Dec
31

2013: One Day at a Time

If 2012 was about big changes, 2013 was the year of buyer’s remorse. If you can have such a thing for life decisions.

I started the year looking forward to the career opportunities ahead, anticipating more school, and feeling quite confident overall that I was headed in the right direction. I am ending the year on the flip side: burnt out and wondering every day if I (we) made the right decisions.

I’ve spent most of my life looking ahead to the Next Big ______. Not content to rest on my laurels (or for that matter, to rest at all), I graduated with my Master’s in 2012 and immediately asked “What’s next”. I told myself this time it was for S, but we all know that this move benefited me just as much as it did him (if not more so). We left stable jobs and a city we loved to put 3,000 miles between us and our family, forcing S to wait a year to establish residency in a new state before we could afford for him to start PA school prereqs. I dove headfirst into a program that I am busting my a$$ to succeed in, and still wondering every day if it’s putting me in a professional place I actually want to be. S and I are like two ships in the night between our work and school schedules.

Rather than hitting the pause button and taking time to enjoy life-as-it-was, I forged ahead and pushed us headlong into life-as-I-thought-it-should-be. And I’ve never felt more lost. Irony of ironies.

Nonetheless, I did set a few goals for myself this year. Let’s take a look at how they fared in the midst of my self-induced guilt-o-rama…

  1. Walk the walk. Ha. We won’t go there. Anyway, The Holistic Nurse (and every other blog series) are on hiatus. Self-care has been supplanted by survival…for now.
  2. Get certified. I did complete the Med-Surg review course at work but when I found out the cost of taking the test (Hint: $$$$) my eyes bugged out a little bit. Instead I’m going to sit for the oncology certification course in the Fall of 2014, after I’ve completed my oncology NP classes. I figure they’ll prepare me just as well for the exam and I’m paying for them anyway. Any certification counts toward a bonus at work…this one will just take a little longer. I’m hoping to take those earnings and treat S and I to a much needed vacation.
  3. Get credentialed in chemo administration. Done. Did the class, got signed off at our cancer center. Dread giving chemo. I’m just full of irony today. ;-)
  4. Pursue clinical ladder. Also done. I’m a “Clinical Nurse III” as of August (and a charge nurse and a preceptor). The whole experience was quite eye-opening. But at least my paycheck thanks me. And maybe, just maybe, I’ll have it in me to go for Clinical Nurse IV. Maybe.

In other news, I’ve decided not to make a “New Year’s Resolution” post for 2014. For one thing, I’ve neglected this blog far too often and I don’t want to make content-related promises I’m not sure I can keep. For another, I’m hoping that by not concentrating on the future, I can better grab hold of (and appreciate) the present. Even if the present is going to be tough.

Thanks for sticking with me through a tough year. May 2014 be full of moments to celebrate!

 


Dec
06

Voila

Now I can finally say it

YIPPEE!! I SURVIVED MY FIRST SEMESTER OF NP TRAINING AND LIVED TO TELL THE TALE!

Submitted my last exam earlier this week. Went to work on Wednesday night. And then proceeded to sleep for about 20 of the next 36 hours. Glorious, glorious sleep, unimpeded by stressful dreams about unfinished assignments.

Though I did have a weird one involving being bitten by a rattlesnake. Analyze that, Dr. Freud. (Or maybe I was just chuckling inside about the latest Modern Family episode…)

Because there is time now for activities like catching up on hilarious TV. Phil Dunphy, you slay me.

Anyhoo, my days are now consumed with sleeping, Christmas shopping online, putting away/throwing away content from this semester, and did I mention sleeping?

I’m going to take FULL advantage of this month off!


Dec
05

Nurse Teeny’s Favorite Things: 2013 Holiday Gift Guide

It’s that time of year again! Time for your favorite nurse or nursing student to a) Finally have a bit of a break from school and/or b) Learn what it means to spend the most wonderful time of the year at work. ;-)

Since I haven’t had much time to do anything BUT study for the past few months, I’m dedicating this year’s holiday gift guide to goodies of the non-academic variety…

First up, this awesome mug I found on Amazon and promptly purchased for my work Secret Santa gift. It’s so awesome I want one for myself (ahem, cough, cough):

superpower_mug

(Source)

Continuing along the caffeinated vein (heh), a hand-stamped coffee spoon from MilkandHoneyLuxuries over at Etsy.

coffee_spoon

(Source)

Other Etsy finds this year:

If you’re a practical type, I’d suggest checking out a website like Allheart.com and springing for supplies your nurse will need on the job or at clinical. As an oncology nurse, I love the Share the Care watch…so much so that when I wore the first one out in nursing school, I went out and bought another one!

watch

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I’ve also become a big fan of the subscription idea. In addition to magazines, there are a whole number of items that can be ordered for delivery over several months, making them the gifts that keep on giving. I’ve read mixed reviews about Birchbox, which seems to have started this whole craze over the past couple years. My personal wish list includes Barkbox (for the poor neglected pups), Naturebox (which appears to have some very yummy snacks), and Ipsy (because I am 33 years old and still don’t really dress or wear make-up like a grown woman…this is my SOS call). A couple Christmases ago, I bought my sister a subscription to Adagio Teas, which she seemed to like. Other ideas to consider include gifting a subscription to a local CSA (community-supported agriculture) for ongoing deliveries of fresh produce or to a favorite coffee company.

As someone who appreciates free time now more than ever, I’d also suggest checking out your local daily deal websites for “experience gifts” (wine tasting, special meals, local tours, sports events, etc.) It’s a great way to learn more about the place where you live, and –  trust me on this – the nurse in your life will appreciate the gift of time with you.

Of course, a hot stone massage wouldn’t hurt either. ;-)

May your holidays be merry and bright! I look forward to another year to come … hopefully this time with more consistent posting!

For suggestions from years past, check out my previous gift guides:

I was neither paid nor perked to suggest any of the items listed above. No affiliate links are present in this post – I’m simply sharing the neat stuff that can be gifted to the nurse in your life…


Nov
26

Debrief

Well, I survived. Assignments and papers are submitted and all I have left are final exams (one of which has been taken already).

Thank you for the emails and comments I’ve received over the past few weeks. I promise I’m still alive, just digging myself out from under a mountain of patho notes.

I wish I could say I feel relieved … hopefully that feeling will come when I’m *officially* done with the semester from hell. All I can say is I.am.exhausted.

This was definitely the hardest semester I have ever experienced. And I’ve been in school a long time. Part of it is the whole work-school-life balance, part of it is the nature of the classes I am taking and the discomfort of feeling like a newbie all over again.

I don’t really know where I’m headed from here. I’m registered for classes next term (fewer credits than I originally planned) and find myself getting caught up in the excitement of shopping for textbooks and a fancy white coat for my first clinical course. And it is exciting, it’s just oh-so-draining to think about.

I put in a request to reduce my work schedule to .75 (which translates to 5 shifts per pay period instead of 6. One less shift would make all the difference.) My manager said no, which was disconcerting and pretty frustrating. I know he has a unit to manage but I feel that I’ve demonstrated I’m a team player, and he’s not working with me. He knows I would pick up extra shifts. Plus HR apparently “overlooked” my FMLA application, so I could be screwed with the call-outs I’ve accrued in the past two months.

I’m getting that restless feeling I seem to always get after being in the same place for a while. At the same time, I’m scared to leave and deal with the stress of learning a new job in the midst of all this other craziness. Which is worse…the devil I know or the devil I don’t? Plus I feel guilty about leaving before our Go-Live, since I am our unit’s only night-shift Super User. Not to mention the love I have for my co-workers that makes this job bearable. Last month I turned down an interview opportunity in peds hem/onc at another hospital. PEDS HEM/ONC, PEOPLE. What is wrong with me???

I have my moments of loathing my current situation, and then I have a good shift or a good conversation or feel like I’m doing a good job and I think I can stick this out, even on the bad nights. I believe I have something to contribute. And then a new migraine shows up or I get overwhelmed by school, and all bets are off. My confidence withers away and I’m back to feeling like I’m a square peg in a round hole.

It doesn’t help that I fired my therapist and haven’t had time to look for a new one. (N.B.:When you start feeling manipulated by someone who is supposed to be helping you, that is usually a bad sign.)

I wish I had something more positive to report. I wish I was shouting from the rooftops “Yippee, I survived my first semester of NP training and lived to tell the tale!” I wish I didn’t sound like such a damn whiner right now.

But it’s raining outside and for the first time since August I have no homework. I think I’ll go take a nap. ;-)


Oct
09

Crash. Burn.

Well, Nurse Teeny went and did it again.

I took on too much and I hit bottom. Hard.

Meltdown -> migraine -> meltdown -> migraine. And so the cycle has continued for the past two weeks. Farewell, PTO. It was fun while it lasted.

I’ve now realized why I get crazy looks from people whenever I tell them I am working full time and studying full time. It’s because I AM crazy.

But this time I’m not letting the crazy win…

First and foremost, I am slowing the hell down. My curriculum plan was just plain sadistic. Maybe if I’m not trying to juggle 12 credits (including a doctoral level stats class), I’ll actually enjoy school again. Maybe not. But I’m giving myself the space to find out. It will stretch out my advanced practice certificate by a semester, which is not a big deal in the grand scheme of things. If next semester isn’t better, I’ll reevaluate again whether this is the right educational path for me.

It will also push my ultimate DNP graduation date back by a year. At first this troubled me. But then I realized by the final year, it will be 99% online and/or capstone work. I can handle taking an extra year for a doctorate if I’m still sane at the end of it.

What I can’t handle is all the pressure I have put on myself to balance something that is impossible.

Second, I am really thinking about where I want to practice. I went back into acute care because I felt like I had unfinished business – some kind of pride thing, that I had to show I could do the clinical stuff just as well as the next nurse. But guess what – I can’t do it just as well and I need to be okay with that. The cerebral stuff comes much easier than the hands-on stuff. Relating to my patients and spending time with them is WAY more interesting and exciting to me than administering chemo or, God forbid, coding them. I’ve been aware of this cognitive dissonance from the beginning, but even with two years in community health and a lot of amazing non-acute-care nursing role models, somehow I still bought into the myth that “real nurses” are floor nurses. Rather than focus on my strengths, I’ve been dwelling over my weaknesses, which has handed me a whopping dose of anxiety. But as I told my therapist this week (yep, therapy rocks and I’m proud to admit it), what the hell am I trying to prove, and to whom? That is a question I am still trying to answer. Hence, the therapy.

Third, I am hoping that slowing down helps me reprioritize a little. I mentioned before concerns about my uterus shriveling up. And while that may have been a little dramatic, I am more than aware that my 33rd birthday is around the corner. S and I have been so focused on our professional/educational 5-year plans, we haven’t even really factored in our other goals. Not to mention the fact that I really don’t want to spend the next several years passing like two ships in the night. That’s no good for our marriage or for our emotional well-being. We keep saying it’s for a greater good, but I’m tired of being in survival mode for a greater good. It’s not a happy place to be.

In the meantime, life goes on. I should be studying for a patho mid-term right now. I have a weekend off to fly out west and see my mom get married!!!! :-) In the midst of the turmoil, there are moments to treasure.

For that, I am thankful…


Sep
25

Follow Your Bliss

I mentioned my first (of likely many) meltdowns that occurred last week. A large part of it was due to stress, exhaustion, financial concerns, self-pity, you-name-the-problem…

But part of it is due to a bit of a vocational dilemma I am experiencing.

I love oncology nursing. But what I love about oncology nursing is not the treatment. The treatment sucks. It is hard on patients and families and it can be downright toxic. I’ve been on both sides of the experience. I just went through the chemotherapy certification process and I am dreading the first time I have to give chemo on my unit. The more I learn about the treatments, the less I want to be a part of it.

What I love about oncology nursing is the patients. Especially the patients who are facing the poor prognoses with grace. And the patients who are facing the the poor prognoses with anger. I just love being with the patients. Which is hard to do when you have 5-6 of them at a time.

My proudest moment as a nurse was helping a patient prepare for the transition to hospice. This is a telling sign for my future. As is my anticipated DNP capstone of improving palliative care at my hospital.

When I started thinking last year about the next steps, I always figured I would do advanced practice oncology nursing because it would make sense to bridge from there to palliative care/hospice. But my palliative care nursing seminar is taught by a professor who is a certified palliative care NP. Who knew there was such a thing? Apparently I didn’t do enough homework before I gallavanted off toward the next shiny degree. Unfortunately my current nursing school does not offer such a certification. But there are others who do, who would allow me to do my coursework primarily online while continuing to work.

At the same time, however, I want to get my DNP. I want to use it for teaching and improving health care in whatever corner I end up. And I think my current school’s DNP program is excellent, so I don’t want to leave.

I guess I have some decisions to make. Continue on the path I’ve set for myself, or investigate the possibility of transferring the credits I’ve already taken to another school? Or finding a palliative care certificate program that I can do in addition to/concurrent with my current studies (because I wouldn’t be me without wanting MORE SCHOOL)? And in the midst of this process, how do I continue on my journey toward earning my DNP?

All I know is I’m not having fun. Nurse Teeny, who loves school and delights in learning, is miserable. Part of it is transition shock and I know I should just suck it up. But part of it is doubt and fear that I’m not on the right path, that I chose this one because I thought it was the “best” option rather than knowing it was the right choice.

I had lunch with a good friend this week and was telling her about my worries. She looked me in the eye and said “Follow your bliss”. I’m wondering if my bliss is waiting for me somewhere else. Or if I’m just being neurotic and restless, as usual.


Sep
22

Grad School Ain’t No Joke

Don’t you just love my grammar? ;-)

Apologies for the silence. I have so much to say and no time to say it. Grad school is a whole new ballgame. Especially grad school when you are learning and relearning clinical knowledge and skills at an overwhelming depth. The difference between nursing school and this experience is this: in nursing school, I learned what I needed to know to get through the program and pass the NCLEX. A lot of my actual clinical learning has occurred on the job, which I don’t think is unusual at all.

However, training to be an advanced practice provider is on another level. Now I really need to retain this stuff. I need to practice “deep learning”, as my patho professor loves to say. It is a little bit insane. And unfortunately, I am not having fun yet. I’m too busy cramming this sh*t into my brain and hoping it stays put.

I had my first major meltdown last week. At 2 am, I told myself (and S) through my tears that I wanted to be content where I was and I didn’t need these fancy certifications and degrees to be happy in my profession. I sobbed that I just wanted to go home (as in, back to the west coast where my beloved family lives). I complained about working full time and studying full time and never having a day off and wanting to just quit it all and take my damn kids to their damn soccer games on Saturday mornings. Speaking of which, I wanted to have the damn kids before my damn uterus shriveled up and died.

Like I said, meltdown.

do want to be content where I am. And I sure as hell want to go home…this 3,000-miles-from-family-thing is for the birds, especially when you’re in your 30s and all-you-want-is-to-feel-settled-and-stop-moving-every-damn-year-for-the-love-of-God. And I do want to have the kids and go to the soccer games. But my uterus is still intact and I’m still healthy and a better time for all that will come, but that time is not now.

Sometimes I think S knows me better than I know myself. He looked at me and asked “If you went to work every day doing what you do now (or something similar) without moving forward in your profession, would you really be okay with that?” And unfortunately for me and my sleep patterns, the answer right now is no. Because I went back to work this weekend and got frustrated with things I couldn’t change and patients I couldn’t help and knew that I needed to keep growing and learning.

So we press on…


Aug
30

Overwhelmed

I have one week of classes officially under my belt. Which was hard to accomplish thanks to getting sick during orientation – I don’t know how a person can cough as much as I did without losing a lung. (Obviously I jest. I know the pathophys of an upper respiratory infection. Dear God, let’s hope.) I finally went to the doctor this week when my coughing fits were interfering with my sleep (and S’ sleep, for that matter). Thanks to the wonders of codeine I’m starting to sleep better and feel better.

However, this whole back-to-school thing is quite an experience. I’m in this weird nebulous place where I’m taking DNP classes with advanced practice nurses who know their stuff and simultaneously taking advanced practice assessment and patho classes with NP students who are just starting their journey. Some of them are brand new nurses who literally graduated this summer. It’s an odd situation to be in – I feel like a fish out of water in both types of classes. I’m both starting and continuing my journey at the same time. If that makes any sense.

And I have one word to describe the workload: impossible. Granted, I am taking 12 credits on top of working full-time, so it’s really my own fault. But when I’m not at work or sleeping, I’m studying, reading, writing. And it’s only week 1.

Overall I really like the professors (especially my palliative care nursing professor. She’s the bomb. I am going to LOVE that class.) My only gripe is that in a couple of my classes they only post the assignments one week at a time, making it impossible for us to get ahead or anticipate our schedules. If we’re supposed to be adult learners, I feel like we should be treated as such.

More to come later… I have discussion posts to write before I head to bed for work tonight, tomorrow and Sunday. Sigh.


Aug
19

I’m In Trouble

Orientation for my doctoral program started this morning. It was a loooooong day. (P.S. My body is now completely befuddled about when it is supposed to be awake. Coffee is going to be my best friend.)

Good thing our orientation swag included a nice big mug. And a pretty sweet new messenger bag. And a bigass binder full of orientation materials. Eeps.

I’m not really sure what I’ve gotten myself into here. Let’s just say that when my Statistical Methods class met with the professor today to review course content, the syllabus they handed out was SPIRAL BOUND.

And that’s one class of four. My brain hurts. For the first time EVER as a career student, I’m a little worried about being in over my head…


Aug
16

New Grad Novelties

December will mark my four-year anniversary as a registered nurse. I have no idea how that happened. In some ways I feel like quite a seasoned nurse overall – I’ve seen my share of practice settings, I’ve honed a lot of skills and I’m finding leadership opportunities at my workplace.

On the other hand, there are nights when I feel as if I just stepped out of my pinning ceremony. In so many ways, I feel like I’m still finding my feet. My only consolation is that nurses who have been doing this for years, even decades, are sometimes still finding their feet too. I’m discovering that I don’t have to know it all – I just need to know where to look and who to ask. It’s comforting (and exciting) to know that I’ll still be learning 40 years from now.

Since I’ll be precepting a new grad nurse this fall, I’ve given a lot of thought to the transition process from student to professional RN. Especially considering how rough my own transition turned out to be…

preceptor

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I’m more determined than ever to give her a positive experience, to help her realize what a privilege this job truly is, to learn and grow and be confident that she will survive, even on the nights that make us all question ourselves. I want her to understand that transition shock is normal, that she will get through it, that she will hate nursing even when she loves it and she will love nursing even when she hates it.

In the past year I’ve seen two extremes from new grads:

1) The Doubters – These nurses don’t believe in themselves yet and therefore ask a million questions. They may struggle mightily once they’re “on their own” and even drown for a bit. Everything is overwhelming and nothing is clear. Since those first months of nursing are so task-oriented, they haven’t developed the critical thinking skills to process problems on their feet. They are constantly asking for help and rarely believe that they can do anything right. They also tend to be very “by the book” because it’s more comfortable there.

syringe

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2) The Know-It-Alls. These folks act as if they’ve got it figured out. They ask barely any questions, complain about other nurses/doctors/staff members as if they’re the only ones who have their sh*t together, and sometimes even treat you like you’re a blithering idiot. At times they can be downright condescending. Sometimes their confidence comes from being better at technology (such as electronic medical records), and using their knowledge to lord it over the more experienced nurses.

tylenol

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Obviously most of us fell somewhere between these two ends of the spectrum. Very few of us fit either stereotype. In my PCU job, I was a doubter through-and-through. In this job, I’ve tried to find a balance between hounding the experienced nurses with questions and relying on my own knowledge. There is some truth to the “fake it ’til you make it” mantra. On the other hand, faking it can kill your patients. So a dose of humility is never uncalled for.

If I had my druthers, I’d rather work with a Doubter. Confidence can be built over time with positive reinforcement. Questions can be reflected back with more questions, forcing a new nurse to think through a problem, rather than always relying on the judgment of others. Students don’t pass the NCLEX and suddenly become sages. It takes time to develop into a professional nurse. Time and mentorship and support. I’d rather be bombarded with questions than find out later that a new grad brushed off a warning sign because they thought it was no big deal. That to me is a much bigger danger sign than someone who is drowning a month off of orientation. Hell, I’m still drowning on some nights. It’s the nature of the job.

In some ways, I feel like I got to be a new grad twice. The first time I struggled with the cognitive dissonance of my job, felt unsupported by my leadership and ultimately succumbed to health problems that did me in mentally and physically. The second time I got to emerge from the ashes of my previous acute care life, armed with knowledge, education, increased confidence and two additional years of developing my assessment skills in the community (not to mention learning survival and resilience). Not only was I better prepared and better equipped this time around, I was surrounded by a community that wanted me to succeed. I was working in a specialty I loved. I was ready for the challenge.

I got a do-over. May the lessons learned from the past four years make me the kind of preceptor who helps new nurses not need the same.

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