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.

Oh, but this is all just review for you, isn't it?

I kind of love and kind of hate that some of my teachers have so much confidence in me sometimes, or assume that the content is easy for me. They think, oh, she's got a biology degree already, this content is effortless for her!

But stop and think about that for a minute. How many undergraduate biology courses do you know of where they go over acute interventions for increased intracranial pressure? How about the specifics of traction setups? Or different methods of modifying the bowel after a portion of it has been removed?

Yes, I have probably a better understanding of some of the anatomy and physiology of mammals than some of my classmates. And I'm a good critical thinker. But I'm still working HARD!!!

My training in marine biology is not so much helping me with patient care, I promise. If anything, the greatest benefit of having a couple degrees behind me already is that I know how to be a good student; I know how to study well, and I'm not as shy about asking the questions I need to ask.

"RN = Real Nurse"

Today I felt like a real nurse more than ever.

I was on outrotation to ICU yesterday, and asked permission to stay again today. It was really worth it. My more difficult patient, I already knew the nuances of all his equipment & tubes & wires, and was familiar with his MO and particular breed of family drama. My second patient, I knew a lot about her condition from my own health experiences & so felt comfortable managing the interactions, education, medications. It was only my second day in that unit, so I didn't know where everything was, but I knew enough to get by. I was able to do & chart full shift assessments on each, and do a lot of the maintenance stuff all day long as well as both med passes.  I got some positive feedback from the staff nurse, who happened to be charge nurse, early in the shift, which made me feel more confident. She complimented me on my charting.

I feel like everything is starting to come together. Our next two skills on the horizon...IV push and IV starts, I think will really put things over the top. IV push is going to be a game changer in terms of time management, but the next time I go back to clinical I will be switching to DOU (from mostly med surg) and taking one patient for the first day, which will help me get my footing.

Excited! Exhausted. But mostly excited!

Clinical After-Burn

I seem to do a lot of after-processing after clinical and internship. Thinking about the patients I had that day, what their symptoms were and how they led to a diagnosis. How I interacted with them and other members of the healthcare team, and what went well and what didn't. Picturing procedures that I did or saw in my mind's eye.

I think it's a good thing...like how you keep burning calories for a little while after vigorous exercise, even after you've stopped. Getting more bang for your buck. (So long as it doesn't interfere with sleep, which it usually doesn't).

But sometimes there is something that puzzles me, and I get stuck on it, and really without more information I can't reach a plausible conclusion and it BUGS me. Like yesterday. A middle aged woman came into the ED because another HCP noticed that one pupil was larger than the other. They were both still responsive to light. She hadn't been exposed to any chemicals or medications that she was aware of. She had no neurological symptoms, had not hit her head. Her scans were negative for any sort of abnormality...no brain bleed, no hematoma, no tumors. She didn't really even have any symptoms related to the eye being dilated; wouldn't have noticed herself if the chiropractor hadn't pointed it out to her. Her blood pressure was a little high, for her, but seemed hospital-stress related. Over the time she was there, her pupil slowly returned to close to the size of the other one (it started at about 4mm vs 2mm in the other one).

The doctor didn't know what had caused it, and basically told her she might follow up with an opthamologist, but that he thought she must have accidentally rubbed something in her eye (she couldn't think of anything she might have been exposed to). I ran this by my neuro teacher, and she didn't know. She googled a little bit, and ran it through her own experiences and brain circuitry, and finally just told me I needed to let it go! I hear that a lot from my teachers.

Mid-sleep panic

I spent many hours yesterday making my flashcards and reviewing lecture and reading material. Right up until bed time, in fact.. of course, I did listen to a book on tape of something entirely fictional and fluffy in between studying and really falling asleep, but I think the nursing material was still on my mind.

I remember waking up a couple of times in the middle of the night and feeling panicky with thoughts of, "I'm not going to be able to do this, I'm not good enough, I can't memorize it all, I won't get a job..."

I was able to tell myself that the middle of the night is not the right time to be considering these things, and fall back asleep. And I feel..well..pretty good about my path and future by the light of day.

I'm doing well in my classes, clinical is going very nicely this term, and I feel very supported and liked by my teachers and most of my classmates and the staff nurses I've worked with. I don't know why I'm filled with so much self doubt sometimes.

Exam jitters

I had to miss class one day last week. I had caught a stomach bug (two faculty have had it, one of my classmate's daughters). It happened to be a test day. I was feeling only somewhat prepared for the test, so part of me wasn't unhappy about having to stay home.

Now, though, I have to make up the test, within a week. And There are two tests this coming week already, so now I will have three. Adding to my nervousness, without sharing any details of the exam (which I wouldn't want to hear), my classmates have said that it was, "really hard," and, "make sure to read the chapters, not just learn the powerpoints." 

I have been feeling low energy since the day I was sick, though most of the vomiting etc was done within 24 hours, and I have sort of gotten behind on everything. I don't have clinical this week (but do have my internship one day) so it will provide me a little more time to catch up, which I desperately need to use wisely. Instead I am just sitting here being sort of anxious and jumpy, while at the same time my head feels foggy.

I think if I just make myself get started, I will be on a roll. I can intersperse cleaning chores in between to get me up and moving now and then, and stop me from being in a study stupor. Yeah...now...GO.   I said GO!

Brain not cooperating ;-)

Better get to it.

New job, feeling slightly awkward

So, my new job is a two day per week caregiving position. There is another woman who helps out the client on the other days. It pays well, is inherently very easy work, and allows me to keep tabs on the residents of the facility I used to work at without actually having to participate in the drama of working there.

I really like the client. She's not used to me coming there in that role yet, and is a little confused about it, but likes me too. I basically show up during the evening and see her through her sundowning time, keep her occupied and socializing in the evening, and help her get ready for bed at night. We do puzzles and arts and crafts together. It really is sort of a dreamy job to have while I'm finishing up nursing school.

I do feel a little awkward about it though. There is space and time to be filled, and it seems to be important for me to keep talking and moving and creating things to do and ways to interact, because if I don't, she starts to feel self conscious like she should be coming up with something to say or a way to entertain me. That is what I'm perceiving anyway.

I'm sure it will pass, and we will find a routine. Maybe I can take her out to a concert or dinner sometimes, to help pass the time, or talk her into participating in some of the activities in the building together.

She does seem genuinely grateful for the company, but also a little overwhelmed by having someone new there. She already knew me, of course, as one of the people who brought her pills and was friendly, but it is different now that we are together for 4 or 6 hours at a stretch rather than just a few minutes here and there.