy will make a marked difference in the grades you earn on an exam.  I’ve been fortunate enough to pick ones that seem to be working so far, but all of that can change in the blink of an eye.  It seems to me that my classes vary greatly from unit to unit.  I’m still carrying all As in my classes, even after the first round of tests.  So I thought I’d share my thoughts.  Here are the two biggest hurdles I’ve encountered in my program so far and the solutions I found to leap over them.


1. Boil down the information

info overload

There is a ton of information coming at you very quickly in nursing school.  Several of our classes have more than one textbook.  We’re assigned multiple chapters every night, and even worse is the fact that every single tiny little detail seems just as relevant as every single other tiny little detail.  It’s very challenging to pick out the important themes and concepts when every word seems applicable to a hypothetical life-or-death situation.  So, how do you choose?

Solution 1: Limit your space

I found that as I was taking notes alongside my readings, I wasn’t so much summarizing the information as I was just rewriting it.  I didn’t seem to be cutting down on the data at all, and that pretty much killed the whole benefit of studying from my notes.  So instead of typing them into a word document like I’ve been doing (quite successfully!) for over two years, I switched to regular, boring, analog index cards.  The limited space that I had to write on forced me to make better choices on what information I selected.

Solution 2: Focus on the headers

Most textbooks are designed in a way that they’ll focus on one concept at a time.  This gets a little fuzzy in nursing texts, because everything is interrelated with everything else.  The best way to organize these details is to try chunking them together based on the area of the text you found them in.  Focus on the big topics at hand, and flesh out the nitty gritty pieces as you go.


2. Familiarize, don’t memorize

rote memorization

Memorization has its place in study strategies, but the buck stops when you enter upper division nursing curriculum.  There are just too many details.  You won’t be able to successfully cram them all into your skull through your eyeholes.  Trust me: I tried.  Unfortunately, my dear fellow student, you’re going to have to find a different way to digest the plethora of material before you.

Solution 1: Learn the concepts

Every process in the body is dictated by a cause and effect style of balance.  Something pushes the body away from its homeostatic set point, and as a nurse it’s your job to figure out what it is.  For instance, decreased neuromuscular excitability is a symptom of both hyperkalemia and hypokalemia.  How can two polar opposite conditions result in the exact same set of symptoms?  To answer that question, you need to have a firm grasp on what role potassium plays in the body and how an excess or deficit of this electrolyte will affect every system.  If you try to memorize every single symptom of both imbalances, you’re going to have two columns that look almost identical and you’ll have no goddamn idea why.

Solution 2: Let go of perfectionism

Trying to memorize every minute detail of every single paragraph is a total exercise in futility.  Just give up now.  You’re never going to learn it all.  Focus on the big moving parts, absorb as much detail as you can without confusing yourself, and move onto the next objective.  Nursing school requires a shotgun spray approach, not a laser precision approach.  You’ll be much better served by covering large amounts of material in moderate detail than you will by driving yourself crazy with an avalanche of data on one particular subject.


These hard-learned lessons have served me pretty well thus far.  I’m still learning how to study in nursing school, and as I get better at it I’m sure my scores will improve too.  There will be plenty more to add later, but for now, take what little wisdom I’ve accrued and run with it.  We do better as a group when we learn from one another.

The Dreaded Adjustment Period

Exhausted student asleep in library

Everybody I’ve talked to and every online resource I’ve accessed says that the first semester of nursing school is the hardest.  Adjusting to NCLEX style questions is difficult.  Shouldering the coursework is difficult.  Finding time to destress and get a good night’s sleep is difficult.  Balancing work on top of all of this is doubly difficult.

I wish I could tell you that things are going well and that I’m sailing straight through it, but…well.  The fact of the matter is that I’m struggling.

My surgery last week put me a week behind my classmates, and I’m still trying to fight my way through that setback.  My first exam in Pathophysiology this morning did not go well.  The grades haven’t been released yet, but what I spent 15+ hours studying for was not the material that was on the test.  I have a second test in Clinical Calculations tomorrow.  A 90% total average in that course is required to pass onto the next semester in spring.  It’s not difficult work, but having only a 10% margin for error is nerve-wracking.  On top of that, all points come from exams.  There isn’t a single homework assignment to provide a buffer zone between myself and failure.

The program is disorganized.  Our group is the first set of students to undertake the new curriculum and technology initiatives that the College of Nursing recently implemented.  They have all 116 of us in one room for the first time, every exam is taken on a laptop in the same room we’re lectured in, and yet there are always technical difficulties accessing the content we need or the test we’re to take.  In four weeks, there has yet to be a single day that’s gone completely smoothly or without major incident.  Addressing these issues in a room with over a hundred people is chaotic and eats up a ton of time.  This pushes back the test.  Which pushes back the lecture.  Which reduces the amount of material we actually cover in class…but not what we’re responsible to learn.

incoherent rage

I knew that the transition period would be rough, but what we’re going through as a class seems perhaps worse than what other students face in other programs.  There’s a lot of negative chatter among us, and about six have already dropped.  More than once now I’ve found myself considering joining them and majoring in something else.  If I weren’t already over $10,000 in debt from my coursework thus far, I might have actually done it by now.  But switching tracks will cost more.  More money, more time, more wasted effort.  As crazy as it sounds, pounding my head against this wall feels like the path of least resistance.

This post really has no meaning other than to say I’m tired.  I’m so tired.  And I’m not sure that it’s going to get better any time soon.

A Series of Un/Fortunate Events

hospitallizedsmall

Yes, that’s me.  Yes, that’s me in a hospital bed.  No, it was not related to anything education based.  I was actually hospitalized for two days last week.  Don’t let to picture fool you, I was completely miserable, but my mother was freaking out and I had to stop her from hopping in the car and speeding down here like a bat out of hell.  I make it look so effortless, don’t I?

So.  What happened?  Well….

Friday

I got up for work and left on time as usual.  Ended up getting assigned  to the phones since one of the operators was out for the day.  It’s not my favorite position, but I don’t really mind it either.

About 9:00, I noticed a pain right around my navel.  It felt like an ulcer actually.  I was afraid I’d given myself some sort of gastric lesion by stressing out over class.  I threw my drink out and switched to water, but it didn’t help.  After hearing me complain about it for a few hours, one of my coworkers gave me a gas pill and sent me to lunch early.  The gas pill didn’t help, but the pain did move to my lower abdominal quadrants after lunch, so I figured it was just indigestion.  Despite the fact that the pain was getting worse, I just grumbled about it and finished my shift.  They were already shorthanded, and frankly, I needed the cash.

It started to feel better about the time I got off, so I had Michael pick me up for our usual Friday Night Blue Pants Brewery tradition.  There was some plan to knock whatever it was loose with good pizza and beer.  Two drinks later, and it was none the better.  We came home shortly afterwards since I was feeling puny again.  I went to bed early.

Saturday

I woke up about 4 in the morning in some pretty radical pain.  Michael set up the heating pad for me, and that seemed to help.  I drifted back to sleep for awhile, but it was short lived.  By 6, I was up again and this time I proved that it wasn’t anything in my gut through a bathroom visit.  The pain had migrated down into my bottom right quadrant.  Death was looking like a pretty okay alternative to dealing with the pain by that point.  I decided to let Michael sleep until 8 and then we’d head towards something medical flavored.  I had a pretty good idea of what I was dealing with at that point anyway.

My UAH student insurance isn’t exactly the most comprehensive form of coverage available, though.  I didn’t want to head to the ER with just a self-diagnosis.  I had Mike take me to the Chase Urgent Care facility, and while we were waiting for them to open I almost threw up on his shoes.  I didn’t though, because I’m a champion.  Actually, I was just really worried it would make the pain worse, so I held it back with a hitherto-unknown source of sheer stubborn self control.

The doctor took one look at me, tapped me on the abdomen a few times, and then instructed me to stand up on my toes and come down hard on my heels.  He asked me where it hurt, and I pointed to a spot just above my right hip bone.  He didn’t even look at me, but instead turned to Michael.

“You need to take her to the emergency room right now.  I think she has appendicitis.”

On one hand, I was happy that my first medical diagnoses as a nursing student was correct.  But I was equally sad that my diagnoses was correct about myself.  Sigh.

So, off we went.

I signed in at the ER, and they pulled me back for triage pretty immediately.  I must have looked like death warmed over.  In triage, I told them that the Urgent Care had sent me there to rule out appendicitis.  The triage CRNP looked at me twice, asked me to lift my right leg and asked me if it hurt, and then sent me back out into the lobby.  My ass barely made it to the chair when they were calling me back to a room, skipping about 20 people in the lobby.

Sorry guys.

Once they got my peripheral IV started and got a bolus of morphine in me, everything started to feel a lot more manageable.  I could breathe normally, and more importantly, I could converse with people without that tight urgency in my voice.  And most importantly, once the pain was in check, I was able to look around and think to myself something that nobody else in the history of medical emergencies has ever thought before:

“Hey, this is pretty cool!”

Michael blinked.  Apparently I said it out loud instead of thinking it.

When I told the ER nurse I was a student nurse, she opened right up, spoke to me like a peer, and even gave me some tips for passing the NCLEX. She talked me through everything she was doing and how I could get the most experience out of my clinical rotations in the ER.  She gave me the run-down of some evidence based practice changes they were putting into effect in the ED in regards to myocardial infarctions (heart attacks).  A couple other RNs stopped by and gave me their two cents about what they enjoyed most about nursing and how to be successful as well.

My surgeon was really a stand-up guy, too. I guess one of the nurses told him I wanted to work in the OR after graduation, so he pulled out his phone and showed me some pictures he’d taken from the last surgery he’d just completed a couple hours ago. Even offered to let me shadow him in the OR when I’m recovered, which has me extremely hyped.  I really hope he keeps that offer open.

When they wheeled me into the OR, the nurses in there were class acts.  I was totally mystified by the sarcastic, relaxed, competent atmosphere that surrounded each and every one of them.  I asked the guy closest to me if he enjoys OR nursing, and he laughed.

“Yeah, it’s a whole different ballgame here in the OR.  I like the fact that I get to spend my full attention on just one patient.  Gotta deal with some pretty strong personalities in the OR, though.  As long as you’re fine with that, I think you’ll love it.”

A female nurse from the back of the room laughed and chimed in.

“Strong personalities, huh Jason?  You obviously don’t have one of those.”  He laughed, shook his head, and placed a mask over my face.  That’s the last thing I remember.

________________________________________________________

I had a really great experience, actually.  Although I wasn’t really planning on having an emergency appendectomy this weekend, I’m pretty happy that I got to experience what I did.  It has completely solidified to me that I do definitely want to work in the OR after I graduate.  And all it cost me was an appendix and a few weeks of having some sore incision sites. Of course, the actual process of having appendicitis was pretty miserable. I’ve never felt so nauseous, hot/cold, hurty, and light-headed in my life.

But, I’d say the rest of it was pretty rad!

Second Week Recap

Well, it’s been two full weeks of nursing school now. I think that I can draw some early conclusions.

Number one.

The material is challenging, sure, but it’s not absolutely impossible or anything. It’s just a time sink more than anything else. For some reason I just have a head for this stuff. It could take me months to learn something in statistics, but if it’s related to biology or physiology even remotely, I’m just a sponge for information. Let’s hope that this trend holds true throughout my tenure in the program.

Number two.

We’re the first class of students who are fully transitioning to the new curriculum, and it’s showing. None of the professors really seem to have a handle of the new online portal. I’m a bit concerned about that, but there’s really not much that we can do about it.

Number three.

Working while going to school is going to be a complete bitch. There’s just so much material to cover.

And finally my biggest takeaway, number 4.

I can do this. Suddenly I feel confident enough to be able to say that.

It’ll be difficult. I knew that going in. There will be times that I want to quit, but I’ve made friends with a great group of people. We’re diverse, and our strengths are in different areas. I really think that we’re going to be able to pull each other through.

Our instructor told us to take an index card and write our names, followed by the letters ‘BSN RN.’ She said that sometimes looking at it will be the only thing that gives us the motivation to make it through the another chapter’s worth of reading. I put mine where I can’t avoid seeing it.

And honestly? It looks pretty damn good.

Negative Nancy Neutralizes the Attitude

ready

When I first started on this journey two and half years ago, I imagined that I would relish the task of sewing my UAH patch onto my scrubs. It was supposed to be this momentous occasion, a meaningful road marker of the progress I’d made, and something to be proud of.

In reality, I cussed a bunch, managed to break the thread twice, and at one point considered taking the whole kit and kaboodle to a seamstress so I wouldn’t have to deal with it.

That’s the beauty of starting out on adventures, though. What you’d envisioned and what you end up with are usually two completely different experiences. Sometimes the two line up, but…well, most of the time they don’t. I wouldn’t change anything that’s happened in the last two years, even the things that were difficult, off-track, or outright embarrassing. These experiences have led me here. Frankly, I’m pretty happy with where I’m sitting at this point in time.

When I think about stuff this way, it also makes me realize that I’ve been really needlessly pessimistic about starting upper division. That’s not to say that my concerns were unfounded, just that they were perhaps a smidge overly negative. Or a smudge. Midge? Actually, it was more like, um…a smidgegeddon?

Whatever. You get the idea.

Even though this is going to be a really challenging program, I should still be excited about it. Enthusiasm should be oozing from my pores. Two years ago I was denied entry into the university, and now I’m enrolled in their nursing honors college with two hefty scholarships. That’s a pretty incredible turnaround. And the really interesting stuff is now sitting right in front of me. No more boring arts electives! I get to hang IVs and dress wounds and read EKGs!

So I’m going to be excited, damnit. I’m pumped! I’m so pumped, I’ve never even been this pumped! Let’s do this!

Well…I can fake it until I feel it for real anyway. At the very least I can stop being a whiny bitch about finally getting everything I’ve worked for.

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