algebra_demystified

That's a weird thing to deal with. Gender insecurity is RAMPANT in nursing. That sucks. I don't know what to say, just thought maybe it would help to know that somebody else feels the same way from time to time.

Custom made is the way to go.

Nope.

I worked some of the time while I was in school. During the EBP class, there was no way I could have gotten as much out of the class as I put in during that time while still working. It was a transformative experience and I would suggest that anyone looking into the program decide whether they want to work during that time. If I had worked during that time I would have passed the class, but I would have missed out on the research I did in that time. It really changed everything for me. I changed my course 180 degrees with great confidence. I went to campus once each semester. There is no support finding preceptors. There are +/- to this approach. If you make it on your own, you are much more likely to have a job waiting for you at graduation. There will be quite a few of you who will compete for the lowest-paying jobs right out of school, undercutting each other for a piece of the bottom line. Try to do what you want to do, and negotiate a rate that is in line with what you want. That practice requires call 7 nights a week for three years? No thank you. They want you to take overflow calls of theirs? No thank you. On call only? Let's see what that looks like. You decide what works for you.

I just finished up this past Friday. Here is what I have to say about the program. The quality of the student body is excellent. I studied with nurses who have decades of experience in various specialties. All of the students in my class were fluent in English. The discussion board was energetic and engaging. There was the same kind of peer support in the online program as there was in my Associates program at Glendale Community College (Go Vaqueros!). When we got together face-to-face at the immersion sessions I felt very comfortable discussing work issues and future plans. While we didn't spend ten hours a week together at coffee shops, we sure did have a facebook group that served as our coffee shop. The instructors are excellent. They were flexible, approachable, knowledgeable, and demanding. Feedback on papers was timely, informative, and fair. If there was a problem with a quiz or test question, they were fair about grading. In the toughest two classes in the program (600 and 563), the materials provided were sufficient for anyone with the energy and ambition to earn an A. For example, I turned in a monster paper for 563. It was so big and strange that the instructor took two whole calendar days to grade it. She gave me a 100% on it even though it was two days late. I think it was apparent to her that I did everything in my power to get that ship into shore, so she didn't dock me any points on it. My final grade was a 94.9%. At Gonzaga, a 95% is an A. She gave me the A-, because I didn't make it to 95%. I think that's tough, but it's fair. She is going to help me with submitting that paper for publication. That's awesome. You have to book your own preceptors. This is not easy. It takes time. It's similar to looking for a job. You have to sell yourself to potential preceptors. The good news is I learned a great deal about myself and had to risk rejection. The bad news is that I had some work to do. I should have started sooner, but it all wound up working out well. I am completely satisfied with Gonzaga and would recommend it to anyone.

If you are objecting to a nurse busting out of her uniform, you need a time out.

Do everything you can to learn about pharmacology. It will pay huge dividends in your career to come.

If it was me, I would ask the patient for their preference. Do you want me to do it, do you want me to get a female to do it, do you want a female observing me during the procedure, what would make you the most comfortable? It doesn't matter to me how the bed bath gets done as long as the patient is satisfied with the care. They may have to pay more to have services delivered in their most preferential setting. I have changed urinary catheters for teenage girls, have changed diapers on toddlers, have fed anorexic teenagers via gastric tubes, etc. I am there to provide a service to a paying patient. The patient is not there to provide me with a job, I am there to provide services to a patient who can pay.

I don't worry about the gay male nurse thing at all. There are quite a few gay male nurses, but I don't feel like I need to comment on that situation. What does that mean to me? Most of the gay male nurses don't make their sexuality a thing in the workplace. The few who do, I avoid. The gay nurses I work with are skilled and competent. I guess I'm not really sure where this discussion is going. I enjoy working with straight male nurses above all other demographic groups. Less drama, lower conflict, and less trouble. We all show up to work and don't have too much hormonal stuff going on. I know none of this is politically correct, but I don't care. It's easier to work with people who are easy to work with.

I don't think you're being hard enough on yourself. Everything you see in A&P 1-3 will be back again. The last time I counted it up, I repeated all the same content from A&P six times through nursing school. If I had any idea how important it would be for me to master the content in that class the first time around I would have studied twice as much instead of slacking off at three hours a day, seven days a week. Studying that material for the test is not enough. I recommend that you think about your A&P classes as essential foundational education for the medical profession. You'll see all that material again in your med/surg or pathophys classes four times. If you learn it the first time you don't have to relearn it in every subsequent class. You'll go over it again in pharmacology. If you go on in your education, you'll go over it all again in advanced assessment, advanced physiology, advanced pharmacology, psychopharmacology, and every clinical hour from then on. It's very much worth it to study that material to the finest granularity of detail. I wish somebody would have told me at the time how important it was.

I'm a fellow student, so I feel your pain. Working hard for good grades takes a lot out of you. That said, there is no substitute for a 4.0GPA. Nursing schools are very competitive right now. They have to use something to screen applicants. For some, it's GPA. For others, it's a previous educational goal. A B in micro can tank you, and that's just how it goes. I wish there was another way to prove yourself. Medical school (MD) is easier to get into than nursing school is. Medical school has a 50% acceptance rate, and nursing school commonly has less than 10% acceptance. Good luck.

Nope.

I found this great book on psychiatry called Psychiatrists and Witch Doctors that changed my mind about a lot of things. It was probably the most important book I read in my masters program (though it wasn't on the book list... I just liked it). In psych, one of the most important things is the relationship between the patient and provider. If it is culturally congruent, it is much more likely to be successful. If the patient is part of a culture where demonic possession is "real" then the patient is most likely to respond to an exorcism. If a patient is part of a culture where wanting to have sex with your mother or father is the most important thing, then that is the issue to be addressed. If your culture says that your beliefs are not as important as harmony in your family or tribe, then solo therapy probably wouldn't work at all. It would mean nobody cares about you. There are elements of my culture that are stupid. For example, nobody bats an eye when someone says, "That apartment is way too small, I would never have a dog there." They might even say that to somebody who lives in a comparable place and has human children living in those conditions. And the person with children would not be offended! I can be an ethical nurse in this place. I do not perform pastoral services, that is somebody else's job. For talk therapy, I can engage with religious people, but I don't address spiritual needs other than to see whether that person has the ability to access spiritual care. If they do not, I help them find someone who can help them with that. If the patient sees everything in their life as having a spiritual focus, that kind of bumps me out of the picture and they should probably see somebody else for talk therapy. Maybe I can do their meds. If medication side-effects are secondary to demonic possession, I can't do their meds either and they need to see another provider. I can choose to see or not see any patient, so I can select out patients I cannot treat.

Well, I had another appointment after the one under discussion where I almost left. The missionary guy was proselytizing and that struck me as grandiose and entitled, but the couple that came after him were astonishing. Grandiose and entitled are very much in line with the psych patients I see. Describing full-on demonic possession in a church, and pondering how Satan is plotting to destroy him and his wife, was a bit much. He actually clutched his hands like claws, drew his mouth back into a teeth-baring rictus, bugged his eyes out, and hissed about how the devil was going to take everything from him and leave him penniless. It was all I could do to not just get up and walk out of the room. It was like being in a cartoon or something. I can't imagine "going there" with him and trying to be therapeutic. Nope. I told my cotherapist I would not be seeing that patient again.

That's a really great answer. Partly because it is true. The other part is because it puts the focus back on the patient, and that's where it should be. Why should a patient pay to help me with my issues?

Definitely go the community college route first. You can take your prereqs at a uni, but you'll pay 20x the tuition. I believe that figure is fairly close to the truth, twenty times as much money. It's a lot of money. Do your prereqs at a CC, and then apply to BSN programs. Another avenue I would consider, if I was getting started again today, is I would think about PA school. I would also think about getting my MD. I think it's a great idea to pick up your nine-week CNA or EMT cert and work in that capacity during prereqs, and then apply to a program that allows you to sit for your LPN after the first year. Then, work as an LPN while you study for your RN. I am not aware of any BSN programs that allow you to sit for your NCLEX after the first two years, so consider doing a CC RN program, and then applying to schools for your BSN or your direct-to-Masters program. Part of the value of working as an entry-level medical provider is that you learn the scope of practice of those other disciplines. You learn what they should be doing, and you can consider the performance of your teammates later on. Stay away from LA Trade Tech, that place is a zoo. I went to Glendale and loved it. Pasadena is supposed to be good. LA County is supposed to be good. Stay away from Phoenix, that place is a swamp. Aye yi yi. There are many respectable online universities that offer a great program.

Lots of interesting feedback. The background makes all the difference. I'm in clinicals with a very senior and experienced PMH-NP in outpatient private practice. All of the providers in this practice group are Christian, and I think most of them come from the same family of churches. The psychologist who works next door believes in literal demon possession and would participate in an exorcism in full faith. He lets me sit in on his sessions when a patient agrees, and his practice is very interesting. He's great with the kids. I am not a believer, but I am very friendly with religion and Christianity. A couple weeks ago I went to church for the first time in a decade or more because I wanted to go somewhere comfortable and just think about things. I thought about the things I went there to think about, and participated in the ritual as the community would expect. The practice is in psych, and my two main therapeutic techniques are Interpersonal Therapy and a variant of CBT that is more structure oriented and less statistically driven. If I BS my patients, my therapeutic approach is compromised. This isn't a medical practice where there is a right answer and the person delivering the information is not the most important thing. The relationship is absolutely key. That's where I'm coming from with this story. Anyway, I thought about it a little today and figured out how I'm going to deal with this the next time I see the guy. I need to apologize for being disingenuous the last time we met, but I'm a "pray in the closet" type of person and don't really like talking about my spirituality. Then I need to set some relationship boundaries and put this behind us. Part of the deal with my preceptor is that I'm going to take call for her later on, and this time period is my introduction to her case load. So, I could potentially be getting a phone call from any one of these characters later on and it is worthwhile to establish a professional rapport.

Evidence Based Practice, Mental Health IV, Mental Health Practicum IV, and then graduation. PMH-NP, Masters in Nursing Science. Then, on to a $250K/year slot in clinical practice. Make sure to nail your nursing school prerequisites so you can wind up in the kind of practice you care to do.

This is in the context of an outpatient appointment with a guy who was a missionary for decades. I do not happen to be a believer, but I have quite the religious background. It's been enough years that I am very friendly with my religious culture and use what I know. It is the underpinning for my thoughts on culture, morality, etc. I said I do. I think I do. At the same time, it's a complete lie in HIS context. He wanted to know if I was "saved" in his terms. I knew at the time what he was asking about and deliberately misled him. He prayed for me towards the end of the appointment, and I participated with him when his obvious cues became apparent. I'm not sure I really have a question to ask here. Part of me thinks that it's really none of his business what my spiritual/religious life is like. Part of me wants to be honest with him. Part of me is irritated that he feels welcome to make me feel uncomfortable for his own benefit. It's a bit presumptuous, isn't it? I don't feel offended. I'm more thinking about how my dishonesty will affect our therapeutic relationship. He's probably run into people like me before and I'm guessing he figured out I was BS'ing him about this. I'm just not sure where to go with this, so give me your thoughts.

Think about what you want to do with your life. Some things are more fulfilling than others. I would not be happy as a CRNA, or a floor nurse working in psych. As much as psych is my passion I just don't see working the floor anymore. PMH-NP is a much more fulfilling role for me. Yes, I'm going into debt. Yes, the money isn't as much as some other options might be. That's fine. I find the role of a PMH-NP to be VERY fulfilling and satisfying, much more than any other job I've had. I don't think I'll work a day in my life once I graduate. Clinicals have been amazing. I really have a passion for what I do. There aren't many people who can say that. The hours may be lousy, but the actual minutes are pretty good.

I bought all my textbooks and sold the ones I didn't think I would use again immediately. Amazon will buy textbooks back at something like 50%, so I didn't lose much buy buying and then selling. Renting is fine, but if you think you might use the book again buying/selling might be something to look at.

This weighed heavily on my when I decided to switch from sales to medicine. The bottom line was that I needed to make a living NOW rather than wait far too long to start my family. I'm in an NP program now. As far as money goes, I can tell you something about that. There were three people I shadowed this summer in my advanced clinical assessment class. One was an NP, one was an MD, one was a PA. Guess who made the most money? It was the PA. He worked family practice like he was in a factory. He worked his nurse hard, and he gave her a year-end bonus that was the envy of the practice. He saw three patients an hour and busted those appointments out like an efficient professional. The NP spent a lot more time hand-holding. She did a lot of female exams, which I did as part of the rotation. It takes a few minutes to get a female patient comfortable with a male nurse who has a speculum in his hand. The MD was an extrovert in that he stared at the patient's shoes instead of his own. If there's any doubt in your mind, go for the MD. The PA made no less than 3x what the others made in a year.

I took five classes in their MSN track. I thought it was awful! The students had little to say that was meaningful in the discussion, and the material in the classes was not useful to me at all. In the end I decided that the experience was so bad that I would simply quit. Later, I enrolled in Gonzaga's online program and it was so much better! The students were MUCH more interesting, and were all fluent in English. The instructors were much more helpful. I had to repeat all the classes I took at Phoenix, but this time I found material that was useful in my work as a floor nurse. Gonzaga would not accept the credits I had from Phoenix, by the way. I have a BS in Public Relations from Illinois State University. That was a very easy program and I learned very little. When I went back to school for nursing I attended Glendale Community College just outside of Los Angeles, and that was one of the most difficult things I ever completed. Even the prerequisites were killers. I had no idea you really needed to study 3-4 hours a day every day just for one class. It seemed ridiculous. I've heard of other community colleges where you could retake exams if you didn't like your grades. Glendale Community College was outstanding, and without a doubt the crown jewel of my academic experiences. GCC! My fellow graduates have gone on to good jobs and successful careers. Before Glendale Community College, I took a couple prereqs at LA Trade Tech. In the intro meeting, students were called up to have their assessment test graded and students were advised on how to get themselves up to speed for class. Quite a few applicants were functionally illiterate. Some brought their kids to class and told them to sit in the hallway during class. I took the Nutrition and Lifespan classes there, but wound up just walking away after about half of the first semester. The instructor for the Lifespan class showed up AN HOUR LATE commonly and was usually drunk. I could smell him from the middle row. I had to explain to one of my classmates that academic journals are not the same kind of magazines that you get in the grocery store. Another student turned in his first paper as a single run-on sentence on one side of a ripped out sheet from a spiral notebook. In the nutrition class, half the students failed the first test. The content was the simplest I had seen since grade school. Is wheat a protein or a carbohydrate? It was beyond ridiculous, and I was ashamed to even mention to anyone that I attended a school like that. Bye! I got my EMT license from West Valley Occupational Center. My instructor was very cool and a nice guy. The material was useful and difficult enough that I learned a lot. After I got my license, I felt well prepared to do the job. At Gonzaga, I found the students to be intelligent, experienced, well-read, enthusiastic, and engaging. The on-campus immersion weekends were both challenging and enlightening. I can visit the campus any time. The alumni association has provided me with networking opportunities among successful graduates. The bottom line is that I've been to multiple schools. Phoenix is not the worst, LA Trade Tech was far worse. Phoenix was a big notch below Illinois State University. The University of Illinois is the good state school in Illinois. Northern is #2, ISU was probably #3, Southern was probably #4, and Eastern is definitely #5. I would put Phoenix below Eastern. An exceptional student can learn anything they want at any school, and no library can turn you away. Just because somebody went to Phoenix doesn't mean they didn't learn, but I would have to assess that graduate carefully if the education meant anything significant in the job.

If the administration at my facility knew how much I loved working swing shift they'd cut my pay in half, and I would GLADLY take it just to spend my time there. There is nothing I enjoy more than working swing shift as a psych nurse. Can I please have more? There is a sentiment out there that if you love what you do you never work a day in your life. Swing shift on an acute ward is that for me. If there was a way to physically synthesize swing shift into matter I would roll around in it every day for the rest of my life in ecstasy. I really like swing shift. The AM meds have worn off, the patients are exhibiting the behaviors that are most likely to wind them up in jail. I love not taking the bait. Every time I file away the mental picture of the staff who are shocked into disbelief when I tell a patient that blocking my way down the hall has got me and I'm done. I guess I'm going to have to go around the back way to get to the other unit. If you're blocking the door I'm certainly not going to force you to do anything. That's fine. No manual restraints on my shift tonight. Not a single one. On other units I saw things that made me cringe, but I'm not a supervisor so I don't have to do anything about it. That is not to say that if I saw abuse I would not report it, I certainly would. I have in the past. That was how it was with my previous employer. The shift supervisor was famous there for taking patients down and putting them in restraints for any one of a number of reasons. When I was the charge nurse we had no restraints. Zero. Month after month, we had no behavioral problems that required a patient to be strapped down. I'm not a pollyanna on this subject. If somebody needed to be restrained, you had to run if you wanted to beat me to the takedown. I had violent criminal adult men who could kill you if they wanted to. Sometimes they did their best and caused serious life-changing damage to staff. There is no way I would tolerate anything like that. Hundreds and hundreds and hundreds of times I struggled with everything I had to make sure that somebody didn't get an eye ripped out. I am not exaggerating when I say that mental health patients can be dangerous. There was a staff who suffered permanent damage to her eye in a relatively recent event, so this is not just me talking, it is real life. Maybe that's the experience that has caused me to think differently about the kind of power I have as a psych nurse. It's really something to be able to tackle somebody into the corner and force them to comply with my orders. I am a jailor to a certain extent. Who does that? It's a ridiculous thing to pass the handcuff keys to somebody and hope they will be responsible with them. I no longer have any urge to use the power of my position to force anyone to do anything. It's a beautiful thing to strip myself of authority. A patient said to me recently that I could throw my weight around a lot more than I do. That was one of the nicest things anyone had ever said about me. This patient had recently threatened me with violence and I backed down until something happened and he found a way to get out of it all. I relish that experience. There was a security staff who taught me to calm down and not engage. He was a giant. His physicality made anyone cringe at the thought of going toe to toe. I had the opportunity to take a patient down from the back, and I would have had 30 of my closest friends available to help me with this. I was so sure I was right in exercising my authority that it seemed ridiculous for him to back all those staff down the hallway yard after yard until it all spun out and the patient was ready to rest. I wanted to fight and win, the security guy wanted to end things with nobody getting hurt. I'm really embarrassed that I wanted to engage. I must have looked like an ass to all those people, and I would apologize to them all if I still had the opportunity. Maybe this is something that can't be learned from a book. There is so much left for me to learn. The further I go in my education the more gaps there are to fill.

I see it as a good thing. The role of the RN will continue to evolve, and I think it will be upwards. Less paper-chasing, more assessment. I say let the marketplace decide. Would you rather have RNs take your blood pressure, or would you rather have them treat patients for HTN?