End of Term and ALL THE THINGS

Whelp, I'm gaining enough space, now, to kind of gauge what the hell happened that required a hiatus in the first place.  Yeah, it's still a lot, and a great deal still to think about that.  

Real picture of me in those last few weeks

I chose the accelerated program because I wanted the intensity of that kind of structure.  I requested the DEU clinical structure (six or seven shifts of twelve hours instead of ten to twelve of six or eight-ish) because I wanted that similar density.  That doesn't mean, though, that when I was staring down my finals and juggling group projects and weighing my required reading list that I was feeling particularly grateful in those moments.  

Meanwhile, I had also been fitting in tech shifts, 0700-1900 on different days.  Even now, I'm making many mistakes, but I'm appreciative of the moments of correction--I need to know what other facets I can improve.  I need to be reminded to check X or Y until it becomes a habit (*cough* turning off the bed alarm before moving the patient *cough*).  I need those nudges of "the hospital prefers that Z be tracked in THIS box instead of that one, if you could go fix it."  I've had one patient call me multiple times for the same issue in a ten minute span while I was unable to leave my current patient for their safety.  I've watched how other persons have interacted with an unruly patient to choose what tactics I could adapt in the future.  I've had patients teach me better ways to care for them.  And I'm absorbing.  I will keep refining.

At the end of each shift, I found my brain hurt, my body was tired, but my heart was full.  ...and maybe a little tired.  

However, there were three unexpected byproducts of working as a tech while in school.

1. My focus in class shifted from "what do I need to know to perform well on the test?" to "what interests me and what can I take away to keep in my practice?"  I took the pressure off of myself in those spaces while simultaneously giving myself permission to be invested where I want to be rather than out of obligation.  It worked because I like to learn; it probably would not work for everyone.
2. I felt less pressure to absorb everything in my clinical days, which means I tend to relax a bit into them.  I'm VERY confident charting and taking vitals, given how frequently I do them in a shift as a tech, so I tend to focus on other aspects on my student days, finding other skillsets to explore.  
3. As I find more comfort in walking around in a hospital, I do carry myself differently, hesitating less to go into different spaces or to jump in and help.  I tasted independence as a tech.  Here's the real kicker:  the impending imposter syndrome is ebbing.  As a new tech, I have asked questions, made mistakes, corrected those mistakes, found help, and found places to improve--this will happen as a new nurse, too.  I will ask questions.  I will have places and people to lean on when I feel overwhelmed and support them in turn.  

The result of all of these pieces is I feel ready to start.  Moreover, I'm impatient to start.  There are still things to learn, but I want to get to the apprenticeship-like portion.  

And then a new abrupt stop:  another "hurry up and wait" period.  I'm picking up a good swath of tech shifts (the hospital is FULL about now), getting back to a regular workout routine, and working through a few house projects.  This space feels like I'm just in a week off between classes, so there's pressure to rest and accomplish projects as quickly as possible.  It's difficult to switch my head out of that pattern--there is no new normal yet and there won't be for some time yet.

I'm trying to lean into that discomfort, that it's okay for things to be soupy for a while.  I've got a lull before boards, and depending on when that happens, there may be some additional lag before orientation starts and at some point after enough training days there will be a switch to night shifts, more likely than not.  So, yeah, no steady kind of normal is in the periphery for a while yet.  It's uncomfortable, but I have the space to ask myself why, to dwell in some of those spaces.  

There are going to be a LOT of changes before the end of the year, drastic stretches of personal growth in a number of spaces.  I won't be able to see it if I don't take good stock of where things are now.  Thinking back to how much I knew last year at this time compared to what I know now, well, what I know after another year is going to be something worth seeing.  

Reflection, for the Accelerated BSN Group 2021

 So, I had the opportunity at our pinning ceremony last week to say a few words.  This came about because I had offered to entertain questions for the incoming class on what to expect in the course of the program.  After that experience, I was also offered space to say something at the pinning ceremony a month or two later.  Ordinarily, I prefer to have major bullet points and talk through them as preparation, however in this case I needed to adhere to a three to five minute time limit and the remarks needed to approved by the dean first--so I did write everything out this time.  It felt a lot like a blog post.  The following is a transcript of those remarks.  

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Hello all!  Thank you for allowing me to say a few words to and about this accelerated cohort. 

We all came into this program for different reasons, with different contexts and baggage.  I came into this program with some sickeningly type A study skills; others have a nonchalance about deadlines that I simply can’t understand.  Some came in with a clear objective of where we were going to land and have not wavered; others have allowed the experience to shape and explore their interests.  For some of us, we will graduate as nurses needing experience for whatever that next step might be—be it NP, CRNA, or some other flavor of alphabet soup—and for others this has always been the destination. 

And as we were preparing to start this new adventure, the world around us broke a little bit. 

No one had planned on the ‘Rona, and it colored our experience.  The logistics were a veritable mess to sort through, and I did not envy the powers that be the task of untangling them.  All of our expectations required significant adjustment and more than once it was highlighted to us that one of the most important nursing traits was flexibility-- in some ways, this was far harder on the staff because at least we didn’t have anything to compare to.  Both the frustration and determination existed in the same space. 

On the one hand, we had a more hands-on maternal infant experience, since we did not have to manage crowd control.  We had the opportunity to be participate in vaccine administration.  We have been a part of changes that will become permanent.  At the same time, we can grieve some of the experiences we missed out on.  These exist in the same space. 

And time continued anyway.  In the second week, I recall very clearly looking at the syllabi and thinking “my God, what have I done?”  As we started to delve into the material, there were places where we recognized the information was just something we needed to remember but there were also those spaces where the material had a face, reminding us of someone we knew and the information was real in visceral ways.  And eventually there were the names and faces of patients that made that information real all over again.  We started alone on Zoom islands and they steadily became archipelagos.    

We all first met in person a week before second term for a skills day.  My favorite part was realizing how tall people were and whether that fit with the mental image I had of them.  This last term, the water between the islands dried up and we were together.  It required some new logistics, but I found it to be cathartic, one last hurrah together. 

That continued tenacity has brought us through—I won’t say unscathed, because we all might burn a little sage when we uninstall examsoft—but we have the foundation to ease into a more apprenticeship phase.  Whether we face our new opportunities with imposter syndrome or find the journey with that sense of coming home, we are all ready for that next step, for that new sense of becoming in our true skin—these can exist in the same spaces, too. 

Families and friends, you have loved us through these places, and you’ve been supportive of us when we were caught on mountains of doubt, even in some places you were low-key terrified of what we were learning.  This has meant some repriortization and hard conversations in different places. Where we go from here will be as unique as the contexts we brought in with us.  We have met people that we will carry with us; we have people that we are exceedingly grateful to never be in a group project with EVER AGAIN; and at least this is the last time some of ya’ll will have to listen to my voice. 

Reflecting on this journey and journeys to come, I want to share a paraphrased quote that has become important to me when processing major events.  “Ten spears go to battle.  Nine shatter.  Did the war forge the one that remained?  No.  The war only revealed the one that would not break.”

I wish you all well in your future battles and in your further discovery of self in those places.  I wish you a well-deserved rest and those that love you a contented pride.  And most of all, I wish you good health.  Congratulations on your accomplishment.  Any questions?

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Return of the Blog

AHHHHH!  After [fifteen months] I'm free [from nursing school]!  It's time to conquer [the NCLEX]!

Well, it kind of feels like that.  It's finals week, and we're celebrating the homestretch.  And, yes, it's starting to also feel pretty real.  

My post-it to-do lists started dwindling.  The chapters left to read did not have new ones added.  I've shelled out a chunk of money for my licensure testing.  And now I'm trying to figure out what to do with the sudden shift of everything.  For example, I can binge watch a show without feeling guilty about avoiding my classwork.  ...And then I felt pretty terrified, because I still find blank space rather triggering, putting me back into mental spaces where I was immobilized due to illness.  So I started writing a list of things that I was looking forward to, mixed with some tasks that simply needed doing.

• Reading...FOR FUN
• Drawing a new family portrait in charcoal
• Fun doodling on my Surface and/or resuming Bob Ross Parties
• Fix the drywall hole in our closet
• Finishing up the last few pieces of our bathroom project
• Remember what a workout schedule is, particularly if it can involve a pool
• Get a semi-regular walking schedule with Luna
• Prep for the NCLEX
• Hanging with some good friends this weekend :D
• Getting a tattoo :D
• Getting some good catch-up conversations started

I'm also picking up several tech shifts, to absorb everything that I possibly can.  Every shift I am picking up something new, whether it's the minutia of things that must be done but cannot be well-articulated in a welcome packet or a helpful trick that someone has cultivated over years of practice.  And I get to start thinking about some of those next things.  At the same time, I have a lot of processing to do on some of what they hell just happened.  

It's good to be back. 

Peterson Family Update, #5902908 Gamma (Hiatus Announcement)

 It's that time again:  Deploy the Bulleted List!

• I've been gone between class, clinical, and work enough that Luna sees me as a novelty and/or rare commodity when I'm home.  As such, there is much moping in my office (so I'm told) or she is my little red shadow when I'm home.  
  

• I have enjoyed being in person with my peers more than I had thought.  The random side conversations, the friendly waves, the occasional shared "WTF" expression from across the room, it's...nice.  Maybe that's the extravert in me.  I was content learning from home, but there is something about a classroom that feels different.  I am, however, burnt out on group projects.  
• Simultaneously, there are a lot of extra logistics in going to class on campus--parking, allotting enough time to walk to the building, packing a lunch, ensuring that Luna gets out in the morning, etc.  The needs are different.  The balance is different.  Also, now that I have places to go, I've been having fun rediscovering some of my favorite parts of my closet. 
• Had a patient in one of my clinicals that was a level of confused--even when they were threatening to throw their water at me or were actively yelling at me to get out, I didn't have any kind of "I can't do this profession" kinds of thoughts, which I think is a good sign.  I am learning so much as a CNA and it's definitely taking huge chunks out of the impending imposter syndrome as a nurse by furthering my independence and confidence now.
• One of my favorite things to do both in working and in clinicals is asking people what their "secret move" is.  Everyone seems to have some trick that they have picked up or a technique that they developed along the way, some special way of approaching a problem that makes things easier.  I've learned a lot of helpful things and allowed different folks to share their own expertise.  
• Some of my peers at the hospital have been noticing my particular patterns of expression.  Lately, this means I was teased for saying that someone's IV was "deedling" rather than "beeping," which I felt was still clear from the context clues.  Oh, that will be just the tip of the iceberg for weird phrasings from me.
• Had our first roadtrip since the pandemic started to attend Josh and Morgan's wedding--a delightful day to share with some lovely folk.  Congrats, you two!
• Random project toward my own random learning--I have learned how to draw winged eyeliner and the effect is quite fun. Also have been practicing how to do a Dutch braid now that I feel pretty confident on a French braid, because random things are always fun to learn. 
• Had a dream the other day that one of my patients was a penguin.  Spent most of the dream trying to find out how to properly put the heart monitor pads on him, while he held his wings out so patiently.
• Andy has been doing a LOT of work leveling out the lawn--the backyard looks much different than it did last year.  
• I saw an owl in our magnolia tree this week.  For reals.  
  

• Andy has been doing videogame streaming every Saturday and Sunday morning!  My favorite parts are definitely the panicked squawks when he misses a ledge or has a surprise enemy pop up.  Please, check him out on Twitch or on YouTube whether you're able to watch the livestream itself or revisit the videos later.  
• I am having a hard time keeping up with everything right now--last week, I was very activated in my depression/anxiety/PTSD wombo-combo, between a number of different factors.  As such, I'm pulling back on things that can be pulled back to help reestablish some balance:  I am officially putting my blog on hiatus for the first time.  I have every intent to start it again once nursing school is over, and I may even sneak in a couple more updates here and there, but I am taking away the pressure of a schedule.  

Homestretch, Homeslice

So, yes, I've been a wee bit behind on blog posts, hence the void last week.  The summer is here with a roaring presence, and I'm keeping up well with most places, yet specifically I haven't honed down any kind of writing schedule.  

Okay, so that's not entirely true.  I've had space to write.  I've had ideas on what to write.  But there's been something lately about staring at the expanse of blank, white page.  

And in the end, there are a lot of words happening but none that solidify on paper.  It's a buzzing sound when I sit down to pour it out, sometimes because there are too many words or because I don't know how to isolate them.  Or maybe there is that deafening silence, which then I feel the need to fill with something else--that's the space where I have the TV, my computer, and my cell phone all going at once in some capacity.  

Too many things happening at once, poor writing hygiene, adjusting to a new schedule and its obligations, it's all an excellent list of excuses.  But it's also what is real to me in the moment.  

We're in the last stretches.  The pressure is there, but the excitement is too.  It's just a matter of time and taking one task and then another until we've completed this goal.  A goal that I've been working on for about three years, all told.  And there's a lot of processing to do there, working through these adjustments.  

That means there maybe some shorter posts in the meanwhile and a few more gaps before the end.  But we'll get there.

Kinds of Tired

• That particular kind of tired when you've been on your feet and moving for twelve hours.
• The kind of tired from waking up after a depression nap somehow more tired than before.
• The feeling of running on empty for too many weeks in a row.
• Being "peopled out."
• Feeling unappreciated.
• Waiting to have an uncomfortable conversation with someone.
• When your brain is exhausted.
• The straight-up bad night of sleep.
• My dreams were too "busy" last night.
• Company politics are being stupid again.
• National politics are being stupid again.
• Active waiting or hoping.
• Something interrupted rest and there was no returning in a timely manner.
• When you've given more emotion than you had.
• When everything is everything all at once.  
• When you realize you haven't allowed yourself to be still in far too long.
• Having done absolutely nothing productive all day.
• Having done absolutely nothing productive all day and feeling guilty about it.
• Anticipatory tired.
• When your heart full.
• Exhaustion by a thousand cuts.  
• The satisfying workout.
• Waking up on a rainy morning.
• "Ordinary" physical exhaustion.
• The "I didn't even realize I was this exhausted," sneaky tired.
• Tired because of a flash of anger.  
• The particular space where you would like a short pause from existing just for a couple hours.
• That feeling when pausing to assess or relax somehow makes you feel more tired.   
• The space where you do want to do anything in particular but you don't want to be doing nothing.
• When you want to write because you know it feels good to write and otherwise good to continue the habit but at the same time you cannot manage to find words together in any kind of sense because your brain doesn't feel like working that way today.

Wherever you mind find yourself in that list, I wish you the kind of rest you need.

Starting as a CNA

So, I have made a calculated risk and accepted working as a CNA while simultaneously finishing up my last term in my nursing program, before starting the nurse residency program after I pass my NCLEX.  While this will certainly increase my allostatic load during my final term, I'm incredibly excited to start getting experience, begin working with patients, fully understand the complexities of the role of a nurse tech, understand where to find hospital resources, iron out the "normal" mechanics like clocking in/out, and otherwise getting a true feel for Carle Bromenn as an employee rather than as a student.  Plus, I have my own locker where I can leave my hospital shoes at the hospital.  I also keep my emergency ostomy change there.

At this point, I've gone through all of my pre-shift trainings, the general "Welcome to our Organization!" meeting, and three official shifts with a coach.  Now I'm able to pick up shifts wherever I can pick them up, set free to fly solo.  It's already been quite the adventure!

Here are some of the things I've learned so far:

• Highlighters are hella useful, as I start to set up my own patterns for what I want to do in the day--specifically, my tasks as a CNA include vital signs, assisting to the bathroom (or cleaning up after), assisting with bathing and other hygiene activities, assisting with eating, changing the batteries on heart monitors, measuring blood sugar levels, and otherwise communicating with the nurse for other needs.  Not everyone needs all of these tasks (aside from vital signs).  So I spend the first few minutes gathering my bearings on who might need what over the course of the day.  I don't have a complete system yet, so I'm starting to play with color coding, at least starting the day cleanly.  
• My organization system usually collapses by 1300, as situations change or patients are either added or discharged.  This is part of the process, rolling with the punches.
• Ingenuity is an essential skill.  Need to cover someone's IV before they go into the shower?  Find a plastic bag and some tape and get creative.  Only able to find one "leg" for the wheelchair?  Find another to steal or get creative.  Confused, fall-risk patient not inclined to stay in bed?  Have them help fold towels (and then refold after you accidently move them) or print out some crosswords or get creative.  There isn't always a band-aid that fits perfectly; every patient is their own person; the situation is going to keep changing.
• I get a LOT of steps in on the day, moving from one piece to the next to the next, more even than my clinical days as a nurse.  So far, I've left each of these days (twelve hour shifts, mind you) on the floor physically tired but spiritually very full.
  

  
  

• I'm ironing out parts of my script, trying to find what questions I should ask everyone in the first interaction to set the tone for my day.  I've already given up the idea of trying to decide which patient I see first, because inevitably someone has already called for my assistance and they are now my starting point, often followed by another call as my second person, and otherwise fitting all of my other pieces in as I go until I've seen everyone.  
• I delight in those moments where I can stop and listen to someone that clearly needs to feel heard.  I can't do this all the time--sometimes my phone will not stop going off when I'm trying to help one patient to the bathroom, and I have three other rooms that have asked for my attention after that.  But sometimes, there are spaces where I can linger and have those human moments.  I cannot be all things to all people; but I will have the opportunity to be different things in some of those in-betweens.  And in places where I cannot show empathy in a long listen, I can still set their arm down with a gentle touch and smile with meaning as I thank them for allowing me to take their temperature.  
• On a different note, I swear I have sweat off about a pound so far working in some of the isolation rooms--in the plastic gown over my scrubs, incubating in my own heat with the added movement, it gets toasty quickly.  
• Sometimes I forget about Melvin in the bustle of everything.  And sometimes, Melvin helps me remember to stop, take care of the bag, pee, and get some water, just another small but insistent reminder to pause and tend to myself, too.  
• I'm starting to network with some of my teammates--when I can grab something for one of the other techs or I follow-up with a nurse when I said I would do so, I'm establishing myself as part of the team a bit at a time and also making space for that reciprocity already and in the future.  I feel that I'm contributing.

So, yes, I've dealt with pee, poop, sputum, blood, and whatever else already.  I've talked with patients who were counting the seconds until I left the room.  And I'm finding purposeful, meaningful work.  I know that once courses kick up for the condensed summer term and all of the different clinicals therein, it's going to be a very busy period of time, but I'm also excited and ready for that final stretch of the endurance race.  

And I'm sure there will be many more stories along the way.