Thursday, December 4, 2008

death/dying and the nursing student

Finally, a new post!!

I've had a lot of good things to write about, but I seem to be more prolific when I've got an axe to grind, sorrow to nurse or just general blahs hanging over my head.

I've got an axe to grind.

Every class has a know-it-all don't they? The perennial teacher's pet who will polish every apple, dislocate her shoulder raising her hand repeatedly and elucidates neckbreaking eyerolls when she threatens another anecdote. My cohort's know-it-all is about ten of these biznatches rolled into one grating package. Ordinarily, I ignore her save for my sarcastic comments under breath (because, hey, my powers of restraint are only so much). We actually used to be friends, but above know-it-allness (this is tiring; now known as KIA) combined with a deep need to cut others off at the knees with horrible rumormongering just left a bad taste in my mouth, so I separated from her with a clean break shortly before the term started. As exasperating as she is, there's really not much I can do about her. I try to ignore her when she speaks to me, but am civil when necessary. I don't like her in the least, but we can get along for the next year, right?

Not so much.

The scene: clinicals last week. I have a resident with Alzheimer's that I have worked extensively with. I really enjoy her and am currently working on a careplan about her. She's been under hospice care for close to 2 years now and from all appearances will most likely die soon. I've gotten attached to her, but used to work with hospice patients, and have learned how to deal with death in a way that I actually consider healthy while at the same time preserving my own self. Not to mention that as nurses, quality of life is important, no? How much quality of life can a person with Alzheimer's so severe have that they cannot communicate basic things like being in pain, hungry or just wanting to watch TV? If I think too hard about it, yes, it will make me horribly saddened. But, as people like me like to so enigmatically say, it is what it is.

Here is where Kia comes in. At our postconference in clinicals, she had the sweetness and light in her to say that I was cold and unfeeling toward my patient.

Let's pause, for a minute and think about that. I've spent a lot of hours with this patient, do any small interventions that I can. And to have someone tell me that I'm cold because I don't dissolve over the possibility that my patient's death is imminent? Oh hell nah.

We all handle this grief and heavy burden differently. Even though my stating that I dislike her is lightyears away from my actual disdain, I didn't crack a sarcastic joke as per my usual way when her patient that she'd only spent 1 hour with died suddenly between clinical days. I know she doesn't have much medical experience and it would hit her hard.

What is the point of this, you ask? I don't know. A little kvetching maybe. Or, to kind of set the record straight on death and how we each accept it in a different manner. There is no wrong way and it doesn't make someone cold and uncaring to understand the nature of life in a way different than your own.

We can have petty differences that we commonly snark one another about - this doesn't have to be a part of that.

Wednesday, November 5, 2008

Yes I can.

I should be working on an outline for Pharmacology to study in downtime at clinicals tomorrow, but I can't seem to get started. All I want to do is take a bath (thank you, Lush addiction) and hang with the hubs for awhile.

Re: my last entry about how I had a feeling I wasn't going to like the SNF-life? Yeah, I don't. A lot of my classmates think that it's a downer, but that's not my problem. I guess in some ways it is, but I'm of the mind that my feelings aren't necessarily congruent to the patient's feelings/needs, so my downer could be much more positive in their eyes. I am catching on to that whole ideal that the patient's view of the situation supersedes my own. Novel, huh? I am actually assigned to a very nice facility that has its own beauty parlor, movie night and lounge to play Wii (loved the residents playing Wii bowling!). I think being in a place with elders of differing states of ability, memory capacity and other things reminds even the whippersnappiest among us that one day, we could be in the same position. And no one wants to think about that.

My problem is that I'm bored. I know, I know. While I realize that this is prime time for understanding and applying some of the art of nursing aspects we've discussed in class, my science of nursing side can't help but want something clinically interesting to come along. I'm going to spend my time this rotation working on it.

Tomorrow, ahoy.

Wednesday, October 29, 2008

How to complete care plans and influence people

Books, books, books!
Originally uploaded by somnambulantsn
It's a tearful little milestone at Chez Somnambulant today.

I handed in my first extended care plan this morning!! At my school, we do something called comprehensive care plans that include extensive med logs, assessment data and some other stuff. I don't know if any other students out there have these. I think the final product was ~ 20 pages or so. From what I hear from the other university and CC in my area (we sorta chat at clinical sites), their plans are much more abbreviated. I think some of my profs feel like we have extra to prove since some hospitals think less of the BSN SN's because they think we're all theory. Not true, at least in my program.

So, to make this awesomness happen, I ended up editing and consequentially redoing part of my care plan yesterday afternoon after school. Nevermind the gorgeous cool weather and clear sky; I will GET careplanning, damnit! I'd been about 90% done and just wanted to put some final touches on, but then I started picking at it and made the mistake of working from 1400-0100 with brief breaks to eat, pee and other essentials. By the time I was done, my eyes were blurred and I was on a very short fuse. Right before bed, I told my husband to shut up and I loved him, so nursing school is bringing out this really charming part of me. I was a little too hardcore for myself yesterday.

Tomorrow, I start clinicals at a new site. I'll be at an ALF until the end of the semester. The last six weeks I was in a community hospital and though it was rife with problems, it was still a hospital. I know I shouldn't be picky so early on, but I know what we'll see and I'm just not feeling jazzed about it at all. I know someone knows what I mean.

Good news: I made the highest grade in my class on my last test! Bad news: It was an 83! Still, I know I'm doing well. I think my overall average is somewhere around 87 and considering that about 1/2 my cohort just received midterm warnings to shape up or ship out, I do find some solace in this.

Overall, I just need an attitude adjustment. I am cranky (crankier?), impatient with others and just painfully tired. My fuse is pretty short lately. This is my first day in two weeks not working on a care plan or studying for a test/quiz of some kind and since I have no lecture tomorrow, I'm going to 1. take a sweet nap and 2. read some of the third book in the Twilight series. Ahhhh. That makes it a little better.

Sunday, October 26, 2008

I come here often to at least make an attempt at blogging. Twice I've fallen asleep and more than a few times I've started for a minute and lost the mojo. Working on that.

For all of my unusual (for my cynical self) hopefulness in the last entry, I'm much more worn now. And it's okay; I'm expecting this as the ebb-and-flow of things. Things are really starting to click and that's what matters. And hey, we've finally gotten some fall weather here in the warm & humid state. That alone perks my mood a bit.

It's been a hard couple of weeks though. My first care plan deadline looms a few days away. I have a quiz tomorrow on lab values, a Fundamentals theory test on Tuesday , care plan Wednesday, clinicals Thursday and a Pharm test Friday. So, I knew this was coming, but I was still ill-prepared. It's also been a tough week emotionally. One of my classmates' parents died suddenly, so most of my class skipped a clinical day to be at the funeral and give her some support. She's just had a rough time for the past year or so and needed to know she has an extended family.

I worked out the study issues from the last entry and thankfully enough, amicably parted from one person in my group, sat another down and gave her a reality check and added a couple of low-maintenance people. I really don't mind helping people as long as they want help and don't elicit the do-it-for-me vibe of desperation. I realize that people have to do what it takes to get by in school, but have a little bit of class and integrity. As I was writing this, I started receiving a litany of texts. Phone is now off as I'm doing my own work and getting some downtime at some point. I want to help, but I also want to set boundaries on the smattering of private time I occasionally get.

Clinicals have been going well. Classes for the most part are going well, except for the shareaholics that just won't shut up. I know that people get excited when they hear something familiar, but it's gotten out of hand. No. More. Stories. And and and, just for extra giggles, stop giving your rationale on every test question you get wrong. It takes up so much class time and you've still gotten it wrong.

I'm getting drowsy as I type. Maybe a short nap before getting back to the care plan.

Tuesday, September 30, 2008

Livin' the somnambulant life

I've been trying more valiantly than you might think to get myself here and update to no avail. Until today!

School is awesome. And scary. And exhausting, boring, amazing, strange and at times, disgusting as hell. In the last 5 weeks, I've surprised myself with how strong I am and thank my mom every morning for ingraining in me so hard the ability to face the hardest of situations with humor. I also love the camaraderie we've been building up. It helps to start reaching that comfort zone with people you see all the effing time.

I had a rough start, due in part to my stubborn insistence that I could help myself study as well as drain my own small pool of stores trying to help everyone around me that was helplessly drowning instead of treading water as I was. Last week, I had to have a self-intervention and let my friends know that while I would do everything I could to help them, we all had to figure out a different methodology. I was the only one prepping outlines, doing flash cards, the whole nine. Essentially, I was killing myself and not having any time to study on my own. I'm all for the group dynamic, but it wasn't working. So, I ease up a bit and bam! 95% on both my Pharmacology and Fundamentals tests! I feel like I've finally hit my stride now.

I started clinicals about two weeks ago. It's in a medium-sized hospital known in my city for not exactly being...the best in a lot of areas. Still, it's exciting to actually apply things we're talking about in class. I'm always especially exhausted after clinicals (our day lasts 9-10 hours), but am so awed by all that I've already seen. Last week, we talked about bruits/thrills in class; a couple of days later, my friend was assigned a patient with an A-V graft. The poor man had everyone from my class shuffling into his room, but he said he liked the attention. I tied my first restraints, did a very elementary assessment and have learned a lot about classroom training to real world doing. It's really neat. And luckily, I've worked with very patient and helpful nurses. One had graduated about a year ago and was giving me some excellent advice.

So, it's really worth the lack of time and the realization that I've no clue what day it is or the near-constant fatigue. Or that I'm verging on irritation or tears at least a couple times a day. I'm such a nerd right now. So, give me some caffeine and I'll go. : )

Wednesday, September 10, 2008


I am excited. I am scared. I am, however, not taking drugs. But really, was she taking caffeine pills or actual speed? Because if it's caffeine, I miiiiiiiiiight have a problem.

Actually, at this particular moment, I'm physically tired, mentally alert and superficially sleepy, if that makes any sense at all. I made the mistake of letting myself take a nap this afternoon and woke up later in a panic that I have 2 chapters of Pharmacology and 5 chapters of Fundamentals to cover for tests Friday and Monday. Add to that a dash of BLS today, Skills Lab tomorrow (vitals, fun!) and orientation at my clinical site on Friday (along with that Pharm test I just mentioned), and well, I'm kind of overwhelmed. Not as overwhelmed as a lot of my classmates, but yeah, that doesn't help.

We also just got our first tests back. No one was expecting the questions to be so NCLEX-esque (why, I've no clue -- we'd been properly forwarned). I did not make a grade befitting my usual performance, but I also did better than about 2/3 of the class (we're talking tears in some cases), so I'm not complaining. I think now I get the idea of how we need to think for tests, not to mention that our professor said this was our "wake-up call". So, wake-up. I looked at my test, saw that I effed myself up on 90% of what I missed by judgment error. Yay for critical thinking!

I've just been texting/talking with someone from my study group about the possibility of finding places to study late/early (I'm talking after midnight and open by 4:00 for early). I don't want to make a habit of it, but I know there will be nights like this that we need to. In Pharmacology, we're working on routes, prep, admin, sites and etc. In Fundamentals, it's care plans, care plans, care plans. The way we've divided the work is that every person is responsible for reading all material alone, then each person takes a chapter to dissect and create scenario-based questions from. The study materials are individual choice. I'm partial to typed outlines and flash cards. It's worked for me so far. My chapter happens to be planning. Trying to pare down the material is tricky for me, but I'm managing. When I get overwhelmed, I walk away (which is why I'm blogging right now).

And, just for the sake of my own sanity, there are things other than nursing school that I love and remind myself of for about 0.5 seconds of the day:

- My husband is the best, most supportive, wonderful person ever. BFFF.
- If I didn't have an iPod right now, I would probably go insane. Really.
- It's September and that means Pumpkin Spice at Starbucks for Fall. (!!!!)

Okay. Me + fork = done.

Sunday, September 7, 2008

Well, I will say this: I am thoroughly tuckered.

It's been a long, exciting week full of a mad rush of things. So far, I'm enjoying the classes, my classmates and the two professors that are currently teaching my classes. One is younger, was a rehab nurse and just received her MSN about a year ago. The other is a seasoned psych nurse who still works PRN at the local Big Hospital and also worked for my state's BON for a number of years. They're both different and like to emphasize different things for different reasons. So far, despite being overwhelmed, I'm happy.

I'm actually just taking a break from studying for a test I have tomorrow on nursing theory. I get that it's necessary to learn, but it is dry reading to me. We had a review the other day, set up Jeopardy style. I ended up with some decent cash, but not enough to earn the NANDA Diagnosis book that was 1st prize. Mine was a pen that looks like a syringe with some metallic red fluid floating about in it.

Up on the block for this week: aforementioned test, assessment, vitals and CPR certification as a class (I know most schools require certification before entry, but my university was finding that people who came in certified via work or whatever were expiring partway into the program, so this is easier for uniformity's sake). The week after, we have our first clinical date. I'm really holding back on the exclamation points here, guys.

Annnnnd, that test won't study for itself.

Thursday, August 28, 2008

Well, that's just fine.

um. well.
Originally uploaded by somnambulantsn

Or: How I Spent Eleventy Billion Dollars on Stuff for Nursing School (And Spent My Short Vacation Getting Ready for It)..

I've heard the legends and been warned, but really, until the past few weeks had no idea the accoutrement involved with starting nursing school.

First off, it was the uniform debacle. White tops with nursing program logo/crest and navy bottoms. Okay. While I'd rather not wear white at all, I guess a white top is more passable than white bottom so as to not disrupt my 50% state of awakeness upon dressing most mornings without looking. It would be awkward to realize or be told around 10:00 that my festive polka dots are peeking out for all to see. That has been a disaster with wearing white scrub bottoms before. I actually got sent home from a past job for such an indiscretion (even though I'd asked my husband that morning if anything was visible; thanks to this and other oopsies he's let slide, he is no longer asked). But, it was an icky, icky place to work, so in retrospect, I had the prescience to show them my true feelings early on. So, with white tops comes the responsibility of attaining (ahem) the proper undergarments. In addition, I bought a few cami-type white tank tops and long-sleeved shirts. We get lab coats as part of our uniform, but they're incredibly thin. I'm always cold.

Anywhoodle, after I'd managed to snag enough uniforms to make me comfortable (4 is the magic number for now), then I had to get shoes. Since my program has ixnayed my beloved Crocs, I had to go to Plan B. After consulting every corner of the internet, I felt fairly comfortable in choosing the Dansko Courtney and the NurseMates Quincy. The Danskos are fantastic and well worth the cost; I'm still waiting on the NurseMates I really love maryjanes. Our shoes have to be leather and all-white, which kind of automatically eliminated the idea of a sneaker for me. I really dislike all-white sneakers (no flair! no zip! what?) I'm a child of the 80''s and equate all-white or all-black sneakers with guidos (This is nothing personal and I apologize for my insensitivity toward you classic Reebok-loving people who are not and do not resemble guidos).

Then came compression hose for clinicals and some new white socks, because my dingy ones peeking through wouldn't cut it. There are daily inspections as to dress code adherence. I wish I were kidding. But, at orientation, they lined up the cohort before us and pointed out each infraction. Hoo boy.

Next, there was grooming. I'm all for the preemptive strike and being of such makeup, cut my hair into style requiring less maintenance and dyed my summer-blonded hair back to its natural, more placated state of a few shades darker. I don''t want to fuss with my hair when I know soon, sleep will become a precious commodity of my time.

I also needed a new pair of glasses. So, I've gotten my exam and those are on the way. I have no idea how much time I will have, so I've made sure to have checkups with all my physicians and med refills.

The one thing I've held out on has been the Skyscape Nursing Constellation Suite. because even though I have a Palm T|X, I realllllly want an iPhone. And if I cave, I'd rather have everything on it.

And finally, the coup de grace: as pictured, you can see (in part), my fundamentals and pharmacology books (and stethoscope. bandage scissors, etc.). From what I can understand, there are indeed more books and our nursing kit on the way that were delayed due to Tropical Storm Fay closing my school for three days and causing a delay in shipment. My NCLEX review book is not pictured. If you look closely, you will notice how lazy I was for not cleaning my desk first. Cut me some slack; I'd just amassed all these things into one conglomeration for the first time and was a little overwhelmed to say the least.

I have Chapters 1-5 from the fundamentals book, the nursing program handbook and JCAHO's 2009 Patient Safety Goals to have remembered by the first day. There will be a test.

5 days. I got this.

Tuesday, June 17, 2008


It seems that I've been amiss in keeping up with the blogging.

But, in all fairness, I've had the following superawesome and completely un-awesome events happen:

  1. Gotten engaged! Woo!
  2. Planning a wedding for July (more on that in a moment).
  3. Gave notice at my job. That was actually bittersweet.
  4. Summer term at school = fun times.
In case you can't tell, I'm that person that likes to make lists. It's soothing and, actually one of the things that the physician I work with has complimented me on, because he loves my (as he puts it) "meticulous-bordering-on-psychopathic organizational skills". But, I also know when to let go and make peace with things that aren't tidy. My doc is brilliant, moody and socially awkward; I'm the only person who enjoys working with him because I've adapted to his working style. Most of the other staff have become intimidated by him because he's gruff; I'm gruffer. He's already having separation anxiety about my replacement. I really will miss him and a cluster of my BFF coworkers because they get it and we can laugh about all the nonsense.

So, the soon-to-be Mr. Somnambulant proposed to me a few weeks ago in a really special and wonderful way. I'm not one for gushing, but we've been together for a long time and I'm extremely happy. It's been full on crazy ever since with visits to my parents, his parents and several phone calls regarding dresses, cakes and various bridal whatnot. I have been very firm about the fact that when I am in school, that is going to be the most important thing going down for the next 1.5 years and as such, was not in the least interested in planning a wedding during that time. So, in the wake of the realization that our parents wanted a big wedding in my hometown (my father is too ill to travel) and we wanted something small/intimate in a place that is special to us, combined with my school obligations plus a little bit of practicality (read: he will be my sole support and has rockin' health insurance through his employer), we've opted to compromise. On my short break from school, we, plus two friends will travel to said special place & get hitched (which is NOT Vegas, just in case you wondered). I'm pretty excited for this because we get the best of both worlds, with a lot of small touches that although our parents would never fully object to, I don't think is in their vision of a wedding. This way, the mister & I spend a lot less money, have a great long weekend, get back to the grind with silly grins on our faces. Then, after I graduate, we have this fancy fete where I wear a poofy dress, we have a lovely time with a bunch of family, friends and people our parents know and the whole nine of videographer, photographer & the like while I can still put a personal touch on things that everyone is happy with and our parents pay for the bash. Everyone wins. Still, even though the wedding for this summer is quite small, there is still a lot to do. Long-distance at that.

Needless to say, there is all of this (and more) going on right now. Luckily, there is a lot of good. I'm happy about that. I've been hearing a lot about how lucky I am right now. I don't know about luck, but I have an enormous amount of gratitude for how well everything is fitting into place right now. We've worked hard as a couple to be ready for marriage and I know that I'm marrying the person I'll spend my entire life with. I've worked exceptionally hard to get into my nursing program. I've pushed every day, and started pushing even harder once I was diagnosed with RA because I know how easy it can be to give in to pain. I'll keep pushing, because I don't see any other option.

Take a note, fibro whiners. Life is so much better this way.

Friday, May 23, 2008

Already be startin' somethin'

I don't think anyone is reading this yet and may not for some time (ever?). But, I'm about to say some things that someone will eventually get their knickers in a knot about.

As previously mentioned, I work in pain management. Let me level with you: I hate pain management. I love the office I work in and I especially love my coworkers. But, 70% of our patient population has a critical dx of waaahhitis secondary to mental instability or victim mentality. I work on the clinical team and as a surgical coordinator. I could diagram you the ways in which people annoy me, but Blogger doesn't have the space. So. I'm going to present a little list of bad touches that pain management patients inflict on our staff:

10. Stay off of your cell phone. I know that your 10/10 pain requires constant conversation despite signs everywhere that specifically state NO CELL PHONE USE, but even so, I will ask you politely once to hang up. If you don't comply in 10 seconds, I'm moving on with another patient and you will have to wait until I'm free. You will not cause other patients to needlessly wait nor will I waste my time watching you yammer.

9. There are two crucial pre-procedure instructions that clearly state no NSAIDs 5 days before a procedure and no ABX one week beforehand. Should you oopsie on either and neglect to call to inform, you will be canceled when you sashay your little self into the office. The rules DO apply to you, snowflake, and no matter how long Dr. X has treated you or that you were patient #1 when his office had one exam room (amazing how many of you there are), you will still be canceled and told to reschedule when you are smart enough to treat.

8. We use this handy thing called EMR. Aside from notes, it keeps track of how many times you have "lost" your prescriptions, had them stolen, what drug stores you use and various other fuckery you employ to gain our sympathies and try to outwit the system. Chances are you won't win. And if you do, it's temporary. You will be caught, discharged and turned over the the appropriate authorities who we all know quite well.

7. Yes, you have to piddle in a cup for the tox screen. Again, snowflake, rules. 20% of our patients abuse their meds or someone else's. No pee, no Rx. Nothing personal.

6. If you schedule a surgery, regardless of how minor, keep the appointment. Despite what you may think, it requires clinical staffing, anesthesia and time alloted just for you. And your last minute cancellation could have been a procedure done sooner on a little old lady who cringes at the thought of tramadol. I love them. BTdubs, if you could stop salivating over the thought of the narcotic buffet long enough after you got the referral to our office to read the mission statement, we're therapy-driven, not medication. Just, um, something to consider.

5. If you are 23 and on the highest dose of Duragesic possible, use breakthrough narcotics, a muscle relaxer, two antidepressants, Lyrica, anti-anxiety meds AND have a spinal cord stimulator, but you feel like nothing is working, give up the ghost, sister. We can't help you any longer.

4. No matter how many names you sweet talk us with, it's not going to get anything done more quickly. Your crocodile tears intermingled with agonized cries of how abandoned you've been really do nothing to help your situation. I don't know where the idea started that childish foot stomping greases the wheel, but asking for something reasonably is pretty much all I need.

3. "I wish you could be in the amount of pain I'm in everyday!". This has quickly become an old chestnut. In my office, there are 3 breast cancer survivors (one just recently in remission), an Iraq vet with shrapnel in his body and daily pain, and many who have daily achy backs (and hell, probably as much DDD as any patient) from lifting patients who are pushing three bills and wonder why they have low back pain. I have rheumatoid arthritis controlled nicely by non-narcotic therapy. So, we know pain, and as a bonus, wake up every day to be productive members of society. Don't make assumptions. You kind of look like an asshole in the end.

2. If you are: laughing/talking on your cell phone/talking to anyone about anything other than pain/not crying/not begging to be put out of your misery and have normal vitals, please hear this: YOUR PAIN IS NOT A 10/10. Listen, people. I know pain is subjective. But, there are certain facts that belie the amount of pain stated vs. patient appearance. Ugh. This makes my brain hurt at 10/10.

1. For those who will tell me I lack compassion, you're so far from correct, you're just living in Wrongland. I have all the compassion in the world for people who suffer with pain and are in need. Like those with cord injuries, MS or the kids with CP that we treat for spasticity. I'm there and I love it. But, for those of you draining the system and my will to live at times, you get the perfunctory civility and not a whole hell of a lot more. That's how I roll.

This has been a Somnabulant, future-BSN PSA.

Tuesday, May 20, 2008

Somnambulant: beginning

Main Entry:
1 : walking or having the habit of walking while asleep 2 : resembling or having the characteristics of a sleepwalker : sluggish

I am a student nurse about to enter fundamentals in the Fall semester (hence the above descriptior). I am pretty excited about this, but also somewhat realistic given my 6+ years in healthcare.

In the meantime, I have spent the last 2+ years working in pain management. I could scrawl a diatribe here and now about my daily travails, but then what else would I tell you about later when my fury is at fever pitch? I do so love telling stories about work.

So. Hi.