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I’ve been working as an RN at Super Hospital for seven weeks now.

I’ve attempted a couple IVs, I’ve removed foleys, I’ve removed central lines
I’ve dealt with chest tubes, I’ve drawn blood
I’ve made my first minor but scary error in patient identification
I’ve had a patient try to climb me like a tree because he thought he was going to die
I’ve held the hands of frightened people dealing with illnesses they can’t pronounce

My preceptor has been exceptional
She asks for my opinion, she gives her advice
She makes herself available, she doesn’t loom over my shoulder
She looks things up when she doesn’t know the answer
She commiserates when the craziness of administration interferes with patient care
She puts up with my constant barrage of “why”
She laughs at my poop jokes

I really like what I’m doing, and I’m glad I struggles through all the garbage of nursing school and emerged an RN.

The horizon

I’ve been quiet for a bit (yet again).

I graduated in December. I finished the necessary hours for my CNL certification in early January. I sat for the CNL test in mid-January. I studied for a couple of weeks and took the NCLEX in early February. I started working a few days later. My daughter officially became a teenager a few days ago.

Feels like I finally got a chance to actually breathe with the next few days off.

To begin, I’m soooooo glad to be done with school. I don’t have all the other stuff looming that was constantly in the back of my mind. Work has been going great. My preceptor is absolutely awesome. She’s supportive and available for questions or assistance without constantly hovering over my shoulder. I couldn’t be happier with the match. I had an enormous advantage over other new grads in that I’ve worked there for close to 2 years and actually was able to pick my preceptor. It would be nightmarish to be manacled to someone I didn’t know and discovered I couldn’t work with comfortably.

The CNL certification was a bit of a denouement, as here on the Left Coast the CNL hasn’t caught on yet. This doesn’t mean I won’t be able to benefit from the education, just that I can’t actually use the certification yet. No letters after my name on my badge, as I’m not practicing within the scope of that title. I don’t mind at this point, since I’d rather lay low and learn instead of trying to flash a bunch of creds after my name when I’m still getting my feet under me. I’ve been told that I’m progressing very quickly, and they’re happy with the decision to bring me on as an RN. That is very cool, as I’m enjoying the work very much.

I’ve been catching up on a lot of blogs since I basically stopped reading or writing much of anything aside from study material for a while there. I’ve noticed a distressing amount of ill will towards patients from those in the critical care field. I don’t know if I just was used to it before, or this is a relatively recent phenomenon. I know there are always the burnt out nurses harping on how lousy their lot is, but the flavor of this seems somehow different. Bloggers I liked and read have become pretty negative. In response, I’ve simply unsubscribed and stopped visiting. I’ll need to make sure my attitude doesn’t follow that path. Great power there is in the dark side, but strong I must be.

I’m not sure what my daughter’s birthday has to do with all this, but it seemed like a milestone. Maybe I’m just exhausted from all the change?

This is pretty much how I feel after going over electrolytes for an hour, or reading blogs surfing for boobies taking another practice test.

I’d be the monkey in this scenario (in case that wasn’t clear).

I’m going right back to that practice CD after I clean up the pee in my pants from laughing so hard. I know that I’ve had songs that I thought I knew the words to and was wrong, but this takes it a bit too far.

OK, I’m really going to study now….

Pet Cemetery

Being so close to taking the NCLEX (still no word on the date) I find myself distracted from this important event by our dog, Kailie.

To really understand the situation, some backstory is necessary. Kailie came to us from my ex-girlfriend. Yup, you read that right: ex-girlfriend. Back when I was a young Indian Brave this woman and I, (whom I shall refer to as “S”) were and item. It lasted a while, and we parted friends, staying in infrequent touch ever since.

Now the weird part.

The Queen and I have known each other for our entire adult lives. We literally met our Freshman year of High School. We never dated during school, but had an attraction that both shared. It so happens that S didn’t treat my then-friend and future-wife very well during the period we were together. Oh yeah, it gets better. You can’t make up this type of stuff.

Fast forward a couple of decades, and now S is dying of cancer. I take a couple of days to spend with her since she has no real family, and end up promising to take care of her kids (how she referred to her dogs, since she never had any). The inevitable happens, and after we arrange for one dog to be placed with a friend, we take the other into our family.

Kailie is a great dog. Potty trained, loves people, doesn’t chew on stuff, likes travelling in cars, loves being wherever her people are (inside or out). Her one difficulty is she was never socialized with other dogs. S rescued her and her sibling from the pound, and then kept them away from other dogs for the entire time she had them. They spent 90% of their time inside, and even more in the last months of her life.

After over three years of loving Kailie, we reached a point where she couldn’t do anything right in the eyes of the Queen. She shed. She walked on flowers. Her food was expensive. She pooped. She was left outside for longer and longer periods. There was no active animosity, but the woman I love had taken a dog in under odd circumstances, having never had more than a guppy in the past. It reached the point where we actively searched for another family to take Kailie. We almost had her placed a couple of times, but her inability to be around other animals was a problem. We posted online in a couple of different places. We worked our friends and acquaintances. We put up flyers.

It finally came down to bringing her in to the pound. I was the bad guy, and I left her there with strangers. It broke my heart walking out of that place. I called periodically over the next week and half, checking on progress to see if she was doing OK or maybe even getting adopted. They had no info for over a week, just that her evaluation was pending. My next phone call I found she had been “put down” because of behavior problems and difficulty adjusting to the environment. She stopped eating, was vomiting, and had diarrhea.

Intellectually, I know that we didn’t really have a choice with the way things were going at the castle. We tried every avenue we could. But I just keep thinking how sad and lonely she must have been, and how I was the one that left her there.

I received an email tonight from someone either starting or possibly applying to my school nursing program. She got my contact info from one of the faculty there (with my permission).

Her email was (slightly edited):

Hi Markie,

I got your email address from XXXXXXXXX. I’m a prospective nursing student and looking for someone who can share their experience with the program while also managing family life. I have a nine month old son and am trying to get a feel for how one balances motherhood with class, studying, internships, etc (I know it’s a relatively short, but intense program!). Unlike working full time, I know being a student is not a 9-5 job. I’d love to hear any insight you are willing to share. Some thoughts running through my mind…

– What’s a typical day like?
– How much evening time is spent in class or internship?
– Do weekends end up being spent 100% in the library / lab?
– What is the most appropriate childcare option given that we’ll want to keep costs to a minimum while I don’t have a salary?

Thanks so much for your time!

Best Regards,
Possible Student

I wrote back to her, and said:

Possible Student,

Thanks for dropping me a line. If by “prospective” you mean “just starting”, then congratulations on getting in.

I have many opinions about the program, but will try to limit them to the topics you’ve asked about. 😉

To give you some background, I have a BA in commercial photography, over a decade in software development, a wife, two daughters, and an hour commute to campus. First off, I don’t think you can safely apply the word “balance” to nursing school. I haven’t gone anywhere else, and I hear it’s tough anywhere, but I suspect the intensity of the 18 month program is above and beyond whatever the norm is.

I half-seriously joke that my wife has been a single mom during the last year and a half. The program will literally take any spare moment you can possibly devote to it. There are always chapters to read, papers to write, projects to work on, quizzes to study for, postings to make, skills to practice, study groups to attend, etc etc. I was a smart slacker prior to this program. I could coast with A’s and B’s without a lot of effort. This program has kicked the spit out of me. I’ve worked harder and more than just about any other time in my life. Continuously. I learned to let go and settle for a B in order to keep myself and my family sane. You simply will not be able to compete with the available time that the unmarried students can throw at the curriculum. Balance is not an option, but success is.

On the other side of the coin, if you really want to get into nursing, and have that desire to help people in some way or another, this program will get you there. The fact that you have a spouse and a child will be to a great advantage. You have emotional ties and commitments that are simply not teachable or able to be conceptualized by people that haven’t experienced them. You’ll bring that to your practice, and your patients will very much appreciate it. It will make you a better nurse.

How you can go about doing it with the family is an individual gambit. You will absolutely need a supportive and understanding partner. A network of friends and family that you can pledge your service to once an RN to lure them in is invaluable.

-Typical day
You cannot expect to actually accomplish much in the way of studying while caring for your son at the same time. The days in the first semester are very long, with a minimum of a couple of hours of difficult reading each day. Not hard to understand so much as hard to absorb. Yes, you know it, but can you repeat it or explain it to someone else? Can you answer questions about the subject matter if quizzed? Knowing the material is different from being able to recognize it (that was a hard lesson for me).

– How much evening time is spent in class or internship?
The classes for us ran into the later evening, 8 or 9 pm. This will vary depending on the instructor and the schedule you get. It will also fluctuate as you move through the program, and do things like go to workshops outside of class and clinicals at a hospital or other site. For instance, you’ll take a parenting class during Pediatrics or Labor & Delivery. That you’ll schedule yourself, and could be at night or on a weekend. Classes themselves are long. As in 3 or 4 hours. You may have 2 or 3 of those in a day. Sleep time will become a rare thrill (remember the first few weeks of your son’s life?).

– Weekends
They can be spent studying, or spent studying. You might be in a study group, or do better on your own. At least part of every day will be studying in one form or another. There’s just no way around it if you expect to pass the courses. A ‘C’ grade in a class will get you on probation. Do it again, and you’re out of the program. The only option is to get a ‘B’ or better. There is simply too much material to cover NOT to study.

– Childcare
The best thing is family and friends. Expect to feel like a selfish pig through the program. You can’t spend the time to cook extravagant meals to say thank you. You won’t have the money to buy presents or take people out to dinner as thanks. You’ll have to promise to answer their questions for the rest of your natural life in exchange for babysitting in all likelihood. Abusing family like that is difficult, and even harder on friends. But it can be done, and it’s only 18 months.

I may be painting a bleak picture, but I want to communicate that it’s not an easy road. The cost of doing this is high. But the rewards are great. You don’t get to change or save someone’s life routinely in a lot of different professions. This will be a strain on your relationships, do not doubt that. But we had two marriages and no divorces in our class. I’ve been blessed with my wife and daughters supporting me throughout the program. Your son will forgive you, and won’t even remember this period.

Sorry to drag on so long about this, as you can see I’m pretty passionate about the whole thing. Please feel free to reply or you can call me on my cell if you’d like to talk XXXXXXXXX

I’m very curious to see if she goes ahead with it or not.

The American President

As Michael Douglas said in The American President, “My fear exists on several levels”.

I find this to be true for me as I approach graduation. I’ve done fine in school. I’m not the best student in our group, but I’m a strong “B”, verging on “A”. Considering the constant pressure of texts to read, internet group postings, papers to write, drugs to study, videos to watch, skills to practice, articles to review, quizzes to study for, exams to study for, practice tests to take, and all the rest of the stuff that comes along with being in school, I’ve never had to deal with so much happening at once. Even working in software with multiple timelines at once I didn’t have so many things to track simultaneously.

And then there’s the big HESI (comprehensive test which is an indicator for ability to pass the NCLEX). This Friday I take the Big One. It has all the content that they can fit in. Geriatrics, Pediatrics, medication calculations, anatomy, drug interactions, Mental Health, Community Health, Med/Surg, nutrition, lab values…. If I don’t pass I’ll have two more opportunities to try. Third strike and you’re out. Out of the program.

So long and thanks for all the fish. Been nice knowing you. See yah, wouldn’t wanna be ya. Elvis has left the building ** cue “God Theme, intro to 2001 a Space Odyssey” **.

And even if/when I get past that test and graduate, there’s the NCLEX looming out there. Sure, just another test. Except that it’s the barrier to my new career. After a year and a half of pre-requisite classes. A year and a half waiting to be accepted into a program. A year and a half of nursing school.

And as flattering as it is to have a job offer at this point, if I don’t pass, that could disappear because of it. Let’s face it, if they can pick and choose, they’ll pick and choose someone who passes their boards on the first attempt.

As much as people say “don’t worry, you’ll do fine”, it doesn’t help. Great, just one more person that thinks I’ll have no problem passing.

If I pass, it’s as expected. If I fail, people expected me to pass.

My fear still exists.

Mean People Suck

It’s been a while since I did a thoughtful post, and that’s mostly due to burning the candle at both ends. I also seem to be in a rut where there are more witches people nurses not using their “play nice with others” manners around me. It’s likely my own perception, but it sure feels like a lot of people are going out of their way to act rudely.

Mean nurse
This woman reminds me of the nurse asking me about my choice of areas once I graduate. She actually sat next to me and said “What are you planning on doing? You know you can’t be in **insert her specialty here** because you’re a guy.”

How 18th century of her.

Another told me that since I was getting my masters in nursing but didn’t have a bachelors “Sounds like you’re doing it ass-backwards to me”.

At that point I wished for the powers of Johnny Storm to be able to taker her out in style.
Human Torch

Johnathan Swift wrote in his infamous “A Modest Proposal”

I have already computed the charge of nursing a beggar’s child (in which list I reckon all cottagers, laborers, and four-fifths of the farmers) to be about two shillings per annum, rags included; and I believe no gentleman would repine to give ten shillings for the carcass of a good fat child, which, as I have said, will make four dishes of excellent nutritive meat, when he hath only some particular friend or his own family to dine with him. Thus the squire will learn to be a good landlord, and grow popular among his tenants; the mother will have eight shillings net profit, and be fit for work till she produces another child.

Swift was (supposedly) making a comedic point, and not actually promoting the behavior he lauds.

Which brings me in a roundabout way to my point: Why are nurses like rodents?

Seriously, there are rats that consume their young, and some squirrels. They are not the only ones, but they convey the reverence with which I hold those people that do the same.

I don’t even really understand it either. I recognize that nurses are under an increasing amount of stress in their jobs. I get that the respect they expect from other members of healthcare is rarely displayed. I see the marginalization dealt them in many situations. That doesn’t explain to me why they would purposely be rude/abrasive/mean to a nursing student or new nurse.

What does this behavior actually gain the offender? Status within the nursing community? Is there some personal gain in making another less experienced nurse feel bad? I don’t see the upside.

And I’m not being sensitive here. I have a pretty thick skin. I don’t have to be offended by such behavior to still recognize it. It’s like an egg timer with a broken dial. It’s constantly ticking, and no one knows when it’s going to just “go off”. Other nurses hit with the spillover as often as not; I’m not the sole focus of their ire.

I believe that the consequences of this behavior have to be consistent, rapid, and severe. No one looks away when a racial epithet is used in the workplace. No one ignores when inappropriate innuendo is used in the same situation. Why should we all just allow this abusive practice to continue? There’s no reason that I see.

Someone find a guitar! We need to sing Koombaya!
Group Hug

Tired bear

First clinical day on my Pediatric rotation.

Up at 5am, off to bed now (11pm).

I think they’re crazy
I’ve had this week off school, so I haven’t had to sit through any long lectures. Maybe that’s made me extra sensitive, or maybe I’ve just had the opportunity to read more non-school stuff due to the break.

But I swear people are losing it.

The state of Washington is looking to pass a law that will make it illegal for people to chant or boo at a college game. This seems to peg the needle on the “We need to be PC” scale. Protect people from racial slurs and dangerous behavior, yes. I absolutely think a college game is an inappropriate place to cast dispersions (or fecal matter) without thought. But I think someone getting their feelings hurt because the other team has a better rhyme is just a tad too much.

Then there’s another state, New Mexico, that’s decided to make Pluto a planet again. Since when do we get to ignore scientific definitions? Can I decide I don’t have to obey gravity? Do I “opt-in” on the whole Round Earth idea? How could it possibly make sense to purposely teach the wrong thing to the kids growing up in that area?

And let’s not stop there. No, state legislators can do more. They want to imprison a substitute teacher for not being able to stop a window popup attack on a computer that wasn’t hers in a classroom she was substituting in. Now, according to the article this woman likely won’t have a movie about her inspiring kids to tackle calculus in middle school, or win a state wrestling championship because of her inspiration. She might not even deserve to continue teaching because she’s been reprimanded about spending too much time not focused on the students prior to the event. But she isn’t promoting porn or trying to show it to the kids. Just an example of a posse of worked-up parents that can thrash the school administration into a lather and over-react.

And speaking of over-reacting — a jury has awarded a man 400K even though the nurse named in the lawsuit was found to not have caused any injury.

On the other side of the coin, there was a recent bruhaha in the medical blogosphere where Scalpel made a bad joke and Graham reacted. Now, I don’t know either of these people, but what looked like an innocent, albeit dumb, misstep (which I didn’t get the joke on by the way), turned into a long back and forth about compassion and appropriate behavior. From my point of view, Scalpel flubbed the joke. Graham and others on his blog called Scalpel on it, and told him exactly why it was a bad joke. This is where I was a bit surprised. Scalpel took the stance that it’s his blog, his opinion, and he doesn’t care what anyone else thinks. I can understand that — to an extent. Don’t read it if you don’t like it. But what it fails to recognize is the public-ness (I just made that word up) of the posting. While I may not have been offended by the joke, the fact that someone was and made it known why in a cogent and respectful manner seemed dismissed by Scalpel’s rebuffs. That just strikes me as wrong headed. Why not try to learn some compassion and sensitivity. The “Oh you can’t take a joke” mentality tends to allow for inappropriate behavior under the guise of “just funnin”, but it’s not fun for everyone.

Now I really need to get back to the real world.

I’ve only caught bits and clips of this guy’s show, but I tripped over a link to this video and have a lot of respect for the guy now. If it’s a marketing ploy, he’s got me fooled. I’ve been around my share of alcoholics, and can appreciate much of what he touches on.