girl in greenwood

Since Meeegan asked - I am working tomorrow (Saturday) for 12 hours. I'm off on Sunday, though!

I forgot one thing on my list of stuff I've learned so far - working as a nurse is excellent for dieting if you can avoid the junk food in the staff lounge. I barely have time to sit and eat my lunch - and I'm not even up to a full patient load yet. Also, I'm down 10 pounds since taking the NCLEX. Just 20 more to go to get back to my pre-nursing school weight. It's like I was pregnant for two years, or something.

Tomorrow I'll be moved up to taking two patients. I handled one today pretty much independently and it went well. So I hope I don't have a meltdown with two tomorrow!

Labels: nursing

I've worked on the floor at BCH for 5 shifts and here are a few things I've learned so far:

1) There is a device for cleaning out gnarly wounds called a waterpick. I did not know such a thing even existed before last week.

2) Fentanyl lollipops (excuse me, transmucosal delivery systems) don't look like lollipops at all. They look like an instrument that is the perfect size to shove into a nostril, actually.

3) If you are a morbidly obese diabetic man, you may want to look into personal hygiene, before you develop an infection where the sun doesn't shine. Holy crap, I've never seen wounds like that before.

4) Apparently having a rectal tube (excuse me, fecal continence management system) installed feels like "having a Ho-Ho shoved up [your] butt". Or so my patient informed me.

5) If you inject heroin into your subclavian veins, Very Bad Things can happen. If that's not quite enough information for you, google necrotizing fasciitis. See? Very bad.

6) Working 2 12-hour shifts on consecutive days makes my hips ache by the end of the second day. But with support socks at least my feet don't hurt.

7) I really need to work on my time-management skills.

8) I probably need to make myself a more structured brain sheet/to-do list if I'm going to not forget stuff.

Labels: nursing

Took the NCLEX today. It shut off at 75 questions, which is the minimum. I think I feel okay about it. I won't know my results for a couple of days. Stay tuned!

Afterwards, I went for burgers and beers with two classmates, then we went over to classmate E*'s house and drank beer and watched a movie, until more classmates arrived and we gave up on the movie and gossiped instead. It was fun.

Labels: nursing

I overheard an interesting point of view tonight at clinical. A patient was admitted to the floor, apparently had been nauseated and over-sedated in the ER, came to the floor and complained of major pain, then began to projectile vomit. Lovely. The nurse was advocating strongly for the patient, saying "I need pain meds for this patient, they are hurting badly" and generally agitating to get the patient's meds ordered right away. But then behind closed doors, I heard the same nurse saying that she didn't feel any sympathy at all for the patient, because the chronic pain issues are the result of blown-out knees secondary to morbid obesity. In fact, the nurse said something along the lines of, "I feel sorry for the patients with brain tumors because they didn't do anything to bring it on, but the ones with problems from obesity I don't feel sorry for at all because they made that choice."

Wow. That's not very compassionate. And it made me wonder: Is this attitude okay? Does the patient with morbid obesity deserve less sympathy than anyone else? The nurse didn't appear to TREAT the patient any differently... but her attitude was pretty clear. And I also wondered if it's even fair - once someone gets overweight for whatever reason, it is really really hard to lose, especially if you have blown out your knees and can't exercise effectively.

What do you think?

Labels: nursing

More support stockings.

More UnderArmour to prevent chafing.

A fancy clipboard with a calculator on it.

This book.

A pocket security blanket, because when in doubt, I do research.

I am scared to death of starting my new job, actually, in case you couldn't tell!

Labels: nursing

I accepted the job at Big County Hospital today. I had an interview at University Teaching Hospital that actually went really, really well... but even so, I think I will be more comfortable with the BCH job. The UTH job was on a very busy mostly surgical unit, and I was frankly intimidated about the idea of trying to learn about all these complex surgical patients while at the same time trying to figure out how to be a nurse without passing out from anxiety. I like the idea of learning from the ground up with all the other new staff. I really like the idea of being in a position to help develop a positive culture on a new unit instead of stepping into established political crap. And I like the idea of having mostly medical patients. Diseases are interesting.

But, the experience of having a really good interview and having the nurse manager offer me the job on the spot was extremely affirming. I had this irrational fear that the nurse manager at BCH was hiring everyone with a pulse just to staff her unit... but today's experience gave me a lot more confidence.

Now I just need to finish the quarter, pass the boards, and get a license. You know, piece of cake. Haha.

P.S. to Doug - 0.9 means 90% of full time, in this case 36 hours/week in the form of 3 12-hour shifts. That means FOUR DAYS OFF every week, rock!

Labels: job, nursing

Job stuff update:

Big County Hospital offered me a 0.9 day shift position with orientation starting June 2. I have not told them yes or no yet, although I did send them an email letting them know that I got the offer, I am interested, but I have another interview scheduled. The reason they have day shift jobs, which is an excellent jaded cynical old nurse question, is because it's actually a new unit. The hospital is expanding and this is one of the new units that will be opening up when the construction is complete, so they're hiring for all shifts right now, both new grads and experienced nurses.

University Teaching Hospital is interviewing me next week. If I understood correctly, the interview is with the nurse manager on the ortho unit where I had clinicals a couple quarters ago. I didn't love that unit but didn't hate it either. So we'll see how that interview goes, and then I'll make a decision. I feel so lucky that I may well have a choice of jobs.

In other news, I am sick sick sick with a cruddy cold that has robbed me of my speaking voice and filled my head with snot. I dragged my arse out of bed this morning at 5:00 to get to clinical by 6:00 where I supervised 1st quarter students for a few hours, then went to campus and took a terribly difficult test (I passed! Not all my classmates did so!) and stayed for lecture. And now I am home and I am going to bed. Night night.

Labels: job, nursing, nursing school

I went to my interview at Big County Hospital yesterday - I met with the HR nurse recruiter and with the nurse manager for the new med-surg unit that is yet to open. The manager from the tele unit cancelled on me, not because she was disinterested, just a scheduling conflict (according to the recruiter). That was fine - tele was my second choice.

So I interviewed with the med-surg nurse manager, and she was very nice, calm & low-key. She was looking at my resume and saw that I went to KSU, and it turned out that she was born half an hour away from where I grew up. Small world. She asked me a bunch of those interview questions ("how do you deal with conflict?" and so on) and then we toured the unit that will be converted into the new med-surg unit. I had clinical on that floor in the past, so it was familiar. I asked the NM lots of questions, too, and I was pretty pleased with her answers.

So. It wasn't True Love at First Sight, but it seemed like a pretty good option. There are several factors in the plus column: a long preceptorship (12 weeks!), day shift hours are available, it's a vibrant academically-oriented environment, the patient population is highly variable, the pay is competitive. There are a few minuses - there's nothing swanky about this hospital including the cafeteria, it's in a kind of crummy part of town that does not make me feel safe, parking in the hospital garage is expensive. Still, it would be a fantastic experience.

Then when I got home I had a request for references in my inbox from the University Teaching Hospital. I applied for three positions there and I'm apparently being considered for two of them. I don't know if anything will come of it, but we'll see.

Oh, and as a special bonus from being in the nursing home full of sick people all week, I seem to have come down with a cold. I'm taking fistfuls of echinacea and other herbals as well as Advil Cold & Sinus, and chugging vast quantities of liquids. I don't have time to be sick!

Labels: job, nursing

I have been getting up way, way, way before dawn to go to clinical this week. What I've learned: I really like mentoring the first quarter students. I am flattered and encouraged by the confidence the faculty is placing in me. And I really, really don't want to be an RN in a nursing home, because it is all about paperwork and hardly any patient care. That is actually good information for me, because I previously thought that I would be interested in nursing home work.

I have two interviews at Big County Hospital tomorrow morning. One for med-surg, one for telemetry. Both are for new graduate RN positions, which I imagine will have a long & thorough training and preceptorship period. I will know more about that tomorrow. I do know how much their starting pay is, and it is not too shabby. Also, both of the units I'm interviewing with have day shift positions available! That's pretty great, considering that most new grads end up working nights until they earn some seniority.

More tomorrow.

Labels: job, nursing, nursing school

Baby Catcher: Chronicles of a Modern Midwife
by Peggy Vincent

I enjoyed this book so, so much! One of my classmates recommended it to me while we were in our labor & delivery clinicals in nursing school. I was fascinated and moved by the author's description of her work as a nurse-midwife. I had several realizations while reading this book: I am not cut out to be a labor & delivery nurse; it's a shame that the medical establishment is reabsorbing the homebirth movement; I really don't want to have a medicalized birth when I have my own child; and I feel like my labor & delivery clinical experience was a freakin' joke.

I'm not cut out to be an L&D nurse because I feel too inexperienced. I know that the author of this book went into the field without having birthed her own children yet, but I really don't feel I could do that. I'm also not sure that I want to become such a specialized sort of nurse, especially considering my anti-medicalized birth rant that is forthcoming.

Part of what Vincent writes about in this book is her experience with being an L&D nurse in San Francisco during the 1970s, where she met women who wanted to take charge of their own birth experiences and refused drugs, IVs, and confinement to bed. She was frustrated with (mostly male) doctors who imposed their concepts of how labor "should" progress on women in labor. Most memorably, one of the doctors told Vincent that a normal birth was always a retrospective diagnosis, and that he considered birth to be complicated and unsafe until proven otherwise. Inspired by these women, Vincent went to midwifery school and started her own business as a midwife and delivered thousands of babies at home.

But as medical malpractice cases increased and insurance carriers refused to insure nurse-midwives, practitioners like Vincent found themselves unable to continue their businesses. Vincent is upfront about the fact that she continued to deliver babies for friends and previous clients, but informed them that she was uninsured ("going bare"). There are still midwives available in some places, such as here in Seattle, but medical insurers are making it more and more difficult.

Which brings me to my personal preferences... I am well aware that I have never given birth, so all of this is basically a**talk. But it's well-educated a**talk. When I think "hospital birth," I think IV, continuous fetal monitoring, contraction monitor, limited ability to get up and move around, doctors wanting to deliver the baby in a certain timeframe and on a certain schedule, encouragement to use narcotics or an epidural, nothing to eat or drink throughout the entire labor, episitomy, 30% or higher rate of caesarean section, and delivery flat on my back with my feet in the air. When I think "midwife birth," (and let's be clear, I have no intention of giving birth at home, I would much prefer to go to a birth center) I think eating & drinking what I want, intermittment fetal heart monitoring, no drugs, no IVs, ability to move around, get in the shower or tub, get down on the floor if it feels right (knowing what I know, I would NEVER get down on the floor in the hospital!), and laboring at my own pace in the positions of my choice. This sounds way more comfortable to me. I fundamentally trust that my body will know what to do and do it well, and I don't need a hospital for that. If something were to go wrong, there are more hospitals in Seattle than you can shake a stick at, and I could be transferred by ambulance in a very short time.

Finally, I feel really let down by my clinical experience after reading about Vincent's student nurse experiences. I did witness one baby's arrival during my clinicals, but it was a c-section and the mother was not in hard labor at the time the decision was made. I didn't see any women in serious labor. I didn't see any vaginal births. I didn't even care for any postpartum women who had had vaginal births, so I didn't even get to see what stiches that repair lacerations look like. I thought it was going to be a really educational, uplifting quarter and it just wasn't. All I learned in the hands-on way was that I really don't want to give birth in a hospital.

My nurse opinions aside, this is an excellent book and I would recommend it to anyone wanting to read honest and open descriptions of lots of different births, including a few that didn't go well. Plus there's a bonus recipe in the back of the book for caramels that sounds really yummy. And there's a lot of resources for additional information - articles, websites, and other books.

Labels: book reports, nursing

I've had an interesting experience at work in the last week - I worked two shifts masquerading as a CNA rather than my usual team-nursing nurse tech role. (Why would I do such a thing? One day I got called in because of a scheduling mix-up, and I was available so I went, and the other time was because I'd agreed to cover a CNA who needed a day off.) At my hospital, CNAs are responsible for about 8 or 9 patients, and take care of the basic caregiving stuff such as: checking vital signs, bathing, changing beds, ordering meals if patients need help, helping patients eat if necessary, toileting, monitoring intake and output, refilling water pitchers, emptying catheter bags and wound drains, toting meal trays to the tray return cart, taking out laundry bags, and answering call lights (which ends with, "I'll tell your nurse" about 50% of the time). Okay, so since I usually do primary care for my own patients, I do all that stuff on a usual day, but not for 8 patients!

Things that I didn't have to worry about as a CNA were: attending report, passing meds, assessing pain, troubleshooting IVs, talking to doctors, or documentation.

One of the RNs who precepted me earlier this summer asked me which I thought was harder - the CNA role or the nurse role. I actually hesitated quite a while to think it over - and I'm still not sure. I felt busier as a CNA, because I had to see to the needs of so many different people. But I felt like I was much more superficially involved with each patient - I didn't even know what many of their diagnoses were, and I did no followup whatsoever on their plans of care. I just covered the basics and passed the buck for anything else to the nurse. I actually found that deeply unsatisfying, because I wanted to know what was going on with the patients. Were they getting better? Worse? Would they be discharged tomorrow? Were they getting medicines that might be causing unpleasant side effects?

I think this means that I am thinking like a nurse. This is a good thing.

Labels: nursing

May posted today about (among other things) what she does when a patient has something negative to say about another nurse. This is what May said:

sometimes, they have bad things to say. to that i say something to this effect: “i’m sorry you had some problems with your nurse today, i’m sure she/he had reasons. sometimes, we do get crazily busy around here.” this is not because i am some sort of a saint or a hypocrite or something, but i just think it is unprofessional to fire up negative issues. there are a lot of real issues we need to deal with, and nurse bashing, or the implication of it, in my opinion, should not be one of them.

I appreciate May's tact! I dealt with a similar situation at work recently, where a patient called me in to ask me to get some clean linens, and spent the whole time I was changing the bed ranting about the nurse who had been taking care of him all day. He complained about his pain control, his perception that his nurse had been ignoring him, and about his frustration with being sick and not knowing why he was sick or when he would get better. My first reaction was to feel defensive about his nurse - she is a terrific nurse and had been taking good care of him - but before I opened my mouth I realized that this didn't have anything to do with his nurse. So instead I said something like "I'm not going to defend the nurse because I wasn't here and I don't know what happened between you" and then followed up with "Of course you're frustrated, you don't feel well and you are hurting!" and he visibly calmed down. He continued to vent and I continued to acknowledge his feelings and by the time I finished making the bed, he was much calmer and apologized for unloading on me. I told him it was no problem, that I was glad he felt better after getting it off his chest.

Labels: nursing

If the medication record says that your elderly patient is supposed to be wearing a nitroglycerin patch from 8:00 pm until 12:00 noon, you should go in and look for the patch at the start of the shift instead of waiting until nearly noon, at which point you will go into the room to remove the patch and instead find that your patient has not had a patch on all night and is now having angina (chest pain, for the laypeople in the audience). Because then you have to take some vital signs and get even more concerned when your patient's heart rate is in the 130s and he's saying, "It hurts here" and pointing to his jaw and chest. And then you'll have to go find the doctor and give your first-ever report to a real live doctor in an urgent situation. And the doctor will look alarmed and say "get a nitro patch on him stat and call for a stat EKG" and then you'll start to wonder if Something Bad is going to happen. And then the guy comes in with the EKG machine and says "Hmm, sinus tachycardia, oops, there's some a-fib" [translation: his heart is being really fast and sometimes it's not beating right]. Criminy.

The outcome was all right by the end of my shift - the patient was in a tele bed [translation: he was hooked up to a machine to monitor his heart rate and blood pressure automatically] and got some medications and was doing fine.

You can bet that if I see another order for a patch of any kind on a patient, I'm going to go look for that patch with a flashlight and a hunting dog, if necessary.

Labels: nursing, work

I'm officially done with orientation at my new job. Last week I spent two days shadowing a nurse and two days caring for one patient pretty much on my own. This week I've cared for 2 patients on my own for a couple of days. I'm off tomorrow, but when I go back, I'll be practicing the team nursing concept. It will be kind of like being an LPN, I think - I will be teamed with an RN, and we will be assigned a larger-than-normal set of patients. For example, if a normal patient load for one nurse is 5 patients, my team would be assigned 8 patients and I would take 3 of them, or something like that. The reason that it needs to be a team effort is because my employer doesn't permit nurse techs to handle IVs, like, at all. All I can do with IVs is assess IV sites and troubleshoot the pumps.

I feel like I'm starting to get the hang of it... I'm doing a decent job of taking care of my patients, and I know where most supplies are and what the usual routines on the floor are like. Of course there are things I can work on - that will never end, I'm sure! I think the first thing I need to do is create a brain sheet that will help me stay organized better.

I'll get my first paycheck later this week. I think that will be the best part. Being a broke student is frustrating!

Labels: nursing, work

I just finished my third day of orientation for my new nurse tech job. I spent all three days at one of the big campuses of the hospital, even though I'll be working at Neighborhood Private Hospital. It was mostly snoresville like I was expecting, and I really did read an entire novel during the course of the three days, although the biggest chunk of the reading occurred at lunchtime and only a little under the edge of the table while various people yapped about corporate culture and whatever.

Overall, though, I was impressed with how organized the whole experience was. There were lots of people from different departments who came to present to us, and they all had Powerpoints and handouts and were able to answer questions. They provided us with breakfast the first day, and had coffee and tea and juice and water available for us all the time. We learned today in a nurse tech-specific session that someone from the professional development area will be coming around to our units every couple of weeks to check that everything is going smoothly for us in our new role. It all sounds pretty great.

Next week I'll go to the unit where I'll be working and start orienting there. We'll see how that goes!

Labels: nursing

Okay! I finished 4th quarter on Wednesday. Final grades haven't come out yet, but I believe I'm going to get a 3.5 in both classes.

We signed a lease on the apartment I mentioned previously. Now we are in the middle of packing up and getting rid of stuff, putting other stuff into storage, and generally trying to make our house look beautiful and uncluttered so people will want to buy it. My parents are going to come help us do some of the last repairs and painting and stuff, which will be excellent.

I'm looking forward to the opportunity to get rid of extraneous stuff. It feels good to simplify a bit. But it sure is a lot of work to go through everything we own and make decisions about whether we're going to take it with us, throw it away, Freecycle it, give it to someone specific, or put it in storage.

New job starts on Monday. I talked to my new boss this week and she told me she's going to have me orient with the RNs, so I don't know if I'm going to be a "junior nurse" and have my own patient load or what! Regardless, I'm looking forward to it and I'm sure it will go fine. This first week is going to be all classroom orientation, anyway, which will be snoresville. I've done clinicals at this hospital before so I already know how their documentation works, how to use the Pyxis, which brand of blood glucose monitor they use, blah blah blah. I think I'll take a book and read under the table like I did in 5th grade social studies class. Haha.

Labels: moving, nursing, nursing school

In a moment of complete dorkiness, I'm going to show you all the new scrubs my sweet mom bought me for my new job.
Thanks, Mom!

Labels: nursing

Happy Nurse's Day to all the nurses out there. I can't wait to join your ranks next year!

I read a lovely, lovely tribute to nurses on an infertility blog - please take a moment to read it because it will make you feel good.

Dear Nurses

Labels: nursing

Passage
by Connie Willis

I felt a strong connection to this book, as it dealt with many of the issues I've been pondering over the past couple of years: medicine, end-of-life issues, what happens in near-death experiences, Alzheimer's disease, how survivors deal with loss when someone dies, hospitals...

The main character, Joanna, is a nurse working on a research project interviewing people in the hospital who have had near-death experiences. She believes in her work but is often frustrated and thwarted by a colleague who contaminates the subjects' stories by blathering about angels and spirits and generally convincing everyone to follow his script of a near-death experience. Joanna meets a new researcher, Dr. Wright, and gets involved with his project which involves creating near-death-like experiences using drugs and sensory deprivation. He is trying to discover the biolgoical purpose for near-death experiences. Joanna and Dr. Wright try to find unbiased subjects on whom to experiment, but have a lot of trouble finding volunteers who are not biased by the angels/light/tunnel script or do not have trouble getting into the near-death-like state. So, Joanna volunteers to undergo the experience herself. She has no difficulty reaching the correct mind-state, but perplexingly, always finds herself on the Titanic just before it sinks whenever she undergoes the procedure. Joanna has the feeling that the Titanic is somehow related to something she learned in a high school English class, but when she goes looking for her English teacher, she finds that he is now in the throes of Alzheimer's disease and can't explain to her what she wants to know.

Then something really sad happens.

I was completely entranced by this book. It was clever and smart and touching and sad all at the same time. It probably helped that I read it during a power outage when I was feeling sort of displaced and confused already. And I love the way the book wrapped up, with an answer of sorts arising out of the Really Sad Thing.

Labels: book reports, nursing, science fiction

A selection of the health-care nonfiction I've read recently.

Cutting Remarks: Insights and Recollections of a Surgeon
by Sidney M. Schwab

Dr. Schwab is a well-known blogger who has written a book reflecting on his medical career. I checked out his book after I read someplace that he lives in Western Washington - which is a dumb reason to pick up a book, but I really enjoyed it, so I'm glad that the reason presented itself. There is a stereotype that all surgeons think they're God and are assholes to the nurses, the med students, etc... but either Dr. Schwab is an exception to the rule, or he's in deep denial. He writes about events in his career with a sense of wonder and humility. And he's had a lot of events, including a stint overseas during the Vietnam War. Best of all, the man is FUNNY. I really liked this book and am now a devoted reader of his blog, too!

Nursing America: One Year Behind the Nursing Stations of an Inner-City Hospital
by Sandy Balfour

I was excited to read this book based on the description - I haven't had any experience with the nitty-gritty of nursing in an inner-city hospital and so I'd like to learn about it. But while Balfour did a great job of portraying the personalities and convictions of the nurses he shadowed in Memphis, he shied away from the medical details. For example, I was intrigued by the burn unit nurse who said, "I love to clean a dirty burn!" but there was no following description of what she would actually DO. However, Balfour did hit on some very serious and pertinent issues in nursing in a public hospital, such as the constant budget strain, race relations, noncompliant patients, and the stress of working under all of those pressures and more.

Forensic Nurse: The New Role of the Nurse in Law Enforcement
by Serita Stevens

This book was informative, but I didn't think it was very well written. I did learn a lot about an area of nursing I had previously not been aware of - forensic nursing. Forensic nurses contribute to law enforcement by collecting evidence and testifying in court. For example, a forensic nurse might examine a rape victim and testify about the evidence that she found at trial. Or an FN might examine a child or vulnerable adult when abuse is suspected, or even examine a corpse for evidence of homicide. The case examples were very interesting and did a great job of clarifying the role of the forensic nurse. However, the book could have used a tighter edit - it was kind of repetitive and I was distracted by the "political" remarks that the author made. I don't mean political as in about government politics, I mean political as in airing complaints about different factions in the nursing community. I found that a bit jarring. Overall, though, this book is worth a skim if you're interested in learning more about the field of forensic nursing.

Labels: book reports, medical, nursing

I have a huge backlog of books that I've already read but haven't written up, and it occurs to me that I'm starting 9 months of school in a few weeks and I don't really see myself doing a lot of book reporting in that time... so prepare yourselves for a great deal of literary rambling. If book reports bore you, come back next month when I'll have interesting nursing stuff to talk about.

But before I turn back into my former lit major identity, I want to write some more about working with hospice patients. I know it's too early in my nursing student experience to declare what I want to do - but I really think I like working with people near the end of their lives. Putting that down in black & white sounds kind of morbid, but my most satisfying caregiving experiences have been with patients who are on hospice or about to die.

I've already written about Hospice Lady, who I think is just holding on because her children are going to come visit her soon. There was also Tired Lady, who went rapidly downhill and passed away peacefully in her sleep (my name for her refers to the fact that over the last week of her life, every time I asked her how she was feeling, she said "I'm just so tired." I think she was just done, you know?). I was one of her caregivers during that week and while it seemed obvious to me that she was going to die, her family and her doctor didn't seem to notice. Interestingly, her children called me every time she needed anything at all - help to the toilet, changing a soiled nightgown, eating some food (although they were successful in getting Tired Lady to come up with something that sounded good to eat), getting dressed, whatever. Of course I was glad to do all of it - but it was neat to have this moment of "aha! that's why I'm here! Her family is dealing with emotional stuff and baggage and can't just take care of her, so I will!"

And finally, the last couple days I took care of Bedridden Lady who was given less than a month to live... six months ago. She is basically unable to bear weight on her limbs and can barely speak, and spends most of her time in bed. I didn't do anything heroic while caring for her - I fed her and changed her and put lotion on her face and cleaned her mouth and put some moisture goo on her lips and opened the blinds when she gestured toward the window. And all I got in return was some smiles and a couple of "thank yous" - but that was more than enough.

I know a lot of people are creeped out by caring for patients who are near death - and even my husband has asked me if I'm setting myself up emotionally by getting attached to terminal patients. But I'm not. When Tired Lady passed away I felt relieved for her - she was just so tired, and now she can rest. And when Bedridden Lady and Hospice Lady pass on, I will be relieved for them, too. I will miss Hospice Lady but I know she's ready to die, and that death will not be a sad thing for her. And spending time with her near the end of her life has been a joy for me, and for her - I know because she tells me! It is really, really rewarding for me to be present with these people.

Who knows, I may end up feeling this excited about other areas of nursing as well. Which is why I won't make up my mind until I've been through all my clinical rotations... but I have to say, I'm really drawn toward hospice work.

Labels: CNA, nursing, nursing school

One of my residents who is on hospice told me she was ready to die.

She is very weak and mostly incontinent, but is still able to get around a little in her wheelchair. She takes pleasure in spending time with people, passing out hugs and kisses in the dining room like a politician running for office. She has very little appetite but still eats a bit at each meal. She has some memory loss but is perfectly capable of holding a conversation and expressing herself appropriately.

Last weekend I worked the evening shift on the floor where this resident lives. And when I was getting her ready for bed, she told me she wanted to die. I took a deep breath and said, "you feel like you're ready?" and she said yes. I sat down and took her hand, and said "It sounds like you're tired of the way things are now." And she exclaimed, "Yes! I'm exhausted!" I told her I could understand why she might feel that way. She got very quiet for a few minutes and patted my arm and petted my hair (I have long hair and was wearing it in pigtails) - she seemed to find the touch reassuring. Then she said, "Maybe I just won't wake up tomorrow." And I agreed, "Maybe you won't. Or maybe you will, and either way, whatever happens will happen." She smiled. I asked her what I could do for her before she went to sleep - she wanted a drink of water, and a hug and a kiss, and then she smiled again and said, "And hit me over the head with a baseball bat!" I couldn't help but laugh... but pointed out that I wasn't going to do that. She said, "Well, I don't have a baseball bat anyway."

I sat with her for a little while longer just holding her hand. She told me after a few minutes that she would be able to sleep. So I kissed her goodnight again and went on my way.

How did I do handling this situation? I wanted to make it clear that it was okay for her to talk with me about dying, that I wasn't uncomfortable or creeped out. She seemed comfortable with my response.

Labels: CNA, nursing, nursing school

Do you have Britney Spears in your head now? No? Then go back and read the title of this entry again.

Today was my first day training at the Old People Hotel. I've been away from the CNA role since April 1st, which really isn't that long. And I've had 10 weeks of nursing school, which really isn't that much. And yet I found today that I feel completely differently about the CNA job than I did in April.

The girl who trained me is actually one of my classmates from my CNA training class last fall, which was a nice surprise - it was nice to see a familiar face in a new setting. But I was very much struck by the attitude of "getting my work done" that all the CNAs showed - not that they are uncaring or abusive to the residents in any way. But instead of putting the residents' well-being first in their minds, they are more concentrated on finishing their tasks on time. That is such a contrast to the conditioning we've gotten in nursing school, where we are taught to be primarily concerned with the client's needs and preferences even if that makes our job harder. (Up to a point, obviously.)

I think I was probably somewhat this way before starting nursing school, although I'd like to think that I was more attuned to what my residents wanted and needed. I guess it was easier at The Home because the residents were for the most part more "with it." So it was easier for me to remember to respect their individuality, because they would remind me.

In any event, I'm pretty sure that what my nursing instructors would tell me to do is to model the behaviors that I believe to be correct. So I will model good teamwork, respectful treatment of residents, and personal responsibility. And I will earn my stardust ('cause you sure can't call a CNA's wage "money") and keep my head down until it's time to go back to school.

Also, I went to the gym and worked out after work - and then soaked in the hot tub for my aching feet. I am not used to be on my feet 8 hours a day anymore.

Labels: CNA, nursing, nursing school

Nurse
by Peggy Anderson

I read this book while in a frenzy of nurse-book-reading last year. This was a tough read for me - while it was published in 1990, the author reminisces about her beginning years as a nurse in the early 1970s. Man, things were different then. Not only did she have to wear a ridiculous uniform, the (all male) doctors treated nurses like crap, and there weren't as many technological advancement to treat severely ill patients as there are today. The procedures and techniques she writes about are mostly obsolete today (like when she makes fun of other nurses for putting gloves on to do peri-care [that's butt-wiping for those of you not in the health care field]) - but the emotional experience of being a nurse has not changed. It's still tough to see your patients lose their battles with cancer or heart disease, it's still hard to get chewed out by a family members, and it's still rewarding when you realize that you've made a difference in someone's life.

I was chatting with the director of the nursing program yesterday about my reading habits, and she was pleased to hear that I'd read some of these not-so-recent nurse stories. She made the excellent point that some of the nurses who were trained in the 1960s or 1970s are still working in the field today, and knowing what their experiences were like may help me see things from their point of view.

Nightingales: The Extraordinary Upbringing and Curious Life of Miss Florence Nightingale
by Gillian Gill

No nurse's historical background is complete without reading about Florence Nightingale. I personally didn't know much about her, just that she was considered the founder of nursing, and that she was known as the Lady with the Lamp.

The book begins with a detailed genealogy of Flo's parents and their families... which seemed boring to me but does have relevance later in Flo's life. One of the major familial themes has to do with the inheritance law in Great Britain at the time - since women could not own property in their own right, the ladies in the families were desparate to produce sons in order to preserve their own lifestyles. This sets the stage for Florence's mother's complete outrage when Florence refuses to marry. Florence had a sister, but no brothers, and so after the death of her father, her mother was out on her ear. Okay, not literally, but one of Flo's cousins inherited the family estate because Florence's mother could not legally inherit her husband's property.

Anyway, about the nursing stuff - it seems that Flo was always a very religious and very sensitive, guilt-ridden child. She decided quite early in childhood that she wanted to care for needy creatures, and took in countless pets. She also cared for her sister and her cousins (she was very close with many of her cousins) when they were ill, and seemed to take great pleasure in the act of caring. One theme that cropped up over and over in Flo's private writing was of her overwhelming guilt about some unnamed bad thing that she felt compelled to do over and over. I crassly interpreted that as masturbation, but the author believes that Florence had a deep tendency to daydream or fantasize, which took her away from the concerns of the material world, which caused her tremendous guilt.

Oh, right, the nursing stuff. Florence insisted on taking nurse's training, which caused her upperclass family no end of grief. At that time, nurses were either nuns (and the Nightingales were Protestant) or else they were "working girls" who were alleged to be drunken prostitutes and lousy patient advocates. Florence refused to back down and eventually her family gave in, reluctantly. After training, Florence immediately took on an activism role, advocating for sanitation, a healthy diet, and peaceful surrounding to help patients heal. During the Crimean War, British soldiers in Turkey were dying hand-over-fist, and with the help of her family's connection, Florence managed to get herself appointed to the hospital treating the wounded at Scutari. She loaded a ship with medical supplies that she convinced wealthy friends to donate, recruited a staff of women to train as nurses, and took off for Turkey. The Army's medical director was not impressed with Florence's demand that he give over operations of the hospital to her, but eventually changed his mind after she sad, mule-like, out on her boat in the harbor and refused to hand over the medical supplies.

Once she got inside the hospital, Florence insituted all kinds of changes. She insisted that each soldier needed his own bed with clean linens. She demanded that the dressings on the soldiers' wounds be changed regularly, and the wounds washed with soap and water and redressed with clean bandages. She insisted that the kitchen be sanitized, and that all the soldiers required a healthy diet to be able to heal. And most of all, she showed the wounded men that she cared, personally visiting each one of them. She got the name "The Lady of the Lamp" because she carried around a small lamp as she walked the wards at night visiting soldiers who couldn't sleep or needed comfort.

There's a lot more that Florence did to advance the profession of nursing. But since I'm not writing my own book on her, I'm going to stop there.

Labels: book reports, nursing