LovingLearning

In addition to those mentioned, I took Physics. Surprised myself and got an A...and it comes in handy. It's not directly RN school related, but I understand things better and techniques come more logically to me, because I understand the principles behind it (eg smaller lumen = higher pressure -> HTN/BP (and it's medications), needle choice, barrel choice, and so on). Sounds kinda dumb, but I'm glad I took it. I wish my second language was anything but sign language...spanish would've been good... Best- Lovin' Learning

notes from first year on the floor at los angeles county rn school... things to tell your patients: ~if you have a whoopsy stomach at the sight of blood, don't lean over and watch me change the surgical dressing on your leg. that will lead to vomitus in the wound, and several other people in scrubs answering my call for help. it will also wind up with you in the or again getting irrigated to make sure everything that was in your stomach which is now on your leg is not in your wound. ~if you're a gang banger, got shot in a drive by (for the third time), please don't have your homies come into the hospital and scare other patients by their presence. and please, when i (the student nurse, at that) enforce the 2 at a time rule, don't threaten me with 'making sure' i get mine. and then don't get miffed when i don't run down to the cafeteria to get you a double bacon burger. and it really doesn't help to have an escort watching everything i do. *i* am not the bad guy here...and i don't need monitors. and no, they can't come into the med room to 'watch me get the good stuff.' ~when you're limited to bed rest because you've had hardware put in both your legs, and pt hasn't cleared you for movement and not given you any assistive devices (like that wheelchair you so greatly desire...), don't get your girlfriend to get a rolly-chair from the nurses' station, manage to get into it, use the toilet, and then get back in bed. and when asked, you didn't get that idea from me. ~and yes, when you urinate dark green colored, putrid smelling urine, you're probably not going home tonight. the dr will very likely think you've gotten an infection in your abdomenal gunshot wound, and bring you down for emergency surgery. tell your dad dark green urine is not normal, and he doesn't have to yell at me because he wasted a trip to take you home. i already know parking's terrible...i walk more than 1/2 a mile to work from my parking place in whatever weather is going on. have a towel, and relax a bit. it's probably going to be a long wait. and no, coffee on the floor is for the rns, so we can keep up with people's needs. ~and expect the nurse, and the student nurse, to chastise you when you're caught trying to shoot illegal drugs in to your already ravished body via the iv we put in so we could put medication in there. dude, where'd you get that stuff anyway? and yes, we really did have to call the police. ~when you've asked for yet another ice pack, and i have to make one out of a latex glove because you've used the two dozen we keep on the floor, don't be mad that it leaks. that's why i wrapped it in a towel in the first place...and yes, ice melts when you've got it under your head. ~and yes, i will ignore you wolf whistling at me to get my attention. and don't get embarrassed when, in front of your homies, i explain that using the call light will indeed work...and i know you know where it is, because you've used it before...quite a few times. if you're wolfwhistling, you're breathing...and sometimes, that's all i need to know. thanks for the learning opportunities: ~leaving the poop in the potty for me to look at. i really do need to chart what it looks like; i don't do this because it's fun. ~making sure i know you need your pain meds. other patients informing me of the screaming woman doesn't actually make my feet move faster, but it does make me laugh. ~keeping your eyes closed and holding your breath when i come in the room, just "to see" what i'll do, especially if i've just given you medication for that pain you were screaming about. i will come and thump your shoulder. be happy i stopped before i decided chest compressions were a good idea. and for that patient who listened to me, who helped me help him, who asked good questions about his illness, and who hugged me when i told him i was going off shift, thank you, thank you, thank you. because of you, i was able to leave the floor in a good mood. because it only takes one person saying 'hey, nurse, thanks...' to make our day. and just as a last note, spitting at me and calling me names doesn't really make me want to do anything extra for you, like bring you that burger you're demanding. it was a good idea, and it was a good dinner...sorry you smelled it on me when i came back in the room after lunch. other adventures which were outstanding: ~seeing how abusive parents explain to the po-po that you weren't actually boiling the baby, you were just "cleaning his ass with hot water." and being able to walk away before i beat the parents. ~watching a patient bleed out and die on tuesday, and calling a code blue on a patient on wednesday. ~doing post mortem care on a patient who, last week, was chitchatting about horrid hospital food. ~finding out as one inserts the syringe that the patient's family has already given him something 'for the pain'...and then discovering that the bottle reads "morphine to be administered sublingually"...and yanking the hypo out as fast as possible so he doesn't get any more. ~discovering that someone really can have a bp of 63/37, and be talking and asymptomatic...while you run into the hall and get help. ah, first year rn. what an adventure. for the first time since returning to school, i did not make dean's list. i passed, two as, one b, and a c...but there is always next semester to get back onto it. i'll do it, too. and when i came off the dean's list, my instructor asked me if i had a learning disability. no, but you may have a teaching disability...and yes, i did really say that...and walked off very, very quickly (she was too stunned by my comment to say anything that day, and prudently didn't ask me any more about why my grade was slipping in medsurg...during her lectures in particular...smart chick, she.) i've come to discover that 4 am coolness and dark is a good time to see a quiet, calm city but not a good time to discover that you're out of printer ink; that 3 pm and hot is a better time to find that damned ink; but that it's best to stock up on it in the first place. i've discovered that my local diner really didn't mind that we held study group on the porch, sometimes spreading out "sterile field" on the neighboring table and practicing foley insertions on paper drawings until midnight. i've learned that even a quick "i love you, dad" makes the difference in my father's day. i've learned that a quick hug for a colleague whose day just got horrendous because a patient let her have it, makes a difference. i've learned that buying the lunch for the person behind you in line makes a difference. i've learned that most kids will respond to you when you make faces and talk in character voices, even if you're doing something scary...and that a bandaid that *they* select will make a difference. i've learned having a license plate holder which says "i save lives; what do you do?" gets you out of tickets...and that really makes a difference (problem with the license plate holder, though, is that you actually come to the police's attention far more often than before). lol. i've learned that the nightmares do go away after a while, and that what bothered you two weeks ago can easily be trumped by what you discover today, and that getting a hug from a colleague - or a patient - will make a difference. i've learned that fine print and low light do not make the studying go more easily; nor does studying in bed. osmotic absorption from books is a myth, but will leave you with lines on your face when you sleep on the books all night...and those lines can't be covered by make-up. i've learned that cornering my instructor and asking for help is a very, very good thing. i've learned that instructors are people too, make mistakes, and have a lot more pressure on them than i first thought. i've learned that most learning happens on the floor, while struggling to put theory into practice; that things are supposed to go one way, but often go another...and being flexible is key. i've learned that assessment really does drive the train. and i've learned that some doctors really do appreciate your help, and rely on you to catch things and bring it to their attention...even when it's really hard to gather the courage to do so. but what i've learned most, through the trials and travails of rn school, is that i love this stuff. it's hard. it's trying. it's scary. it's very, very tough. and it's the best thing i've ever, ever done. nursing is the right choice for me. just thought i'd post this up for you guys. best- lovin' learning

In re: changing the level to 4...there are a whole lot of economic implications with level 4 and above; large companies have plans to deal with things like this, which include closing operations, and bringing people home, stopping shipping, et cetera. There are also a whole lot of trade implications, including stopping imports/exports, in some cases. I've even read where the stock market would close at higher levels. I suspect that the WHO is getting pressured to not change the levels just yet, d/t the enormous ramifications to the economic structure and financial health (or lack thereof) of this country (and the world at large). It is stunning, however, that the WHO has not acted independently, and done what should be done; follow their own guidelines and let the chips fall where they may. If, however, they do change the levels and institute guidelines which restrict import/export, I wonder about how that will affect interstate commerce; trucking, agriculture, and supply lines may be affected. And if that happens, that will be a serious challenge to day-to-day life for everyone. Just my thoughts this morning...it will be interesting to see how the politics of being ill will affect the health of a nation, both economically as well as physically. Best- Lovin' Learning

Ditto...Nebraska it is for me too. It is a great book. I'd rather it stay in fictional land, though. I've been doing a lot of reading about this today; it seems there is a lot of concern, and the CDC/WHO is not producing much reassurance. I live in EQ country, and have, for the last 20 years, kept a goodly supply of food for me and my critters (cats and horse) on hand. I think, however, that tomorrow, when I do my regular marketing, I will look into getting a bit more on hand than I usually do. I am pretty calm...but the stuff I'm hearing/reading isn't reassuring whatsoever. Best- Lovin' Learning

What have I sacrificed for NS? My sanity. But I have to say, it's worth it. Being sane wasn't too much fun anyway, and I don't actually miss it **too** much. Best- Lovin' Learning

I just wanted to update the thread... Spring break, and that rotation has been successfully completed. I had my evals by my professor, and nowhere on the evaluation was any comment about this incident whatsoever. He did say that I took initiative, and that I was able to manage patients' needs effectively, but other than that, there wasn't even a hint that this occurred. YAYAYAY! Now, on to Peds and OB...only 9 weeks left for second semester, and I even managed to pull off a B in pharmacology! Thanks again for all the support...I appreciate it a lot. Best- Lovin' Learning

Thanks for the support, you guys...I appreciate it a lot. There has been zero issues regarding this event, literally NONE. Apparently, no complaints from staff, none from my instructor, and none from the patient, so I figure it's all good. As a matter of fact, I had a patient this week who was very, very ill...with no dx. When I was done with my day, my instructor (who'd helped me carry out Drs orders that were new, et cetera), told me I was a very good nurse, and was able to take excellent care of my patients. So I'm pretty satisfied with that, going into midterms and rotation shifting. Thanks again, everyone. I do appreciate the feedback and support. Best- Lovin' Learning

Hugs, love and prayers to you, as you start this new part of your life. You are not alone; God sees, knows, and holds each dream and tear in His hands. Your beloved is watching you through the holes in the floor of Heaven, and will not leave your side. In this time, remember that there is always a Plan, and that you are never alone. Best- Lovin' Learning

Just wondering how you're doing? Despite my fear that I was going to have nightmares, I haven't, at least not yet. I will say I'm taking a lot of good natured teasing from my colleagues, but that's to be expected. LOL. Hope you're handling it well. Best- Lovin' Learning

She's not going to help you because you need to learn how to break down a question...I'm learning that, too. 1. If a patient has pneumonia and becomes restless: vital signs are T 100F, P 110, RR 28, BP 130/72, what should you suspect? O.K., let's see. Pt has a fever, is tachycardic, resp are high, BP a little elevated. So what's going on? Look at your NANDA dx book, and look up the diagnoses. Match the symptoms to the characteristics, and you can narrow it down. Then, consider the airway, breathing, circulation issues; choose the one which deals with those both, and I'll bet it's the answer. 2. The usual dietary recommendations for a cardiac patient includes? Break this down, too. What is the biggest issue with cardiac patients? Which diet is best for them? In your medsurg book, look at cardiac diet, low sodium diet, low fat diet, and see which one appears best. Then, look at your nutrition section in your text, and determine which would be best for a cardiac patient. Between those two sections, you should be able to figure out the answer. 3. A nurse should be alert to complaints of decreased exercise tolerance and dyspnea in African American males because they are at risk for ? If you really can't figure out the answer, look at the recent billboards peppering most cities. This illness has a higher constituency of African Americans, and is on the rise. What do you nearly almost always find as a co-diagnoses on the Kardex? Another way to look at the question is to once again, hit the text. Which one of these illnesses causes both of those symptoms, and appears in the African American population more often? What the instructor is asking you to do is learn about the s/s of the illnesses, and learn your NANDA dxs, and then apply that to the questions. I'm going to give a wild guess and say that what she wants from you isn't guessing, but to start putting 2+2 together and coming up with 4. It's not easy, but if you break it down and do the research, and then apply the nursing process and critical thinking skills, you'll come up with a good answer, and be able to justify your choices (give a good rationale). Good luck! Best- Lovin' Learning

Hey back, All Star... Thanks a bunch. With this instructor, he is all about applying the nursing process, and doing what needs to get done - as long as we stay within the parameters of what the school has cleared us for, and as long as he knows we can do it. And in this particular situation, with the weirdness of the fire alarm, nurses locked off the floors, and whatnot, the charge nurse was who gave me the direction, and who guided me until my instructor was able to get back up. It'smyturn said: Yes, it was one heck of a day...LOL. But that's what happens sometimes; the day gets weird, and you have to go with what you have. And no, I didn't figure you meant I was going nuts...it's all good. I am a strong personality, and I do ride the line between aggressiveness and assertiveness. And like you, I go at it full force and effect, as the old song goes. In this instance, it was a strange combination of events; a staff RN who is the kind who, when a student gets assigned to her, groan...and a fire drill...and a missing instructor...and a SN who was stuck with the instructor, and a patient who I was covering for in pain and needing some help...and a charge nurse who trusts and knows me. Thanks for clarifying...I appreciate the time you took, and the feedback you gave. As it stands, I took my instructor aside yesterday, and asked again if there was any issue. He looked at me and said "why would there be any issues?" with a puzzled look on his face. LOL. It was just a weird day. Followed by a second weird day. But it's Friday now; I've learned a lot this week, and today is a day to just relax with the cat in my lap and a cup of coffee at my side...ah, Fridays! Best- Lovin' Learning

I hear you. Bear in mind I wasn't running down the hall screaming or anything. I was also a little startled when the charge nurse said "well, call the Dr. and let him know." But I hear you. Thanks for your input. Best- Lovin' Learning

Thanks, Nurse educator. I was concerned enough to go through the chart, check allergies (both chart and with the patient and her oldest daughter), take vitals and look at last labs, pull my med book and review this particular med's contraindications (it was vicodin), check tylenol intake for the last 24 hours, talk to the patient about her reactions, and also her daughter who were both familiar with the medication. It wasn't early in the shift, and I was guided by the charge nurse who was right there with me for the conversations with the Dr. Let me also add this: the pt had a chest tube placement with only motrin on the chart for analgesia s/p. The Dr. wrote an order for morphine (IV) for BTP along w/ the vicodin. Thanks for the compliment. :) Daytonite, I've written a response twice now to your comments, and chose to delete. What I've decided to say is simply thanks again for your feedback; everything is a learning experience. Best- Lovin' Learning

Daytonite said I don't know which rules I broke? I asked the staff rn twice to help the patient, and asked her what I should do to start the process. She declined to either give me instructions or to take care of the patient herself. I went up the chain of command in a situation I was unfamiliar with and I didn't let a patient suffer. The staff RN went home. My instructor let me into pyxis. I gave the pt the vicodin and she reported 2/10 in 30 minutes. I followed school protocol...patient care comes first. I followed the charge nurse's directions in getting ahold of the Dr in the absence of my instructor. I did as we are taught...interacted with the Dr as appropriate (very little, in fact). Since the fax was down, the NA took the oder (as usual) to the pharm. Pharm put it into pyxis. The patient got her meds. No one complained, or was even upset. My instructor wanted all the details just in case - as I would, if the roles were reversed. Leaders, to me, are those folks who step in and deal with a problem when it arises if no one else is doing it. Leaders set an example. Leaders go to their leaders when there's a situation they don't know how to handle. Leaders take responsibility and action when the situation calls for it. For me, being asked to take care of a very delicate situation yesterday by the same charge nurse from the day before spoke of her confidence and trust in my judgment...additionally, my staff RN asked me to come with her for emotional support during a procedure she was uncomfortable with. Apparently, with the charge nurse and the RN I was assigned to, they're comfortable with me. And my instructor didn't see fit to write me up, discipline me, or admonish me in any way other than what he did in the parking lot after hours. So I'm not sure which rules I broke. Best- Lovin' Learning

I don't think you should give up...you've got a lot going on right now, between the struggles with studying and with your father's health issues on top of it. Take the break, but don't give up... And I'll share my favorite "secret study tip": tape the lectures. Spend the money to get one of those really good digital ones, and tape the darn things. Listen to them while you're driving, while you're exercising, while you're cleaning the house...but listen to them. It gets in better that way somehow... And my favorite "stay sane at all costs tip" is to take ONE day a week - only ONE - and make it a book free, study free, stress free day. Sit on the sofa, and watch your toenails grow. Go to the mall and watch the people. Do anything other than struggle and stress. I guarantee you, you'll be more able to get the stuff you're studying to stay in there...and come back out when you need it, if you take the time to have YOU time. And I'm old, too...we can do it. We can so completely do it. Best- Lovin' Learning

Seeing as I had my first post mortem care tonight, and it was a very similar situation...all I can say is I'm right there with you (he wasn't my patient, though...). After we were done, I nearly passed out and then vomited. The RN with me told me it will get better with time, and that she'll make sure I get to do all PM care in the future so I can get used to it. Sigh. But it's really freaky when the body moves around on it's own like that. It's all normal and natural, but it's still pretty freaky. I'm right there with ya...I'm just hoping there're no nightmares. Best- Noni

Let me clarify a few things...in my first post, Daytonite, I stated clearly that my instructor let me into the pyxis, and that he was aware something was afoot, but didn't have all the details but enough of them to know what was going on (in general). HE was the one who let me into the med room, took the meds out of pyxis, and did the Q&A. The Charge Nurse herself gave me the instruction to call the Dr., I didn't just grab up the phone and start dialing; I am not allowed to take phone orders, and was uncomfortable with it...so she stood there with me while I dialed a pager. We are allowed to interact with the Drs...as a matter of fact, it's encouraged. I had two different dealings with Drs today - one ortho, and one oncology. They didn't get upset that a student nurse was doing the job she was supposed to be doing; and my staff RN was with me the whole time. So maybe it's different elsewhere, and it sure was different last semester, but this semester, we're expected to be interacting with the Drs at the level we're at. Tonight, the charge nurse from last night asked for my help with a delicate situation...I was happy to oblige (with my instructor's full approval). That instance itself told me that she didn't mind what happened yesterday...and that it was not an issue, no complaints had been made, and that I had not acted impetuously. I can't help but think that if it's perceived that a student nurse is accidentally 'outshining' a staff nurse by taking the time to do something which she was unwilling to do, then it's not the student's problem, it's the staff nurse's issue. And since the charge nurse was the next in the chain of command, I don't think there was any real issue going to her for instruction, either. As for telling the staff RN to do her job...I just can't imagine that saying anything along those lines would've changed a thing...not to mention that I am unsure of all the rules (and the culture) to actually do more than ask her twice to take care of the patient, and she refused both times. So what else was I supposed to do? I went up for direction...and got it. Upshot of this is that I've learned something, and that I've also put the patient's comfort first. No one's complained, there's been no crisis, it was just an odd situation all the way round...and while I understand the concerns and caution voiced in this thread, as my instructor said last night, "you're doing what we're teaching you to do...patient comfort comes first." HE'S not upset, the charge nurse isn't upset, and the patient felt better in the end. As for me, we had two code blues and two behavior team calls tonight, and I helped do post mortem care for the first time (and immediately afterward ran for the bathroom and brought up my lunch...). I'm bushed. I don't mean to come across upset, as I'm not...I'm just a wee bit too tired tonight to communicate perfectly, and 5 am will come early and fast. I know you understand how that is... Thanks again for all the feedback - I really do appreciate it, and it's all a learning experience. Best- Lovin' Learning

First, let's clarify the stairs issue. We can go DOWN them, but cannot go UP them (except to the roof...). They do not exit into the hospital or on floors, but rather outside the hospital, and thus bypasses security. So if you go into the stairwell, you cannot get out on other floors, and can only exit by the downstairs door. Don't even ask me why it's this way; I think it's one of the dumbest designs around, but then again, I'm not an architect. Go figure. Daytonite, I see and hear your point. I was not trying to outshine, but can see how it might've been seen that way. And that's why this whole thing was strange...my instructor was making sure I followed the chain of command (if not him, than the charge nurse), was not doing something outside the scope (e.g taking phone orders), and agreed that he'd've done the same thing. OTOH, there is the issue of the RN, it not being 'my patient', and the fire alarm/stair thing...so it was just a weird time on the floor altogether. I also understand wanting to go home...the RN had had a rough shift apparently, and was tired. I know that feeling, too. I don't really feel like I did anything wrong, but since it was odd, I wanted feedback, and I appreciate all of yours. I am not always the best at seeing boundaries, but as my instructor said, "I can't fault you for doing what we're teaching you - patient comfort comes first. You were doing that, and did it within protocol." But I can always learn, and will always try to do better...and I take things into consideration and try to apply them the next time something comes up. Thanks, everyone! Best- Lovin' Learning

First, I didn't get into any difficulty or trouble. Phew. LOL. But this experience has me a bit baffled... I'm a second semester student, doing a med/surg rotation on a trauma/neuro floor. I am utterly loving it...it can get really hairy, but hey, that's all right. Yesterday was one of those hairy days, though...and I ended up getting 'talked to' by my instructor. I had two patients, both who discharged before I got on the floor. So I picked up two more, and then ended up giving one to another student. So then I got a third, who was comfort care/DNR/DNI. His family was there, and I did my assessment and charted. While I was charting, the fire alarm went off...and locked down the elevators. No big deal, right? Except, it was during shift change, and half of the student nurses were downstairs taking a break, half the RNs were trying to get up to the floor, and the RNs on the floor were off-floor, waiting to give report to their replacements who were stuck downstairs. Our instructor was downstairs, too...and he doesn't have a cell phone. So this one patient had both her regular nurse going off shift, and her student nurse was on break. This patient was reporting 10/10 of pain, and I was one of three SNs on the floor (we normally have 9). I chased down her RN(literally...quite literally), and told the RN. Who looked at me, said "well, I want to go home. I'll let the other RN deal with it." The other RN was NOT on the floor, but this RN was not going to even check the chart for PRNs for the patient. And since she wasn't my patient, I had no real idea what was going on. I grabbed the chart, looked at what was up (chest tube placement this afternoon, only motrin given 4 hours earlier, mets Ca brain/lung), and there was no order for anything stronger than motrin. Long story short, I went to the RN again, asked what I could do, and she just told me again "I'm going home. Let the next RN deal with it." I'm sorry; the patient is in incredible pain, crying, muscle guarding, grimacing, praying out loud to die, freaking her kids...and my instructor and her SN were stuck downstairs, her RN wants to go home...so after checking my two patients, I went to the charge nurse. I explained what was going on (she was also stuck because of the fire alarm), and told her I can't take phone orders. She said to page the Dr. on call, explain what was happening, that I was an SN, and that I couldn't do phone orders...and see what the Dr. said. Well, I did it, and the Dr. was on the floor (but another wing), and came right over to get the order written so we had something we could give. All this time, I'm back and forth to the pt's room, asking her to hang on, I was working on the meds, just hang tight, and reassuring her children that I was working on things as fast as I could. Ended up having an NA walk the order to the pharmacy because our fax machine was down...and about 20 minutes later, the meds were in the pyxis. The fire alarm had ended, elevators were working again, my instructor came back to the whirlwind, and I had him let me into the pyxis and we got the meds into the pt and 30 minutes later she was reporting 2/10. YAY. I gave report to the new RN, and filled in the SN as to what had happened, and went back to my pts (who were all just fine...). After our shift ended, my instructor asked if he could talk to me. He wanted to know what the heck had happened that I was med-passing to a patient who wasn't mine, how come I'd called the Dr for an order, et cetera. I explained everything to him, and asked if I was in trouble. He looked at me and said "you're doing what we are teaching you to do...patients are first, their comfort is priority, and I would've done the same thing." I was relieved...but then he said "but the problem is, you have to let the RN go home when it's time...they look unorganized if they work unauthorized overtime, and we are a 24-hour hospital, and the new RN should've done it." I reiterated the issues (fire alarm, people stuck up and down stairs, et cetera), and he said "no, you did the right thing...I would've done the same. But just be cautious about that in the future; you don't want the RNs to look bad for not getting things done in time." Like I said, it was strange...I completely get his feedback, I understand the rationale. But I also had a patient in 10/10, whose nurse was not willing to do anything even though she was stuck upstairs during a fire alarm, and didn't even want to start the process of getting meds for the pt. because she wanted to go home. My instructor did say "if I had been up here, what would you have done?" and I told him "of course I'd've gone to you, but since you weren't, I went to the charge nurse." He then asked what I'd've done if the charge nurse had said to wait and relax, and I said I'd've just waited and relaxed...but the charge nurse told me what to say to the Dr., so I was able to adhere to the SN status and issues, as well as take care of the issue at hand. Again, I got into no trouble...and my patient and her family were so appreciative. Even said something to our instructor about how caring I was. So again, no problems, but definitely strange. What would you have done, and what is your opinion about what I did? I am wondering if I indeed overstepped a boundary, but my instructor assured me I hadn't and that he'd've done the same thing...but it was just...strange. As a final note, my patients were all doing well during this time, so no worries that I had ignored their needs. And the other SN didn't have any problems with me helping while she was on break. Just interested in your feedback. Thanks in advance... Best- Lovin' Learning

I do it a bit differently. I have separate binders for each topic, and the syllabus is three holed and put in right off. Then, as the lecture occurs, I put notes, PPs, and other handouts behind the syllabus page for that topic. That way, everything is in, at the right place, and ready for me to work on. No more scrambling for that handout or this note page, it's just right there. As for exams and quizzes, I use a calendar. I do some reading every day, so it's never one hundred pages at a time. I can't do that... I take one day for myself. That's a 'free day.' I can do whatever I want, as long as it's not studying. I can sit on the sofa and watch my toenails grow, I can go ride my horse, I can do whatever I want to do...with no books, lectures, or anything. Those are my Mental Health Days...and sometimes, that's all that keeps me going. I keep a calendar, more of a master calendar, with dates of papers, quizzes, exams, and Mental Health Days put in. Life does, of course, occur, so sometimes things have to get switched around. But if I keep my master calendar near to hand, I can always quick reference what needs to be accomplished that week, and get working on it. I also 'front load' on things like papers and computer studies. If I can get them all done right off, I don't have to concern myself about finding time at school for that. As for clinical days, I have a set series of paperwork that needs to be completed for each patient each day. I put it in packages, make sure I have enough copies for the entire rotation, and stock up. That way, I always have it available for me. In the package, I have a time schedule...at X time, this needs to happen. At Y time, this needs to be prepared. At Z time, this other thing has to occur. Yes, things get swapped and changed, but if I stick to my time slots, I am more able to accomplish everything so that I can deal with those surprises without worrying I didn't get vitals, or the Fs, or panic about the medrun. The trick is, I think, to find a system which works for you. I am not able to account for each minute/hour in re studying, but if I have a general idea and a 'big goal', then I can chunk it down, and get things accomplished while still having some time to myself. I do make sure I have my MHDs, though...I find if I don't, I get waaaaaaaay too stressed, and can't focus on things the right way, and studying takes twice as long. Find your plan, use what you can to make things easier, and give all ideas a try. You'll find what works for you, and then stick to it...and hang in there, it's only 2 1/2 more semesters to get through. You can do it!! Best- Lovin' Learning

I've found reading the whole question to be really important...figuring out what's being asked for, instead of just going by gut response. For example, a question on my last test read: "Jim has to get an insulin injection. 25 units, 70/30. What would be the regular unit dose and the NPH dose?" At first glance, it looks like a straight math question. And you don't know this yet, but there's a way to mix regular and nph together. In this calculation, the quantity of NPH is 0.70/25, and regular is 0.30. Like I said, easy to answer, right? Except... The answers were given with both NPH and regular units first. Eg. 17.5u NPH and 7.5u regular, and then another one read 7.5 regular and 17.5 NPH. At first glance, they were identical numbers, except switched. That's when I suspected I needed to look back at the question and find out what they wanted. What the instructor was looking for was the 7.5 regular first, because that's how you draw it into the syringe. Regular first than NPH. Despite the fraction being 70/30 and the natural inclination to answer it as a 70/30 set up, the question itself asks for 'regular...and NPH?' So the answer had to be exactly as the question asked it. It's those little things which drop one's score if you have a core base of knowledge. A few of those on each test, and you'll end up with a C instead of a B, which is more reflective of your knowledge. The critical thinking aspect also is important. If you think about things from 'what has to be tended to first', or 'what is the worst problem here', then you'll usually come near enough to the answer to figure it out from the answers given. Knowing the issues being discussed, pure knowledge, is vital here, but so is sorting out what's the issue itself. An example of that was also on my last exam. "Jim has lab serum results of Na 149, glu 126, K+ 5.4, BUN 19.6. Which of these labs is most crucial to correct?" Pure knowledge says that all his labs are a bit high. What's important to understand is which one will kill Jim faster...which is the K+. Because the potassium range is so much smaller than everything else on the list, it's proportionately more out of range than the others. But it doesn't even take that kind of figuring out to understand...if you remember that potassium has to be kept in a tight range (the given lab values), and know (from your reading) that K+ imbalances will kill faster than Na+ imbalances. It's both knowledge and application. Always think "what's going to kill my patient faster", and make sure you really understand what the question is asking you to answer. Pay careful attention to how the wording asks the question, answer the question and do not add anything to it (a "favorite trick" of mine that I have to be very careful about), and then verify your answer by reading the question and seeing if the answer fits when you put it all together. And don't get discouraged. It's hard to switch to application thinking from knowledge based thinking, but that's what you're learning to do. It takes a while, and yes, getting NCLEX books really do help. I happen to really, really like the whole "...Made Incredibly Easy" series...they've improved my scores a lot. Best- Lovin' Learning

Thanks, you guys...I just feel so good that I can feel this stuff starting to come together. The muddle of first semester, the f/e of second...and all the stuff in between, have managed to find space in this poor brain and come together when I need it to. And that feels sooooo good. Best- Lovin' Learning

Tn Butterfly, thank you. I dunno if I was right, but it was enough that the Dr. wrote new orders...addressing all of my concerns (eg the haldol, the effusion...). Rbezemek, I don't know if I saved her life, but something was going on for sure...and I just couldn't get it out of my head that there was a slow bleed (I kept picturing a balloon slowly deflating...), and tried to account for all aspects of what was going on with her. I even went and spoke to the SN who had her last week about her mental status, and she came over...and then told me that was not the same patient she tended; she was nowhere near as difficult to deal with (the crankiness, the confusion, irritability)...just not the same mental status patient she had last week. That helped me, too...because if this is new, then something 'new' is going on. If I can find out what happened, I will let you all know...but I have to say it's fun (and a relief) to have the brain finally start making sense of all the stuff I've been shoving in there, you know? LOL. Best- Lovin' Learning

It's starting to come together, I think...thank God for that. I'm in second semester, and I have a rocking professor and clinical group/assignment. It's tough, but I'm lovin' it. But on Wednesday, I could feel things clicking in my head, and I was putting things together like I've never put them together before... My pt had been in for several weeks, a shunt placed in her liver; she had ARF, HTN, cirrhosis, and Hep C as co-diagnoses. I pulled her labs before I saw her, and her K+ was over 6, BUN at 60, low platelets, low H&H, and BP last two vs were 90s/40s, satting at 100 w/O2. She had had a transfusion of PRBCs the day before. She scared me a lot...those are not good things to have going on. She had just been returned from echo, having undergone a TEE. She was complaining of pain, wanting her pain meds (morphine), wanting to eat, wanting this, that, and the other thing. Dr. came in to evaluate her, and told her she could take out the nasal cannula as long as she stayed above 93 sat. She took off her NC, and was very irritable. Cranky. So I did what I could for comfort, and took her VS again. HR 67, O2 sat dropped to 89 (so I had her replace the cannula...), no temp, resps at 18. She wanted her morphine. I checked her MAR, she could have it, but...I was uncomfortable giving her morphine w/ her BP so low. I talked to her RN, and her RN said it was my call...so I took it to my professor. His eyebrows went up when I told him her new BP was 92/38, and agreed with me that morphine right now was probably not the best idea. When he went with me to check on her, she was asleep, so we decided to let her sleep while we talked about it. I told him she was confused, but didn't seem to be in too much pain; no facial grimacing, no muscle guarding, no other indicia that she had pain. I said "I think she's confused, and trying to relieve her anxiety and confusion w/ the morphine." He said that was definitely possible, esp. with the K where it was. He asked me what I thought would be best in the situation, and I said to him 'I think there's something else going on, not just low BP." I walked him through my rationale - hx of HTN w/ bp the way it was now, 3rd spacing all over, labs wonky, refusing to move off her left side, confusion, the PRBCs yesterday with her platelets now being at 7.3...I told him I thought there was a bleed somewhere. She hadn't lost weight despite being on renal diet and NPO most of the last week (while waiting for the TEE), and she was very fluid-filled in her abdomen. So I figured there had to be a bleed; slow, but still, a bleed. He asked me how the ARF fit in, and I said I thought it was symptomatic of the liver issue, rather than a cause...and that the filtering was overloaded which might account for the high k+ and subsequent confusion, but high K+ could also be from a bleed. He said "you may be on to something. How about you call the res and see what he thinks?" I went to call him, but he was on the floor. So I pulled him aside, and asked him if he had r/o a bleed, or if he thought it was something else, and explained I was concerned about giving morphine with her vitals like they were. He asked me to explain why I thought there might be a bleed and why I was reluctant to put morphine on board, and I took him through the same rationale. He didn't say much...but took the chart from me, and went to the phone. An hour later, I found the new orders...chest and pelvic xray stat r/o effusion in abdominal/thorax, prn haldol, hold morphine. :) Made me thrilled I was able to get something checked out...I don't know the results, but I do know she was being looked at for 'effusion in abd and thx', and had changed from morphine to haldol. She was taken down to xray about an hour before I went off floor, so like I said, I don't know the results. I'm tickled...I don't know what the issue is, but I couldn't account for some of the things going on if it wasn't a slow bleed somewhere...and I was thrilled that I was able to put something together and be able to rationalize things for both my professor and the Dr. Dunno if I was right, but it's nice to know my brain is starting to look, assess, put pieces together, and come up with something that other people agreed might be going on. Just thought I'd share...I am lovin' learning! Best- Lovin' Learning

40 when I decided to chase the RN degree, 42 when I completed the prerequisites, and am 43 now and in second semester of an RN program. Is it hard? Yes. Can I do it? Yes. Is it stressful? Oh hel yes. Do I have a life away from books? No....in about 18 months I will, but right now, it's all little print in heavy books. Was this the best decision I've made in a long time? YES!!! It can be done...and if you want it, you might as well chase it...'cause, as a friend of mine put it, you are not going to get younger...but if you have the discipline to get through the studying, you'll manage just fine. Good luck, and give it a shot and see what goes on. Best- Lovin' Learning