energy slump!

I have sort of been dragging my feet on everything for the last couple of weeks. I can blame part of it on having had bronchitis, and it's lingering effects. But part of it, I think, is just due to getting a lower grade than I expected to get on my midterm clinical eval and letting it get me down. A B+ is a fine grade, but I had it in my mind that my semester was going so well that I deserved an A. Woe is me. Not.

Asking around to my classmates, I haven't yet come across anyone who got an A on their midterm eval, not even an A-. And a general theme in the feedback is that we need to exhibit more confidence in the clinical setting.

That feedback and grade, unfortunately, I let have the opposite effect on my confidence. I skulked into clinical feeling worse about myself, and self conscious, and wondering what it was I had been doing that made me seem not confident (because up until that point, I had felt confident!).

I think a big part of doing well in nursing school clinical is letting go of the anxiety about being judged, and just diving in. I hope that by next Monday, when I go back, I won't be feeling sick anymore, and I can really bounce back and go full steam ahead.

My teacher told us not to do that.... :-/

So, I took 3 patients yesterday, from morning 'til post conference. The assessment and morning med pass time period was pretty hectic, and I got kinda sweaty (from being nervous I think, not from running) but it all worked out. It was complicated some by two antidepressants for different patients not being available on the floor and having to contact the pharmacy multiple times (and ways) to get them there. Also, at one point I needed to give my patient morphine, both oral and IV push forms were prescribed either routine or PRN, and I pulled the wrong one out of the pixus the first time. There was a line of staff nurses waiting to use the pixus and I let myself go more quickly than I should. Also, there are three pixus machines on the floor and I had to go to all three of them to get the various medications one of my patients needed.

But I got through it! Yay! I think I'm the first one in my clinical group to try three patients. The two that I spent the most time with (they were higher needs than the 3rd, who had her family with her and was just waiting for surgery) kept bragging about me to my clinical instructor or my staff nurse, whoever would listen. So apparently I did OK. Even with re-heating one patient's coffee about 15 times while trying to get through morning med pass.

Back to the title of my post though... so we are covering central line care and use in school right now, and one of the things my teacher for that subject emphasized, was that whenever you have a catheter going into someone's blood stream, peripheral or central, if the dressing is loose, or soiled, or the site is leaking, you've got to take care of it to prevent infection. Makes sense, no? But she said she ran into IV sites that just had their loose, sloppy dressings taped down a million times rather than removing and replacing them, and that's one of her pet peeves.

Two of my patients yesterday had sort of alarming looking PIV's; one was on a hand, and the dressing was half off. It was awkward placement and I'm sure with eating meals and just going about her day it was pulling loose constantly. The other one had a fair amount of blood visible leaking from the site, underneath the bandage. I asked my staff nurse about it... we haven't been taught to insert IV's yet, but I could change the dressings, could I do that? And in both cases she declined. "Just tape it back down," she said, and to the blood: "Yeah, it was like that yesterday, too. The thing is, she has really difficult veins, and I'm worried if we take the dressing off, the line might come out, too." I heard the words come out of my mouth, "My teacher told us not to re-tape dressings down, just to replace them..." and immediately felt like a little snot. Luckily, my tone wasn't attacky, and she just smiled and said if I wasn't comfortable, she could do it. She is a fairly recent (in the last 2 or 3 years) grad of the program I am in so I'm sure she gets where I was coming from. I suppose I could have advocated more strongly.

I've never been that comfortable with I & O's... for one thing, their meal tray is brought by the CNA and might disappear before you have a chance to look at it. For another thing, remembering how many mL is in a carton of milk vs a plastic foiled cup of OJ vs a styrofoam cup is just bewildering. And some staff nurses prefer you to chart them while others want you to write down the amounts on a little paper inside the closet doors for them to collect at the end of the day. I've got a little reference sheet, specific to the hospital I'm at for clinical right now's dietary materials, which is helping. Got it from the ward clerk.

My next question that has been bothering me... when you do incentive spirometry with someone, in the computer charting system there is a check box item: "Did they hold their breath?" with yes or no responses, and I don't know if they are *supposed* to hold their breath!! I don't remember being taught that they should. Exhale completely and take a deep breath in to make the spirometer go up, try that 3 times, and record the highest one. Get those alveoli open. I guess maybe there could be some benefit from holding the breath with the lungs completely full so that the alveoli are open longer?...

**quick research break***

Yes, you are supposed to have the patient hold their breath with full lungs for 3-5 seconds before exhaling slowly. Well, that was easier than I thought :-)

I had a kind of frustrating start to my day yesterday. I arrived expecting to take care of one person that I had had the day before and pick up two new ones, but the the hospital I have clinical at just hired a boat load of new grads, and they are all orienting right now; us student nurses can't work with a staff nurse that is also in charge of orienting a new grad. A new hire mentoring nurse was assigned to my one patient left from yesterday, so my instructor put me with a different nurse. I had my notes sheet all filled out with my new patients' info, and then, "Oh, oops...that one has a new hire to train, too." So I had to start from scratch twice.

I'm proud of myself though, I kept my cool, and managed to get through my first day with 3 patients. It's all good.

One scary thing...

At the end of our all day skills day, our teachers sat the whole group down for a "serious talk" about the policies of the program. Most of it seemed pretty reasonable and manageable, like absence and tardy policies, etc. But many of us jumped when they outlined the policy on clinical practice plans.

They went into this long thing about how they are meant to help, not hurt. They will make us better nurses. Oh, I guess I should explain what it is first. If your clinical instructor notices that you are doing something wrong while out in a care setting, they will sit you down and you have to write up a plan together to work on making it better and eliminating the problem. That all sounds great. Maybe a little threatening just in that it's a criticism, but not a HUGE deal. And they say most of us will get one at some point, and probably more than one. Okay. I can cope with that. But then they say, oh, and by the way, every time you get one your grade drops by half a grade. So, say, if I have an A-, but then they notice that I forgot to wash my hands once in a situation where I should have, then B+. Ouch.

Makes me a little more nervous about going into the clinical arena with the instructor.

I've noticed in myself that in the first few days of school, I've been feeling kind of insecure, kind of shy. A little overwhelmed by everyone seeming to know my name and I haven't quite picked up theirs yet. A little self conscious when I ask a question that feels a little out of my league. Happy but suspicious that there's some negative connotation behind it when one of the other students teases me that I'm their class president (elections have not been held, and yeah, I've thought about it, but...).

Deep breaths. No biggy. This is going to be stretching my definition of who I am, but in good ways.

First few days of RN program

Monday: Arrive at 8am, sit through 6 1/2 hours of mostly lecture. Ask lots of questions and feel little timid about asking them because I don't know my teachers and classmates yet, not really. Feel completely awed by the first two professors I meet. Go to work immediately after school until 10:30pm, leave about an hour before shift end with my med tech partner's agreement, and crash HARD.

Tuesday: Arrive at 9am having slept like a brick the night before. Everyone is sitting in the same seats as yesterday. There are about 20 chapters of reading I was supposed to have done just for the first week, out of 16 or so different books, and feeling pretty overwhelmed by the quantity of information coming our way and being behind on the reading, but yet also thankful that I'm able to follow everything the teacher is saying so far, and that my most recent job has given me a lot of valuable experience that will help me in this first semester. Almost start crying during the portion of a lecture on therapeutic communication because I've just had a somewhat traumatic experience (for both me and the resident) two nights ago at work that is still lingering in my mind). Even more awed by the teachers today than the ones from yesterday. Especially one of them. I contemplate the fact that I never really admired my science professors as much as I do these nurses I've just barely met. Knowledgeable, wise, and so very intelligent, both academically and emotionally/socially.

Get to go home early that afternoon, around 1:30. Need to tune my brain out for a bit, so put on some TV and end up watching it longer than intended just because it feels so good to let go of that brain overload feeling for a few hours.

Get myself back on track, do a review of some math that's going to be on a test tomorrow (already!) to make sure I remember how roman numerals work and can do all types of fraction math with speed, briefly consider watching the videos about basic bedside care that I'm supposed to watch for tomorrow's skills day, but decide sleep is more important. Then have a fitful night's sleep.

Wednesday: Arrive on campus at 7:30am to the skills lab for an all day basic care activity nicknamed "CNA in a day". Realize that although I have been working in an RCFE (residential care facility for the elderly) for the last 8 months, I don't have a lot of the skills that are considered basic in a long term care facility, like giving a bed bath, sitting a bed bound patient on a commode, taking blood pressures the old fashioned way, brushing a patient's teeth for them or shaving their face, etc.

Tomorrow, Thursday, I'll be going to my first clinical site for orientation with my clinical instructor. My clinical instructor just got hired two days ago, and I'm a little wary of that fact. She will be shadowing another more experienced instructor while teaching us. She seems nice enough so far though.

Betrayed by the financial aid office!

I found out today at a pre-school year test-taking skills seminar that I could have put in an application for a whole bunch of school based scholarships that I was aware of, but had been told by the financial aid office I was ineligible for due to already having a degree. I feel so betrayed. I would be eligible up the wahoo based on financial need as well as past educational performance. DARN. Next year I'll know better.

The financial reality of returning to school

A couple of updates: I have my phlebotomy license now (but I'm not using it at the moment). My nursing school orientation is coming up in a couple of weeks. I finally, finally, finally have health insurance again...okay, so the card hasn't arrived in the mail yet, but I'm covered as of a week ago.

Nursing school is getting closer and I am getting more nervous about money. I have been working hard on shrinking my debt. I had about 6,000 in debt at its highest point in the last year. All on 0% apr credit cards, thank goodness, but it was still weighing on my mind. It's hard to get back on track when you only make $11 an hour, and medical bills come up, and taxes have to be paid, and the car needs new tires. I'm down to about 2,000 and if I keep being very careful that will all be paid off by August. But there really isn't any extra to set aside *for* school.

I think part of my worry is all of the unknowns. Will my low income fee waiver come through again (I need to do the FAFSA to find out)? Will I be able to keep working at least 4 days a week to keep my health insurance at least partly covered by work? My dad agreed to loan me some money (LOAN, with interest), but how exactly is that going to work, and will it be awkward and difficult? What will I do if/when unplanned for expenses come up during school? How much can I realistically work while I'm in the program without running myself into the ground? There needs to be time for laundry and paying bills and doing dishes and cooking, not to mention a small amount of just "down" time to keep my sanity.

Even though I've had these concerns weighing on my mind I haven't done a lot to remedy them since I got the hospital scholarship. I need to be applying for more scholarships, and go ahead and fill out that fafsa, even if I'm worried the answer might be no. I also need to stop freaking out about it, because that doesn't help anything. I will know more after my orientation meeting in a couple of weeks and then I can just continue to approach things rationally and one at a time. Deep breaths!

Nursing School Update

I've been checking my mailbox recently with a little extra spring in my step. I know the nursing school I applied to said that I'd hear by March "at the latest", and it is only December, but I don't know, I just hoped that I would hear something significant sooner.

About a week ago, after having sort of a crummy day at work, I got home, opened my mailbox and....there was an envelope inside with return address "Nursing Admissions" and the logo of the school I am applying to. I practically danced inside. I was so excited, and certain that the news would be wonderful, and was already planning when to share it with my family.

Inside, it read (roughly): Thank you for your application to blah-di-blah school of nursing. Your application is complete and your admission score was an 85. You will hear from us by March. Please do not call the nursing department for your admission results as we cannot give these out over the phone. Now is the time to start applying for financial aid and scholarships.... etc, etc.

So... not the big whooping news I was hoping for. But at least it's not a big denied stamp. I've already known what my admissions score was since I took the TEAS test, so that was no surprise.

There are all sorts of rumors that circulate around town about the nursing program I am applying to. During my phlebotomy externship, one girl told me that her friend who had an 85 admission score was 5th on the wait list to get in during her year (eep!). Another told me that she had a score "in the low 90s" which shot my confidence down a little further. Some say that you have to know someone in the administration in order to get in. I ran into my 5th grade teacher at Costco the other day, and when I told her I was trying to get into nursing, and about the admission process, she said "shouldn't teaching college biology count for something?!" I sure think so. She told me her sister in law is the assistant Dean (or something) of the program. I wonder if she'll put in a good word for me, and if it would matter if she did.

Someone told me recently that although the school I'm applying to doesn't put any time limit on how long ago you took your prerequisites, when you apply for your nursing license at graduation it matters. I took microbiology ten years ago. I hope that person was misinformed.

Another woman, someone I know well, told me that she was sure that nutrition class is required for getting your license. I looked at all of the state licensing web pages and school requirement pages I had the patience for, and didn't see anything about that. Not that it wouldn't be a good idea to take some nutrition.

So, I'm still waiting. And wishing. And Hoping.

Beginning the scholarship search process

As nursing programs go, the community college here is a very good deal. Only around 5k for the whole 2 year program (plus normal living expenses), versus more like 60k for those accelerated bachelor's programs that they offer in the bay area. But I still have to find a way to finance it.

I do still have some $ socked away in my retirement fund that I started in my early 20s, but I've already had to withdraw some from it this past year to get by and I'd rather leave it be.

I'm not eligible for federal financial aid or loans at the community college level because I have way, way, way too many units already. I looked at a private loan through my local credit union, and it appears their floor rate on an educational loan is 5%; not too bad, considering, but still I'd rather find another way. I don't think unless something big changes in my work situation, soon, that I'm going to be able to save enough cash up by the time I (hopefully) start nursing school in Fall 2012 to just front the money myself.

So in the mean time, I'm going to keep the private loan idea on the back burner, and look into a bunch of scholarships. There's also something called a board of governors fee waiver that may cover part of the cost for me since I'm low-income. I had to provide evidence to the school to change my state residency in order to be eligible for that at all (which I did today). Again, that's another thing I need to look into.

I got a photocopy of a list of websites to check on for scholarships and aid from the college financial aid office today. And I know there is another list specific just to nursing students on the nursing program's website. So I've got a good starting place. Here's hoping!!

P.S. I'm trying a new background theme for this blog. The tan with birds flying through it wasn't working for me anymore ;-)

Nursing School Application...Turned In.

I think I forgot to mention here that I turned in my nursing school application a couple of weeks ago. Things have felt so busy since I started my new job. But I guess it's worth mentioning.

I hand-carried it to the admissions office. I got a former teacher of mine to verify my proficiency in a second language, I had a previous community college where I took a music class send my transcripts (they already had my other ones on file), I included copies of my paystubs from the time when I was taking pre-req classes, and checked and double checked that all blanks were filled out correctly. I wrote a cover letter, not required or even suggested, but I thought it would make it come across as more professional.

When I handed it to the guy behind the glass window, he looked through all my documents I had included...I guess to check that the necessary stuff was there, and although it's not common practice, I specially requested that he write a signed note and date/time stamp it that he had received my application. This would not be the time to have the college lose my paperwork!

I probably won't hear anything for a while. But it's in!

Update on Job Status -- Receptionist Position

I still haven't heard anything back from the people I interviewed with recently for the receptionist position at the nursing home, but my current boss told me that they had called to ask about me. I guess that is a good sign. I get nervous thinking that they are calling around to that long list of previous employers I gave them. I think most of those folks would give me a positive review, but I know there's a chance one or two might not just to circumstances at the time, and it makes me nervous, that's all.

There is another woman who worked in the tutoring office last semester who is going to start the nursing program locally this fall. She came in briefly today to talk to our boss, and I asked her if she was excited about starting in August. She said, "Yes!...but I am a little nervous about what it will be like, with all that they put us through just to try and get in at all." She also said that she had bought her required uniforms, and that one of the required scrub shirts was like 50 bucks (the school has an embroidered insignia on there, but geez!!)