Likelier

I'm writing 4 and a half months into my job as a pediatric nurse. I've conquered some steps of likely RN-ing: I passed the NCLEX in August (truly horrific, nasty exam but, apparently, passable), began work in September and finished my nursing orientation last week. I've also claimed some personal developments: Daniel and I are getting married in June and we got a dog, "Belly," the best dog in the world.

I'm still learning. I still make mistakes. Most of these mistakes would have been sort of cute in nursing school (Oh, look, I forgot to clamp my patient's PICC line, blood is oozing all over the sheets) are now just evidence of idiocy. Some patient's don't like me. I've only had one stuffed animal named after me (some nurses boast dozens of christenings). But things are mostly wonderful: I do truly love working with children and, better yet, sending them home. It's also immensely satisfying to see kids getting better (our patient's in DKA (diabetic ketoacidosis) can perk up over the course of a single shift). I like my co-workers, I like being autonomous, I like now knowing what my day will be like.

Nursing is a very strange profession: we're expected to teach families complicated home health care tasks and be able to pick up on the slightest changes in a child's condition but it's also my job to change my patient's sheets or to make sure my patient has the right size of diapers. Are there other professions like this? I honestly don't know.

The very good news is that I love my unit: endocrinology and neurology/neurosurgery are very clean, precise specialties with often certain outcomes (except the brain tumors, I hate the brain tumors). And I'm learning a ton. I definitely want to soak up as much nursing knowledge as I can and try my best to consider the nature of the profession so that I can begin to look at the bigger picture.

Finis!

I graduated this morning and am now officially a "graduate nurse" (the "RN" only comes after passing the NCLEX). The graduation itself was lovely and so much more meaningful than the average graduation since it was only my 120 classmates and I. I am also the very proud recipient of the Edna Schoen prize for "excellence in clinical nursing." The prize was a total surprise and I was so pleased. I was flattered to be noticed for my nursing strengths (v. academic ones).

I had to say "good-bye" to my friends at the reception following graduation as Daniel and I are leaving to go back to Chicago tomorrow morning. Maybe I would have made it through the year without these friends but I don't think I'd have been half as happy or half as un-anxious without them.

PS: I lied about this being my last post - I'll write something a bit more conclusive when I'm back in Chicago and have been able to catch my breath and my thoughts.

Dictation

The Unlikely RN is dictating this post to her handsome boyfriend, who is NOT editorializing as he is dictated to. The post is being dictated because the Unlikely RN is trying to pack up 13.5 months worth accumulated nursing school junk, which includes 22 hardcover nursing text books, totalling about 200lbs and a cool grand.

My last couple of shifts on the floor went very well. My primary preceptor was on vacation, so I worked with a different preceptor each day. This was a little nervous-making as everybody likes things done their own way (so much for standardization of healthcare). But it was obviously a great way to draw from different people's experiences.

As mentioned ad nauseum, my final hurdle is to write the licensing exam (the NCLEX), so Kathy and I have been doing practice questions. The questions run the gamut from depressingly obvious (I spent a year learning this?) to tear-producing difficulty (I only had a year to learn this?) to willfully obtuse. An example of the first would be something like:

1) A patient discloses their intention to commit suicide to the nurse and says that he has a handgun at home. The nurse's most therapeutic response would be:
a) "Please promise me to go home and throw away the gun."
b) "Doesn't your family love you?"
c) "What type of gun?"
d) "I am really concerned about you. We need to admit you to the hospital."

I'm not even going to bother telling you that the right answer is c).

An example of the second type (tear-producing difficulty):

2) Aluminum hydroxide gel (Amphogel) is prescribed for the client with chronic renal failure to take at home. Why will this patient receive this drug?
a) To relieve the pain of gastric hyperacidity.
b) To prevent curling's stress ulcers.
c) To bind phosphate in the intestine.
d) To reverse metabolic acidosis.

Amphogel? I have no idea what it is. Do we bathe in it? Do we stick it up our butts? Do we suck it down like so much Pepto-bismal? And what in god's name does it have to do with curling? These are things I do not know. Things are things I have never known. These are things I will not know when I am in a sweaty cubicle trying to write this damned exam in several weeks. As it happens (and this does make sense) Amphogel is used to help eliminate excess phosphorous. And it turns out that you drink it. I would like to see the compliance rates for this drug (Mmmm...yummy gel).

The worst sort of question is the one that makes no sense at all. For example:

3) A 30 year old patient is experiencing a spontaneous abortion (miscarriage) at 8 weeks. What do you expect the patient's primary emotion to be:
a) Anxiety
b) Guilt
c) Fear
d) Ambivilence

One thing nursing school did not teach me and, in fact, taught me NOT to do was to presume a patient's reactions to a difficult situation. I would be frightened if baby-parts were coming out of me; I would be anxious about my ability to conceive again; I would be guilty because maybe I did something to cause the miscarriage; and, depending on the circumstances, I might feel quite ambivilent, since I might not have wanted the baby in the first place. The answer is guilt.

So this is what I'm struggling with. To prepare me for questions like the last one, the Illinois liscensing board has been kind enough to make the application process an absurdist's wet dream: a charming combination of Ionesco, Beckett and the flippin' urinal on the gallery wall. It keeps me awake at night.

So all this brings me to this Friday when I graduate, which signals the end of both nursing school and the Unlikely RN. I think it's inaupicious to go into nursing with the epithet "Unlikely" and I plan to go about becoming a likely RN offline.

I'll be back on Friday for one last post. See you then. And boy my boyfriend is handsome.

2 Things

Thing That Made Me Cry Happy:

There is a contingent of clowns that visit the Children's Center during the weekdays. They are specially trained Big Apple Circus "hospital clowns" that are meant to delight and amuse inpatient children. Working on an adolescent unit, I haven't seen these clowns once. Clearly, their training lets them know that their act would not be a hit on the floor. However, they came by the other day and asked if there was any one who could use a clown. I was taking care of a severely disabled teen-aged child (cerebral palsy with mental retardation) with a developmental level of 6 months or so. I had told them to come in an see this patient who can use all the stimulation she could get. The clowns came in a did a little song and dance and then blew bubbles popped them on the child's hands. The patient broke out into a huge grin, showing a dimple I hadn't seen before. The kid was so happy her whole body shook. I cried, the clowns cried, everybody to whom I've told the story has cried.

Thing That Made My Cry Sad:

It is a sad thing but I can no longer eat pudding, or at least vanilla pudding for the rest of my life. I had two patients yesterday who vomited the vanilla pudding that originally appeared on the lunch tray (the problem was clearly in the pudding). I was present for both "episodes of emesis" and one episode came dangerously close to my own pudding hole. It was an awful smell (sickly sweet) and I showered the moment I got home. The thing is, I really liked vanilla pudding.

A Couple More Things:
- Thanks for people's NCLEX advice - I can use all the advice I can get
- 15 down, 3 to go
- Last night was the first time I slept more than 5 hours straight in the last 14 days

Circadian Arrythmia

I missed my shift on Monday night due to what's turning out to be a very nasty chest cold and the fact that I looked so sick I wouldn't want me coming within 3 feet of me. Well...that's actually impossible but you get my point.

So instead I'm trying to prepare to work three day shifts over the coming 4 days. As I've mentioned, it is so hard to go back to being awake during the day. Not even NyQuil (big "N", small "y", big "Q") and some Sleepy Time tea let me get any sleep last night. So I'm hoping exhaustion gives me some uninterrupted sleep tonight. You think my body would by dying for some sleep without ear plugs and a pillow squished over my eyes to mimic darkness.

But enough whining about my schedule. Let's whine about the NCLEX! The NCLEX is the national licensing examination I'll have to take before I begin my job in September. It is a test of "minimal competency." The good news is, then, that the test can't possibly be THAT hard if it's only showing you're not a complete nurse moron. On the other hand, how devastating would it be if you didn't pass it? I'm doing my best to start studying but it might have to wait until after graduation (in a mere 16 days!).

12 down, 6 to go & 8 notes

I have six shifts left and I worked 4 of the past 5 days. All night shifts. And I'm tired. And physically sick. My lymph nodes resemble Volkswagons. But it's not that bad. Honest! I'm still enjoying the work and have had all sort of positive and negative experiences but even the bad ones have been worth it.

Several notes:
1. Teenagers can be real a-holes (again, I work on an adolescent-only unit). The full-out 100% lippy a-holes are fine and I can cope with them. The ones who are manipulative and whiny and boss their parents and nurses around make me want to throttle them. This is a worst-case patient scenario because you not only have an undesirable patient but you also have a cranky and pissed off family looking for someone other than their sick child to get angry at (hello student nurse!).

2. I have found the caregivers of my severely mentally and physically disabled patients to be shockingly caring, patient and good-humored.

3. I have tried to demonstrate initiative and sticktoitiveness becoming of a nursing student by offering to help the other nurses on the floor. This means I change 3-5 diapers a night. Remember, these are adolescent diapers.

4. I suctioned my first tracheostomy patient and it was not terrible. It was actually sort of satisfying to get all of the mucous out of the trache so that the patient could breathe easier.

5. I continue to be master of the urethra and successfully catheterized a young woman on the first try.

6. While the other nurses are scornful of the new residents who started on July 1st, it was wonderful for me because all of a sudden there was a crop of physicians who were pleasant and willing to answer my questions.

7. I am showing progress towards being a "likely" RN.

And one more thing:

8. I got a card from a patient thanking me for my "compassion" and "making [their] family's stay easier." Yeah, I cried.

Singapore

I had a relatively long break from my placement (4 days) and go back tonight. It was pretty much impossible to re-adjust to sleeping during the night during this break. It was like going abroad and being jet lagged. However, I've never been more than 6 hours away from my home time zone and this time I'm 12 hours away. It's like the 5 blocks to the hospital has turned into a 14-hour flight to Singapore.

Of course, my friend Erin is actually doing her placement in Singapore so she technically could experience no jet lag at all. However, seeing as she might have travelled to Singapore to do something other than sleep during the day, I imagine it's been pretty tough. Also, they do 13 hour shifts on her floor! However, they also encourage their nurses to take a wee nap over the course of the night. I can't wait to hear how her experience has been so far. Hey Erin - wouldn't it be great if you could write a guest post? Wouldn't it?

At the end of my last entry, someone commented that they think it's all right for me to talk about patients. I'm not so sure. On a legal, privacy standpoint I'd be fine as I never reveal too much information about anyone. However, it wouldn't take brain surgeon (or even a mildly delayed child) to figure out where I go to school. Also, I try to put myself in a patient or parent's place: would I be happy if the nursing student who took care of me or my child today ran home and wrote about the experience so that hundreds of people could read about it? Probably not.

But it's a shame. Patients and their stories are more entertaining and/or tragic than anything I could come up with.