SO. I wouldn't normally blog about the negative things that happen in my life, but what is life without a few set-backs? I can't paint a rosy picture for you all and pretend that I haven't encountered a few bumps (or ditches) along the way, and I feel like it's semi-therapeutic to share my experiences. Helps me to learn and grow. And most importantly, to move forward. Nothing worse than over-thinking situations and letting them stew... it only compounds the issue and prevents progression. Which is why I feel it necessary to get this out, and then I can hold myself more accountable and motivate myself to press on....
Last week in my clinical rotation, we started on a new unit - Postpartum. Most people immediately think "Postpartum = depressed patients" but this is not the case! Postpartum is the term used to describe the unit that cares for moms and their babies after they have delivered. Most patients are on the unit for 2-4 days, depending on the type of delivery (vaginal vs c-section) and related complications or concerns. This is a much different environment than L&D... slower paced, more monitoring and basic nursing care (comfort measures) and routine assessments. It was a big adjustment, both in activity level and what we were focusing our attention on. I was assigned a patient who was stable and fairly knowledgeable with the expectations in postpartum following her c-section, and her husband was a great support - he was an RN so he was also watching for any concerning signs or symptoms to alert us. It made my first couple days a little more relaxed, but looking back, that probably wasn't the ideal first postpartum patient experience for me. I've figured out how I learn best - hands on, in the moment, addressing issues as they are presented and processing through their implications. It's much harder for me to take information from the book or lecture and apply it without prior exposure to the situation. So.. on Friday, I had my midterm evaluation with my clinical instructor, and she brought up some concerns she had with my prioritizing and care of my patient, mostly related to my ability to assess my patient as a whole and think critically regarding any and all issues that might be of concern to us while she is under our care in the hospital. In my defense, it was only my first couple days and I hadn't had any prior experience in postpartum so I wasn't well-versed on the major concerns and issues of that unit, but she did have a point. And it really knocked some sense into me. Yes, I finally had my break-down and a good cry in the nurse's lounge, it was bound to happen, but most of all I was grateful. My instructor took the time to point out areas where I need to improve, and if I have any desire to be the best nurse I can be, I must be willing to hear feedback and then (most importantly) apply it to my practice. It wasn't so much a smack in the face as it was a wake-up call. I have been doing quite well in this program, and I haven't had anyone challenge me to work harder to reach my potential. My last rotation in Psych was not a great indicator of what is to be expected of us as nursing students - I lowered my expectations of myself and my work ethic suffered. I sunk back into old habits and wasn't focused on the bigger picture - that what I am learning here and how I choose to practice will translate into my work as a nurse. If I don't learn how to effectively care for my patients in this environment, how can I expect myself to perform with confidence as an RN? So I made that clear to my instructor - we may only have 2 weeks left of clinical in postpartum, but I have committed to myself and to her to extend myself beyond my comfort zone and push myself to think outside the box and care for my patients accordingly. I also explained to her how I can learn best in the clinical environment and asked her to help me by challenging me to look past what is in front of me and consider alternative explanations for any values or assessments that I might come across. So although I might have been disappointed in myself and the level of effort I had been putting forth, I was grateful that I had this chance to take a very critical look at my performance in order to make necessary adjustments. It's so much harder (near impossible, I believe) to grow and progress if you don't have someone pointing out areas where you can improve. Self-evaluation can only go so far.... outside input is what really drives change. Yeah, it was hard to hear... but now I am motivated to live up to my potential, because I know I am capable of so much more than this!! And with that said... only a few more weeks left in this semester to finish strong, then it's holiday break! THEN will be my time to relax and breathe. Hard to believe that Thanksgiving is next week... ahh don't even get me started!
I also have a little bit of an update: I've expressed how interested I have become in L&D, but it has become a recent decision to pursue a career in that field. I haven't been so sure of a decision for a while... I know the Lord is guiding me and nudging me along, and He has helped me to realize how passionate I am about this specific environment in medicine. Yes, I love working with teenagers, and maybe I can adapt my work to include care for teenagers in the future, but I feel like I have found my calling - as a nurse midwife! It's going to be a long process, but I am eager and excited about the road ahead of me. It's been a long time since I've really been excited about what I am working towards... reminds me of when I first started nursing school. Now that I realize what I want to pursue, it makes preparation so much more enjoyable. I love studying about the aspects of women's health related to pregnancy, so much that I am slightly overwhelming my schedule next semester so that I can take a class to learn about caring for the neonate. I know my life outside school is going to be non-existent come January, but it will be worth it! I am actually much more productive when I have a busy schedule... pressure to get things done, and helps me keep school at the front of my mind. Besides, winter in Baltimore probably won't be so pleasant... I'll be stuck inside anyways, might make the most of it right? haha. Not so excited about that. But this will be my last classroom-intensive semester of school! How did it go by so quickly...? I'm almost half-way there! Yikes. With that said, I need to go get my study on... had a wonderful past weekend escape to New York City with Amanda, just relaxing and enjoying our time together with our friends up there. Much-needed time to refocus and get back on track. So let's start this week off right.... and if I don't get on here before next Thursday, HAPPY TURKEY DAY!! Wish all of you an enjoyable holiday with your families, and of course, enjoy the pumpkin pie....
Monday, November 16, 2009
Sunday, November 1, 2009
season of change...
It has truly shifted to fall here in Baltimore... green trees have given way to beautiful shades of amber, gold, and crimson dotting the surrounding mountains. I have loved driving the winding back roads of the Maryland country side just to take advantage of the natural beauty of this region. I feel so blessed.. I love seasons! Not sure how prepared I am for the winter that is sure to follow this mediocre fall weather, but it's coming whether or not I am ready for it! So I am trying to enjoy all that this season has to offer, including the start of the holiday season. Yesterday was Halloween, and it was (albeit rainy and cold) an enjoyable evening and celebration in Charm City (aka B-more). Amanda and I were able to make our way out to the cobblestone streets of Fells Point (my neighborhood) for the festivities last night, and it drew out quite the eclectic crowd! We mainly enjoyed the opportunity to people-watch, as there were plenty of costumes to gawk at.... people never cease to amaze me! I dressed up as a ladybug and Amanda as a bumble bee - we were quite the twosome, and were proud of how classy and cute our costumes turned out to be! My high heels were not the most favorable shoes for the cobblestone streets however... I was grateful that I didn't injure myself as a result of walking the streets - I'm positive that there was some unfortunate girl who woke up with an ankle swollen two sizes this morning. We called it an early night, after a very long week and I was very appreciative of the extra time to sleep - the only reason I like the end of Daylight Savings Time! Now I have early darkness to look forward too... it's only 5 pm as I am writing this, and it's already dark outside! Oh winter, how I loathe thee..... at least I have holidays to look forward to! Only a few more weeks and I'll be on a plane back to Utah for Thanksgiving... I can't wait!! Maybe get some snowboarding in if I'm lucky.... but until then, I have plenty to focus on and worry about with school, which has been keeping me very busy over the past couple weeks! I'm sure you're eager to hear about my recent adventures, so without any further adieu....
The past couple weeks have been quite the whirlwind, to say the least! I'm sure you're eager to hear about how my transition has been into the Labor & Delivery clinical... I really don't even know where to begin! We started our new rotation last Thursday, and I remember the feelings of anxiousness and nervousness as I walked onto the unit for the first time... I had been in Psych for 7 weeks, never seeing an IV stand or Foley catheter, so imagine my nervousness when our instructor informed us that we needed to be prepared for these skills when we were assigned patients on Friday! I was hoping that I would remember the steps and how to maintain a sterile field... just picturing opening up a catheter kit and then having my patient kick it off the bed in the middle of a contraction. Okay, so I knew that probably wouldn't happen, but I was still picturing the worst. The field of L&D seems so unknown to me, and I was unsure of how my presence in the room would affect the experience for the new mother and her family, and I felt a load of pressure on me! Our instructor gave us clear instructions on what to expect and how we needed to prepare in order to participate in nursing care of our laboring patients, and I was a tad bit overwhelmed. I think not having a clear understanding of the labor process really affected my outlook, so I made sure to study that night in order to better prepare for what was to come on Friday morning. Unfortunately... nothing in a book can adequately depict the environment that you're thrown into as a nurse for a laboring patient! So, as we walked into the unit on Friday, I was caught a bit off-guard as our instructor threw a few of us into our patient's rooms first thing! No orientation? No warm-up period? I got report on my patient - gravida 1, parity 0000 (her first pregnancy) who had gone into labor the day before and had an epidural started early that morning so she was resting comfortably. I walked into the darkened room and introduced myself... the girl was sleeping with her mother sitting at her side and the baby's father sleeping on the couch. I sat off to the side, quietly observing the monitors and the patterns of contractions and the fetal heart rate (FHR) on the print-out strip, trying to apply the material I had looked at the night before to the real-life scenario playing out right in front of me. For a while, I sat in pure awe - medical technology never ceases to amaze me. I could watch a computer monitor and follow the tracing of contractions and how it affected the baby's heart rate. Incredible. Such simple things... but it made me realize how grateful I am to live in a country where such technology is so standard. I spent the morning monitoring my patient and her baby, and was grateful that the nurse had time to share some insight into the foreign language of L&D. Thankfully (for me) my patient was progressing through her labor quite slowly, and so there weren't many changes to her status other than the constant progression of her cervical dilation and effacement. I was hoping for a delivery, but was a tad grateful that I had another week to better prepare myself for the delivery atmosphere. One of the girls in my group was able to participate in a delivery that day, and hearing about her experience gave me a better understanding of what to expect and how to be of assistance in that situation. However, as much as I read up and prepared for the scenario in which I would undoubtedly be witness to, nothing can prepare better than first-hand experience. With that said, I'm sure you can guess where this is going... :] This past Thursday, I was put into my patient's room, her third pregnancy and she was 6 cm dilated, 80% effaced. Her husband and mother were in the room, and I introduced myself and learned that they were an Orthodox Jewish family, which I was completely unfamiliar with, when it comes to traditional expectations. I tried to be as supportive as possible, but gave them their privacy to prepare for the arrival of their son/daughter - they had left it as a surprise! I stood outside at the nurse's station, monitoring the FHR and contraction pattern from the screens, and had the opportunity to observe the staff as they busied themselves about the unit. As I stood there, amidst the flurry of nurses and anesthesiologists and OB physicians, I started to picture myself in that environment - and I really felt a sense of belonging. I really enjoy the atmosphere of L&D, and the role that the nurse plays in the patient care, so much so that I am giving it serious consideration as a possible field to work in! Getting a master's degree and becoming a Certified Nurse Midwife... I could really enjoy that position and responsibility. I'm still keeping my eyes and options open, but that is one path I NEVER expected to consider pursuing. So I'll keep you updated on that! But back to my patient... unfortunately, my patient's husband was a bit on the over-involved side, and every time I came in the room he pressured me for information about ever flashing light and beeping monitor, wondering if there was anything wrong with his wife or the baby. I kept reassuring him that everything was progressing as it should and that there was no reason to be concerned, and he was grateful for that. I found out later that one of the physicians had told him that the baby should be delivered by 5 or 6 in the morning, and now it was closing in on 11, so he was worried that the labor was taking longer than it should. Thankfully my instructor was there to provide some reassurance and inform him that he had no reason to worry, that baby and mom were doing just fine. I was grateful for that! Because her labor was not progressing as they would like, the doctors started her on Pitocin and hoped that her contractions would develop into a more regular pattern (they were only 5-7 minutes apart, lasting 50-90 seconds) and decided to grab some food while I was waiting. I didn't have much time to wait... I heard that there was some commotion coming from my room, and I rushed back to my patient's side (literally - her husband was waiting outside) and helped her through the (relatively) quick delivery of her son! It was a "beautiful" experience... it all happened so quickly (she delivered about 20 minutes after she reached full dilation) and I was there, a part of the entire process. Her baby was delivered, 8 lbs 8 oz with a full head of hair and some mighty powerful lungs! He wouldn't stop wailing for about 45 minutes after he was delivered, and he made it very difficult for us to clean him up and administer his medications. But I did it - I gave my first shot and took his vitals and was able to do a quick assessment before handing him back over to mom. It was a rush - it took me a while to really process the entire experience, but I felt so grateful to have been a part of it. Words can't adequately describe the emotion and feeling of being present for the delivery of a new spirit into this world... I can't imagine what it will be like when I have children of my own! All in all, it was a fantastic first birthing experience, and I am really interested in the option of becoming a nurse midwife... we'll see how things go over the next few weeks! As for Friday, without going into a long, detailed description of my clinical day, I will say that the OB wing of the hospital is never boring... I spent the morning in the NICU, assisting with the care of the premature infants and those with congenital problems - I have definitely ruled that unit out! The little babies, as cute as they were, frighten me.. any little change in their status or care can have such dramatic effects on their health. It is a very quiet and controlled environment... I like the action of the L&D unit. Speaking of... as I was returning to the unit from the NICU, I was rushed into the first room to help care for a woman who had delivered her baby in the hallway after arriving on the ambulance! The paramedics stood by in a state of shock after what they had just witnessed, and I pushed through to help care for the baby. The doctors and nurses worked to treat the mom, and I focused on baby. Thankfully the little baby girl was healthy and happy - 8lbs 10oz! I guess she was just ready to see the world... couldn't wait until her due date in a couple weeks! Mom said it was her fourth child, and she had just started labor a few hours earlier. Wouldn't that be nice... one minute you're waking up for the day, next you're arriving at the hospital for the delivery of your daughter! It was an exciting mash of people in and out of the room, everything in order and treated as need be treated. I was able to give the baby girl her meds and assess her vitals before handing her back over to a somewhat disillusioned mom... I think she was still in a state of shock. haha. In the end, mom and baby were just fine, and I left them to rest after a very exhausting morning. What a couple days! Never a truly dull moment... even in the quiet, the constant FHR monitor sounds of the baby's heart beat remind you of what you're caring for, and it is a special role to play. We'll see how the coming weeks turn out... I feel lucky to have been a part of two deliveries, as some girls in my group haven't seen one yet! I'm hoping to be able to follow a patient to the OR for a C-section, but I don't know if that will happen... we haven't had a patient go into the OR yet during our clinical hours. I still have some time left though! It may be November, but we are only a couple weeks into our 6-week OB rotation (three of which will be spent in postpartum). I can only imagine what the coming weeks have in store for me...
Wow. This has been quite the entry! I guess I am just really excited about the experiences that I've had over the past couple weeks... I feel like I'm still processing what I was a part of. So much left to learn! I feel like I've only reached the tip of the iceberg... but I'm loving the progression and acquisition of knowledge. It is a fascinating environment, and I'm realizing more and more how much I enjoy being a part of a specialized focus, so I'm trying to learn more about this field and my available options and opportunities. I will make sure to keep you updated! But for now, I have to get back to my Pharm studying... test #3 this week, and then I have to write up my L&D care plan for my patient... it's going to be a LONG and busy week... but I can't begin to tell you how grateful I am that I am not dreading the work I will have to contribute! How pleasantly reassuring it is to find my niche, and discover my individuality and independence in this oftentimes overwhelming environment. I am just grateful that I have been blessed with a passion for this type of service, and look forward to my future... it won't be long now... 9 more months and I'll be an RN! And with that, I'll leave you until next time.. happy start of the holiday season to you all!!
The past couple weeks have been quite the whirlwind, to say the least! I'm sure you're eager to hear about how my transition has been into the Labor & Delivery clinical... I really don't even know where to begin! We started our new rotation last Thursday, and I remember the feelings of anxiousness and nervousness as I walked onto the unit for the first time... I had been in Psych for 7 weeks, never seeing an IV stand or Foley catheter, so imagine my nervousness when our instructor informed us that we needed to be prepared for these skills when we were assigned patients on Friday! I was hoping that I would remember the steps and how to maintain a sterile field... just picturing opening up a catheter kit and then having my patient kick it off the bed in the middle of a contraction. Okay, so I knew that probably wouldn't happen, but I was still picturing the worst. The field of L&D seems so unknown to me, and I was unsure of how my presence in the room would affect the experience for the new mother and her family, and I felt a load of pressure on me! Our instructor gave us clear instructions on what to expect and how we needed to prepare in order to participate in nursing care of our laboring patients, and I was a tad bit overwhelmed. I think not having a clear understanding of the labor process really affected my outlook, so I made sure to study that night in order to better prepare for what was to come on Friday morning. Unfortunately... nothing in a book can adequately depict the environment that you're thrown into as a nurse for a laboring patient! So, as we walked into the unit on Friday, I was caught a bit off-guard as our instructor threw a few of us into our patient's rooms first thing! No orientation? No warm-up period? I got report on my patient - gravida 1, parity 0000 (her first pregnancy) who had gone into labor the day before and had an epidural started early that morning so she was resting comfortably. I walked into the darkened room and introduced myself... the girl was sleeping with her mother sitting at her side and the baby's father sleeping on the couch. I sat off to the side, quietly observing the monitors and the patterns of contractions and the fetal heart rate (FHR) on the print-out strip, trying to apply the material I had looked at the night before to the real-life scenario playing out right in front of me. For a while, I sat in pure awe - medical technology never ceases to amaze me. I could watch a computer monitor and follow the tracing of contractions and how it affected the baby's heart rate. Incredible. Such simple things... but it made me realize how grateful I am to live in a country where such technology is so standard. I spent the morning monitoring my patient and her baby, and was grateful that the nurse had time to share some insight into the foreign language of L&D. Thankfully (for me) my patient was progressing through her labor quite slowly, and so there weren't many changes to her status other than the constant progression of her cervical dilation and effacement. I was hoping for a delivery, but was a tad grateful that I had another week to better prepare myself for the delivery atmosphere. One of the girls in my group was able to participate in a delivery that day, and hearing about her experience gave me a better understanding of what to expect and how to be of assistance in that situation. However, as much as I read up and prepared for the scenario in which I would undoubtedly be witness to, nothing can prepare better than first-hand experience. With that said, I'm sure you can guess where this is going... :] This past Thursday, I was put into my patient's room, her third pregnancy and she was 6 cm dilated, 80% effaced. Her husband and mother were in the room, and I introduced myself and learned that they were an Orthodox Jewish family, which I was completely unfamiliar with, when it comes to traditional expectations. I tried to be as supportive as possible, but gave them their privacy to prepare for the arrival of their son/daughter - they had left it as a surprise! I stood outside at the nurse's station, monitoring the FHR and contraction pattern from the screens, and had the opportunity to observe the staff as they busied themselves about the unit. As I stood there, amidst the flurry of nurses and anesthesiologists and OB physicians, I started to picture myself in that environment - and I really felt a sense of belonging. I really enjoy the atmosphere of L&D, and the role that the nurse plays in the patient care, so much so that I am giving it serious consideration as a possible field to work in! Getting a master's degree and becoming a Certified Nurse Midwife... I could really enjoy that position and responsibility. I'm still keeping my eyes and options open, but that is one path I NEVER expected to consider pursuing. So I'll keep you updated on that! But back to my patient... unfortunately, my patient's husband was a bit on the over-involved side, and every time I came in the room he pressured me for information about ever flashing light and beeping monitor, wondering if there was anything wrong with his wife or the baby. I kept reassuring him that everything was progressing as it should and that there was no reason to be concerned, and he was grateful for that. I found out later that one of the physicians had told him that the baby should be delivered by 5 or 6 in the morning, and now it was closing in on 11, so he was worried that the labor was taking longer than it should. Thankfully my instructor was there to provide some reassurance and inform him that he had no reason to worry, that baby and mom were doing just fine. I was grateful for that! Because her labor was not progressing as they would like, the doctors started her on Pitocin and hoped that her contractions would develop into a more regular pattern (they were only 5-7 minutes apart, lasting 50-90 seconds) and decided to grab some food while I was waiting. I didn't have much time to wait... I heard that there was some commotion coming from my room, and I rushed back to my patient's side (literally - her husband was waiting outside) and helped her through the (relatively) quick delivery of her son! It was a "beautiful" experience... it all happened so quickly (she delivered about 20 minutes after she reached full dilation) and I was there, a part of the entire process. Her baby was delivered, 8 lbs 8 oz with a full head of hair and some mighty powerful lungs! He wouldn't stop wailing for about 45 minutes after he was delivered, and he made it very difficult for us to clean him up and administer his medications. But I did it - I gave my first shot and took his vitals and was able to do a quick assessment before handing him back over to mom. It was a rush - it took me a while to really process the entire experience, but I felt so grateful to have been a part of it. Words can't adequately describe the emotion and feeling of being present for the delivery of a new spirit into this world... I can't imagine what it will be like when I have children of my own! All in all, it was a fantastic first birthing experience, and I am really interested in the option of becoming a nurse midwife... we'll see how things go over the next few weeks! As for Friday, without going into a long, detailed description of my clinical day, I will say that the OB wing of the hospital is never boring... I spent the morning in the NICU, assisting with the care of the premature infants and those with congenital problems - I have definitely ruled that unit out! The little babies, as cute as they were, frighten me.. any little change in their status or care can have such dramatic effects on their health. It is a very quiet and controlled environment... I like the action of the L&D unit. Speaking of... as I was returning to the unit from the NICU, I was rushed into the first room to help care for a woman who had delivered her baby in the hallway after arriving on the ambulance! The paramedics stood by in a state of shock after what they had just witnessed, and I pushed through to help care for the baby. The doctors and nurses worked to treat the mom, and I focused on baby. Thankfully the little baby girl was healthy and happy - 8lbs 10oz! I guess she was just ready to see the world... couldn't wait until her due date in a couple weeks! Mom said it was her fourth child, and she had just started labor a few hours earlier. Wouldn't that be nice... one minute you're waking up for the day, next you're arriving at the hospital for the delivery of your daughter! It was an exciting mash of people in and out of the room, everything in order and treated as need be treated. I was able to give the baby girl her meds and assess her vitals before handing her back over to a somewhat disillusioned mom... I think she was still in a state of shock. haha. In the end, mom and baby were just fine, and I left them to rest after a very exhausting morning. What a couple days! Never a truly dull moment... even in the quiet, the constant FHR monitor sounds of the baby's heart beat remind you of what you're caring for, and it is a special role to play. We'll see how the coming weeks turn out... I feel lucky to have been a part of two deliveries, as some girls in my group haven't seen one yet! I'm hoping to be able to follow a patient to the OR for a C-section, but I don't know if that will happen... we haven't had a patient go into the OR yet during our clinical hours. I still have some time left though! It may be November, but we are only a couple weeks into our 6-week OB rotation (three of which will be spent in postpartum). I can only imagine what the coming weeks have in store for me...
Wow. This has been quite the entry! I guess I am just really excited about the experiences that I've had over the past couple weeks... I feel like I'm still processing what I was a part of. So much left to learn! I feel like I've only reached the tip of the iceberg... but I'm loving the progression and acquisition of knowledge. It is a fascinating environment, and I'm realizing more and more how much I enjoy being a part of a specialized focus, so I'm trying to learn more about this field and my available options and opportunities. I will make sure to keep you updated! But for now, I have to get back to my Pharm studying... test #3 this week, and then I have to write up my L&D care plan for my patient... it's going to be a LONG and busy week... but I can't begin to tell you how grateful I am that I am not dreading the work I will have to contribute! How pleasantly reassuring it is to find my niche, and discover my individuality and independence in this oftentimes overwhelming environment. I am just grateful that I have been blessed with a passion for this type of service, and look forward to my future... it won't be long now... 9 more months and I'll be an RN! And with that, I'll leave you until next time.. happy start of the holiday season to you all!!
[New York City]
[Central Park]
[Yankee Stadium - after they beat the Angels to advance to the World Series!]
[Halloween bugs]
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