Daily Dose of Microbloggery

• 09:46 Spent a few hours messing with Circus Ponies' Notebook, but I can't get along with it. It just doesn't seem intuitive to me at all.
• 11:07 Stepping it up: finished 100 peds/OB NCLEX practice questions. Learned I STILL suck at peds.
• 12:50 Sex and the City is a bad movie for engaged ppl to watch
• 18:10 Thinking of bringing back Not Nurse Ratched.
• 19:56 OK NNR is officially back! notratched.wordpress.com/
• 20:14 I think I've heard about two dozen "Joe the plumber" jokes just today.
• 21:47 Anyone have a link for the articles justifying the higher cost of a Mac?

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Home again, jiggety jog

I can't cozy up to this blog. I'm putting NNR back up. Sorry. All 20 of you who are reading over here will have to change your feeds again: http://notratched.wordpress.com. Long live NNR!

Daily Dose of Microbloggery

• 09:02 Any other seniors feeling paralyzed by stress? NCLEX, ATI, and job hunts, oh my!
• 09:37 My cat Hedwig is having a fantastic time chasing a piece of dirt around. Oh that I were so easy to make happy!
• 11:06 Thunder is causing a dog and two cats to all try to be on my lap at once (third cat is blase about the whole weather thing).
• 12:51 I'm off to the courthouse again to try to take care of my expired car tags problem. Renewed anger toward moronic fiance.
• 14:12 OK getting an acceptable form of payment for NCLEX application has now taken me like 5 hours. WTF. WTF. WTF.

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I'm in a funk

My first try for that title was "I'm in a junk," which kind of fits with my week. I must be star-crossed or something. External things have been going wrong, but I also just don't feel right. Anxiety over boards and finding a good job feels overwhelming. I thought I would feel a huge weight lifted when I finished my mental health clinical and just had a few tests to take before getting married and starting Capstone, but no. Expectations'll getcha every time. 

Then my fiance, whose PhD is evidently in Stupid, failed to alert me in August that my car tags were due for renewal, so I got pulled over earlier in the week and now have a misdemeanor CRIME to deal with. This seems unjustly severe. I yelled at Mr. Up To No Good for a few days, especially after I discovered this throws yet another wrench into the hideous process of completing NCLEX and State Board paperwork. I mean who does that? Who just puts stuff like that in a drawer and assumes that magically someone else will take care of it? I'll be assuming control of all paperwork and such after we're married: it will feed my dreams of being in control of something, and he hates it anyway. 

I'm not worried at all about our wedding or getting married. I figured I would sink into a terrible panic and call the whole thing off. Perhaps I am simply distracted by terrible panic over my ATI predictor and boards. I did get level III on two subject-area ATIs last week, though, so I am feeling marginally more confident. I just so want this to be over.

Job stress: I'm grateful that in this market I'm highly unlikely to be unemployed. If possible, though, I wish to find a job that I really really like. Problem is I'm not sure what that is. I don't feel qualified to jump right into a specialty area, but lots of other folks are doing that and doing fine. Part of me (a big part) wants to go back to the med-surg floor where I worked as an aide and get a year or two of floor-nursing experience so I feel more confident; however, I'm not getting any younger, so another part thinks if I want to be an ER nurse I should just do everything I can to start out that way. I have alerted The Powers That Be that there is a Situation here and that I am Open To Any Suggestion. I have to try to trust that if I take next right actions and keep puttin' one foot in front of the other I'll end up in the job that is best for me, but that's really hard.

How nursing school has changed me

I have been talking to all the folks one has to talk to to coordinate a wedding, even a small one, and one of these folks remarked how much things have changed for me in 3 years. It doesn't seem like it day by day, but when I look just from there to here: zoiks! It takes my breath away. The pic is the stack of books I had to buy for my first semester in the nursing program. I kept looking at it and thinking, "Erm. Perhaps this is not the best idea I've ever had."

But I had to take a year of prerequisites before that point, and THAT was when the major fear had to be overcome. I used to be the type who fundamentally abhorred change of any kind, so tossing over a well-paying career to venture into the unknown doing something totally different was nearly akin to my saying, "Gee, I think I'll fly to the moon." Forget fears like "I won't pass boards/start an IV right/get a good job." Mine were "I will get lost commuting" and "I won't be able to do this science stuff" (my other degree is a BA in literature). It felt like jumping off a cliff in the dead of night.

It's also funny to think that not so long ago I didn't know how to wipe ass or change hospital beds, etc., and approached it intellectually in my first clinical. Yes, it took me about a year to figure out that common sense is the starting point for all nursing interventions. I was terrified to approach my first patient, and I didn't much care for, you know, TOUCHING people. Now I'm a champion ass wiper, among other important skills, and most importantly I have Nurse Attitude. I don't know when or how I got it, but I now stride in as if I know exactly what I'm doing and exude the nursely air of competence and efficiency (even if I have no idea what I'm doing).

This is not even mentioning that I used to live alone in my little house that I worked so hard to buy and maintain, and now I live in a bigger house and am about to be married. It boggles the mind, just on purely external changes.

The internal ones are more difficult to enumerate. In this time I've now seen people enter and leave the world. I've been kicked, spit on, punched, called an angel of mercy, and had my hand squeezed in gratitude and in pain. I've seen so many naked people and waded through so many body fluids that it's very difficult to impress me anymore (I used to be a sympathetic puker). I am no longer the scared stay-at-home-in-case-I-get-lost person I used to be; I am no longer the person who never played a game in case she might lose. Somewhere along the way I developed confidence, willingness, and curiosity: confidence that I've succeeded before and might do so again, willingness to fail the first time if need be, and curiosity just to see what happens next.

For me, nursing school has been much more than adding tomes of knowledge to my protesting brain and teaching myself to think like a nurse. It's not like a regular degree where you can learn a lot of stuff and stay the same person you were before. Nursing school itself puts you through the wringer, and I nearly fell prey to it and emerged full of bitterness and hatred (there's still time to revert to this). Managing your life while you're too busy to have regular bowel movements puts you through another wringer (no, I'm not kidding about that). I just didn't have any idea! Which is good, because then I would really have been unable to even start...

iPhone artistry

I use "artistry" in the loosest sense of the word, obviously. I'm a photography fan. I used to gravitate more toward high-res printable photography, but my current bent is toward what I am calling "snapshot art" because that pretty well describes it. I can spend a really long time on Flickr looking at strange things people have done with camera phones or crap disposable cameras: some of those pictures end up looking strangely cool! The signal-to-noise ratio is bad, though. There are a lot of "why bother" photos.

Still, there is something intriguing about from-the-hip snapshots even if they are technically awful. The blur of motion or a well-placed accidental sunspot can add just the right ambiance.

I've wandered past all that, though, and into the relatively new territory of iPhone art. I don't have an artistic bone in my body, but I totally love the programs for iPhone that let you scribble on or otherwise transform camera roll photos. My favorites are Sketches ($4.99), Picoli ($4.99), and CameraBag ($2.99). Sketches lets you draw and paint on photos (or a plain canvas), as well as add little thought bubbles and mustaches and stuff. I think this photo, enhanced with Sketches, captures my ire at faculty censure quite well:


The photo at the top of the post is from Picoli. It seemed a fitting transformation to depict my cat tripping on catnip. Picoli lets you flip photos left to right or top to bottom and adjust brightness and contrast, as well as adding interesting effects such as dithering, sunburn, and night vision. Then there is CameraBag, which just lets you add a little interesting oomph to your basic snapshot:


You can give your snapshots a Helga, Lolo, or Cinema effect or go retro with a 1974 or 1962 look. All these are legit App Store programs. I tried Snapture, which is a jailbroken app, and it caused two irrecoverable freezes, so I jettisoned it. Really, this is pretty cheap and nearly endless entertainment.

Maybe things will not be fscked up

In keeping with my new less negative (but, it is to be hoped, not therefore totally boring) blog, I thought I would write what for me is an optimistic post. For me, optimism means "it's POSSIBLE that doom may be averted." I got my graduation pictures back, and they look good! This makes it feel official that I will in fact soon be an honest-to-goodness RN. Now I need a job, but that's going to have to wait a bit. I'm having difficulty deciding what I want to do, because I pretty much like everything I've tried. Except for psych. This probably guarantees that I'll end up being a psych nurse and loving it---I say this knowing the usual course of my life and the perverse sense of humor that that universe regularly directs toward me.

I have been busting ass to knock off the papers assigned for this semester: I don't mind writing papers normally, but this is worse than when I was a freakin' LIT major. I'm almost finished with the last one. Then I hope to be able to relax a bit for a week or two before I take my comprehensive predictor exam and get married. Next month I'll be doing my Capstone clinical with an ab-fab preceptor in the ER I want to work in: can't beat that with a stick! I've done OK with all my exams and work so far that I've gotten back. It truly seems that I may get through this in one piece.

NCLEX, of course, looms large, but I've made an executive decision to postpone panicking about it until I take the predictor exam. I have a decent memory, I am a good test-taker, and I've been diligently doing 50 practice questions a day since this summer, so I can't see what else I can reasonably do to prepare. I don't want to get psycho about it.

I promised I would not bitch about my school or the faculty on this blog, and I did decide to make it a personal blog as opposed to one directed toward scathing bitterness about nursing school. Perhaps the psychological bloggery change has changed my outlook magically or perhaps I have finally reached acceptance, but I really haven't felt bitter for DAYS. It's a record. No one has pissed me off, and I adore my clinical instructor, so no doubt that contributes. Being engaged also seems to have shifted my perspective.

I'm feeling like the idiotic Pangloss from Candide, psychotically chattering, "It's the best of all possible worlds and couldn't possibly be better," so I'll pipe down now. If readers are looking for a good rant, just keep coming back (I'm only in an optimistic mood about once a month, if that).

Impressions of veterans

I have been working with veterans for the last few weeks and am increasingly struck by how incredibly wrong my assumptions were about this group of folks. I'm as left-wing as they come: antiwar, pacifist, the whole shebang. I was raised by hippies, and I can't totally blame my parents, but in my world "Vietnam vet" was somehow generally temporally connected to discussions of My Lai and other atrocities. I have largely viewed the military as a horde of hired killers who had luckily found a lucrative and socially sanctioned outlet for their sociopathic tendencies. I assumed I would mix with veterans like oil and water and that I would have real personal difficulty even being a compassionate care provider. Wrong, wrong, and wrong again.

My first inkling that I might have to eat crow was when I noted that the veterans were going around making sure everyone was registered to vote: for Obama. One tries not to mix politics with nursing care, but sometimes one fails. Apparently McCain has really shafted veterans with his legislation. This totally messed with my head.

With the obvious disclaimers regarding generalization, these men are the most polite and respectful group I've had the pleasure to be around. They call me "ma'am" and behave chivalrously.

I would butt heads with HIPAA if I were to truly refute the remainder of my misconceptions regarding the "baby killer" ideas on this blog, but I can say this: this story, like most stories, has more than one side. No side is pretty. I have learned a very important lesson from these people and will be MUCH slower to jump on my moral high horse and start judging people in the future.

Seeing patients as their former selves

I have often found myself envisioning patients the way they used to be, when they were young or before whatever happened to them happened. The result is that I wax nostalgic by proxy over sometimes-fictionalized accounts of their lives, but I can't stop myself. It happens even more with elderly folks who just love to reminisce (and I love to let 'em). I think keeping in mind that people are far more than what we see in the moment keeps my interest and compassion alive.

I once had a patient who had advanced Alzheimer's disease, and every 30 minutes or so, she would say, as though it were a brand new idea, "I know what we should do. We should go dancing!" She would sometimes go on. "We could find two fellas: one for you, and one for me, although I'm probably a little bit older than you." Her face lit up, and it was impossible for me not to envision her as a young woman going out dancing. Another time I was dance-walking a lady back into bed (nurses, you know what I mean), and she burst out of her flat affect with a huge toothless grin and said, "May I have this dance?"

I was once in an OR observing a below-the-knee amputation for a very elderly woman, and as the OR nurses put the lower limb in the red bag they observed a moment of silence and then addressed it: "You have been a good leg and served her well for a long time." I got a little tearful and began to imagine all the things that leg had done for that lady over the decades she had had the use of it: did she jump rope as a child? Play hop scotch? Climb trees? Did she go dancing with the man who would become her husband? Walk the floors at night with a new baby? Wrap her legs around a lover (possibly the husband...) in the throes of passion? Given all those possibilities I thought the OR nurses' habit of addressing amputated limbs was highly appropriate.

In the peds ICU of one hospital where I had clinicals, the staff would put photos of the preaccident child on the wall near the head of the bed so that they would remember to interact with the still form on the bed as if he or she were still that person inside.

Patients come to us with a few major problems, and we have to focus on those because we have limited time and resources (we can't get all rogerian for every patient we meet). Still, my life has been greatly enriched in the short time I've worked in this wonderful field of nursing by the times I have been able to get to know patients beyond their chief complaint and last bowel movement. There is no doubt about it: if you are a nurse you may be busy, angry, overworked, and underpaid, but you will probably never be bored.