I find the longer this goes on, the more superstitious I become. I can hardly bear to speak of my predicament, lest I somehow give it power. Keeping up the positive energy to continue to send out resumes, each with a cover letter tailored specifically to the nurse manager and her facility, is becoming harder and harder. The interview at my former hospital was the only call I have received from nearly a hundred applications and resumes. Yes, I call to follow up. It is just that bad out there.
The only thing that makes me feel better is volunteering. In my role with the MRC, I’ve helped vaccinate half the county against H1N1 this Fall, and I spend twenty hours a week supervising the sorting and packing of donated medical supplies to overseas clinics. At least I get out of the house, and get to do things that feel like nursing.
I know I won’t be unemployed forever, but things are so dire right now it is hard to stay positive.
Nearly six months after I was laid off, I returned to my little community hospital to interview. My first interview as an RN, no less. It is not my first choice, but there are definite perks. First of all, it’s the devil I know. I enjoyed working there as an aide, and the familiarity will make transitioning to my new role much easier. The benefits are great, the hours are guaranteed, and there is a $10 an hour incentive for picking up extra shifts.
The position is on the acute neuro/ortho rehab floor, which would be fun. The average length of stay is between eight and ten days. I’d likely have the same patients for most of their stay, which will give me time to actually get to know my patients.
It’s an evening shift, 3-midnight, which is really nice, but going back to eight-hour shifts could suck. It’s really the only bad part. I just started volunteering with this really great agency that sends medical supplies and clinicians overseas, and I really want to be more involved with the Medical Reserve Corps.
I am in no place to be picky. New grads all over the country are unemployed. It’s a pretty crazy time.
Luckily the interview was just with HR. I’ve been out of work for six months, and away from nursing for almost four. I feel like I’m losing my mojo. I was kind of a spaz despite all the mental prep. But I have a second interview with the manager tomorrow, so I guess I didn’t totally crap out.
People who don’t want you to think are never your friends.
The following is a short essay I wrote for a reflective practice assignment way back in OB class:
I have friends who are med students. I work closely with doctors when I volunteer, and to a lesser extent as a tech in the hospital. I don’t think of a nurse’s relationship with doctors as adversarial or subservient, but collaborative. Until a doctor shows me he or she feels otherwise, in my mind we are colleagues. I know it is not quite the same in clinical, because there I am a student first, nurse second.
None the less, when the pediatrician failed to greet me with more than a cursory glance, I admit I bristled. My nurse, who had so far introduced to me to everyone as her “partner in crime,” also remained silent. I was about to introduce myself, but before I could even nod, Dr. M was addressing his patient.
He was not unkind, nor did he do or say anything particularly compassionate. He had to rupture her membranes and insert both a fetal monitor and intrauterine pressure catheter. While he and the nurse messed around with the equipment, I took the young woman’s hand and told her to breathe. She was still in a lot of discomfort throughout the procedure. Perhaps this is why, after he was done, he asked her if she wanted an epidural for the rest of her labor. Without hesitating, she said no.
“Why not?” he asked her. He sounded incredulous, at least to me. “You’re only dilated 3 centimeters. It’s going to be a long process.”
She didn’t reply, and he didn’t wait for her answer. He was out the door. My nurse followed behind, and I knew I was to go with her, but I couldn’t leave without saying anything. I’d like to say I weighed the pros and cons of speaking up as a student when my nurse had not, but really, all I thought about was the young woman in the bed, and how none of us had any idea why she didn’t want an epidural. I told the young woman that she shouldn’t let the doctor pressure her into an epidural.
“It’s always an option, but there are other pain meds available as well.” I said. “Just call the nurse if you want to talk about it.”
In retrospect, I would have asked her about her concerns, not in the patronizing way the pediatrician had, but in order to best care for her. Did she want a natural birth? Was she concerned about the drugs’ effects on her fetus? Was she afraid of the procedure itself?
Those are not the only questions I ask myself now. I also wonder what the doctor’s investment is in his patient having an epidural. He could simply want her to experience as little pain as possible. As a physician, he probably holds a lot of value in his ability to relieve pain. But isn’t it also easier to manage a patient with an epidural? This would seem to be more of an issue for the nurse, who is, after all, the one who is present for the majority of the labor. My nurse had not been involved in the conversation at all, and I hadn’t asked her about it.
One thing that I find interesting upon reflection is this: I am a huge proponent of pharmacological pain relief. There are so many myths about opiates that many patients who would truly benefit end up suffering. It was a little odd that I wasn’t more on the doctor’s side. Usually, when a patient refuses pain medications, I really investigate their concerns, with my goal being to alleviate those concerns so they will take their medicine.
On the floor where I will soon be working, the nursing staff follows Watson’s Carative Theory of Nursing. In reading more about this theory, I came across the following:
Essentially, respect is easily acquired until the person disagrees with your recommendations, at which point, respecting the other person’s choices can become more complex(Chantal, 2003).
This is an interesting perspective, because it gets right down to one of our most basic codes of ethics as nurses, respect for human dignity. Am I respecting someone’s dignity if I encourage narcotics when she has made it clear she doesn’t want anything until her pain is at a 9/10? I like to think I am providing teaching about how medications work best to relieve pain, but is this any different than this doctor?
The patient ended up receiving an epidural. I was attending another birth, so I missed how the final decision was made. In the future, I will be more cognizant about the way in which I speak to my own patients about their choices regarding pain relief.
The Board of Nursing met to decide my fate this morning. Their decision was just posted online: APPROVED! I am a real live Registered Nurse! Now I just need a job…
Despite an overwhelming feeling of entropy, quite a lot has happened in the last month. Jamey had his back surgery and is recovering well (at least physically but that is a whole nother post!). I finally sat for boards last Friday. The whole thing was rather anticlimactic considering the about of emphasis put on the test. I spend a decent amount of time studying the areas in which I was weak, namely Child Development and Obstetrics, in the week preceding, but the test itself had NO Peds or OB questions. Of the 75 questions, at least 60 were medication-related. The other 15 were either prioritizing/delegating care, or infection control. I was out in forty-five minutes.
Passing boards does not guarantee licensure in my case, of course. Because of my sordid past, my application must be reviewed by the Board of Nursing at their next meeting on the 19th. At this point it is out of my hands, so I don’t spend too much time freaking out about it.
While I wait I am taking advantage of my open schedule by helping with the H1N1 clinics at Public Health (next week we get to vaccinate the firefighters!), and trying to be more involved with the Grillo Health Information Center. Both Grillo and the Medical Reserve Corps are going through some pretty exciting changes, and I have been conspicuously absent the last few (okay, more like six) months. I really need to get back on the front lines.
As a well-spent day brings happy sleep, so a life well used brings happy death. ~Leonardo da Vinci
On October 16th, eight days after her mets were diagnosed, my aunt died . With the help of hospice, we were able to keep her comfortable until the end. She had a very good death. I was sure she would fight the process in the dramatic fashion that is typical among the women in my family, but I could not have been more wrong. I was not there, but her husband was at her side, and he told me that she after only a few minutes of labored breathing, my aunt simply gasped and was gone.
I found out last week that my Aunt is dying. What we thought was pain from a fractured rib turned out to be bone cancer. In the last month it has progressed from a single shadow on a bone scan to seven or eight large masses in her bones, liver, and lungs. Because aggressive treatment would only extend her life by a few months, the oncologist recommended palliative care.
Thankfully I am between jobs for at least another month, because I am spending as much time as possible supporting my Uncle and Aunt during my Aunt’s dying process. Hospice is, of course, amazing. Within hours of the intake interview, the nurse had a hospital bed with a pressure-relieving air mattress, an O2 condenser, and other medical supplies arriving at the door. When my Aunt’s pain was bad, a nurse was here at ten o’clock at night to get her comfortable.
My Aunt has only weeks at this point. She no longer eats or drinks, and she sleeps most of the time now. But she is comfortable, and wakes briefly to her name. After that first night, she is no longer in any pain.
All her adult children came to see her last weekend. It was pretty agonizing; even though last years strokes left her with cognitive deficits, my Aunt was pretty stable until a few weeks ago. As recently as Saturday, she was able to get out of bed (with maximum assistance) and sit in the living room with her children, but she hasn’t been out of bed since Sunday.
Yesterday several of her friends stopped by, and she woke enough to smile and tell them she loved them. Even so close to death, she was able to make each of them feel special and loved. Today she is less responsive. She opened her eyes and smiled at me, but she hasn’t spoken to anyone today.
I keep myself distracted by cleaning the house, which hasn’t been done well since my aunt’s stroke. I cook for my uncle. I study (a little) for next week’s NCLEX. I am able to keep her clean and comfortable–I bathe her in bed, give her morphine around-the-clock, and read to her as she sleeps–but most of the time here is spend oscillating between boredom and despair.
I saw a guy I thought looked like Jesus. Then I got closer to him and he turned into Jim Morrison. I got even closer and he turned into Charles Manson. I was going to ask him if he was Jesus, but then I saw his Charlie Manson eyes, and I thought:
There is no way I’m going to ask that guy!
I finally got down to the board of nursing to find out why my application was taking so long to process. They informed me that they needed some more information regarding my background. This is fine, except that there is no indication anyone ever planned to let me know what they needed. If I hadn’t gone down there, my application would have sat there forever. The “specialist” authorized my test right there, but the application must be referred to the board for review. Again, no problem, except I missed the deadline to get on this month’s agenda (by five days), so my application won’t be reviewed until November 19th. I turned my application in on the 1st of September, but the BON staff didn’t receive it until the 29th.The earliest I will get my liscense now is 25th of November.
Serenity Now!!
The most frustrating part is that the new grad program I was hoping to get into starts November 16th. So I must move on to Plan B: get a job as a Nurse Intern until the end of the year, and try for the next NGP. This, of course, sets our plans to move to Amarillo back as much as a year. Grrr…
