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.