Episteme

I am really sorry this is happening to you. I just tumbled upon your post and the many responses and I apologize I didn't (couldn't) read every word of every response. Let me channel some of the people that have helped me deal with adversity (abuse both psychological and physical...) It can sap your soul. It is so very, very painful. Nothing you're going to read here or elsewhere will make it hurt any less. But let me give you some perspective 1. No one gets through this life without pain. Look around you and you'll be looking into the face of people who have suffered, or are currently suffering. You just don't know it. 2. Do you know anyone who has a burden greater than yours? Would you change places with them? (I just lost a dear friend to esophageal cancer. I'm ashamed at how I reacted to some... relatively speaking... trivial news about one of my joints.) 3. Have you looked for a person who has been through things like this and triumphed? (For me, support has been found in the church. I don't know what your beliefs are, but the black church... Dear Lord! got generations of people through slavery and Jim Crow. Have you looked for a spiritual mentor? One who has survived racism without becoming bitter? Did you see how the people at Mother Emanuel Church in Charleston responded in the face of death? They set an inspiring example of love and courage that moved the hearts of thousands upon thousands of people.) 4. If you flee from racists... they own you. If you let bullies win, then they've won. They don't deserve to win. To win, you have to be a better, stronger person than they are. 5. In your time at this hospital and in this town, how many friends have you made? If you have a friend who is white, you've demonstrated that race means nothing and you're no better, or worse than the next guy. The racists have just lost a round. If you've made a friend who is non-white, hopefully you can both support each other in tough times. So, you can flee and maybe relieve some of the immediate pain. But will you be any better equipped emotionally and spiritually when you encounter the next racist, or the next difficulty that challenges your character? Yep... I've just become my mother. And my father. And my Grandmother. And about a dozen or so pastors, and teachers (including nursing professors) I've known along the way. They wrapped their arms around me and made me stronger. They didn't fix my problem and make the pain go away. But I'm glad they were there for me and that I survived and I can take joy in what I did and who I am.

1. When you begin working, you should have a robust new-grad orientation program wherever you apply. 2. Once you land on the unit that will be "home", you will begin to develop a systematic method for assessing patients, making your way through the record and so on. 3. The meds you'll be giving and the pathological conditions with which you'll be dealing will become increasingly familiar. 4. The learning curve for new graduates is very, very steep. Six months after you begin your first job you'll look back and be amazed at how much you've learned and how competent you've become.

Mancoww, I'd like to tag onto what GrnTea said and comment on Esme's mention of the Defining Characteristics My question is this. How can you make this diagnosis (impaired gas exchange) without some essential numbers? Specifically, %sat and/or PaO2, (and both of those numbers are useless unless we know what FiO2 she's breathing) and PaCO2. Sometimes serum HCO3- can provide useful data as well. You have no information to tell us what is happening at the alveolar capillary membrane. (Unless I missed it which is always a possibility because I need trifocals when reading the computer screen... big sigh!) At the end of the day, you could be right in your diagnosis... (because the patient has pneumonia, after all), but if you have zero information about respiratory gas exchange, you are required to be agnostic about this diagnosis. I like to say, you cannot make a nursing diagnosis in a fact free zone. You have no objective about her levels of oxygen and carbon dioxide. None. Zip. Zero. So until you do, you cannot use this diagnosis. You COULD however, legitimately say "RISK FOR impaired gas exchange." And if you do, your priority actions would be "GET MORE INFORMATION!!!" Like, vital signs? % sat on room air? %sat with ambulation, etc., etc.?

When did SOAP notes rise like a zombie from the dead? We were glad to see it go away back in the 70's! Maybe someone found the corpse, dug it up, dressed it in fancy clothes and (having written a book or journal article or presented their "original" idea at a symposium) called it the greatest thing since instant grits... the practice that will solve all medical infomatics problems. As far as clinicians were concerned SOAP notes were mind-numbingly tedious to write and also to read and were dropped because there was no evidence that they were more effective at communicating clinical information than the traditional narrative note (of that era.)

So I quoted from the Quarterly Journal of Economics, on hard data, from events that happened on a state level, can be examined retrospectively with statistical accuracy in a study given the thumbs up in Science magazine. (The only journal with the prestige of the Journal Nature.) You reply with a non-sequitor from a CBO report that attempts to explain the jobless recovery. Well, Oh-kee-dokey then.

This is an abstract taken from a round-up of abstracts published by Science magazine. I tried to get it directly from Science but they have a paywall. But it was published intact on Powerlineblog.com If you give poor people middle class stuff... can you make them into middle-class people? Does giving access to health care for free contribute to unemployment. Here is a case study from the State of Tennessee Gilbert Chin What is the relationship between employment rates and access to public health insurance? Garthwaite et al. analyzed what happened in 2005, when the state of Tennessee discontinued Medicare health insurance coverage for about 4% of its non-elderly adult population, many of them nondisabled low-income adults without children at home. With a new need for private health insurance, which is often provided by employers, many of these people found new jobs. State employment rose by 6 percentage points from 2004 to 2006. This change mirrors the Congressional Budget Office projections of the decline in employment due to the expansion of public health insurance mandated in the U.S. Affordable Care Act. Q. J. Econ. 129, 653 (2014). There are many causes for our sluggish economy. I would suggest the ability to get free health care and free food and 99 months of unemployment are a disincentive to work. Hence a jobless "recovery".

I will correct you before our progressive friends. The VA is not a single payer system. It is overtly socialized medicine where the government owns the facilities and the people that work in them. But your point is taken. VA, Post Office (an interesting "hybrid" that was supposed to work with government input) TSA, IRS, ATF, NSA, BLM... They're all doing great work for the American people. I am so glad the Feds are taking over to make sure I can get health care. They know what I need and how much I can pay much better than I do. Holy Smoke... how did I live as long as I have without their direct intervention?

No... single payer doesn't work flawlessly. Consequently, some of the "big boy" nations are allowing people with resources to operate in a better, parallel system much like we can still remember. So single payer appears to become a dual system, one for the haves and one for the little people. There's a lot about progressives I don't understand but I know the current buzz words are "equity" and "equality" and I don't believe the rich having excellent care and the less rich getting to wait 18 months for a knee replacement is what they are after. If I'm wrong, I'm sure you'll tell me. Broad introductory comments are very easy to twist. Here is what I find indefensible. WE DON'T HAVE THE ACA. We have whatever the h*ll HHS wants the law to be this week. It had an incredibly incompetent roll out, we have had arbitrary delays on uncomfortable provisions that could swing elections. As we speak, the computer program is being reworked to something else for the November open enrollment deadline. There are over 2 million applicants whose data don't fit (remember, PAPER applications are still being processed) and it cannot be determined whether many have paid their first premium. Which is just A-OK with the politicians whose careers are riding on this because if the real data were available, it would look lame. It's data no one can get. Just trust us. 8 million people are enrolled. The cost curve is being bent downward and if you like your doctor you can keep your doctor. Most egregiously, it is now being admitted that almost no one is going to pay the penalty for not signing up for insurance because (again, totally apart from the law itself) if you've had a "life-changing event" in the last year, you're excused. WITHOUT THE MANDATE YOU DO NOT HAVE THE ACA. The care for the uninsured was supposed to be born by the young and healthy who would perforce buy expensive policies OR, having failed to do so would face a penalty to be assessed by the IRS. NOW we are told that anyone can avoid the penalty. You just sign an attestation to the fact that your life has changed... and you skate. THIS IS NOT IN THE ACA. The interest group with the most pull in DC are labor unions whose members will pay a 45% tax on their "Cadillac plans" and the betting is on as to how the law will be twisted again to keep that constituency happy. We don't have a health care law. We have a slow-rolling train wreck. And it is at this point that those who celebrated the ACA (per the quote noted above)... tell us "well, we wanted a single payer system... we could only get a half measure because the T-party, foul Republicans, Chamber of Commerce, rich 1 percenters wouldn't let us have what we really wanted. So, you see... it's their fault. No one on the right supported this. It is your baby. Live it. Love it. I am also told that the "party of no" has nothing positive to offer. The President laments that all he hears is criticism and if just one person would come to him with suggestions... (meanwhile if you like your doctor you can keep your doctor and Oh baby, of COURSE I'll love you in the morning). While I don't think it's my job to dig up information readily available to those who have complete field-cut/neglect on their right... I offer just one of many that are being proposed and have been proposed by evil conservatives. There have been all along. This is only ONE offering available from the Manhattan Institute. http://www.economics21.org/commentary/covering-pre-existing-conditions-market-driven-health-system

I was just yanking your chain. We Southerners don't play the victim card. We know who we are and let the world think what they want. No worries. By the by... My daughter was an Internal Medicine resident for 1 year (before she could go to her anesthesiology residency) and and one of her rotations was at the Cardiac Clinic at the VA here (and ours is not bad...) Woman had her little old husband in a wheel chair, he was diaphoretic as heck, barfing, holding his chest in a death grip and Katie could not get an attending/VA doctor to him. She almost told the lady to wheel him to the curb and call 911. This went on for several hours. My daughter was beside herself and calling every VA doctor she knew, pulling every string she could. The guy did finally get care, but it shook my daughter up pretty bad. She felt so helpless.

Oh, my yes... Do not be put off because another student can put on gloves w/out contaminating themselves. Listen, in some ways the CNA/LVN/EMT thing can hold students back because they have a hard time transitioning to thinking like a nurse. In my years I have taught 1. A former Navy SEAL 2. Retired Highway patrolman 3. A grammar school teacher with a Master's degree in education 4. A waiter at Chile's 5. Beauticians 6. Masseuse 7. Investment Banker 8. Underwater Demolition Specialist 9. Two transgendered men (one who was an Air Force veteran) 10. Human resource people 11. Grocery store clerks 12. Small business owners 13. Flooring contractors 14. Retired miner (as in Gold mines... yep.) 15. Security guard at the VA 16. Public Relations specialists 17. Master chef desert maker (Oh, the cheese cakes he would bring in! We hated to let him graduate.) 18. Pharmaceutical reps 19. A Navy Corpsman who'd been in the battle for Faluja (the Navy was sending him to school for a BSN. He'll be a fabulous Navy Nurse.) Gosh... I probably will think of a dozen more before I go to sleep tonight but that's what I can recall right now. You can do it.

You go girl! I think your story is a real saga that could encourage a lot of people who will be coming up behind you.

Get established with a BSN and some clinical experience. Then... consider becoming a nurse entrepreneur. You have outstanding credentials and can obviously see a market, put together a business plan... I don't see it as an either/or proposition.

You are incorrect on the hour ratio. If a theory (lecture) class is worth 3 credits, then figure 3:1 hours (9) of study for that. If you have a lab course (med administration, for example) it's about 1:1. So 2 credits in a lab class = 4 hours a week. When you are in clinical (let's say you are doing 12 hours/week in the hospital) it is about 1:3. Or 4 hours of outside study. This is just a rough guess-tament. Everyone is different. But no school has 40 hours/week in the classroom. Rather, being a full time student is a full time job and it should take about 40 hours/week TOTAL to succeed.

Can anyone know what nursing school is like before they experience it? Hmmmmm... It's rather like becoming a parent, don't you see? When I became pregnant for the first time, (I'd already been to nursing school) I thought I understood pregnancy, caring for an infant, toddlerhood, first steps, potty training, boo-boo's, sibling rivalry, first grade... But did I have any idea what I was in for? Not by a long shot! Had I heard all about parenthood from about a bazillion people? Yep. Nursing school? You won't know what it is until you're in the thick of it. But don't let that dissuade you. If people really knew in advance what parenthood had in store for them, the species would die out.

Thank you for your observations. I teach seniors and every semester at their last post-clinical conference, I ask them to close their eyes and remember the person who walked into the School of Nursing doors that first day. Then I ask them to mentally examine where they are now. I give them time to think about it. Then I go around the table and ask them to tell us how they see their evolution. There are always several students who are wordless. Or, they can't think of words that can describe how they've changed their view of nursing and of themselves. Always a few students can give examples... (I used to think this, and now I think that.) It is a really hard thing to articulate. I wish there were a way to put it into a simple paragraph so that we could give it to prospective students before they sign up. But I've concluded there is just no way to really describe what they are about to undertake. What you are experiencing is ABSOLUTELY, COMPLETELY, TOTALLY NORMAL. Every student goes through the same course of discovery. And some months from now... at your last clinical post-conference, I want you to close your eyes and try to remember the person who came in the doors for the first time. Compare him/her to the person you are now. If you can figure a way to put the contrast into words for other students, please share them with us.