A Father’s Encouragement

Reflection: A Difficult Preceptor

I attended an ICU clinical rotation yesterday and experienced my most difficult nurse “preceptor” I’ve ever had. A preceptor is a nurse to whom you are assigned during your clinical rotation that serves as a teacher/mentor of sorts. I used quotes because technically during clinical rotations, you are assigned a nurse to follow/shadow/help but not all are “preceptors” or teachers. Even though this particular rotation is one that is directly tied to my Advanced Med-Surge Lab (we have been going to this hospital pre-pandemic and go to this hospital as students as part of our course requirements), the nurse to which I was assigned didn’t want the role of preceptor. The other nurses were already assigned students, clinic nurses, or had COVID cases, so this was the nurse they assigned to me.

My nurse was in a room with a patient when my instructor announced to her from across the patient’s room that I would be the student with her that day. After my instructor left, I entered the room to introduce myself to her and the patient, and the nurse “shushed” me. The nurse whispered she didn’t want me to agitate the patient as her heart rate goes up whenever she interacts with her. Ok. I wasn’t there earlier. Maybe she just spent all this time getting this patient’s heart rate under control. I didn’t want to undo that.

After we left the room, my nurse asked me to be completely transparent if I’m uncomfortable about performing any skills. She asked me to perform a number of tasks, including Foley care. I shared with her I had never performed Foley care on a live patient. I peformed the skill first semester (last summer) on mannequins. I’ve never had a patient that required me or my nurses to do this for a patient. (Not that Foley care didn’t occur when a Foley was present – CNA’s can peform Foley care. Also, many hospitals avoid the use of in-dwelling catheters due to risk of infection). While I go to open skills lab to continue to practice my skills, skills lab access has been suspended due to the pandemic. Even though I hadn’t practiced in a while, I knew I could do the skill and wanted to do it. However, because I shared I never did it on a live patient and wanted her to watch me to make sure I was doing it right, she did the task herself and declared, “I am not your teacher. I am not here to supervise you. YOU are here to help ME.”

Wow. Uh, ok. This is a great way for me to start my morning. I know how to do a lot of things, but I don’t get tons of experience doing certain skills on live patients. I’ve practiced numerous times on mannequins, read instructions, and watched videos. I’ve done lots of skills once or twice before on patients with a nurse or instructor present. However, I’m not super confident in all my nursing skills yet – even though I passed all my skills exams. I recognize that getting a pass in skills lab doesn’t necessarily translate to being flawless in doing the skill with real-life patients. I don’t want to do anything that could jeopardize a patient, which is why I just wanted to her to briefly oversee me.

Shortly after she performed Foley care, my nurse asked if could spike a bag and hang a Lactated Ringer’s (LR) solution. I said, “Yes, ” but as I was preparing and doing it, she stopped me and asked me to talk her through the process. I hadn’t even finished explaining when she stopped me again and took the bag and just did it herself. I was a little stunned as I’ve hung a number of IV’s already. She said I should hang the bag first before spiking it. I was used to spiking a bag before hanging it. I’m short and don’t want to have to reach up to the IV pole or adjust and readjust a pole every time I hang a bag. I am also used to checking an IV line and flushing it before connecting anything to it, but my nurse did not do this. She connected the line to the patient after priming it with LR and flushed it from a port upstream. I had never seen this before. As I was trying to assess the IV sites, my nurse motioned me to leave the patient alone, again with the intention of not wanting to bother the patient, I suppose.

Maybe half an hour later, the patient seemed agitated and kept raising her arm. It turns out the chuck (an absorbant pad typically placed underneath a patient’s hips) was wet by her left side. She had a Jackson-Pratt (JP) wound drain, so my nurse figured the drain was leaking, added a dry chuck on top of the wet one, and re-positioned the drain and patient. A little while later, when I was alone with the patient, the patient was agitated again. The chuck was wet again with clear liquid. I tried to find the leak. It couldn’t have been urine because she was connected to a Foley, and the patient’s urine was dark yellow. I couldn’t see a leak from the JP, and the liquid in the JP drain was red and serosanguinous. She had three IV sites on her left side, by where the leak was: her hand, her wrist, and her forearm. Two were running and one was on saline lock. Which one was leaking? I couldn’t find the leak so I placed a towel underneath her left hand to keep her dry and determine if the towel would get wet. If the towel would get wet, it was one way to confirm and isolate the leak to the IV sites. I couldn’t see where the drops of fluid coming directly from any line, but because of the pattern of the leak and where it was wet, I determined the leak was from IV site where my nurse connnected the LR.

When my nurse entered the room, I shared with her the site was leaking and asked if we could switch sites. She switched the LR to the other IV site not being used and then gave me a tip not to use a towel for a patient because it can cause skin breakdown versus a chuck. I silently wondered, “If she had flushed the line before connecting the LR, could we have discovered the leak sooner?” I asked if we should DC (discontinue) the IV site that was leaking and she said why would she if she could save it? When I later told my instructor about the leak and wondered how it could be saved, she said maybe it was kinked or not hooked up correctly. A leaking IV could be saved if the hub was replaced or reattached. I clarified with my instructor if I could do skills on patients, even though I’ve never before done it beyond skills lab. She said I could and shouldn’t need any supervision. With that assurance, I knew I had to give myself a pep talk to be more confident in my own skills and just do things I know how to do, even though I haven’t had a lot of practice doing it in real life.

I also clarified with my instructor if my process for hanging a bag (spiking before hanging) is acceptable – it was. I followed up with the my preceptor and asked, “Why did you stop me from hanging that LR bag?” The nurse shared I was talking too much and not “doing” enough, and she didn’t see me do an assessment. I was frustrated because this nurse asked me to talk her through things, didn’t allow me to do things I normally do, and kept discouraging me from interacting with the patient. I had an entire day in front of me, and I needed to find a way to ensure I was able to do things. So I talked less, did assessments without my nurse present, and eventually got to push IV meds, administer oral meds, empty urinal bags, colostomy bags, and JD drain, witness a CVAD (central venous accesss device) placement, and spike and prepare an NS bag. It didn’t feel good, but I fought to have a day where I could practice my skills and learn.

Around two in the afternoon, my nurse asked if I wanted to eat. She had kept offering me to go on break and eat all morning, but I kept turning her down. I finally agreed I should probably eat as it was now 2pm. She said I could leave early if I wanted and not return from lunch. I was leaving the floor around 3:30pm, so if I was gone one hour, I could just leave. However, I wasn’t planning to be gone an entire hour since most nurses get only half an hour. When I asked to verify if her lunch was only half an hour and how I wanted to match that (how else am I going to get used to the work schedule of a nurse?) she replied saying someting about time management and how she doesn’t know me or my schedule but that I should do what I need to do to manage my time. I explained I would return from my lunch and that I still wanted to learn and do things. We had a patient that had urinary retention so I anticipated needing to do a straight cath (in & out catheter) on the patient. I didn’t want to miss the opportunity to insert the catheter; I had never done this on a live patient.

I ate lunch and returned to the floor. The patient who was unable to pee refused the catheter. However, the same patient needed to have a CVAD inserted so we helped prepare the patient for the procedure and monitored him while the doctors inserted the device into a jugular vein. I held the patient’s hand, helped monitor him, and used therapeutic communication to keep the patient still and reassure the patient throughout the procedure.

I had to reflect on the day because while it was rough, I fought to have a valuable clinical experience, and I got it. It’s not often that students get to see a CVAD inserted and sutured to a patient. I wouldn’t have seen that if I left early, as my nurse seemed to encourage me to do. I also got to practice adjusting to different personalities. As a nurse, I’ll need to adapt and adjust to different conditions and personalities. My nurse kept saying multiple times throughout the day, “I am not your instructor”, but I took that in stride, accepted her feedback, adjusted, and performed more and more skills that day. I also learned I need to have more confidence in my own abilities.

My experience reminded me of a Winnie the Pooh quote from a book I’ve been reading my daughter “Pooh’s Grand Adventure”. Christopher Robin tells Pooh, “You’re braver than you believe, and stronger than you seem, and smarter than you think.” I have to remind myself of this. No growth is without challenges. I have to think that my difficult preceptorship experience just helped me to be stronger and forced me to reflect and be more confident in my abilities. Whether she wanted to teach me or not, I learned something.

One last thing my nurse told me before I left the floor. “Be kind when you’re preceptor. Always be kind”. Okay, I’ll remember that.

Return to the Hospital Setting

This past week, I returned to the hospital setting with my cohort after nearly a month being off the floor, away from any direct patient care. We were at a hospital to volunteer and support various departments in whatever capacity they needed. Eagerly and without knowing much detail, we got assigned to various units that day, attended a brief orientation, and assigned ourselves to numerous 12-hour shifts through mid-May.

Wearing the hospital-provided surgical mask over my personal cloth mask and glasses for some eye protection.

To give some background, all my clinical rotations were indefinitely suspended on March, Friday the 13th, due to the global pandemic. I would have never imagined that the pandemic would cause life-altering changes here in the United States for so many. For me, I still wanted to be nurse, but without the patient-interaction provided by my clinicals, my ability to graduate from nursing school was threatened . (The California Board of Registered Nursing (BRN) requires at least 75% of clinical hours to be with patients). As news of the pandemic began to worsen, however, I was relieved to be able to stay safe at home and not have to be in the hospital setting.

Honestly, during the first couple weeks of “stay-at-home” orders, I couldn’t prioritize school or graduation requirements when I felt like I was scrambling to survive and keep my family safe. After the orders were announced, my daughter had come down with a high fever (105 degrees) and started vomiting on an evening my husband was asked to go into work. My husband was sent home, thankfully, and my daugher seemed to gradually improve. A couple afternoons later, however, my daughter’s fever spiked again to 104/105 and she began coughing in her sleep. I listened to her lung sounds with my stethoscope, and I was convinced I heard wheezing in her upper lobes. Her fever broke early that morning, before dawn. I was still worried, so I reached out to her pediatrician. We were able to conduct a tele-visit with her doctor’s office who wrote a prescription, and my daughter has been well the past three weeks. The week after my daughter got sick, I took my 77 year old father to urgent care (for completely separate symptoms). In those first couple weeks, I used my nursing skills and tools to take care of my family. I prioritized family over school or studying for my future career. I was happy to use my nursing knowledge to focus on my family because I did not want to jump back into clinicals with all the uncertainty and seemingly unsafe conditions.

There was so much unknown about the virus and what was required to keep people safe. Should droplet precautions or airborne precautions be used? Even if the type of protection needed was consistently defined, personal protective equipment (PPE) was not readily available. A month before my cohort was called off the floor, hospitals were already asking their staff (and nursing students) to reuse their N95 respirators when dealing with airborne precaution patients. I preferred not to work with these patients because it made me uncomfortable to see a piece of intended-for-single-use equipment used repeatedly. I didn’t want to have to re-use a mask and increase my chances of contamination. With the pandemic, it has unfortunately become normal practice to re-use a mask or have a single mask in a 12+ hour shift because of the PPE shortage.

With what I was witnessing, hearing from the news, and learning from personal accounts and advice of nurses, it seemed best to stay away from direct patient care. I was willing to accept that it might take me longer to get my BSN than I planned. The health and safety of my family is more important than graduating with a BSN on an earlier timeframe. I was okay with taking classes online and patiently waiting when we could safely return to the hospital.

Then, at the end of March, the governer of California called for student nurses to join the Health Corp. I felt compelled to join and signed up. While I’m not a licensed RN, I am a nursing student about to graduate this year. I recognize I have a special set of skills and training that can be useful in caring for patients compared to someone without healthcare experience or education. I signed up with the comfort of knowing I could turn down a deployment. I also signed up because my school (and the BRN) said the volunteer hours could count towards the required direct-patient care clinical hours. I reasoned, “They wouldn’t put student nurses in unsafe conditions, would they?” In reality, the BRN is not set up to protect nurses; The BRN exists to protect patients. Ultimately, I know I need to rely on myself to be protected and safe.

I want to keep my family safe and not expose them to this virus or other illness because of my chosen line of work. Being a nurse lends itself to some risk, however. Nurses and other healthcare professionals are exposed to patients with communicable diseases. Before, the level or risk was acceptable because we had proper PPE available, vaccinations for most things we could be exposed to were offered, and effective treatments known. With COVID-19, the safety measures that made the risk acceptable of working with contagiously ill patients were diminished. After serious thought, I determined I still wanted to be a nurse; I hope that once I’m an RN, conditions are greatly improved.

As a student nurse, I’m fortunate to have the choice to stay home and not go into the hospitals. Because I’m not yet an RN, I’m privileged: I can’t lose a license I don’t yet have, and I can’t lose a job by refusing to work with patients at this time. I figured, if I’m truly uncomfortable and feel compromised, I can walk away from a volunteer position. My school isn’t forcing us to return to the hospital but explained that if we do, we can have our hours count towards our missed clinical hours. They presented us an opportunity to return to the hospital setting, separate from the California Health Corp. We were told we would have PPE provided for us, and we would not be on the COVID units. With all of that under consideration, most of the students in my cohort (including myself) decided to return to the hospital setting last week.

I was conflicted; I cried and prayed over my decision to return to the hospital setting. I love my family and want to do what I can to protect them. I have a husband with diabetes and a preschooler. I have parents over 65 for whom I’ve become their personal shopper to enable them to stay in their home. People for whom I am responsible and love dearly are considered vulnerable populations for COVID-19. I also feel strongly that I am supposed to be a nurse, despite the risks involved. God put in my heart a desire to help people and this is the best way I know how at this point. I am not yet a nurse, but I’m asked to use my training and nursing skills I’ve learned to help others. I don’t want to do it foolishly, and I take this opportunity to serve very seriously. I pondered over this opportunity with my husband and parents. Nurses are short-staffed and could use help. My classmates and I can offer that.

I miss working with patients; I am simultaneously excited and scared. I am anxious about the chaos I might encounter, but also hopeful to help fight this pandemic and support healthcare workers and other patients. At times, I get a little panicked, but mostly, I’m at peace with the choice I made to return to the hospital setting and continue with my pursuit of becoming a nurse.

These are such extraordinary times. The news and what we know about the corona virus keeps changing. I have additional training this week and will start my first shift later this week. The opportunity to be in the hospital gives me more reason to focus on assignments and overall learning to be more prepared once I’m on the floor. Who knows if I will change my mind and want to leave the hospital setting as a volunteer student nurse? A fundamental part of the nursing process is asseessment, and I’m constantly assessing my situation. Either way, I will continue to proceed with caution, but also with the confidence that I have skills and training that can help other nurses and patients.

If you pray, I would appreciate prayers for me, my classmates, and my family’s continued protection and safety. Also pray for guidance for nursing students as we apply our training into practice to support the current workforce. Thank you, be safe, and please continue doing what you can to flatten the curve!

Milestone: My first IV Blood Draw on a Patient

My major milestone this past week was completing my first IV blood draw on a patient, during my ICU rotation. My nurse guided me. I stuck the patient with a butterfly needle and was able to draw blood on my FIRST try! 💉(Luckily, my patient had a really nice big, palpable vein).

My nurse and I walked into the patient room, she handed me the supplies, told me to go ahead, and began charting. I was lost and told her I needed her supervision. I had seen a nurse draw blood from a patient line the week before, so I thought I was going to take blood from an existing IV line. My nurse stopped me when she saw that I was about to sanitize a peripheral IV port. My nurse looked at me like I had three heads 🤔. I worried I wasn’t going to be allowed to do the skill anymore! She explained blood is never drawn from a PIV. The blood draw I saw was from an arterial blood line. I hadn’t realized blood draws are not taken from PIV lines; in retrospect, it makes sense not to draw from a line where a patient received meds.

Photo by Pranidchakan Boonrom on Pexels.com

Despite my nurse’s obviously concerned look, my nurse patiently guided me and let me continue. She repeatedly commented how she was astonished I hadn’t done an IV needle stick on a patient before. I was totally nervous and felt judged, but I knew I had to take my opportunity to practice such an essential skill of getting a needle into a vein. I’ve practiced many times using IV catheters in the skills lab on mannequins, but it’s not the same as inserting IV needles into humans.

LESSON 1: Speak up when uncertain about how to do something. At the very least, talk through the steps BEFORE walking into the room. While our patient’s primary language was not English, it would have been better to have the conversation that I had never drawn blood on a human and discuss the expected process OUTSIDE the patient room. It’s stressful enough being a patient in a hospital; I don’t want to raise a patient’s concerns about me or my abilities with the procedures I’m about to perform.

LESSON 2: Talk out loud while completing steps in a process. While I’m still new and learning, talking out loud helps to reinforce what I’ve learned and the expected process. This applies to any skill, even medication administration (i.e. “…clamp the NG tube…insert syringe…unclamp…push syringe…clamp, etc). Verbalizing steps helps me confirm what I should do or stop myself when something sounds incorrect or strange. Also, my nurse or instructor can hear me as I do things, and guide or interrupt me as needed.

Last week, I also spent more time in my Pediatric rotation. 🧸I’m really loving my Pediatric (Peds) clinical rotation and feel drawn to the particular hospital and patient population. However, I recognize I need more practice feeling baby pulses, particularly pedal ones 🦶. I can usually find pulses quickly on adults, but I find babies’ pulses harder to palpate. I eventually felt the pulses on my infant patients, but it took me a long time. My nurse would feel a pulse and point me to where “it’s a good pulse”. I’d put my finger on the location, and feel hardly anything. I may have been pressing too hard in trying to feel a pulse. I gotta ask my mom friends if I can feel their baby’s pulses to practice this skill – at least it’s not invasive so it should be relatively easy to practice. I often practice assessments on my family and myself, but my daughter is now a toddler – I just need access to more BABIES!

Milestone: First Day in Pediatrics

I had my first day in my pediatric clinical rotation this week and was in tears by the end of the day. I saw sick babies, preschoolers, and teens during my morning in the emergency department (ED). I wasn’t allowed to pass medications, but I felt useful taking vitals or assisting with assessments. I was honestly enjoying learning about the ED and the quick pace of the unit. I felt like working in the department would be something I’d be able to handle. I was fine until I encountered a patient that cried and wailed continuously when we’d see her. Due to her size and coloring, the patient reminded me of my daughter.

Photo by Lucas Pezeta on Pexels.com

I felt awful at the end my interaction with the patient because I was asked to hold her down to keep her still for a procedure that needed to be performed. The patient was unable to follow directions and kept struggling and fighting against the procedure. The non-verbal patient was terrified and screamed and cried non-stop. I wanted to explain that we weren’t trying to hurt her, that we were trying to help her, but I knew this would be something she’d be unable to understand, let alone be able to hear through her cries. This little girl endured two unsuccessful attempts at this procedure by two different nurses, with me assisting each time.

I started to cry when I looked at the patient’s mom and saw that she was tearing up during our second attempt; I could see mom struggling to hold back tears, continualy wiping her face. Ugh. I imagined what it must be like for her…to feel helpless at seeing your daughter struggle, to be upset with what was happening, but to know it needed to be done. We had explained the importance of the procedure to the mother and why it was necessary so she knew why we needed to keep trying. I wish the patient could have understood this, too. It was hard for me to see this little girl so terrified and be part of what was causing her terror.

After our second attempt, we gave this girl a break and called in a specialty team to perform the procedure. My rotation ended before I could witness this third attempt, but I was relieved to see the patient had calmed down and was in her mother’s arms quietly resting by the time I left the unit. I wanted to be able to comfort this little girl, but I recognized just showing up in her room made her upset. I got the sense she’s interacted with medical professionals before; just the sight of us with our scrubs, masks, and gloves seemed to terrify her. I question how I could have served this little girl better. Was there anything else I could have done to make it easier for this little girl? She was crying before we even touched her. What could I have said or done differently? And what about mom? Was there something I could have said or done to comfort mom? Was there something we could have encouraged mom to do to bring more assurance to her little girl?

Since becoming a mom, I’ve become a lot more sensitive regarding children’s issues. Before I became a mom, I didn’t used to cry everytime I’d hear news stories about children getting abused or killed or injured in a terrible accident. I’d think it was awful, but I wouldn’t necessarily cry over it. Now, it’s not unusual for me to be sobbing after I see or read awful stories about children dying in accidents or getting abused. This was why I was hesitant to be in an ED. The pediatric ED is likely where one would see abuse cases or trauma, and I didn’t want to get emotional about seeing kids this way. I didn’t want that experience on my first day in my Pediatric rotation, yet the ED was where I was randomly assigned. I didn’t object to the assignment, because I felt it was the universe’s way to have me face my fears. No trauma brought me to tears that day; instead, a seemingly simple procedure and interaction caused me to cry.

A nurse on the unit saw me tearing up in the hallway and asked if I was okay. I was in denial and said I was, but started to cry. I then explained how I felt awful, like I was assaulting this little girl, when I know logically, I wasn’t and her nurses and I were doing the best we could for her. This nurse pointed out that at least I cared. What if I were a nurse that didn’t care if I had to perform an invasive procedure on a patient multiple times? In retrospect, I also realize that caring about the wellbeing of this little girl is what had us push through, despite the patient’s tears and cries.

I’m passionate about children and have considered Pediatrics as a possible specialty when I graduate. However, I recognize my sensitivity and don’t want to have to emotionally regulate myself every day I work. I care about people, but never want my emotions getting in the way of what must be done. I don’t believe my emotions stopped me from providing the best nursing care I could have provided that day. When the nurse found me crying, I had already left the patient room and completed my rotation for the morning; I was waiting in a hallway for my instructor to meet me and mulling over my experience. Because I care, I want to know and understand what I could have done better. If I encounter something like that again, I want to know how I could influence things to go more smoothly and have a better outcome.

I spoke with a doctor friend of mine who explained she was starting to feel burnt out: She does what she can for a patient to prevent something from happening, but it happens anyway. It’s frustrating, but that’s medicine/healthcare/nursing – that’s life. We can do our best, and sometimes, that still won’t result in the outcome we wanted. I know I did my best, but it didn’t result in the outcome I wanted on my first day of my Pediatrics rotation. I’m still new and my “best” can only improve with more knowledge and experience. I may be afraid of my emotions being a weakness, but I recognize it’s also a strength that drives me to want to do better for my patients. I’m still not sure if the Pediatric specialty is for me, but I know I’m committed to doing better.

What I Learned at Preschool

Photo by Pixabay on Pexels.com

I attended my first parent-teacher conference this week for my preschool daughter.  I had wrapped up my final exams just two days before.  While my own grades were still unknown, my husband and I learned about my toddler’s progress and “grades”.  We got a snapshot of where she was as far as cognitive skills, emotional development, gross motor/fine motor, and social skills. My daughter’s ratings were “P”, “B”, or “D” for her various skills.

I asked the teacher, “What do the letters mean?”

She replied “P is for proficient.  B is for building”. 

I then inquired, “Is D for deficient?”

She said with a laugh, “No, D is for developing.” 

In a prior Facebook and Instagram post, I shared how a professor described my “deficiency” after a clinical simulation and provided solely negative feedback to me.  I was unexpectedly triggered by my own insecurities at my daughter’s preschool review, thinking “D” meant “deficient” for areas where she could use more work.  Instead, the areas where she could improve are ones in which she is still “developing”.  What if I gave myself the grace and focused on how I am still developing?  What if I transformed “deficient” to “developing?”  Stating, “I’m developing a skill” elicits a very different response and attitude from, “I’m deficient in a skill.” 

What if I transformed ‘deficient’ to ‘developing’? Stating, “I’m developing a skill,” elicits a very different response and attitude from, “I’m deficient in a skill.”

The Mature Student Nurse

I got emotional during the conference and started to cry. I cried at the recognition of myself in my daughter.  I cried about projecting myself on her progress and development.  In a moment, I felt my issues had me resigned to suck at parenting.  The traits and behaviors I notice in myself that I try to “fix” or change show up strongly in my daughter: stubbornness, perfectionism, and inflexibility.

  • She may give up on doing something if she notices she is not doing it perfectly.
    • She was doing a cutting exercise with scissors but just gave up and decided not to do it because she saw she wasn’t exactly following the cutting line.
    • I have multiple calligraphy sets that I don’t use because I get discouraged with how my writing ends up looking – even though I know the whole point is to practice.
  • She can be very driven and direct herself, but so much so where she does not welcome working in teams.
    • She loves working on puzzles by herself, but she gets upset when her classmates try to join her.
    • I sometimes find it challenging working on group projects. I dread them at times. 
  • She can fixate on things and become emotionally derailed if things do not go as she planned.
    • She melts down over clothing. 
    • I go into panic mode over a bad test grade.
  • She gets an all-or-nothing attitude.
    • She was supposed to draw a picture of herself.  She started, but was unhappy with how it turned out. She erased the image and tried to re-draw the picture, but never finished.
    • Because I want to do things perfectly, I can take a long time doing things or worse, I won’t do it at all.

I realize my daughter will naturally take on her parents’ traits – good AND bad, whether we purposefully do this or not.  How can I expect her to act differently when I do not know how to do this for myself?  How can I give her tools I do not have?  To an extent, I realize my stubbornness and perfectionism has served me well and allowed me to get into a very competitive nursing program.  However, I also recognize where it has not served me. 

I’ve heard the saying, “the enemy of great is good enough,” but I know my issue can be summarized as “perfection is the enemy of good enough.”  I can get overwhelmed or paralyzed from not being able to do things perfectly or exactly the way I think I should.  Comically, I now recognize that my perfectionism is what had me put so much pressure on myself as a parent that I was driven to tears at my daughter’s parent-teacher conference. 

I would not want to label my daughter as “deficient,” so why am I so quick to label myself this way?  My daughter is DEVELOPING. So am I. 

The acknowledgement that I am still developing is a gift and empowering.  I can work with that.  If I want my daughter to know that it is okay to make mistakes and pursue projects imperfectly, I need to demonstrate that.  Before I can change my behavior, I need to notice it.  I see how my behavior impacts my life (and my daughter’s). I can do something about it now that I recognize it.  I am figuring it out as I go along. I feel lost at times and may not make the best choices, but I’m trying – I am still developing.

How I Scored in the 99th Percentile for TEAS – and how you can too!

If you’re pursuing Nursing, you may have heard of the TEAS because some Nursing programs require applicants to take it and submit their score as part of their application. TEAS, or the Test of Essential and Academic Skills, is a standardized, nation-wide exam administered by Assessment Technologies Institute (ATI). Like many nursing programs, my BSN program uses the TEAS as a screening tool for their candidates. The minimum TEAS percentile my program considered was 80. However, some of my cohort classmates shared that they scored 95-99 percentile overall on their TEAS, well above the minimum for my school. If you want to apply to a competitive program and be an attractive applicant, you must do well on the TEAS. For this post, I’m sharing my tips for how I scored in the 99th percentile when I took the TEAS in Fall 2018.

My Biggest, Most Important Tip: Know Your School’s Requirements!

My most important tip is to know your school’s requirements. If a school in which you’re interested in applying is offering a Nursing forum or information session, attend the session to understand the admissions requirements and clarify questions you might have. Some schools do not require the TEAS for admission. Other schools do not require the TEAS until you submit an application and they give you an invitation to take the TEAS. Some schools require the TEAS but will only allow students to take it once in a six month period. Some programs will not take your best TEAS score in their application timeframe; they will take the first score in the allowed timeframe. Understand your prospective school’s admission policies.

One other perk I discovered while attending Nursing School Information sessions before taking the TEAS is one school offered a discount code for ATI TEAS study packages. However, the biggest reason to attend an information session (or speak to an admissions officer) is to clarify admissions requirements and any stipulations the school or program may have regarding the TEAS exam. This is particularly important if you’re applying to multiple schools since each have their own admissions policies.

Tip: Complete your Pre-Requisites

When I took the TEAS, I had completed all my Nursing School pre-requisites (except for Philosophy and Religion). My Anatomy & Physiology and Chemistry prerequisites definitely prepared me for the exam. Completing my pre-requisites was particularly helpful because the TEAS emphasizes Science. (The TEAS covers Science, Reading, Math, and English and Language Usage. For more information, visit https://www.atitesting.com/teas/register/). I had taken the pre-requisites within the year so a lot of the material was recent for me, and I was grateful that the exam material was a review of what I already learned.

If you’re not done with your pre-requisites, do not get discouraged – other students online said they took the test and did fine without completing their pre-requisites. However, they spent a lot of time teaching themselves and learning the material for the first time.

Tip: Use a study guide practice exam to focus your efforts

I invested in the yellow Mometrix study guide since it was so highly recommended by people online. My time was limited, and I had no intention of reviewing and reading the entire study guide. Instead of studying each chapter, I took a practice exam in the book to identify my weak areas so I could focus on them. I only reviewed the topics or areas where I scored low from the practice exam. After I felt I studied sufficiently, I would take another practice exam. I would continue to use my lowest scores (and wrong answers) to guide me on what I should study. After studying some more, I would take a different practice exam. I would continue this process until there were no more exams in the study guide to take.

My answer sheets for all my practice exams. I would time myself and give myself the same amount of time as the TEAS for each section. I would then review my incorrect answers and study those topics a little more.

Tip: Use your library to access study guides for FREE

I eventually ran out of practice exams in one book, so I used multiple study guides to prepare for the TEAS. My library had TEAS study guides available both online as ebooks and hardcopies. Take advantage of your public library since it is typically a FREE resource! Research availability and reserve your TEAS study guides early because these books can be in high demand! There was a waitlist, but I was able to place some study guides on hold and have them sent to my local branch weeks before my TEAS exam, which gave me plenty of time to prepare.

Tip: Use study tools according to your style of learning

Take advantage of any or all the tools that will help you learn or retain the material you need for TEAS! I know I’m a visual and kinesthetic learner. Flash cards are often an effective way for me to study. I do well when I write/design my own flash cards and study from them. I kept my flashcards from Anatomy & Physiology and used some of them again when studying for TEAS. Another study tool that I thought was helpful was “The Anatomy Coloring Book”. I actually used this during Anatomy & Physiology pre-requisites. It helped me learn and understand various systems of the body. I think it’s a great resource to have regardless of the TEAS, and I even referred to it recently while in Nursing school to review the kidneys and urinary system for Pathophysiology.

Other learning tools I found useful were YouTube videos from Khan Academy and
Armando Hasudungan (a doctor who is also an incredible artist). Many students today use YouTube to supplement their learning, so take time to explore which channels best complement your learning style. Another popular tool is Quizlet, where you can create and share electronic flashcards and quizzes for yourself, but also where you can view other people’s flashcards and study guides. (WARNING: Be cautious when using shared content or YouTube – sometimes material other students post is not the most accurate).

Now that I’m in Nursing school, I watch the YouTube channels for NRSNG and RegisteredNurseRN. While these are resources geared for Nursing students, take advantage of their Anatomy & Physiology reviews in preparation for the TEAS. If you are an auditory learner, you could also listen to NRSNG Radio.

Since starting Nursing school, I have also discovered Picmonic – a great tool for visual learners and for folks who can use stories and pictures to remember concepts. It would have been nice if I knew about them earlier because they have lessons for Anatomy and Physiology! You can try Picmonic for free with one lesson per day. If you want to view more lessons, a subscription fee is required.

There are many tools beyond study guide books to help you prepare for the TEAS – take advantage of them and use the ones that suit you best!

Tip: Invest in practice exams from ATI

While the study guide practice exams were certainly helpful, I found the ATI practice exams to be a little more detailed than what was in the Mometrix or McGraw Hill study books – which helped me on my actual TEAS exam. The practice exams also summarize the areas needed for review and provides a study plan. The review topics correlate directly to chapters in the ATI Study Manual (which I did not have), but still gave me enough information for me to focus my review using the materials available to me.

The online ATI practice exams are structured the exact same way the computerized TEAS exam is structured – with flags, countdown timer, and calculator embedded into the exam. Like the online exam, you can flag questions you would like to review in your practice exams before submission.  The actual TEAS test and practice exams allow you to easily revisit flagged items at the end of a section so you don’t have to toggle back and forth through all the other questions. I’m the kind of person who always double-checks my exam and doubtful answers prior to final submission, so I found the flagging feature helpful. I also liked that the practice exams were modeled after the actual computerized TEAS exam, so I had an idea of what to expect on exam day.

Tip: Find out if your TEAS exam will be computerized or not. 

The TEAS was offered at one of the universities to which I was applying via computer. For my TEAS, I was in a computer lab with a proctor, and each student had a computer. What’s nice about the computer version is the sections can all be taken at your own pace, within the allowable timeframe. Currently, students get 64 minutes to complete the Reading section, 54 minutes for Math, 63 minutes for Science, and 28 minutes for English and Language Usage. Each student gets the same amount of time to complete each section. However, if you finish a section early, you don’t have to wait for the time limit to end before moving onto the next section. The times are all tracked on your computer so you can’t exceed the alottment, but you can easily move on once you’re done with a section.

Some people I know hate taking tests via computer, so they purposefully signed up for a test center offering the paper version of the TEAS. (However, if you plan to continue with Nursing, I believe the NCLEX is on computer, so you might as well get used to computerized tests)! It’s always good to minimize surprises on test day, so find out if your exam is offered on paper or computer to set expectations. Plus, if you take a paper exam, you’ll need to find out what kind, if any, calculator you’re allowed to bring!

Tip: Follow ATI on Facebook

ATI offers live video tutoring sessions for the TEAS. They also offer TEAS workshops via Facebook. If you can’t join live, you can view recordings. This is another FREE tool I recommend you use to prepare for the TEAS.

Tip: Do NOT take the TEAS as practice

I discourage students from taking the TEAS for practice. For some Nursing programs, you are unable to retake the TEAS until six months after your prior TEAS. Some students think they will take the TEAS for practice and simply retake it if they do not do well. They may come to find this is not possible for the program to which they are applying. Use the study guides and ATI practice exams for practice – not the TEAS! Your goal is to do well when you take the TEAS the first time. Save yourself the agony from having to study again and save money on your test registration fees! It is possible to take the TEAS once and do well. I did, so I believe it’s possible for anyone.

Personally, I relied on doing well on my TEAS (and pre-requisites) because my undergraduate GPA was low. It was so low, it fell below some school’s admissions requirements. I got a 4.0 GPA on my pre-requisites, but I knew I also needed to do well on my TEAS to get into my accelerated BSN. I guess it worked, because I got into my top choice nursing school! If I did it, you can too!

Hopefully, my tips and experiences are helpful and encouraging. I didn’t number them because I don’t think any one is necessarily more important than the others (except for knowing your nursing school’s requirements – definitely do this first)! If you have found something useful in this post or on my site, please share it with others! If you’ve taken the TEAS and have other TEAS tips to share, I welcome them! Please also let me know if there are other topics you’d like for me to discuss. Thanks for reading!

A New Beginning – the First Day of Nursing School

I was so anxious and nervous about my first day of school this past Monday that I could barely sleep the night before. I kept my husband up most of the evening verbalizing all my worries about the start of Nursing School. It didn’t help that my toddler came into our room in the middle of the night crying; needless to say, I was tired for my first day of school.

Aside from lecture 9a-3p on my first day, I ran around campus and collected my student and nursing school identification cards, picked up my scrubs/nursing school uniform and ATI booklets, and paid for my lab skills backpack. I then commuted through L.A. traffic and made it home in time to pick up my daughter from daycare before 5p. I felt like I accomplished a lot in just the first day; I think adrenaline and/or caffeine is what kept me going. Despite the tiredness or overwhelm, it felt so satisfying to finally start Nursing School. I had worked so hard to get to Nursing School, and the day had finally arrived! I was exhausted after that first day (and second, to be honest) but happy.

If you’re feeling hesitant to start something new or are growing weary pursuing your dreams, know that the culmination of your efforts is worth it. I shared a quote via Instagram tied to my first day of school, but I thought it was worth sharing here, too: “The best time for new beginnings is now”. I just wanted to give people encouragement, especially those who are contemplating a career change or starting something new. This quote is a great reminder not just in regards to career or education, but also for healthy habits, relationships, etc. There’s always an opportunity to try or learn something new – cheers to new beginnings!

Clearance Checklist Complete!

This list makes me giddy…and is a sign that I’ve completed my background check & clearance for school!

I’m a checklist person, and this list is so satisfying!   Anyone else use checklists and feel happy when all tasks are completed?  Completed checklists instill a feeling of accomplishment and productivity for me.  I love the visual cues and color-coding, too!  No “Incomplete” reds or “In Review” yellows here! I mean, just look at all that “Complete” GREEN!

My to-do list for my background check and clearance for my nursing program is finally complete! Some of the things I had to do or submit before school started were a criminal background check, drug screening, immunizations and titers (immunization records were not enough), CPR/Basic Life Support Certification, Hospital Fire & Life Safety certification, physician’s physical examination and respirator clearance, and HIPAA Certification. I had many items on my list already done since I volunteer at a local hospital, but there were many school-requirements not needed by my volunteer program or that were about to expire.  Even if I had the task or item complete, it took time to scan and upload all the documentation and more time for the background-check company to review and “approve” the submission.

TIP: Gather and electronically scan all your immunization records because immunization requirements (or waivers) are standard for working in a hospital setting.  Have your certifications available too.  An instructor advised me that I would need to provide these items regularly since each hospital/clinical site has their own clearance process and some things must be done annually or periodically as a healthcare worker. Having these records readily available and organized saves time and allows self-tracking of upcoming expiration dates. 

If you already collect and organize your documentation, I’d love to hear what organization system you use! How do you keep track of tasks you need to accomplish? Share your tips in the comments below!

Comfort Wisdom

Taken by #thematurestudentnurse from the trails surrounding Baldwin Hills Scenic Overlook (Culver City, CA)

I enjoyed spending time with a friend hiking some local hills this morning. It was perfect weather and we got to enjoy some pretty wildflowers and scenic views.  I so appreciate carefree timelessness with friends. I don’t often have a lot of free time being a wife, mom, volunteer, and student pursuing a second career. However, I recognize how restorative it is for me to spend time connecting with others and exploring my neighborhood.

What nourishes or comforts you? It’s important to understand what brings you joy or soothes you. Identify what that is and make a list you can reference periodically.  In times of stress, you can choose healthy coping mechanisms from that list or at least be aware of what you can do to nourish and restore yourself. In “The Gifts of Imperfection”, Brene Brown refers to having this list as comfort wisdom. Brene Brown asks her readers to distinguish between what we use to numb ourselves versus what comforts and refuels us.  It helps to have this self-awareness, particularly because it’s easy to confuse numbing or escape for comfort.

I developed my “comfort wisdom” list years ago after taking an online Oprah course with Brene Brown, compliments of my employer’s women’s resource group. The list of what comforts me still applies today.  At the top of my list is “intimate sharing and time with loved ones”. Also included is “travel & exploration” and “hikes, walks, and exercise” among other activities. I am grateful I was able to incorporate multiple items from my comfort wisdom today, particularly before I begin an intensive nursing program.  I’ve discovered I have more joy and peace in my life when I use my comfort wisdom.

Identify and develop your own comfort wisdom.  Once you make that list, regularly incorporate items or activities from that list into your life.  You may find you have to schedule time for it.  My friend and I planned this hike over a month ago and even had to reschedule a couple times due to illness and then out-of-town guests visiting, but we were committed to spending time with one another.  Everyone has their own comfort wisdom; something that refuels me may not refuel you.  As an extrovert, I love hanging out with groups of friends and meeting new people.  In contrast, my introverted husband would be exhausted doing the same thing.  Honor yourself by using your comfort wisdom and refueling periodically – I know it’s a practice I’ll need to do for myself in nursing school and in my future career!