Two Years a Nurse

Two years ago today I was officially listed on the Texas Board of Nursing website as a registered nurse!

The past two years have been good, bad, hard, fun, and such an expansive learning experience as a new nurse. Nursing school did NOT prepare me for what it’s actually like to be a nurse at the bedside, completely responsible for my patients for a 12-13 hr shift. Of course I knew that the reality of being a nurse was going to be different than what I was able to observe and practice in nursing school, but being a “real world” nurse is SO much more than I expected.

In my residency program I was given 16 weeks to orient to being a nurse. I honestly felt like it was the perfect amount of time…in the beginning I thought I’d never get to the point where I was comfortable taking patients on my own and fully taking care of them, but then by the end I was so ready to not be hovered over anymore, haha!

Of course in the beginning my preceptor and I started out with just one patient, and it was basically me learning how to develop and follow a routine, tackle time management, and take care of a patient with the guidance and help from my preceptor right there beside me. And then as time went on and I was comfortable with completely caring for one patient, another patient was added to the mix. Gradually of course the patient assignment increased until I was doing everything for 3-4 patients with only occasionally needing guidance and help from my preceptor.

About 6 months after I came off orientation the realities of bedside nursing, hospital politics, short staffing, and various other things started to catch up to me and I found myself frustrated and bitter with work on a daily basis. I dreaded going into work. I really enjoyed being with the patients and the patient care that I gave but everything else weighed me down. I was (and am) afraid of making a mistake. I was (and am) afraid that I wouldn’t catch something that I should have. Plus a part of me was angry with myself that I didn’t hold out for an ICU job right out of school like I wanted (even though in retrospect I think starting out on the stepdown unit was the perfect first job for me!) I found myself disillusioned and dissatisfied.

And I was frustrated because nursing had been my passion for a long time. I worked hard for my degree and I didn’t want to lose that zeal and that love for the profession.

Well thankfully I was able to take 3 months off for maternity leave in September. It came at just the right time and surprisingly when the time came to go back to work I actually found myself excited again and ready to get back into nursing. And while I still have bad shifts and days when I don’t want to go to work, I have found that the extended break really help “reset” my emotional self and somehow gave me my love for nursing back.

I’ve learned a lot in the past two years and have built the foundation for being a good nurse. I still have a TON that I want to accomplish and I know I will forever be learning but I’m so glad that the first couple of years of being a nurse are behind me. And I’m so excited to be continuing my career as a new ICU nurse starting in March!! In the middle of January I interviewed for a CVICU and a general medical/surgical ICU and actually got offers for both! I surprised myself – I really thought I’d go for the CVICU (considering I LOVE the heart and I’m familiar with the cardiac system the most since I work on a cardiac stepdown unit) but I ended up accepting the offer for the general ICU. I like the fact that it will give me more experience with the other body systems and I will have a wider knowledge base. Especially because I want to become an acute care nurse practitioner in the future and I want to have a good understanding of more disease processes than what just affect the cardiac system.

I’ll put a blog post up somewhat soon (as soon as my 4.5 month old will allow me the time to write it!) summarizing a typical shift and what my nights generally look like. For now let me just end by saying I’m happy to be back and I’m super excited for the new experiences to come! 🙂

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Amber, BSN, RN

I took the NCLEX on Monday! And I PASSED!!! Using the quick results option (you can pay Pearson Vue $7.95 48 hours after the test in order to get your test results) I found out this morning that I passed.

I passed the NCLEX in 45 minutes with 75 questions. I contribute this to the great education I received at TWU, and the amazing Kaplan class I took after graduation to help prep me for the licensing exam.

I’m so freaking excited right now!!! After 5 years of laboring in school, I have finally accomplished what I set out to achieve!!! I AM A NURSE!!!

 

Kaplan NCLEX Prep Course Review

Hello again, everyone! I know I promised you a Kaplan NCLEX prep review awhile ago and alas, I didn’t deliver on time…it’s been a whirlwind around here but thankfully I’m slowing down for a bit as I prepare for taking the NCLEX!

I took the Kaplan NCLEX Preparation Course right after Christmas; it’s typically a four day back-to-back class but I choose the weekend class option, so my four class days were split into two weekends. This was the only option that worked with my holiday and work schedule, and I was initially upset that I had to split the classes in that fashion, however it turned out much better than I expected.

Each day we met for 3 hours in the morning, then had an hour-long lunch break, and then met for another 3 hours. In the morning on the first day of class our instructor gave us explicit detail on how the NCLEX works and began to introduce the strategies Kaplan uses to answer questions. After that morning session, every session thereafter was mostly going through and answering questions using the strategies that we were being taught. On the last day of classes, we took a “readiness” test (even though our instructor said it doesn’t indicate whether you’re ready for anything or not) that consisted of 180 questions and then got together in the afternoon to discuss the test questions and answers. The last hour of class we discussed “what to do now” and how to continue preparing for NCLEX based on how many weeks after the last day of class we’d be taking the NCLEX.

The strategies that Kaplan introduces in order to answer NCLEX questions are BRILLIANT. I especially love that with purchase of the prep course I have access to over 2,000 more questions to practice with before taking the NCLEX. I have been doing 150 questions a day and practice tests as I lead up to taking my test. And I have found that even if I don’t know the answer to a question, if I use the strategies that were taught to me I more often than not can arrive to the right answer anyway!

I highly, highly recommend taking the Kaplan Prep Course due to the fact that it’s not just content review but actual STRATEGY to answering questions. The content review comes AS I’m answering the questions every day and as I look up the stuff that I realize I don’t know/forgot!

It IS an expensive course but I just considered it part of being in nursing school…and TOTALLY worth it if I pass the NCLEX the first time, right? All I know is that I don’t want to regret anything should I happen to fail the NCLEX on the first try (crossing my fingers that I DON’T). I want to know that I’ve taken the necessary steps to passing it on the first go-round.

And there you have it! It’s not a super complex review, I know, but in all honesty the class itself it not very complex – but completely worth it!!

Amber, BSN

Oh yes it’s been quite some time since I’ve blogged, and obviously a TON has happened! I have FINALLY graduated nursing school with my BSN!!!!!

AND I managed to get ALL As this last, final semester. What a way to end things!! My final GPA for my undergrad is 3.823. I’m super, super pleased. My two goals for nursing school were to make no Cs (I didn’t) and for my final GPA to be above a 3.75. Score on both accounts!

I just received my Authorization to Test (ATT) this morning and I have officially scheduled my NCLEX exam. It’s all wrapping up and it’s becoming all too real that I am no longer a nursing student but about to be a nurse (God-willing I pass my NCLEX!). My last shift as a PCT will be on February 5th, and my first shift as a Graduate RN will be on February 23rd – can’t wait!!!

I am in the midst of taking the Kaplan NCLEX Prep Course. I am loving it and highly recommend it – I’ll write a separate post on that later this week. So far I think it’s been beneficial; of course it helps that one of my favorite professors happens to be teaching it and she is just amazing when it comes to explaining ANYTHING.

I’ll leave you with some pictures now to highlight the whirlwind that was pinning, graduation, and graduation parties. 🙂

We didn't want to jinx ourselves by saying 100% RN until we passed the NCLEX! This was our celebratory cookie cake after our last final. :)

We didn’t want to jinx ourselves by saying 100% RN until we passed the NCLEX! This was our celebratory cookie cake after our last final. 🙂

Received my college ring during finals week! I'm so happy to wear it!

Received my college ring during finals week! I’m so happy to wear it!

Got my hair and makeup done before my pinning ceremony...

Got my hair and makeup done before my pinning ceremony…

All dressed up!

All dressed up!

So proud to have him by my side during this journey. So happy he pinned me. :)

So proud to have him by my side during this journey. So happy he pinned me. 🙂

There it is!!! The long-coveted pin!!!

There it is!!! The long-coveted pin!!!

Cardiac cookies for my graduation party the morning of graduation.

Cardiac cookies for my graduation party the morning of graduation.

Nurse-themed cupcakes! And they were GOOD.

Nurse-themed cupcakes! And they were GOOD.

The four amigas...they have been with me from the very beginning and I couldn't have made it through without them.

The four amigas…they have been with me from the very beginning and I couldn’t have made it through without them.

More sweet nursing school friends at my graduation party.

More sweet nursing school friends at my graduation party.

Graduation Cap!! It certainly wasn't the most creative but I thought it was cute!!

Graduation Cap!! It certainly wasn’t the most creative but I thought it was cute!!

Walking down the aisle during graduation!!

Walking down the aisle during graduation!!

We're DONE!!!

We’re DONE!!!

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Smiling with the Chancellor of TWU :)

Smiling with the Chancellor of TWU 🙂

Officially a graduate!!!

Officially a graduate!!!

HOLY COW!!!

18 days until my last final, 21 days until Pinning, and 23 days until GRADUATION!!

vsv (<– the dog decided to contribute to my blog post by licking my keyboard. He says hi!)

You remember that list of last things that I had to do before graduation?? Here’s that list a bit more updated:

  • 2 tests (L&M tomorrow, Communities next Monday)
  • 1 Communities Quiz
  • 1 Communities Project
  • 1 clinical (last one on WEDNESDAY!)
  • 1 Communities Clinical Log (I’ll complete that tonight)
  • 1 HESI
  • 2 finals

I made a 93 on my 2nd Leadership and Management exam, and an 88 on my 2nd Communities exam! My class averages thus far are:

  • Communities: 88%
  • CCI: 93%
  • Leadership and Management: 95%

I have a really good chance at keeping my A in both Leadership and Management and CCI, but I’m pretty sure there’s no way I’m going to make an A in Communities. I’m ok with that (I HATE this class)!!!

I got my invitation to Sigma Theta Tau International (STTI) on Monday! So thrilled to be a part of such a prestigious honor society. I also found out that I’m DEFINITELY graduating with honors (Magna Cum Laude).

I picked out my dresses that I’m wearing to Pinning and Graduation also! I just can’t wait to dress up and celebrate. 🙂

Ok that’s all I’ve got for now! I’m ready for Thanksgiving to get here so I can enjoy some family time and good food before finishing out the very last semester of my Bachelor’s degree!!

Last Nursing School Clinical

It’s so surreal; wasn’t I JUST writing a blog post about my very first nursing school clinical? But when I really think about it that was about two years ago. How crazy!! Yesterday was my VERY LAST NURSING SCHOOL CLINICAL.

I took four patients yesterday on the med-surg floor that I was assigned to, and with the help of my preceptor, took care of those patients for 8 hours, including charting on them and discharging one of them! It was a busy, busy day. And I wasn’t even TOTALLY caring for them since my preceptor was the one making phone calls on their behalf and doing the brunt of the discharge work that was required. I can’t imagine having four patients on my own someday soon…it’s terrifying. And also exhilarating. I can’t wait to be a nurse to my very own patients!!

Picture to commemorate my very last nursing school clinical - and the very last time I had to wear TWU nursing school scrubs!!!

Picture to commemorate my very last nursing school clinical – and the very last time I had to wear TWU nursing school scrubs!!!

We took our class pictures on Monday for our pinning ceremony!! And as a side note…our pinning ceremony is only 4 weeks from TODAY!

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Some of my classmates in my communities clinical group.

Some of my classmates in my communities clinical group.

Can’t even believe sometimes that I’m here…I’m at the point where I just have to wrap up a few things and then I’m literally going to be DONE. Not just done with this semester, but done with my bachelor’s degree!!

Entering Week 12

It’s the start of week 12 already!!! In a little under 5 weeks I will be graduating!! (And just in case you’re wondering, only 29 days until my last final and only 32 days until pinning!!!)

I’ve had some changes with my CCI schedule…in the middle of October I got an email stating that I was no longer allowed in the ED at the VA due to them taking precautions with potential Ebola situations, so I was given a new preceptor and a new floor – a med-surg floor. Honestly I wasn’t thrilled, for several reasons. I had grown to love being in the ED and I knew what was expected of me, I LOVED my preceptor and we got along really well, and I was scheduled to be done with my shifts on Halloween. Due to the timing of when I was able to get ahold of my new preceptor and begin shifts with her, plus the fact that she works 8hr shifts instead of 12hr shifts, meant that my CCI shifts were stretched out a bit further into November. Instead of only having 4 (12hr) shifts left to complete, I now had 6 (8hr) shifts to complete.

I also thought that I wouldn’t enjoy this new change due to the fact that I’d be on a med-surg floor, but honestly I’ve really had a good time with my new preceptor and on this floor with these patients!! I’ve done a TON more charting and medication administration, as well as looking at lab trends and looking into the H&P of these patients, which I really didn’t do in the ED because our patients were with us for such a short amount of time. At this point I’ve taken up to 3 patients, I’ve given report on 3 patients at the end of the shift (not very successfully, but thankfully the nurse I was giving report to was kind and gave me tips for how to do it better next time), and I should be taking 4 patients on my next and last shift which is this upcoming Wednesday. I can’t believe my VERY LAST CLINICAL IN NURSING SCHOOL is this Wednesday!!!

Tomorrow after our leadership and management test, our entire class is going to be taking a class picture for our pinning ceremony, so we get to wear our scrubs but actually look pretty in them for once, being that we can wear our hair down and wear makeup. Everything is wrapping up so quickly now that I feel like I can’t keep track of it all! I can’t believe that we are so close to being done.

A couple of days ago I bought my graduation announcements, all my honor cords that I will be wearing at graduation, bought my diploma frame (it’s gorgeous!) and registered with Pearson Vue to take the NCLEX. AHHHH.

I took my exit HESI about two weeks ago but I made a 904 on it (which converted to an 83%) so I’m going to re-take it. I don’t feel like I NEED to retake it since I made over an 850, however I figured it’d be good practice, plus I BARELY have a chance at making an A in CCI with that score so if I can get a better score the second time around, then my chances of making an A are much higher (they take the higher of the two scores – they don’t average them out, thankfully!).

So here’s what’s left in this semester and then I’m DONE!

  • 2 tests (L&M tomorrow, Communities next Monday)
  • 2 quizzes (Communities quizzes before each exam)
  • 2 projects (One in Communities, one in CCI)
  • 1 clinical (last one on WEDNESDAY!)
  • 1 clinical log (for Communities)
  • 1 HESI
  • 2 finals

I can’t believe it! I’m so close it’s insane!!

I’m Back!

Hello everyone! I had to make my blog private there for awhile during the whole Ebola situation due to the fact that I had journalists tracking me down at my house to try and get information out of me. I just decided to make everything private for the time being.

But I’m back now! There’s been a TON happening with school that I haven’t written about and that I will get around to writing about soon! (This week!) But for now I have to begin studying for my 2nd Leadership and Management test on Monday…so blogging will have to wait a bit.

BTW, the countdown is ON folks!! Only 30 days until my LAST FINAL of college!!!

Emergency Department Thoughts

My clinicals in the ED for CCI have been AWESOME. So far I’ve completed 5, and will have the other five completed before November 1st. Whoop! That’ll open up even more time for me to work on projects and prepare myself for finishing up this last semester of nursing school.

My preceptor in the ED is a former TWU grad herself and she has been so amazing with me. She has a lot of patience but she tells me exactly as it is and I so I don’t have to wonder what she’s thinking or if I’m doing something that will ultimately hurt my patient. She allows me to be independent but she’s right there if I need her. Even when she’s super busy (as happens often in the ED) if I have a question or am nervous about doing something then she will patiently guide me through it.

I’m to the point now that I’m taking one patient completely on my own (well as much as I’m able to…I can’t get into the pyxis so she still has to get the meds for me) and then helping her out wherever I can with her patients. This means that I’m doing the initial assessment on the patient, getting them hooked up to monitors to take vitals, documenting in their medical record, and then carrying out the doctor’s orders on my patient while they are in the ED. It’s SO fun but it’s also quite exhausting. The ED moves at a weird pace…you’ll have moments where you are not busy at all and sometimes that can last for a couple of hours. For example, we have patients in each one of our beds, we’ve done all orders, and now we’re just waiting on what the doctor wants to do – are the patients going to be admitted or discharged from the ED? And then we’ll have hours that are SWAMPED. We’ll receive one patient just as we discharge another, and then receive another in his place…and you feel like you’ll never get caught up with the initial assessment & documentation as well as carrying out orders for each of your patients. I’ve never had 12 hours go by in such a manner…it’s a long 12 hours but at least I’m having fun while I’m there!

I’m really glad I’ve had the opportunity to be in the ED while in nursing school, for several reasons. First, it’s been great to know exactly how emergency departments work and the flow of how they run. I have the perspective of nursing from an emergency nurse’s eyes now. Second, I’m glad to have had this experience so that I can rule out ever wanting to work in the ED in my nursing career. I thought that it’d be a great place to work as a nurse but I’m discovering that it’s REALLY not for me. Not in a bad way – I think that all nurses have a “niche” and the ED just isn’t mine. Why don’t I like it? Well there’s a much more limited contact with the patients in ED. Even if they are with you for hours, they are generally NOT in a mood to be talked to. Most of them try to sleep their day away, in actuality. But most patients aren’t even with you that long. Either they get admitted up to the floor pretty quickly or they are released back to the street pretty quickly. There’s just no satisfaction of seeing a patient coming in really sick and then watching them get better over time, because once they are admitted you never get to know how they’re doing later. And then, and I’m sure I’m NOT correct in my assumptions, I feel like when we “treat” a patient in the ED they really aren’t getting better. We have  patients come in for a pain in their back, and we can’t find anything wrong with them, so we give them pain meds and street them and I’m left to wonder “well what happens when their pain comes back??” (And no I don’t think they’re just drug seekers.) And so on and so forth. A lot of patients that we see are “treated” and then sent right back out but I’m wondering if they were really helped at all. And so with that I get very little satisfaction.

That’s not to say that all the patients we see are that way. We have had some truly emergent cases come through our doors that have been admitted to ICU, all the while we were crossing our fingers that they wouldn’t crash and burn right there in the ED. Those types of patients are definitely rare though.

But I have had a great experience in the fact that I’ve had the opportunity to practice a TON of skills and see some really cool things as well. I’ve:

  • Inserted more IVs than I can count
  • Inserted two male foley catheters and one female foley catheter
  • Inserted an NG tube
  • Drawn blood cultures (my least favorite skill, I think; it’s extremely tedious)
  • Done several butterfly sticks into the veins to draw blood
  • Hung IV meds, IV fluids, given IVP meds, PO meds, IM tetanus vaccine
  • Drawn, labeled, and sent blood to the lab
  • Performed EKGs
  • Seen a STEMI on an EKG of a patient going through a heart attack at that moment
  • Watched a urologist irrigate a foley catheter for almost an hour to pull out clots so that the urine could drain
  • Watched a plastic surgeon sew up a DEEP hand laceration
  • Listed as a mentally altered patient screamed obscenities for about an hour before his meds kicked in and he fell asleep
  • Seen a BAD case of ascites
  • Had a patient that we nearly had to intubate due to a COPD exacerbation and resulting respiratory acidosis
  • Seen a hypochondriac throw themselves on the ground in an attempt to get someone to pay attention before they stormed out of the ED and were brought back in by police
  • Watched as the VA had a medical disaster drill and taught their staff how to respond in that type of situation (they had tents set up and were wearing HAZMAT suits and everything!)

Another awesome thing about being there for clinicals is the fact that there’s one doctor in the ED who LOVES to teach. Whenever he has the opportunity, he will teach you about what’s going on with his patient even if it’s not your patient. I’ve learned a lot just from listening to him!

All in all I’m SUPER SUPER thankful that I have had this opportunity. I can’t believe I’m already half-way done though! Clinicals go by SOOOO fast when you’re in charge of scheduling them when you want!

Vent Status

Yesterday (Monday) was rough. For the first time in nursing school (I’m not including pre-reqs here) my class had two tests in one day. And those tests were absolutely, purely brutal. The kind of test that makes your head throb halfway through and makes you walk out of there thinking that you’re a failure. I can’t tell you how many times I heard those words yesterday…and after our grades went up for CCI one of the most calm people in our class literally flipped out, cussing up a storm and declaring that she doesn’t know why she’s in nursing school since her test grade shows she’s a failure. Of course all of this was in the heat of the moment and of course we all know that we’re not failures (at least I hope we do!) but it’s really hard to know that the test you had just taken was supposed to be REVIEW material for HESI/NCLEX preparation and then discover that the class average was a 79 and that the grades posted online were final grades after “extensive” adjustment to our scores. All this makes it sound like I did really bad but I didn’t…somehow I got a 90! But I feel really bad for my classmates and I’d have to agree with them that it was a crazy hard test and something needs to be done to correct the situation. Because I’m pretty sure I didn’t earn that 90 since I guessed on a lot of my answers and a TON of the questions didn’t even make sense!

And then I thought I had COMPLETELY bombed the communities test. I’m pretty sure they tested in a different language altogether because most of what was on that test was completely foreign to me. I definitely did not prepare well for that test AT ALL. I was told over and over that you have to read the textbooks in communities in order to succeed but since I never read the textbooks and I always do ok (I know I know, not great at all) then I figured that wouldn’t apply to me. WELL I WAS WRONG. I definitely should’ve read the textbooks. I’ve learned my lesson! Thankfully I pulled off a B (HOW?!) and now I know that I HAVE to read if I want to make good grades on the tests. MAN. Thankfully we have three projects in communities that will help even out my test grades by the end of the semester. I think I can maintain a B and MAYBE get an A if I work hard enough. But do I really want to work hard enough? Just being honest here…I’m SO DONE. I’m SOOOOOO ready to graduate and move on.

But looking on the brighter side…I’m almost DONE with CCI! All I have left are 5 clinicals (My last one will be on Halloween if all goes well!), the HESI, and an EBP Presentation. We don’t even have a final in that class. YES!

My Leadership and Management class is going well so far…the first test was a couple of weeks ago and I made a 97. Amazing. We only have two more tests (one during the semester and then one final) and that’s it for that class. I’m hoping for an easy A. We’ll see. 😉

And communities so far has been my nemesis. I am NOT cut out for community health, as much as I thought that I would love to get my Master’s in Public Health once I graduated. Unfortunately it just doesn’t hold my interest…not at this point in my life, anyway. And the fact that the tests are ridiculous on top of all the crazy projects we have to do makes it even worse. I’m sorry I’m whining so much but this is exactly how I feel right about now in the semester. I just want to be done.

Ok moving on to more exciting talk…graduation!! I ordered my cap, gown, and class ring last week! AHHH!!! And we finally found out when our official graduation date is: December 13, 2014. I LOVE IT! I’m going to graduate on 12/13/14! 😀 I also signed up for an NCLEX prep class with Kaplan after Christmas. I’ve heard that it’s super beneficial to take an NCLEX prep class and this one just happens to be taught by one of our S1 instructors and she has an AMAZING way of teaching. I’m so excited about it.

I think that’s all I needed to get off my chest for now. I promise a post is coming about my experiences so far in my CCI clinical ED placement! It’s been a great time so far!