Things have been hectic for me this week because I started a new job on Monday! I am a COVID tester for a studio! Hollywood studios have resumed filming and frequently test their cast and crew to ensure people do not have or spread COVID.
I found out Sunday night I got the job and was expected to work at 3:30a the next morning in a city about 45 minutes from my home (without traffic). I scrambled Sunday night searching for scrubs to purchase in-store, laundering them later at home, applying for professional liability insurance, reviewing, signing, submitting paperwork, and reading the policies and procedures manual. I also had to complete and submit an application for a new grad program due that same Sunday. I was up until about midnight and out the door by 2:30a. I was tired but running on adrenalin! I am like a substitute teacher – I don’t know where I’m going or what time I’m working until the afternoon before each workday. It’s been a whirlwind for me since Monday!
My former classmate referred me to my current job. I am lucky that I have such a supportive cohort – we frequently share new grad job opportunities. (TIP: Keep in touch with your classmates, even after you graduate)! He texted our cohort one afternoon. I immediately sent my resume to his contact, and I received a phone call less than a week later! It helped that I updated my resume and was prepared since I had been applying to new grad positions. It’s luck that I got this job, but “Luck is when opportunity and preparation meet.” A year ago, I found this quote, cut it out, and have it posted on my computer monitor as a reminder.
I encourage you to keep striving for your goals. Stay prepared, move forward, and use opportunities as they come along as stepping stones toward your ultimate goals. It’s funny how this opportunity came along just after I posted about rejection and failure last week. I don’t think it’s by accident; maybe I needed to lead by example. When you feel down and as if you’re not moving towards your goals, pick yourself up, and keep striving! Most importantly, when you lift yourself up, take others along with you!
For Christmas last year, I bought tickets for my husband and me to watch the musical “Hamilton” in Los Angeles during my semester break scheduled in May. I figured it would be a nice treat for us before my last nursing school semester. That was until the pandemic hit and canceled the show. While I was disappointed, I agreed with the CDC recommendations and state orders not to have large indoor gatherings. I figured I had already waited years to watch the show; I could wait a little while longer to enjoy it safely at a later time.
Once summer arrived, I was excited to learn that I could watch “Hamilton” from home on Disney+. However, I didn’t allow myself to subscribe to the streaming service until I graduated because I didn’t want to become distracted from studying. As a mini graduation gift to myself, I subscribed to Disney+ to watch “Hamilton” in August.
I know I’m years behind, but I finally watched and loved the musical, “Hamilton”! My preschooler has grown to love it too and will ask to play songs from the musical. She loves and will continuously replay the “The Schuyler Sisters,” “Satisfied,” and “Helpless.” Personally, “Wait for It” appeals to me. While “Wait for It” is the song of the musical’s anti-hero, Aaron Burr, I can identify with the feeling of waiting.
Waiting to take the NCLEX
Life after nursing school requires a lot of patience. It’s almost anti-climactic to spend all this energy in an accelerated nursing program and graduate only to wait in what feels like forever to get permission from the nursing board to take the NCLEX. While other classmates’ accounts showed they conferred their degree soon after the semester ended, I had to wait for my transcripts to show I graduated weeks afterward. About a month after graduating, some of my classmates sat for their NCLEX; I still hadn’t received my authorization to test (ATT) from the testing company. I grew anxious and started to feel like I was on hold, waiting for my life to begin while everyone else was moving forward. I had to remind myself that my life was already in motion, and I had accomplished many of my life’s goals. I could choose to be content with my life as it was or wait for some external factor (like an ATT) before allowing myself to feel content.
I received my ATT about a month and a half post-graduation. I gave myself a little over a week after receiving my ATT to study and take my NCLEX. Passing the NCLEX took a lot of weight off my shoulders and made me eligible to apply to many more jobs. However, after passing the NCLEX and becoming a registered nurse, I continue to wait for: new graduate positions to open, status updates to job applications, and recommendations or replies to recommendation requests.
Waiting for a job offer
As an unemployed nursing graduate, I miss being in a clinical setting and am eager to return. I often feel like I’m not a real nurse since I’m not working. I want to work but don’t qualify for many RN jobs since I’m a recent graduate who hasn’t worked in an acute setting. I want a new grad position so I can get proper training as a novice nurse. However, I don’t want a new grad position doing any type of nursing in any setting. I am a second-career nurse. I evaluated my skills and desires to change careers, and I know I want to work in a specialty. I want to either start in that specialty or start in a role with a clear path leading me to it. I’m older, and I don’t want to waste time. I’m willing to wait a little while for a good opportunity for myself instead of broadly applying to jobs I don’t want.
While I wait for my first RN job, I am preparing myself for my career. I studied and took certification courses for PALS (pediatric advanced life support) and NRP (neonatal resuscitation program). I reached out to early-career and mid-career nurses to ask them about new grad programs and what it’s like to work in various hospitals. I revised and had people review my resume. I targeted specific people for recommendations for different job applications.
Even though I’m unemployed, I know I’ve done and continue to do what I can to prepare for my nursing career. Knowing how to delay gratification and wait for things allows me to enjoy my free time. I’m satisfied with the work I put in during school and after graduation. I don’t feel guilty when I take breaks from studying for certifications or job hunting; I genuinely enjoy myself. I get to explore Los Angeles and venture into areas I hadn’t seen before or finally watch shows I put off watching. The pandemic has put travel plans and trips to visit family and friends on hold, but I’m willing to wait for it. I can have fun doing other things while I wait to get a job (#funemployment).
Waiting as a skill
Learning how to wait while preparing and working toward your goals is a life skill. Like any skill, it may take some practice before you are good at it. For example, I decided to watch “Black Panther” the day before an Anatomy & Physiology midterm because it was opening weekend, and I figured I could study afterward. I loved the movie, but the pre-test movie resulted in a low midterm grade. It such a drop from my usual scores that my professor asked me what happened. I couldn’t admit to him that I watched a movie instead of studying the day before. I felt terrible that I jeopardized my prerequisite GPA to watch a film I could have easily watched another time. Luckily, I recovered; my prerequisite GPA was good enough to get accepted into competitive nursing programs. I did something similar again in nursing school. Eventually, I learned my lesson, which is why I refused to subscribe to Disney+ until after graduation. When I feel burnt out from studying, it’s too easy for me to feel like I need to escape, de-prioritize school, and take an overly long break. I realized my long-term goal of becoming a nurse was more critical than watching a long-awaited musical (and maybe I needed more frequent breaks and rewards for myself so that I wouldn’t feel burnt out)!
We need the recognition that some things, whether it be goals or skills, take time to cultivate. Learning how to prioritize and determine what needs immediate attention versus what can wait is as much a life skill as it is a nursing skill. It takes years to become a nurse. Sometimes, especially during prerequisites, it felt like I was getting nothing done since I was spending all my time in school and studying but had no degree or job to show for it. I could only hope all my efforts would lead me to my ultimate goal: a working RN. I’m still working towards my goal but appreciate that while waiting to become a nurse, I developed new skills, made new friends, and pushed my limits of what I thought was capable. Waiting has given me time to prepare and develop into the person I need to become a nurse. I’m still waiting to become a working nurse, but I know I haven’t wasted my time.
Waiting as a parent
Similarly, as a parent, life requires a lot of waiting and unknown. My husband and I can only hope that the love and attention we give our daughter leads her to be a smart and decent person with a happy, healthy life. I love what my doctor shared with me about parenting, “We can cultivate and fertilize the soil, but who knows what will take root and grow?” Even if I weren’t pursuing a second career, having a child demands patience and waiting. Have you ever had to deal with a toddler insisting on putting on their shoes or clothes? Or waiting for them to pee on a potty? Trust me – Parents understand waiting! I now have more patience and grace for myself because I continuously practice patience and grace with my child.
Wait for It
The “waiting” we do in life is often the journey to our destination. We can feel stuck in “waiting” or allow for growth and development to occur. In some ways, the waiting is fun – it’s an unfolding of a story, a discovery of who we have yet to become; it implies potential. If you ever think you’re stagnant and waiting for life to happen, know you’re not alone. I feel this way from time to time. Sometimes, we need a little reminder of the power we have over the choices we make. You are the only thing you can control, so set your priorities and do what you can to move towards your goals. Other times, we need a little encouragement. When I’m doing what I can but feel I am not getting the results as quickly as I want and start to doubt myself, I remind myself of the lyrics from “Wait for It”: “I’m not falling behind or running late. I’m not standing still – I’m lying in wait”.
Last month, I convinced a former nursing school classmate to join me in giving blood. She had never donated before, so I was so excited for her, but I was also happy someone was willing to join me! Is it sad that the only time I feel I can be “social” during the pandemic is when I’m doing things like going to school or donating blood? If you’re like my friend and have never given blood or wonder what blood donations are like during a pandemic, this post is for you!
Donors receive gift cards and discounts.
Aside from supporting someone else’s life, donors got perks such as gift certificates and discounts to restaurants or retailers like Amazon. Depending on the blood drive, donors can be entered into prize drawings or receive items like water bottles. Donors typically get water, juice, and snacks after their donation, too. Recently, the American Red Cross announced they would test blood donations for COVID antibodies – this free antibody test is a significant new perk in donating blood!
Blood donors get free COVID-19 antibody testing.
My friend and I were both eager to get the COVID antibody test for free. We knew of healthcare workers and personally worked with a nurse who showed no COVID symptoms but tested positive for antibodies. “Antibody testing may indicate if the donor’s immune system has produced antibodies to this coronavirus, regardless of whether an individual experienced COVID-19 symptoms. A positive antibody test result does not confirm infection or immunity” (redcross.org). Regardless, we wondered if we would have positive antibody results and secretly hoped we were one of those asymptomatic people with possibly protective COVID antibodies.
Make a donation appointment early – appointments fill up quickly.
Before the pandemic, many blood drives accepted walk-in donors without appointments. Now, anyone donating must make an appointment ahead of time. Many drives fill up for several weeks or even a month in advance.
There are many blood drives – make an appointment for a location/date/time convenient for you.
We found a blood drive and made a donation appointment at a beachside hotel in Marina Del Rey, here in Southern California. I decided to pick this hotel in particular, because I liked their restaurant and knew they had a scenic outdoor dining patio. I figured I could brunch with my classmate as a mini celebration to her inaugural blood donation but also to us graduating from nursing school. We had not celebrated our graduation together in-person due to the pandemic. We had spent enough time together at clinicals and lunch breaks in hospitals during the pandemic, however, that we thought an outdoor post-graduation brunch would pose minimal risk.
Save time and use RapidPass for pre-donation reading and screening.
To save time completing questionnaires and screening questions before the actual donation, donors can answer health history questions and complete the pre-donation reading using their computer or mobile phone the day of the donation via the RapidPass application. Travel, medications, and certain kinds of activities may make people ineligible to donate blood. Doing the pre-donation reading via RapidPass may help a person discover whether they should donate blood before showing up to a blood drive.
I used RapidPass (https://www.redcrossblood.org/donate-blood/manage-my-donations/rapidpass.html) to minimize the amount of time I had to sit and wait in a room filled with strangers. While appointments ensure spacing between donors and minimal crowding, I still felt uncomfortable at the prospect of spending an hour in an indoor, enclosed room with random people. (I don’t know why, but I never had this concern during clinicals at hospitals. Maybe it’s because I had to be at my clinicals, but blood donations are entirely voluntary). Upon arrival, I showed the registration volunteers my photo ID and RapidPass confirmation barcode. After that, it was a quick process for the temperature and hemoglobin screening before my actual blood donation.
Wear a mask. If you are sick, visit a doctor or stay home.
The American Red Cross requires blood donors to wear a face cover or mask and keep their mask on upon their arrival and during their appointment. They also screen donors to ensure they are not running a fever or exhibit other symptoms. My temperature was taken twice by two different people before I gave blood. The registration volunteers asked me to use hand sanitizer, and everyone wore masks and displayed proper hand hygiene. I appreciated all the precautions during my appointment.
Although donors get free COVID antibody screening, if people are sick or have COVID symptoms, they should get screened for COVID and diagnosed elsewhere. “The Red Cross is not testing donors to diagnose illness, referred to as a diagnostic test” (redcross.org). If I had an active infection, I wouldn’t want to risk exposing blood drive volunteers, staff, and other donors to my illness, even if I thought it was only a cold. I would hope others would do the same and quarantine themselves according to CDC recommendations if they were sick.
Hemoglobin levels will be tested and must be normal.
Before every donation, the American Red Cross gathers a drop of blood by pricking a potential donor’s finger and tests that sample for hemoglobin levels. The process is very similar to the point of care glucose testing I did during clinicals. I tried giving blood in August but could not since my hemoglobin levels were too low, which was likely caused by low iron.
Because the American Red Cross no longer accepts walk-in appointments, anytime a potential donor is turned away from giving blood that same day, the Red Cross cannot quickly fill that newly-vacant appointment. The pandemic has severely impacted the usual avenues of blood drives at schools, offices, or churches since these groups have not been meeting in-person or on-campus. To ensure I could donate and not waste a donor spot, I decided to take some iron supplements a week before my September donation appointment. Luckily, it raised my iron levels high enough that I was able to donate blood. I only needed one finger prick to show my hemoglobin was within normal limits! There have been times when I required a second sample to qualify as having normal hemoglobin levels. Or, like in August, the second sample confirmed that I was below normal limits. (For additional information about iron levels and blood donations, check out: https://www.redcrossblood.org/donate-blood/blood-donation-process/before-during-after/iron-blood-donation/iron-informationforallblooddonors.html)
After all the screening questions and tests were complete in a makeshift cubicle area, the staff person led me to the room’s blood donation section. While you donate blood, you lie on a cushioned table that is as comfortable as the doctors’ offices’ exam tables. I was fascinated by the venipuncture and blood donation process and asked the person who collected my blood if she had any tips. Unlike some of my personal experiences during nursing school, she was confident in poking me and didn’t struggle to find a vein. Poking people all day for the past ten years made her skilled at venipuncture – I hope to be just as confident and proficient someday! (Tip: go for a vein you can feel, not one you can only see)
Full transparency: the collection needle is big.
I will not lie – seeing the needle they used to collect my blood was a little intimidating. I had never been afraid of giving blood before, but it had been a while. I had never seen or used a needle that huge (16-17 gauge) on a person or mannequin in all of my nursing school! The needle they used reminded me of a draw needle (used to draw up medication from a vial, typically more massive than any injection needle I ever used on any patient). Because a pint of blood is needed instead of merely test tube quantities, the collection needle needs to be big enough to allow for decent blood flow. Otherwise, the donation process would take much longer.
Once the needle is in, it typically takes no more than 10-15 minutes to donate blood. Some old co-workers I know would try to race each other and see who could fill up the bag and donate the fastest. I think their donation took only 3-5 minutes on one occasion. However, I was in no rush and was honestly just happy to be out of my house and around people.
After the actual donation, prepare to rest for 10-15 minutes before leaving
After my donation was complete and they bandaged me up, they invited me to sit and relax in the snack area . There is usually a table of juice and snacks like granola bars, trail mix, or crackers and cookies at every blood drive. Donors are encouraged to sit and rest and snack on something after their donation, before they leave. This also allows the staff to observe donors for any reactions to the donation.
I had a friend who wanted to skip sitting and resting after her donation and ended up fainting as she walked out the door. If you feel light-headed after donating blood, sit down and let someone know! Blood loss and dehydration can cause people to experience orthostatic hypotension or dizziness upon standing or changing positions.
It’s essential to hydrate just as much after a donation as much as it is before donating blood. The hotel restaurant was having a happy hour in their outdoor patio that afternoon. As tempting as it was (I haven’t been to a happy hour since before the pandemic), alcohol is not recommended after donating blood. I stayed hydrated!
You may need to modify activities after your donation.
Like alcohol, strenuous exercise is not recommended the same day after donating blood. If you think you need a high-intensity workout the day of your donation, do it before giving blood. Years ago, when I had daily running routines and ran marathons, I would schedule my workouts before donating blood or use a donation day as a rest day. Give your body at least the evening to recover from donating before resuming working out heavily. [Un?-] fortunately, regularly working out hard-core is not something I’ve been doing recently, so I didn’t have to reschedule anything.
I’m not eligible to donate whole blood again until next month; I plan to donate once 56 days have passed since my last donation. My friend wants to do it again, too. Donating blood helps replenish an impacted blood supply. It is an easy, smooth process, I get to ask highly experienced professionals about venipuncture tips to support my nursing practice, and I get to invite friends to join me! Plus, my friend and I like the idea of regularly getting a free COVID-19 antibody test!
I’ve been scarce here because I took the NCLEX last week. I was busy studying and preparing for the NCLEX. The NCLEX is the national exam that nurses must take to gain licensure. Nurses cannot practice nursing or work as nurses without their license; it’s what makes a nurse a “registered” nurse.
After impatiently waiting, I received my authorization to test from the testing company on Monday, September 14, at 9:47 pm. I took the NCLEX for the first time on Thursday, September 24, at 1:00 pm. I wanted to give myself at least two weeks to study. However, I was anxious to take the NCLEX before the end of the month because a job application was closing on September 28. Additionally, starting on October 1, the minimum number of exam questions would increase from 60 to 75. I studied as much as I could in those ten days, taking a day or two off to say goodbye to a good friend who suddenly decided to move across the country. It would have been nice to focus solely on studying, but life happens even as we make plans.
On the day of the exam, my friend/old classmate/neighbor walked with me to my testing facility. Just a couple of weeks before, I had done the same for her when she took her NCLEX. I hadn’t received my authorization to test when so many of my classmates got to take the exam. It was finally my turn!
I took my time with the exam and spent over an hour answering the items presented to me. My computer shut off at 60 questions, the minimum number required to pass the NCLEX. I was relieved when it shut off at 60 questions since I knew the computer-adapted exam could be much longer. The four practice exams I took and passed also shut off at 60 questions. The one practice exam I took and failed reached the maximum of 130 questions before shutting off. I felt the computer shutting off at 60 questions was a good sign.
The testing company does not share official results until 6-8 weeks after the exam. However, in California, nursing licenses post as little as two days after an NCLEX is taken and passed. License numbers are issued by the Board of Registered Nursing and listed publicly by the Department of Consumer Affairs. My friend shared she could search and find posted license numbers as soon as midnight, two days after an exam. I decided to look up my name on Saturday, September 26, shortly after midnight. My parents and husband were with me as I tried to search for my name. The video below is my recorded reaction.
I graduated from my Accelerated Bachelor of Nursing Program! Until about a week ago, I was busy with finals and organizing my cohort’s virtual pinning ceremony. However, TODAY, my school finally posted that I officially conferred my Bachelor of Science in Nursing degree on August 08, 2020!
I graduated, but there were MANY people who made this possible!
Like many in my cohort, I feel God lead me to the nursing profession. Through constant prayer and faith in God’s plans, I arrived at this point in my life. I was able to move forward in my path toward Nursing because of God and the people and circumstances God placed in my life.
In my virtual pinning ceremony (*a pinning ceremony is a nursing school tradition to celebrate the completion of the program where graduates are pinned with a lapel pin – often their school’s emblem), I dedicated my pin to my husband, daughter, and parents. My husband and daughter have sacrificed time with me and their schedules to accommodate my classes, studying, and clinical rotations. My parents often volunteered to watch my daughter so I could study, and they would visit and offer to help with dinners, dishes, laundry so I could focus on school. Nursing school was a journey my entire family shared, and I can’t imagine graduating without their love and support.
I consider myself lucky to have had such generous and collaborative classmates. Instead of competing with one another, we worked together to create study guides and study sessions. Life would have been considerably harder without everyone’s contributions and kindness in my cohort.
I was also blessed to have another mom in my program. I discovered during orientation that she was my neighbor! We became carpool buddies and, eventually, close friends. Being a nursing student in an accelerated program is tough – balancing school with kids in a pandemic makes things even trickier. We both understood and could commiserate in our unique struggles.
I want to acknowledge the teachers, instructors, and school staff for making it possible for students to continue learning. It was not necessarily easy for students to move exclusively to online lectures and have their schedules changed, but I recognize it was not easy for those teaching and supporting students as well. I’m very grateful for our instructors for being flexible and making themselves available. Some of our clinical instructors were on-call and taught us over the Summer when they initially planned to guide us in the hospitals in Spring. Our administration also hustled to place all the nursing students in rotations when many hospitals canceled their preceptorships. When the pandemic started and we were pulled from our clinicals, we were in limbo. If we were unable to return to the hospitals to complete our clinical hours, we would not graduate. After going through all the clearance requirements at one hospital, our instructors, alongside the students, scrambled to complete clearance requirements at other hospitals finally open to students. Despite the obstacles, a pandemic, and a revolution, we managed to graduate on time!
Doing nursing school in 15 months while being a mom was no easy task, but I’m a testament to the fact that it is possible! I had a LOT of support – including friends and family who prayed for me, guided me, and encouraged me along the way. Form your support system if you don’t already have one. Life’s too short to spend time with people who bring out the worst in you! Your journey and timeline may not look like mine, but I encourage you to pursue your passion and dreams. I was the oldest student in my cohort, but I have a lot to offer, and I intend to work as a nurse for multiple decades. It’s cliche, but it’s true: You are never too old (or young) to pursue your dreams!
I know many are starting school this Fall. I wish nothing but the best for the students returning to school and those taking steps to move closer to their goals. These are uncertain times, but I applaud all those adapting, reorganizing themselves, and moving forward. Good luck to everyone this new school year, and CONGRATULATIONS to all the 2020 graduates!
Many people, even non-nursing professionals, have heard of famous nursing pioneers such as Clara Barton, founder of the American Red Cross, or Florence Nightingale, considered the founder of modern nursing who was also known as “The Lady with the Lamp” (her moniker, since she would administer to hospital patients at night with her lamp). During a recent lecture, however, my professor asked the class if we had heard of nursing pioneer, Mary Seacole. None of us had. Apparently, Mary Seacole was a nurse of Creole descent who also nursed wounded soldiers during the Crimean War, during the same time as Florence Nightingale. Supposedly, Mary Seacole’s fame rivalled that of Florence Nightingale during the Crimean War, yet not a single one of my 28 other classmates ever heard of Mary Seacole.
Mary Seacole was a Jamaican woman who came to London with a desire to volunteer as a nurse and be recruited as part of Nightingale’s delegation of women to serve as nurses in the Crimean war. Mary Seacole was instead met with racism and was refused the opportunity to serve as one of Nightingale’s nurses. Mary Seacole, therefore, independently traveled to the Crimea to establish and fund her own hospital, the “British Hotel” and tended to sick and wounded soldiers. She wrote an autobiography describing her experience as well as personal travels, “Wonderful Adventures of Mrs. Seacole”.
Mrs. Seacole was a woman who was undeterred and forged forward doing what she was called to do, to be a nurse, despite the racism and other obstacles she encountered. After hearing a bit about her from my professor and googling more about her, I decided to put her book on my wishlist and received it as a gift on my birthday a couple weeks ago. Aside from my textbooks, I’m glad to add this to my library of nursing books alongside my “Notes on Nursing” by Florence Nightingale.
While overwhelmed with school works and projects, I felt compelled to start reading and learn more about this woman. I kept meditating on the fact that I never heard of Mary Seacole, or didn’t really know of any other famous or pioneer nurses of color. It bothered me because, prior to the recent Black Lives Matter protests, I also had never heard of “Black Wall Street” or the “Tulsa Massacre”. I’m a person of color, born in Kansas City, Missouri and raised in a suburb of Kansas for my childhood. I did not grow up in a diverse area and was typically one of only a handful of minorities in all my schools. Now that I’m an adult, I realize there are gaps in my education – history, in particular – that exist due to the omission of the non-white perspective.
I’m grateful to have the opportunity to have professors offer different perspectives and illuminate the history of nursing and nursing pioneers beyond “The Lady with the Lamp”. We need to celebrate and encourage diversity in Nursing. I feel that one step towards cultural competency and addressing racism in healthcare is to take time to hear different voices and promote diversity in healthcare. This also allows me to draw from a richer well of people to inspire me to move forward in nursing, despite obstacles I might face. I encourage you to move forward, seek different voices, take action, and draw inspiration from where you find it, too.
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.
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.
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!
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.
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!