Fall semester - SENIORITIS

This fall I took:

- Critical Care Nursing and clinicals
- Community Nursing and clinicals
- Informatics
- Leadership/Management and clinicals
- Ethics

Critical Care nursing was a beast of a class with a TON of information covered and much more in depth than previous classes. I had to go back to a bunch of my old pathophysiology stuff to understand some of critical care. Our clinicals were on a medicine floor, which could be considered slightly more acute than the other floors, more like a step down or progressive care unit which this hospital didn't have.

The best part of these clinicals were that we got to go on 4 observation days to the ICU, CCU, ER and Trauma/Neuro ICU. I didn't get to go to CCU, and instead went to the ICU twice. But that was fine with me because I am really not a cardiac nurse!

I was shocked to discover that I REALLY LIKED critical care!! I loved ICU as the first place I went and I love Truama/Neuro ICU even better. I already knew I liked the ER and I liked it again, but critical care nursing in an ICU is so much different from other nursing. I could definitely see myself doing trauma or neuro ICU in the future. It definitely is hard and you truly have to think on your feet and be a great nurse, but there are great rewards.

Skills performed:
- Med administration including oral, IV and IM
- Head to toe assessments
- Charting
- 4 catheters and 2 IV starts in the ER
- Bed baths

Community Nursing was not my favorite class. This class required us to drive to sites all over the city to take parts in different types of community nursing. I went to or followed around: a home health care nurse, a free clinic, a soup kitchen, diabetes educators, in hospital navigators, cancer center nurses, an acupuncture provider, a school nurse and a couple of other ones. My favorite was definitely the free clinic where I had actually volunteered before. They provided a much needed service to their community and it was super interesting to help out there for a day. Could I ever do community nursing? Maybe eventually. When I'm tired of working in a hospital.

Informatics was only a didactic class. It was boring, boring, boring. I understand why technology and computers are important to nurses but this class was a yawn.

Ethics was actually a sort of interesting class. Sadly I didn't have much time to devote to it with community and crit care. But it was at least applicable to being a nurse. I enjoyed some of the writing we got to do on topics of our choice and I researched and wrote about the ethics of fertility treatments.

My leadership/management clinicals were in the Trauma/Neuro ICU and I really enjoyed them, even though I was on nights which was pretty hard to do when I had other stuff to do during the day the rest of the week. I got to see some great things, interesting cases and I came to understand what managers and charge nurses truly do. Which is put out fires, help out the nurses and work to satisfy a variety of employees from housekeepers to doctors.

I really like the trauma and neuro side of ICU. I find the brain fascinating and its interesting to see what happens when there is trauma, strokes, brain tumors, etc. The trauma was just pretty horrible, but interesting all the same. Car, moped and bike accidents, falls from heights, tractor accidents, etc.

All in all it was a tough semester but I think it was worth it. It was pretty awesome to finally see and find some nursing that I really liked and could want to do for a while. In the end I still feel somewhat unprepared to be a nurse, but I know that you come out nursing school with just the basic skills to be a nurse. The rest you learn on orientation and by doing your job hands on.

Now that I'm done I've started the never-ending loop of looking for and applying for jobs, polishing my resume and writing cover letters. Hopefully there are jobs out there and hopefully I get offered one I like.

Now to study for the NCLEX and pass that sucker.

GRADUATION!!

I'M DONE! I'M DONE I'M DONE I'M DONE!!!!

I finished my last final this morning at 8 am!! Then I went out to breakfast with some friends from school.

I took my critical care final last friday and got a B. Critical Care was the one I was stressing about the most because it was a cumulative final and there was soooo much information on it! But I made a 56 page study guide and studied my butt off!

Then Ethics was monday, but that was easy-peasy.

I had my last leadership clinical last week and left at midnight from there. I didn't really even think about the fact that it would be the last time I was leaving the hospital from a clinical. But it is bittersweet. It will be weird not heading to the hospital every week for clinical.

I still don't think it's set in. That I'm actually done.

Pinning is tonight. WOOHOO!

I'll officially have my BSN!

A more updated post is coming on how my last semester went and what's going on now. As well as my NCLEX study plan.

What jobs am I going to apply for??

Here with less than a month left of nursing school and I'm still not decided on where I want to work. People keep asking... and I still have NO IDEA.

This is not great..

Places I know I do not want to work:
- Geriatrics, nursing homes, rehab hospitals
- Ortho
- NICU
- Anything cardiac
- Really any floor nursing

Places I might like to work:
- Trauma/Neuro ICU
- ER/ED
- Labor and Delivery (in the right hospital)
- PICU (Mybe?? I never got to observe here and now I'm wishing I had)
- High risk OB
- Medical ICU (or other. NOT Cardiac)
- Progressive care unit
- PACU (not likely to happen due to no ICU experience)
- Peds?? (I thought I was over peds.. but then I was thinking about infant/toddler the other day...)

So what jobs am I going to apply for? People keep telling me, apply for everything. Get your experience and then go wherever you want. The problem is I don't know if I can stick it out for 1-2 years in a job I hate! So... I don't know. Maybe we'll see how desperate I get.

I'm actually still really leaning towards ER. I'll get lots of skills practice. Lots of assessment. See lots of different stuff. Less wiping butts/bed baths. People are only there for a couple of hours. It's fast paced, etc. I would love to do ICU but I'm still super scared of how much I have to learn to do it. Plus it may be super hard to find a new grad ICU job.

What jobs did you apply for straight out of nursing school? Where did you end up?

Where have all the nursing jobs gone??

Where have all the nursing jobs gone?!?

I don't know if it's some horrible combination of the economy, the affordable care act, general panic or what... but the hospitals around here are just plain not hiring. Or at the very least not hiring new grads.

I don't know if this is widespread but in my, large midwestern, city there are few RN jobs to be had for new grads. The hospitals have been laying off nurses for months now. They're rarely posting new jobs and the ones they do post are not for new grads.

When I got into nursing school everyone assured me there would always be jobs! "Oh you're going into a career where you'll always have a job!" "Oh there's always a shortage of nurses!" HAH. Yeah, sure.

Until now apparently.

Veteran nurses, my instructors, and pretty much everyone keeps saying, "Don't worry. It'll turn back around. Nursing does this all the time. They try something new. It doesn't work. They'll hire more nurses again. It'll only take 12-18 months."

12-18 MONTHS! Because I just have that kind of time to sit around unemployed.

Needless to say I'm quite perturbed. I got into nursing, yes because I actually like it, but also because... they always need nurses! Always! You can't get rid of us. And yet...

I'm hoping that the situation is not as dismal as it looks. I'm hoping that things will turn around by the time I take the NCLEX and start looking for jobs.

In the meantime I'm considering moving to other states, doing some certifications to make myself look more appealing... and well.. praying.

How long did it take you to get a nursing job after you graduated? Does the nursing job market suck everywhere??

Adult Code 1

Controlled chaos. No not even that. There's really no chaos. Even with 18 people in and around the room as I counted at one point. Everyone has their set job to do. There's no yelling and things don't really move as fast as you would think. There's 3 minutes in between epi's. Three minutes is a lot longer than you would imagine. Chest compressions are a lot harder and faster than you'd think, rocking the bed from side to side.
The eeriest part is the wide, unseeing eyes, still open. That's what got me. I was fine until that point. There was no one left inside.
Again I told myself, you can lose it when you get home. But you have to keep it together here. Deal with it later. Even afterwards, when his wife came running down the hall, heaving "we're too late, we're too late I know it". Keep it together. Feel later.
It's amazing how disconnected you can be from human suffering when you tell yourself to. Frightening really.
And after. When they become a not person, an unperson. As if they never truly were.It's disconcerting to me how easy it was, how people joke and laugh. Because you have to. You have to laugh because you have to move on.

Critical Care?!

I never expected to like critical care... I came into this program assuming that I would graduate and get a job in Labor and Delivery. Interesting thing is, turns out I didn't much like L&D in the hospital.
And then along came my final semester of nursing school with critical care nursing. Our clinicals are on a basic medical floor, but with slightly sicker patients than med surg. More like a progressive care unit.. kind of.

But this clinical involves observations in the ICU, Trauma/Neuro ICU, Cardiovascular ICU and ER. ICU was my first observation of the semester. I really liked it.

I like that you have to think on your feet. That you have to be clued in to your patients and watching for small changes in their conditions that may mean big problems. I like that you have use your brain. This is also what scares me about ICU. You are the one that is responsible for this perhaps VERY SICK patient. So you have to HAVE A BRAIN.

Lately I'm struggling with feeling like I can't do this job. I'm in my last semester, you'd think that I would have most of this figured out. You'd think that I'd feel more secure in my choice and in my role as a nurse. NOPE. In some ways.. maybe. Some things aren't as hard as they used to be. Things like bed baths (although I'm still not great at them..), vitals, head to toe assessments.

But I've only gotten one blood draw and I've attempted four now. I've started one IV out of two. Not horrible odds... BUT ONE IV START?? Really? I've done one in and out cath on a woman after childbirth. One patient with an ostomy. I've done IV push meds and given oral meds, crushed up meds, etc. No NG tubes, no drains (although I've seen some). No big clinical procedures!

But the vast amount of SHIT I DON'T KNOW scares me. My first day on the unit for this semester I royally screwed up a lot of the charting I did. On ONE patient. What about when I have 2-6??
What about when I graduate in.. oh, LESS THAN TWO MONTHS and try to go find a job somewhere.

How can I convince someone that I am worth hiring when I'm feeling hopelessly stupid?

This is not even to consider the beast that is the NCLEX and how I don't feel ready for that. That at least I have time to study for after I graduate. Once I get out of school, I feel like I'm supposed to actually know some shit. And lately I just don't feel like I do.

Is this normal? This impostor syndrome when you get close to the end of school? Will it get better?

This was supposed to be a post about how I learned I love critical care... and yet somehow it morphed into a word vomit of feelings on nursing school in general.

Regardless, I do love critical care now. I spent a day on the Trauma/Neuro ICU and LOVED IT. I could see myself working there. If only I could get over this feeling that I can't do any type of nursing.

But alas, jobs are hard to come by in this area so I may be taking any nursing job I can get for now.

Did you feel like this at the end of nursing school?? Did you feel better when you actually got a job and started settling in?

Summer Part 2: Pediatrics!

Pediatrics was my only clinical of the last 7 weeks of summer!

Well Peds has been over for a couple of weeks but I only had 4 days off in between my summer and fall semesters so I feel like I'm still playing catch up.

We did our clinicals on a general pediatric floor with kids of all ages and diagnoses. I worked with a 2 week old, 1 year old, 10 year old and 11 month old on my weeks there. They were all in for various diagnoses like fever, seizures, short gut, etc.

Procedures accomplished:
- Vitals
- Med administration
- Swab/culture on newborn

Care plans:
Still required. These ones were better than others. They required less info overall, although more about cognitive and developmental stages obviously. I did my three early on so I was done with them.

Observations:
Pediatric Clinic
I observed in the peds clinic run by the hospital where they see all the kids that don't have insurance or are on the state insurance. It was a pretty routine doctor's office routine. Bring kids back, get vitals, height, weight and then get them in a room. I did watch them do a couple lead tests, other blood tests and vaccinations. Super cute kids, but I think I would be bored working there.

Pediatric ER
I really enjoyed my pediatric ER observation. They weren't super busy while I was there but I got to observe them triage, assess, treat, etc. They attempted to put an IV in a 6 month old who was actually diagnoses with an intussusception (which I had just learned about so that was cool). It was interesting to see how the child life specialist helps the nurses by trying to distract/entertain the child.

Overall Peds was fine... although nothing spectacular. When I was younger I always though I wanted to be a pediatric nurse but I don't really think I do. I could possibly do Peds ER, but not floor work probably. It's just like doing procedures on adults, but they're smaller and they scream more. Also most children come with parents.

Where do you wanna work?

RN on the neuro unit towards the end of our clincials: So, do you know where you wanna work?
Me (in my head): NOT HERE!
Me (out loud): Well I know where I don't want to work. Ortho was definitely not my favorite. I'm not really sure.

I could see how med surg would give you tons of clinical and time management skills. There's also a huge variety so you probably wouldn't get bored. Of course that also means you have know a lot about a bunch of different disease processes.

Ortho was just incredibly boring for me and I am definitely not an ortho nurse!

Neuro was actually more interesting as I look back. I enjoy the knowledge behind neuro and brain/cognitive stuff is more interesting to me than a lot of other things. Neuro exams are kind of interesting, but I'm not sure I would do neuro long term because sometimes the patient's are just screwing with you... and that's annoying.

Labor and delivery was obviously my true love, which I hoped it would be. It has just enough excitement and down time (usually) that I don't think I would be bored or exhausted constantly. There's all sorts of new skills to learn with reading fetal monitoring strips and participating in c-sections all that jazz.

Mental health is hard for me. I really liked some of it and I reaaallly didn't like other parts. I liked being on the youth unit and sitting in on outpatient adolescent groups, so I could see myself working with adolescents, especially teen girls. But I think that if I were going to do mental health I'd really rather be a NP that does counseling or therapy. But I'm not going to go to school for that... so that's kind of a moot point. Regardless, there are people with mental illness everywhere so mental health will be useful in any nursing.

I'm excited to do an ER observation this fall because I'm also super interested in working in the ER.

Peds is pretty interesting and I think it would be good from the aspect that I like kids, but unfortunately kids come with their own parents and sometimes they're hard to deal with. Also, IV starts on kids freak me out.

So the current answer... I STILL HAVE NO FREAKING CLUE.
I'll let you know.

Still fairly organized!

I just wanted to write and check in on my organization strategies! Midway through the third semester and they're still working pretty darn well!

I'm still using my ical for the majority of my due dates/etc. Then I plug them into my paper planner.

Monthly view

Weekly view

I'm also still using checklists for what's due each week (with due dates)

I'm still doing pretty good with submitting things on time! Only missed a few and that's mostly because I think my brain is just completely fried!!

What organization strategies do you use??

Summer Semester Part 1 Labor and Delivery and Mental Health!

Whew! Summer's on its way to being over and I never wrote about the first half of my summer semester!! (Or the end of spring for that matter).

From the middle of May to the end of June I was in my Maternity and Mental Health clinicals!

I only had about 5 weeks of each sadly (well sad about L&D being short, not so much about mental health).

Labor and Delivery:

I sadly only got to spend about 2 full days in L&D which sucked because I LOVED it, like I was pretty sure I would. The hospital we had clinicals at is considered a large trauma center so there is a high risk OB unit and therefore much more high risk L&D than other smaller hospitals. There are about 15 L&D rooms and 2 ORs.

I saw two inductions, both with epidurals. I didn't get to see the delivery on my first mom. The second mom I got to witness her vaginal delivery (in four pushes none the less!).

I saw two c-sections when I was doing my NICU observation and pretty much all I can say about c-sections is... UGH violent. They just seem so, brutal the way they rip the mom's apart, cut them, everything.

Procedures accomplished:
- Immediate assessment on baby
- Baby bath
- New baby shots
- Antibiotic ointment in baby's eyes
- In and out catheter on mom
- PP assessment on mom
- Fetal monitor interpretation
- Vitals on baby
- Footprinting baby

Postpartum:
We spent 3 days on the postpartum unit which is definitely a much different pace. Much slower, and more boring in my opinion. Tons of time to work on breastfeeding with moms though, which I did enjoy. You do get a chance to do lots of assessments on babies, though which I didn't have any experience with before. It broke my heart to see the babies being sent to the nursery though. I'd say that it was split about 50/50 on mom's rooming in vs sending their kids to the nursery. The ones that basically lived in the nursery because mom was "tired" pulled at my heart strings. I'm like.. but its this brand new, squishy baby! So that was hard as well.

Procedures accomplished:
- Breastfeeding assistance
- Multiple assessments on newborns
- Change diapers
- Post circumcision care

Observation in the NICU and ultrasounds:
- I got to follow around two different nurses who were called to c-sections where they perceived that baby may have some difficulty. I loved this part of the NICU nurses job, and I think it'd be awesome. But then we took one baby up and the nurse basically became the baby's nurse and she was attempting to start an IV on the baby and that part of a NICU nurse's job is NOT FOR ME. They are so tiny.. and I don't know. Just not my thing. I also watched a PICC line inserted into a baby which was kind weird.

My other observation was with the ultrasound techs in the clinic. So I basically just watched them perform ultrasounds all morning. It was sort of interesting, but also kind of boring to me. Interesting to find out that their job is HARD though, they are the ones who may find out if there has been a fetal demise, if there are anomalies, etc, etc. So it is not all happiness and rainbows.

Mental Health:
Mental health, mental health. I'm still not sure how I feel about this clinical. At times I really liked it and found it very interesting and at other times it was SO BORING and I felt like it was pointless. We did see some interesting cases like mania, schizophrenia, psychosis, etc. So I did enjoy that, because the human brain and mental illness fascinates me.

Our clinicals basically consisted of being assigned a patient, reading their usually 2-3 inch thick hard chart to get information for our care plans and then sitting down to talk with the patients. We were practicing our therapeutic communication (which I found SUPER HARD in the beginning, but it does get easier), and allow the patient to tell their story to someone. I think a lot of students didn't like it because they felt that we weren't "helping them", but I don't know, I hope maybe we helped a little. Or at least we broke up the monotony.

After we accomplished that some of the students would sit around with the patients. One day we colored with a woman who was actively having auditory and visual hallucinations, so that was interesting to see. And another day we did a puzzle with a woman.

I also got to spend one day on the youth unit with two teenage girls which I found quite interesting and another day observing outpatient groups of teens. I definitely feel that if I were going to be a psych nurse I would want it to be with adolescents, because I enjoyed that much more than adults.

Procedures accomplished:
- Vitals
- Mental status exams
(Yeah, that's it)

Care plans:
OH DEAR GOODNESS they were so long for this class. Like 14-20 pages. We were required to do a care plan, mental status exam and a couple of process recordings. The process recordings I felt were incredibly hard because in them you basically write down, verbatim what you said, what they said and what therapeutic techniques you were using (or not using). Sooooo much writing and paperwork.


Overall, I loooooved going to the hospital for L&D each morning, and pretty much dreaded mental health, although I usually ended up enjoying it at least a little bit.

I loved finally being in the setting I could see myself working in (L&D) but was sad that I had such little time to spend and that we couldn't do more.

I do think that the therapeutic communication techniques we learned in mental health will be invaluable in any sort of nursing because communicating with patient is a huge part of a nurse's job. Not to mention that people with mental illnesses are everywhere, in every type of nursing, so it's good to have exposure to that.

Have you already done mental health or L&D? What did you think??

Take a peek inside my clinicals bag!

Take a look inside my clinicals bag!  (so that i can procrastinate on studying)

left to right

- purple clipboard that I can store stuff in (care plans, paperwork, etc)

- notebook

- striped pencil case

- stethoscope

- bag of random lab goodies (tourniquets and other stuff that i don’t use)

- drug reference book!

- my pocket notebook to write down important info

-  my gloves that i accidentally left in there yesterday

- kleenex, pretezels

- nu skin (awesome liquid bandaid)

- extra batteries for my pen light 

- pen light (crappy white one and expensive but actually usable black one)

- pen

- chapstick, watch, gum

- bandage scissors

What do you keep in your bag? What should I add to mine?

ASN vs BSN?

Whats the difference between an Associate of Science in Nursing and a Bachelor's of Science in Nursing??

ASN (also called an ADN)

- Typically takes 2-3 years to complete
- Often offered at community colleges, technical schools, etc
- Requires fewer general education classes
- May accept students with lower GPA's/fewer pre-req courses (depends on the program)

BSN

- Typically takes 4 years to complete
- Offered at colleges, universities, community colleges, etc
- Usually requires 30-60 credit hours of general education classes (math, science, english, history, humanities, etc) in addition to nursing core classes
- Often includes more courses in critical thinking, leadership and nursing management
- May include more opportunities for clincials
- May include the option of a capstone (where you can choose an area of interest and spend time there before graduating, for example: ER or Labor and Delivery)

Both degrees:
- Prepare students to take the NCLEX-RN test (aka boards). Both ASN and BSN students take the same test.
- Allows a student to become a Registered Nurse (RN) upon passing the NCLEX.
- Allows nurses to work in a variety of environments including doctor's offices, skilled nursing facilities, home care, clinics and hospitals


Some distinctions:
- Some hospitals may favor BSN educated nurses over ASN, especially for new grad hires
- Some hospitals may need x number of BSN educated nurses if they have magnet status or are trying to achieve magnet status

Med surg 1 - Ortho

Well my clincials for Med surg 1 are over! We were on the ortho unit at the hospital for four weeks and my general feeling about ortho is that it's not for me.

I guess if you really like learning about ortho procedures and assisting patients with PT it might be fun. Just not my favorite. Most of the patients are simply post-op and therefore not especially "sick", so there's not a whole lot of things to do.

Procedures accomplished:

- Med adminstration
- Charting
- Head to Toe assessments
- Pain assessments
- Safety checks
- Bed baths
- Linen changes
- Physical therapy assistance

Procedures witnessed:
- Fellow student put in a foley catheter
- Assessment on a patient that appeared to have possibly had a stroke.

Care Plans:

They're still annoying but they seemed easier this time. I knew what was expected of me and it seemed easier to express my thoughts. It also helped that my instructor didn't want pages and pages of care plans. Short and sweet is much easier.

OR observation:

I got to do a day of OR observation this 8 weeks which was fun. I've observed in an OR before but I got to see a craniotomy this time which was really neat. I like being in the OR but I don't think that I'd want to be a nurse in the OR, honestly they don't get to do very much. Being a scrub nurse might be fun, but both times I've observed in the OR there have been surgical techs instead of scrub nurses. Being a circulating nurse is just kinda boring to me. I was amazed at how fast the nurse put the patient's foley in. It was amazing!