The Dog Ate My Care Plan…

Just a mom/wife/nursing student extraordinaire trying to make it in the big bad city…

Posts Tagged ‘clinicals’

Some Boo-boos You Can’t Kiss Away…

Posted by isntshelovlei on April 11, 2010

A lot of boo-boos and ouchies in clinical today. First, I had a postpartum mom with a fourth-degree episiotomy. She was postterm so of course the baby was big, and they “had to” use the vacuum to assist with the delivery (I’m not a big fan of vacuums and forceps and such). To me, the situation just screamed C-section, but hey what do I know? So for those not fluent in the language of OB, a fourth-degree is the most garbungular type of episiotomy you ever want to have. This cut goes not only through the skin (first degree), muscle (second degree), and rectal sphincter (third degree), but through the rectum as well. “Ouch” really does not even graze the surface. I’ve had a second-degree episiotomy myself and while I hardly noticed it compared to the “ring of fire” during birth, afterward it felt like I slid down a razor-blade-lined water slide and landed in a pool of lemon juice. So I could only imagine what my patient was going through. And those puppies take time to heal. Cold packs help reduce the swelling and pain; and sitz baths circulate (warm) water to the area increasing circulation which promotes healing. You have to be careful with sitz baths though; if you sit in that water too long (which is a breeding ground for bacteria) it increases the risk of infection–15 minutes per sitting is fine. Some women also find witch hazel pads (better known as Tucks) to be soothing.

Second, I got to see a circumcision performed. Let’s just say it made me want to go home and profusely apologize to my 10-year-old son. It just seemed like so much trauma for that little piece of skin they removed. However, the doc that performed it informed me that it “really wasn’t that traumatic for the baby.” Yeah, okay–if that helps you sleep better at night… She used the Mogen Clamp method, which I wasn’t familiar with though all of the methods look pretty unpleasant to say the least. For those of you that have the curiosity and the stomach, you can find a video of the procedure here. I will say I’m glad that the myth (or maybe it was just denial) that babies do not feel pain was finally debunked–it is obviously so not true.

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I Just Didn’t…

Posted by isntshelovlei on March 29, 2010

Clinical this past Sunday was a little more interesting than last week—but not much. I did a newborn assessment, and charted a little in the paper and computer charts. Oh, and I got to help make a couple of beds—exciting stuff for a student nurse thirsty for hands-on patient care right? I did not get to do a postpartum assessment on mom (her regular nurse completed it when I whisked the baby off to the nursery). I did not get to see a birth (vaginal nor c-section). I did not get to pass meds. I did not pass go and I did not collect $200.

It was a little strange at first handling “normal” newborns. I’m used to my NICU babies who have various catheters and such attached to them; these babies were so….free—bundled up like little burritos. Mom was still kind of out of it and preferred that I fed her daughter so I did. It just felt weird being able to scoop up the little peanut from her bassinet and stroll over to the rocking chair with no IV poles or monitors to navigate around. Sitting there with that 7lb bundle of joy made me think back to when my own children were that small (and before they learned to say words such as “no” and “mine”). My lecture instructor said in class that someone always gets pregnant during this rotation—uh, no thanks, I’m retired from that line of work. I already have three strikes, so I’m out of that game.

Sadly, most of the nurses weren’t any better (read: nicer) than the ones we had last semester. I thought (or hoped) that since these nurses cared for hormonal women and babies their demeanor would be a little more accommodating—guess not. No one was outright hostile like my dear Nurse Nasty from last semester, but they did tend to make you feel like some colossal inconvenience. I still don’t quite get that whole “nurses eat their young” thing…

No clinical next weekend since it falls on Easter. Good thing too since I could really use a solid weekend to catch up on some much-needed reading.

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Spring Break!!

Posted by isntshelovlei on March 5, 2010

Health Assessment is over. Finished. Finito. We took our final exam last night and now have to wait 48 long hours for our grades (probably even longer for our final course grades). I actually didn’t think the test was that bad. And since I made benchmark on the HESI I already have an extra 10-point cushion. There were a lot of questions that looked let’s just say “familiar” and I found myself thinking “ooh! I know that!” throughout most of the exam. There were 70 questions total and I was done in about 35 minutes. My professor hesitantly took my scantron—“Are you sure???” I just smiled and shrugged. You know my motto—“Either you know it or you don’t.” I have never been one to sit and stare at test questions as if the answers are going to magically pop out all of a sudden. I have also made it my policy to never change my answers on exams. Most of the time when people change their answers they had it right the first time.

My interview for the nurse extern program was today—I think it went pretty well. It was initially a group info session and then we broke out to tour and interview with the managers of our preferred units. They received almost 600 applications for the program and can only take 32-34 externs so my fingers are crossed—matter of fact while we’re at it, cross yours too! My only concern is the scheduling of it all. They would like for you to work as an extern fulltime—which of course I can’t do or I’ll lose my benefits. So I would have to work my extern schedule around dropping down to a 0.5 FTE at my “real job” (*smirk*), plus my lectures and clinicals since my nursing program runs all year round. Not an easy task, but it can be done!

And so spring break it is—sadly there will not be any sandy beaches in my forecast. I will say it is starting to warm up a little since that record-breaking snow we got but it’s still probably only about 45 degrees on a good day. But at least I’ll get to go to sleep at a normal hour for a few days…

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Buh-bye Health Assessment

Posted by isntshelovlei on March 1, 2010

Health Assessment is just about coming to a close—thank goodness. For a minute there I thought I wasn’t going to make it–my hair even started falling out again. But I’m still here, balding and all lol. We had our clinical final exam/check-offs this past Saturday. You have to do an assessment of one major system (Neurological, Thorax & Lungs, or Abdominal) and two minor systems (CN 1-6, CN 7-12, Cardiac & Peripheral Vascular, or Head/Neck/Face/Ears)—which you basically pick out of a hat. Since you don’t know which ones you’re going to get until that morning you have to know ALL of them perfectly—or at least sufficiently well as clinical is pass/fail. With so many minor details within each system I must have studied for it for a week straight—I even slept with my notes the night before. Instead of visions of sugar-plums dancing in my head I was having nightmares about cranial nerves, diaphragmatic expansion, and liver spans. But it actually turned out ok. My major system was abdominal—which of course was one of my least favorites. I’m just not comfortable with the percussion aspect of it. Liver spans, splenic dullness, tympany over the gastric bubble—most of the time it all sounds like the same ol’ shit to me. And how many nurses really percuss in their daily practice? I am almost 29-years-old and I don’t remember ever being percussed. For my minor systems I had Head/Face/Neck/Ears (and I remembered to hold the otoscope upside down!) and Cranial Nerves 7-12—piece of cake.

We still have to take the HESI tomorrow night and our final exam on Thursday. If we make benchmark on the HESI (we’ll see how that goes), we get 10 points added to our final exam grade. Now I wouldn’t mind that at all…

Up next, Maternity/OB. But first, spring break here I come! Of course it won’t be a full week of pure unproductive bliss since we’re expected to have read the first five chapters in our maternity textbook for the first day of class—oy!

In other exciting news, I have an interview scheduled for the 2010 Nurse Extern Program at the #1 pediatric hospital in the nation! Go me! And from what I’ve heard, due to the economy they’ve had to cut the number of spots in the program in half, so I would just about pee myself if I actually get a spot. It is such a great opportunity—clinicals are such a tease to me at this point! If I’m selected I’ll get to do more hands-on direct care, and in peds at that! For those of you looking for a similar opportunity check out the 2010 U.S. Summer Externship and Opportunity Resource Guide. UPenn puts this out every year; it was recently updated so it should be pretty accurate. Good luck!

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Now Back To Your Regularly Scheduled Program…

Posted by isntshelovlei on January 31, 2010

That’s right. Winter Break (and nights that involve a solid eight hours of sleep), is officially over. Back to the grind.

This semester they’re shaking things up a bit (BIG shocker there). So instead of taking two classes simultaneously for 14 weeks, we’re taking Health Assessment for seven weeks and then Maternity/OB for 7 weeks. At first I thought it would be better to only have to concentrate on one subject of books, BUT now you have to learn everything twice as fast! So even though we’ve only had four classes so far, we’ve already had to read about 20 chapters! My brain, is so overstuffed with information, that I am starting to have dreams about Kaposi’s Sarcoma, black hairy tongues, furuncles and frickin’ cranial nerves! We had an exam last Tuesday; we have an exam this Tuesday. I have to do a genogram and health teaching project in the next two weeks. And check-offs are fast approaching at the end of February. Sheesh. Things are moving so fast I feel like a walking case of vertigo!

Clinicals are good so far. Again, it’s a lot of information being crammed into a few short weeks, but my instructor is good. She’s thorough and always willing to answer any questions you may have. My lecture instructor, on the other hand, replies to 90% of our questions with “It’s in the book.” Gee thanks. Well instead of me coming and sitting in this classroom for three hours listening to you read off the powerpoint, maybe I should just stay home and read the book. She’s nice and all, but it just feels like yet another course where I basically have to teach myself. What exactly does my $480/credit get me around here?…

Well this is going to have to be one of my shorter posts–duty (aka studying) calls!

~Peace, love, and coffee 🙂

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Slow and Steady Wins The Race!

Posted by isntshelovlei on December 18, 2009

So it’s a wrap! At times I wasn’t sure that I would be able to do it (or that I even wanted to anymore), but I made it through my first semester of nursing school! I also got my first B in about eight years—damn philosophy/ethics! It was a high B at that—like an 88.5—so close and yet not close enough. But I’m actually okay with it. My primary focus was on nursing and I did extremely well. Finals were not as bad as I expected them to be; neither was the dreaded HESI. For anyone planning/needing to take it, what I found to be really helpful were the case studies and practice quizzes/tests on Evolve. I also liked that they gave you the rationales for the correct and incorrect answers—it really helps you learn to critically think through the scenarios. I’m not saying the HESI was a breeze because it wasn’t, but it was manageable. Some of my classmates may not agree with me seeing as though the class average on the exam was a 613. But I got a 1033—not too shabby. So I’m feeling pretty good—and it was comforting to know that all of the stress, the meltdowns, and the hair loss were actually turning out to be worth it.

But now when I get home from work I find myself totally stupefied. No chapters to read, no care plans or concept maps to develop, no exams to study for—what in the world am I supposed to do with myself for an entire month? And has cable always been this crappy?—there isn’t anything good to watch that I haven’t seen enough times to be able to recite the script on my own. I will get to spend more quality time with my family though. It gets so hectic during the semester that sometimes I feel like I’m just a family member visiting from out of town. Even my son has said a couple times—“it seems like I haven’t seen you for three days!” Between getting up at the butt crack of dawn to go to work, not getting home from class until after they’re asleep, and then tiptoeing out to clinical like a thief in the night on the weekends—sadly, sometimes that’s almost true. In order to pull this off everyone is making a few sacrifices—not just me.

During the break I’ll also have a little time to work on a few scholarship applications (times is hard, lol)—I know for one the deadline for the FNSNA scholarship is coming up in mid-January. Join me for a little friendly competition?  

But before I know it I’ll be bored out of my mind and ready to go back to school (and back to bedlam). Spring semester I’ll be taking Health Assessment and Maternity—maybe I’ll get to catch a baby or something 🙂

Happy Holidays and New Year to all—I’ll see you in 2010!

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Not Just a Pretty Face: The Ugly Side of Nursing School

Posted by isntshelovlei on November 23, 2009

Clinicals are officially over the semester—praise Flo (Florence Nightingale, that is)! I can retire that mix-matched blue thing of a uniform until late January—shoes too. Of course the last day dragged like hell, and as my luck would have it, I was assigned to one of Nurse Nasty’s patients. She was just as evil as before, except she wasn’t wearing her red scrubs today—still had her horns though. I started to object, but figured that we were only doing a half day and I could put up with her for that long. So I took a deep breath, went into the room where they were giving report and said good morning Nurse Nasty, I’m assigned to your patient, Ms. X today. “WHO?!?” she asks, looking at me as if I had a third eye. Silly me, I must have forgotten that she only recognizes her patients by room number. “Your patient in room 123,” I corrected myself. “Oh.” She then turns her back to me and proceeded to ignore me. I just went about my business; I didn’t have time for her crap. I wasn’t assigned to give meds that day and my patient was on dialysis for four out of the five hours I was there so I basically stayed in the patient’s room trying to keep her comfortable and learning a few things about dialysis from the tech that was running her treatment (in between the tech clipping her coupons of course).

In other news, one of my fellow students made a comment labeling me as “anal.” WTF was that about? I laughed it off at the time, but obviously, days later, I was still bothered by it otherwise I would not be tainting my blog with it. Wikipedia defines anal (retentive) as “a person with such attention to detail that the obsession becomes an annoyance to others…” Nice right? However, in the world of academia, we know that professors hate Wikipedia so I’ll try another source to see if it gets any better. Dictionary.com, defines anal-retentive as “indicating personality traits, such as meticulousness, avarice, and obstinacy, originating in habits, attitudes, or values associated with infantile pleasure in retention of feces.” Wow, all that? Well I’m glad she let me know what she really thinks of me. Thank you Mrs. Freud.  

I’m sure she’s not the only one who feels that way. But what’s interesting is that other students don’t really seem to mind my anal-ness when they’re emailing me with questions about upcoming exams, quizzes, and papers—“I need to talk to you ASAP…call me.” And I wonder if I was being anal when I was out with my family and a student in my clinical group called, completely out of care plans (and we had two due the next morning), and I stopped at her house on my way home to bring her some more? Was that anal too? Though I’m sure only the most anal of nursing students ride around with extra care plans in their trunk… 🙂

I will admit to having a reputation for being a bit “extra” at times. I color-code my note cards and invested in Unbound Medicine’s Nursing Central (HIGHLY recommend!) for my iPhone 3G, though not required, so that I would have a good drug guide (among other resources) at my fingertips while at clinical—meanwhile they’re all scrambling for the one ancient drug book on the unit. I have a coworker who calls me “The Professor” and another student that has nicknamed me “Supa Dupa Student Nurse”—but I know it’s all in fun. Calling me anal though, I interpret a little differently. Over the years I have really gotten sick of taking other people’s shit for doing well and getting good grades. Contrary to popular belief, I bust my ass just like everyone else—I don’t just wake up in the morning with a 4.0 on my transcript. I have everything in the world counting against me and I’m still here, doing the damn thing. There’s nothing wrong with striving to be the best. Who wants a half-ass nurse anyway?

However, I did succumb to my Piscean sensitivity and emotionality and unfriended this person on Facebook. I didn’t do it in an elementary “you’re not my friend anymore!” type of way—because hey, we’re not kids in the sandbox. But my friends on Facebook are my “real” friends and family (on Myspace however, I only know about 2% of my 1400 friends—they’re mostly mob/mafia members for my apps!). I am sharing my real life and my journey through my updates on FB (and Twitter) and I don’t need negative energy or potential trolls in my circle. So I’m sorry if my “attention to detail” annoys you—but as I always like to say “I am who I am—your approval is neither desired nor required.”

UPDATE: My fellow nursing student and I have talked and worked things out. Gotta love the high-intensity stressed-out environment of nursing school where miscommunication runs rampant.

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Nurse Nasty Not Niceness

Posted by isntshelovlei on November 3, 2009

mean-people-suckLast clinical weekend I had a nurse from hell. Not only was she nasty to me, but her attitude even trickled down to my (I guess I should say “our”) patient.  The day started out how clinical days usually do, getting up at the butt-crack of dawn, hot-wheeling (as my children would say) to the hospital with just enough time to grab a cup of Starbucks before running in for report. I find the nurse I’m assigned to—”B”— introduce myself, tell her I’m assigned to such-an-such a patient…all that good stuff. She looks at me like I have three heads. I shrug it off—it’s too early, we’re all a little grumpy and most of us are waiting for the caffeine to kick in. She grudgingly pulls out her little notes to give me report. She tells me a few relevant things about the patient, but mostly just complains that she was “too young to need such total care.” She then asks (herself I’m guessing, because how the hell would I know), “Is this ‘the one’ with MRSA?” And proceeds to go back and forth in monologue about whether or not the patient had MRSA–something you’d kinda wanna to know before going in the patient’s room. We finally did establish that the patient did not in fact have MRSA.

So I go to check on the patient, introduce myself, etc. She’d had a dilaudid PCA from which she was being weaned (or actually by the time I got to her it had already been dc’d). Poor thing was clearly in pain and was wondering why her IV “didn’t seem to be working” so apparently no one had talked with her about it. I got my own set of vitals and asked her to rate her pain for me—which she of course rated as a 10 on a scale from 0 to 10. I reported this back to “B” who replies unsympathetically —“Oh well, she ain’t getting nothing else.” OH-KAY… The patient recently had a lumbar laminectomy, was discharged, then fell and broke her wrist. So she’s laying here with post surgery back pain, which was most likely made worse by her fall, a splint holding her broken left wrist together, and an IV in her right arm which was clearly infiltrated—unpleasant to say the least. So right about now, I’m stumped. Am I supposed to go in and tell my patient that her “real” nurse doesn’t give a crap that she’s in pain?

I return to the patient’s room to find breakfast trays are being delivered—good—a welcomed distraction. I helped her get set up—between the splint and the IV she really had limited use of her hands. She relaxed a little as we talked, but as the last traces of dilaudid wore off you could tell the pain was beginning to bother her again. Usually after breakfast we do hygiene and personal care, but she refused as she was in too much pain and did not want to be touched. I let her be for the meantime and decided to get started with my meds. Nurse Ratched finally allowed me to see my patient’s MAR (medication administration record), so I was able to look up the meds I didn’t know. She did not want to give me the key, nor let me into the drawer so that I could pull my meds. “You don’t need ME, you NEED YOUR INSTRUCTOR!” she snapped. Now at this point I’m seriously wondering what is this chicks’ malfunction? I went to find my instructor, who mind you is running around like a chicken with her head off helping all six of us pull meds (this was the first weekend that ALL of us did meds, previously just one or two of us would). After I returned with my instructor, “B” didn’t want to give her the key to the damn med drawer either!! She walked her devil-red scrubbed arse down to the room with us in tow, unlocked the drawer, and left without a word. Why couldn’t she have just done that 20 minutes ago? So I pull my meds, my instructor double-checks them, and then down the patient’s hatch they go.

At the beginning of the day the nurses were informed that the students would only be doing PO (oral) meds and injections—no IVs. Lo and behold we’re meeting with our clinical instructor in the cafeteria and Nurse Nasty hunts us down, MAR in hand—mind you the unit is two floors up, over the river and through the woods. “Why didn’t you give the such-and-such?” (I don’t remember what it was). I responded that was an IV medication. “Well how was I supposed to know you weren’t giving it?” Now she was really beginning to annoy me. If she took the time to actually l@@k at the MAR which she snatched back from me seconds after I gave the PO meds, she would have seen that I had not signed off on the IV medication—hence I did not give it! My instructor also added “I informed all of you this morning that the students would only be giving PO meds and injections today.” Nurse Nasty turns and leaves, horns just a-glistening. When we returned to the unit she now wanted to know why I also neglected to sign off on the patient’s Desenex powder, “You haven’t even bathed her yet…well what exactly ARE you doing today?” Nurse Nasty aparently forgot that “50” (she referred to all of her patients by room number and not by name) refused hygiene because SHE refused to acknowledge her pain status! Why would I apply desenex powder to a soiled ass behind?!? I figured we (more like I) could give it another try a little later after the oxycontin I had given her had a chance to kick in and her pain was a little more under wraps. Needless to say I could not wait for this day to end.

I realize that most of the time the nurses aren’t given a choice as to whether or not they will have a student nurse—I get that. The clear discontent of some of them is quite evident. And while they may be good at their jobs, some clearly do not have the right attitude to teach. But do they have to take out their frustration on us and even worse, the patients?!? Can’t they remember back to when they themselves were students? Sometimes I really do wonder why certain people have chosen this profession.

Thankfully, the next day I was not assigned to any of Nurse Nasty’s patients (which by the way, sucked for one of my classmates). I had a great nurse and two patients both of whom asked if they could take me home with them :). It was also the first time that I had more than one patient so I was busy—vitals, breakfast, baths, meds, fall risks, bed monitors going off, safety checklists, care plans…the whole shebang. My older patient (I believe she was 85-yrs-old) had literally about 15 9 a.m. PO meds. It took her three tall cups of water and about 30 minutes to get them all down. On top of the PO meds I had to give her a subcutaneous lovenox injection, “up close and personal,” as she called it. But I must admit that I do love when I give injections and they ask “are you done already?!?” It was an exhausting yet exhilarating day, and before I knew it, it was over.

We have clinicals again this weekend so we’ll see if Nurse Nasty remembers to take her happy pill. I guess sometimes the devil doesn’t wear Prada, but scrubs…

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Finally—Patients With A Pulse!

Posted by isntshelovlei on October 16, 2009

thumbnailSo we are finally out of the lab and in the hospital—woohoo for making it through all the exams, math tests, and lab practicum that made it possible. For a minute there I was becoming a little unraveled and thought I wasn’t going to make it. Our first day we had hospital orientation—which of course was boring as all hell. Videos upon videos we watched—fire safety, restraints, Accu-Cheks—ancient VHS tapes (do they still make those?) that they’ve probably been using for decades. And since watching TV has become such a rarity in my life these days, having to sit there and actually watch those videos for hours was just pure torture. Afterward we took a tour of our unit and the staff rolled their eyes at us with this “OH GAWD–we’re being invaded by nursing students” look on their faces. But whatever—never mind them. On my way home I stopped at Barnes and Noble to pick up a care plan book—Ackley’s Nursing Diagnosis Handbook—I LOVE that thing and highly recommend it. That along with my Medical-Surgical Nursing textbook (which at 2016 pages is more like a nursing bible) helps me crank out care plans with no problem.

Day 2 of clinical we were actually assigned a patient. The nurses were still less than enthusiastic at our presence, but none of them were downright nasty—though there were a couple that were a little more snappish than I would usually tolerate. But since this wasn’t my turf I had to fall back. I was assigned a sweet, older woman who basically had surgery but was discharged from the hospital too soon (imagine that—damn insurance pressure). So she had a fall, which landed her right back where she didn’t want to be. Acute pain, impaired mobility, and risk for peripheral neurovascular dysfunction were my nursing diagnoses for her. Probably should throw risk for impaired skin integrity in there as well. But basically all I did all day was vitals, hygiene/toileting, and meals. I didn’t get to give meds even though my patient was on plenty of them. I must admit I was bored out of my mind. The downtime at least gave me a chance to get a head start on my care plan. But even that was difficult given how cumbersome the nursing station had become with all the extra bodies—the only place left to sit was probably the bathroom!

And last but not least, we took our Fundamentals midterm last night (NCLEX-style questions of course)—I didn’t think it was so bad. You can usually narrow each question down to just two possible answers anyway. Both might even be right answers, but you have to determine which one is more right. Ah, the joys of nursing school…

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Who Really Gets 8 Hrs of Sleep Anyway?

Posted by isntshelovlei on September 24, 2009

3c2249779a720196It’s all true…what they say about nursing school that is. The reading is gargantuan, you’re sleep-deprived and cranky, and if I could drag an IV drip of Starbucks around with me all day I would. People take one look at me and know I’m in nursing school—there must be a certain “look” that we have. The past three weeks have been a whirlwind of trying to keep up with reading the non-sequential chapters, watching gillions of videos, practicing skills in lab, quizzes, NCLEX practice questions, drug dose calculations, and writing journal reflections (“What Is Nursing?”—are you kidding me?)—in addition to balancing the circus act that is already my life. I am a total and complete rattled mess. All in one week, I lost my wallet, car keys, and threw my iPhone 3G in the trash! My brain is absolutely overloaded—there is just no more room to store anything else. As one of my friends on Twitter @GoStudentNurse so eloquently put it—“It’s not an issue of ‘hard’ or ‘overwhelming.’ It’s stuffing 10 lbs into a 5 lbs bag.” Couldn’t have said it better myself…

So let’s see what we’ve covered so far—Patient Safety, Hygiene, Medication Administration, and Wound Care in Fundamentals; plus the history and humble beginnings of nursing in my Intro to Professional Nursing course—no, I did not know that the first nurses were prostitutes… This weekend in clinical/lab we’ll be doing catheter insertion, wound care/culture, and administering injections–into an orange no less. I wonder when we aspirate and get juice are we still supposed to inject? 😀

All in all I have to say I am developing a love/hate relationship with nursing school. When I have a clear and quiet 30 seconds (which is about all I can spare these days) I can actually sit back and think—“wow, this stuff I’m learning is really interesting and I can’t wait to actually put some of it to good use.” But when I’ve only had about four hours of sleep and am still three chapters behind in my reading, I’m running late for class/work, there’s a pile up on the expressway, and I’ve been reviewing for a lab day on hygiene only to find out it’s now on vital signs instead…I certainly do not feel any of those warm and fuzzies…

Till next time…

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