One more milestone

Yesterday was the big day. To become a registered nurse, you have to graduate from an accredited nursing program AND pass the National Council of State Boards of Nursing’s RN Licensure Examination (NCLEX-RN) - known in my house as the Big Bad Boards.

The exam is only offered at a few testing centers in the state. The closest one for me was in Renton. Of course, they start it at 8am, which means everyone gets to deal with rush hour traffic to get there on time. Then you are photographed, fingerprinted, and all of your personal belongings are locked up. Sounds like jail, right? They give you a laminated sheet of paper & dry erase marker. You have the option of using their Kleenex and earplugs if you want them. You are fingerprinted again, then ushered into a room full of computer stations where you are monitored via audio, video, and in person.

The NCLEX is a computer adaptive test, which means if you answer a question wrong, it gives you an easier question. If you get that one right, it gives you a harder question. It keeps going that way until you have either shown that you are competent entry-level nurse, or you are too incompetent to be trusted with patients. You can pass or fail in as few as 75 questions, or as many as 265. As soon as you have proven your competence (or incompetence) it shuts off, giving you no idea whether you have passed or failed.

I tried hard not to watch the number of questions as I plowed through, because I didn’t want to freak out if I went over 75. But it gets harder not to look as the test goes on. The further I got, the more I wanted to be done. So when the screen went blank after #75, I felt a huge wave of relief. I felt certain I couldn’t have failed in so few questions. I raised my hand, turned in my notes, got fingerprinted for the third time, and was free to go. Still, I will be glad to get the results tomorrow online.

Next I wait for my license to be activated. Then I start orienting in my new job at the hospital. I’m sure this coming year will be a tough one, but I’m looking forward to the day, somewhere down the road, when I actually know what I’m doing!

1st day

I started precepting today. And what a day it was. I'm in the Cardiac Specialty Unit at Good Samaritan in Puyallup. Not exactly what I was hoping for, but today was certainly interesting.

I didn't sleep great, because I was nervous and Mike was back with his snoring ways. 5am came along very early. I hate commutes almost as much as I hate early mornings, but I will admit it was a beautiful drive with the sun rising next to Mt. Rainier. Of course just the fact that the SUN was rising (and you could see it) was a novelty since it's only the 5th sunny day of the whole year, or something like that.

We started out with three patients. One with influenza and pneumonia, one with chest pain and alcohol withdrawal, and another one I can't even remember.

The first one went in to respiratory distress right away, and ended up transferring to the ICU shortly thereafter.

The second one was just DONE. When we got back from the ICU, the patient was dressed and packed, and almost walked out the door with the telemetry monitor and IV still in. Thankfully, we managed to get them before they walked out the door as well. But we weren't able to stop the patient from leaving.

We finally took a short break and when we returned we had another withdrawal pt who was having severe respiratory issues. We got that patient started on an IV drip that was SUPPOSED to help with the withdrawal symptoms and went back to discharge our third pt from the start of the day.

My preceptor got her "lunch" break at 4:15. When we got back to the floor, our withdrawal patient was not doing well at all. We ended up calling a code so that the hospitalist could intubate. That patient went to the ICU on a ventilator.

So we ended the day with just one chest pain patient who arrived at some point in all of the insanity, and a whole lot of documentation. They all said it was an unusually crazy day, I guess we'll see. Overall, I liked Good Sam. Their equipment is updated, the staff is helpful, my preceptor was great, and I learned quite a bit. I came home with a bunch of stuff to look up about cardiac drugs, labs, and treatment. Looking forward to taking a patient next time!

March is here!

I have to say, this quarter has not flown by as quickly as I expected, hoped, or would have liked. But we're finally getting to the end. I have two days left this week of 6am clinicals at Tacoma Lutheran Home, and then just two more Thursday lectures before finals. I will be unbelievably relieved to be done with the bulk of my coursework in the nursing program.

It's been tough deciding what I want to do with my career. I think I've decided to go ahead and apply for the critical care residency program at St. Joseph Medical Center, where I've been working since November. They keep asking me for my application, but I'm still scared I'm committing to something just because it's familiar. And there are nights at work when I think, "Who in their right mind would ever do this job?" But I've always thought that about my jobs. The nice thing about critical care is that it is a good jumping off place for anywhere else I might want to work later. I'm still very interested in oncology, hospice, and eventually being a nursing instructor. All of those things need more experience on my part.

Overall, I'm still glad I chose this career. It has been a very good fit so far for my personality, gifts, and knowledge base. I am looking forward to moving from the nurse tech role to the registered nurse role, even with all of the responsibility that comes with it. And I'm looking forward to a more balanced life once school is over.

140 days, 19 hrs, 51 mins, 00 secs

My kids are so adorable! I love this photo.

I have a countdown to graduation on my facebook page (under boxes). 140 days still seems like a lot, but 4 months and 3 weeks doesn't. It's flying by as I expected. We're already heading into week four of this quarter and it seems like New Year's Day was yesterday! The rapidly passing time has a side effect, though. It's really hard to get all of my homework done. With only one day of class per week, you'd think I'd have no problems. But throw in two days of clinical, two nights of work, 12-24 hours of homework, my family and all of their schedules, along with everything else I've got my fingers into, and you've got a real problem. My facebook addiction has got to go or I'll never make it!

One of the hilarious things about nursing school is how you start to overreact to everything your body tells you. This happens to medical students, too. A headache becomes a brain tumor, chest pain is always a heart attack, and every time my kids get a stomach ache I worry it's appendicitis. Half the students in my class are undergoing diagnostic testing for one condition or another, and while some of them will turn out to be quite real, the majority turn out to be simple anxiety caused by too much information.

This week we studied Alzheimer Disease, dementia & delirium. Fun stuff. If I start asking you to spell words backwards, I'm really checking to see if your brain still works. This coming week is stress & anxiety. Since I start clinical this week in the mental health unit, AND I have two papers due on Thursday, AND I go back to work Thursday night after 3 weeks off, I'm sure I'll be asking for a prescription for Paxil by the time I get off Saturday morning!

Thank God the clock turns back tonight...

I've been studying the heart for hours. And hours. If you need to know anything about coronary artery disease, angina, congestive heart failure, or acute myocardial infarction, just let me know. I'm pretty much convinced I'm going to die of a heart attack any minute now after being immersed in them all day.

I still have to finish two assignments and write several new sections for my ongoing research project before the weekend is out. The paper isn't due until midnight on Wednesday, but I'm working Tuesday & Thursday so I need to get it done.

I also need to do laundry, go grocery shopping, change all the clocks back and make sure my family remembers what I look like. I'm just too tired to do anymore at this moment. Someday I'll look back on this and... probably just be really glad it's over!

I hate being late

Today was truly terrible. Actually it started yesterday when it took me three hours to get to Ft. Lewis, get through the gate, get my hospital ID badge, get my computer password to access the charting system, and eat lunch. Then it took two more hours to figure out which patient might be staying at least 24 hours and compile huge amounts of data to figure out later.

I was late getting home and it was my last chance to go dress shopping for homecoming with Jumah. Then I was late starting on homework, late getting the house ready for missional community, late getting the cornbread in the oven, late getting the kids to bed, late starting more homework, late getting to sleep, and late waking up this morning.

I DID get the children to school on time.

After that, things seemed to improve. Until I realized (too late) that I had an additional piece of paperwork due today at clinical. I scrambled to finish it, but couldn't. And I shouldn't have tried, because that scramble made me late to print my paperwork, late to leave the house, late to get to the gate, and eventually, late to clinical. Which is grounds for being sent home and failing the whole assignment, but my instructor was feeling generous.

I learned right away that my patient had moved to another floor and I needed to pick a new one. And compile new piles of data to figure out. I started on that and within an hour the doctors decided to send my new patient home. So I picked another patient (my 3rd for the night). My instructor promptly showed up to check on me right as she was violently vomiting up her dinner. After cleaning that up, I got to answer a million questions about all three of my patients and anything else I might have ever learned in nursing school. Then I got to spend four more hours following the Madigan nurses around like a shadow, not getting to actually DO anything. Pure torture.

Yes, I know that in six short months I will be caring for more than one patient at a time. But I won't be having to do 8 hours of paperwork beforehand to prove that I'm smart enough to do so.

So now that I feel completely incompetent, I'm going to try to sleep and wake up to spend the weekend studying for a test on Monday. Maybe at least I won't be late.

Back to school

Now that the kids are all settled in with their classes and routines, it's my turn. This is orientation week in the nursing program at TCC. We do this for a week every single quarter.

Orientation week is not like normal school at all. For one thing, the schedule is different. For another, no one, not even the instructors, is ready to be back. There is a surprising level of being taken by surprise or caught unprepared this quarter. For all of us.

By the end of this week, I will have download thousands of megabytes of forms, syllabuses, spreadsheets, documents, articles, and powerpoint presentations. I will be in deep syllabus shock, wondering how I will ever accomplish everything on all of those lists in 11 weeks. I will pass yet another dosage calculation test. I will catch up with classmates, have my TB test read, mourn the fact that my laptop only holds a charge for 2 hours now, panic intermittently, and start losing sleep.

But all in all, it's good to be back. I like the structure. I missed the routine. I'm looking forward to many of the things I will learn this quarter, even if I do have to learn it at Madigan Army Medical Center on Friday evenings. And best of all, since time seems to skip to double speed when I'm in school, it will only feel like about 4-5 weeks and Christmas will have arrived and one more quarter will be over.

On another note, my nurse tech license hasn't come yet. And I can't start work at the hospital until it does. Several other students took nurse tech jobs over the summer and they all said their license took 6-8 weeks to arrive. It's been 4 weeks today since my application went in. That's terrible news when it comes to us EVER getting a mortgage on this house, but good news that I will be able to adjust to the school schedule before starting 12 hour graveyard shifts. Just trying to look at the bright side.

I better get back to downloading vast quantities of paperwork!