Someday is Now

Graduation has finally come, and with it, a new blog site:

neuronurse.net

New Header

The other day, my mother mentioned that she reads my blog. The only comment was how disgusting she found my header. Seeing as this was the only thing she found to complain about (at least to me) I went ahead and changed it.

Speaking of changes, in a few weeks I will moving this blog to a new domain in celebration of my graduation from “somedaynurse” to real, live novice nurse. I really appreciate everyone who has followed me on this journey. I promise, I’m just getting started! Watch this space for details!

I got to play Sim Lab at the local med school today. It was interdisciplinary exercise with the baby docs (third years, they call themselves). It was interesting to have a simulation where the docs were actually in the room (even if none of us exactly knew what we were doing). Our patient presented with an abdominal aortic aneurysm, and the doctors got through the initial ABCD survey, but then they kind of hit a wall. The patient was already bleeding into his abdomen, he was confused then unresponsive, and his bp was dropping, so I focused on treatment for shock. I kept asking for orders to treat it (Would you like fluids hung, Doctor? Should I draw a type and screen for blood?) which varying degrees of success. The whole thing was less than fifteen minutes long, but I suppose a real patient would have died in five, if he made it to the hospital. I love working with students from other disciplines. We can all get pretty isolated during our program, and this takes us out of our comfort zone a little. Plus, the med school has a much cooler sim lab!

image credit

One for the Road

After two weeks without home internet, I finally have a cable modem installed. Just in time, too, because I have the dubious distinction of being one of the students given the opportunity to write one last scholarly paper before graduation. It is supposed to be a punishment for skipping out of the second half of class, but the topic has proven to be quite interesting.

If our instructor had really wanted to punish me, she should have assigned a group project.

During the first half of class, my instructor and I had a somewhat heated discussion during which she accused one my favorite clinical facilities of Medicare fraud. I felt uncommonly vulnerable to criticism, and was unable to adequately explain my point. I didn’t realize how all the stress at home has affected me until I felt a cold panic overtake me as the class adjourned. I told a few classmates I was leaving because I was bored, but all I really wanted was to escape before I started to cry. I said nothing to my instructor, planning to call her when I composed myself.

Of course the real punishment was the disappointment of my instructor, who I respect greatly. Had I slunk off alone and called her to explain later, everything might have been okay, but apparently their were FIVE of us who disappeared during break, as well as another seven who never showed up in the first place.

The paper is to be on the subject of professional behavior and NCLEX preparation. I have found some great articles on the subject of professionalism, including a study linking the unprofessional behavior of medical students to subsequent disciplinary actions by the medical board. On the other hand, everything I have found on classroom preparation for NCLEX found no statistically significant benefit. I concur; while the questions are fun to answer, there is little time spent on rationale, and an inordinate amount of time spent arguing over the questions, as if our protests would somehow change the NCLEX exam. I just could not handle such a scene that night.

Still loving it

Another week down, another amazing experience. The charge nurses are great about assigning my preceptor and I the most acute patients every week. This weekend, I got to take care of a guy who had grand mal seizures during his alcohol withdrawl, a woman waiting for surgery to repair a carotid artery dissection, and a ventilated patient who was found down with a blood sugar of 20.

I’ve never had any experience with vents before, but after two days of caring for my ventilated patient, I feel like I still know absolutely nothing about vents. No, that’s not quite true. I know how to do trach care. I know how to suction. I know what some of the settings mean…soft of. Most importantly, I know the respiratory therapist’s number. The RT’s at this hospital are all really great, and really time to collaborate with me when my patient decompensated last night. Agonal breathing looks quite different in a trached patient than it ever did in hospice care. I was concerned enough to call my patient’s daughter at 330 in the morning and tell her she’d better get over to the unit. We were able to stablize her, though, and she was breathing at her baseline and her ABG was great by the time I left.

Although I ran everything by her (of course), my preceptor really stepped back and let me make the decisions about who to call and when. I’m sure she was ready to jump in at any time, and I am glad of that, but I really felt like these were my patients. All my meds were on time, and I even got out of the building by 830 in the morning! I left feeling like all my patients were stable and each got good care. I love both the acuity and the nurse:patient ratio on this step-down unit. Three high-acuity patients is challenging, but never so rushed that I feel like I’m not interacting with my patients. I really, really want to work there when I grow up! A new grad is starting next week, but I think she’s going to work days. I’m trying not to wish her ill. The next new grad program doesn’t start until November, but I don’t think I’ll be able to sit for boards until the beginning of October anyway.

Things I’m glad I’m experiencing in Practicum

I read a lot of posts on AllNurses.com about new nurses trying to figure everything out. It’s kind of scary to read sometimes, but it does make me realize that I have had a pretty great learning experience in school.

One thing I notice over and over is new nurses on that forum don’t ask enough questions while they are at work (I doubt anyone in my graduating class will have such a problem…); they all run home and post their questions online.  Also, look stuff up when you aren’t sure! Once you pass the NCLEX, you are no longer expected to remember every little thing you learned in school. Experienced nurses ask questions and look stuff up all the time.

Some things I am happy I am experiencing now:

• calling doctors: I am so glad my preceptor is giving me lots of practice with this. It gets a little awkward because as a student I can’t take orders directly, but the practice is invaluable.
• computer charting
• using the Pyxis
• full patient loads each shift
• admissions and discharges

I REALLY want to work at my unit when I graduate, and I plan on using the fact that I will have basically had 200+ hours of (unpaid) orientation on the unit (600+ hours in the unit’s hospital) as a selling point to the clinical manager.

Honey, I’m Home!

My preceptor told me last night that it seemed I was born to be a nurse. It was the greatest thing anyone has said to me in a long time. My practicum is turning out to be such an amazing experience! My preceptor does a great job of letting me set my own priorities with patients and figure out my own way of organizing the shift. All the nurses are open to answering questions and explaining new procedures, and we are always looking up the answers to clinical questions we run across during the night. The patients are really challenging. I love neuro, and we also get a fair amount of surgical step-down and ICU overflow, which keeps things interesting.

Was it only five years ago that I made the decision that will impact the rest of life? It was so spontaneous that decision is a misnomer. I started on this path almost on a whim, but once the idea was in my head, there was really no turning back.  My sister was furious, convinced I was hatching a plot to usurp the attention she was getting as a (waitlisted) nursing student.  My mother told me not to get my hopes up; my past mistakes would surely prevent my success. Choosing to get my BSN only made things worse. My mom thought I was wasting money on something I would never stick with. My sister was now convinced I was simply trying to steal her glory. I’m pretty sure she still thinks that. Not that she has anything to worry about. The last time I saw my mother, she absolutely gushed about my sister’s progress in nursing school. She went on and on about how much my sister has grown as a person, and how wonderful it has been to watch her blossom into a confident woman. I’m pretty sure my mother wasn’t being ironic on purpose.

I’m not surprised by my family’s reaction. This has been the first time I have ever had a real, tangible goal. Until now, I simply did stuff. I went to art school, then design school, without any idea where I was going from there. I’m sure they all thought I was having a manic episode, and next time it would be Mortuary Science or something (which would be really cool, but I digress).

The fact is, while some acknowlegment from my family would be nice, it is not terribly important. It’s much more important to me to do well in order to take the best care of my patients.

Family time is fun time

I saw my aunt today. She had a stroke at the beginning of the year. It didn’t effect her motor ability, but it had some pretty devastating cognitive effects. She was on the phone with a friend when the stroke occurred, so she was able to receive TPA in the ED. I never heard exactly were the infarct was, but I can tell by her behavior that there was right-hemisphere damage. She has an impulsive, child-like quality now, and there is much receptive aphasia evident in her speech. Mostly it involves word substitution, but she does experience some poor comprehension of the speech of others. Her short-term memory is practically non-existent. My uncle thinks she is still deteriorating, but she seems about the same as the last time we visited (which was much too long ago).

It’s sad to see her so debilitated, and I can tell my uncle is exhausted. My aunt argues with him because she doesn’t understand why she can no longer cook or drive, or stay in the house alone for more than a few minutes. I feel guilty that I haven’t been over more often, and now that my schedule is so open, I will get over there at least once a week. My son loves it. They are really our only family since my mother couldn’t care less and my sister has actively disowned me. Of course, I am no better.

When people ask if I have siblings, I tell them I had a sister but she died in some sort of auto-erotic misadventure involving a vacuum cleaner and water balloons.

It’s a shame she and I don’t get along. I really miss her. Even when we were speaking, she was always guarded and ready to defend herself against some imagined attack from me, but it was worth the awkwardness to be near her. She has a truly sparkling personality and a beautiful smile. I know she feels inferior somehow, but it’s ridiculous. I may have a sharper intellect (my mother claims it was all the wheat germ she ate when she was pregnant with me), but she has a natural emotional intelligence. She has friends she has known since grade school, mentors and patrons that would do anything for her.  I’ve always admired that.

Not the Brady Bunch

I don’t know what to do anymore. For months now, everything with Jamey is a crisis. He hates my son and is very vocal about what a permissive  mother I am. Jamey has decided the only way to interact with me is to act “pissed off” all the time, so I will never be able to tell if and about what he is really mad. I told him I could not live like that. I thought he understood. After talking to him for hours last night, I thought I’d convinced him things would be okay.

This is your fault, he tells me, looking at the hole in the door. Of course he’s right, though not in the way he means. It’s my fault because I thought we could get through this. I thought our love was stronger than the demons that haunt him.Ostensibly, he is upset because my son asked me to cook dinner. The thought of his “dirty, grimy hands” touching his food was apparently more than he could bear. As soon as I saw Jamey was upset, I told my son it was not a good night for him to cook, but Jamey still accused me of purposely trying to upset him by allowing this atrocity.

He should have known not to make me choose between him and my son. He would never come out ahead of that game. I fought for and with my son for years, and I have no intention of abandoning him now. He made different choices when his girls were here. He told me after they left that he would punish them for things he didn’t think he should have, just to show solidarity with me. Had I known at the time this was what he was doing, I would have kept my mouth shut about their behavior. I can’t help but wonder if I was this bad when they were here. Sure, I complained a lot to friends about how miserable it was, but I still cooked them dinner and drove them to school.

Not that it matters how I remember. It’s how Jamey saw it that affects his behavior towards me and my family. Even at the time, I agonized over my feelings for his children, which was, I admit, extreme. I still have a visceral reaction to the subject, and this torments me, because we are supposed to someday be a family. But was it so obvious?

I don’t want to abandon Jamey, either. I can handle the rough stuff. I know what it’s like to be haunted. But Jamey has to want to be happy, and I am not sure he’s ready for that. Happiness was a difficult concept for me, one I still struggle with. Both of us grew up in a time period when being happy was often equated with being complacent. Being moody and dark, sarcastic and even violent was more excepted than showing optimism or expressing love. Being negative, wallowing in depression and angst is not an entirely uncomfortable place, not when it is so familiar. Allowing myself to be happy, knowing full well that happiness may be short-lived in the ebb and flow of the universe, that is what is difficult.

I want desperately to share my life with this man. When things are good between us, I feel loved in a way I never thought possible. I feel beautiful and brilliant and capable of anything. I am a better person because he loved me, and because I love him. It breaks my heart that I cannot give back this gift he gives me. It breaks my heart that my love is not transforming, transcending. If anything, the opposite seems true. Faced with my love for him, he is weakened; he feels undeserving and ugly, trapped by his feelings for me, and sure I am moments away from realizing my mistake.

The Big Interview

You passed the NCLEX.  You have the four-year degree with Magna Cum Laude in fancy script to prove you aren’t as stupid as everyone thought. You’ve been told for the last two years by your prestigious private university that graduates from your program are the most sought after in the state.  Your resume is full of carefully-worded accomplishments and polished descriptions of your brief but broad experience in healthcare. You are feeling like hot sh*t. Recruters should be calling any minute. Shoot, they should be at your doorstep bearing shwag and waving hiring contracts like you are the #1 college b-ball pick.

But of course, in this market, there are twenty new grads for every position, and each look just as good as you on paper. If you want that dream job in (for instance, the neuro step-down unit of your favorite hospital) you need to ace the interview.

I’ve collected tips from nurse managers during my program, and while they all have their own style, some advice stood out:

• Be honest. This may seem obvious, but no one wants to talk about why they were fired from that CNA job two years ago (just a hypothetical). You don’t need to bring it up, but don’t stutter when the interviewer does.
• Do your research. Know the job you are applying for, as well as the hospital you are applying to, and be able to explain why you would be an asset to them. A good place to start is with the mission and values statement.
• Be prepared for some of the standard interview questions (see below). Some hospitals even have policies that mandate certain questions be asked.
• Don’t ask about pay or benefits on the first interview. Most places will go over this stuff if you are called back anyway.
• Show enthusiasm for nursing in general, and the position in particular. Don’t let on that you don’t care where you work. Convince the interviewer that you would be happy nowhere but there.
• Have some questions prepared to ask the interviewer. Choose questions that reflect your interest in the unit and in becoming a member of the team. Some suggestions I received from nurse managers included:
  • What do your employees like best about working on the unit?
  • What opportunities does the hospital offer for in-services/continuing education? Best to say ‘opportunities’ and not ‘requirements.’
  • What are your expectations for new hires during the first six months?
  • What is your management style? This is good; remember the Leadership class we all slept through? I would personally be wary of anyone who can’t readily name their style. You can always run home and Google it after the interview.
  • Are there any challenges that this unit or facility is facing or anticipates in the next year? I really like this one. It’s from this page, which has some good questions, and some questions that seem a little intense.

Okay, so that’s great, but I’m sure people want to know what specific questions to expect form the interviewer. This of course will vary, but there are a few you should prepare for:

• Be prepared to discuss the types of patients you have cared for, as well as specific interventions, etc.
• When were you most satisfied at work? When you were you least satisfied?  Why?
• What nursing duties(s) give you the greatest feeling of accomplishment?
• Be prepared for a scenario or two as well. The manager will want to gauge your ability to prioritize. Another way to discover this would be to ask how you decide which patient to see first. I ask every nurse I work with this question and I have yet to get a straight answer. I wonder what they say in their interview?
• What is your philosophy of nursing? What do you do in your everyday practice to demonstrate this philosophy of nursing to your patients and families? I don’t know how often this is asked of new grads, but I wouldn’t want to stutter if I am asked.
• Give me an example of a mistake you made at work (or during clinicals) and how you corrected it.
• Describe a time when you had a difficulty with a family member of a patient. How did you resolve it?
• When delegating to other team members, how do you ensure you are communicating effectively?
• Tell me about an improvement you initiated at your current job. What prompted you to make the changes? What was the outcome?
• Describe a conflict you had with a co-worker and how you  resolved it.
• Considering the responsibilities of this position, where do you see yourself contributing the most?

Well, that’s more than a few, and I could probably go on. Nurse managers would likely want to know you understanding of your role, scope of practice, etc. Do you have anything to add or argue? Please do so in the comments. It’s freaking me out a little just thinking about it, but I have another seven weeks of on-the-job interviewing during practicum that will hopefully give me an edge.