Tenth Week of Nursing School

November 27th, 2012

Dear Off-Campus Clinical,

            Yesterday, I had my last off campus clinical for this semester and I was surprisingly saddened by the fact that it was the last day I would be with my clinical group. The whole experience has been very surreal and I can’t believe that my first semester is coming to a close. I’m glad that for my last off campus clinical experience, I was able to observe the charge nurse perform a sterile wound dressing change on an unstageable pressure ulcer. It was exciting to be able to see how a sterile field and wound vac is supposed to be applied in the clinical setting. When the soiled wound dressing was removed and the wound was revealed, the wound looked so much like the pressure ulcers I’ve seen in my textbooks. I was tremendously relieved that I did not feel nauseous or faint. Is this possibly a sign from the universe that I might be cut out for this field…who knows?! At the moment, I need the encouragement so I’m going to be positive and take this as a sign that I should stick it out in this program.

            At the end of the day, I was given the chance to discuss my overall clinical experience with my clinical instructors. At this time, I was able to thank my clinical instructors for providing me a comfortable environment for my transition from a simple student to a nursing student. I’ve realized that I have become progressively more confident with addressing patients and healthcare staff. I was glad to have exposure to both the hospital and nursing home setting because it has given me a better idea of which nursing specialty I want to pursue in the future. For now, I have an inclination toward the hospital setting because I feel that a faster paced, critical environment suits me better. Furthermore, I don’t believe I want to work in geriatrics until I am older and until I gather experience in other specialties.

Goodbye Off-Campus Clinical,

Clos3tGirlyGirl

Ninth Week of Nursing School

November 15th, 2012

Dear Life’s Curve Balls,

            I don't understand how it is possible for so many problems to occur in just a few days. My mood has completely plummeted. Not only am I sick with a runny/stuffy nose, sneezing, headache, and sinus congestion, but on top of that I had to study for Pathophysiology. I ended up attending my integrative seminar on Tuesday morning, but ended up skipping the rest of my classes so I could get some rest and gather energy to study for the test. I'm just glad I wasn’t sick on Monday because missing off campus clinical would have been bad. After trying to sleep off my illness on Tuesday and Wednesday, I ended up staying up all of last night to cram as much as I could. I don't know how I did on the exam, but considering the circumstances I hope I get at least get a B.

            On top of that, it's my time of the month, I lost my microSD card that contained the majority of my Europe trip pictures on it, and my current living conditions are absolutely disgusting. I could have easily have tolerated these little problems individually, but it just felt like everything piled up all at once. It being my time of the month, of course my emotions were running wild. The fact I lost my microSD card made me extremely depressed because I am a person that likes to hold on to happy memories and my trip to Europe this summer with my mom was very important to me. As for my living conditions, my apartment mate is a slob and I keep having to clean up after her. It's ridiculous because I clean the bathroom and kitchen every few days and she still manages to make a mess within hours. I want to move out because feel so uncomfortable in my apartment; I feel like I'm living like a homeless person. Like a big baby, I ended up calling my parents to spill my guts to them.

Please Stop Coming At Me,

Clos3tGirlyGirl

Eighth Week of Nursing School

November 12^th, 2012

Dear New Clinical Site,

            Today I had to wake up early to make the trek to uptown New York for my new clinical placement since the hospital I was previously assigned to was evacuated during Hurricane Sandy. I didn’t think getting there was going to be a problem, but I ended up getting lost along the way and was bit late even though I left my place 1.5 hours before I was supposed to be there. This made me worried for what might happen if I am placed out of Manhattan in the upcoming semesters. I heard from other students that the new location was a nursing home facility. Since I had previously worked as a nurse aide in California, I was kind of disappointed that our new clinical location was not a hospital because I wanted more exposure to the hospital setting. Once I arrived I found the facility was a lot nicer than other nursing homes I had worked at. Unfortunately, my opinions changed as the day progressed and I will explain in a little bit.

            My clinical group ended up being placed on a floor where the majority of the residents could perform their activities of daily living and required little help from us. I was glad that we were not assigned specific residents to attend to because this gave me a chance to get to know a variety of personalities. Just like my previous nursing home experiences, I knew I could become to some of the residents I talked to. This makes me wonder if I want to work in geriatrics because I don’t know if I could handle if one of the residents I become attached to passes away.

            Now to talk about why my opinion changed on the nursing home. Although the facility was nicer, more spacious, and clean, the employees were definitely lacking in quantity and quality. Our clinical instructor ended up reporting an employee for taunting one of the residents. What had happened was that after lunch time ended and the cafeteria was being cleaned up, a resident became very upset with the nutritional employee because the nutritional employee was not professional at all. The nutritional employee continued to taunt and joke around with the aggravated resident, and the resident became more and more agitated. Another reason I became distraught was that when a continent resident needed to go to the restroom, there were no PCTs on the floor and when they were summoned over the intercom they just took their sweet time and didn't end up helping the resident until a good 10 minutes. The lack of professionalism shown by the staff is not acceptable.

            On a more positive note, I did meet nice residents and each had her own special personality. One resident with dementia was truly a very nice lady but was also very defensive due to cultural differences. I realized that this particular resident was very focused on racial discrimination because she had mentioned several times about how "Blacks" were overrun by the "Whites" and also that I had "oriental eyes" and if I had lived in the south back in her day I would be overrun as well. Although I felt awkward about responding to her racial defensiveness, I felt like it was an essential lesson learned on how to deal with cultural competency situations. In addition to the conversations I had with the residents, I enjoyed the time our clinical group spent covering current events and holding an exercise circle. The happy expressions on the residents' faces is evidence that socialization events are essential to create a tight knit community, encourage social interaction, and create a comfortable environment for the residents to live in.

Until Next Time,

Clos3tGirlyGirl

Seventh Week of Nursing School

 November 8^th, 2012

Dear Horribly Stressful Nursing Catch-Up Week,

            After Hurricane Sandy hit last week, most of my exams, evaluations, and assignments were pushed back a week. Unfortunately, for some reason my Adult and Elder on campus Simulation evaluation was not pushed back. This completely threw me off track studying-wise and emotionally. To be honest, it's a bit embarrassing but I broke down after reading the professor’s email. I didn't expect to still have the simulation evaluation because open simulation was cancelled for the week leaving me no chance to practice the scenarios. The only time I had to practice the scenarios was two hours before my scheduled testing time. I had not attended any of the previous open simulation slots because I was expecting to practice the Wednesday and Friday of the week of Hurricane Sandy. After getting a pep talk from my fellow nursing students and a few hours later, I managed to regain composure and convince myself that everything was going to turn out fine in the end. Going into the evaluation, I was pretty certain I was going to have to remediate. With my luck, I ended up with the Anthony Cunningham case and did not pass because I exceeded the time limit. The scenario called for a dressing change and medication administration. Sounds easy enough, but it was difficult to accomplish the nursing orders within 15 minutes when I was a bundle of nerves, paying close attention to make sure I didn't miss any steps or break the sterile field, and never acted the scenario out fully by myself. I also feel that the grading was very subjective depending on which clinical instructor was overseeing the evaluation because each clinical instructor taught the skills differently, had different expectations, and focused on different aspects of the skills. All in all, what I learned from this experience is to prepare for the worst and to not wait until the last minute to go to open simulation.

            Sadly, failing the A&E simulation evaluation sent me on a downward spiral. The past weekend I found it extremely difficult to concentrate fully on studying for my Health Assessment and Promotion midterm which was the day after. Not only could I not concentrate, but I could not sleep because I was so anxious. I came out of my HAP midterm feeling not very good about it. I'm pretty sure I missed at least 7 problems and I hope I got at least a B-. I feel like I studied for this test wrong because it was the first time I decided to focus my attention on the reading. If I had just stuck to my usual study habits of focusing on the slides, I know I could have performed much better. Again, lesson learned. Don't change your study habits when your study habits aren't broke.

Until Next Week,
Clos3tGirlyGirl

Sixth Week of Nursing School

October 29^th, 2012

Dear Hurricane Sandy,

My sixth week of nursing school is nonexistent. This is the week of Hurricane Sandy. School has been cancelled Monday, Tuesday, and the school hasn't decided whether or not classes will be cancelled as well. Is this a blessing in disguise, is the world giving me time to catch my breath? Or is this a horrible nightmare? The "perfect storm" has made me miss my off campus Adult and Elderly midterm evaluation and my Health Assessment and Promotion midterm exam as well. If there aren't classes Wednesday, I will be missing my HAP Simulation evaluation too. From the looks of it, all exams will be pushed back to next week and then I will be in deep, deep trouble. Next week, I was supposed to have my A&E on campus evaluation and second Pathophysiology exam. The combination of this and next week's exams is going to be killer. I may be relaxed right now, but I am trembling at the thought of what is to come next week.

            Currently, I am sitting in the 12th floor hall way because the power went out about 45 minutes ago. The resident assistants told us that the generator is probably only going to last us another 45 minutes. Internet access was disconnected soon after the power outage and my phone only has service at random places on the floor. Since there isn't much nursing for me to talk about this week, I guess I'll talk about something that happened that extremely bothered me. About ten minutes after the power outage and right after the resident assistants warned us about how the generator will last, a group of students decided it would be a good idea to take the elevator down to the third floor for finger sandwiches and scones. I could not for the life of me wrap my mind around how young and stupid these kids were. Besides the fact that we should be conserving energy, the power outage means that these kids could have been stuck in the elevator. I'm only a few years older those kids, and I am greatly disturbed over how immature they are.

Goodbye Hurricane Sandy,

Clos3tGirlyGirl

Fifth Week of Nursing School

October 23^rd, 2012

To My Fifth Week of Nursing School,

            I can't seem to confidently and precisely measure blood pressure as I would like. My simulation professor said I have good technique, but I'd rather be more precise and within the 2 mmhg required for next week’s midterm evaluation. I'm debating on getting a better stethoscope to see if I could hear the blood pressure pulses clearer and get a better read. I decided to skip out on Pathophysiology lecture this week because I wanted more time to study for the Professional Nursing quiz. I ended up doing better than I thought on the quiz, so maybe skipping wasn’t such a bad idea? Unfortunately now I have about 6 hrs of lecture podcast to catch up on for the Pathophysiology midterm in 2 weeks. I also ended up not going to the Making Strides for Breast Cancer Walk as I had previously planned because I wanted to spend more time studying for today's Adult and Elder midterm. I went into the test nervous and tired and came out wishy-washy and tired. It seems this is a consistent state I fall into when it comes to exams

            I've noticed that no matter what I just cannot sleep the nights leading up to an exam. Since we have had at least one exam every week, several nights I'm only been "sleeping" for 3 hr intervals. Maybe, it's because I’ve started drinking tea and diet coke in addition to my everyday coffee. My increased caffeine intake and anxiety over tests is wearing me out. I wouldn’t say I’m stressed over the difficulty of the material covered in our program, but it’s has more the accelerated aspect of the program that is difficult. I can’t seem to catch my breath. It’s kind of crazy, but even though the work is piling up and my subconscious is keeping me awake, I don’t believe I am consciously freaking out just yet.

            In on campus clinical we went over medicine administration and learned how to give subcutaneous/intramuscular injections on dummies. I was excited to do injections because I felt like this was my territory, being diabetic and giving myself 3+ injections per day and all. Surprisingly I learned something new! I had no idea that drawing air into the syringe and injecting the air into the vial would create a pulling pressure to fill the syringe to the needed dosage. Of course adjustments for air bubbles need to be made, but overall the technique was eye opening. Unfortunately it doesn't seem to work with my insulin syringes. I think it might have to do with the fact that my syringe is much smaller than the syringes available in the lab. I'm disappointed because I found that I won't actually be allowed to give injections in the hospital setting until next semester after the dosage calculation exam and enrollment in pharmacology. Bummer…

Goodbye Fifth Week of Nursing School,

Clos3tGirlyGirl

Fourth Week of Nursing School

October 16^th, 2012

To My Fouth Week of Nursing School,

            Recently I joined the undergraduate nursing student organization as the 15 month accelerated fall start representative. I didn't want to mention running for the position before because I didn't want to get my hopes up and be disappointed. For some reason, I happened to be the only person to run for the position, and was elected by default. I'm thankful that I got the position and am excited to be involved with UNSO. In the future, if I can keep up with my grades I will hopefully be able to join Sigma Tau Theta, the nursing honors society, in the future.

            Last week I took my first exam for nursing school. Man, oh man...studying for pathophysiology zapped the energy out of me. I ended up doing above average, but of course I could have done a lot better if I had started studying sooner. Procrastinating to the max is the story of my life. I need to change my study habits, but how do I change if this is how I've been since grade school? Since the test, I have been extremely tired, out of it, and I sometimes feel like I'm in a drowsy-dreamlike state. It just might be that I need to keep tighter control over my diet and diabetes. I think the combination of stress and anxiety from the upcoming cascade of exams and assignments along with stress bingeing and lack of exercise has to do with it.

            Yesterday, I had my third off campus clinical. The patient I was assigned to this time was admitted with complaints of syncope and was under observation to try and figure out why she was experience prolonged episodes of lightheadedness. My patient had past medical history of Parkinson's disease and during the hand off, the nurse stated that the doctors thought that the lightheadedness was a secondary autonomic reaction to medication and her Parkinson's. Compared to last week, my patient was much more stable and I felt like I had less to do. I did notice that I was not as comfortable with approaching the patient because she always had a family visitor in the room. I was very self-conscious about my words said and actions performed on my patient. I definitely realize that I need to learn how to be more confident and more bold in the care I provide for my patients. I checked on my patient about every 30 minutes and in between I tried to keep myself busy on the floor.

            I was able to help a fellow nursing student and PCT help a patient use a commode and transfer to the bed for an echocardiogram. I was informed later that the patient had lower extremity edema and a skin deterioration condition as result of her vascular problems. At first, I thought that the odor was due to bad hygiene but was surprised to find that the skin deterioration was the reason behind the musky odor in the patient's room. I felt sorry for the patient because I am certain that the PCT's did not help her clean as efficiently as they could of. Furthermore, I heard that the patient's family members visited the hospital often. This surprised me because I feel that the patient would not have gotten to such a bad state if her family had just been more involved with her health.

Goodbye Fourth Week of Nursing School,

Clos3tGirlyGirl

Third Week of Nursing School

October 5^th, 2012

To My Third Week of Nursing School,

            Wow…I’m already 25% done with the first semester of nursing school! I find it crazy how fast time has flown by. School is beginning to become more and more hectic and it’s hard keeping all of our assignments and exams for each class in check. Most of the students are anxious about next week’s pathophysiology exam and the feeling is extremely contagious. I’m constantly re-compiling a list    of what is due just to make sure that I don’t miss anything. I’m not sure if this is my stress shining through or if I’m just trying to avoid the inevitable of studying for pathophysiology. I swear that my stress level skyrockets whenever I open that book.

            Anyways, since I talked about my second off-campus clinical already I figured I would address some thoughts that came to mind yesterday in my Professional Nursing class. I felt that the whole discussion about the heart of nursing was too over the top and unrealistic. In theory, the concepts covered may sound wonderful, but in practice it is very difficult to uphold that mindset. I do agree though that every patient that comes in is another opportunity to meet someone new and another opportunity for me to make an impact on the patient/resident and vice versa. When discussing this topic, I thought back to a couple months ago when I was still attending my nursing aide clinicals. I remember many of the residents’ faces and remember the names of exactly four individuals who I will probably remember for the rest of my life. In a time span of a month, I became attached to these four residents, more than I had ever expected. For example, there was a resident that I was assigned to one morning who was known to curse out anyone who would try and give him a bed bath or shower. After performing the task, I disregarded all the rumors I had heard. Sure, the resident was “difficult” but by thoroughly explaining to the resident what I was going to do to help him with every step of the way, he became noticeably calmer and stopped cursing. After completing my task the patient said “Am I all straightened out now?” and apologized and thanked me for my help. That “difficult” patient was by far my favorite patient to deal with and in fact I frequently asked if I could work with him. I constantly wonder how the residents in that nursing home are doing, and whether they are still going strong. I believe it is going to take some getting used to, this whole meeting and leaving patients that we have the honor of coming into contact with.

Goodbye Third Week of Nursing School,

Clos3tGirlyGirl

Second Week of Nursing School

October 1^st, 2012

To My Second Week of Nursing School,

            This week began with on-campus clinical. Although I was glad that I didn’t have to wake up at 5:00 AM, I would have preferred more off-campus clinical opportunities because I want as much patient exposure as possible. I want to be able to practice communicating with patients and master the skill. For the most part, this week’s on-campus clinical was review for me since I had recently earned my nursing aide certification. Even though I had practiced skills on a dummy in the past, it was still very unusual speaking to the dummy because Professor Latimer acted the voice of the patient. I wish that we had the time to perform the skills individually because it would have given each student the opportunity to speak up. In a real clinical setting, I believe multiple nurses will not simultaneously address the patient, possibly interrupt each other, and in the process overwhelm the patient. In our HAP simulation this week, we were introduced to possible traps when talking to a patient. After the class, I was a bit overwhelmed thinking about how I should properly approach patients and gather health history data without being too methodical and without offending the patient.

            I was going to address my experience in today’s off-campus clinical in my third week journal entry, but I want to write my thoughts and feelings down since they are fresh in my memory. Today, I was assigned to a patient who was admitted to the hospital due to pleural effusion fever. The patient had an AICD placed last week and experienced complications from the procedure that left her feeling anxious. My patient expressed her concern for her fever and her shortness of breath. As the morning progressed, she became increasingly agitated because she kept insisting to the nurses that she was about to pass out and that she wanted to see the cardiologist. When the nurse practitioner was finally notified, my patient’s condition suddenly plummeted. Her blood pressure dropped, while her heart rate became tachycardic, and the healthcare team gathered in her room with the proper equipment in case she coded. Later they moved her to the ICU and I was told by the nurse that the healthcare team believes she went into sepsis. What I learned from this experience, is that healthcare professionals should always treat each patient as a separate case and to always listen to the patient when he/she expresses concern about his/her health.

Goodbye Second Week of Nursing School,

Clos3tGirlyGirl

First Week of Nursing School

September 24^th, 2012

To My First Week of Nursing School,

            Where to start? There’s just so much going on in my head that I don’t know where to begin. The past month has been a wild, crazy, whirlwind adventure. The day after I moved all of my belongings across the country for move-in day, I hopped straight on a plane to travel around Europe for two weeks before our classes began. I figured it was my last opportunity to travel for a long time at least until I graduate and work for a couple of years. I’m still trying to catch my breath.  Even now, after the first week of nursing school, it hasn’t sunk in that I’m going to be a nurse in the very near future. I don’t think it is going to hit me until I pass the NCLEX, land my first job, and walk down the hospital halls as a registered nurse.

            This week has passed by so fast! I barely got any sleep Sunday night because I was anxious about possibly not being able to wake up in time for my off campus clinical. As nerve wracking as it is, to strut down the streets of New York in bright purple scrubs, I realized that they are a necessity! When I arrived at the off campus clinical site, I wandered around for a good 10 minutes before Professor Rempel, sitting on a couch nearby, acknowledged me. From what I gathered, this semester I will be working in a cardiac telemetry unit. For the most part, the hospital staff was welcoming, but the nurse of the patient I was assigned to seemed as if she was very in a hurry and it felt like she just wanted to concentrate on her tasks at hand. I was surprised to see that the patient was so kind and thorough with explaining her condition even though she wasn’t in the best of shape. Since I hadn’t attended any classes before the off campus clinical I was shocked by the careful charting nurses need to perform. I think that day I had the most difficulty when trying to communicate with the patient. Since we were paired with another student, I allowed my classmate to take over the conversation because I did not want to interrupt her and overwhelm the patient. Also, I can see how difficult it is to speak to patients who are hard of hearing because it’s hard to find the balance between being too quiet or too loud.

            I guess the last matter I want to address is that I’m still getting used to being away from my family, friends, and the awesome California weather. I still have so much to learn and to explore in New York. One of my biggest worries was meeting new people and making new friends. It may not be apparent to others, but I am a very shy and self-conscious girl. I am constantly battling with myself to squish my shyness, and once I overcome that hump the “getting to know people” and “people getting to know me” part is considerably easier.  I’m glad that everyone I’ve met thus far is so friendly and welcoming.

Goodbye First Week of Nursing School,

Clos3tGirlyGirl