cheska_rn 3,005 Views
Joined Oct 4, '09.
Posts: 176 (19% Liked)
He was an elderly patient, unresponsive and on comfort measures only, when I met him at 8:00am that morning. The staff had guessed based on his current state that he would pass away that evening, or perhaps overnight. I was following a kind and compassionate hospice nurse for the day as part of the class I'm in. She asked if I would like to help assess him, and we got to work. The first thing I noticed was his breathing. I watched his chest. I glanced at my watch. 36 breaths per minute, using accessory muscles, with expiatory wheezes in all lobes. The nurse looked up at me and said gently, "this is not comfortable, let's treat this first". She gave him IV Morphine and Ativan, and we went on to care for several other patients.
We returned shortly to reassess him. His son met us in the hallway, and glancing at his father and back to us with anxious eyes, asked "How is he doing?" The nurse explained that we had given him some medication to allow him to breathe more comfortably, and she wanted to see how it was working. The three of us could see the medicine hadn't had much of an effect, so the nurse went to get some additional medication. It wouldn't be necessary.
Several seconds after she left the room, the patient stopped working so hard to breathe, and a long period of apnea began. The son's eyes bulged. I ran to the hall and called for the nurse. With her stethoscope on his apical, and my fingers on his pulse, we watched, waited, listened. There were no monitors, just us. A long pause, followed by the nurse's voice, barely above a whisper, "I'm sorry. He's gone." It was 10:17am.The son knelt down and kissed his father's forehead. The patient's wife of 68 years and several other children were on their way there. "Let's get you looking nice for Mom", the son said softly, and walked out of the room.
What happened next I wasn't expecting. Before I could begin to perform postmortem care, I began choking back tears. The nurse looked up and asked gently if I was okay. I felt my face flush with embarrassment. I thought to myself that it was not my place to cry over a stranger. To lose composure. I tried to answer her question, but holding back the giant lump of a sob in my throat was the only sound that came out. "First...time. Patient...Death." That was all I could get out, but she knew what I meant. She put her arm around me for a moment and told me it was okay. I rubbed my face for a few seconds and went back to work.
I looked down for a profoundly odd moment at the man who was just "there", and was now "gone", and tried to figure out why he's passing had such an impact on me. I had never heard him say a word. Never saw him on a "good day". I didn't even know of his existence until 2 hours before he left this world. I had expected as a part of my training and profession, to feel compassion, to show empathy to the family, to offer comfort. I was not prepared for my own personal emotional breakdown, which followed me home.
As I lay in bed that night, I began to realize that it wasn't specifically that man's passing that had upset me so unpredictably. It was a son's agony and tenderness in watching his father leave him behind. It was the love of a man's life, his childhood sweetheart, wanting to be by his side, and arriving 15 minutes too late. It was standing by while a large, loving family walked into a room to reluctantly face the "goodbye" that they didn't know how to say. It was being intimately in the middle of the frailty of life and the finality of death, and feeling like I had no clue as a nursing student, as an outsider, what my place was.
I talked with my clinical instructor the next day about my emotional response to everything. I was expecting to hear a cliche of comfort, or the ever popular "it will get easier". Instead, I was touched to hear, "Maggie, your level of control and outward response may change, but if you ever get to a day where your heart doesn't break for the breaking hearts of others, it's time to find another line of work." I still have a long way to go in learning how to remain strong in the face of pain, to offer sincere comfort to people I may barely know, and to understand the profoundly important position of a nurse in standing by a patient's side at life's end. Yesterday was a big step, and I will not forget the man, or his family, who allowed a young nursing student in to begin to figure it out.
Next stop Med Surg 1!!
Hmmmmm....sounds like the honey moon is officially over.
What you are going through is very, very common especially in any high impact job. For the most part, it is considered a portion of growing pains and will pass as your skin toughens and time/people management becomes more second nature.
I believe the others above have a good point on deciding what you wish to accomplish as a long term goal and then structuring your current practices to match.
However, my advice is a touch different:
First, give yourself a bit of time to work through this period. Reality is a kick in the pants and most of us end up more than a little stressed and bitter before appropriate coping can set in.
Second, should point number one be deemed unacceptable, update your resume and have it ready to go. In fact, go ahead and begin your job search now so you can take your time to find something that is more fitting if it will end up benefiting your long term goals. In the meanwhile, keep working as you are so you are continuing to build experience and bring home a paycheck. Yay for money.
Third, work on filtering the drama and bull crap, i.e. reduce your mental clutter. I find that I can deal with most anything provided I keep myself from getting sucked into the unnecessary horse-hockey that is going on around me. I have various tactics I employ: from wearing ear buds and listening to relaxing music when I take lunch, to walking away from conversations at nursing stations that have nothing to do with anything pertinent to my patient, to verbally declaring the three foot area around me a "drama free zone" with the looming threat of a beating with a slab of smoked salmon as the punishment to any would be offenders. And when in doubt, ignore it. Just let it go.
On a different note, do you have vacation time? Sounds to me like someone could use some time in the sun being waited on by well-oiled cabana boys touting margaritas and chips. Even without vacation time, be sure you are taking care of you when you are off. Set aside time on a weekend or, my personal favorite, one night a week is my night to spoil myself rotten. I prepare my favorite meal, sip my favorite wine (or tea, depending), take an uber long shower and use special yummy smelly shampoo, watch shows that I love or rent a movie I've been wanting to see. When my foot is not busticated, I work out first or practice some yoga and just, in general, give myself a night of indulgence.
As my dear friend L'Oreal says, "Because you're worth it."
Just wanted to say be careful! I had an 80 year old resident who wanted me to dial the phone so she could call her mother and I thought she was confused. Turns out her mother was 100 and living in a nursing home in another state!
I've been a member of this site since 2008. I graduated this past May from ADN program. I have been lurking on this thread for the past 2 years esp the closer it got to graduation. I just wanted to drop in and share my NCLEX experience(s) and hopefully give some type of encouragment or inspiration..something! Forgive me for my brain is stilled fried..lol!
I was probably the FIRST one in my class that had a job interview before we graduated which was in April for my dream position at an out of state hospital. I found out in June that I was hired for the position and scheduled my FIRST nclex for 7-7. At this point alot of my classmates had already started taking the exam at the end of June, and not hesitating to post on fb how they were passing at 75qs, so this gave me the conifidence that I could do the same-NOT! My first mistake was telling all of my family when I was taking the exam (it just made my anxiety worse). To prepare, I used Saunders 4th edition, Hurst Review, Kaplan Strategies 2012-2013 (green book), nclex 3500, the 35 pg "study guide" and questions from any and everywhere else I could find. I studied MY ASS OFF for this exam! The day of the test I was a nervous wreck. When I got pass 75qs I was thankful that I was still "In the game" but once I got to like 120 I started to freak out and this made me lose focus tremendously. I actually believe that this is the reason that I did't pass. I lost my concentration because I figured since the computer didn't turn off I was doing horrible plus fatigue started to set in.
At the end of the exam I felt like I had been mind raped! I literally walked out of the building like a zombie..I balled my eyes out the entire 1hr drive home. I was numb and deep down inside I thought "There is NO way I passed that damn test". I got home..balled some more to my fiance and finally got up enough nerve to do the trick and then BAM..CC page. I literally wanted to die and I cried for everyday for about a week or two. Here I was banking on passing this exam because I was the ONLY one in my group that had a job waiting for me that I was scheduled to start the following month. I didn't want to have to face my friends or family with the news that I didn't pass because it was so embarrassing. I felt like I would looked down upon as "stupid, dumb, or not smart". To make matters worse, I was faced with the heart wrenching fact that I had to tell my recruiter for my dream job that I didn't pass. I am so thankful to God that she informed me that everything was ok and that they would hold the position for me until I passed.
This gave me hope and the strength I needed to regroup and start studying for The Beast again. I got my performance report exactly one month after I failed which was 8-7 and I Near Passing in all 8 categories which meant I had to start studying from the ground up again. I got my second ATT on 8-20 and scheduled my exam for yesterday. Because I had already had all that info stored in my brain from the first time..it kind of gave me an advantage to study something different so I ordered PDA by Lacharity. I wish I would have had this book the first time! It is A MUST have to practice those priority type questions on NCLEX. I kept calm the entire 3wks of studying. It may sound weird but I didn't to put as much effort into as I did before because I was so crushed to know that I studied so hard the first time only to only fail. This second time around I didn't tell ANYONE but my fiance the date I was taking it again. People would randomly ask and I would just say "whenever I feel ready in a few months". But I knew the day!
*This time I also focused more on putting my trust in God. I kept telling myself, whatever you decide Lord is fine with me I will accept it. If its not my time again..then its not. I put post it notes all over the place with my name with RN behind it and a msg that said I WILL PASS NCLEX*
9-13..I was very calm on the way to the test center and I even got there about an hr 15 mins early but I sat in my car listening to the song Some Nights by Fun. This helped me relax. I went inside the testing center at about 1:15 and by 1:30 I found myself sitting infront of this monster again. I said a little prayer to myself "He will not leave me, he will not forsake me" and began. The 1st question I thought to myself..oh crap. I pushed through all the way up to 75, and once I got past 75 I was thinking..ok I can do this. Got to 115..140..200..265. I was the last one testing in the center-AGAIN. I was drained-AGAIN. I had 32-35 SATA, 5 math over 90% was infection control, teaching and PDA. Somehow when I left I was peaceful. I didnt shed a single tear but deep down inside I feared that there is NO WAY that I could have passed this exam again. On most of the questions I could narrow it down to 2 answers but after that I was pretty much a guessing game. I had a crap load of meds that I wouldn't have known with Einstein's brain! I basically felt like I guessed on 98% of the questions and that is NO LIE!
Well I get home, and I still have the mind set that it is what it is..if I didn't pass that would just be another $200. There is NO WAY that I was going to allow myself to be as distraught as I was the first time around. I never wanted to feel that pain again..so I just didnt allow myself to cry. I accepted the fact that I failed it again. I took a shower, ate and got in the bed on came to this site to read about all those who failed twice with 265qs. I didnt even want to try the PVT because I already knew what I was going to get. Finally about 2 hours later and reading all these stories on here..I thought to myself "Just do the damn thing..you've already failed it so seeing the CC page again is not going to kill you. So I logged into my account, entered the req info got down to the BON..took a breath, got a little shaky and faint because my heart was racing and hit Next...and there it was...
"Our records indicate you have recently scheduled this exam. Please contact a member of your boards, another registration cannot be made at this time."
I DID IT!!! I conquered this beast...this monsterous cloud that has been hanging over my head for the last 4 months..it's over!! I can get back to a normal life..I have secured my future with a career that I can be proud of. I pray to God that it is true and I won't believe it until I see my name on the BON. This just goes to show that you can fail at 265 and PASS at 265 questions. I am living walking proof of it, it may seem dark and gray but don't give up or loose focus on what you are trying to achieve..NEVER give up..EVER! I promise it will be worth it in the end. I am floating on cloud 999999!!
Thank you for taking the time to read this long story but I hope it helps someone else in the future! Peace be with you all on your journeys
I'd hate to read what you wrote back when you really were hateful toward nurses and our profession.
The directors of Press Ganey should be all be arrested and charged with extortion, fraud, and racketeering. How Press Ganey or JAACHO for that matter, are allowed to operate is true, modern day exercise in governmentally protected organized crime.
And thank you, I'm still weighing my options. But hey, at least we have options right?
I'm a dude. But thanks for the vote of confidence. Wish you luck in your new endeavor!
I had to learn this in school, along with making an occupied, unoccupied bed, and the mitered corners. And, I just graduated 2 years ago. Those mitered corners went out the window after my first clinical, just not natural for me lol.
I learned baths (and was expected to bath my patients each day in clinicals - especially the first round). Also learned different bed making techniques, but don't really remember them. Usually the bed is either occupied during the change or I am flying through it in hopes of finishing before the patient gets back from the bathroom...
Bed-making is still taught. Whether they're still remembered after the mind-numbing classes on nursing research and ethics and etc... is questionable.
Funny thing is, I first learned proper bed-making by a drill sergeant -- tight, neat, wrinkle-free. Years later, I encounter a nursing instructor who I thought really knew how to teach making a bed... Turns out she's ex-military too.
You will lose some "skills" as others have said, but you will gain many others that will translate well to the ER. Thinking and acting quickly in an emergency, is a big one that I can think of. Time management is another, as you will often be managing and passing medications for upwards of 10 people. I've worked on units where the med pass was split, each nurse passed meds for 10-12 people, and I've worked on units where there was 1 med nurse for a 27 bed unit. Passing meds for 27 people requires great time management. You will learn how to interact with physicians, as well as work in a pretty autonomous environment, much like (I imagine) the ER to be. You will learn to be a patient advocate "hey (psych) doc, he is pretty out of control, I think he needs a nice dose of (insert your favorite psychotropic here)...OR "hey (medical) doc, I know you hate coming down here and you think all our people are just crazy, but I really think this guy is going into DT's. I really need you to come evaluate him now." (Okay, maybe leave the first part out :lol: )
So, if we are being realistic, (because is it REALLY that easy to just go grab yourself an acute care job and get the "right" experience?), take full advantage of what you have now, keeping the big picture in mind. Try to get a dysrhythmia course somewhere, take ACLS, and when you do get that chance to sell yourself to that ER manager, remember to play up the relevent aspects of psych as they relate to the ER.
Patience is a virtue for a reason. Congrats!!!
I am by no means an expert (licensed in June...still looking) but I have heard from a few classmates (in FL) that their background checks took over a week. They did paperwork on a Tues and didn't hear back till the following Fri. (10days)
I say give it another day then make contact inquiring on the status of the background check and if there is any further information they require as you are very interested in the position.
Just my 2 cents.
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