Internship in ED this fall

During our 3rd (of 4) semester, my class was given the opportunity to apply for internships with some of our local hospitals. We get 1 unit of course credit for the experience, and it's a good networking opportunity as well as a way to get more hands on skills and experience.

We put in our application (a cover letter, a resume) to a person in the education department of a group of hospitals, told her which unit was our 1st, 2nd, 3rd preference, etc and then waited to hear back. I said emergency department first, NICU second, ICU third. We've gotten to do "outrotations" from clinical to some other areas in the department. So, so far, I've seen med surg, ICU, ED, Peds, mother-baby, NICU, L&D and OR. The outrotations that I was the most excited about so far have been the emergency dept and NICU. I was torn about which to put first, however the hospital that was offering a NICU internship was quite a bit farther away. Also, I thought I'd get a better broad experience and wider variety of skills in the ED.

I had an interview with the ED department manager over the summer. I believe ED was the only department that actually had us students come in person for an interview; the others were phone interviews. Three of us got placed in the ED at this hospital. During our third semester of the RN program, we have 2 days of regular school clinical every other week, so I'm doing one day per week at the internship only on the weeks I don't have normal clinical. The requirement for the course credit is that we do 54 hours of hands on time, but with the department director's consent, we can do more. It's unpaid.

 I had my first day there this past Monday. What a blast. I was there for about 8 hours, and had about that many patients. I was working directly with an ER nurse that is a graduate of my program. I got to see a dressing type I hadn't done before on a finger wound, do lots of glucoscans, discontinue IV's, do assessments on a wide variety of patients, lots of urinalysis, talk with someone who had just tried to commit suicide, prime IV lines (we are not allowed to actually *give* any medications at the internship), do patient education.

I left really excited about becoming a nurse, and hopeful that maybe at some point I could become an ED nurse. It think the variety is really the excitement for me. And the faster pace. On the med surg floor, it can sometimes feel like babysitting. Morning assessment, morning meds, hygiene care, morning treatments, nursing interventions, noon meds, more hygiene care. Some people really like it because it's a more wholistic experience with the patient. At this point in my student life though it feels really good to just be exposed to *a lot* of different situations, even if I don't get the same depth I would if I were following the same 3 patients all day.

I'm sad I won't be going back for another week and a half; I've got a lot of stuff to do in the mean time. Had a quiz today, an exam is tomorrow in my neuro class, we're covering IV push meds in lab on Friday, and I'm back at normal clinical for two days in a row at the beginning of next week. So I'll stay busy. But I'm really excited about going back to intern again!

Feedback at the new job

Things have been going alright at my new job. It is unnerving feeling like I am being watched so closely. And there were some tasks that I had difficulty with, to be honest. For one, I've never used an adding machine, or balanced a cash drawer. I'm talking an old-fashioned with the paper tape type adding machine. My grandpa had one. It's fine now, but I just didn't get it at first.

Then there's the phone. I've always been a little anxious around phones. And this one has a bunch of lines and impatient people (both callers and callees) and special bells and whistles, not to mention very, very specific language that has to be used per company policy (I switched in a "can" for a "may" a few times one day and heard about it later).

But overall, I'd say I'm ding alright. It's, as my counselor says, "a peon job", and it really shouldn't be a huge source of stress for someone my age with a master's degree. The last year has really shot my confidence to hell though, and the combination of low confidence and feeling so *watched* probably made me come across in not the *best* of lights.

Anyway, at the end of last week, Thursday actually, my immediate supervisor started giving me all sorts of praise. Said that I really seemed to be picking up on things, that I had done so well today, that I seemed to be much more confident on the telephone. Really, really laid it on thick. I was feeling good. Whew, I thought, I can relax a bit. And then she says, "because we were worried for a while there".

Back down to a zero again. Thanks, boss.

She apologized the next morning when I came in. Said that it was a rude thing to say, and that she wishes she could take it back. Really seemed genuine about it. But it's already out there, and it bothered me.

I'm trying to just let it go. It's not a career move type job, it's just a way to try to support myself while I retrain. I may even be switching to a different place that is more likely to give me health benefits in a couple of months. But I want people to like me and think well of me.

My counselor told me to focus on the praise that preceded the remark, and remind myself that she said "we WERE worried", not "we ARE worried". Past tense. Let it be in the past and move on.

So that's what I'm working on.

Classes Update (for Fall 2011)

I decided that even if the 2nd job doesn't work out, I will probably be doing the CNA on the job training at a place in town this fall, so I went ahead and dropped the medical assisting class that I had on the back burner for fall semester at the community college.

In its place, again as a sort of back up, what-if scenario, I signed up for maternal/child nutrition, gerontological nutrition, and community health. These are all 3 unit, online classes. So now as my options for fall semester (in addition to whatever work I'm doing) I've got:

-Phlebotomy (2 nights per week driving about 50 minutes to get to class plus to do externship hours later on in the semester). Could get me a good job but it might take a while.
-EKG monitor technician (1 day per week for 6 weeks, driving 50 minutes to get to the other campus for a 3 hour training before I go to retirement home job). There's a possibility I could get this training at a local hospital instead, starting in October, which I would prefer. However, none of the details about schedule are out yet.

And the 3 online classes to chose between, main purpose of which would be to (a) keep my tutoring job, (b) fluff up my healthcare resume:

-Maternal/Child Nutrition (has a textbook that's over $100 dollars, unfortunately)
-Gerontological Nutrition (has a cheap textbook, only 20 bucks or so, but less appealing to me than the mom/baby class)
-Community Health (seems like a great idea to take, but again $100 dollar textbook)

Maybe, given that I'm going to have pretty much full time hours at the nursing home job for the next few months, and I'm going to feel tight on time, especially if I keep phlebotomy, I should quit the tutoring job. I don't want to. I enjoy working with the students and I feel like I am doing a good job there. And it gets me priority registration at the community college (which, in fairness, I probably won't need anymore if I go ahead and take phlebotomy this semester). Maybe if I cut my hours way, way back? :-/ Also seems like a cop-out.

I'm going to have 6 weeks to accomplish 40.5 hours of clinical externship, and the website says I need to have weekday availability to work with their externship sites. If I had all day Wednesday (assuming I stop tutoring at that point of the semester), I would be doing it 8 hours at a time, meaning I would barely get it done in the 6 weeks.

It looks like, assuming my coworker who's on maternity leave comes back on time, I could also do Friday afternoons if they could take me then. I would need time to change, plus time to travel to North County...if all the externship sites are there. So realistically I could probably start at 2pm? Another 4 hours per week (I'm guessing here). If I did that I could get the hours done in (4x12=48 hours) four weeks.

Phlebotomy is a really, really hard class to get into. So I feel like I should keep it if I can. Hmmm.

Hopefully it will all fall into place!!

Too many balls in the air!

My head is kind of swimming at the moment. Too many things to juggle and arrange and prioritize for this Fall.

(1) My boss at the tutorial center asked me to teach the supplemental instruction group for physiology this fall. The hours I would need to work for that directly conflict with the hours at my new job. It felt too soon (only 2 weeks in) to start asking for special shift considerations at the new place, so I turned my tutoring boss down.

(2) At my new job at the retirement home, one of my coworkers is going to be out for maternity leave for the next 3 months, so they are raising my hours to full time while she's gone, as well as having me put through paperwork (fingerprinting and physical) for one of their other facilities so that I can substitute there. This means (a) I will be working or volunteering *every* day of the week, including weekends (b) It's still more information to take in

(3) Various educational opportunities abound:

(a) Phlebotomy: I'm signed up for a class that would require me driving 50 minutes two nights per week and finding time in my schedule to accomplish externship hours on week days, also 50 minutes away, and well-rested and ready to be professional.

(b) Basic cardiac arrhythmia: A course necessary to apply for jobs as a monitor tech in a local hospital, which pays more than either of my current jobs and would probably let me have more flexible hours around my nursing school time about a year from now. I am signed up for a version of this class at the community college 50 minutes from here on Tuesday mornings (would require cutting back on tutoring hours and cost some money for tuition, textbook), and there is a possibility I could take it at the local hospital instead (would require approval of the hospital, probably free, might give me a better in for getting a job later, on Wednesdays but don't know what time yet.

(c) I have to stay in at least one class if I want to keep my tutoring job...maybe even 6 units worth? Not sure. Eeeek.

(d) I am also signed up for medical assisting at the local community college but that was just an "in case I don't have work" option, because it would require 3 or 4 days per week basically all day during Fall. However, I'm reluctant to drop it yet because I still have anxiety about being out of work and not being able to get the class back.

(e) the pre-nursing advisor suggested I sign up for the first in the series of nursing program classes, which they will let someone take if they have completed all the pre-reqs. There is an online option for this class, and I think there are still spots available, but should I take it now? Should I wait and take it in person when I start the program because most everyone else will be? Should it be my 1 class that I am taking this Fall if I need it to remain a tutor?

(f) I will probably hear from the 2nd in-nursing-home CNA program I applied to in August or September, and I will have to make a decision if I feel okay leaving my new job (at a time that would be difficult for them), and if it is worth it to get full time benefits/less pay/work nights/perhaps more flexibility/etc....(my health insurance from my last job runs out in 4 months)

Blahh....it's hard to keep track of everything.

I think.... I think at this point, I probably should be feeling more stable at my new retirement home job, and I should go ahead and drop the medical assisting course. And maybe I should sign up for the online version of the "nursing 101" class (that's not its actual title, I just can't remember right now).

Phew. I feel a little better just having laid it all out there. But I'm still kind of stressed.

New Job = Stress

I feel like I have been doing alright at work so far. I'm not picking up on things perhaps as quickly as they would like me to, which is frustrating for both of us. The problem I've been having with the training I'm going through has to do with both speed, and organization. There are 10+ instruments that I need to learn, all with their individual techniques, quirks, trouble-shooting approaches, rules about paperwork, etc. And the way I am being trained, they are not teaching me about one instrument, letting me practice it, and then moving on to the next; we fly around the building from one instrument to the next gathering little bits of information along the way as we go and hopefully cover all bases by the end. And there is added pressure due to my trainer leaving to go to school and wanting to be out of the schedule as soon as possible.

By the end of next week I have to have passed several "competencies" with supervision. I am getting more confident with more practice, but it is all pretty stressful, and whenever I do something slightly out of line with procedure, I get barked at. Add to that the newness of being on my feet all day, regimented breaks for going to the bathroom or grabbing a snack, and rapidly changing day vs. night shifts that throw me for a loop, and I'm really hanging on by a thread sometimes.

So that gives you some background as to where I am at right now... *then* ...

I come in today, and get word that there may be some problem with me getting "approved" to take my pre-nursing physiology course this Spring, which starts next week. I registered for this class over two months ago. There almost no hope of switching to a different time/section at this point (all sections are full). When I put in my application for the job, I put in a very clear note compounded with the pdf application stating the times and days that I could not work due to my class. I also brought this up several times, with multiple people, including my supervisor, during both interview sessions, and everybody including him said it would be fine.

But when I met with him today, he acted as if this was some big surprise that I needed that time off for my class, expressed what an inconvenience this was to both himself and the rest of the lab, told me that it would not be allowed, intimated that I had been doing a shoddy job so far in my training, and expressed that my job was on the line over this scheduling issue. WTF!

I held it together in the meeting with him, asserted over and over again that this was a necessary course for me, that it would set me back a whole year to not be able to take it this spring, and reminded him repeatedly (and respectfully) that he should have been aware of this issue before hiring me due to our multiple previous discussions.

Afterward, I went to the breakroom to take my 10 minutes and the person who has been training me was in there. I asked her if she was aware if my supervisor would ever hire three people at once with the intention of "testing" them and planning to fire one ultimately. She paused, said she didn't know, and asked me what our supervisor had said. At this point, I started crying and couldn't stop for a while.

Then, in walks the HR person, notices that I am crying, and asks if she can help. I explain to her, through my gasping crying, what has happened, she asks me clear logical questions confirming that I did in fact put in writing my need to have those times off for my class and that I had verbal agreement from my supervisor prior to being hired that it was okay. The person who is training me kept playing the politician and saying she could see both sides, but the HR woman said that our prior agreement should hold, and said that she would talk to my supervisor on my behalf and either he or she would get back to me.

I went on a 20 minute walk after that to try to pull myself together and stop being emotional. I ended up running into a friend who also works there, and we walked together and talked about what had happened, and she told me about her own issues at work. I was somewhat cheered up by the time I had returned.

I also reminded myself that I have not yet put in notice at my old job (which is on hiatus during the semester break), and that I have not yet unregistered from the "extra" classes that I was planning on taking if I couldn't find full time employment by the time the term started. One of those classes is phlebotomy, and it is quite difficult to get into, so I didn't want to drop it until I was very sure that the work situation was going to be stable and doable. So I have backup, but I need to know by the end of the week on both fronts (my old job, and the courses) if I am going to be working, or not.

I went back to work, jumped into running samples again, and when I was loading some vitamin D tests on a machine, I ran into my supervisor and he came up to me and asked if I knew what I was doing. I told him (confidently) that yes, I did. He said that he had talked with so-and-so and that they decided they would be able to work with my school schedule.

So for the time being, everything is okay.

One of the work-arounds for my schedule is that I am potentially going to have to work 6 days a week until the term is over, i.e. every Saturday. And I am willing to do that, though it will be hard to power through sometimes I'm sure, if it means everything will work out.

So that was my day. Things seemed to smooth out somewhat by the end of the day, but I am still anxious about this development, about my supervisor's threat that I need to shape up and prove myself, and everything in general. I needed to vent somewhere and get my experience down, so there you go. Hopefully the next post will be happier.