Taking the NCLEX for the first time

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.

Me, right after the NCLEX, outside the testing facility, crossing my fingers that I passed!

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.

Perfect is the Enemy of Good

*My imperfect attempt at lettering the title of this post. I could have spent more time making it pretty, but I would have never published my post. It would have been ridiculous and ironic to delay my post to make my lettering nicer, given my post’s subject, so I went with it.

I had my annual physical yesterday with my primary care physician, whom I’ve been going to for over 20 years. I like her because she takes time to talk to me and check in on my emotional and mental state rather than focus solely on my physical ailments. She was happy and excited to learn I had graduated from nursing school. She asked whether I planned to have more kids. I shared my anxiety over my ability to have another healthy child at my advanced maternal age. I started to talk about parenting and the guilt I feel about being an older mom to my daughter. She knows me well, however, and knows I can be overly critical of myself.

I responded that this was the problem with being a perfectionist; I recognize I can be needlessly hard on myself. She declared, “I want to eliminate the word ‘perfectionist.’ What if we replaced perfectionist with ‘overly critical’? No one wants to be overly critical!”

“What if we replaced ‘perfectionist’ with ‘overly critical’? No one wants to be overly critical!”

Dr. M

I tried to explain I am not proud to be a perfectionist and am trying to change. Still, I shared how my perfectionist attitude got me through pre-requisites and helped me complete a competitive accelerated nursing program. She shared how she can relate to this and proceeded to tell her story when she was younger.

When she was in medical school, residents were required to go to counseling. She met with the counselor, who eventually noted, “You have a harsh critic inside, don’t you?” The counselor encouraged her not to be so critical, “You don’t yell and scream at a two-year-old to learn their alphabet. You don’t yell and scream at a toddler to get them to walk. You don’t have to be so difficult on yourself”. My doctor defiantly declared to her counselor that she had no intention to change since her harsh critic served her well. My doctor rationalized to her counselor that she accomplished her goals and got to medical school because of her “harsh critic.” Her counselor responded that she didn’t do those things BECAUSE of her harsh critic; she completed those things DESPITE her.

I appreciated my doctor’s story because it paints an alternative to being “overly critical.” As a parent, I can relate to the patience and compassion needed to teach a child a new skill. I could scream and make my daughter cry about brushing and flossing her teeth, for instance, but there are other ways I can guide and encourage her. In the same way, I can choose different ways to talk to and motivate myself. I don’t have to suffer so much by my internal critic or be perfect to achieve my goals.

I have had to consciously and regularly examine the toll of aiming for perfection in nursing school. I shared how I would reason, “I could kill myself to get 100% on a care plan, or, I could spend more time with my family and get a 93%.” After hearing this, my doctor exclaimed, “Perfect is the enemy of good.” She echoed what I have struggled to remind myself over the years.

“Perfect is the enemy of good.”

Dr. M

There’s a book entitled “Good to Great” by James C. Collins that my pastor talked about during one of his homilies years ago. From it, my pastor learned and shared, “Good is the enemy of great.” I never got around to reading the best-selling book, but that message stuck with me: I would challenge myself to do better. I’d ask myself if my work or actions were the best I could do. At some point, however, I’d get discouraged and have an all-or-nothing attitude. If I couldn’t do things as well as I thought I should, I didn’t want to do it at all, or I’d scrap an entire project. I’d be ashamed of myself and compare myself to others. Striving to be perfect, I would feel frustrated, resentful, and spent. However, years since that homily, I’ve often thought, “Perfect is the enemy of good enough.”

While I do not advocate living one’s life by always doing only the bare minimum, sometimes the bare minimum maintains my sanity. “Good enough” has allowed me to survive and move forward from perceived failure. I’m learning to ask myself more often, “What’s it going to take?” and “Is it worth it?” (like in writing dreaded care plans) or “How can I approach this without so much suffering”? I still need reminders to be gentle with myself and that not everything has to be perfect to be great, so it was nice to hear my doctor affirm my previous thought.

I appreciated my doctor taking the time to remind me: perfect is the enemy of good. No one is perfect. Humans are imperfect and fallible, and it’s our struggles that lead to our growth…And sometimes, “good enough” is pretty frickin’ remarkable.

September 11 Reflection

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September 11 is a date in our nation where we remember the loss of thousands of lives due to a terrorist attack in 2001- it's sad reflecting on that day in history… At the same time, on September 11 in 2020, I recognize the pain and grief people are experiencing today. We're fighting a pandemic that's already claimed thousands of Americans' lives. Many are struggling with unemployment, social inequities, and racism in a volatile environment. Southern California's skies have changed yellow and orange as fires devastate the West coast, claiming people's homes and lives…There's a lot to process that simply cannot be ignored – it's to the point where the air i breathe is literally deemed unhealthy. My worries about when I'll finally be able to take the NCLEX and get a job are silly compared to what others are dealing with and the urgent needs facing people today… . . I'm an unlicensed, unemployed, nursing graduate – not on the frontlines fighting fires or medical emergencies. However, I'm also a wife, daughter, mother, and friend who is capable and cares deeply about others… . . When I feel helpless or overwhelmed, I try focusing and taking action on the things I *CAN* do… some of those things I'm doing are: praying for others, calling and connecting with friends, preparing healthy food for my family, writing postcards encouraging citizens to vote… I'm not doing anything heroic, but my small actions are done out of love… which is always better than acting out of fear… . . If you're feeling overwhelmed today, know you're not alone. Sometimes you have to focus on immediate needs before you can be of service to others-you need to survive before you can thrive… . . Stay safe, and take care of yourselves!

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Press on with Purpose

Last week, the world discovered that Chadwick Boseman, an actor best known for portraying The Black Panther, died at the age of 43 after a 4-year battle with cancer. He played a superhero and legends on the screen, but as we learn more about him and his life, we realize he was a heroic icon himself. While he battled cancer and underwent treatments, he visited sick children in hospitals and continued to film movies without revealing his illness.

Chadwick Boseman used his gifts and talent to make a positive impact in the world. He found his purpose and pursued it with a passion. Below is an excerpt from a 2018 commencement speech he gave at Howard University where he speaks about his struggles in pursuit of his purpose (the full speech can be found at Howard University’s channel on YouTube)…May Chadwick Boseman’s life and words inspire you to think about your purpose and your own pursuit of using your talents and gifts to best serve the world.

“Sometimes you need to feel the pain and sting of defeat to activate the real passion and purpose that God predestined inside of you. God says in Jeremiah, ‘I know the plans I have for you, plans to prosper you and not to harm you, plans to give you hope and a future.’… when you have reached the hilltop and you are deciding on next jobs, next steps, careers, further education, you would rather find purpose than a job or career.

Purpose crosses disciplines. Purpose is an essential element of you. It is the reason you are on the planet at this particular time in history. Your very existence is wrapped up in the things you are here to fulfill. Whatever you choose for a career path, remember, the struggles along the way are only meant to shape you for your purpose. When I dared to challenge the system that would relegate us to victims and stereotypes with no clear historical backgrounds, no hopes or talents, when I questioned that method of portrayal, a different path opened up for me, the path to my destiny.

When God has something for you, it doesn’t matter who stands against it. God will move someone that’s holding you back away from the door and put someone there who will open it for you if it’s meant for you. I don’t know what your future is, but if you are willing to take the harder way, the more complicated one, the one with more failures at first than successes, the one that has ultimately proven to have more meaning, more victory, more glory then you will not regret it. Now, this is your time. The light of new realizations shines on you today. [Howard’s] legacy is not wrapped up in the money that you will make but the challenges that you choose to confront. As you commence to your paths, press on with pride, and press on with purpose”.

Chadwick Boseman, excerpt from 2018 Howard University Commencement speech

RIP, Chadwick Boseman. We are thankful you pursued your purpose, inspiring generations.

#Maskne – Acne in Pandemic

I’ve been suffering from breakouts on my face. Even as an adult with aging skin, I periodically battle acne, but feel like it’s been especially pronounced recently. In some ways, my reusable cloth mask is a nice way to hide my recent acne breakout, but I realize it might also contribute to it. Recently, the term #maskne has been used to describe acne appearing around or underneath masks. However, I am a mask-wearing advocate and believe a mask should be worn during this pandemic when in public or around others outside my household. Outside of staying home more and un-masking, here are some things I’ve done to address my #maskne:

1. Wash my reusable masks or change them more frequently

Reusable masks should be washed after every use. My usual routine at the start of this pandemic would be to handwash my only reusable mask with a laundry bar soap as soon as I was home for the day. Four to five months into the pandemic, I started to get lazy and would re-use an unwashed mask if I only wore it briefly the day before. I recognize this is poor hygiene and have resumed ensuring my face covering is washed before wearing it, even if I wore it for only 30 minutes the day before. Also, now that I have more face coverings, I throw them in the hamper to eventually be machine-washed with my weekly load of laundry.

Lagarto is the name of the bar soap I use to for hand-washing my mask. I bought this on a trip to Spain to do laundry while traveling. It worked well and came in a 3-pack, so I took it home with me and still use it for hand-washing clothes!

Another thing is it’s been a lot warmer since the pandemic started. We have had heat-waves where I’ve been continuously sweating, and my cloth face covering would absorb my sweat. I’ve had to replace my face covering multiple times daily to ensure it was clean; I didn’t want to have a dirty piece of fabric resting on my face all day. When a reusable face mask is soiled, stop using it and wash it!

2. Change my toothpaste

Before masks ever became a standard fashion accessory, I would periodically suffer from adult acne. I would breakout, particularly around my mouth. I read a blurb in a magazine stating that ingredients in one’s toothpaste can cause breakouts and skin irritation. After reading that article, I switched up my toothpaste and noticed a considerable improvement in my skin. I would rarely break out around my mouth.

To celebrate my recent graduation, I went on a road trip vacation with my family. Unfortunately, I did not pack my usual toothpaste. Complacency got the best of me, and I didn’t think it would matter for a 3-day getaway. I got a zit by my upper lip and then a pimple on my lower lip shortly after our trip. I’ve since switched back to my usual toothpaste.

I also started washing half my masks by hand to see if it makes a difference compared to my machine-washed masks. Just as personal care ingredients can cause skin irritations, detergents’ ingredients can irritate the skin, too. It’s for this reason that there are non-allergen and fragrance-free detergents. If your skin is breaking out by your cloth mask and you clean the mask regularly, try washing with a different detergent.

3. Use acne patches or dots

When I was a teenager, acne dots or patches did not exist. The popular anti-acne products back then were Sea Breeze, Clearasil, Clean & Clear, and Neutrogena. I only discovered acne dots or patches recently and started using them about a year ago. Some patches contain medication (like salicylic acid, a typical anti-acne ingredient), and some are merely hydrocolloid patches. In nursing school, I learned hydrocolloids are used to treat some wounds. My acne can sometimes be painful and feel like a wound! I never had the opportunity to perform wound care on a patient using hydrocolloids, so I think it’s neat that I get a sense of what hydrocolloids are like when I use these patches on myself.

Somehow, I have started to accumulate acne dots and patches. Some I forgot I purchased while others I bought while traveling. I think they work, but they are all a little different, and they each have their merits.

I love these patches or dots because they protect the pimple or zit from further irritation. If I have a pimple and wear an acne dot, I don’t have to worry about fabric or skin rubbing up against it and further aggravating my pimple. It’s pretty much an adhesive disk applied to the skin. One drawback of using these is it’s been challenging to get them to stay on my skin when I’ve been sweating.

4. Relax

I get acne due to hormones – stress or menstrual. During nursing school, I drank mostly caffeinated beverages, ate quick-to-eat not-so-nutritious food, and periodically got less than 6 hours of sleep. Poor diet, lack of sleep, and project and exam stress would undoubtedly affect my skin and cause me to break out.

I never drank so much coffee until I started nursing school. Now that I’ve graduated, I try not to drink coffee daily. The pandemic and not wanting to go out frequently have also forced me to better plan my meals. Since I’ve graduated, I get more sleep and have been trying to relax more by catching up on tv shows and doing things I enjoy while I quarantine at home. However, I continue to feel a little anxious because I still need to take the NCLEX and find a job amidst this pandemic.

I don’t think that I will ever eliminate stress or anxiety, but I don’t want to either. I believe stress can sometimes be a good thing, giving the motivation to move forward, improve oneself, or providing an impetus for change. On the other hand, too much stress or high stress for too long can lead to health problems; I recognize this and try to lead a more balanced life.

Even with efforts in reducing stress, I still periodically get acne due to hormones associated with my menstrual cycle. There’s not much I can do about it, according to my doctors. This week, I tried washing with Panoxyl (thanks to recommendations by YouTube bloggers Cassandra Bankson and Dr. Dray) and targeting specific areas prone to breakouts. I have yet to determine if this acne wash truly helps since I just started using it, but it feels good that I’m at least trying to care for myself and try something new.

Since many variables can lead to “maskne”, it’s hard to say that there is one sole cause or solution. So far, doing all of the above has improved my skin. One pimple has disappeared altogether while the other is shrinking and less painful. I’m not the only one suffering from #maskne; I want others to realize their mask may not necessarily cause their breakouts. Instead of reducing mask-wearing, try switching masks or washing masks more frequently. Change toothpaste, soap, or detergents. Treat breakouts when they occur, and practice self-care by reducing stress and anxiety. I encourage others to follow public health recommendations and WEAR A MASK around others. We are still in a pandemic – with acne or without, I’m wearing my mask!

#LAProtects Get your free downloadable print of the above poster at https://corona-virus.la/la-mask-print-project

HUGE Milestone: Graduation!

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!

Class of 2020 BSN Graduate!

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! 

A Nursing Pioneer, Illuminated

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.

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!