Whew! It’s been awhile since I’ve sat down and typed up a storm on here. Weird thing just happened when I tried to come to the site though. This site, MY site, is www.nursingchronicles.wordpress.com. I forgot to give credit to my awesome host WordPress however and just typed in www. nursingchronicles.com, and up popped a site that looks almost IDENTICAL to mine that someone had created & made two posts on in the fall of ‘07! I swear I had no clue that site was out there and the insane similarities of our sites names & appearances was a complete freak of nature coincidence!!
Anyway, it’s been a busy month since I last posted. I studied my little heart out for NCLEX and finally tested on July 21, 2008. It was a Monday at 12 noon. That weekend one of my uncle’s & his family were in town, along with my parents, so thankfully that forced me to relax from studying and enjoy their presence. I made a concerted effort to be all “zen” about my NCLEX preparation because I knew I’d been studying like mad, but the morning of the exam I was so nervous. I sat outside the test center in my car, called my mom almost crying, and told myself a million times that I was ready and more than “minimally competent,” which is what NCLEX tests for as a nurse.
The whole testing process makes you feel like some kind of secret agent entering a locked down area. You give your ID & Authorization to Test (ATT) letter to the girl at the counter, sign a waiver, and put everything you have in a locker. You are then fingerprinted at least twice before entering the actual testing room and have your picture taken, which is guaranteed to be one of the worst pictures ever snapped of you because you’re practically hyperventilating at that point. This tiny lady with a Russian accent then fingerprinted me again and walked me to my assigned computer, equipped with ear plugs and the most uncomfortable chair imaginable. At home I would just spread out, get comfy, and take practice test question in my underwear at my computer, but if I’d known that chair at the testing site was going to be so darn uncomfortable I would have practiced while sitting on a hard wooden straight backed chair to get used to the experience.
After a quick tutorial on how to use the computer (what is the mouse? where is the enter key?) the questions that would decide my entire future began popping up on the screen. This test really was critical to the continuation of my happy life flow that I’ve established here in New City, because if I’d failed NCLEX I could potentially have lost my job, or at least been demoted with a wicked pay cut. The gist of this test is that you get a minimum of 75 questions & a maximum of 265, and of those questions 15 of them are just being trialed and don’t count towards your score. You can pass or fail at any number of questions. So when I got to question 75 and the questions kept on coming, I was freaked at first but then decided to try to get comfy in that awful chair because I figured I was going to be there for the long haul. Around question 95 though (I’m not sure of the exact number), the screen just went blank. BLANK. It was terrifying. My jaw dropped and I realized I was done.
I left the test center as fast as humanly possible and called my mom. It was like I was in a state of shock, realizing that I was done studying for this thing. The way I described how I felt to people was: “I don’t feel like I failed, but I don’t feel like I passed either.” It’s like you don’t want to say you think you passed because you’re almost too scared to say it out loud for fear that you might jinx it. Two days later the other intern and I checked on the testing center’s website to see if we could pay the $8 to see our results early, and it let us. Paying $8 was completely worth it to find out our test results a few days early. I would have paid even more because the days spent waiting after the exam was even worse that the anticipation of taking it. At that point it’s just out of your hands and there’s nothing else you can do about it.
Thankfully, after checking the website constantly like maniacs for two days, we were authorized to pay and see our results. And there is was…”PASS.” We had both passed!!! Massive relief, oh man. Thankfully we found this out together and at the end of the workday, because after we found out we couldn’t settle down. We were skipping and running to our cars just laughing and screaming like idiots, we were just so happy! It’s a wonder that security didn’t stop us. Once I got in my car, I called my mom and she pulled my dad in on a 3-way conference call, so that I could tell them together. I sat there on the phone for half and hour crying and laughing with joy. Relief was definitely the best way to describe it.
So there you have it! I am an official Registered Nurse – and as of today it even says so on my work badge. Plus my pay raise goes into effect this week, yay! It’s a little tough after taking boards to be so excited and free and still have to wait and watch as your other nursing graduate friends continue to stress over their upcoming exam, but so far I don’t know anyone who has failed. We must be smart after all. It’s also weird after coming home from work everyday and studying for at least an hour per night to leave work and realize you have a whole evening now to do whatever you feel like.
And what did I feel like doing in my newfound free time? Karate, duh! Well it’s “duh” if you know me. I’ve done Kenpo Karate for 4 years and when I moved an hour away from home, I told myself that my reward for passing NCLEX (besides keeping my job and having income) would be to go find a new karate school in my new city. Thankfully I had brought directions with me to two karate schools on the day that I took boards, because otherwise I wouldn’t have known what else to do with myself during that stressful time after boards when you’re awaiting your test results. I found a school that seems awesome and I’ve been going there for two weeks now. Between karate 2-3 nights a week, that tango class I payed for (which I’m glad is almost over cuz I’ve decided tango’s not really my thing…I like salsa better), having friends & family visit on the weekends, going home on weekends, and trying to establish a social life here in my new town, I’ve been pretty busy! There have also been lots of little loose ends to tie up in regards to my move – such as car registration in my new state, transferring accounts with banks & insurance, and finding new health care providers – which have taken up time too. Hence the lack of blogging for your unimaginable enjoyment…although I doubt anyone actually takes the time to peruse my endless rambles on here, and if you do, I’m not sure whether I should be thanking you and applauding your interest or trying to help you determine a more constructive way to utilize your apparent excess of free time.
Speaking of which, the reason I write this blog is not so much for the benefit of anyone else out there, but more so because I think that I might find it amusing to look back at when I’m old and gray, or when I’ve become an experienced nurse who re-reads her initial nursing follies and enjoys them as a laugh with her super cool nurse friends. It’s also really cathartic and helpful in working through some of the experiences that I have and will encounter. If, however, there is somebody about to graduate from nursing school who’s moving away from home to start their first real nursing job in an OR who has stumbled upon my blog and finds that it strikes a chord with what they’re thinking/feeling/experiencing, then by all means I’m glad you’ve found me as your kindred spirit – and rock on! OR nursing, woo!
Hmm…big things that have happened at work in the past month…a lot. The other intern & I finally met our Educator, which was a big deal because she essentially runs our lives until mid-January (when our 6 month internship ends & we will start circulating/scrubbing on our own). I was relieved that our Educator is exactly the way she is – confident, approachable, knowledgeable, and fair. We have post-conferences nearly everyday with her for an hour to discuss how our cases went that day and what we learned. She assigns us our cases for the next day and we do a bit of research on them at night using the huge stack of textbooks she’s loaning us. At first I was peeved at this concept because I felt like this is a job, not school, but I guess when you’re a professional, that line can become very blurred because in something like health care, you will always be a student. You will always learn something new every single day because the cases, technology, and policies change. And I want to push myself to excel as a nurse so that someday I can go back and further my education, so I guess it’s also good that these assignments kind of keep me in that mindset.
Our Educator also holds lab with us about once a week, which is very helpful. Our hospital is in the process of building four new OR’s. One of them is already finished but hasn’t received it occupancy approval yet for patient use, so we use that space to learn how to position patients & operate the beds, practice prepping patients (in this case, each other), and getting used to the equipment and how it works. Lucky us to have a brand new, state-of-the-art OR just sitting there unused for us to play in!
These labs sometimes cause me to feel pretty conflicted though. In the name of educating the other intern and myself, our Educator obtains lots of equipment and items that are one-time use disposables. Yesterday in lab we were practicing the correct way to scrub and gown, as well as how to properly toss sterile items from their packaging onto the sterile field. The equipment we use/waste exercising these important principles costs an extraordinary amount of money. One sheet of Ioban, which is impregnated with betadine solution and basically looks like a big sheet of brown sterile sticky paper, for example, costs $1000. That’s INSANE. And we just opened it up and threw it away. I wouldn’t consider myself a green-activist and I’m bad about recycling here in the city, but I do have a conscience and I do try my best when I can to be good to the earth. I also think about the economy and the outrageous expenses that are incurred upon our patients when they walk in our hospital doors. But working somewhere like the OR, it’s necessary to use one-time-use disposable equipment due to the extreme importance of sterility and infection control. Sterlizing stuff is not a cheap process. Plus a lot of the equipment we use is highly specialized and can be hard to come by, which makes it all very expensive. The money that passes through the OR – any OR, anywhere – just boggles my mind. It’s not something I really anticipated as an issue that I would encounter and feel conflicted about when I entered my nursing career. All I can do is try my best to be mindful of what I use and not to waste anything unnecessarily, for both the sake of the environment and the economy.
Well now that it’s August and we’ve been working for almost two full months, it’s a strange thought that in September there will be a whole batch of new OR interns coming in. I’m so used to telling people “I’m one of the new OR interns” that I’ll have to change that, because I won’t be one of the new ones anymore. I’ll be more experienced than these other new people, haha! That’s a funny thought because I still have sooo much to learn. I’ve been told that there are 3 of them coming and that they are all new nursing school graduates also, so maybe it will be an opportunity to make some new friends. Wow…this paragraph had the word “new” in it a ridiculous number of times.
Anyway, even though I’ve technically been working now for 7 weeks, I’ve only actually been in the operating rooms themselves for 2 weeks. Last week we started orienting to the circulating role in the General Surgery service (with some random other cases mixed in). So far I’ve seen several gastric bypasses, a spinal fusion, some cholecystectomies (gallbladder removals), and lots of other surgeries too. After awhile it gets hard to remember all the operations you’ve been a part of because it’s just like any other job once you get used to it, at least in the sense that at first every surgery you see is a big deal to you, but after awhile it’s just the norm and not every case is quite as memorable as the first few you ever saw. Working in the OR can be a very serious place and you don’t often get to know your patient very well, but today I had a really awesome lady coming in for a hysterectomy. I love funny old women. In pre-op, this woman gave us a big box of chocolates. Then after we’d put her to sleep on the operating table and lifted her gown up to prep her abdomen for the procedure, we all just cracked up because this dear old lady had placed 5 smiley face stickers on her stomach along with a taped-on note thanking us for taking care of her and wishing us luck with the operation. It’s patients like that who make you stop and smile that really make me love this job.
It’s not always fun though. There was one case that kind of got to me in particular, and it took me by surprise. I had a six year old patient getting her tonsils, adenoids, and frenulum removed. She was the first child I had observed undergoing surgery. I’d seen a tonsillectomy during my junior year of nursing school and it was no big deal then, and even when I had my own tonsils removed in December ‘07 it wasn’t a big deal to me going into surgery. But after the surgery, I had pain like I’d never experienced because it’s such a highly vascularized area and I was old for the procedure. So watching this little girl get that same surgery done and remembering my own experience and how grueling the recovery was, it really got to me. By the time they were waking her up from anesthesia and she was kicking, crying, and screaming, I had to leave the room because otherwise I was about to pass out. My vision got dim and my knees got weak. It was embarrassing to me because it was so unexpected and seemed so ridiculous for me to react that way especially when I’d seen the procedure done before, but I guess it just happens sometimes when you don’t think it will. I think it just hit me hard because unlike other surgeries I see everyday, I had actually had that one and knew the pain that I associated with it in my mind, and I had trouble dissociating my experience with what I anticipated that child was going to feel afterwards. Hopefully it won’t happen again, but at some point in a job like this I think something is going to get to everyone eventually and you have to take a step back for a minute.
Looking ahead, next week we’ll scrub in on General Surgery cases all week, which I’m really looking forward to. Maybe I’ve explained this before, but in the OR different kinds of procedures fall under different “services,” which are kind of like sub-specialty areas in OR nursing. There’s the GYN/GU service (gynecology & genito-urinary), the ENT service (ear/eyes/nose/throats), the Plastics service (burns & plastic surgery), the Vascular service, the Neurology service, etc. In General Surgery, it’s basically surgeries that deal with the abdomen. Like if you’re getting a colectomy (removal of part of your colon/bowel) or a gastric bypass…those would fall under General Surgery.
I don’t mean to demean anyone who does know what I’m talking about, but I figure some of this stuff might not be common knowledge to non-medical people, so I’m trying to do a fair job of interpreting our jargon into layman’s terms. When I mention “scrubbing” for a “case,” “scrubbing” is when you wash your hands really well at that big sink like they do on TV and then you come in the OR and put a sterile gown and sterile gloves on. A “case” is just whatever surgery you’re doing. As a nurse who’s scrubbed into a case you’re the person passing instruments from the back table to the surgeons/fellows/residents/interns who are actually performing the surgery.
There’s also confusion about who these doctor people are that sometimes just randomly show up at your surgery or at your bedside when you’re a patient in the hospital. Let me try to break it down for you, as best as I can. First they go to undergrad and get whatever degree they think will help them get into med school. Then they go to med school, during which time you may see them around the hospital observing. Lots of times, these clueless med students come into our OR and look helplessly to us nurses for direction, and being the nice people we are, we sometimes choose to accommodate them (other times, it’s only because we have to). After they graduate from med school, they are MD’s. But don’t be fooled! Just because it says “MD” on their name tag does not necessarily mean that they are fully trained. Often, far from it. Because after med school, these newbie doctors still have a long road ahead of them. They generally go through 4 years of post-grad training, and during that time they are sometimes classified as “PGY1, PGY2, PGY3, or PGY4.” This stands for Post-Grad Year such & such. A PGY1 – that is, someone who is in their first year out of med school – is called an Intern. After a year as an intern, they become Residents during PGY2-4. Following their residency, doctors may become a Fellow. Fellows are training for a medical or surgical specialty, such as neurosurgery, for example. A fellowship can last several years. And if they’re lucky, maybe these long-suffering doctors will be full-fledged Attendings (a.k.a., the doctor in charge of all the other less trained doctors) by the time they’re 40. See why I didn’t want to be a doctor?
Alright, enough blogging for today.
