A First-Year Story Resurfaces

Today I've been packing up nursing school books to send to my sister-in-law who starts her nursing classes this month (Yea!). While going through some old folders, I found this little paper from very early in first year. This was an extra-credit psych assignment to describe an experience where I used a method of therapeutic communication with a patient from clinicals. Exchanges like this are what keep you going when you're in nursing school. I think it might be an inspiring story for students and can also show more experienced nurses that nursing students can find awe even in the simple task of bringing someone a blanket.

D had been an unrestrained passenger in a motor vehicle collision. He was ejected and thrown 30 feet through the air and into the side of another vehicle. He had been badly injured and in the hospital for a month already when I cared for him.

He had a tracheostomy with a tent, and was completely unable to speak. His eyes often stared off into some unknown space, and then come back to rest on me, wide with anxiety and fear. Because of his neck brace, he was unable to nod or shake his head “no�. His level of consciousness was diminished in such a way that he did not attempt to mouth words, and even with the attentions of rehab care and speech therapists, could not communicate using any reliable yes/no method such as eye blinking or hand squeezing. But he could wave his hand.

The first time I saw it, I had no idea what to do. He was looking at me – his eyes wide like a terrified child. His right hand shook in a banjo-strumming motion. I asked him if he was in pain. No change. I asked if he needed to use the bedpan. No change. Still the hand shook, and I was becoming worried about what he may be trying to communicate. I asked the nurse to hurry in because I thought D needed something.

She said he was anxious and that he got this way when he was worried. She asked him to point to where the problem was, and the strumming moved lower. She asked if he needed to use the bedpan, or if he needed to be cleaned. The strumming got faster. More urgent. “OK� she said, “we’ll clean you up.� And when we rolled him over, there was a small poop down there. It sounded to me like during certain times he was more oriented than others, and the idea of soiling himself caused him a great deal of distress. Now that I had seen it, I felt I could try to communicate if it happened again.

The next time he started waving his hand, I asked questions. “Do you have pain?� No change. “Do you need suctioning?� No change. D put his hand on his chest and then up in the air again to banjo-strum. “Does your chest hurt?� “Do you want another blanket?� The hand moved furiously and his eyes opened wider. “Ok, so you want another blanket, you are cold?� He reached over toward me with the strumming hand. I took his hand and said “Let me go get you a warm blanket.�

When I returned with two pre-warmed blankets, I rolled one out over him pulling it up near his chin, and put another over his feet. “Is that what you wanted?� “Does that feel better?� The hand no longer shook. In answer I got the biggest smile I’d ever seen (think of the guy on the Enzyte commercials). I had to laugh. “I’m so glad that was it. You just let me know whenever you need something, and we’ll work it out until I can see you smile like that all the time.�

There are no communication methods I could recommend for use with D. The easiest way to communicate was to take the time to get to know him and learn how he used his body to tell a story. I was happy to see him two weeks later on the day he was headed to rehab. He still had the trach tube in, but he could whisper. He seemed much more oriented, and recognized me when I went in to tell him hello and how happy I was for him that he was recovering so well. I had enjoyed caring for him, because I was able to be with him one-on-one and he gave me a great learning experience (both in communication and practical skills), and I was able to give him the attention he needed to help alleviate his anxiety and fear. Even though communication was always tough, with practice I became familiar with his different states. I was pleased, and felt I had given him good care.

Metamorphasis

I haven't posted much about graduation and boards because I just didn't feel like announcing anything until I knew exactly how things were going to go down. Today I guess I'll let all the poor cats out of the bag and let you all know whats up!

Although I had offers to work in Critical Care and Telemetry at two other hospitals, I turned them down to work in med/surg in the hospital I work at now. The tele job was downtown, and although it was at a large hospital that is extremely well-known for it's cardiac care, I still felt like I'd have more opportunity staying where I am. The CCU job was in a smaller hospital that I felt was just not a good fit for me once I interviewed for it. I don't mind starting out in med/surg rather than critical care. Like I've said before, I'll get paid the same either way, and I truly feel I'll have a better foundation than if I just jump into critical care. In my last career I was one of the best of the best. I had confidence and ability. I really enjoy the feeling that comes from knowing that I do what I do very well, and that people can come to me for direction and know they can count on me to get the job done. Maybe that explains me a bit. I'm trying to position myself for the long haul.

So I ended up taking the NCLEX-RN on Monday the 18th. My friend and I studied a lot using the Kaplan book and CD that I got when I took the class. She didn't take the class, but having her there to study with helped me focus and helped her with the 'decision tree' (Kaplans way of choosing the right answer). We signed up to take the test the same day. I was pretty excited, and not really as nervous as I could have been because I was doing well according to all of my Kaplan pre-tests. The thing about the NCLEX is that they ask you questions of greater difficulty level each time you get one right. The last two Kaplan study tests asked only 265 of the highest difficulty level 4 questions. The goal was to get 65% or better of these questions correct on the practice tests to feel that you would pass the real NCLEX. It's a very difficult thing to get 65% and feel like a success after spending 2 years in nursing school where under 80% means you're out of the program. 65% feels like failing, but I had to change my thinking and realise that if I felt like I was getting at least half of them right, I would do ok.

We both finished the test in 75 questions, meaning that we went up to the higher difficulty questions and stayed there, not having to go back down to the more basic levels. I knew I passed, my friend (who worries a lot anyway!!) thought she had failed. I say there's no way that we could have had the computer turn off after 75 questions unless we had passed. (The computer can also shut off at 75 questions if you're totally bombing, but we STUDIED and there was no way that was happening!). Anyway, that was over and we went to Claim Jumper's for some frosty blended fru-fru drinks. Awesome!

The people who actually put on the NCLEX test say that they'll tell you your score in about 48 hours is you give them $8. Funny thing is, our state Dept of Health posts licenses online in their Provider Credentials Search in about 48 hours also, so if you know where to look, you can go online and look to see if you're a Registered Nurse and you've got a license number. Cool! If you're patient and don't mind hitting re-dial a few times, you might even be able to talk to someone at the DOH and find out if you've passed (you must ask very nicely, but I heard it could be done). I called and found out I had passed on Wed afternoon. My bud called and found out she had passed also!

I went and showed my listing and license number to my new manager last Monday. I'm signed up to start orientation Monday the 1st. I got my actual license in the mail yesterday. My life will never be the same.

It's an amazing feeling to know the whole 'nursing school' thing is finally over. It was really an incredible journey. I remember the times I cried from frustration, and saw my friends cry. I remember being physically sick the night before a big test that I thought I hadn't studied enough for. I remember certain teachers who were extremely unkind people, and others who I wish I had gotten to know better so we could go out for drinks after graduation. I failed a demonstration once and was put on probation - if I had failed to do it on the second chance that would have been the end of school for me. And coming from a career where I felt I knew what I was doing to one where I thought I couldn't get anything right was difficult. I mean, I'm over 30 and I guess I'm at that point where security and stability in my life are so very important, but this whole career change has been so stressful.

For the students out there: It DOES suck, but you'll get through it.

And it will make the victory even sweeter.

New Activity!

I'm happy to announce that a few of the blogs that had not had posts in a while have now got something new. I'm going to move them back up into their categories this afternoon.

Adventures in Nursing
ImpactED Nurse
The Angel of Life (Portugal)
DanaSaur has a nice new format that seems to work with IE.
Hellooo Nurse is now Oriented x1 and also has a new design.


Now that blogrolling seems to be working the way it is supposed to (it still misses some posts) I'm going to go ahead and pay the $20 a year to have more than one blogroll. I'd like to see the student and pre-req categories with 'new' markers when there are new posts.

I know I said I was going to change some of the graphics, but I'm actually going to go ahead and spend some money to get a professional to design a template for me. It will probably be similar to what I've got now, but with a better design/layout and viewable properly with all browsers. I think it probably only works properly with IE right now. I'm going to have to get that fixed!

Rodeo Nursing

I came across this the other day while searching for interesting things, and today I had the chance to witness a little rodeo nursing myself.

(She has some cute shirts that say NurseChick on them too.. and one that says "ETOH= Job Security", which I happened to find humorous in my twisted way, but unrelated to this particular experience)

We have a patient going through DT's, partially sedated and hallucinating. He's got on 4-point restraints because he's thrashing about wildly, trying to pull everything out. He's talking to people who aren't there about things that aren't going on. He obviously needs more sedation, but he's got respiratory problems also, so we're waiting for the doc. He's naked and yells (and growls!) at you if you try and cover him up with anything or even put a set of pajama bottoms on him. I really felt for the guy, though. It was surely hell for him, and he was looking at me as if I were one of satan's minions. I kept thinking about that 'rodeo nursing' t-shirt.

Anyway, he's pulling at his wrist restraints and saying to Nurse R "scissors... scissors...". He gets louder and more insistent: "scissors... scissors...". She sort of ignores him and continues with her paperwork. "SCISSORS!", he says loudly.

She says "You're in the hospital, M".

I say "We haven't got any scissors to give you".

He processes this for 5 seconds and says "SCALPEL!"

I Guess I Still Don't Get It

Blogroller is counting a comment on a blog as an update, and saying that some blogs have new posts when they actually don't, then totally missing blogs that DO have posts from today. I'm glad to see the "NEW" tag is there, but it's a downer that it's not right.

For right now, just ignore the "NEW" graphic. It's obviously not working right. Maybe in the next few days after it gets a chance to get a few more blogs updated we'll see something else. For right now, keep clicking on blogs you already know update often, because some of them aren't getting counted. I've emailed Blogrolling already to try and figure this out. If anyone knows (come on, somebody...?) PLEASE email me and explain why this is doing this.

The New Shipment Is In

It's that time again - let's crank up the activity at this little pool party!

Home Health Hangout Is (obviously!) a home health nurse. She says she started blogging to keep up with her husband, who evidently spends a few hours a day doing it. Better make room for another computer!

Auryn says you're in for a "bumpy ride" on her blog A Nurse With a Little Bit of Attitude. She posts about all sorts of things. She's a med/surg oncology nurse from Louisiana.

Horses In The Waves is written by a new grad RPN in Canada. Sounds like she's just been hired and is starting orientation.

Terri from Portland is involved (really involved)in lobbying for an office of National Nurse. Her blog, aptly named National Nurse, tells of her travels and adventures getting this whole thing going. Take a look at her blog for more information about this movement. It looks like they're doing well, and it sounds very interesting!

I have wanted to put a link up to Navel Gazing Midwife for a while. Although I don't believe she is a nurse, she does have some great stories. I respect her for what she does, and I'm going to put a link up to her just because I want to. She posts interesting stuff, and keeps her blog updated often. It's a good read.

Ellen's Little Blog describes the daily life of a brand-new 24-year old nurse. She talks a bit about pro-life issues and how it is to be christian and single. In an older post she makes the statement "God designed us to have sex in the context of marriage. Ideally, one should not get married unless you could eek by financially and emotionally having a baby 40 weeks after your vows." People who agree with that statement should enjoy reading her blog.

Shrimplate, noted for posting creative comments to other nurseblogs, finally gets a link here! He's got a great blog with lots of personal, political, and amusing stories. His recent post tells of how he was floated to a spine unit and saw some new things. I followed a link he had up to Dr. Dillin's spine page. This is an amazing interactive site that uses flash animation to explain spinal problems and surgeries. Dr. Dillin is getting a link from me also, down in the 'interesting stuff' category.

DC is from Australia and is a new-grad nurse. She also just started her blog last month but is already sporting a highly fashionable NurseBlogs logo. ;) At Cold Hands, Cold Feet she wonders how she'll dress for work when she starts Monday, but the uniforms won't be there for a month...!

Nurse Tips is a newsblogger who posts the latest health headlines and tips. No stories, but interesting factiods.

And lastly (but certainly not least!) is Walk This Way, A photo-wonderful blog from Joan in Charleston. You've gotta love a lady who starts a post with "I headed into the swamp this morning" as if it's the most natural thing in the world. Her photos make me yearn to walk the Charleston alleys and byways with her. She seems to have friends all over the place and her blog reads like a (well-written) travel brochure. I'm going to adopt her as my cyber-aunt!

SO, to all the new bloggers WELCOME! Lets go out and take a look and make a couple comments and a some new friends.

If you've got a blog that I'm not linked up to, let me know and I'll include you in the next group. Livejournal users will not be able to notify us when they have new posts, because that feature is incompatible with BlogRolling, but I did try and make a little flag for when a blog updates. I haven't seen it work yet, but maybe tomorrow.... I hope.

Hospital Scouts Nursing's Future

By Nancy Deutsch, RN, BAA
May 01, 2005

Pam Cislo, RN, MSN, vice president of nursing services and chief nursing officer at Genesys Regional Medical Center in Grand Blanc, Mich., portrays Florence Nightingale as she speaks to members of Girl Scout Troop 829.

For years, the Girl Scouts and Boy Scouts have worked to instill leadership values in youngsters and unlock their potential while giving them a chance to learn different skills that will help them in the adult world. Many of these young problem-solvers will be tackling the significant issues that face us all when they grow up.

One of those concerns is the nursing shortage. Nurses at Genesys Regional Medical Center in Grand Blanc, Mich., recently partnered with the Girl Scouts and Boy Scouts to help resolve this problem. They invited a group of 26 junior Girl Scouts and Webelo Scouts (scouts who are older than Cub Scouts but younger than Boy Scouts) to attend a three-hour workshop that may have planted the seed for a nursing career in at least a few young minds.

Blair Merlo, 12, attended the workshop. Blair’s mother is Beth Merlo, RN, BSN, patient care director of Genesys’ neuro trauma ICU, so Blair already has a pretty good idea of what nurses and other health professionals do every day. However, she says many of her friends do not. “It helped them know what nurses and doctors do every day,� Blair Merlo says.

Even after the workshop at Genesys, Blair Merlo holds to her career choice of veterinarian, but she thinks the event was great fun and it may have influenced a few of her friends’ career choices for the future.

Debbie Smith, leader of Girl Scout Troop 829, says a handful of kids came away from the workshop with an interest in nursing. “It really helped them see what nursing is like,� she says, adding that even those not contemplating a nursing career had a great time.

Get ’em while they’re young

Whether or not the day actually produces future members of the profession remains to be seen, but everyone involved says the experience was fun, and the Girl Scouts involved earned a nursing badge, which is no small feat considering there is no national badge for nursing available to Girl Scouts. The Sahuaro Girl Scout Council in Tucson, Ariz., developed the badge and has applied to make it a national program, but it hasn’t been yet. The Sahuaro Council gave the Genesys nurses permission to give out the badge.



The idea for the workshop came after Pam Cislo, RN, MSN, vice president of nursing services and chief nursing officer of Genesys, attended a conference where she heard about the nursing badge for Girl Scouts in Arizona. When Cislo returned from the conference, she approached nurses on the Professional Development Council with the idea that they should offer the badge locally. The Professional Development Council works to establish an environment of nursing excellence through communication and mentoring, recruitment, and retention programs.

The Professional Development Council nurses then contacted the Sahuaro Council in Tucson to get the badge and learn the criteria for earning it. They then developed their own workshop day.

“We believe we’re the first ones in Michigan to offer [the Girl Scout nursing badge],� Cislo says. And her motivation is clear: “We wanted to get girls and boys interested in a career in nursing early on,� she adds.

One of the nurses on the council has sons who are Webelos, and she thought they should be involved, too, explains Sue Jacko, RN, BS, patient care director of cardiovascular acute care at Genesys. The nurses readily agreed, wanting to encourage the profession among young men, as well. Although the guys couldn’t earn a similar nursing badge based on what they learned, they could get some credit toward a Webelo Readyman badge.

Gina Freske, RN, a pulmonary floor staff nurse who is also on the Professional Development Council, designed a patch for all the children to receive. It reads “Genesys Regional Medical Center 2005 Nursing Badge Workshop� and depicts a large hand reaching for a smaller one. The nursing badge that was obtained from Arizona shows a stethoscope attached to a heart. The Girl Scouts received both, and the boys received a pin “to even things out,� Jacko says.

Education stations

At the beginning of the event, which was manned by volunteer nurses, nursing students, and a physician, the group of 26 children was divided in two. Half listened to Jacko interview Florence Nightingale, who Cislo portrayed in full period dress. Cislo told the history of Nightingale’s life as a nurse. The second group of youngsters dressed as surgeons and watched Cheri Mys-Curtis, MD, suture chicken legs. After the demonstration, the kids were allowed to try their hand at suturing. The groups then switched presentations after 15 minutes.

After this portion of the workshop, the 26 scouts broke off into six groups. Each group then took turns at six different activity stations.

At station one, the youths learned about the basic tenets of CPR. The second post was a patient care station. Here, the children watched a video and volunteers showed them the various pieces of equipment that might be in a patient’s room and explained each one’s function. Vital signs were the emphasis at the third location, and the scouts learned all about them, including how to take a patient’s blood pressure.

Nursing students (who received community service hours for their participation) staffed the fourth station. They discussed what kind of education is required to be a nurse and what those interested in a nursing career could do to prepare. At the fifth spot, the kids made first-aid kits that they were allowed to take home. The final, and most popular, area was the hand-washing station. Here, the students washed their hands, put a powder on them, and then shined a black light to show how well they had done their job.

“We did a survey afterwards and they absolutely loved [the three-hour session],� Jacko says. And they weren’t the only ones. Beth Merlo adds that the nurses really enjoyed it, too. “There was a sense of being involved in the community,� she says.

An engaging success

Although most of the children’s comments about the workshop were positive, there were a few negative, but typical, statements. “They didn’t like blood,� Beth Merlo remembers. “One little boy got faint when we were suturing a chicken leg.� But Merlo says they were definitely interested. “The kids were engaged. They seemed like they walked away with a knowledge base on nursing and health care.�

Freske worked at the patient care station that day. She says the committee targeted children at the right age to have them think about a nursing career. “These days they start young,� she says.

Freske’s daughter, Ashley, 11, attended the workshop. Although she says she doesn’t know if she’ll become a nurse, she liked the day. She especially had fun with the chicken sutures. In fact, the stitches seemed to have made quite an impression on all the children.

Sherri Pepitone, RN, a neuro trauma ICU staff nurse, member of the Professional Development Council, and mother of two Webelo scouts, also was in attendance. She remembers that “one boy said [the suturing] was freaky, but he liked it.� Another boy said his favorite part was hearing the history of Florence Nightingale.

The day was such a phenomenal success that the Genesys nurses are already planning to do it again, perhaps on a larger scale. “We’d like to do this a couple of times a year,� Jacko says. She adds that several other area Girl Scout troops have expressed interest in offering the badge to their girls. Although the first group was a trial and the hospital absorbed the cost, Jacko says future troops may have to pay a small fee, such as $5, per child.

Freske says the hard work of organizing the workshop day was well worth it. “We felt really rewarded that we were able to do something like this for the kids.�

“It was really a good experience,� Pepitone agrees. Although she loves nursing and likes to share that feeling, having all those inquiring minds asking questions and doing things was even more exhausting than working on the floor, she says.

Only time will tell if any future nurses were created, but there was one sure positive outcome, according to one of the nurses. “At least [we opened] their eyes to what we actually do,� Pepitone says.

Special Order

Here's the code (it links to a nice site that explains what NP's are):

<a href="http://www.womenshealthchannel.com/nursepractitioner.shtml"><img src="http://www.geocities.com/neverlost_seattle/NPS-RULE.png"></a>

Anyone want anything else?

;)

Tobacco-Free Badge

Because there was an interest in it, here is a logo badge for tobacco-free nurses. I didn't have room for the word tobacco, so this is what I do have:



If you'd like to link up to the Tobacco Free Nurses website, just cut and paste this code into your template:


<a href="http://tobaccofreenurses.org/"><img src="http://www.geocities.com/neverlost_seattle/SMOKEFREE_RN.png"></a>

If you prefer the larger, square image, then you can take this:

<a href="http://tobaccofreenurses.org/"><img src="http://www.geocities.com/neverlost_seattle/tobaccofree.gif"></a>

It Took Me This Long....

I think I've got it figured out. I tried to use blogrolling (which I don't exactly LIKE, but I haven't found an alternative) to list the nurse blogs in order of recently posted. I thought it was not working, but evidently it is putting them in order from this point on. SO, as of now, if you update, you'll go to the top of the list. I can only do it for the nurse blogs, because blogrolling wants me to pay for more than one roll ($20/year). I'll pay if I can't come up with something I like better, for now let's try this and see if it's working like I think it does.

Construction Zone

I've tried to divide up the links between nurse/student/pre-reqs. Without actually going back through and reading all of them, I have forgotten who is in pre-reqs and who is a nursing student (note: you're not really a "nursing student" until you're going to nursing school, doing clinicals, and gaining the extra 15 lbs...).

Help me out if you see any that are in the wrong category. I'll come back and work on it some more tomorrow, unless we decide at the last minute to go camping again.

I'm working on getting them in order of most recently updated, also.

Oh, and I don't like the graphics much at all. I'll change them soon so they all sort of have one theme instead of looking like a garage sale. Ugh. The new banner will stay, but with more of a 70's look to the font.

I guess. :)