Week 1 Wrap-Up

I mentioned that I make a lot of lists, and today I organized the huge running to-do list I keep on my computer desktop. Now that I’ve started this blog about my nursing experiences, I also started a list about some things I may want to write about on here. This sounds really OCD, doesn’t it? *Sigh* oh well. My lists keep my scatter-brained head in line and help me get things done.

My first post was massive. This one will be shorter (at least by a little, promise).

The OR internship that I was accepted into at New Hospital requires that you attend a consortium. This is basically a bunch of classes that introduces you to the major principles and practices that are implemented daily in every OR, and our consortium started on Friday. Before this, all the new employees at New Hospital had to go to 2 days of general job orientation, on Wednesday I shadowed and observed nephrectomies all day (kidney or kidney tumor removals), and Thursday all the new nurses had computer training & more orientation. After all that general orientation it was nice to finally get down to some specific training that related to my purpose: to become a super awesome OR nurse.

So Day 1 at consortium: Learned about “surgical conscience” (always put the patient first). Learned about the electronic surgical unit (ESU), or Bovie, which lets surgeons cauterize and cut during surgery but are also the single greatest fire source in the OR. Learned about how the OR is set up and why, along with some key terms and names of supplies.

A few gripes. Perhaps it’s because I am a young new nurse and because nursing is not a second career for me, but I get very annoyed when other new nurses (or just nurses new to my field of nursing) come to orientations and meetings like this and talk talk talk. In that kind of setting I just want to get through the educational material and get out so I can go home, but these folks seem to see it as their personal opportunity to share stories and reminisce. To me, it’s quite frustrating and their contributions rarely seem to be of value to the lecture. Another thing: It was so cold in that room. I understand keeping the OR cold to decrease the spread of infection, but I don’t get why every lecture room that I go in has to be freezing. The place we went was very accomodating though – lots of free food. You will quickly learn that in the nursing world, food is abundant. Everybody gives us food. It’s great, unless you’re on a diet.

As in most classes, no matter how riveting the speaker is, sometimes you get tired or your mind wanders. During Day 1 of the consortium my mind wandered towards the differences between Hometown Hospital and New Hospital, and I came to recognize that most of these differences were based on each institution’s judgment calls about where to best use their budget. They are two very different hospitals – one is suburban, one is urban. They’re in different states with different laws, regulations, standards, and public expectations and attitudes.

Before I accepted the OR internship position at New Hospital, I had interviewed at several others. Maybe 4 or 5. Each of those interviews was for the same type of position in the different OR internship programs at these various hospitals, and each interview required that I come on a second day for what is called a “shadow” or “share” day. This is when you basically come in, change into their OR attire, stand in the corner and watch OR procedures all day. The purpose of this is to prove that you can handle the sights, sounds, and smells of the OR atmosphere without getting scared, passing out, or vomiting (all very frowned upon, naturally).

As a result of doing so many of these shadowing days while trying to land a job, I got to see a wide variety of OR arrangements and supplies. While I was shadowing at work on Wednesday of this week, I couldn’t help but think about some of the things that were blatantly absent in New Hospital’s OR. My observations of what was missing (don’t hate on me for not knowing the correct terms):

- Sponge counter bags

- Surgical helmets to which facial shields attach

- Electronic boards in the OR, PACU, & family waiting area that denotes where & in what stage of the surgical process a patient is in

- Re-usable sharps containers

- An OR-specific pharmacy

Other things throughout New Hospital that caught my attention:

- There’s no swipe-in, swipe-out system for attendance & time clocking

- Can’t dial 911 directly during emergencies, must dial a non-intuitive internal system number

- Use of disposable blue chucks instead of re-usable pink pads for incontinence

- Not a smoke-free campus

Now the reason that this doesn’t fluster or upset me is because of what I mentioned before about allocating the budget. By the way, as a new grad I felt that this was a rather astute observation on my behalf. For example, New Hospital may not have some of the things in that list, but the money that those items would have cost was instead spent on purchasing state-of-the-art robotic surgical technology which will better serve our patients. I’m okay with that. I must say also that New Hospital has the best customer service and employee satisfaction that I’ve witnessed anywhere.

My mind decided to wander to other things as well during class. Primarily, I thought about how cool it was that I’m getting paid to learn. It’s like the Pleasantville version of college. I also thought about how I’m proud to be entering the nursing profession early in life with a Bachelor’s degree. Once in awhile I’ll run into someone who’s looking into attending nursing school and they will ask me – “Should I go to a 2-year Associate’s Degree (ASN) program or a 4-year Bachelor’s Degree (BSN) program?” Well, that depends on you. If you have any inclination that someday you may want to further your nursing education and go beyond being an RN, such as entering management or teaching, you will need your Bachelor’s Degree in nursing anyway. If you know that all you want is to be an RN for the rest of your days, an Associate’s Degree will do you just fine. Both programs will get you an RN license (if you pass boards).

My experience has shown, however, that most people who enter an Associate’s Degree nursing program end up taking 4 years to graduate anyway though because they have to wait for clinical spots, whereas Bachelor’s Degree programs rarely seem to have that same struggle. I don’t know if it’s because of the different connections the schools around my area had with the local hospitals, but it seemed like a shame to have spend the same amount of time in an Associate’s program as the people who went to the 4-year Bachelor’s program and not get the same diploma. At many hospitals there’s a pay difference that favors BSN graduates over ASN graduates, and most hospitals nationwide are pushing ASN’s to get their BSN anyway. Some places won’t even hire ASN grads.

If you’re one of those people (as I was) who think of nursing as a job that sticks you by the patient bedsides for the rest of your life, allow me to change your perspective. This may be particularly of interest to anyone who’s in that position of trying to determine if all they’re going to need is their Associate’s in nursing or if they should dive into a Bachelor’s track program (my preference, if you couldn’t already tell). In my Book of Lists, this list is titled “Nursing Career Options…For in case I ever get burned out.” I’m sure there’s more that I have down because nursing is such an incredibly varied profession. Below is my compilation of the many amazing things you can do and become as a Registered Nurse:

- Bedside Nursing (Med-Surg, Pediatrics, L&D, Psych, etc.)

- Specialize in one of those areas

- Surgical Nursing (Working in the OR like me, where patients are asleep & catheterized so they won’t make a mess on you, yay!) in a hospital or outpatient surgical center

- Become a Nurse Practicioner (many states allow you great autonomy, even prescriptive authority)

- Become a Legal Nurse Consultant or an Expert Witness (if  you’re interested in nursing and law)

- Work for a pharmaceutical company either as a sales rep or working with research participants

- Can work in many settings (Hospital, community clinic, private doctor’s office, etc.)

- Work for National Institutes of Health or other government agencies

- Work for a professional nursing organization (such as the American Nurse’s Association, Sigma Theta Tau, etc.)

- Become a college nursing professor (my long-term hope) or part-time clinical instructor

- School nursing

- Nurse at summer camps, resorts, and cruise lines

- Travel nursing

- Work in nursing administration/management

- Become a nurse researcher

- Work in public health nursing (lobbying for health issues, etc.)

- Instruct NCLEX review courses

- And much, much more! (cheesy, I know)

Another thing I thought about during the consortium lectures which hadn’t struck me before was the realization that as a new nurse graduate, this may be the last time in my career in which I am so generalized in my nursing knowledge. This is a good thing, because it’s good to specialize and to focus in on one particular discipline of nursing in order to best serve my patients, but it’s also a bad or sad thing because I’m worried I will lose some of the knowledge that comes so easily to me right now once I’m not using it on a regular basis.

Right now I’m definitely using all of my cumulative nursing knowledge on a daily basis because I am studying to take NCLEX. This is my nursing licensing board exam and it’s coming up soon. I’ve taken the Kaplan course and that has definitely been helpful (free advertising for ya Kaplan, congrats), but naturally I’m still anxious. This test determines a few things: if I get to become a nurse, if I get to keep my job, if I have a livelihood… oh and just about everything else I have planned out for my future. I’m confident that I will pass, it’s just that at this point I want it to be over and done with.

PS – Please don’t think that I’m a slacker who didn’t pay attention at all during my consortium classes. I really did! Most of the time

First Post

One day, I will be old. And perhaps my children will wonder what my youth was like. Okay well maybe they won’t care, but hopefully somebody will be and/or is currently interested. In an effort to remember what it was like to be a new nursing graduate moving to the big city, and maybe to help ease (or increase, who knows) the fears of others following in my footsteps, I have decided to start writing this blog. Plus I’m selfish and want to write it down because it can be cathartic in times of stress. Whatever, it helps.

I should probably start off with some background information about myself (the author). When I was in high school, I was determined to bust out of my regular surroundings and not end up like so many others in my position who had ended up going to the University right down the street from our high school. It’s not like ours was a small town necessarily, but it certainly felt that way. There was a real “everybody knows everybody” feel to life. But wouldn’t you know that during my sophomore year of high school, my audacious mother (love you!) decided to get a job at that exact University which was down the street from my high school, and that her new job offered me free college tuition? How dare they! Of course, I’m just kidding about being upset and I’m thrilled Mom got that job. It was actually fantastic news for both her, myself, & our family. It did, however, pretty much seal the deal that I was going to be going to the university which I had convinced myself was not for me.

Later I figured out how juvenile my whole perspective on that whole situation was. Thankfully, I was smart enough even back then to realize that nobody in their right mind turns down free college tuition and I applied early decision to the University. That done, it was time to figure out what major I wanted to declare. Now when you’re a senior in high school, it can be quite daunting to look at a list of options and say “That right there, that’s what I want to do for the next 40+ years of my life!” So being the logical person I am, I made a list. I make lots of lists. To do lists, shopping lists, life goal lists…I literally have a journal that is designated just for list-making. What a personality quirk, geeze. Anyway, I made a list about what I wanted and what I liked.

Number One: I like helping people. All through high school I was a member of the Key Club, which is basically a junior Kiwanis Club, and did lots of volunteer work through that organization. So I had that down.

Number Two: I like science. I’m not particularly gifted at it, in fact I hated chemistry and physics, but I had a biology teacher who pushed me to love that and to enjoy the challenge of it, so science was in.

Number Three: Job security and decent pay are a must. After seeing my Dad go through the hardship and heartbreak of being laid-off while I was young and the strain it put my parents under to provide for our family, I knew that I wanted a job that would give me independence, autonomy, and a guaranteed paycheck.

This all considered, I looked through the University’s catalog of majors and came up with nursing. I didn’t consider the fact that this would involve handling a lot of blood, guts, and grossness. I certainly didn’t realize that my decision would lead me into a part-time job during college in which I would be directly responsible for cleaning up incontinence (that’s the nice word for it). Yet it worked for me. Every nursing course I took confirmed more in my heart and mind that this was the profession I was meant for. I can tell my family and friends stories that make them want to hurl, I can eat ice cream while watching someone’s arm get sewn back together (my brother’s motorcycle accident in ‘06), and I have a fairly decent understanding of many general mishaps that can happen with your body. It’s fun times, man.

Nursing school was an amazing experience. We had some of the best professors you could ask for. Our simulation labs were large, well-run, and supplied with cool mannequins that pooped, peed, died, and even gave birth. We had clinicals all over the place and left with some crazy stories about patients, situations we faced, and our instructors. I studied abroad twice – working with AIDS orphans in South Africa my sophomore year and then doing sun safety & skin cancer research on the beaches of Australia during my junior year. Best of all was the bonds of friendship that formed between us nursing girls. It’s kind of like an exclusive club to be a nursing student, you have to be in it to understand it. Your other college friends have no clue what you’re studying or doing most of the time, but they know it’s hard and that you’re going to get a job before they do. But at the same time, you’re not isolated from the rest of the campus community. No way…us nursing girls like getting out there and mixing it up.

Despite my juvenile desires to reject this university that was just down the street from my high school, in the end I am so thankful that I went there. It allowed me to save money, stay close to home while still growing in my independence (living on campus & then in an apartment), do laundry and get great home-cooked meals at home (thanks Mom & Dad!), visit my Mom at her office on campus whenever I needed a hug or encouragement, and I got to stay close to my high school girl friends while also branching out and embracing college life. There is nothing I feel like I missed out on in college, which is a pretty great thing.

Okay now I’ll get into a little bit about how I got to be where I am right now. So while I was at the University, a lot of us nursing students worked as nursing assistants (techs) at a local hospital. I’ll call this Hometown Hospital. Hometown Hospital had a heavy role in most of our clinical learning experiences, lots of our professors worked there per diem, and it was the kind of situation where it’s just sort of assumed that most – or at least a lot – of the new graduates from our nursing program would end up working there. That’s kind of the reason why this hospital and my university get along so well – it’s a healthy reciprocal business arrangement for both institutions. I should mention that this is also the hospital where I was born, the hospital where I had been a patient, and the hospital where (just like in high school) I was DETERMINED not to work. It’s not like it was a bad place, that’s not it at all. Hometown Hospital afforded me huge educational benefits as a tech that you just don’t get out of nursing school alone, and it had done great things for my family’s health. The reason I was determined not to end up there was that just like back in high school, I felt like I was destined for bigger and better things. Kind of uppity, I know. There you have it though. I didn’t want to feel pigeon-holed.

I knew all of this well before my graduation from nursing school. About halfway through senior year of college you start applying to jobs and figuring out what you want to do with your life after graduation (the entrance into adulthood – eek!). This time it wasn’t quite as simple as making a list. We’d had plenty of clinical experiences to help guide our decisions about what area of nursing we wanted to pursue, so I tried to think about which one had been the most interesting and exciting to me.

Med-surg: Tired of it, been teching there for 2 years.

Pediatrics: Never baby-sat, not good with children (although I like them and want some!). Also requires dealing with anxious freaking-out parents…not my cup of tea.

Labor & Delivery: Gross & miraculous at the same time, but devastating to all parties involved if anything goes wrong. Too upsetting, no thanks.

Psychiatry: Depressing/frustrating/eternal uphill struggle. No.

Community Health: Not hands-on or clinical enough for me.

Emergency Room: Too much craziness & stress.

Critical Care (ICU’s, etc.): Perhaps…

Operating room: Bingo!

I never had a clinical in the operating room (OR), but I had had several field experiences and seen some procedures. Overall, I liked it! I liked the teamwork I saw, the technicality, the sterile field, the ability to hugely impact somebody’s life in a positive way in just a matter of hours, and the mystery of “What do they do behind those closed doors?!” It was appealing. But how do you get there?

This led to my job search for a spot in an operating room. In recent years many hospitals have developed “nurse internships” for new nursing graduates as a means to train new RN’s for specialty nursing positions. This is good for me because that’s how I ended up getting my job. These nurse internship programs are expensive for hospitals to run, but it’s beneficial to them long-term because nurse grads are indoctrinated right out of school with their specific practices and policies, plus they tend to have good nurse retention rates. All of these things are important in a world where nurses are in high demand and short supply, particularly nurses who are specially trained to hold positions in areas like the ER, ICU, or OR. Areas that are not generally considered nursing specialties include med-surg and the like, however it’s my opinion that pretty much every area of nursing is specialized and unique. After awhile it can be very difficult for a nurse familiar with one area of nursing to switch to another area, and attempting to make such a switch (known as” getting pulled” to a different unit or area) may be downright dangerous for patients unless that nurse is provided with a thorough update and review about nursing practices in that different area.

Back to Hometown Hospital. This hospital had one of these nursing internships, in fact they had several of them, one for each specialty nursing area. Although I was *determined* not to end up there, I applied to their OR internship. I also applied to lots of others in 4 different states, but in the end it came down to Hometown Hospital and one other. The other hospital was just over an hour away in a different state, and is pretty well known and respected throughout the medical community and the nation. I will call this hospital New Hospital.

I had anguished over my efforts to get a job before graduation because early in the spring semester of senior year, it seemed like all of my friends and fellow nursing majors were signing on for jobs well before I even had an offer on the table. I kept reminding myself that it was taking longer because I was applying for competitive nursing internship positions rather than regular floor jobs, but it’s an understatement to say I was worried. Finally during the first week of May, just weeks before graduation, I got the two job offers I had been waiting for – nursing internship positions in the Operating Rooms of both Hometown Hospital and New Hospital. Now I was faced with a daunting decision: Stay at the Hometown Hospital you know and are comfortable at, or leave everything you know and take a leap of faith by moving away to work at this other well-renowned New Hospital? In the end I guess it’s a good thing my Mom got that job at the university down the street and that I stayed in my hometown for college, because that experience (although I loved it) of not stepping out of my comfort zone pushed me this time to take that leap of faith. I accepted the position at New Hospital. Everything happens for a reason.

New Hospital carries some weight when you tell people you work there. I gotta say, I enjoyed telling people and especially my extended family members, that I was headed there. I’m still proud of it. I’m still getting used to it! This has been my first week there and already I can tell it was a good thing for me. The people are so friendly and nice, as are the facilities. Getting here, however, was not without it challenges.

I found out on May 1st that I had gotten the job. Ecstatic! My original start date was September 15 or something, and I was planning on keeping my tech job at Hometown Hospital for the summer. Had no idea at that point what to do about my apartment since my roommate was moving out and I didn’t want to pay the rent alone. Also had no idea what I was going to do all summer about health insurance, as my parent’s insurance company was dropping my coverage the day after my college graduation (how nice of them). On May 13th, however, I received a call from my nurse recruited at New Hospital informing me that “Surprise and good news! We have reviewed our budget, made some changes, and would like to offer you a revised start date of June 23!” I was floored. This was amazing news – I wouldn’t be bored all summer, I’d have a real nursing job and be cool like my other nursing girl friends, wouldn’t have to worry about rent & insurance – but oh…wow, June 23? Um…that’s only 5 weeks away. So I tell her “Sure, I don’t know how, but I’ll be there!”

Haha this started a whirlwind of action. It was only a month and a halve ago but I sit here today wondering how in the world I pulled it off. That afternoon, I dropped everything (including schoolwork) and hopped on craigslist.com. Five days later my Mom and I drove out to the city where New Hospital is located and checked out at least 7 or 8 different places to live. I settled on the second to last; a row-home with an older nurse (whom I did not know) who works at New Hospital’s affiliate location that was 2 blocks from some night-life, 5 blocks from the water. Nice place with cheap rent too, for a city! I signed the lease less than 10 days after accepting the new start date. Can you say “hectic?”

And now I’m here! In the meantime between getting that epic phone call and starting work this Monday, I finished clinicals, graduated from college, moved out of my apartment into my new house, hugged my life in hometown goodbye, and did LOTS of research and made LOTS of lists to help manage my entry into this new, unknown life. I’d be lying if I said I acted all smooth and cool about it. At times I felt like someone was going to have to drag me to my new city kicking and screaming. Honestly, I had a lot of anxiety about leaving home. I never knew I was such an emotional person! Everyone told me “You’ll be fine, it’s only an hour away from home” but having never lived away from my friends and family before, or anywhere other than my hometown, moving (especially doing it alone) was a little traumatic. They also told me this would be a huge learning experience for me, and they were right. It’s been less than a week and I already feel like I’ve learned a lot about myself, not to mention the stuff I’m learning at work!

Now that I am working full-time, it’s gotten a lot better. I have a direction and a purpose in life, people expecting great things from me, and I am expecting even better things of myself. I thrive on productivity and goals. Leave me with nothing to work for and I’m a sad sack. So no more crying spells, at least not for now. I’m too busy! The OR internship that I am doing at New Hospital involves extensive training and orientation, including a huge class that spans several days and is held cooperatively with many other medical institutions to train their new OR nurses as well. That starts tomorrow morning and will cover information given to me in the biggest three-ring binder I have ever laid eyes on.

I’m also busy learning my way around New Hospital and around my new city. Today I found the employee gym and was excited to see that it has a large, empty, mirrored workout room designed for aerobics classes. I’m not much for aerobics classes but a space like that is perfect for me to practice my karate skills, techniques, and kata. I have done kenpo karate for 4 years now, which was another thing that made it so emotional and hard to leave my hometown. My karate school and all the people there holds a very dear place in my heart, and I was truly heartbroken to leave them.

There are some kenpo karate schools in my new city, as you would expect, but I’m taking awhile off from karate or from looking for a new school right now while I study for my nursing boards. Talk about stress. New job, new city, new residence, plus the most important test of my life all rolled into a short period of time. I won’t say the exact date when I’m testing, but I took the Kaplan prep course and am feeling fairly ready. I’ve got a few weeks to go still. Karate is my motivating force – well, along with the desire to keep my fancy new nursing job! – because I’ve decided that once I get my RN, then I will allow myself to go find my new karate school. It’s my reward system for myself, yay!

Well I think that’s plenty for this post. Wonder if anyone will read it or find it interesting. Doesn’t matter too much, it’s mostly for me anyway! If you do read it, feel free to give me encouragement or happy thoughts for my continuing journey into the nursing profession and into adulthood. Just keep it PG, kids.

PS – If it seems like I’m being vague, it’s on purpose. I don’t want to mention names of any particular institutions and risk getting sued someday if they don’t like what I say on here. I kind of like not going to court or jail…maybe that’s just me! Hence the nicknames.