Mr. ****

I wish I could just type his name as the title of my post, but HIPAA says I can't. But I want to because people like him deserve to be recognized. 

I've been caring for him for over a month now. And although he hasn't been my patient throughout the entire duration of his time spent at GSMC, he has been on my mind and heart since the day he was admitted. 

As nurses, we care for all of our patients. But what no one tells you is there will be certain ones, for whatever reason, that really grab hold of you.

They inspire you, and teach you, and in their own special way, fill up an empty space inside of you.  I've written many posts, specifically dedicated to certain patients.  They consist of lessons and things I've learned through my experiences with them.  But even so, "He" has been different.  Maybe it's because he stayed a lot longer than  average, but I think it had a lot more to do than that. 

Maybe it's because I know he spent several years in the Air Force, delivering newspapers in Massachusetts. Maybe it's because I know the name of his wife and all his children...even his oldest son, that took his name, who passed away years ago.  Or the fact that he named his dog "POD."..because he found him outside the post office and called him "poor old dog" until he finally decided to take him home and then "POD" stood for "post office dog." 

Maybe it's because his wife brought in old family photos, in frames, and showed me their 62 years of a beautiful marriage together. (62 years this Saturday) Or that she sat at his bedside every single day, helping him bathe, and eat. Maybe it's because every morning before she got there he would ask, "where is my bride?" 

It could be that he, despite his deteriorating health, maintained his sense of humor.  I asked him one afternoon, "how are you feeling?" And he responded..."well, just as good as I did when I was 28, but just a little bit older." (I'm 28). Or the day I had to give him a soap suds enema and I asked, "how ya doing?" And his response was..."well, I've been a hell of a lot better, but I'm doing alright considering."

Maybe it's because I know he used to love duck hunting but never understood Canadian geese or that he could eat bananas all day, every day. 

Even today, after he told his wife that he didn't think he was going to make it, I asked him what he wanted his daily goal to be... He said, "Just get on my feet, I just want to get on my feet." 

Truth is, he left the hospital today, and he most likely isn't going to get better. And as selfish as it sounds, I just wanted to keep him at GSMC because the thought of coming back to work and him not being there is a loss for me.  

I loved his smile when I walked into his room. I loved the big hugs I received from his wife every morning, and the wave down the hall I got from his son.   I loved his positive spirit and sarcasm.  

As we wheeled him out today, I couldn't help but feel sorry for everyone who never got the chance to know him or his sweet family. 

What no one tells you is that sometimes...sometimes your patients help you more than you help them. 

To Die Alone and Happy

A patient of mine, a few weeks ago, inspired me to me think about whether or not it is possible to die both alone and happy. More so, she forced me to think about whether or not I let the love, or lack of love, I receive from others define me. 

She was alone, but was she okay and content in the last quiet moments she held with only herself? Did she need someone there to validate the life she lived? Did she need reassurance that she was important and worthy and loved? If she did, there wasn't anyone there to do it...except the medical staff, complete strangers. 

And isn't that what we all want? To be important to someone, to be loved by the people we love, to have meaningful friendships/relationships with others? 

And it hurts when we realize we cannot force nor demand love. It hurts when the people who you think are supposed to care, don't.  When the people you hold closest to your heart, hardly acknowledge your existence.

I've experienced this many times, starting with my biological mother. Emotions regarding that non-existent relationship continued on and poured into other faucets of my life.  And those emotions are vicious cycle, especially if you feed the insecurities and the chronic self doubt while constantly desiring the love of someone else to define your worth.  It can eat you alive. It can literally destroy you. 

My patient died the next day. I was left wondering for days, and even now, about whether or not she was content in her own skin and comfortable enough with herself to die alone. Its not ideal to think about laying in a hospital bed, staring at white walls, listening to the occasional beeping of an IV pump while you die but did she "need" someone there? Did she need the presence of another being in order to feel at peace? To feel loved?

Maybe she didn't have friends or family in the area. Maybe they were too busy. 

My hope for her, and what I would like to believe is that she was okay... That she was at peace with the person she had become over her lifetime.  I hope that she was so comfortable with herself and confident in her character that being alone didn't make her feel any less cared for, less loved or less of a human. 

And while love is one of the greatest emotions we will ever feel, give and receive, the reality of death is that even with the physical presence of others, we all die alone. 

I plan to start living in such a way that the approval, reassurance, and love of others does not define me. That my value does not decrease just because others may not recognize it. 

Loving yourself is what I think it means to die happy.  Because in the end, we are alone... and if we don't love ourselves, the love we receive from others becomes meaningless. 

Distraction

I've lost count on the "lesson" numbers and the quotes, but since this is no longer a blog about "what I've learned in nursing school" and more about the lessons nursing is teaching me, I decided to change the format a little.  I'm still looking for a new blog name, so suggestions are welcome. :)

So here is today's lesson. 

My preceptor had a patient today who has dementia.  Early this morning while we were helping one of our other patients, he was out roaming the hall peeking into other rooms.  He was completely disoriented all day. It didn't matter how many times she escorted him back to his room, he wandered back out. She would take him back and no sooner than she would get back to the nurses station, the bed alarm was going off again. 

You could tell his mind was full of words he wanted to say, but couldn't get out.  You could see his frustration when he tried to explain to us things we could not understand. All he wanted to do was make sense of what was going on, and no matter how hard he tried, he couldn't...

There wasn't anyone available to sit with him, so my preceptor decided the next best thing was to take him to the nurses station.  And when I say she brought him to the nurses station, I mean he sat next to me, at my designated desk, IV pole and all. It's slightly comical when I imagine it now, I felt like it was bring your friend to work day.  We tried to entertain him with magaizines and a puzzle, but neither worked.  So we got out some washcloths and he finally sat there. 

He folded them meticulously. Fixing each wrinkle, and refolding the ones that were not perfect squares.  He placed them neatly in a pile, one on top of the other. When he finished he patted the top and looked over for approval.  We said thank you, and I pretended to take them to the linen closet to put them away. I secretly unfolded them all and brought them back again.  We repeated this process many times over.

I realized then that when we are lost and confused, sometimes all we need is the silent company of others and a temporary distraction to keep our mind from the thoughts that consume and frustrate us. 

For some of us it's cooking, writing, or getting lost in a good book.  Others prefer a long nap or a great movie.  Some like wine or dancing, and for others maybe it's folding washcloths.

I've heard people say before that distractions are bad, and just a way to avoid the inevitable truth. I disagree.  These distractions are not meant to be a permanent fix but a temporary way to give our tired hearts a break. Sometimes a distraction is all we need to ease our mind and give us a moment to focus on something other than our troubles.  

"It is what it is."

I have a really bad habit of wanting to take broken pieces and fix them immediately. Maybe that is why I love nursing, because it's the profession of taking care of, fixing, and making people feel better. Truth is, not every thing that appears broken is, and even if it were, sometimes it doesn't need to be fixed. 

I especially do this in my personal life. I like harmony, and when the littlest ripple is created, in my otherwise peaceful state of mind, I instantly begin looking for resolution. 

I had a patient this Tuesday who was scheduled for a below the knee amputation that afternoon.  It was cancelled last minute because he wasn't stable enough to handle the surgery.  

It was such a cliche and simple quote, but one that I give credit to in helping me with some recent disappointments. 

I went into his room to turn him, and he immediately smiled at me.  I was surprised because for most of the day he was sleeping. When he wasn't asleep, he was short with his words, answering only my questions.  I asked him how he was feeling and he said "ok." I then asked him if he was disappointed that his surgery was cancelled. He replied with, "It is what it is. I'm going to get it eventually, whether it be today, tomorrow, or a week from now." 

I smiled back at him and asked if he cared if I stayed a while to chat.  He didn't object, so I stayed and we talked for the next 20 minutes about fishing. I know our chat was more beneficial to me than it was to him. 

Sometimes situations are what they are, nothing more, nothing less.  Sometimes there is nothing we can do to immediately fix things to be the way we think they should be and sometimes time is all that is required for things to work themselves out. 

Until that time, it's better to focus on and talk about things that make you happy...like bass fishing in the summertime on the sand bar.  <3

The Dreaded NCLEX

I'm not going to tip-top around the topic, I failed my boards today.  It's not officially posted yet, but I'm sure when it is, I'll feel this terrible all over again. 

I didn't go in overly confident, but I felt like I knew my core content. I didn't spend 6 hours a day studying, but I reviewed at least 3 times a week since graduating and studied the week prior. I honestly felt I had as good as shot at passing today as anyone else who has graduated from nursing school. 

Yeah, didn't happen. 

I can sit with myself in my failure. The hardest part is knowing how many people had confidence in me and believed I could do something that I obviously didn't do.  Disappointing myself is one thing, but disappointing friends, family, co-workers, bosses, teachers/instructors and my school is a bit harder to swallow and quite frankly, it sucks really *explicit word* bad. 

What I would really like to do today is crawl into a hole and disappear for a little while.  I know it sounds dramatic, but after 16 months of really hard work, I just wanted to feel accomplished today, and instead, I feel like a complete moron. 

I know tomorrow when I go to work, I'm going to feel even worse having to look at and talk to everyone about it. But, I also know that a test cannot measure my compassion and care for others nor my determination to succeed.  

So, today I will have my pity party, and beat myself up over it, and perhaps find a hole somewhere to crawl into. However, I won't pack up and stay there. I have too much left to do :) 

What every GN should know about the first day...

I officially made it through my very first day as a GN! I can't even say I barely made it because honestly, it wasn't nearly as "bad" as I thought it was going to be.  

I imagined every terrible situation possible, and as my luck would usually have it, they all would have happened...but not today :) However, here are some things I wish I would have been a little more prepared for and I hope this helps my fellow classmates as they set out for their first 12 hour day on the floor. 

1- Practice your introduction.  I've been walking into patients rooms for 16 months introducing myself the exact same way. "Hello, my name is Shauna and I am a Kilgore College nursing student.  I'll be working with *insert preceptor name here* and will be assisting them in your care today." 

Sounds like a great introduction, except for I am no longer a student.  So on your way to your first day, practice saying nurse/graduated nurse outloud because after saying student for so long, nurse actually sounded awkward coming out of my mouth. 

2-If you are a female, invest in high quality makeup. This 5 dollar eyeliner isn't gonna make the cut! Nothing looks or feels worse than walking into the bathroom after 6 hours and realizing your eye makeup is a full inch under your bottom eyelid. 

3-Do NOT forget to put on deodorant. 

4-They *your instructors and nursing friends* did not lie.  You will hardly find time for a break.  Up the stairs, down the stairs, up the hall, down the hall, sit down, stand up, Dr. sits down at your work station, move all your stuff, go to lab, etc.  Refer to #2-your foundation will sweat off. Refer to #3-You may end up with sweaty armpits. 

5-Even if you are not confident, act so when you're with your patient.  Your preceptor will help if you need it *and not make it look obvious* and your patient will never know the difference. Everyone feels good about the learning experience in the end. 

6-If you have any doubt about losing the weight you gained in nursing school, refer to #4 and fear no more.  Just make sure to pack a healthy lunch because a lot of people you work with will order out or go to the cafeteria. I'm bringing my pedometer tomorrow because I'm quite certain I burned WAYYY more calories than I consumed! 

7-RELAX!! Seriously, no one expects you to know it all. Ask questions, even if you think they're stupid. 

8-Apparently, I'm a mouth breather when I'm stressed/anxious. Do everyone a favor...bring a breath mint. 

9-Have fun and take it all in.  We worked really hard to get to this point....so enjoy the moment. We only get one first day on the floor as a graduated nurse, and it felt pretty darn good to me! 

Pinning Ceremony

 Lesson #10: "We don't meet people by accident."

As a level one nursing student, I decided I was going to volunteer to take pictures for the graduating class.  The only nurses I have ever known were in the Air Force, and they don't participate in a "pinning ceremony." On the day I went to take pictures, I had no idea what it was, what it entailed or how it worked.  So, for those of you who are not nurses, this is what I gathered from it:

A pinning ceremony is a symbolic way of welcoming a newly graduated nurse into the nursing profession.  The graduating nurse chooses an RN to perform the actual pinning, which is done on a stage in front of  your classmates, faculty, family and friends.  It's a much smaller, more personal ceremony than graduation and has been a tradition among nurses for many, many years.

I watched as some students chose to have family members who were RNs pin them, some had co-workers, others had friends, and some chose to have a nursing school faculty member do their pinning.  My first thought was, "I am going to have to do this in a year and I don't know a single RN in Texas." My  next thought was, "How do I even choose?"

I'm a pretty sentimental person, especially when it comes to situations that only occur once in a lifetime...so I really wanted this person to mean something to me.  I wanted to be able to look back years from pinning day, and think of that person and smile. From that day forward, after the ceremony, I started thinking about who I wanted that one person to be.  There were many factors for me to consider.

I wanted it to be someone I could model my nursing career after, someone who I could look up to and say, "that's the type of nurse I want to be."  It also had to be someone who was patient, compassionate and empathetic...who wasn't judgmental, who remembered what it was like to be a student and who I could honestly say was an all around kind hearted person.  I  wanted it to be someone I could keep in touch with after graduation, someone I could call a mentor and someone I could call up as a brand new nurse and ask for guidance, advice, etc.

After much consideration, I narrowed it down to two people.  After a full semester of clinicals with Mrs. Lewis, my decision was very easy...

One day in class we were doing skits.  Mrs. Lewis sat behind my row and on break, I'm sure after over hearing a conversation I was having with Stephen, asked me who the person on my computer screen was.  In my experience, telling the truth about my sexuality has not always worked out in my favor, and her being my clinical instructor, I was very hesitant to tell her the truth.  But I did.

Instead of the thousand questions I normally receive when a person first finds out I'm a lesbian, and the shocked look that engulfs most faces,  I got the most reassuring response I had in a very long time.  "Oh, okay.  My step-son is gay and my husband and I are going to his wedding in Vegas this February."

I earned a ton of respect for her that day,  not because I thought she approved, but because whether she did or didn't, she never led me to believe that she thought she was any better than I was and we continued on our conversation like I just told her the sky was blue.

On another occasion, I was having a really bad week, I was stressed to the max and failing Med Surg. After post conference one day, I made it out to the car before I realized I had left my bag in the conference room.  I went back to get it and Mrs. Lewis and Mrs. Hicks were still there finishing up.  I knew I needed some extra help because I just wasn't understanding the material.  After a few tears and a quick pep talk,  Mrs. Lewis reminded me that I had her telephone number and if during my study sessions this weekend, I had any questions to send her a text or call and she would be willing to help answer any questions I had.  I ended up having lots of questions, she answered them all and I passed my exam that Monday morning.  The following week in post conference, even though she's not a classroom instructor, she had a Med Surg book out and helped us all review for the next exam.  Not because she had to, but because she knew the majority of us were struggling.

It was then I realized the genuine care and concern she has for her students.  I began to pay closer attention and listened to the way she spoke to my fellow classmates.  She has always been eager to teach, with an easy-going approach.

She's taught me many tips and tricks for completing clinical skills more effectively and efficiently.  I feel through having her as a clinical instructor, I have learned "real life" nursing skills, not "text book" nursing.  (not that text book nursing is wrong, it's just not always realistic.) I'll never forget the "ah-ha" moment I had when she showed me how to get air out of a line by simply using a 10cc syringe.  It seems simple enough, but it's not something I would have learned from my text.

She has been so patient with me.  I'll be the first to admit I am sometimes pretty needy, demanding and emotional.  I know I must drive her crazy with my insistent questioning, especially when it's on a weekend, when she's trying to enjoy her free time away from the hospital and away from the school.  Regardless, she always answers and always helps when I ask.  I'm sure she gets frustrated when she tells me how to do something more than 3 times and I still don't understand it, but she explains it a 4th, 5th, and 6th time, or until it makes sense to me.  And even though I feel dumb for asking something more than once or twice, she always reassures me that I'm doing just fine.

I've seen nurses in the hospital who walk around frantic, crabby, and on edge.  I've heard them speak to students poorly, snap at co-workers and ignore patients who require a little extra care.  I admire the way she keeps her composure and professionalism when dealing with those difficult people/patients and her "firm but fair" attitude.  I hope one day I can find that same balance.

Mostly though, it's her genuine kindness.   You can hear it in the way she talks to her patients,  the communication she has with her students and in the way she treats those around her.  (Read Mrs. Finkle) Her presence at a clinical instantly calms my day...she has an aura around her that can lighten a mood and make you smile when you're on the verge of tears. (it has happened to me many times in nursing school) 

I have had the privileged of having Mrs. Lewis for Med Surg 1, Med Surg 2, and Med Surg 3 clinicals. (which is almost unheard of) In all this time, I have never wavered in my decision to have her do my pinning ceremony, not one time.  In fact, the more time I spend listening and learning, the more I realize I could not have crossed paths with a better teacher, nurse and person.

 * For Mrs. Lewis: I don't think people realize the impact they can have on another life, or how deep their influence runs, but I hope you know you hold a very special place in my heart.  You have been a really big part of my journey through nursing school and I could never thank you enough for your support, guidance, and kindness.  When I get out into the nursing world, I'm going to start with the things I've learned from you, and I hope one day in the future we cross paths in a hospital somewhere and you're proud of the nurse I am.*

The Group

Lesson #9:  Understanding is deeper than knowledge.

During orientation to nursing school, we had many teachers stand before the class and introduce themselves.  One of them made the statement, "nursing school is a long, gruesome journey and you couldn't pay me to go back and do it all over again."

I braced myself for the worst and as it turns out, nursing school has enriched my life in ways I never expected. 

It's really hard to explain the bond you share with your fellow classmates but to describe the friendships I have made within my own circle of nursing school friends is nearly impossible.  I have put this post off for quite some time, trying to gather words that could express the respect, trust, and love I have for Stephen Harms, Brittany Bryant and Amanda Peables. 

It was the very first day when we went to Chili's and I met Stephen.  He was tall, with gorgeous eyes, great hair, and looked just like McSteamy from Grey's Anatomy. So what did I do? I asked if he'd be willing to donate sperm!  Looking back, if I were him, I would have ran in the complete opposite direction.  Oddly enough, he just said, "Ummmmmm.....no? But lets be friends." And so from that day forward, Stephen was my very first nursing school friend. 

Weeks passed, and I'm not quite exactly sure how it happened because I remember being slightly "annoyed" by the girls who were constantly whispering and giggling in the back, but Stephen ended up going to the Student Nursing Association Convention with Brittany and Amanda.  When they came back, Stephen and I went from being best nursing school friends to part of, what we now call, a small gang. 

We have been inseparable ever since.  

We each have our own individual relationships within our group.  They are unique in themselves.  But what makes our group special to me is that when we are all together, we mesh perfectly.  We are all SO different, with almost opposite personalities, but we are such understanding and accepting people that we blend together, almost like we are "the same people." We play off eachothers strengths and help with eachothers weaknesses. 

We are a team in every sense of the word. 

I can honestly say each one of them would have my back in ANY situation.  I can call at 3am for a ride, I can borrow money when I'm broke, tell them any secret, with certainty, they wouldn't tell a soul.  You're lucky in life if you can find that in a friend, but to find it within a group is almost unheard of.

They have been my backbone in this wild, crazy place we call nursing school.  My study buddies, drinking pals, my confidants, my go-to people, my safe haven, my "can always count on", my stress relief, and my best friends.

I never have to filter myself for them. I can be 100% Shauna, flaws and all.  They tell me when I'm being a stubborn, hard-headed, bossy, rude, cranky...they know when I'm PMSing before I even have a chance to say it.  They know when something is bothering me, they know my real laugh and when I'm having a bad day.  

What would be embarrassing for some people to talk about, we talk about on a random Tuesday afternoon for absolutely no reason other than we feel completely comfortable doing so.  I'm certain that if an "outsider" listened to us, they might think we were bat-crap crazy.  And we might be, but we accept that about one another. 

They have made me laugh a lot harder, and smile much bigger. (I have crows feet now and I blame it on them).  We have made more memories in 16 months than I have with some people I've known my entire life. I will carry and cherish the memories we have made for a lifetime.  They have shaped me, changed me and have made me a better individual. 

I am honored to call them my friends.  I am also proud because I know the type of nurses they are going to be.  It would be a privledge to work beside any single one of them.

There are people who know all about you and could tell you any random fact when asked. But there is a big difference in knowing all about someone and understanding them to their core. 

 Keep those people who understand you, they brighten the everyday life. They are what the journey is all about.  They have shown me what it truly means to be connected.

I love you Stephen, Britt and Peabs. Regardless of the changes ahead, y'all are my people and you'll always have a friend in me. 

The Darker Side Of Nursing

Lesson #8: Admire the struggle it simply means to be human.

My nurse said something yesterday that inspired this blog entry.  As we wheeled our ICU patient down to a different floor, she said to her, "I enjoyed caring for you over the past week and I hope to see you again, but next time it should be at Wal-mart buying groceries." My patient thanked her, smiled and said in her Maine accent, "You'll find me at Target."

It got me thinking about how in a few short months, I will be working in a place that everyone on earth wants to avoid visiting.  I've never put much thought into it before, but a hospital is a place that harbors all the emotions in life we try ignore and feelings we try to escape. 

So for the last hour, I started to pay closer attention.  For a moment, I stopped and just looked at things exactly how they were:

I found fear.  When you walk into a room to deliver lab results, there is no denying their world stops for a minute as they hold their breath, waiting for good news.  And if you're lucky,  you get to deliver good news. But sometimes you will have to disappoint them.  I found anger as I listened to family members demand answers from doctors and nurses over the telephone and more anger when another patient realized she no longer had control over her health.  I found regret and guilt as I listened to patients say they wished they had taken better care of themselves.  How they wished they would have spent more time doing things they loved or spent more time with their families. I witnessed embarrassment when a man, who couldn't speak English, didn't make it to the bathroom on time and had to be washed from head to toe by the nurse, who was a complete stranger, and half his age.  I found pain, both physical and emotional.  When a person winces from only trying to sit up in bed by themselves, you realize how much you take for granted and your heart breaks for them as they struggle for their independence.   I found sadness. I literally saw the hope drained out of a granddaughters eyes when she realized what my nurse already knew.  Her grandads fight was nearing an end.

The emotions we find surrounding sickness and death shouldn't be ignored or swept under the rug.  Because we are human, because we know how it feels to be afraid, how it feels to have regret, and how it feels to lose control, we try our best to ease the pain of our patients.

We try and avoid the darker emotions but what we don't realize is those emotions are what fuel our desire to be great nurses and compassionate caregivers.  The darkness is why we try to bring light.

Mrs. Finkle

Lesson #7: “I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” ~Maya Angelou

On July 30th, 2013, I gained a better idea of the type of nurse I want to be.  

It was another clinical day at Good Shepherd Medical Center in Marshall, TX.  I was assigned to the 5th floor (my favorite), and I was looking through the list of patients available for me to take care of for the day.  I always ask the nurses which patient they think will keep me busiest, because 8 hours is a lot of time to kill when there isn't much to do and if you know me, I can't really sit still.  My nurse chucked and said "take room #5071, her name is Francis Finkle (*not a real name*) and she is an Alzheimer's/Dementia patient who was admitted for hypotension."  
 
When the nurse said that Mrs. Finkle would keep me busy, she was right.  All that woman wanted to do was eat, and talk, and walk, and talk, and eat, and talk, and press her call light.  What made the day interesting, to say the least, was that each time I walked into the room I could have been a different person because she forgot who I was after 10 minutes of leaving the room.  I must have introduced myself 20 times that day, trying desperately to get her to remember me.

Because of her Dementia/Alzheimer's she would ask for something, I would go get it, and by the time I brought it back, she would ask, "what the hell is that for?"  I would try so hard not to laugh to myself, because Alzheimer's is such a sad disease, but Mrs. Finkle was hilarious and I like to think she was that way before the disease process started.  

Mrs. Finkle's admitting diagnosis had been resolved the day before, so she was basically waiting to be discharged.  Because of this, I wanted to introduce my instructor to Mrs. Finkle so she would understand why my paperwork was over her primary medical diagnosis, not her admitting diagnosis. 

Now remember, at this point in the day, I had spent 6 hours with Mrs. Finkle.  I stayed in her room with her for most of the day because each time I left, she managed to get herself into some sort of trouble. (like squatting over the trash can to go to the bathroom) We watched soap operas, I listened to her stories (not knowing if they were true because of her memory), ate lunch with her (she ate, I sat bedside), she talked about church and God, she told me how men can be the most terrible creatures on the planet and that she actually had a favorite child.  Her stories were filled with elaborate details that could not have possibly been true because they contradicted stories she had told me in the earlier hours of the day.  But I didn't mind, she was funny, witty and made me laugh. I didn't know exactly how to talk to her because her thought process was all over the place, so I mainly listened.  She was the true definition of a "difficult" patient, but at least she was good company.  

So, in walks my instructor. 

Mrs. Finkle says, "Oh great, another nurse who's going to tell me what I can and can't do."  I explained to her, for what must have been the 10th time, that I was a student, and this was my instructor.  Mrs. Finkle said, with her curly, matted white hair and little attitude, "Well instructor... do you have a name or are you going to stand there and not introduce yourself?"

*I'm laughing right now as I type this* 

With a surprised look on her face, "Well hello Mrs. Finkle, my name is Wendy and it's very nice to meet you!" 

And then the talking began. "Wendy? Such a pretty name.  My middle name is Winifred and people used to call me Wendy." And Mrs. Finkle went on and on and on...

In between their conversation, we passed her medications and Mrs. Finkle moved to the chair so I could change her linens.  I stayed out of the conversation mostly because I wanted Mrs. Lewis to hear what I had been listening to all day but also because she was better at talking with Mrs. Finkle. They talked, and talked, and talked some more.  Mrs. Lewis kept calling her ma'am, and Mrs. Finkle finally burst out with, "Calling me ma'am is RUDE! What do you think I am, old?" 

She then proceeded to ask Mrs. Lewis how old she looked and to guess her age.  Apparently, it took her too long to guess so Mrs. Finkle shouted, "I'm 80!" 
Mrs. Lewis: "You look great for 80!"
Mrs. Finkle: "Well I bet I look damn good for 87 then because that's how old I REALLY am!" 

Mrs. Finkle shot us a grin and Mrs. Lewis and I burst into laughter.

Not long after that, Mrs. Lewis said she had to go help with some other students, that it was very nice chatting and left the room.

Mrs. Finkle went back to talking, and this time around I received a whole new set of stories.  Her children's names were different, she had a different career than she had previously told me, and she said she hadn't eaten, even though she just ate TWO sandwiches only a two hours ago.  As I was getting up to get her a yogurt from the patient refrigerator, she stopped me.

"When you come back, will you bring Wendy with you? She was really nice and I liked her." 

I couldn't get Mrs. Finkle to remember my name all day long and in that moment, I learned a valuable lesson. 

Mrs. Finkle was not going to remember me and she wasn't she going to remember Mrs. Lewis next week.  She didn't remember the conversations we had earlier that afternoon and she could barely remember where she was half of the time.  She couldn't recall that I was a student, and she had no idea that she suffered from Dementia/Alzheimer's.  

My goal for the day shouldn't have been to get her to remember me by name because at the end of my 8 hour shift, the only thing Mrs. Finkle remembered was how someone made her feel.

That is the kind of nurse I want to be.  
   
I want to be a nurse who leaves their patients at the end of the day with feelings of worth, joy, laughter, and kindness. (And obviously provide the best medical care possible)  Not a nurse who wants to be remembered for the who they are and what they do, but for how wonderful they make their patients feel about themselves. :)





(A few weeks later, I had Mrs. Finkle again.  She didn't remember me, but by the end of the shift she knew who I was when I walked into the room. :)

It's Okay to Care.

Lesson #6: If you're compassionate, don't restrain yourself from spilling all that you are.

Before I ever stepped foot into a hospital in the role of a student nurse, I had a preconceived idea of how I would react in certain situations.  I believed I knew myself well enough to predict my emotional response to death, even though it is not something I've been surrounded by or exposed to very many times in my life. 

When I started my nursing journey, I prided myself on keeping my personal views, opinions, and emotions to myself.  Especially my emotions.  I've always been a "sap" but I started school with the idea that I would condition myself to keep emotions regarding patients out of sight.  I thought in doing so, I would portray a "professional nurse" image.

Fast forward a year.

I showed up to clinical and was assigned to the ICU.  Oddly, my patient was awake, alert and oriented X3.  He was going back and forth about whether or not he was going to get an internal jugular tube (central line) that afternoon.  After chatting for 2 hours over breakfast (pancakes and sausage) about life, his past, his family and his medical condition, he decided to sign the consent forms and follow through with the procedure.

We wheeled down to the lab, prepped, suited up in the appropriate medical attire, and I was able to stand in on the procedure.  I stood at the head of the table, where I could see him under the sterile blue sheet.  We continued chatting as the procedure began...

I had no idea the mans hand I held that morning was going to code on the table later that afternoon and I was not at all prepared the way I had planned in my head.

My first code was a roller coaster ride full of emotions.  Everything I had conditioned myself to believe, immediately went out the window.

I replayed the conversations we had that morning about his wife and children and how the scariest thing he had ever experienced was during war.  I replayed  his words when he said how he really didn't want to do the procedure because it would only prolong his life, making himself a burden to his family even longer.  I recalled his laugh when I accidentally spilled his juice all over the table and how he told me what a great job I did when my instructor checked me off on his IV push.  All I could think about was his voice,  (that I heard just 15 minutes earlier) and how he wasn't breathing now.

The room was chaotic, I couldn't focus on one single person because there was so much going on.  The voices all blurred together and in my mind, this was going to be the end of his life.  I could only focus on the monitor and the nurse doing compressions.  It took every ounce of my being not to cry.  I started sweating, it felt like a million degrees.  I stood in the corner, zoned out.  One minute felt like eternity, but after an hour, he was stable again.  Unconscious and intubated, but "stable."  (He died later that week)

I will never, ever forget that day.

I know they say it gets easier and easier each time you're exposed to the death of a patient, and that may be true. However, I don't ever want to be so disconnected from my patients that I cannot feel the emotions associated with grief and loss or share their joy in the happier moments.  I want to be able to have enough control over my emotions to not buckle under pressure but not so much control that I lose the genuine ability to sympathize/empathize with the people I care for. 

It was silly for me to believe that I could take a passion and put reigns on it, or that I would want to dull something about myself that makes me who I am.  I no longer believe that the "tough" nurses are the most admirable, nor do I believe that being emotionally invested in your patients health and well-being is a weakness. In fact, I think it's what makes the best nurses.

Unexpected, Unlikely Friendships

Lesson #5: You'll make friends and meet people you'll never forget. 

On the first day of class, I only saw two people I knew prior and the rest were strangers. 

Here I am a year later, and I can tell you that I have made some pretty awesome memories and those unfamiliar faces are now the faces of my friends. 

"Call it coincidence, or fate, or sheer blind luck." Whatever it is, I know that I somehow ended up in the right place, at the right time, so I could meet the right people. 

Each of these people have completley different personalities, and that's what I love most. They all bring something unique to our friendship, making me a better person at the end of the day. 

Without meeting these people, it may have taken me a little while to learn these valuable tidbits:

 #1: 

     Humor is the best therapy. There will be moments when you'll find yourself in, what feels like, the most unfortunate situation. Some of those situations will be completely out of your control. Don't get too bent out of shape, instead find the humor in it and laugh it off. Sometimes that's all you can do. 

 #2:

     Don't judge a book by its cover. When you meet someone, it's our natural human instinct to make a snap judgement. However, rarely are these judgements accurate. If you take the time to truly get to know someone, you may find that you have a lot more in common than you would have imagined. People will surprise you!

#3:

     You don't always have to talk to say something. I am a person who finds comfort in conversation but not everyone is like me.  Most of the time you will learn more about a person by watching their actions than by the words they speak. It's okay to enjoy silent company. Just because someone doesn't speak about everything on their mind, doesn't mean they don't have a lot to say. It just means that when they do talk, it really, really means something. 

#4:

     Some people you'll just click with.  You won't be able to explain why, or how, but it's a feeling that doesn't happen often. I think it's because you need something from eachother that you can only get from one another.  Don't ignore that connection. 

Nursing school is one of the most difficult challenges I have accepted, but my friends make it one of the most enjoyable experiences. And the truth is, you may not stay in touch after nursing school, or you might. Regardless, the people you meet and the friends you make will change you. That alone makes them irreplaceable and unforgettable. <3

P7693

Lesson #4: Small things really do matter.

*Disclaimer: the names used in this blog are fictional.*

P7693 was my laundry mark.  In the Air Force we were given the first letter of our last name, followed by the last four numbers of our social security number.  That number is what you wrote on everything to identify it as yours.  P7693 was mine. 

I remember one of my very first clinical days back in level 1.  I was brand new to the hospital setting and didn't know much about anything, so I followed my nurse Lisa around like I was her shadow, and I watched.  I watched and I listened to every single move she made, and how she made it, and how she said things.  As far as I could tell, she was a great nurse.  The other nurses seemed to like her, she was well organized, and always on her feet. But as I listened, there was one thing that really bothered me. 

We were sitting at the nurses station and one of the other nurses asked Lisa a question.  "Hey! Does "49" need new linens?" And later I heard from another nurse, "Don't give "64" anything, they're NPO," and "36" needs a chest x-ray ordered," and "57" is being discharged."

So I thought to myself for a little bit, and then I decided to try something to see if what I was hearing was actually true. I approached Lisa and said, "Ma'am, does Mr. Whatley need his vitals taken Q2H or just the regular scheduled vitals?"

I was hoping her response wasn't going to be what I thought it was, but here is what I got. "Um, Mr. Whatley....ummmmm....Whatleyyyyyy.....what room number is he again?"

I remember being really disappointed in that moment.  I couldn't believe that she didn't know the name of the man she had been providing care to for the past two days.  I imagined how I would feel if I was his daughter, niece or friend and heard him being referred to as "39." 

Our patients will feel more respected and valued when we remember their names.  They will feel more engaged in conversation.  Knowing and using someones name can make a difference in how that person feels about you, how much they trust you and how much they share with you.  Sometimes it's the little things that make a big difference. 

So please, the next time you find yourself or hear someone else shouting out "47", "96", "64", remember that our patients are not room numbers.  They are people and they have names.  

All For One, One For All

 Lesson #3: When you help others become successful, you will also succeed.


You will begin with 40 to 60 individuals. 

There will be men and women from all different states and some from other countries. Some will have lived in the same town their entire lives and others may be here in Kilgore for the sole purpose of attending nursing school.  The ages will vary greatly.  Some will be in their early 20s and others will be in their 50s.  For many of us, this will be our first career and for others, it may be their 2nd or 3rd.  There will be single people and people with families who have up to 8 children.  You'll witness pregnancies, marriages, divorces, births and deaths within your nursing circle.

There will be a wide range of personalities.  You'll have the question asker, the over achiever, the slacker, the coat-tail rider, the quiet one, the loud mouth, the class clown, the crier, the brown noser, the leader, the 4.0 student, and the one who is barely hanging on.

Yet among all these differences, you will have one thing in common: nursing school.

And because of nursing school you will have many other commonalities.

Only your nursing circle will comprehend the enormous amount of pressure you will feel before you take that HESI.  They will accept your moodiness from lack of sleep and exhaustion.  They know why you no longer have time for a social life or why you can't afford to go grab a few drinks on a Friday night.

Your nursing circle will understand  what it feels like the first time you lose your patient, or how excited you were to stand in on a surgery.  They will share your frustrations. They will know exactly what to say to cheer you up after a failed exam or how to make you laugh when all you want to do is quit.  You will spend a ridiculous amount of time with one another and during this time you will cry together, laugh together, fail together, succeed together, learn together but most importantly, you will one day be nurses together..

Support one another and take the time to help your fellow student nurses when you can.  If you see someone is struggling with the material because it's hard to learn 8 chapters in a week, invite them into your study group.  Lend a helping hand at clinicals, don't just look out for number one. Bring extra copies of your paperwork, use teamwork in patient care. Take advantage of each others strengths and aid with each others weaknesses. (Tom Steele is the reason I learned how to confidently use dimensional analysis and I sometimes feel like if it were not for him, I might still be in Pharmacology) Share your best study tips and be generous with words of encouragement.

You never know when you'll be the one who has a sick child at home all weekend and don't have time to complete the study guide, or maybe a family member ends up in the hospital and you don't have time to print out the required documents for the next day.  It could be you just need ONE day for yourself to keep your sanity from slipping, and you just can't bring yourself to wake up and get to school.  You may need someone to take notes or record a lecture. Your nursing circle will understand because despite our different backgrounds, beliefs and lives, we are all trying to survive nursing school.

Whatever it may be, big or small, remember that a little help goes a long way and when you help others succeed, you will also be successful.



 

Perfection Does Not Exist

Lesson #2: "Sometimes we succeed, sometimes we learn." ~Shauna Painter

I have not mastered this lesson and I have a pretty good inkling it may take me quite some time to do so, but regardless, this lesson deserves a spot at the top.

A clinical instructor once told me that I needed to work on my need for perfection, because perfection does not exist.  

Everyone remembers a time when they had to walk into their patients room, with their instructor and perform either a skill, or an assessment.  It's a pretty stressful experience.  You've got your patient laying in the bed and all you can do is hope they are cooperative while your instructor stands behind her clipboard and watches your every move from the corner of the room. I was more focused on making sure I didn't miss something on the checklist than I was actually caring for my patient.  Mostly,  I got nervous because I didn't want to mess anything up. 

I can recall starting IVs at my kitchen table on all of my friends and being successful on every single one.  However, as it would happen, the day I went to start one on my patient, I had 3 failed attempts before the nurse had to do it.  (she got it on the first try).  I was bummed out for the rest of the day, knowing that I had been successful many times before, but buckled under the pressure of trying so hard to get it right.

I learned very quickly the importance of clamping a G-tube in-between medication administration.  Not because I naturally knew to do so, but because it only takes one patient, coughing one time, for you to realize that gastric content mixed with medication is capable of projecting 5 feet in the air and hitting the ceiling.

I also learned that it's always a great idea to turn off the pump when you're discontinuing an IV because when you come back into the room to take down the tubing and bags,  it's very likely there will be a gigantic puddle of normal saline on the floor. 

Each time an incident like this happened, all I could think about was what a failure I was going to be as a nurse.  I'd say things to myself like, "geez, you're an idiot.  Use some common sense." Or "how on earth are you ever going to make it when you don't have an instructor following you around making sure you're not destroying the place." 

The truth is, we are not going to be perfect and we are never going to know it all.  There will be times when we have to admit that we don't know the answer and there will be times we will need to be shown one more time how to do something...and that is okay.

 It does not mean that we are failing, it means that we are learning.

"ZERO WEEK"

Lesson #1: There are some things in life that you can never be fully prepared for.

In the Air Force, when you first arrive on base you are greeted by screaming, angry drill sergeants.  You get off the bus in a foreign place, surrounded by strangers with blank confused stares and terrified faces.  You have no earthly clue what is going on or what the next step should be.  They call this week "zero week" and it is the week dreaded by all trainees entering the military. 

The first week of nursing school is EASILY comparable.

 I once conducted an interview with Ms. Schneider, our level one classroom instructor for nursing foundations, and asked her for one piece of advice for level 1 students just entering the program.  She said, "Don't listen to the horror stories of nursing school.  Just take one day at a time."  She was absolutely right.  Don't listen to the horror stories, they are lies.  It is FAR worse than anyone could ever describe. 

Seriously though, the first week of nursing school could be described in nearly the same fashion as hell.

What do you mean we have a test next week?  We haven't even had a lecture yet! And what is this class I have to attend for an additional 3 hours that isn't even listed on my schedule?  I am going to be up here 5 days a week? And a dress code?  No nail polish, or jewelery or colorful socks? Khakis and polos? Gross.

For someone like me, with no medical background or history, the first week was a debacle. Complete and utter chaos.  It has taken me 27 years to learn the English language and now all of a sudden I'm supposed to know the meaning of PRN and NPO?  Those aren't even words....and come to find out, the letters don't even make sense for what they stand for. 

You have no idea how to take notes, you feel like you have to write down every.single.detail that comes from your instructors mouth, you can't keep up, they use big words that you have no idea the meaning of, your hand cramps when you write, and at the end of it, you look to your new best friend on the right or left of you and realize that neither one of you have a clue what's going on.  I believe dumbfounded was a word created just for the way a "zero week" student nurse feels for the first 7 days of school. 

Lets not talk about the load of crap you are now responsible for toting around.  Approximately seven books, a computer, a purse, a lunch box,  a calendar, a skills kit bag, stethoscope, blood pressure cuff, pen light and a phone.  Oh, and you have 2 feet of table top space to organize your belongings.

If you're lucky, your school won't have difficulty with the thermostat, but if you're at Kilgore College you'll either leave the classroom as an ice cube or with pit stains.

I never knew it was possible to sit in a chair for 8 hours a day and leave feeling exhausted...like you could sleep for the next year exhausted.  Your brain never stops, they don't let it.  They bombard you with foreign concepts and tell you that from this point forward you are to critically think.  By the end of the first week, you will honestly consider rethinking your decision to become a nurse.

But stick with it, because even though there isn't a single thing anyone could say or do to prepare you for that first week, it gets better.

Better, not easier.

Oh, the things Nursing School will teach you.

You just don't apply for nursing school.  There is a process set in place leading up to the moment you actually get your acceptance letter.  For me, that process began with many derailed paths, followed by a desire to be successful.

I can't share one of those stories about how I used to "play nurse" with my teddy bear or how I "always knew" that nursing was my calling.  Truth is, I never even thought about becoming a nurse.  I never had dreams about it.  In fact, I never even considered it until the fall of 2009 when I went back to school. 

Class after class, I kept truckin' along with my eye on the prize: become a nurse, make great money. Become a nurse, cash that first paycheck.  I am guilty of looking for the fastest way to make the most amount of  money, and nursing seemed to be that answer.

Then came the day I realized I was in my last semester of prerequisites. I was nervous to apply.   Not because I was desperate and determined to be a nurse, but because if I didn't get into the program, it would mean I had failed after 2.5 years of hard work.  It meant I would have to explain to my friends and family that I, once again, had to find another career option.

I sat in my car that day and cried when I opened my packet.  I read the acceptance letter over, and over, and over again because I could hardly see through my own tears.  They were tears of joy and relief. It was a very proud moment for me. 

What I didn't realize in that very moment was that I was facing a 16 month journey.  I also didn't realize it would be one filled with many new friends, struggles, successes,  and many, many life lessons. 

So here is to nursing school and the many things I have learned here. Here's to the good, the bad, the ugly, the fun, the tears, the struggles, the friends, the teachers, the patients and the memories.