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.

Preceptor behavior (how not to be an asshole)

I have been the orientee and I have even done a little precepting. I lucked out so far and had wonderful preceptors (except for one but anyway…) but I have seen some TERRIBLE preceptors.

One thing that I noticed from a few of the preceptors that I would definitely label as “assholes”, is that they take pride in being intimidating to their orientee. I have witnessed this behavior and have had other nurse confide in me about their preceptors after they were out of orientation. Some of the things I heard were appalling.

It is NEVER okay to make your orientee feel “dumb” or “stupid”. You were a new nurse at one time and you didn’t know everything when you started, you had to be taught as well. You know what else is not okay? It’s not okay to just leave your orientee to fend for themselves. You are not on vacation, you are responsible for teaching this new employee the ways of your unit. Get up and check on them, make sure that they are actually alright. STOP USING THE AMBUSH TECHNIQUE!!! For those of you that don’t know what the ambush technique is, let me fill you in on this bs. Basically what happens is the preceptor ambushes the orientee when they aren’t prepared for it and starts hammering them with questions of “things they should already know” in the eyes of the preceptor. Do I know the normal range for a CVP? Yes, I do. Do I know the normal range for a CVP when you show up out of nowhere, while I am catching up on charting on a patient that I just had to start on norepinephrine and give two units of blood? No, absolutely f*****g not! This does not mean I am less intelligent than you, it means I was focused on my charting and not expecting a nursing ambush! The ambush technique neither proves nor disproves someone knowledge, it just makes you look like a douche. While we are at it, stop making your orientee feel like they are bothering you when they ask you questions. They don’t know. You do. Spread the wealth of knowledge. Learn how to give constructive criticism and praise. A lot of preceptors seem to miss that last part. Your orientee is already paranoid and trying to be a close to perfect as possible. Let them know you notice the good things they do along with the things they may need to work on. Your orientee will be much more receptive of your criticism, trust me.

Look, i’m not asking for a lot. I am simply asking you to remember what it was like when you were orienting. Remember how stressed you felt. Remember how confused you were. Remember how intimidating it was. Remember that you aren’t perfect.

Teach back

Get your patients to “teach back” what you have taught them. Get them to repeat what you have taught them. You may be surprised at how little information your patient has absorbed from the education you have given. Using the “teach back” or “repeat back” method can help you gauge just how much information your patient is retaining.

With the “teach back” method, it’s exactly as it sounds. You get your patient to teach you what you taught them. This method is really effective for education that involves hands on training. Things like changing a colostomy bag at home, changing a wound dressing, giving tube feeds, doing peritoneal dialysis, etc all require a lot of teaching. These are thing you want to make sure your patient understands before they return home. When you get them to teach it back to you then you know that they have an understanding of the information they have received. As they are teaching it back, you can correct them if necessary and give them little hints to help them with the process.

“Repeat back” works well with information that may not require as much hands-on work. I found that it works well with my patients that are being sent home with multiple prescriptions, especially different inhalers. I had a patient with COPD and asthma (and yes, she still smoked, how did you know?) that had both Symbicort and an albuterol inhaler. She ended up on our unit from a bad asthma attack. When she started to get wheezy I took her the albuterol inhaler to help open her up and she refused. I couldn’t understand why. She said “that’s not the one I need for my asthma, I need the other one”. Confused, I asked her if she was referring to her Symbicort. She said yes, that’s the one she takes when her asthma flares up. She took her Symbicort whenever she felt tight or wheezy and took her albuterol twice a day. OH, nooooooow I know why you’re in here. I tried explaining to her that the Symbicort is for her COPD, not asthma. She argued with me for a good 10 minutes that I was wrong. I had to not only print out information on Symbicort but also have the doctor talk to her before she accepted that she has been using her meds wrong this whole time and that is why she was in the hospital. Upon discharge I made her repeat the education I had given her and show me which inhaler was her twice daily inhaler for COPD and which inhaler was for her asthma. I felt comfortable that she understood her meds upon discharge.

I think this teaching our patients about their health is where the medical system is lacking. Often, we are in such a rush to get people out so we can get people in that we just assume the patient understands because they didn’t ask any questions. Often, it’s the opposite. Some are embarrassed to say they don’t understand. Some can tell we are in a rush and don’t want to bother us by asking us to repeat what we have told them. It is up to us to make sure our patients are leaving with a full understanding of their health and their medications.