4th Semester - Am I really almost done?

I didn't even attempt to try to post the beginning of this semester. 5 day a week, 8-4 classes or 4 day a week clinicals which ran from 3-11 pm dominated my calendar. Throw in an occasional NA shift on my cardiac floor and you get the picture.

Now we are only 4 weeks from finishing up the school work (but don't graduate until the end of May- WTF) and I can breath and start looking back. I still have a lot of work to get done, plus I am in the middle of my Senior Partnership (that's a whole 'nother blog in itself).

The best news of all is that the Husband unit has started his pre-req's for the program. He is right now enjoying (hah) the pleasures of A&P and American History. After seeing what he has to do, learning how to put a rectal tube in seems much more interesting.

Dormancy

This blog has been in a dormant state since last October. Can't decide if I will pick it up again or let it go - 4th semester is a wild ride. Stay Tuned.

Getting My Ass Kicked

This semester is just kicking my ass. I'm doing well, but it is a daily struggle to motivate myself to do the work that I need to do.

I spent 4 weeks in the newborn nursery, a week in a pediatricians office, a week at a our local "Big University Hospital" children's clinic and a week so far in postpartum. The only thing that has even remotely been interesting was the one day I observed in the pediatric cardiac cath lab. I loved that experience and realized that all cath lab teams consist of the coolest people in medicine.

Muriel continues to be a source of frustration and amusement. I really like the other lecturer we have (I spent 5 weeks of the semester in clinical with her) and will get a majority of the semester now that we are transitioning to pediatrics.

I wish I had funny stories to tell, but truthfully a lot of this is just mind numbing dull to me. Everyone is healthy and no real psychosocial problems to deal with in clinical. I miss dealing with disease processes.

I'm working once a week as an NA on the floor I spent the summer. Normally I get an assignment of 14-16 people, 4 of which are total care and and 10 need blood sugar checks, and at least one insulin drip so that I have to check their blood sugar once an hour, not to mention that at least 3 of the 4 totals are on contact isolation. Yesterday, I got the easy assignment of 14 people, 8 BS checks, one drip and no one on isolation. Someone else on the floor got my typical assignment. I felt like I had the day off.

Like there was any question?

35 As a 1930s wife, I am Poor Take the test!

A another thought on circumcision

Thanks to whoever sent the link to the article in the comments under "Le Circ". Being a nurse means being an advocate for your patient and the article goes into detail of how nurses at a hospital in NM went the full distance trying to educate their patients. In their case, their jobs were endangered due to this effort.

This last week I changed a diaper on a newborn who just had a circ, so this meant I had to take off the Vaseline gauze used and replace it. It broke my heart to have to cause that infant so much pain in doing my job. Being a nurse means that sometimes you have to do things to people that hurt, but it is for their own good. I couldn't even justify it this time.

At some point in class we will be debating on circ's and if they are necessary. I know that I will be on the side of "unnecessary" because to me it is just genital mutilation.

A New Dr. Seuss Book

We are studying the different phases of birth. The other day we got to the transition phase and Muriel demonstrated the breathing technique she wants to utilize.

She called it, Three Hoo's and a Hee.

I call it the newest Dr. Seuss Book.

Le Circ

No, it's not a fancy restaurant. It's a circumcision. I found out last week that they call circumcisions "circs".

I saw a total of 4 of them in two days. The first day there was only 1 and the doctor used something called a Gomco Clamp, as seen below.

The next day a different MD did the procedure on three babies and she used something called a Mogen Clamp.
If you asked me a week ago what I thought about circumcision, I would have been very casual about it and would have said "What's the big deal?" I have a different opinion about it now. I still think it is up to the parents, but I don't think it is something I would choose for my child.

Why do I say that? Because of the look on my face while I watched it being done. My jaw was down to my knees and my eyes were wide open. My instructor just about peed herself and said she wished she had a camera. I'm not surprised, since that's normally how I look in the OR, but people can't see it because of the mask.

Just so you think it isn't completely barbaric, they numb the baby with lidocaine. Plus, to keep the kid distracted they use a concentrated sugar water called "Tootsweet" which is put on a finger and given to the child like a pacifier. Everyone in my group, except me, was scrambling to give the sugar water. I was thrilled because I got to put on sterile gloves and prep the instruments for each procedure. Naturally, that was the highlight of my week.

One week of clinical down

I survived the first week of clinical in the newborn nursery. I'm so completely out of my element it is funny sometimes.

I haven't changed a diaper in over 10 years, so I had to be talked through it again. It's funny, I can put a diaper on a 190 lb man, but a 7 lb baby seems more complex.

I am also the world's worst swaddler. One good sneeze and the kid would be exposed to the world. My instructor said something to the effect of, "Well, just wrap him like a burrito. You know how to do that don't you?" I looked straight at her and stated, "My husband makes the burritos because I can't wrap them." She just smiled, shook her head and walked away.

This semester is a mess.

We have an instructor that I don't mind, but is a little daft at times. Muriel seems like she is 4'8" (not really, but seems like it), not too worried about using the correct terms (like using semesters instead of trimesters), and is as blind as a bat. BUT, she can be as funny as shit, intentionally and unintentionally.

The unintentional: A friend of mine volunteered to assist her in front of the class in a demonstration. Muriel spent the rest of the class calling her by my name.

The intentional: "Don't fix separate foods for your toddlers just because they are picky eaters. My mother-in-law did that it and it took years to train my husband."

Don't confuse her with the facts. Everything needs to be Muriel's way, even if it contradicts the book and other literature.

It's going to be an interesting semester.

How did we ever survive

According to the lectures I had this week, myself and countless others should be incredibly brain damaged. This is because mothers* of my age group did the following:

• Smoked while pregnant and after hatching
• Drank while pregnant and after hatching
  
• Drank Coffee, Tea, Coke, Pepsi, Tab
  
• Bottle Fed

Throw in the fact that I probably ate some lead paint along the way and it is a wonder I don't need a telethon.


* I'm not implying my mother or your mother did any of the following... I'm just saying.

The strangest Beanie Baby ever created

We learned about breastfeeding this week, so our instructor brought in a (I giggle at the word) manipulative. It looked like a Beanie Baby.

All Men are Preschoolers

I don't like to make general statements like the one in the title, but I think it is appropriate based on two things I learned in lecture.

1. Preschoolers want things how they want them. End of story.
2. Preschoolers are proud of their penises. Enough said.

Adult Temper Tantrum

My last day of my externship was a very interesting one. When the 42 year old in chronic afib who refuses to take his Coumadin because it is "rat poison" (no shit Sherlock) is the least interesting of your patients, then it has been an interesting day.

One patient we had was a woman in her early 50's who was released one morning and came back later the next day for the same kind of pain she had been told was not a heart attack and that Ibuprofen would relieve. So naturally, the MD told her that she would be weaned off of morphine and that she would not get any Phenergan at all, but if she actually threw up she would get Zofran. Soccer Nurse and I stood outside her door and heard the MD explain all of this to her, then the MD came out and discussed everything with us, especially her drug seeking behavior and not to call him for any additional morphine because she wasn't going to get it from him. We smiled and said it wasn't a problem.

The next four hours were filled her calling for "something for her stomach." Naturally, she didn't get anything because she didn't throw up. So lunch time rolls around and we get another call from her. We walk in and on the floor there are peas and potatoes scattered all over.

Soccer Nurse asked what she needed and she said my favorite quote of the summer," I throwed up." Soccer Nurse walked gingerly through the minefield of peas and potatoes and asked where she threw up. She pointed at the floor and said as if we were dumbasses, "I throwed up there on the floor."

It was obvious that this woman took her spoon and threw food from her lunch tray onto the floor. Soccer Nurse pointed out that there was no way that could have been in her stomach because it was intact and no stomach fluids were seen. I think he threw in a comment about doubting she swallowed her food whole without chewing, but I may be making that part up.

I loved working with Soccer Nurse for so many reasons and his lecture to her about her behavior was priceless. He made it clear that what she did wasn't acceptable, nor was he fooled by her claims, so no, she wasn't getting any Zofran. He also pointed out she created a safety hazard with the food on the floor and now he had to call someone to clean it up. He was calm, professional and stern. It was FABULOUS! I on the other hand stood there with my eyes wide open trying not to say, "WTF do you think you are doing? If you are going to drug seek, don't do it for Zofran."

It was my first and not last Adult Temper Tantrum.

"Knee-Deep"

First Day

Lecture Topic: Pediatric Assessment

Subtopic: Genital Assessment

Suggestion: Have naked child sit like a frog in order to assess genitals

Conclusion by fellow student: Sign me up as a sex offender just by hearing the suggestion

Smart Ass Comment by my Husband: "So she is asking the kid to go 'Knee-Deep?'"

And so it begins again...

Last Thursday was our big orientation day. Compared to our other orientation days, it was a walk in the park. In fact, I don't understand why we even had to show up since we could have had one big conference call in our PJ's and it would have been more productive.

This semester is going to be the necessary evil for me. I have to have the material in order to take the NCLEX, but I don't give a rats ass about it. HOWEVER, a majority of my classmates are salivating at the thought of everything we get to do this semester. Either they want to work Labor and Misery (I mean delivery) or do some type of pediatrics.

I spend the first 4 weeks of clinicals in the newborn nursery. Most people in my class would be thrilled because they get to hold babies, I'm not one of them. I think the biggest adjustment I will have to make is working with people who are healthy and I can drop.

I already miss my dirty old men.

FOS

FOS = Full of Shit

It's a real life nursing diagnosis. You get this label if you come into the hospital complaining of chest pain, but really you are just constipated.

I was surprised this summer that we averaged at least one FOS per week.

So what happens to you if you are an FOS patient. The following are included in your stay:
Chest X-ray
Cardiac Monitoring
Nuclear Stress Test
Cardiac Enzymes
Colace

Now please choose at least two from the following menu:
Cardiac Echo
Abdominal Echo
Abdominal CT - getting to drink that yummy Crystal Light flavored contrast
Abdominal X-Ray
Additional Blood Work

Depending on the results will get you any one or more of the following:

Mild
Glycerin Suppository

Moderate
Fleets Enema

Industrial Strength
SMOG Enema
Manual disimpaction by a really pissed off nurse*

Luckily no one required the Industrial Strength this summer.

*Why a pissed off nurse? Because no one I met this summer would have been happy to stick their finger up someone "who could have avoided this by eating fiber" rectum.

McDonald's All-American

This summer I joined a gym in order to help lose weight and avoid being one of the people that I have seen in the hospital this summer.

I knew that I had sit through a sales pitch at the gym, but what I didn't expect was the sales guy wanting me to listen to his "story."

So picture it, I'm sitting in this cramped office in this gym while this fairly in shape guy leans in closer to tell me his story of woe.

He starts off by saying that he's had a tough journey on the roaid to fitness and he started it by saying he was a McDonald's All American.

Keep in mind - I think he is about to tell me something like "I was 400 lbs and was about to die because I was being smothered by my own weight."

So when he said McDonald's All American - I thought he meant that he ate a lot of McDonald's. So I naturally started laughing.

He was offended and asked me what I was laughing at - so I told him that I thought he ate a lot of McDonald's. After he wiped the "I've got a crazy white girl in my office" look from his face, he laughed and explained to me what the hell a McDonald's All American meant.

He made the sale, but I avoid him like a Big Mac when I am in there.

Dirty Old Man

This summer Soccer Nurse (my preceptor) and I had a client that was a self described "dirty old man." I didn't give to much credence to his claims, because to me he really wasn't that outrageous. He did give me one of my favorite quotes of the summer. He felt that his manhood was a bit lacking, so he told me "One inch shorter and I'd be a lesbian."

Crackhead Calendar

Dear Crackhead,

If you smoke crack, it will constrict your blood vessels, which may induce chest pain. If we ask you, "When was the last time you smoked crack?" don't answer "a while." "A while" to most people may mean something like 3-4 months ago, not 30 minutes.

Thank you

CathyXIs, Student Nurse

Standing up for the "Little Guy"

Oh CNN how I love you this morning. You brought me a newstory that warms my heart and renews my faith in my own ability to sniff out bullshit.

I have never trusted John Edwards. From the moment he bought the Senate primary election in NC I knew that he was the epitome of a politician, someone only looking out for his own interests. He is the man that repeatedly told the voters of NC that he wasn't interested in running for President, he wanted to serve his constituents, and then he turned around and ran for president. He's the man that told his presidential supporters that he wouldn't accept a place on the ticket with John Kerry, and then he took it. He is the man that told the laid off workers of Pillowtex in Kannapolis that he would help them in anyway he could, but failed to mention that his vote in Congress to establish free trade relations with China may have been a rung in the ladder that led to their situation.

Now he has admitted to an affair back in 2006.

The article mentions that he "had campaigned on the message that he was standing up for the little guy" I think we now know which little guy was standing up.

The Summer is Over

I haven't been that motivated to write lately. Call it enjoying the summer, being too tired, not giving a shit, what have you.

It is probably better that I've let my summer stories simmer a while. I can write them with a little perspective and hopefully humor.

I finished my PNA program a couple of days ago. I had an AWESOME experience. I give full credit to my preceptor, Soccer Nurse (he coaches his son's soccer team). Not only is he a great time manager, nurse and human being... he also homebrews.

That's one bony elbow

CNN is carrying a story about a flight attendant who was assaulted by a passenger over liquid on an armrest. The flight attendant is suing the assaulter, who happens to be the wife of a preacher of one of these mega-churches.

The flight attendant says "she suffers from anxiety and hemorrhoids because of the incident"... she got elbowed by a mega-church soccer mom, where the hell did she hit her that hemorrhoids were a complication?

Eat some damn fiber and ya'll grow the hell up.

Finally in the Groove

It has taken several weeks for me to finally feel like I have a clue about what I am doing on the floor.

My preceptor is awesome. He is funny, organized, laid back and doesn't sit around complaining all the time about how awful the hospital/floor/money/job is.

Nothing terribly exciting has happened so far and based on what I have seen, I don't anticipate anything really dramatic. It is a good slice of what floor nursing is like.

Since I am on a cardiac floor, the RN's do their own vital signs, especially manual BP's. I will walk out of this experience a Vital Sign Diva. I've done a lot more teaching than I thought I would get to do. It is amazing how much repetition is needed for some people.

There are other people from my school on different floors doing externships. Based on what their stories are, I am extremely fortunate to have my floor and preceptor. I am learning a lot and not just a gopher.

Looking into My Crystal Ball for my Nursing Future

Every clinical week we have a post clinical conference (PCC) where our clinical group sits around talking about our experiences. A few weeks ago I was in the OR, so I had instructor Y (as in Why oh Why does she want me to feel like an incompetent ass) lead our PCC. One of her topics was to talk about the areas where we have interest.

Before this discussion I've made it quite well known that I am interested in Critical Care, especially Coronary Critical Care. After instructor Y made me feel like Jerry Lewis in the PACU, I began to question if that is the best place for me. But, after a few weeks of looking back on the experience and realizing that it wasn't a true test of my abilities, since I still AM IN SCHOOL, I will cut myself some slack and go forward with the plan to be ultimately a CCU nurse.

My summer externship will play an important part of my decision making when I get the chance to see first hand what cardiac nurses do and if it suits my personality.

Side note: Instructor Y has made it very clear that she doesn't like cardiac and considering how polar opposite we are in many aspects, I take it as a good sign that I will like it.

Matters of the Heart

I got a call yesterday offering me a summer PNA (Professional Nursing Assistant) externship in cardiology. This means I will be spending my summer on the telemetry floor being a nursing assistant, but also being mentored by one specific nurse on that floor. I will work their hours and be their NA.

Cardiac medicine was my first choice because I am interested in it post graduation and figured this was a great way to find out if I really wanted to do it. Plus, it is one of the major reasons why I got into nursing in the first place. When my dad had his aortic valve replacement/CABG (coronary artery bypass graft) a few years back he spend some time in the CCU of his hospital. He had an AWESOME nurse named Pauline who took care of him for the two days he was in there. I looked at what she did and how she did it and thought, "Self, you could totally do this." Plus, I loved how she took care of my dad and took care of me by telling me what I could do for him and explained everything that was hooked to him. I thought she was a goddess when Dad was ready to be extubated and it was taking respiratory forever to come and do it. She shooed Mom and I out of the room and did it. Now I know that it was within her scope of practice, but to me it meant a lot for Dad not to have to be intubated for another 1/2 hour while we waited for RT.

I can't wait. Now where did I put my NA study manual??? I'm scheduled to take the test the day after my school final - great timing. But at least I will get a week off before starting the program.

Group Project Theater

Every semester we are assigned at least two group projects to submit to our instructors. Last semester and this one seem to have a theme... you have 1 case study and 1 project with a different theme, but that is geared towards the elderly (last semester it was prescription drugs, this semester it is nutrition).

So last night I finished the elderly nutrition project (I already completed the case study) and there was much rejoicing in the house. I HATE HATE HATE HATE HATE group projects. Our instructors say we do these things in groups "to help us learn to work as a team together" but I think it is so they only have to grade 6-7 projects and not 35.

Here's the type of exchange I wish would take place so that I knew ahead of time who would do their work and who would expect me to do their work for them.

Student Nurse Theater

Me, "OK, so I will do the 15 page patho on Acrocephalosyndactylia, Student Nurse Alpha agrees do the write up on the nursing process and Student Nurse Beta will come up with a teaching plan based on the nursing process. Let's plan to have this done a week ahead of time to give ourselves some breathing room."

Student Nurse Alpha, " OK, I will promise to do my section, but in reality I am going to ignore it for the entire working period and then two days before the final due date post something completely half-assed. Naturally, the whole time I will be claiming some family emergency is occurring so that you don't get too mad at me."

Student Nurse Beta, "Alpha, that's a great plan because I am going to agree to do the teaching plan, but will constantly bitch that you are holding me up. So finally when you get around to doing the work, I am going to claim I had a previous commitment that I claim I told you all about (but that no one remembers) and I expect someone else to do my work for me."

Me," I appreciate you letting me know that I will need to play janitor on this project. Now I can just do all the work up front and not have to get all of it done in 12 hours."

The End

Changing Lives, One Needle at a Time

I can't take credit for the title quote, that goes to a nurse on the medical floor I did clinicals on earlier this semester. It still makes me giggle, so I have to share it with the internet.

Jerry Lewis in PACU

This semester we have to spend two days in PACU (formerly called the Recovery Room). The course coordinator for this semester is a PACU queen, so naturally she oversee's the experience.

Instructor Y sets us (normally three students are in PACU, but my rotation only had 2) up in a bay and we take a client. At least that is how it is supposed to work. Our first day went relatively smoothly. All thumbs here needs to work on anything skills oriented so doing new things like putting on ECG leads quickly was entertaining to observe.

The second day started off slow, so Y decides that she will give each of us a client. As I am helping the other student, my client rolls in. What seemed like a routine situation ended up being an all day affair. The client came in complaining of nausea and pain. No problem, that's why there is Phenergan and Dilaudid. Then a problem arises, the client has a Morphine allergy, but has been able to take Dilaudid. Until now. Yes, she started itching and now gets to add Dilaudid to her list of no no's. So the anesthesiologist is called and Zantac and Benadryl are ordered to help relieve the itching. The pain relief is now switched to Fentanyl via PCA and we think we are in the home stretch.

Oh wait, the foley has come undone and urine is now all over the bed. Let's clean that up, deal with her allergic reaction, pain, nausea and remember to look at her O2 Sats! At this point I felt like Jerry Lewis that whenever Y asked me a question I would want to stammer and say, " Duh, well.." At one point she asked me an easy med math question that I couldn't do in my head in the midst of all of this and so the client answered for me. I thanked her for doing my homework for me. Man I was embarrassed.

This very nice client was about to be discharged from PACU around lunchtime but had to stay around for a fluid bolus and by then I got some help from other students. I went to lunch and when I came back found out that the VAST team (they put in the IV's) was there and had to stick her twice in order to get another access for the albumin she was getting. It was then one more fluid bolus, the family coming in and she was off to her room.

I was certain my evaluation was going to include statements like " Are you sure Jerry Lewis isn't your father?" or "I've never seen anyone tangle up IV lines like that before." Instead I got all S's (Satisfactory) on my objectives and the advice to manage the client's medical problems and not concentrate so much on the emotional issues.

Favoritism

The course coordinator for 2nd semester is a very matter of fact, no nonsense kind of person. I came into the semester all excited because I thought she was going to be the kind of instructor I would love. WRONG.

What I didn't know is that rampant favoritism is also one of her attributes. We have several people in my class who love to inspect our instructors tonsils by using an anal entry. I know this and expect it within any classroom setting. What I hate is when the instructors fawn all over these students. I have a BA in education, I have spent time in the classroom as a teacher and a student. There is a way to keep a balance between your favorite students and the rest of the class. Instructor Y either doesn't know how to keep the balance or doesn't care if one even exists. On top of that all of her favorites happen to be the shallow, appearance matters types of people.

I really, really tried to keep an open mind about this situation but a couple of weeks ago a seemingly benign comment snapped that open mind completely closed. It was in the middle of a lecture and the instructor said something to one of her favorites that I interpreted as a private joke between the two of them. Right there in the middle of class the instructor singled out a student and made an inference that only the two of them understood.

BUZZZZZ! Thanks for playing, but Cathy X. Is wants you boot you right out of the door. I have no problem with students and teachers becoming friends in the type of situation I am in. I have a BIG problem with that friendship not having limits within the classroom.

I have named this instructor Y because - Why oh Why are you such a bad judge of character.

X Band

Our clinical schedule for this semester has us 6 weeks on either a medical or surgical floor, 3 weeks in OR/PACU/Home Health and 3 weeks on the orthopedic floor.

I had instructor X for my 6 weeks on a medical floor and I LOVED her. She was the first instructor I've had that I felt sized up her students and knew their strengths and weaknesses and tried to address them. I really liked her communication style and she didn't let people get away with things that other instructors let slide (like multiple missed clinical days).

I particular liked her because she liked me. Since starting school, I haven't felt a connection with a single instructor. I don't know if it is because I feel I don't need their approval or if it is because they are all fucking looney and my brand of crazy doesn't match theirs (note to self: do a blog entry about apparent mental illness among nursing school instructors). Instructor X is the first one that I feel could be a true mentor for me. I really didn't have that the first time around for my BA, so it is nice to have someone to go to for advice this go round.

Have I mentioned that instructor X used to be a psych nurse? Perfect fit for me.

Anyway, at the end of this semester we go through a ceremony called Black Banding. My school only recently gave up wearing the white hats and it used to be that after your second semester you would get a black band put onto your cap. Hence - "Black Banding". You would pick an RN that you want to put the band on you. Now my school gives you a pin with a black band that you wear on your uniform. I have asked instructor X to Band me. It is such a relief to know that someone who I respect so much will do this honor.

Once Upon a Time

there was a rather large male client with a nasty mouth that needed a bed bath. "Little White Support Hose" nursing student was called upon to bathe the said client, so she bounced into the room to help. "Little White Support Hose" was eager to help and wanted to make a good impression with the big, bad client.

"Little White Support Hose" starts at the top and works her way down, just like a good student is taught. She comes to the nether regions and exclaims in her head, "Oh my, what an enormous ball sack you have!" ""Little White Support Hose" goes to town cleaning the area as best as she can with a straight face.

"Little White Support Hose" gets done and moves down to the feet. That is when the client states, "That was a good job. You weren't afraid to get down in there and scrub."

"Little White Support Hose" left the room feeling dirtier than when she went in.

The End