Addiction

Addiction is rough. I witness it with patients everyday.

I encountered a patient with necrosis in the arm and it’s not a small area of necrosis, it’s pretty much the whole forearm.

They still shoot up in that arm.

The addiction is so strong that they are willing to literally risk life and limb for a high.

It’s sad and disturbing.

It makes you realize just how strong addiction is. We in the medical field often blame the patient:

“Why won’t they quit?”

“They obviously don’t care!”

“They should know better!”

“They did this to themselves.”

I’ll admit, I’ve thought that about patients. I’ve been judgmental even when it’s my job not to be. I’ve generalized and stereotyped people.

I am calling myself out for it.

It’s not my place to judge, it’s my job to treat.

It’s not my job to wonder why a person is suffering from addiction, and they are suffering.

It’s not my job to scold and belittle a patient for being addicted.

It is my job to provide the best care I can. It is my job to connect them with substance abuse counseling if they want it. It is my job to provide as much education as possible. It is my job to be their nurse. I’ve got to remember that.

Breaking point

It happened.

Grad school pushed me to my breaking point.

I’m talking full on emotional breakdown, anxiety attacks, re-emergence of repetitive behaviors…

It got bad.

For some reason I hit a wall and could not move past it.

I went to work and functioned as if I was ok, however mentally I was losing it!

It all started with one class… Pathopharmacology. Now let’s remember, I’m in school for my masters in nursing education. I was not prepared to cross paths with this class. It hit me like a ton of bricks. The grading rubric was 5 pages long with part “A” consisting of like, 3 of those pages. I hated it. It’s not a class I have ever wanted to take. It did not interest me. I couldn’t retain the information. The paper I turned in was basically a pompous regurgitation of information that no one wants to read.

It sucked.

The sheer weight of the paper that was due gave me anxiety so I procrastinated. The procrastination made me anxious. The anxiety made me procrastinate more. The procrastination gave me anxiety.

It was the feedback loop from Hell.

I almost broke. Quitting actually started to look like a viable option. I was literally in tears thinking about the paper.

It was the beast I could not defeat… or so I thought.

I had to have friends and family really rally around me and offer support to help pull me back from the edge. They managed to get me to take a step back, breathe, and break the monster down into manageable pieces.

I have a great support system, something I don’t acknowledge enough.

After hours of research, coming up with an outline of what was needed, and taking the paper in small chunks, I completed it. I turned in 36 pages of absolutely glorious regurgitated information. It’s what they wanted, so it’s what they got.

I passed the paper and the class.

It was if a 10-ton Boulder was removed from my shoulders. I could finally breathe. I celebrated by drinking wine and playing Final Fantasy Online with my cousin. It was amazing.

I’m now in Health Assessments. It’s at least something I have some familiarity with. I know the advanced practitioner health assessment is far more involved but it’s something I can learn and retain. It’s useful information, I mean I’ll have to teach that to nursing students one day (hopefully). So, I’m nervous about the assessment I have to record. I’m nervous but not panicking. I’m learning to breathe and take things one step at a time. I finally have a plan to move forward. It’s doable.

Struggling

I’m struggling. This pathopharmacology class is killing me. I have no interest in it so it’s hard for me to focus on it. I’ve been procrastinating terribly. I can’t seem to make myself write the essay that I need to complete the class.

I can’t focus.

I am so aggravated with myself for not being able to just get this class done. I hate that I am in this funk and I’m starting to feel guilty and depressed.

I’ve got to focus. I’ve got to sit down and make sh*t happen!

I’m hoping I can get over this hump…

It’s that time of year again…

It’s flu season!

Yaaaaaayyyyyy!

That means it’s time for myths, inaccuracies, and “internet doctors” to try and convince everyone the flu vaccine is evil.

Let’s address some of the foolishness, shall we?

  1. The flu vaccine does not give people the flu. If they get the flu after the vaccine there is a good chance they were already exposed to the flu virus before vaccination or right after receiving the vaccine (it can take up to 2 weeks to develop immunity).
  2. The flu vaccine is not made with a live flu virus. The virus used in the vaccine is dead.
  3. People still need to get the vaccine every year.
  4. Vaccines DO NOT cause autism (let’s let this lie finally die, ok?)
  5. Yes, there are sometimes multiple strains of the flu virus. That does not mean there is no point in getting vaccinated.
  6. While it is recommended for the young and the elderly, even healthy young people can benefit from getting the vaccine for protection.
  7. For those people that think getting the flu will help build your immunity better than getting the vaccine, no. Just… no. The flu can be deadly. Don’t play with your health like that!
  8. It is considered safe to get the vaccine while pregnant.
  9. Yes, the vaccine contains some additives, however, they are in small amounts and considered safe (HereΒ is a list of what’s in the typical flu vaccine and why).
  10. Those “essential oils” are not going to effectively protect against the flu.

Flu season occurs every year and every year the same misconceptions pop up. As health care providers, it is our duty to educate and provide as much accurate information as possible. There is a wealth of information (like this, or this, and this) that can help us provide evidence-based information to our patients whenever possible. Of course we won’t be able to convince every patient we talk to but hey, we can try!

Guilt

I’m on school break and restart October 1st.

I didn’t have to take a break because of life events or anything like that. I am on term break until classes restart. I finished my 4 classes for the first term and had 5 weeks left until next term starts. If I had finished my last class a little earlier I would have had 6 weeks left which would have been enough time to add in another class. Since there, technically wasn’t enough time left, my advisor told me to take a break until the next term starts.

OK, cool, I earned a break…

Yet I feel guilty… Anxious. I feel like I should be doing something school related right now. I feel like I should be logging in to see if I can get the requirements for the next class. Not doing something school related makes me feel guilty.

I shouldn’t feel like this. I know that. However, I’ve been a full-time nurse and full-time student for so long that I don’t know what to do with free time. I’ve been playing Final Fantasy, enjoying friends, I even picked back up on learning how to knit. Yet I still feel this anxiety about school. My mind keeps telling me I am wasting my time and should be doing something, anything related to school… EVEN THOUGH THERE IS NOTHING I CAN ACTUALLY DO!

I hate that I have used school and work to occupy my time for so long that I feel guilt about free time. That’s not fair to me… And now you see why I’m in therapy…

One down

So, term one is done.

One down, three terms to go to finally get my master’s.

I’m proud of myself. When I started school I really thought I might have been making a mistake. I didn’t think I was ready. I thought I was in over my head. My first paper got sent back and recommended for the writing center because it was so bad.

I had forgotten everything about APA formatting! I felt like an idiot. I took the recommendation and used the writing center for help. My papers are much better now. I feel more like a student, like I kind of know what I’m doing.

I still second guess myself. That’s just me. However, I feel more at ease. It’s tough, papers suck, I’m tired all the time, but I see that I can do it.

I know that it will get harder from here. More 14 page papers, projects to do, and soon, clinicals. I’m going to gripe, moan, groan, curse, and complain. I’m also going to get sh*t done.

I can do this. I’m ready…

July…

It’s July. For some of you that’s no big deal. However, if you work in a teaching hospital July means something deeper… Darker…

The “brand new” residents begin their rotations…

Chaos ensues.

If you have had the pleasure of avoiding the July rush, you’re lucky. For the rest of us, there’s a sense of impending doom.

So many orders. Most make no sense.

-pediatric doses ordered for adults.

-level one head CT for “AMS” on your 98 year old patient with known dementia.

-12.5 mcg of fentanyl q3hrs for your chronic pain patient.

-one unit of blood for an hgb of 5.

-MRI of the ankle to look for osteomyolitis of the toe.

Many, many more orders from an alternate reality…

In this moment, it is your time to shine! You are the only barrier between your patient and a doctor that is still getting their bearings. You’re going to have to speak up, a lot. You’re going to have to advocate. You may even have to knock a new doc off their self-appointed pedestal (when they tell you you’re “just a nurse” please refrain from punching them in the throat).

You can do this. Take a deep breath and remember: you’ve made it through many July’s and you’ll make it through many more…

Does nursing education need an update?

I am going to share my thought on nursing education:

The way nursing teaches feels like it’s 20 years behind.

There, I said it.

What we are teaching our students and how we are teaching them is outdated.

I graduated with my Associates in nursing almost 10 years ago. Why in God’s name did I have to calculate drip rates? Not once in my almost decade of being a nurse have I EVER had to calculate a drip rate! In fact, most hospitals prefer meds to be given through the IV pump to help avoid mistakes in how fast an IV medication is given. Another thing I learned in school that is absolutely obsolete is how to give the “perfect” nursing bath. Let me just tell you that the bath you are taught and the bath you will be given are not the same. No one has the time to give this elaborate bath and many facilities are moving away from basin baths and moving towards the chlorohexidine wipes. However, those are mminor things that need to be updated.

What I really am appalled by is how nursing school made me feel like I would be all on my own. I spent so long trying to memorize every medication my poor brain could store because I was made to feel like I had to know them all. I tried to memorize all the side effects. I wanted to know contraindications, interactions, dosages…

I needed to know it all because I alone am responsible.

Yeah, no.

I have always had a wonderful relationship with pharmacy. I have no problem with calling pharmacy and asking about a dosage, an interaction, how often it can be given, etc. As a nurse you are actually not alone. If all else fails, there are several apps that can be downloaded to your phone that can provide a wealth of medication information (think Epocrates, Medscape, and so on).

And that is my next gripe, technology.

Why are nursing programs not incorporating the wealth of technology into their nursing programs? Just about eveyone has a phone now with access to Google. This idea that we have to memorize everything because we have no one to turn to is very obsolete. There is literally a wealth of information at our fingertips. We are in the information age and it’s time nursing realizes that.

But nothing, and I mean nothing, is probably more obsolete than those damn careplans! Hours and hours spent writing thorough nursing plans, while thumbing through the nursing diagnosis books and for what? Most careplans are now documented in the online charting systems (Epic, Cerner and such). Furthermore, NO ONE looks at them but the TJC when they come to visit!

Something is wrong with nursing education. Many Associates prepared nurses are coming out of school with plenty of knowledge on how to complete tasks. A lot of ADN programs teach tasks with no real time spent going over critical thinking. There are Bachelors prepared nurses have all the knowledge of theory and delegation but no real idea on how to apply that knowledge in the real world.

This is a problem. We are hammering nurses with knowledge and theory but not showing nurses how to apply what they have learned with REAL patients. Don’t get me wrong, as individuals providing health care we need the knowledge we are given. However, we need to learn how to teach nurses to apply what they have learned. We need to learn how to teach nurses how to reflect and resolve when problems do arise. This idea that nurses have to do it all and be perfect needs to die. Quickly.

Our future nurses deserve better.

Arch nemesis

Classes have started for me. In fact, I’ve already completed one class. I’m liking the program so far but my fight with my old arch nemesis has reignited:

APA formatting πŸ˜’πŸ˜

I despise APA. I don’t even understand its point. Margins of this size, very particular page headers, citations that are done *just* so, reference pages with indentions done differently than the actual paper, references sited differently depending on what they are…

Why can’t I just write this damn paper and send it in?!

I get that APA formatting is to help maintain consistancy with how research is published and readability. What I don’t understand is why make it so damn complicated? It almost feels like the creators made it complicated because it made them feel smart.

I hate it.

APA has always been a thorn in my side. I’ve never been very good at it. I find the rules convoluted.

As you can see, I’m already over it…

Stress

I am about to start school. Another one of my coworkers is about to start clinicals for her NP. Another coworker is about to start her NP program. Needless to say, we are all stressed. At least I’m not alone, right?

I decided, however, I’m not going to let myself break under the stress of school and work. I am going to make sure I have some kind of kind outlet.

The first time I went to nursing school my friends and I would go out as a way to celebrate completing a semester. We would dance and let loose. It helped, it gave us a little something to look forward to. When I went back for my BSN my brother would notice I was stressed and drag me to Starbucks or Barnes and Noble (two of my favorite places) to have a moment of of the house. He would also make me do my studying there where there were no distractions (like the TV 😐) to steal my attention. It worked.

So now I’m trying to figure out what my de-stress plan will be for this go round. I know I’ll be doing the “out of house” studying. I think it may be time to bring back the end of semester party night as well! I just know I can’t let myself break under pressure. I’ve got to figure out what my self care will be for this experience…