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!!

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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!

2 Down, 14 To Go

Well my S2 semester has begun and I’m slowly starting to wrap my head around the fact that I am, in fact, in school AGAIN and that this is, in fact, my LAST semester.

The first thing that has been hard for me, right off the bat, is of course the early morning wake up calls again and the fact that I know I can’t just come home at night after school and sit and watch TV. Man how I wish I could.

The second thing that’s been hard has been the fact that I’m still continuing to try and exercise and eat right everyday but all I want right now is CHOCOLATE. Hello, stress. Nice of you to show up again. (I will not let this semester de-rail my weight-loss progress!!)

The first couple of weeks have been a whirlwind of information overload and assignments and orientations. We even had a simulation already! Our LAST simulation of nursing school!! It was actually super helpful – more so than any other simulation I’ve completed – and I feel like I REALLY learned a lot from it. We covered topics like IV therapy, oxygen therapy (which masks to use and when/why), as well as giving insulin. Then our simulations covered DKA (diabetic ketoacidosis) and PE (pulmonary embolism).

I met my preceptor last week for my CCI clinical at the VA Emergency Department. She’s awesome and also a former TWU nursing student! I am going to love having clinicals with her…we start next Friday.

I also met my school nurse at the school that I will be attending community clinicals in this semester and she seems super amazing as well. I’m blessed by having great leaders this semester! I start those clinicals next week on Thursdays. My weeks are going to go by SOOOOO fast!

I started applying to hospitals last week and have so far applied to 20 different positions at different hospitals. And then yesterday when I checked my email after finishing up at school I saw that I had an email to schedule an INTERVIEW for this upcoming TUESDAY!!! Already?! I’m so not prepared for this…I’m so not prepared for this…I’m so not prepared for this…

But ready or not I have an interview on Tuesday! It’s for the Emergency Department. I have to put together my portfolios today to have them all ready to go…good thing I already have my references and my letters of recommendation all prepared already! I’ll upload a blog post with my portfolio details a bit later next week.

AND I have a test on Monday in CCI. It’s hard to believe we have a test already and we’ve only completed two weeks of school. 😦 Our instructor assured us that we know the material and that it’s all review for us but it’s still nerve-wracking since the test is worth 25% and I really haven’t even begun to study.

Well that’s all I’ve got for now! Time to go study for my test (with Stars-Wars on in the background…this is serious stuff y’all). Happy weekend!

CCI Clinical Placement

I’m sitting here at work…obviously blogging because it’s extremely “Q”-word around here. I’m afraid that if I don’t do something I’m going to start dozing off!!

I finally learned where my clinical placement for my CCI –  “critical competency integration” – class is. I recieved an email on Tuesday with a list of preceptors to pick from with the message of “first come first served” included. There are five of us students precepting at the VA next semester and there were five preceptors listed, so that meant that whoever I wanted I would have to act fast to pick in order to “claim” them!

2 of the preceptors were in the MICU/CCU, one was in the PACU, one was in the TICU, and the last one was in the ED.

And for whatever reason, my first reaction was to go with the preceptor in the ED. WHAT?!?!

I happened to be the first student to respond to that email, and then I got a confirmation email yesterday that made my decision to go with the preceptor in the ED “official.”

So I’m in the ED this next semester for 120 clinical hours!! I’m actually SUPER excited about it. 🙂

But I’m SOOOOO not excited about the fact that school starts in a little over a week. 😦

I’ve been working on my cover letters for the application process – I’m almost done with one of them! I just learned that two of the healthcare systems in Dallas are opening the application process in early September. HOLY COW! That’s just under 3 weeks away!!

 I’m actually realizing more and more that I’d prefer to stay right here on the unit that I work on now. It’s a progressive cardiac care unit (PCCU) which is basically a step-down/telemetry unit for cardiac patients. I’ve talked to my boss about my desires, as I’ve mentioned before, and she said she would do her best to create a position here for me. Now that doesn’t mean that I’m guaranteed the job but it’s certainly a step in the right direction!!

However I will still be applying to other positions at other hospitals. Can’t put all your eggs in one basket! Surprisingly, I know I will be applying for these positions at most of the hospitals: ICU, ED, and NICU.

Random, right?

Random just like my crazy random thoughts are right now. Alrighty…guess I should get back to “work” – about to start reading about stock markets to keep my mind awake! 😉