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

(Source)

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

(Source)

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

(Source)

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.

223_feedback

(Source)


Aug
15

Not Nursing?

I mentioned last week that I’ve been applying for a Clinical Ladder promotion at work. Basically that means that I’ve become involved in the life of my workplace through committee memberships and leadership activities and demonstrated aspects of advanced nursing practice at a level that merits a higher level of pay and requires a higher level of practice. If/when I get the promotion, I have to do additional activities to maintain my higher status.

In other words, if I don’t use it, I lose it. ;-)

Unfortunately this has been a frustrating process for me. I’ve jumped through the hoops because a) I think I deserve the promotion and b) man, I would really love to make more money! But before I started my application, I spoke with many co-workers who thought there was too much red tape to make the process worthwhile. And now having gone through it myself, I have to say I agree.

I won’t get into the nitty gritty details, but one of my most disheartening experiences was writing up a patient care exemplar that was supposed to demonstrate advanced practice. My story involved working with a patient who had advanced cancer and whose doctor had broached the subject of hospice, a subject for which the patient felt totally unprepared. After many, many shifts I helped this patient get to the point of actually being excited about what hospice had to offer. In four years of practice, I have never been prouder to be a nurse.

And my exemplar got shot down by my advisor.

Despite praising me for going “above and beyond”, she didn’t believe the exemplar demonstrated advanced practice nursing. She said I should use the criteria of what would have happened had I not been present. Ummmm, the patient would probably still have been discharged to hospice. But would she have been at peace with that decision? I really don’t know. Probably not. As a nurse whose professional goals include advocating for better, more proactive palliative care, having this story turned down made my blood boil.

I understand that clinical ladder committees are probably looking for those life-saving moments in which we catch something out-of-the-ordinary and change a patient’s illness trajectory as a result. The exemplar I ultimately submitted was along those lines. Woo me.

But it’s the advocacy, the education, the being there at 2 am to answer the hard questions – that’s what keeps me coming back. And that to me is what nursing is all about.

Saving lives has many embodiments. And I feel that as a profession we tend to forget that.

What about your experiences? Have you ever felt that you fought for a patient in a way that went unrecognized or was even dismissed?


Aug
08

Summer of Werk

I know this blog has taken a back seat to the rest of my life lately and for those of you who have been with me since the beginning, I apologize. To those of you who have just now come across the site, I promise I’m a better, more consistent writer than I have been lately. I think night shift has killed a few too many brain cells! Hopefully I’ll have more interesting content to share when school picks back up in a couple weeks and I continue my journey. I think the lack of content here can partly be blamed on a sense of stagnation and restlessness. Shocker, I know.

The past month at the hospital has been anything but slow and steady. Patient acuity feels like it is at an all-time high and we are in the midst of budget cuts (and consequent program cuts) that have made everyone a little jittery. Needless to say, it’s been a tough summer. We repeatedly tell each other on the floor that we keep coming back for each other. No matter our passion for the profession of nursing, our energy levels and morale wax and wane with the times. If I didn’t have such an incredible team to work with, I’d be singing the blues much more loudly!

In the meantime, I’ve been looking for ways to build my skill set (and boost my income). My year-end evaluation was a few weeks ago, and I was happy with the feedback I got. They also asked me if I was interested in precepting and training for charge nurse. Here was my thought process: 1) These people are crazy – I’ve been here less than a year!; 2) That’s actually sort of flattering – I guess they have confidence in me. Sure I can do it!; 3) I have a lot to learn still. I hope my co-workers have confidence in me too; 4) These people are crazy – I’ve been here less than a year!

But nevertheless, the process will begin this week. I’m orienting to charge over the weekend and precepting TWO nurses this fall: one experienced nurse in our health system who is just moving over to our hospital and needs to basically be oriented to our workflow and one new grad. I’m way more excited about precepting than being charge.

With school starting I’ll also be working less overtime, so I decided to go for the next step in Clinical Ladder this summer. I submitted my application a few days ago and should hear next week. If I get the promotion, it’s a 5% raise in my base pay. Yes please!

In between all this hubbub, I’ve had a couple of bright spots: my sister came for a weeklong visit and I actually got a few days off that didn’t involve catching up on sleep AND my mom is getting married! She has found a wonderful new partner who is a total sweetheart and loves her like crazy. Lucky lady!

S and I are counting down from our summer of werk to a fall full of studies. I’m taking 12 credits and he will be in class M-Th evenings and several Saturdays (two PA school prereqs plus EMT class). We’ve basically resigned ourselves to seeing each other in December and try to sneak in a few minutes together whenever we can.

As excited I am about both of us moving forward, I can’t help but dread the lack of time we’ll have for each other in the coming months (years). I miss him when he’s not around! I guess that’s a sign that we like each other. ;-)


Jul
09

Back In the Madhouse

I wrapped up my Super User shifts last week and returned to my normal floor on the 4th of July. And I’ve been running ragged ever since… ;-)

Pardon me for the lack of coherent content. I worked a total of five night shifts last week (will NEVER do that again, even though my paycheck will have me dancing a jig in a few weeks).

One thing I have realized since returning to my normal operating mode? This is the hardest job I have ever had (and probably ever will have). More physically demanding than the PCU (and often with equally acute patients), more hectic than community health, and probably more taxing to my mind, body, and soul than any advanced practice or teaching role I may fill in the future. Working on a medical floor, with 6 patients, on night shift, is just plain HARD.

There are some nights when the only thing that keeps me going is the support of my coworkers. Lesson #2 for the week: the team surrounding you makes all the difference! I had a few very tempting invitations from my Super User site to make a move and work there in a clinical capacity (even more tempting since it’s 10 minutes from my house). The major factor that gave me pause was the thought of leaving my family of nurses behind. We keep each other going when we’re running on fumes!

I am coming up on my first anniversary as a floor nurse. Am I exhausted and wrung out? Yep.

Was this the best decision I have ever made? You bet your a**.


Jun
28

Super Duper Super User

I’ve spent the past week at another hospital within our health care system as they “go live” with our system’s new electronic medical records system. It has been a huge undertaking, and our hospital is next on the list for this process. So in a way, it was a rehearsal for me. A much-appreciated rehearsal.

Here’s what I’ve learned from three shifts as a Super User:

  • Even the best systems have their flaws and can always be improved upon. Better to ask for enhancements than just cope with sub-par options – the least they can do is say “No” or “Not yet”.
  • Things will go wrong. That’s why you’re there.
  • You don’t have to have all the answers. That’s why there are application experts and analysts to help you solve problems.
  • It’s pretty easy to tell who needs an extra hand.
  • You’re there to help people learn a new system, not change policy. If you have an idea for documentation practice, but a unit manager or other leader wants things done a certain way, don’t argue (for now). There will be time to fight for best practices. Right now just show the nurses where to put their freaking Is and Os.
  • Help nurses remember how to be nurses. If the system isn’t working optimally (or at all), stress levels are high. But it’s a computer. Focus on the patient and help them do their jobs. The technical problems will be solved in time.

I have a couple more shifts next week before I head back to my own unit, energized about the process to come. And also nervous. All things considered, it’s been a very successful adoption so far and I think we will be fine. But this experience has helped open my eyes to some of the challenges we will probably also face. It’s also helped me create a “wish list” for enhancements, some of which I have already requested in my role as a Super User. The idea is that by requesting improved workflows now, our own Go Live will be that much smoother.

Here’s hoping…


Jun
20

Summer Haze

Sorry I haven’t been around much, friends! The month of June has been a haze of work, Super User classes, stats modules, and oh yes – sleep. I honestly don’t remember much about this month, except for the fact that my family is currently on a houseboat in the middle of Lake Shasta…without me. And I’m baking (poaching?) in the Southern humidity. Sigh…someday we will be able to afford to fly across the country and take real summer vacations. Right? Actually, someday we’ll hopefully be living in much closer proximity to said family and vacations won’t include those cross-country flights.

For the next couple weeks I will be off my unit (except for a few extra shifts that I volunteered for) and over at a different hospital within our system. They are the first inpatient facility to “go live” with our shiny new electronic health records system, and as a Super User I will be working night shift in a non-clinical capacity, sharing my technical expertise with the nursing staff (ha). I’m excited about the change of pace, the new environment (an Adult Bone Marrow Transplant Unit – yippee!), and a little break. Our floor has been especially hectic over the past month … maybe that’s why I’ve been in such a haze of mental and physical exhaustion. I’m hoping that I return refreshed and ready to take on as much overtime as I can handle, because come August, there will be no time for extra shifts. (Come August, there will also be an extra $600 of income every month, since my student loans will go back in deferment…that fact alone is enough to make me thankful I’m going back to school for three years…)

In other news, S registered for his first two PA school prereqs! Huzzah! He has been patiently waiting for us to establish residency in a new state and to save enough money to make this feasible. And this fall begins his own journey. I know it will be a lot of hard work, but he is so relieved to be getting started. He’s been in a holding pattern for far too long, and it is high time he takes his turn!

I’ve got a couple posts in the works and I am looking forward to sharing the “Super User experience” with y’all as well. Hope you’re having a good summer, wherever you may be!

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