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.

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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

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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.

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! 

My Encounter with Discrimination in Healthcare

On my volunteer shift in the Emergency Room recently, I (along with many other staff members) overheard a heated discussion between a male patient and one of the charge nurses behind patient curtains. The patient was trying to clarify he wasn’t demanding a white nurse, but that he insisted on having an older female nurse. He did not want the black male nurse assigned to him. After the charge nurse explained his request would not be granted, he passionately responded that he wanted someone with more experience; to him, that implied an “older” nurse. The charge nurse assured him that his nurse had many years of experience. The patient assumed his nurse would be a woman because he thought all nurses were women. He argued he had been to the hospital numerous times and proclaimed, “I’ve never had a male nurse!” After some back and forth, the patient confessed he didn’t want a man handling his penis to insert a urinary catheter.

The whole interaction was interesting to me because I am an an older nursing student. When I become a new BSN grad, I will have relatively little experience but will be older than many new graduates. Age does not correlate to relevant work experience or skill-level. Many working nurses I encounter while volunteering may be younger than me, but have many more years of nursing experience. This patient erroneously believed an older nurse would automatically have more expertise in a common procedure than a young nurse.

The encounter was not only an example of ageism, but sexism. Yes, there seems to be more female nurses than male nurses. The patient was adamant that he never knew male nurses existed. The patient was an older man, so it’s quite possible his earlier experiences with nurses in a doctor’s office or hospitals were with female nurses. The demographics are changing, however, and quite frankly, I think that’s a good thing. We need healthcare professionals to be as diverse as the patients they serve. This patient needed a gentle reminder that experience, not gender, make nurses more skilled at procedures.

The black male nurse eventually did what needed to be done for the patient. A while later, the man graciously reported to the charge nurse, “He did a great job!” The patient continued to loudly and excitedly share what a surprisingly wonderful experience he had with his nurse. The same staff that overheard the earlier conversation and I looked at each other and smiled in amusement. Happily, it was a great teaching moment for the patient, but also for myself.

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I’ve read about patients getting discriminated against or experiencing implicit bias from their providers, but healthcare professionals also experience discrimination from their patients, and the interaction I witnessed was a reminder of that. I have yet to have a patient make discriminating remarks directed towards me, but I know that may happen one day. I’m not quite sure how I’ll react, and I wonder if I’ll learn anything about this in my ABSN program. I want my patients to have the best experience and outcomes possible, but does that mean I should ask to be removed from their case if they don’t like me and are therefore uncomfortable due to my race, age, gender, or orientation? In accommodating a prejudiced patient’s request, are we enabling discrimination or giving them better care by making them comfortable? It’s a complex issue.

Luckily, the interaction I witnessed de-escalated and had a good outcome. What if the patient became more hostile instead of agreeable? Would he have been assigned another nurse? What if the patient thought his nurse did a terrible job? Are there hospital policies for situations like this? I really respect the charge nurse and nurse in the situation, who remained professional and respectful throughout the whole interaction. For me, I learned how a nurse should respond to a prejudiced patient: Be respectful but firm, and assure the patient they are in good care. I hope to maintain my composure and act the same way, should I ever encounter a similar situation with a patient.