it's coming to an end...

As I wait for my laundry to dry I decided to write a quick blog. Today was the last time that I will ever register for classes as an undergraduate. Whoa. That is deep.

Future professor...?

So I really need a therapeutic release of all my emotions this quarter. This quarter has been nothing short of amazing! My upper division course is a piece of cake, which is really helpful. My painting class has been extremely stressful. I'm shocked. My first painting caused me nothing but anxiety and I hated every minute of it. I'll attempt a different approach for my next painting.. And now to the good stuff. My senior practicum class.


I absolutely L-O-V-E being a teaching assistant to my mentor. I go to the hospital and assist the students with just about everything. My primary responsibility is assessments and charting. My mentor spends the majority of time with 2 students who give all IV medication to 4 patients and that is very time consuming. This leaves me with the remaining 3-7 students and I focus on their assessments and getting them charted in the computer. 


It's incredibly interesting to watch as the students progress throughout the quarter. We have high expectations of them and they are all very hard working. What I didn't expect was when one student regressed, I felt it as if it was a personal failure. So I explored what made her change and we had a good conversation... I also supervise the students as they perform new procedures. That has been quite interesting...


My other huge responsibility with this class is grading care plans. I sit here with my laptop covering the table which has care plans sprawled all over it. I'm currently avoiding grading. I wonder if faculty do that too?


My experience with this class has just been astounding. I love working with the students and I love that they feel confident coming to me for advice/help. The students in this group chose this professor because they knew she was hard and wanted to be better nurses because of it. I hope that I also emulate her style of teaching/grading and that they enjoy their experience with me. 


They best part is spending time with my mentor... I am able to pick her brain and learn more from her and I love every second of it. I think one of the best parts is that I am making her life easier (her husband is dying so she's going through a lot), which she explained to me in my mid-quarter evaluation... how nice.


So some other exciting things.. I got nominated for a national award through the army/NSNA!! The spirit of nursing! I was nominated by the faculty and I can't tell you how much of an honor that is!! I had to write an essay and list all of my community service in the last 2.5 years... jeeze! When did I ever get anything done?! I'll find out in march if I got it, I'm sure I won't get it, but it's still pretty cool right?


The last exciting thing is that my mentor is being nominated for RN educator of the year! The faculty chose her for the nomination and she gets 3 letters of rec for it. She actually asked if I would write one!! I wanted to offer because it's highly competitive and I know that a student perspective could really help. So I can't wait to sing her praises for all that she does for us!!


Well that's it. I'm on-call tonight so I'm just waiting by my phone, grading care plans, and blogging. I gotta say it, Life is Good.

Whew.. that's over!

Wow, this last quarter just about killed me. I was taking OB theory, and clinical, Senior Seminar, and Externing, I was extremely involved in CNSA, and a research study at school. Not to mention I was working out 3 times a week at 0600 AND still working my 2 night shifts in the ICU. I have no idea how I survived. Point is I did. Unfortunately I got my first B+ in theory since the first quarter 2 years ago. But the main consolation to that was that nobody scored higher than a B+, sad thing is, my final grade was 89.5... OH WELL!!


So I've officially completed quart 7 out of 9, the first of my last year in nursing school. I am a senior!! This next quarter I'll be taking Senior practicum, and whatever else I choose!! How exciting. So in case you don't know, senior practicum is a course where you go and do 108 hrs where you want to work when you graduate (all based on placements and first request honored etc). My love has been the ICU, however that is not where I am doing my practicum.


I was asked by my mentor to do senior practicum with her and her students. I will be a teachers assistant and go to clinical with her class and help 2nd qtr nursing students on the floor. I must say, I'm actually kind of excited about this. I remember my senior students who helped and they were awesome. They made me more confident and made my clinical experience much better. I hope I can do this for these students too...


We shall see, school starts next week. I'm taking 15 units, an upper division course, painting, and senior practicum... I think this quarter will be nice : )

My life's calling?

I'm not sure if this occurs in every nurses life but I believe there is a time when you realize what you were meant to do in life. Nursing hands down is my life's calling, but I think I've found a more specific destiny. I want to educate the world on end of life care.

Last night when I worked in the ICU an ABC (Act before code aka Rapid response) was called to the floor. I went along and it was a older woman who was struggling to breathe. They believe she has severe lung disease and has been in the hospital for 2 weeks now. As the patient is struggling to breathe the ABC team is initiating interventions. The necessary step was intubation. The patient was tired of struggling to breathe but did not want any treatment. As she finally agrees to the procedure the team leaves to prepare and I'm left in the room with her. I explained what was going to happen and question her about her feelings on what was going on. Overall she was very distressed and in my opinion "gave in" to what the team wanted her to do.

I held her hand and comforter her, assured her that she would not be awake or in any distress and that this would procedure would allow her body to heal and rest. She seemed to still be uneasy with the decision, which was hard. I began to tear up and explained to her that I can understand how frightening this must be, and that she would be in good hands with us in the ICU.

We called her daughter and explained the situation. She didn't live in town and agreed that intubation would be best and she was on her way. We then transferred her to our unit and intubated her. Her daughter arrived with her husband and they visited the patient after she was intubated and comfortable. They then left to head home because it was late and she appeared comfortable. About 2 hours later the patient coded.

During the code I performed chest compressions. This poor woman had a very frail chest and the required strength for compressions was not much. After 3 minutes I switched out. I asked her nurse if we should call the daughter and discuss terminating the code. She agreed. We called the daughter and she said "Do what ever you can for as long as you think is necessary".

What kind of help is that? Her chart had stated that changing the patients code status had been discussed a few days ago but no decisions had been made. Therefor CPR continued. As my next turn approached to perform compressions I stepped up and began, the patients chest was sunken in. You could no longer feel the ribs but what may presumably have been her back. After 1 minute I had to excuse myself from the situation.

After we resumed a rhythm she maintained it for a few minutes and we discovered she was in PEA (pulseless electrical activity) and resumed CPR. Having been personal friends with the ER physician responding to the code I reminded him that the family had said to terminate when we felt it was over. He joked and thanked me for being "the conscience on his back". He ended the code.

A few minutes later the family arrived. I brought them into the ICU and the first thing the daughter said in a matter of fact tone was," I don't want to see her, I'm just here to sign any paperwork". No tears, no distress, she was very much at peace with what happened. Her husband on the other hand was not. His eyes were bloodshot and tears were filling up. I reassured him that I also had been in this same situation and told him that she was very peaceful with the situation and I explained to him that I talked to her and held her hand prior to the intubation. He told me the story of her illness and it seemed ever so familiar.

The family thanked us endlessly for being so kind and that they were very gracious for all of our work. After they left I had to excuse myself from the unit. Everything was all to familiar and I couldn't control my emotions. After some "therapeutic communication" with my friend (another nurse) I resumed work. Reflecting on the situation all I could have wanted to change was the manner in which we coded her.

What 80 year old woman with such co-morbidities who had been hospitalized for weeks needs to be coded? Have you ever seen any patient over the age of 65 recover with any quality of life from a code?  I haven't! As I spoke to my friend we discussed the alternative of dying as you "gasp for breaths", I debated that it doesn't have to be that way. Palliative care is a beautiful thing. This collaborative team works together and uses medicines and therapies to make death painless, peaceful, and with dignity.

How many nurses out there actually know the facts about palliative care? Would you feel comfortable advocating to your patients and their family to choose an end of life care that would allow them to be freed from unnecessary testing, medicines, and treatments?

I believe my mission is to learn, practice, and educate others about Palliative care, the importance of advance directives, and discussing that "difficult conversation" with your family. I had a professor during my Med/Surg rotation who was ever so adamant about these things and taught us about "End of Life Care" and I'm thankful for that. It is my mission to continue her teachings but to take them to the next step.

I'm not a nurse yet, but I'm passionate about this. It's never to early to start working on your life's mission and I plan on starting now.

Working during nursing school

Hello everyone, this past week has been especially rough for me. My grandpa is in the intensive care unit because of a medical error and I've gone to be with him. However, rather than dwell on this right now, I've decided to distract myself and explain my experience with working and being in nursing school. Hope this helps some of you who have been considering it.

As you all may or may not know, nursing school is rough. I'm not talking the kind of rough where you have to study for a hard test the night before, I'm talking the kind of rough where you wonder what life was like before you entered hell... when you can't remember NOT reading hundreds of pages a week... the kind of rough where you don't necessarily freak out that you forgot your phone for the day, but you panic because you haven't done nearly enough flash cards or practice questions (even though you've done HUNDREDS) prior to an exam.

Let me start with a background about Sylvia prior to nursing school. In high school I wasn't the smartest kid, I HATED homework and therefor I didn't do it. Come college I seemed to have found my niche. Going to lecture and reading was more my style of learning rather than homework assignments. I completed my pre-requisites for a BSN program in 2 years, however due to a little slacking on my part, I did not complete my final one til summer, so I was forced to wait a year to start the program. Meanwhile I worked part time in an emergency room as a monitor tech/clerk (sat/sun 7pm-7am).

My first quarter of nursing school was not too bad. I took assessment, pathophysiology and nursing basics or something (you know, learning about nightingale and all those gals). Patho on the other hand was rough. I had a professor who believed that he knew more than the text books so I learned to translate his lectures to notes. I actually dictated his lectures word for word, picture for picture. I didn't have much time to study, every spare hour I spent in the library looking over notes, and studying. The weekends were essentially off limits because of the constraints of work.

I honestly believe that I would have done better in my courses with more time to study... I did get 2 A's and a B in patho, but I could have done a lot better if I had the luxury of the weekends off from work. This quarter however was only the beginning of my battle of school and work.

I struggled prior to nursing school with a mean boss. It was weird, we had never had problems before and I had been on a set schedule for quite a while, but the week prior to clinicals started my boss all of a sudden decides that I have to work night shifts during the week. I explained to her that this was not possible, I had clinical during the week and I could not be awake for such an extended period of time AND be expected to safely take care of my patients. This turned into a long drawn out ordeal. She told me verbatim "I did not hire you to go to school, I hired you to work for me." Anyways, long story short, I ended up having to get the union involved and they helped me secure my schedule.

As time passed and the program progressed, it became harder and harder to work. A main problem I had was during finals. I had my first extremely difficult final and asked to have the weekend off prior to the exam. By this time I had a new boss and her answer to that was, "well, if you can find someone to work for you, then you can". This wasn't easy, in fact it was impossible. We already had 2 people on sick leave and there was nobody else qualified to handle my job. So what ended up happening? I worked.

I do not believe in calling in sick just because I have to study. A lot of people say, just fake sick, school comes first. Well, unfortunately you are only allowed a certain number of "occurances" and when that number starts to climb, your annual evaluation shows just how "sick" you've been.

Spring quarter of my first year I started to really feel the stress. I began to ask around the hospital if there was a job that only work 8 hours, or would allow me to take more time off. I strolled over to ICU one day and talked to their charge. She let me know that quite often, the monitor techs who work ICU have to be "flexed home". So this sounded great! The next thing I know I'm being pulled into the managers office and she's hiring me!

My transfer to ICU was not only a blessing but a challenge. Not only did I have to learn a new job, but I would be working nights on the weekends. Now don't get me wrong, I love nights, but imagine waking up at 5 am for school mon-thurs and then switching around to waking up at 5 pm fri and sat. The switch to ICU did kill my circadian rhythm but it allowed me to take time off for my studies. My new boss in the ICU always said, school comes first. Amazing! What a concept! Not only did she encourage me to take time off to study for exams but she constantly asks, "So, you're going to work for me after your graduate right?" Perfect! Not only did I find an accommodating job, an excellent manager, but a guaranteed job after I graduate.

This kind of situation doesn't happen everywhere. I have to make sure that I work my minimum 48hrs/2 wks in order to maintain benefits which are quite necessary. Some other benefits to working during nursing school in a hospital: endless resources. Have you ever not understood something? When it was time for critical care I was lightyears ahead of my class mates. I had only worked about 6 months in the ICU but my mind was a sponge! Nurses LOVE to teach you things, and occasionally give you opportunities for hands on learning (DON'T DO IT! Always remember your scope of practice).

A few other benefits include networking with potential employers and tuition reimbursement (3,000/ fiscal year as long as I pass my classes with a C or better!

In the end, if I had the choice to work during nursing school as a CNA/ Clerk/ Monitor tech/Central supply tech, whatever, would I?

Yes and no. It does provide me ample opportunity for learning and growth, but it also has given me considerable amounts of stress. I often wish I would be able to focus on my studies more, and even have a life. Unfortunately I have to work for financial reasons, I typically don't have time to relax and go out with friends. I am always juggling work and school and finding every moment I can to do one or the other is difficult. But it also has helped my learning during the program because of what all I'm exposed to.

So, in the end, you have to decide what's best for you. How well can you juggle your life? Are you able to force your studying to be during the week only? Can you handle the stress? Could you imagine not having a weekend off before an exam? If you don't have to work during nursing school, then I would strongly urge you to keep it that way. If you're dying for a little experience consider casual/per diem positions that typically do not have minimum hours/pay period requirements.

If you have questions, don't hesitate to ask. I've survived 2 years of this, 1 more year should be as easy as pumpkin pie!

Ammonia cures all

So I'm sitting here watching house and a scene comes on where the doctors are checking a patients level of consciousness  (they've suddenly gone unconscious). They place a pen cross-wise against the patients finger and bend as hard as humanly possible. Try this on yourself. It hurts like hell. This scene reminds me of an inmate patient we had. I'm walking down the back hall and all of a sudden the people near the room say, "Nurse Nurse!! Come check on him, he just slumped over!" So I go by and said patient is slumped over in the bed, I rock his shoulders to try to arouse him. Nothing. Next, I do a sternal rub, nothing. I'm looking at the monitor, HR is normal, SpO2 is normal, BP is normal, Pleth shows good wave form, what the heck?!

So I yell at his nurse to come look at him. He comes over and does other various painful maneuvers to try to arouse him. Nothing! So we get the dr, who asks us to bring 2 packets of ammonia. The doctor then tries to arouse him with similar techniques and no response. I'm puzzled, what is going on? Did the patient have stroke? Did he go in a coma? Next the doctor places a rebreather mask on the patient without oxygen. The nurse comes in and has the 2 ammonia sticks. The doctor orders her to break them in half and he places them both inside the mask.

An entire minute goes by with no response. I'm standing there puzzled, what is going on? Then I noticed that there was no longer steam in the mask from his breathing. He begins to cough and choke. Vomit is spewing out and he's thoroughly pissed.

The doctors walks out laughing. What is going on? I ask him, so what does that mean? He says, "he's full of shit and faking."

Ooh.

I seriously was dooped. I felt stupid, I had fallen for a patients attempt to be "unconscious" and avoid going back to the prison. Honestly, I felt I was more seasoned than this. I retold this story to a professor of mine who is an ER nurse and a psych nurse. She explained that yes, I had fallen for an age old trick, but that I would never fall for it again. I just thought this was funny. Next time an inmate wants a trip out of the prison, they're gonna have to hold their breath for a lot longer than 1 minute.

Feeling lighter ; P

So, nursing school has no doubtedly given me some extra stress, and the extra stress has lead to more studying and less working out... which has lead to a larger tire around my waist and a lower self-esteem. It's funny, self-esteem has never been something that I lacked... In the past 2 years (since I started the program), I have gained about 30#... and that has bothered me. I never wanted to be super skinny, I know it's not possible with my build, but I did want to fit into my clothes I've outgrown. It would be nice to walk into a clothing store and never worry about if their size will fit you. Well since the nursing program has started it's only gotten worse.

As the years have passed, I kept saying that when the program was easier I would dedicate more time to healthy eating and more exercise. Ironically, I LOVE veggies and fruits. Chocolate, cake, ice cream, candy, doughnuts do NOTHING for me. You would think I'd be as thin as a rail. However, with the added stress of the program, my desire to fix the foods I enjoy has gone out the window. I then began to settle for convenience (quick, portable, and effortless i.e. fast food).

These bad habits have got me in trouble, my pant size is enormous... (maybe one day when I get down to my ideal weight I will tell you)... and I feel disgusting. So I recently found out that I have a genetic condition that alters my metabolism and other various aspects to my body.  My hormones are "outta whack" and it only adds to the problem. My PA believes that my weight gain is 50% bad eating/no working out and 50% metabolic disease. So he wants to start me on glucophage (for you non-nursing it's a diabetes medication that helps with glucose metabolism {I do not have DM but it helps for people like me}) Well he hasn't done this yet because I've been having some stomach problems...

These stomach problems have lead me to alter my diet. Basically can you imagine having diarrhea for 3 months? Well I did and it sucked. I thought I may have a lactose intolerance so I began to cut dairy (100%) out of my diet... this lead to no cheese, milk, yogurt etc which was shockingly a large part of my diet. With this new change I began eating differently, choosing different options, which ultimately were healthier options. As I began to feel better I thought about making it permanent. Healthy eating is not difficult, but only takes effort. And the funny thing is I like this much better!

I began to essentially count calories and make better choices. I do not count vegetables into my calorie count because I don't believe in limiting what is naturally healthy, and fortunately for me, what I love. This has been going on for about 2 weeks. With inspiration from  BadEmma by reading her blog, I've began my own journey. Her facebook collection of food is inspiring, and has helped me unleash some new dishes that I love and are super healthy. Thanks lady!!

As of today I am 10lbs lighter. Its a start, I don't quite see it yet, but people are noticing. Plus, I feel better, I don't feel guilty anymore and honestly just enjoy stepping on the scale and seeing my progress.

I wrote this to not only give you insight into my life, but to hold myself accountable. I've put myself out there so expect updates, and if you don't see any (or read any on twitter) then send me some words and remind me LOL...

My goal for this summer is to be down 30# by September 11th... wish me luck!

Anyways, this is lengthy, but necessary... good times and happy healthy living ahead : P