I can't believe I get paid to do this

Seriously, it boggles the mind.

I love it. Love love love love it. In fact, I will probably be so sad when I transfer to the mother-baby unit. Or, maybe I'll appreciate the break from the excitement of L & D. Either way, it sounds like I'll have plenty of opportunity to float between the two units.

Everything is different from the hospital I was at this summer, but the nurses are supportive and seem to genuinely operate as a team. My preceptor is wonderful, with many years of labor and delivery experience and a wicked sense of humor.

I'm happy that much of what I learned this summer is starting to come back to me. I have to brush up and practice my skills, but I have all the confidence in the world that those will improve over time.

And, I just got paid today and found out that even though I am working day shifts during my training, I still get paid my night shift differential. How sweet it is!

An Orientation Wrap Up

My orientation was cut a day short, thanks to this freak winter storm weather we've been having. I haven't had much trouble commuting to work, although I have to drive much more slowly thanks to the ice and snow.

Our little orientation session with the hospital's legal counsel scared the bejeebers out of me in terms of what types of documents can and can't be used in a court of law. (Diaries and, I'm assuming, personal blogs can.) I haven't shared shared any personal patient details from my clinical experiences so far, but I am going to be doubly sure to be careful now.

As for the rest of my orientation wrap-up, I have continued to enjoy being the sole RN in the group. I also got my work schedule for the next couple of weeks and had another little tour of the unit from the manager. I met my preceptor, whom my manager described as being "A tough girl. Good teacher" which kind of has me shaking my shiny new nursing boots.

It's unclear whether or not I'll be starting in labor and delivery or on the mother-baby unit. I guess I'll find that out Monday morning, weather permitting -- which I sincerely hope it does, because after only two days of this I already have cabin fever!

Day 1 of Orientation

And all I can say is, I think love this place. If I feel half as welcomed on the unit as I do by everyone that's running the orientation, I will be very happy here.

I was talking to one of my nursing school buddies about how I think being new to the organization and new to the unit is scary. She pointed out that this basically means I have the chance to 'reinvent' (or in this case, invent) myself as a nurse. I've decided that I will be Robin-the Assertive Nurse. So far I'm the only nurse in our very small orientation group, which makes asking questions a lot easier because I'm not as worried about sounding stupid or inexperienced.

Tomorrow I get to learn a bit about their IV pump system, which I think is one I've actually used before... but I am so excited to get a chance to practice everything!

And maybe, just maybe, I'll find the gumption to call my manager and find out my work schedule next week.

This seems kind of cruel

One of the managers from the unit I precepted at this summer left me a voice mail today. They're considering my application for a night shift position in labor and delivery.

I was so surprised to get the voice mail -- and angry, and frustrated -- that I cried. At school. Again.

Funny thing is, I was told by two different HR representatives on two different occasions over the past week that there no positions available for new graduates in this unit -- nor would there be in the forseeable future. I, in fact, even told this HR department this week (very nicely, might I add) that I had taken a position with a different facility.

Part of me wanted to shout hallelujah and agree to the interview. I mean, even though I signed all those contracts, I didn't start hospital orientation until Monday morning, right? I could call the new hospital, explain the situation, and see where things went from there!

A bigger part of me (my egg nog latte-gut, perhaps) thought otherwise. I was raised to honor my word, and the fact remains that I was ecstatic about the possibility of working at this new hospital after my interview.

After some soul searching and talking with my advisor, I decided to buck up and call the manager back. I wasn't exactly sure what I was going to say. Like I said, part of me wanted to be effusive and thankful and take the interview. Part of me wanted to give them a piece of my mind. And the other part of me just wanted to tell the sad truth about how thankful I am for the offer of an interview, but the timing and series of miscommunications make it impossible right now.

I guess I have more time to think about it, though, because I had to leave your standard "Tag, you're it!" message. Hopefully I'll hear back from them on Monday.

Human pincushion Part II

To all my friends with children, PLEASE BELIEVE THEM when they say their arms hurt after a tetanus shot! I did my arm workouts and everything yesterday, and my left arm is still very stiff.

Anyhoo, my appointment at the hospital was more than just for the free vaccines and blood draws. I got to sign my contracts! Yes, there are more than one.

• One contract for the position of an RN in the Mother-Baby Unit.

• One contract for my position in the new graduate residency class starting in February.

• One hours-agreement contract for my position in the Mother Baby Unit for the time period between December 15, 2008 and February 2, 2009. I think I'll probably be working 12-hr day shifts.

• One hours-agreement contract for my position as a Resident RN for the time period between February 2, 2009 and April 27, 2009. I'll be working either 12-hour or 8-hour shifts during the residency.

• One hours-agreement contract for my position as an RN in the Mother-Baby Unit following the successful completion of my residency program, starting April 27, 2009. That's when I'll start working my 32-hr a week, 8-hr night shifts.

There were a bunch of other documents, too. The HR representative reviewing my new-hire paperwork with me took one look at it all and said, "My God, you have a lot to sign!" No kidding.

I also got to take my ID badge picture, which looks like a mug shot because I took my glasses off and the curmudgeonly security guard (whom everyone else was calling Sarge) didn't tell me he was taking my picture. But that's okay, because it has a nice big sticker on it that identifies me as an OB nurse -- which makes me so happy! It's kind of hard not to feel like I'm in some sort of elite nursing club.

OB nurses, unite!

Photographic evidence

Of just how excited I am to work at this hospital. I had not one, not two, but THREE pokes today. One for the flu vaccine, one for the DTaP vaccine, and one for a blood draw:


I'd like to take this time to apologize to the injection room nurses I terrorized as a kid whenever it was booster shot season. At the ripe old age of 27, I am finally able to get poked with a needle without flinching.

I'm hired!!!

I just got the call from the HR representative, and they chose ME!!!!

I don't remember all of the details, but I know I have to make some quick decisions about benefits and take a drug test -- which I'm dreading because I absolutely hate peeing on demand -- but I am so unbelievably happy. I didn't even think twice about accepting the offer.

I start with hospital orientation on the 15th, and then will have six weeks of working on the mother-baby unit before I start the official residency program on February 2, 2009. Like I said, the rest of the details are a bit fuzzy right now but I'll be sure to share them once I can think straight.

Oh happy day!

Meeting with a Midwife

I had the opportunity to meet with a midwife who is on staff here at school. She's practiced midwifery for over 30 years, and shared some wonderful stories and advice about trying to get started in the profession. She also has connections at the hospital where I precepted this past summer.

It was so easy to talk to her. I felt comfortable asking questions about her practice, how I might be more likely to find a labor and delivery position, and what it was like balancing a young family with her midwifery education and eventual practice. Oh how I would love for her (or someone much like her) to be my mentor some day!

At the end of the conversation, she offered to call the manager from my preceptorship hospital to see if she can get an answer about their hiring plans for L & D residencies. She also mentioned that the hospital that I just interviewed at isn't the "greatest" in terms of its environment and what it has to offer labor and delivery nurses. They also don't use midwives. But -- as this midwife also said -- that doesn't mean I couldn't be the person that starts to change things!

Glimmer of hope?

I caved in and called the recruiter this morning. Of course, I obsessed over the message to leave her just in case she didn't pick up the phone. I wrote a script, practiced it 20 times, and then called Andy at work and recited it for him. Twice. (The man is a saint, I tell you.) Thank God it went to voice mail. I would have freaked if she answered the phone!

The good news is, the recruiter called me back. Naturally, I was driving on the freeway when she called so I had to let it go to voice mail. (Safety first.) Here's the scoop:

• They just finished interviewing for the position.
• The manager gave the OK to check my references.
• The recruiter is working on that today.
• The recruiter hopes that she'll be able to call me in "the very near future" with "good news."
  

I actually cried when I heard her message. The job isn't guaranteed -- but it looks like I'm in the running! And I could start work as early as December 15th. At least we know I'll know by then.

P.S. I got another email rejection this afternoon. This one from UW.

Two rejection emails in two days

From two different hospitals! Rejection still stings, even though I'm getting kind of used to it.

Still no word on the position I interviewed for.

*sigh*

I wonder how long I should wait before I call the recruiter? Interviewing right before Thanksgiving has made the timing of this whole situation quite tricky.

I'm feeling much less optimistic than I was yesterday.

No word yet

Haven't heard back about the job yet, but I'm trying to stay positive. The way I see it, the longer it takes for me to hear back from them, the longer they're considering me for the position. That's the hope, at least.

If there has been any silver lining to my unemployment this semester, it has to be the "extra" time I've had to work on homework. Which, in retrospect, there hasn't been much of because it seems like I've been working full-time looking for a job. Hmm.

As for the paper that's due on Monday, I'm almost finished with a rough draft. It's not going to be a masterpiece, but it'll get done. Which is good, because I have two more papers due next Friday that I need to get started on.

I will be oh-so-happy when this semester is complete!

Am I losing my mind?

I must be more stressed out about finding a job than I previously thought, because two bizarre school-related things happened to me lately.

One: I lost a textbook. Never happened to me before. Very unlike me. Also, very expensive mistake to make.

Two: I misjudged an important deadline. I have a seemingly impossible-to-write 10-12 page paper due on December 8th. Up until yesterday, I thought it was due on December 15th.

Oh well -- at least it wasn't due December 1st!

Crossing my fingers

The good news is, I think the interview went well. I felt a connection with the manager and the nurses on the unit -- which is absolutely beautiful, by the way. And, the more the manager described her leadership philosophy and the details of the position, the more I thought about what a wonderful fit it would be for me!

The bad news is, they may not need another new nurse on the unit. As a new RN, I would require more training than a nurse with even just a year's worth of acute care experience. It technically isn't a resident nurse position, so it would also take some extra effort to schedule my necessary certifications and residency classes. If any of the other candidates they've interviewed have more experience, I may be out of luck.

Still, I'm crossing my fingers and hoping for the best. I might find out as early as Tuesday (!!!) or sometime soon after the Thanksgiving holiday. Wouldn't a new job be something to be thankful for?

Update: Just got a reply to my thank you email from the recruiter that A) they thoroughly enjoyed meeting me and B) the manager probably won't make her decision until after the holiday. I'm still thinking happy thoughts!

Finally, an interview!

I'm working on an unbelievably crummy and long paper that's due on Friday -- but not even that can get me down because I FINALLY got a job interview!

I've never been to this particular hospital before, but a classmate precepted there this summer and liked it. The position is a night-shift (11:00 PM to 7:00 AM, I think; 4 nights a week) in a mother-baby unit. I would be cross-trained in labor and delivery, but the majority of my shifts would be in mother-baby.

I am so happy the the manager wants to interview me! When I originally applied, the recruiter told me she couldn't promise me they would consider hiring a new nurse for this particular position. And even though they still might not hire me, I am so happy to even be considered. It was starting to feel like all of those applications and cover letters were just floating off in cyber space -- now I know that someone actually read one!

Phew! I'm feeling rejuvenated and inspired to call more recruiters tomorrow afternoon. But first... it's back to paper-writing for me.

Back to more of the same

Hunting for jobs and doing homework. It's what I do.

I think the hardest part is the waiting. I've started casting a much wider net, in terms of my job applications for positions in hospital birth centers. For example: I've applied for three jobs up in Seattle, one in Bremerton, one in Auburn, one at an Army hospital, I-don't-know-how-many in Tacoma and Federal Way. Next up is Puyallup. And maybe Olympia.

I often wonder why I'm not getting interviews. Being the last of my nursing school study buddies to find work is depressing and, frankly, kind of embarrassing. It also doesn't help that most of my classes this semester are pretty uninspiring. I hate to admit it, but I'm starting to second-guess myself and my performance in my preceptorship this summer. I know that I've chosen a competitive area of nursing, but I also know that I'm a strong candidate. I hope that choosing this particular nursing school program wasn't a huge mistake for me. Right now it seems possible that my dream of being a labor and delivery nurse (and eventually a midwife) might not work out as I'd planned.

I realize that doesn't necessarily mean it won't work out eventually, but I know that I will be so much happier if I start my nursing career in a specialty that I feel passionate about. Also, it'll make working those night shifts (which I am sure to be scheduled for as a new nurse) that much more enjoyable.

And now for something completely different

Studying for the NCLEX almost robbed me of the majority of one of my favorite months of the year. Fortunately, I strategically scheduled my test around one of my favorite October celebrations: Pumpkin Day.

This past Saturday marked the 5th Annual Pumpkin Day Celebration. What started as a small group of friends meeting for a homemade brunch and trip to the pumpkin patch has evolved into what may best be described as an organized festival of fun.

Our most recent pumpkin day celebration started with a 5K run, followed by an afternoon trip to the patch and ending with an evening pumpkin food potluck and pumpkin carving party.

If there's anything I've learned over these past five years of Pumpkin Day, it's that (in terms of pumpkin carving) my eyes are often bigger than my stomach. Andy documented my "catch and release" of the first pumpkin I picked out from the patch.

Ready to hit the patch and find the perfect pumpkin.

Um, it's really heavy.

I mean REALLY HEAVY.

Seriously, I can't even get it in the wheelbarrow.

I guess it just wasn't meant to be.


We took a moment to say our goodbyes.

Oh well. Maybe next year!

We ended up with three beautiful, albeit significantly smaller pumpkins. Now we just have to carve them and roast the seeds. I love this time of year!

Unofficial results are in...

and I PASSED!

Unofficially.

Now I just have to wait for the state to give me my license, and I will be an official registered nurse! This also means that I will hopefully have a job sometime in the near future.

I'm too excited to write anything more substantive.

I'm a nurse! I'm a nurse! I'm a nurse!

Update:

Holy cow, my license has already been activated by the state! Now I really AM a nurse.

Initial NCLEX update

It was awful and I feel like I failed. Unfortunately, I also feel like the girl who cried wolf -- my dear sweet Andy can vouch for my perpetual lack of confidence in my test-taking abilities. Please trust me, though, that I am not being melodramatic when I say this:

I have never felt more terrible about a test-taking experience for so many different reasons.

I'm trying to take comfort in the fact that everyone said I would feel awful when it was finished. Still, I have a really bad feeling about this. It seems cruel that we don't know our results right away. The wait isn't nearly as long as some other professional exams, but the time between now and Wednesday feels like an eternity.

I predict I will have no fingernails by then. I may also have eaten twice my weight in fried potato products.

Deep breaths... deep breaths...

Yesterday I took a glorious two hour nap in the afternoon, went for a lovely run, and crammed in one more practice test.

While the nap seemed like a good idea at the time (not so much when I tried to go to bed later that night) the run was undeniably perfect. The sun shone through the brilliant autumn leaves and the air was crisp without being cold. Also, I saw a bulldog. And he barked at me. My heart soared with the eagles! I almost forgot about my big test tomorrow.

Yes, I love October! It's usually my favorite month of the year. This year, though, it could either be the best (I pass the NCLEX) or the worst month ever (I don't pass). I'm kind of starting to wish I hadn't told everyone I was taking it tomorrow.

It's mere hours away...

At this time next week...

I'll probably be doing one of two things:

A) celebrating my new R.N.-hood with a ticker tape parade and appropriate libations
B) drowning my sorrows over my NCLEX failure

The Big Test is in T minus 5 days... and you can bet your sweet bippy that I'm paying the extra $8 so that I'll have my results by Wednesday afternoon!

P.S. I'm hoping for option A.

What's new, honeydew?

My little blog is horribly out of date. Seriously, though, you should thank me for it. My days are pretty boring. In fact, I had just started to write out a schedule for my typical day to share with you but it was too depressing. I had to delete it.

I still haven't heard anything back about the jobs I'd applied for in labor and delivery. At this point, with my test date only a week and a half away, I figure I might as well just wait until I have my license. That way it'll be more like taking off a Band-Aid if they reject me -- and less like I'm being strung along, which is how I feel right now.

I'll be honest, it has been more than a bit of a bummer.

I have a test date

It's officially scheduled.

I'm taking my NCLEX-RN on Monday, October 20, 2008 at 0800.

Wish me luck!

And now I can't believe it's already mid-September

I can't believe I had a whole month off from school. At first, things went a little bit like this:

Day One: House cleaned, dishes done, called labor and delivery nurse recruiters at two local hospitals, baked a batch of cookies, and redid the dishes -- all by twelve noon. And then I got bored.

Several friends advised that I should, in fact, appreciate the boredom. Fast forward a couple of weeks, and I finally started to. I also stopped being so disciplined about doing the dishes and keeping the house cleaned. Some things never change!

I went to a Tacoma Rainier's game, started running regularly again, got lots of wedding planning done, went to at least one concert -- and, I think I even finished reading a non-nursing related book. I also applied for several jobs (only to be told that it was too early for me to apply because of the bizarre-o program I'm in), and started thinking about studying for the NCLEX.

Now that school has started, though, it's time for me to actually start studying!

I can't believe it's already over.

I successfully completed my 337-hour preceptorship in labor and delivery. I couldn't be happier with my experience; I feel lucky that I had such a great preceptor and that my unit is so supportive of student nurses. And, I'm proud of myself and everything I learned this summer. The experience was exactly what I needed to confirm that labor and delivery is where I'd like to work as a nurse.

My last day was kind of crazy. First, Ashley and I took care of a c-section patient. Then, my secondary preceptor snagged me patient planning a natural delivery, rich with opportunities for labor support. It was exactly what I wanted on my last day -- because everything is all about me and my needs, right?

Oh contraire.

We ended up having a slightly emergent cesarean section. (Another learning opportunity!) The silver lining for me -- other than the delivery of a healthy and happy baby, of course -- was that I was able to be a helpful part of the team as we prepared for the surgery. If we'd had this situation earlier in my preceptorship I would have just gotten in the way and wouldn't have known what to do.

I promised to keep Ashley updated on the hiring process and my plans for the NCLEX-RN exam in October.

Maybe she could be my residency preceptor!

Blood, sweat, and even a few tears

All for this monstrosity:


If you find a typo, dear God, please don' t tell me because I had to take it to the printer's yesterday.

I swear, the dang thing is almost as big as I am!

Only one day left

Tuesday is the last day of my preceptorship in labor and delivery. I'll have completed 337 clinical hours -- and I think I might actually cry at the end of the day. I'm looking forward to having a vacation from my classes, but I'm genuinely going to miss my clinicals. I love labor and delivery, and I love the culture of this particular unit.

I did have the opportunity to introduce myself and talk with the unit's clinical supervisor about employment opportunities. They have a lot of new hires right now, so she said I would likely start as a supplemental employee and probably work nights. It's not a guarantee that I'll get hired, but I know the staff likes me and it seems like they'd like me to work there. Hopefully that'll be enough to help me get my foot in the door.

And now I'm off to finish my research poster, study for Monday's final exam, and think of appropriate thank you gifts for my preceptor and the unit.

Almost a babycatcher...

For the second time in a week, I came thisclose to delivering a baby.

The first time was with a first-time mom. I'd been providing labor support while she pushed for almost 3 hours. My preceptor took over so I could go to lunch (it was almost 2 PM) -- and when I came back, SHE was delivering the baby!

My second almost-opportunity came with a mom having her fifth baby. She didn't make any cervical change for hours, had her labor augmented, and then *foom!* it was baby time. It went a little something like this:

I check on the patient. Contractions are a little bit stronger, but the patient still feels like she has a ways to go.

(Ten minutes later)

Family member runs to the nurses station looking for me. "She needs you! She says the baby's coming!"

I help the patient to bed and check her cervix. She's dilated to 7 cm, so I calmly instruct the patient not to push, and make sure my preceptor has paged the doctor. I stay with the patient to help her try to breathe through each contraction -- which have definitely turned into strong, get-that-baby-out-of-here kind of contractions.

(Five minutes later)

"The baby's coming! I have to push!"

That's right about when a spare midwife rushed in and took over. The patient was complete and she delivered in about 2 pushes.

Just goes to show that when those babies decide it's time to make their grand entrance -- they really make an entrance!

A cervical epiphany

I finally found the cervix.

I've been doing semi-successful cervical checks for the past few weeks now -- where I was pretty sure I'd found it, but I always a little uncertain. Unless, that is, the baby was half-way to crowning and the mom suddenly felt like pushing. I'd gotten pretty good at those checks.

I don't know exactly what or how it happened today, but it was a like a light came down from heaven when I checked my patient for the first time today. There was no doubt in my mind that I had found that cervix, it was dilated to 3 cm, and that there was still a bulgy bag of waters.

The most satisfying part was when the doctor agreed with one of my cervical assessments later in the day. I still need practice -- especially for determining effacement and fetal station -- but I'm really starting to get the hang of it.

For the first time, I felt like the idea of me being a labor and delivery nurse (or even a midwife!) wasn't just some crazy dream. Someday, I could actually do it!

I've turned the corner...

I'm not yet to the halfway point in my summer preceptorship, but I feel like I've had my "a-ha!" moment this week.

I had my first day with my secondary preceptor, and I LOVED working with her. She has tons of labor and delivery experience, teaches a class for childbirth educators, and worked as a doula for 11 years. We have very similar philosophies about the role of a labor and delivery nurse. And, she's incredibly supportive of students. I think, for the first time, I didn't feel like I was a burden to the unit.

I also had the chance to do my first independent delivery with Ashley, my primary preceptor. She took on the role of the baby nurse, and I helped the mom with the delivery. I couldn't believe it -- early on, I was helping the mom push and I was the only health care provider in the room! Not only that... it was all in Spanish. It went a little something like this:

"Uno, dose, tres...fuerte fuerte fuerte! Bien! Bien! Mas!"

I still have so much to learn, but I really feel like I'm starting to put all of the little pieces together and thinking of the "big picture" rather than the tasks that surround nursing care.

I love it. I love it, I love it, I love it.

Where has the time gone?

Suddenly, it's the first of July. I officially have 120 hours (of my required 336) logged in labor and delivery. It feels like so much has happened, it's like I don't really know where to begin!

I'm 1 for 3 for IV starts on patients. I did, however, manage to start an IV successfully on another nursing student who's working at the hospital as a tech for the summer. I was proud of myself today because I managed to get a mom all cleaned up, gown changed, underwear in place on my own -- even though she was still a little bit numb from her epidural. I've finally gotten used to the 12.5-hr days. Don't get me wrong -- I'm still tired when I get home, but now I can at least stay up after 2100 after getting home from my shift. I'm very comfortable with my preceptor, to the extent that I'm more nervous when I'm in a patient's room by myself than I am when she simply stands in a corner and watches me.

I've had good days and bad. Today was a good day. I had my first delivery where I didn't even feel a bit like shaking while coaching the mom through her pushes (in Spanish!) and I've finally overcome my habit of getting lightheaded in the OR.

I guess what's most important is that I still love it and am so happy to be here. I'm slowly becoming more independent, and each day I'm a little more confident.

I hope, I hope, I HOPE I get a job in an L & D unit when I get my license!

What do I think about L & D?

My past few shifts have been crazy, but I love it. I have been, literally, up to my elbow in babies.

I've been able to practice lots of my skills, and slowly delve into the world of labor support. I was going to take pictures of my war wounds from being labor support during a precipitous birth (the baby came too fast for an epidural), but our camera was out of batteries.

One thing I hadn't anticipated was all of the paperwork and charting involved in labor and delivery care -- I think I have as much to learn about THAT as I do about how to be a great nurse at the bedside.

I'm learning so much from my preceptor, though. She does a great job of labor support, which I felt was really missing from my previous clinical experience in OB. And, she's supportive of me and my comfort level.

I still have to condition myself to the twelve-hour shifts. All in all, though, it's incredibly challenging, an adrenaline rush (I think I've finally got the shaking under control), and extremely rewarding when things go well. I cannot wait to see how much more I have to learn during this experience!

Day 1 is tomorrow!

I met my preceptor for coffee today, and I'm even more excited than I already was about my summer clinical in labor and delivery. I really liked her. She seems super nice, and excited to teach.

She's even going to let me practice starting an IV on her, so she could also be a saint. Or maybe a martyr, because she'll be suffering so that my future patients don't have to.

Oh, and I start TOMORROW.

I've never been so excited to work weekends!

Summer Update

Hawaii was wonderful. I went paddling in the Pacific Ocean in an outrigger canoe, helped plant some pineapples, spent every day at the beach, went snorkeling, got a ridiculously funny-looking tan line, and had papaya for breakfast almost every morning.

I also found out more information about my preceptorship!

I'll definitely be in labor and delivery. (Yay!)

The rest is still kind of up in the air -- but I should tentatively be on 12 hour day shifts at St. Joseph's hospital. Our first day of summer classes is tomorrow, so hopefully I'll find out more then.

I did it!

I finished my first full year of nursing school! And I didn't just survive it... I actually did a pretty good job. I can't believe how much I've learned and grown over the past year.

Last night, I was inducted into the International Honors Society of Nursing, Sigma Theta Tau -- or what I've been casually calling the nursing hall of fame.

I do have class this summer, starting on June 2. We're completing our preceptorships, which I believe is something like 350 hours of working with a nurse in one of the local hospitals. I don't yet know:

A) which hospital I'll be at

B) what kind of unit I'll be on

Or,

C) my shift.

We got to request all of these things, but I believe I wrote on my card: "I will work at any hospital for any shift if it means I can precept in a labor and delivery unit." Who knows where I'll end up? My only hope is that it's not the night shift.

Between now and then, though, I'm going to Hawaii with a friend from school.


Alooooooooooooooooha!

Last day of spring semester!

True, I still have finals Monday through Wednesday -- but this is the last day of my spring semester.

And do you know what that means?

I've survived my first year of nursing school!

Now Andy and I just have to make it through the first stage of our Great Big Move to Tacoma this weekend.

Right now, though, I'm pretty sure I could survive just about anything.

Yay! Yay! Yay!

Friday: A simultaneous awesome and bummer of a day

Awesome because our OB class was taught by the "real" instructor. She's been on sabbatical for the past year (catching up on midwifery work and research) but she agreed to teach the lecture about contraception. It was, by far, one of the best lectures I've had yet at PLU.

Sad because it makes me think about what our OB class could have been like, had she been our teacher the whole semester.

*sigh*

Oh well.

Woo hoo!

I did it! I was responsible for the care of three patients tonight. Up until now, the most I've cared for is two patients at a time.

I'm pretty satisfied with how my night went. It felt a bit hectic at times, but that wasn't unexpected. (I think 2.5 patients would be juuuuust right for me.) In fact, I think I'll actually be able to sleep well tonight, rather than staying up to obsess about things I could have done differently.

This clinical experience has given me so much practice with medication administration, getting comfortable with IV lines, and managing my time. I've actually really enjoyed it.

I feel all nurse-like and stuff!

Nothing too exciting happening...

But I recently got to watch a doctor sew up a patient's abdomen at the bedside. Turns out when you have a ruptured appendix, they leave the incision from the original surgery (to remove said problem-appendix) open for a few days to reduce the number of germs that get stuck inside.

Needless to say (no pun intended) it was pretty cool.

Blech.

I can't believe it, but I missed my first class today. I wonder how many hundreds of dollars that cost me?

I probably could have stuck it out if I didn't have four hours in between my morning and afternoon classes.

Looks like I've finally got that icky cold that has been making its way around the Puget Sound area. My throat is sore, my nose is runny, I've been making stupid mistakes all day, and am having the occasional chills.

A two hour nap and some hot tea made me feel much better but that doesn't change the fact that I hate being sick -- and I missed OB!

Evening clinicals are a tricky thing

I've discovered I really enjoy the evening shift. It has a different flow than the day shift. As long as I save my caffeine fix for the afternoon, I'm pretty alert and thinking clearly from beginning to end.

Turns out I like Adult Med/Surg nursing, too. We have more responsibility now as "Senior I" students, which is both exciting and downright scary. We have access codes to the medication administration system and can give certain medications independently. The medications we take out of the system are double-checked by the RN we're working with, but I'm proud to report that I've now given three subcutaneous injections all by myself. It's exciting, because I feel like I'm finally getting to practice my skills.

I continue to be impressed by the breadth of knowledge the nurses on my floor have to have to do their job well. I'm also impressed with their speed and efficiency -- having a student to mentor can really slow them down. On Monday, though, I was responsible for the primary care of two patients. I've never cared for more than one patient at a time, so it was exciting to take on more responsibility. By the end of this clinical experience, I will hopefully be caring for up to 3 patients per shift.

That whole being alert at night thing is a real problem though. I'm alert for my drive home, and I'm alert when I should be sleeping. I've turned into an insomniac! For some reason, I didn't have any trouble taking naps and sleeping soundly when I got home from my morning clinicals. It makes me miss them.

And now for something completely different

I've switched to evening shift clinicals. That means I start work on my adult medical-surgical unit at 3 PM and work until 11 PM. It makes for a TOTALLY different clinical experience... and it means I don't get home from the hospital until after midnight.

This is the first time I've been on a true medical-surgical floor.  Admittedly, I'm more than a little bit concerned.  Why, do you ask?

A:   Parking at the hospital stinks in the afternoon.  I park my car at a friend's house, which is just about a 20 minute walk away.  It's great in the afternoon, but not quite as much fun after 11 o'clock at night -- especially when you have to pass through parts of a neighborhood that has a reputation for being slightly unsavory.   

B:  The unit has one of the worst reputations as a clinical site among nursing students, due to tension among the staff.  

C:  It utilizes a "team nursing" approach, which means one nurse can be responsible for up to 6 patients at a time.  The care for those six patients gets shared between different staff members: CNAs take vital signs and perform primary care, like give baths and help with ambulation; phlebotomists take patient blood sugars before and after meals; nurses pass meds and do charting... and so on down the line.  

It's very fast,  and seems very task-oriented.  I'm trying not to have any sort of expectations  -- so I guess we'll just see how it goes!   

Riddle me this

Why is it that after two blissfully lazy spring break mornings of sleeping-in, I woke up at 4:45 this morning -- and still haven't been able to fall back asleep?

Day 5 of OB: Labor and Delivery Part Deux

Soooo... apparently there have been lots of OB days that I haven't blogged about.

I've had the opportunity to spend one day in antepartum (AP), caring for women who may or may not be in labor, and two days in labor and delivery (LD). They've all been wonderful in their own separate ways.

My day in AP taught me an important lesson, and that is this: it's not the babies I love about labor and delivery. (Although, I admit, they're super sweet.) It's the moms-to-be! I had the chance to care for all sorts of different moms-to-be and all sorts of different pregnancies.

My days in LD reinforced that lesson. I saw my first vaginal birth on day 1 in LD, and then spent the rest of the day helping admit a new laboring mother to the unit. She was young and scared -- and I think I'm the first person who told her that it's normal to be nervous or scared about having your first baby. She was so relieved! I spent lots of time talking to her and her mother, holding her hand during contractions and when they started an IV.

On my second day in LD, I saw a cesarean section and spent the rest of my day (plus some additional hours) helping a woman through the labor of her 5th baby.

I never did get to see that baby born. I did, however, get to put a catheter in for the first time. (It took a couple of tries.) And, I had my first experience with adult poop. For the sake of those with weaker stomachs, I'll just leave it at that.

One thing I've noticed about my experience in L&D and AP is that, by and large, these nurses love to teach. I have learned so much from my few days with them!

It makes me want to cry when I think about Black Tuesday -- i.e., my last day in OB nursing.

It's almost overwhelming

just how much I love working with moms and babies.

I can't believe people get paid to do this. It should be a crime to find such joy in a clinical experience!

More on my second day in labor and delivery later. It's bedtime for Robin.

Two things

#1. Labor and delivery rocks.

#2. Do not hold your breath with the new mom while she's pushing. First of all, for baby's sake, she shouldn't be holding her breath for too long with each push. Second of all, it makes you (the observer) lightheaded and then you (the observer) have to leave the room to take a walk and get a glass of water.

Don't worry, though, I made it back in plenty of time for more good, hard pushing and the birth.

A birth! I finally saw a birth!

Day Two of OB: NICU

I spent today caring for three of the tiniest little babies I have ever met.

All of our patients were in relatively stable condition. None were on oxygen, and two were almost ready to go home. The third baby was the youngest -- only a couple days old, born prematurely, and weighing in at right around 3 lbs. Little ones like that stay in one of those isolated, heat-controlled cribs like you see on TV.

My sister's cat, Gus, weighs more than 5 times more than this baby. Now, I admit Gus is one big kitty, but it kind of puts thing in perspective.

My nurse just kind of threw me into the thick of things, which was great. It didn't give me a chance to get nervous about taking care of such little babies. I took all of their temperatures, listened to their heart rates and respirations, and helped with the rest of their assessments throughout the day.

Two of my greatest challenges were changing their little preemie diapers and coaxing the two babies who were bottle-feeding to eat. Diaper changes were difficult because they have such small little bottoms. Feeding was especially tricky because the babies kept falling asleep. When I was with the lactation consultant, we did what we could to keep a sleepy baby awake -- take their hats off and rub their heads, tickle their feet, or take an extra layer of blanket off just during their feedings so they could be awake enough to eat.

Preemies, though, have even greater trouble regulating their body temperatures than a baby born at term. The most I could comfortably do was take off the baby's hat and rub his or her head to wake them up a bit, or burp them. And, some preemies need help supporting their chins to get a good seal around the nipple of the bottle.

Despite all the tricks I learned, I had trouble getting my two little patients to eat their minimum amount. I had better luck later with each feeding, but each time my nurse had to take over and try her best to coax more food into them. She usually had more luck than I did -- but she always let me try first.

So far, I've loved everything about OB. On Monday, though, it's on to labor and delivery -- or, as I like to call it, the Big Dance.

Oh, how I hope hope hope there are midwives in the building and lots of babies being born that day. Wish me luck!

Day One of OB: Lactation!

The good news is, my clinical instructor was very understanding about the whole alarm clock fiasco. The even better news is that the lactation consultant doesn't start making patient rounds until about 0745 or 0800, so technically I wasn't late to my scheduled clinical activity.

I really enjoyed my day making lactation consultations -- which is great, because I had many fears and misconceptions about breastfeeding. By the end of the day, I even got to do some patient teaching of my own! I was so happy to be able to answer a new parent's questions. It felt very natural and satisfying.

If anything, my experience demonstrated the fact that a) pregnant mothers, by and large, are not sick or ill and b) breastfeeding is a learned skill for both mother and baby. It seemed that a lot of new moms struggled with that, because they felt like they should just naturally be good at it. Turns out breastfeeding takes practice. Who knew?

There were lots of questions about whether or not baby was getting enough food. Imagine the surprise of new parents (and this student!) when they learned that their newborn baby doesn't usually eat more than a few teaspoons at each feeding. During their first week of life, newborn stomachs aren't much bigger than the size of a walnut.

It is so hard for me to believe that my stomach was once that small.

Just my luck

My first real day of OB clinicals -- a day that, quite honestly, I've been looking forward to since THE FIRST SEMESTER OF MY SENIOR YEAR IN COLLEGE -- and my alarm clock doesn't go off.

Seriously, the dang thing is still set for 5 AM. I don't think I'll ever know what happened.

Luckily, Andy's alarm clock went off at 0700. (Tuesday's his day to sleep in.) Mind you, I was supposed to be at the hospital at 0645.

Say it with me now... awk-ward!

Not exactly the lasting first impression I wanted to make on my clinical instructor.

An orientation to labor and delivery

I know I loved pediatrics, but this really could be the clinical experience of my dreams. I don't know what it is about childbirth or labor and delivery that I find so intriguing, but it really is like a Robin magnet.

Like other clinical experiences, we'll have the opportunity to rotate through different units and shadow different nurses. We're spending most of our time in the mother-baby unit of the hospital. We also get two days in labor and delivery, one day in the NICU/special nursery, one day in antepartum, a day at a community WIC office, and a day to follow a lactation consultant -- which is what I get to do on Tuesday.

I can't wait to get started!

A Pediatric Recap

It's odd. Pediatrics was by far my best clinical experience but I wrote very little about it.

Due to a Monday snow delay, I only spent two days on the hospital floor. I did, however, get to spend a day in the pediatric hematology/oncology outpatient clinic, which provided me the chance to do lots of observing, ask questions, and entertain younger siblings while an older child got their chemotherapy treatment. It also provided what was perhaps one of my most profound pediatric experiences, when a four year old boy rattled off the names of each of his chemotherapy treatments to me -- this was shortly after he and I talked about the joys of a peanut butter, jelly, and banana sandwiches. I felt like someone punched me in the stomach.

My days on the floor were wonderful. I shadowed great nurses (some of them PLU graduates!), and performed lots of assessments on a wide variety of patients. My first day we had an adolescent under observation during her recovery from a suicide attempt, a toddler recovering from a sickle cell crisis, and an infant recovering from several complications from surgery to repair a congenital heart defect.

I spent most of my time with the baby even though I couldn't hold her. I helped the occupational therapist during her assessment, and watched the baby's PICC line get removed. I also had the chance to take out the toddler's IV prior to his discharge. That kiddo had a pretty mean right hook. :)

My second day on the floor was a little slower. I took on the care of a school-aged child with asthma. I performed his assessments, and gave his medications. I also had the chance to help another nurse on the floor with a difficult patient. He was a fussy infant experiencing withdrawal symptoms while being weaned from narcotics. It took me and a nurse tech to calm him down, and then I held him for an hour. The unit secretary came in the room to tell me how sweet it was to see him calm and letting someone hold him. He'd been inconsolable the day before.

And there were so many more wonderful experiences! If there's anything I've learned in pediatrics, it's that I don't like seeing sick kids -- but I do love taking care of them.

Labor and delivery has some serious competition.

I was just thinking....

If you would have told me at this time last year that in just 12 months time I'd be waking up voluntarily at 5 AM... I'd probably still be laughing at you.

But here I sit, at 5:30 AM, sipping on a cup of decaf coffee -- and it's not even a clinical day!

An even MORE Important Announcement?

Andy and I are getting married!


Let the planning begin! We've been engaged for a little over a week now -- and I don't think a day has gone by where one of us hasn't brought up an idea for our wedding. We have a tentative date set in late spring 2009.

Right now looking at wedding stuff is a reward for good study habits. For example, after reading another [terribly written] chapter out of my textbook, I get to look at wedding gowns for 15 minutes.

An Important Announcement

I have never felt this way about a clinical experience before.

I spent my first day in pediatric clinicals in the observation unit -- an interim place for kids who are too sick to be sent home, but may or may not have to be admitted to the hospital. The census varied from teenagers to infants.

I started out mainly as an observer. Eventually, I performed an assessment on a wiggly toddler (my first!) and helped out with patients and around the unit as much as I could. I held and fed a five-week old baby that is failing to thrive, having gained just shy of one ounce of weight since birth. He has some serious reflux, so it was a major achievement that he didn't spit up half of his feedings.

I also watched the "real" nurse change the dressing around a gastrostomy tube (a tube going through the abdominal wall and into the stomach for feedings) on an infant, and use suction on that same infant's nose and mouth.

I put "therapeutic hugging" into practice while the nurse got a blood draw on one very unhappy toddler. No amount of soothing could help calm the kiddo during that particular experience -- but my heart positively soared later that afternoon when that same toddler smiled at me and let me listen to his heart sounds with my stethoscope.

Some of the kiddos have special precautions because the source of their illness is unknown, which means health care staff has to gown up, don gloves and masks. I wish those masks were see-through, especially with the younger patients so they could see when we were smiling at them and trying to calm them. Every time I put one on today it made me think of how Tyra Banks is aways telling her aspiring next top models to "smile with their eyes."

*sigh*

Let me just say that I think I at least have a major crush on pediatric nursing. I don't want to jump to any conclusions, but...

This could be the start of a very serious and wonderful relationship!

Happy New Year's Resolutions!

I'm always conflicted about the first of the year. It's sad to see the Christmas holidays go, but I love the excitement and anticipation of a new year. Like so many other people, Andy and I have a tradition of writing down our new year's resolutions. I'd like to share some of my school-related resolutions with you.

ROBIN'S NEW YEAR'S RESOLUTIONS
1. Ask more questions in clinical settings and in class.
2. Stop fearing having the wrong answer.
3. Eliminate the nervous hand tremors.
4. Pass the NCLEX exam on the first try.
5. Decide which track to pursue for my graduate program (nurse practitioner or clinical nurse specialist) -- and be happy with that choice.
6. Get hired as an RN!

I may add more as I think of them.

One of my other resolutions was to update this blog more frequently, but even just four days into the new year that seems to be off to a rather poor start.

Oh well.