Monday, December 6, 2010

Finals Season

Wow, this whole "school" thing really just sucks your whole life in, doesn't it?

I'm in the middle of finals right now, and am taking a short break from the studying. My public health textbook is really quite awful, and since that exam is not until Wednesday, I choose not to ruin the rest of my night reading it.

Exams started this morning at 0800. Technically that wasn't a final yet, just the second of the "regular" tests in my Client Care course. This is a good thing. Exam #2, though it covered only half the course, was the most difficult one we've seen so far in the whole program. The final is comprehensive, meaning it covers twice as much material, so presumably will be a lot more difficult.

Then again, the difficulty wasn't really due to the material. After a weekend of studying I had all the facts and rationales solidly nailed down. What had me sweating was the question design. Of the three professors who share this course, one of them is quite good at writing intelligible test questions that have exactly one right answer each. The other two instructors... well, I'm told they have great clinical skills.

Fortunately, despite today's ridiculous difficulty (ridiciffulty?), I managed a pleasantly high score. Considering both tests and my clinical grade, I've got an A in the course. Since that comprehensive final is optional and I can't possibly raise my letter grade, I don't need to go anywhere near the final and I am calling this class DONE!

But there are three more to finish before winter break.
And miles to go before I sleep.

Monday, October 18, 2010

Once More, With Feeling

Fall break is here at last. I could not have been more ready for it. I was in serious need of a long weekend without any looming deadlines.

With midterms finished, the semester is half over. This has interesting implications. The whole program is three semesters long, so if I'm done with 1.5 semesters, then I am halfway done with the degree.

I want to say that again.

I am halfway done!

Holy hell, you guys! I'm happy and proud of myself but part of my brain is just freaking right out at this idea.

Since May I've poured an moderately ridiculous amount of work and effort into this-- I don't even want to calculate how many hours. Being at the halfway point means I say to myself, "See those last six months? Go ahead and do all that one more time."

Friday, October 1, 2010

Two Down

I have finished my second clinical experience. That was intense! Most of my class still has clinicals through the middle of October, but my section finished earlier by doing longer shifts. So for the last month I've spent twenty-five hours per week in the hospital, on top of lectures, homework, and the beta clinical.

I'm knackered.

And I don't even get to rest this weekend, because I've got to write two papers and do a bunch of research for my public health project.

Fortunately, a lull approaches. Ending this clinical early means I have two days off next week, and right after that is fall break. Once I burn off the large sleep debt I've been carrying around, I'll get to recording some of the interesting stuff I saw in the hospital.

Saturday, September 4, 2010

Ethics In Practice

Here's the first patient of my career whose case was interesting enough to write about.

I worked with a lady who had been admitted from the Emergency Department with severe abdominal pain. This raised red flags because the patient had a certain ongoing condition, and the pain could have indicated serious complications. She was quickly admitted to the hospital, and by the time I met her, the team was already ruling out those complications.

Less happily, they also ruled out everything else. Nobody could find anything wrong with her. There was nothing apparent to physical examination, blood tests, lab tests, ultrasound, or any of several fancy scans. She didn't have appendicitis, colitis, peritonitis, diverticulitis, gall stones, kidney stones, bladder stones, ovarian torsion, ectopic pregnancy, or even constipation. Only pain, and lots of it.

She didn't appear to be a drug seeker. She did not have any of the common signs of that, like requesting a specific drug, or claiming an allergy to the boring low-end stuff. All the docs and nurses who encountered her were pretty sure she was authentically hurting. Even the hospital's pain management specialist came to assess her, and stated his belief that she was suffering real pain. They just couldn't find out what was causing it.

The patient expressed grateful relief after oral non-narcotic medication, but the effect did not last long enough. Her pain kept returning sooner than she could safely be given the next dose. So to check how the pain responded to something else, the physician ordered a different medication, this one by IV.

Now be aware that before giving any drug by IV push, the nurse must first check that the IV catheter is still patent and correctly placed. This is done by injecting a few milliliters of sterile saline into the IV port.

The patient wasn't watching closely and didn't realize we were going to inject saline before the drug. As soon as she felt the first cold liquid go up her arm, she instantly stopped moaning and holding her belly. She said, "Oh, that's so much better." Her racing pulse slowed and her blood pressure came down a bit. And she shortly rolled over and fell asleep.

I'll say that again: she felt better and was able to sleep after just 2 ml of salt water. Placebo effect FTW.

Here's where the ethical issue shows up.

How about we hold the drugs, stick with the saline, and let her think she's getting a narcotic? All drugs have side effects. A small saline injection is a whole lot safer, no one's allergic to it, and as a special bonus it costs less. Since it works for this patient, there's no reason to use anything else... right?

It turns out that, according to US medical ethics as I've been taught them, there is one right answer. It's one of those questions with no big gray area, rather a clear solution and a simple rationale.

I'll post the answer in the comments in case you want to think about it first.

Wednesday, August 25, 2010

A Great Start

School started up again yesterday! This semester I have six courses, three of them with clinicals attached. Let me predict right now that it's going to be one giant ball of fun. Or else a huge disaster. Or possibly a middle ground of some kind.

Yeah, definitely one of those three options.

I would have posted about it last night, but as soon as I got home I fell straight into bed. That's partly because it was a long day, but mostly because I let myself become dehydrated and overheated, thus demonstrating my own special talent for idiocy.

The schedule for day one was a little funky, and our normal afternoon class ended early. Most people were done for the day at that point. However on Monday nights I have an elective evening course, and the slack time in between was too short to bother going back home. So, a few classmates and I wandered around campus to take care of various administrivia. (For one example, I needed to buy a new parking pass. Necessary but boring.)

Now I, being an idiot, had decided not to eat anything since lunchtime. And, having failed to pay attention, I did not consider that I the only fluid I had consumed all day was a can of soda. The weather was ninety-ass degrees and sunny.

I felt fine until after we got back, when we were killing time in the lobby. After some time I realized I was having a little trouble tracking the conversations people were having around me, but I thought I was just tired from the long lectures and all the walking.

Then I stood up... and found myself sitting straight back down again, because I was suddenly dizzy and my vision had gone a little gray around the edges. It took a few seconds to recover.

My nearby classmates, noticing my precipitous return to the chair, pointed out that I was looking really pale. And when I started paying attention to how I felt physically, I became aware that my pulse rate was up, I was having more heart palpitations than usual, and despite the heat I had entirely stopped sweating.

I was a walking poster for of all the symptoms of mild dehydration. You'd think I would have noticed. Fortunately I wasn't in bad shape, only uncomfortable. After some drinks and a salty snack, and fifteen minutes, I had started sweating again (a good sign) and felt much better.

This was just in time for the start of that evening elective course: NRS 448 - Fluid & Electrolytes.

I'd call that a humorous irony if the whole thing hadn't given me such a big headache.

Friday, August 6, 2010

My Band

I'm going to start a nursing student band. We'll call ourselves "Peripheral Paresthesia" and play trancepop electrocore.

Wednesday, August 4, 2010

One Down

Summer semester is done!

Since the end of May I have completed six classes. This works out to seventeen credits, twenty-one exams and labs, eighty hours of clinicals, a large pile of homework, and some seriously heavy amounts of studying.

(Hence the lag in blog posts.)

While decluttering my desk just now, I gathered up all the flashcards that I made for studying over the course of the semester. The stack is too tall to balance by itself. Judging by the empty packages I left lying around, I've got more than one thousand cards piled up here.

That's at least one thousand distinct facts and rationales I have learned, that I didn't know ten weeks ago. Wild! Want to know the difference between hypovolemic shock and septic shock? How to assess and respond to a morphine overdose? What to worry about when a patient is in atrial fibrillation? The appropriate way to deal with an angry family member? All of that and much, much more has found its way into my bony little cranium.

I'm not even close to being the kind of expert a nurse needs to be, but I'm starting to understand how I will get there.

Saturday, July 10, 2010

Patient Contact

I just had my first day of clinicals in OB. That was wicked awesome.

I was assigned to the postpartum floor. The patients there are moms who have recently given birth and aren't up to going home yet. In this hospital, a mom who's had a Caesarian section generally stays there for three or four days, and others are there for one or two.

Nurses start the day by taking report from the night shift and being assigned to patients. As a student I technically have one patient. I'm responsible for knowing just about everything in her chart: her history, current problems, medications, allergies, pain level, needs for the day, and anything else that might be relevant to her care. I can of course reference her chart when necessary, but life's a lot easier if I read it ahead of time.

A full-fledged nurse is also assigned to my patient. She's there partly to make sure I don't screw up and compromise the patient's care, and to handle things I am not allowed to do solo. But she's also there to instruct me in how to work and think like a nurse.

(I also get teaching from my clinical instructor. She is a nurse associated with my school, not with the hospital, and her whole job is to be our teacher. However there are several of us students, we're not all in the same place, and she's only one person, so I only get to see her every so often.)

My patient was in reasonably good shape and had a great outlook. She had reasons for still being in the hospital, of course, but I didn't have to spend every minute in her room. This allowed me to follow my primary nurse around and help her with other patients. I have to say that the nurse I was assigned to was awesome. She kept asking if I'd like to do some procedure-- like remove a foley catheter, or take out an IV-- so of course I always answered yes!

I think the highlight of my day had to be giving an injection. That's one of the simplest skills to learn, but the idea is contrary to some normal concepts of safety. The instant before I did it, I had to stop and look at the nurse for reassurance, because my brain insisted that sticking sharp metal into a live human was Not A Normal Thing. But she gave me a nod, and I went ahead and did it just like in practice.

The patient I was vaccinating did not like needles. She couldn't even look at the syringe in my hand. But after it was done, she told me it didn't hurt like she expected; in fact she barely felt it. I said, "Thanks! Now I can tell you that this was my first time ever."

There were some other cool procedural things too. I got to remove foley catheters on two patients, remove IVs on two patients, and pass out oral medications. I also recorded vital signs, assessed an incision, and did a "fundus check," which means feeling the woman's belly to make sure her uterus is contracting and shrinking as it's supposed to after delivery.

On top of that, I spent a bunch of time running every errand that needed doing. I refilled a lot of ice water jugs. I handed out towels, ran lunch trays, and stocked some cabinets. I manned the phones at the nurse's station, to the surprise of everyone who called and heard a male voice. This all was new enough to me that it was still interesting and didn't feel like scut work.

A second nursing student was also assigned to postpartum, doing the same stuff at the same time in a different set of rooms. Between the two of us I think we made things easier for the nurses and the tech, rather than making extra work for them.

The other members of our clinical group were assigned to other parts of OB: either in the nursery with the babies, or in labor & delivery. Two of those students got to scrub in to the operating room and observe a Caesarian section! I'm a little envious of that, but hopefully I'll get to see both a C-section and a "regular" birth before the semester ends.

Next week I will be assigned to labor & delivery. Over there I will mostly be watching, because even licensed nurses don't get to deliver babies, but hopefully it will be as fun and interesting as this week was.

Wednesday, June 30, 2010

Pause

Finals are over. I've got one more day of lectures, and then a four-day holiday weekend. Sometime soon I will have a post that talks about something other than how busy I am.

Wednesday, June 23, 2010

Test Season Continues

My most recent post mentioned that midterms had just finished. Today, about a week later, I'm halfway done with finals.

The speed here is set a few notches above "ludicrous."

This week contains six tests, most of them disproportionately crazy-making. Foremost among those was yesterday's drug calculation exam. This is one which you can take up to three times, because you absolutely must pass it to continue in the program, and the only passing grade is 100%. Seriously! Any misplaced decimal or fat-fingered calculator button, and you've got strike one. Some of the math phobics in the class have been freaking out over it since orientation.

Not helping those folks was the fact that our medical math textbook, in my professional opinion, sucks ass. This book is junk. It's crap. It's beyond useless. Despite attempting to teach math at the junior high school level, it somehow manages to be incomprehensible to college graduates. I don't think anybody in the program learned a single thing from its illogical explanations. I have a degree in mathematics and I don't even understand what it's trying to say half the time. I feel stupider every time I crack the cover. In the presence of this book, Math Itself shakes its head and looks disappointed.

(I have rather strong feelings on this topic.)

For my classmates who were nervous about math to begin with, inability to follow the textbook threatened to push them into full-on panic. I did a lot of informal tutoring in med calc this week, and I'm not unhappy to have spent the time, because even the most math-hating person in the room aced the test on the second try.

Anyway, that was one of two exams on the first day of finals. The other one that day was the Communications practicum. It involved a lot of longhand writing in unnecessarily cramped little spaces. That sucker took almost two hours, had no such thing as a right or wrong answer, and I don't want to talk any more about it.

Today we had an exam plus a practicum, covering procedural details. Want to know what gauge and length of needle to use for adult ventrogluteal intramuscular injection? Or how many drops per minute you should set on microdrip tubing to run 125 ml in an hour? Or the proper sterile technique for suctioning a tracheostomy? Apparently those facts and others have seeped into my skull over the past few weeks, because they bubbled back up when summoned.

The real killer exam will be Pharmacology, but that's not until Friday. Tomorrow will be devoted to studying for that. Tonight I shall take a few hours off to rest my overfilled brain.

No grades are posted yet. Every secretary in the building was away at mandatory software training, leaving nobody to run the Scantron machine or log grades into the computer. I profess surprise that the school itself did not audibly grind to a halt.

Monday, June 14, 2010

One Down, Many To Go

Well. That wasn't so bad after all.

Our first set of midterms is done. On average they were about as difficult than I had expected, which means far less difficult than I had feared. In retrospect I think all that anxiety was a good thing, because it motivated me to spend a whole lot more time studying than I otherwise would have. That extra effort definitely raised my numbers.

My lowest score was an 86 in Pharmacology. That just barely makes a B, a very respectable grade which I will by no means complain about. However, I will say that right after finishing that exam, I thought I'd done a lot better. I had spent a lot of time making flash cards and re-reading my notes, and I really had a good grasp on the material. What tripped me up was grammar. A lot of the questions could seemingly be read in more than one way, and on every question where I had to guess, I picked wrong. (On further examination, the intended meanings are clear enough, and I couldn't honestly argue for more points.)

The grades on my other exams are higher. As of today I'm feeling very good about my prospects in the academic side of things.

Skills tests and the practicums have yet to start, but we'll burn that bridge when we get to it.

Monday, June 7, 2010

No time for blog, Dr. Jones!

Oh. My. Crap.
How is it time for midterms already?

The phrase "accelerated nursing program" colossally understates the amount of acceleration going on around here. We have had just two weeks of classes-- minus time for orientation, the hello breakfast, and Memorial Day off-- and that already puts us halfway through the first semester. I thought I knew what I was getting myself into, but the reality of it is doing weird things to my brain.

For instance, I have a list of 21 topics I need to know for my Health Assessment exam on Tuesday. It doesn't sound like a lot, but that's just the high-level topics, and each covers a large part of a textbook chapter. One of those topics is "General Survey," and that is made up of four sections: physical appearance, body structure, mobility, and behavior. The "Physical Appearance" section then subdivides into five things: age, gender development, facial features, skin tone, and level of consciousness. Each of those has a list of things to look for and comparisons to make.

I tried to expand the whole topic tree in the form of flashcards, but I didn't have enough cards to make it work.

(Index cards come in packs of a hundred and fifty, BTW.)

And that's just one of three exams I have this week! It would have been four, but the holiday last week pushed our Monday class out of synch with the others. I'm definitely not going to complain about that.

I expect I'll feel a whole lot more confident after I sit the first exam tomorrow. A lot of my uncertainty is just because I haven't seen what kind of test these professors write. I know that I'm great at memorizing, but who knows how good I am at thinking like a nurse?

Wednesday, June 2, 2010

HIPAA

Today, amid the usual eight-hour day full of classes, we got the legally mandated lecture on HIPAA (the Health Insurance Portability and Accountability Act of 1996).

I'm not even kidding about the "legally mandated" bit. Before we're allowed to go work in a hospital for clinical experience, we are required to get a certain amount of training about HIPAA. Every student in the place had to sign an attendance sheet to show that we were there. Anybody who was absent, or somehow failed to sign it, will have to sit through the same lecture again some other day.

They explained some basic history of the law, and its significance-- biggest health care legislation in the last 38 years, blah blah blah-- but what they're really interested in is the privacy provisions. The hospitals want to be absolutely sure we know that personal information is not a toy. I can understand their reasoning, because if any of us student nurses screws up, the student is not the only one who's gonna get sued.

A lot of the privacy concerns are blindingly obvious: Don't leave charts lying around in the open. Don't tell your neighbor about the procedure you did on his pool guy. Don't take a picture of a patient's unusual wound or condition and post it on Facebook, no matter how awesome or gruesome or embarrassing it looks. (Well, maybe that last one isn't quite as obvious as I thought.)

Some of the stuff is a little more interesting, because even though it may be obvious to me, it may be novel information to anyone without a security or IT background: Keep permanent records safe permanently. Destroy temporary records when they expire. Don't share your computer password. Don't copy confidential information onto your personal laptop.

Then there's the tricky bit. A health care worker may not access the records of anyone-- even in the department where they work-- unless that worker has a need to know that information for their job. This means if a famous celebrity comes into your hospital, and is being treated on your ward, but you personally are not caring for them, you must not access their records. Every access to electronic records is logged. People really do get fired for "just looking," and recently, a surgeon in California even got sent to prison for reading stuff he wasn't supposed to.

There seems to a little bit of a gray area where we student nurses are concerned, because teaching is an expected operational function of the hospital. A student can be given access to case information that is interesting for educational reasons, like a rare disease or a particularly unusual presentation. But there has to be a reasonable teaching purpose behind sharing the information, and "curiousity" does not qualify.

Because I don't want to be sued or go to prison, this would be a good place to note that if I ever post here about patients, everything will be disidentified and anonymized. Any identifying details (like name) will be removed. Anything that could suggest identity (like age and sex) will be randomized by flipping coins and rolling dice. If you ever think you recognize someone in a story here, I assure you that you will be entirely incorrect.

Saturday, May 29, 2010

Friending

This week I tried to meet as many of my new classmates as possible. Thus far they all seem like fun, interesting, and intelligent people. Our average age this year is 27, which means most of the class is younger than me, but that's fine. Everyone acts like adults, not your TV stereotype of college kids. Because this curriculum is designed as a second bachelor's degree, everyone has already been through college once and has some amount of life experience. I suppose no one would have applied for this, much less been accepted, unless they had a working brain and a certain level of self-possession.

I've already found a decent pack of friends to hang around with. I don't know that I would call it a study group yet, only because we have not had any exams to study for. The cliques mostly seem to have assembled based on similar outlook and sense of humor. A very few of us have gravitated together because we were already acquainted, from prereq classes we took at other schools.

Weirdly, though, it seems I have a reputation from one of those other classes. At the welcome breakfast on our first day, someone who knows me told a small crowd all about how I broke the grade curve in Microbiology. Then they brought it up again yesterday at lunch, to a different group. I sort of feel like I should be offended that they're telling stories about me, but it would be ridiculous to get upset just because they told people I'm smart.

That does make me glad none of our current classes are graded on a curve, though. This accelerated program is full of high-energy, type-A students. If they thought I was a threat to their GPA, I might be lucky to get out of there alive.

Monday, May 24, 2010

Engage

Day One of school is complete. Fracking awesome.

Sure, I got up at 5, but I wasn't sleeping much anyway. I woke up about a dozen times overnight to check the clock. (Apparently my subconscious doesn't trust the alarm.) No rest, but also no need to rush out of the house in the morning. I got to campus more than an hour early.

Morning session was largely fluff. We were fed breakfast, listened to orientation, met the faculty, and had the obligatory campus tour. Most of that was just buildings. The simulation labs look like a lot of fun; they're full of complex medical equipment and weird animatronic dummies. I'll have to post more about them after I have some classes there.

At lunch break, I ate in a cafe that used to be a Lutheran chapel. I want to know the story behind that conversion.

After lunch, actual classes! And learning! And homework assignments! I think they tried to ease us in slowly, because the first class is about Health Care Communication. Slightly tougher stuff begins tomorrow. Then they stomp on the gas pedal and don't let up 'til graduation. My first set of midterms are two weeks away. Craziness! I have a Pharmacology exam in two weeks, and I don't know any pharmacology yet!

This is going to be difficult.
This is going to be so much fun.

If I ever complain about the workload, just remind me I asked for it.

Friday, May 21, 2010

Final Check

Classes start on Monday. What have I forgotten?

I have sent or submitted transcripts, medical records, insurance forms, CPR certification, loan paperwork, drug test, photographs and fingerprints. I've been scanned, poked, needled, tested, researched, and background checked. I bought textbooks, notebooks, pens and pencils, scrubs, lab coat, white shoes, stethoscope, and my campus parking tag. I've done everything on my task list and own one of everything on my supplies list. But I can't shake the feeling that I've missed something.

I guess that's probably just nerves. I'll admit I am freaking out just a bit. After years of preparation and anticipation, today is my last free weekday before I'm a full-time student again. I'm not at the point where I'm counting down hours (...yet!) but I really want this weekend to go quickly.

Tuesday, May 11, 2010

Outfitting

Less than two weeks until class starts and my posts become marginally more interesting!

I finished assembling my uniform today. This involved a bit of tailoring. Scrubs don't come in regular pants sizes with selectable waist and inseam. All you get is basic sizes-- small, medium, large, etc.-- and the men's sizes are all proportioned for stick figures. I'm not a particularly large guy, but the smallest size that would fit over my butt was waaay too long in the leg. I had to break out the straight pins and measuring tape and sewing machine, and think back to 7th grade Home Economics where they taught us how to sew a hem.

Finding decent shoes was more difficult. The school requires that shoes for clinicals are white leather, with no decoration or logo in any other color. That doesn't leave very many options. My other inflexible requirements were that they be: 1) men's shoes; 2) available in my size; 3) comfortable and supportive enough for eight-hour shifts of constant standing. If at all possible, I wanted them to be neither hideously expensive nor hideously ugly. I spent a couple of weeks shopping at websites, shoe stores, and uniform stores.

Eventually I found these Brooks sneakers. They're not any uglier than they have to be, and not so expensive that I will feel bad about trashing them in six months. I've added better insoles and a few coats of waterproofing spray, and I think I'm good to go.

Monday, April 26, 2010

Books

Four weeks and counting!

I bought my textbooks this week. Fifty-nine pounds of paper, ink, and shrinkwrap are weighing down my kitchen table. I bought everything new, since I hate the distraction of somebody else's highlighting and margin notes, but with some shopping around I managed to find prices that were not completely insane.

I'm fortunate to have a friend who works at a publisher and who offered to share her her employee discount. Getting half my books through her saved me a couple hundred dollars. The rest of the list came either from Amazon or direct from a few other publishers, at smaller but still useful discounts.

There's exactly one book I did not buy online. In defiance of all logic, it was cheaper at the campus bookstore than anywhere else.

Now that I have assembled this stack o' tomes I am resisting the impulse to sit down and start reading. I really want to get dug into the fascinating sciency stuff, but I have far too much still to accomplish before class starts. I've a long list of home repairs, family obligations, and spring cleaning tasks that all need to get done while I have the time. Reading can wait until it's mandatory.

Monday, April 12, 2010

Hello, world!

My nursing program starts in six weeks!

I've been looking forward to this date for more than a year. Now that it's finally approaching I am getting excited, and anxious to start, and just a little freaked out. Having already stopped working, I have all kinds of free time to sit around and be nervous.

The whole thing has started to get real now that I've bought my first set of scrubs. Looking at myself in the mirror, I realized that this uniform is the first thing patients are going to notice when I walk into a room. They aren't going to see some random computer geek who's worked at a desk for half his life. They're going to see a healthcare professional, because that is who and what I'm going to be.

As revelations go, I suppose it isn't particularly profound, but it's helping me remember my reasons for doing this. I'll be happy when the semester starts because that will leave me too busy for all the second-guessing.

I did notice that I look damn good in the outfit, if I do say so myself.