81 Days

That is how many days I have until I graduate.

To be this close is so hard to comprehend.  I have one final simulation this Thursday, one more roles transistion seminar Monday night, and my last final exam ever (outside of HESI and NCLEX) on Wednesday next week.  I am not sure how to feel about being done with classes.  I have been in classes for the last 3 years, so it is just weird that it is all almost over.  I have been wanting this for myself for so long, and a part of me never felt confident that I would ever achieve it.  That something would happen to blow it all up, or I'd give up, or who knows what else I thought.  I guess I had been so convinced that I'd eternally be a college drop out, that it is hard to believe that I can say that isn't true anymore.

I start my Capstone clinical rotation the second week of March.  I only know my schedule for the first week of which days I will be with my preceptor, so I have this big question mark over my life because I can't plan for anything.  I am a planner, and this drives me nuts!  I am also nervous about what I am going to do about work.  Normally, I have been able to get off of work very easily on Saturdays, but two girls just quit.  Two full time girls.  So, I am going to feel so bad when I have to tell my boss that I have to be at the hospital on the weekends my preceptor works.  And not being able to take off any more Saturdays than that, I am dreading setting up my schedule with the hospital, because I usually try to throw some Saturdays in as an option so that my manager there has more to play with.  However, if I have to give some of my Saturdays to my Capstone, I can't give anymore to the hospital.

I am looking forward to getting back to a normal life of working, coming home, making dinner with Mike, and relaxing.  Being able to make plans with people without worrying about what test I have coming up.  I am ready for us to have our own home again, with the return of our privacy.  I miss my Hello Kitty toaster, and my coffee maker, and my pink Kitchenaid mixer.  I miss not having to listen to the dog bark up a storm because a leaf fell from the tree outside.  I miss a lot of things.

There are so many things that are up in the air for me right now, but I am excited that a new chapter is going to begin soon!!

Fatigue r/t inadequate rest As Evidenced By poor exam performance

Outcomes:

Client will:

• maintain regular sleep pattern of 8 hours each night.
• state feeling rested upon waking.
• state methods of relaxing prior to bedtime.
• return to baseline level of mental functioning
• state methods that can be taken to better manage time so all-nighters are not necessary
• achieve a satisfactory score on all future tests resulting in passing her class.

Interventions:

• Provide education on how to use a calendar to plan tasks and keep track of when assignments are due.
• Administer Xanax (or other anti-anxiety medications) as ordered to treat symptoms of freaking the fluff out.
• Work with client to design a plan of study that allows for a balance between work, school, sleep, and personal life.
• Provide resources that will aid client in achieving time management and study goals (i.e. scary conversations with instructors t discuss performance)
• Assess level of consciousness, be alert for the following: droopy eyes, excessive dietary intake of vending food/starbucks, dead stares, excessive yawning, drooling on desk, snoring, sudden smacking of head into desk, etc.
• Assess quality and quantity of sleep achieved each night.
• Hide school books, keys, wallet, computer, phone, notebooks, TV, etc from client to prevent temptation to stay up all night.
• Put sedatives in "coffee" they drink to stay up all night.
• Play lullabies in background.

Evaluation:

• To Be Determined

So, from last week, its been sort of up and down, up and down, and up and down again for me.  Wednesday was our first exam of the semester, I panicked and ran out of time, but I didn't think I did that bad.  Spent the rest of the day meeting with my mentee, and preparing for our simulation the next day.  MI/Code simulation went WELL.  Even though my partner changed at the last minute, and was a dud (no prep on his part WHATSOEVER....how are you in 4th semester and have not learned the importance of atleast looking up the meds?!?!).  I wasn't perfet, but I didn't freak out, I assessed, I listened to what the patient was telling me, and I took actions to address their complaints.  I needed guidance on the exact steps to take (like ALWAYs tabs before starting a Nitro drip, even though they just had an inch of Nitro paste applied).  I left feeling good about simulation, which is truly a rare event in my nursing school career.

Fast forward to later that day, and I failed my exam.  By 3 questions.  I was trying to come up with all of the questions that I had doubts on, and really started freaking out because there must have been more that I was unsure on that I didn't even know I had wrong!!

Then I had a really great day at work at the hospital.  It was busy, but I had amazingly awesome patients, was working with great nurses, and it just went smoothly for the most part.  Then Sunday, I got my clinical evaluation back from my instructor and made a boo-boo and felt like such an idiot.  I was crying because I was just overwhelmed with how much of an idiot she has to think I am after being so confident that I wasn't worried about failing my test and then I failed it, and now I am screwing up my evaluation and doing a poor job in figuring out what she wants to see from me.  So, I am freaking out and e-mailing her to apologize, and frantically trying to create a hybrid of my evaluations to fix my mistake while I am crying.  Then she e-mails me that it was OK.  So, I felt better.

I was on time for class today!!  And my instructor wasn't giving me the sitnk eye when I was talking to her about an assignment, so I was all like "YAY!".  Then, she explained that she knows a lot of people were disappointed in their scores, but that its ok, we are all gonna graduate!  "SECOND YAY!" Then after lecture we got to look over our exam, and I was all "DOH!!!" I missed a WHOLE PAGE OF QUESTIONS!  Who does this!?!  I seriously lost 10 points from SHEER STUPIDITY from freaking out at the end.  My nerves caused me to fail.  But, at least, I didn't fail because I didn't understand the concepts, I just made dumb-brainless mistakes.  Which I am ok with, and hoped this would reflect to my instructor when I met with her later.

So, I met with my instructor, and of course, she stated she was surprised, and she stated that she can't put me in ICU with performance like that.  I explained to her what happened, this is not typical of my performance, and I even showed her my notes that I used to study with.  So, I think it showed that I put in the effort.  I assured her that it wouldn't happen again, and I was able to discuss with her my problems with my care plan, and felt assured that it was ok to look at big picture problems for my patients instead of just what I assess (a cardiac patient who is well managed will not necessary reflect a problem from a head to toe assessment, however their diagnosis, results of diagnostic procedures like cardiac catheterizations revealing 100% blockage in the right corornary arteries in someone who is Right artery dominant  does!).  It's more clear to me now what I need to work on, what is expected, so I absolutely can fix this!

So, I felt a bit reassured after meeting with my clinical instructor and discussing my concerns with her.  I also got a really awesome letter of recommendation from another of my clinical instructors.  So, like I said, a lot of ups and downs for me this past week, but I am feeling ok.

Me and some of my classmates are all signed up to attend a meeting of the Association of Women's Health, Obstetric, and Neonatal Nursing coming up in a few weeks to as part of an assignment in our Roles Transition class.  I am excited to see what it is like to attend meetings like this, as well as learn more about labor & delivery.

So, I am going to bed early tonight after making sure I have everything prepared for clinical in the morning in order to implement my care plan from up above.  My goal for tomorrow is to spend less time with my instructor, and more time with my patient so I can actually get my LAST HOLISTIC done!  I want to pick it tomorrow because we have to turn it in within a week of the actual day we provided care, and I don't want to spend the day after my birthday working on it to turn it in on the 16th.  Anyway, get my holistic done, come home, work on my clinical eval including the responses to my instructor's questions from last week so that I am NOT working on both days at the last minute, so that I can spend more time studying for my next test!

Oh, and if you are not my husband, do NOT ask me to do anything non-school related until after I have passed the class and know my schedule for Capstone.  Its just not gonna happen!!

Code Blue!!

We have simulation today.  Well, two really.  Simulation is this lovely thing where we are rushed in like cattle, given 2 seconds to look at a chart and orders and meds, and then pushed into a room with our patient and then we are supposed to make magical things happen.  No matter how much you prepare, you could have memorized every med, every symptom that you are supposed to see, and KNOW exactly what you are supposed to do....
                                                
Then we FREEZE.

Your patient starts asking you for mimosas to take their medication with.  The monitors in our life-like simulation hospital don't work, you are supposed to be able to hear the heart beat and lung sounds on our "patient" but we can't....it's not working.  All of these things just make you freeze.  You aren't dealing with a real actual patient, and the interaction is just not a natural one, no matter what you do.  It is supposed to be a learning experience, but you walk out feeling like the only thing you learned was how much of an idiot you are.  The best simulation I had was our Peds sim, but the worst thing the kid was doing was doing was being a picky eater and wanting twinkies for his meal....different story from mimosa dude.

So, we have one simulation with a partner (sometimes this goes great, sometimes it goes wrong,VERY wrong) where our patient was admitted to rule out myocardial infarction.  We have a website where it gives us a mock up patient chart, and she has elevated troponin levels, elevated ST segment on EKG, elevated CK-MB levels.  Lady had a heart attack.  We could go in and she's totally fine, but she's having back pain, so something is still going on.  We may just need to give her nitro, or we will be adjusting her Heparin drip, who the eff knows. 

Then we have a group simulation for code management.  We had a really crappy boot camp run through of a code management.  This I believe deserves a lil mini bootcamp of its own, in my opinion.  We assess the patient, they aren't responsive, no pulse.....call for help, press code button and start chest compressions.  Someone brings in the crash cart, we put a back board under the patient, make sure we have IV access, do an EKG.....we are only shocking for certain heart rhythms.  We may need to administer epinephrine, dopamine, etc.  Someone needs to run the code, someone needs to record the cycles, the shocks, the meds given.  One person does compressions, one person does breaths with the bag, and they need to be relieved after so many cycles.  Hopefully, the person will come out of VT or VF, and return to sinus tachy or sinus rhythm.

Luckily, the code management is a larger group, so they tend to go better.  But the one person or partner sims are usually a crap shoot.  You just have to go in and do the best that you can.  I have learaned to not over prepare, because it doesn't mean that you will do any better.  I just try to make sure I know some things I should do, or what the meds do, but I can't get all worked up about it.  It is what it is!