Success is preparation, perspiration, and inspiration

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So it goes that I am so very near the end of my graduate school journey (at least for this leg of it—more on that in a bit) and the step after graduation includes certification.  That means testing. A big 3.5 or 4-hour test.  Depending on which certification board I choose I will be sitting at a computer (oh the horror!) for that length of time to assess if I have the very basic competency to be safe as a Family Nurse Practitioner. My emotions regarding this are all over the place. I am thrilled that I am reaching a goal. I am terrified that I have too little of an idea of what I’m doing. (I’m told this is normal and good.)  That fear is what motivates me to take any opportunity available to do more, do better, be my best.

One tool in my arsenal of study included a live review provided by Fitzgerald Health Education Associates, Inc. There are other companies providing this service such as Hollier, or Leik.  I have no incentive to plug one over the other and I know little of the latter two. I selected Fitzgerald because it was the first one I heard of and a Family Nurse Practitioner I work with recommended it. Additionally, I was gifted the materials my friend used for her boards and found it works for my learning and study styles.  Margaret Fitzgerald is an excellent facilitator as I learned through listening to the 2013 CDs.  Those primed me for my clinical practice and helped to gear my clinical decision making. Solidifying this practice-specific knowledge allowed me to hone my understanding of assessment, diagnosis, planning, intervention, and evaluation.

Hang on. ADPIE. I thought that was for just RNs. Pshaw! While the order is the same, as advanced practice nurses, this scientific-method based approach is still valuable. The nuances of change are related to the higher level of knowledge and responsibility my new role will entail. These are not nursing diagnoses and interventions. NANDA need not apply. What this process also aligns with is the SOAP format. That “medical” model is necessary to get to the end point and determine the direction of plan of care. Furthermore, as NPs, the vast majority of us will have a collaborating physician.  As that is the model they know, presenting your patient to them if you need to will be straight-forward and not a nurse-report format. Trust me. Out of 8 different preceptors, only three didn’t care how I presented it. It was crucial to be able to say succinctly (with the SOAP format) the presenting complaint and history of it, the physical assessment, my differentials, and then plan.

Back to the review: I attended a live seminar that was an intensive two-and-a-half day affair. Brett Snodgrass, NP is a dynamic and entertaining speaker who reinforced knowledge learned, assisted in guiding us to our areas of weakness, and I could tell not only was she experienced in her own right, she follows the Fitzgerald model to a T. (As compared to the 2013 CDs…the content was almost the same with the differences being updates on guidelines and evidence-based practice.) I gotta say, I came away from that exhausting and exhilarating weekend all the better for it.  My first day home was the first day of my last rotation and darn if those concepts didn’t pop right out into my practice. I was amazed at how concrete some of those guidelines were. I could tell a difference in my approach from a year ago. This preceptor had me for my first rotation and I suspect he sees the growth, too. (So much so that he hinted at needing an NP soon, would I think about it?)

The supplemental certification exam text that I purchased is eagerly awaiting my use. I know it will only further improve my knowledge base and get me that much closer to my goal. Once I meet that I can work on leaving the ranks of Novice toward beginner. Then more graduate school! A DNP is in my future, but I have other fish to fry in the mean time.

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Nurse Practitioner-to-be Despite the Fracas decrying our benefit

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https://www.linkedin.com/pulse/what-can-we-do-preceptor-shortage-nurse-practitioner-students-lynn

I’m reading the above article which bemoans the quality of NPs being churned out by mediocre or poorer quality schools. It further implies that schools requiring students to set up their own preceptorships feeds this inequality. This is especially pertinent to me as a family nurse practitioner student. Graduate work is hard, and I grant that as difficult and stressful as arranging my own clinical oversight was, I think it was a good thing. Hear me out:

  1. I treated that process as a job interview. I did my research. I dressed up as if I were being assessed among a variety of peers and potential job candidates and carried myself as a top-tier contender.  As I drove all over two counties (very large area, too), I kept myself positive and had my stack of folders with my cover letter outlining my course requirements and clinical objectives, my resume, and my student business card [created very inexpensively with an online company].  This portfolio was given to all sites I visited, even if they turned me down right away.

2. I learned how to gracefully accept rejection and to understand that it’s them, it’s not me.  There is a paucity of providers in the area to mentor the glut of NP students currently.  I’m not even in a large market. Many are in organizations which espouse a culture of no students, no way, no how.  Some have willing preceptors, but the organization cannot or is not able to take on students.  Some of the reasons given included a) we already are booked with students, b) we have a contract with XYZ school and cannot use their slots for someone else, c) we have a new EMR and the training will slow us down—therefore we cannot devote appropriate time to you, d) I don’t know your school, afraid to branch out [in so many words], e) it’s too far in advance to tell/it’s too soon to work you in, and f)I can’t do that many hours, and any number of other reasons.

My response to those were, “I understand, I appreciate your time. May I leave my information in case anything changes?”  Only one flatly refused my pretty purple portfolio. (It stood out without being gauche.)  To the criticism that one preceptor couldn’t do my full requisite hour-load, I offered the opportunity to give me what they could. Meanwhile, others were seeing what they could do. That’s how I obtained three different providers for my pediatric rotation. I felt that was both a blessing and a disadvantage at times.

3.  I took the opportunity to network with my soon-to-be peers. Establish yourself with a local organization of advanced practice nurses. I was in full wonderment with these titans of our industry. Well, maybe that’s hyperbole, but I was in awe to be near those with whom I’d be in the ranks.  What assured me that this was the right decision is that at the very first meeting they asked us each to say our names and affiliation. Many are practicing or retired advanced practice nurses. At that particular meeting, I was the first of many students to introduce herself/himself as such. Surprisingly, I received applause. Wow! I’m valued as an upcoming generation of NPs!  Then after we finished the introductions, the facilitator of the meeting implored that currently practicing providers mentor these students. This has been the case at every meeting since. It did pan out for me. I was able to finally achieve my women’s health rotation through this dogged approach. I plan to continue my attendance and have already paid (albeit prematurely) for membership. And yes, I took my portfolios to these dinner meetings.

What have these steps taught me? Determination, perseverance, resilience, and patience. Oh, I did quite a bit of praying, too.  Would I have rather had my work done for me? Well, it would have been so much easier, but I had some say in who I selected. That goes along way with setting the quality meter. How does an online school measure quality in a preceptor? This is a bit tricky, and I’m sure part of the debate as to why this methodology is contentious.

I welcome any comments and hope to spark meaningful discourse.  Cogent comments appreciated!

Most Wanted for Nurses’ Day Celebration

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Me in my cap and proud nursing regalia

Me in my cap and proud nursing regalia

Every year during nurse’s week I dress in my white dress, stockings, shoes, and cap.  This year I’ll have a new pair of shoes to compliment the look. But I am still pining for the emblem of a “super” nurse—the cape!

Dun da da DUN!

WWII Era nursing cape

WWII Era nursing cape

This iconic piece of nursing history is on my wish list.  I truly want to add it to my collection and bring it out every May for the occasion—not as a costume piece, but as an homage to my profession and as a way to show my devotion to this vocation.  I truly feel this is a regal image with my cap as my crown and trophy.  Sure it harkens back to the days when we were considered the physician’s handmaiden and we performed less significant roles than we do today, but look how far we’ve come, baby!

For the most part, the cape, or tippet, is a military garment that was created because of the ability to be mass produced and provide that uniform feel.  Additionally, some collars identified either the school of nursing or military regiment to which the nurse belonged.

One of these days I hope to have one. Even when I graduate with my masters of science in nursing and then pass my ANCC and/or AANP certification boards.  I don’t know how my employer will like my donning that get-up as an APRN, but we can cross that bridge when we get to it.

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I am so tired right now.  My coursework is getting harder, but I am learning so much.  And still days go by with bittersweet sadness and missing my dad.  Right now I’m a bucket of sniffles and tears because I just needed to hear his voice, so I found a youtube video he posted.  He’s not saying much, just playing a card game with my sister and nephew, Jill (dad’s widow), and Jill’s son.

But I so miss the timbre of his baritone voice.  I miss the steel in his speech and affectations he would employ when he’d speak to me, “You’re my angel.”  So, it is with resolve that I want to honor him, get back to the task at hand, and rest, hopefully to dream of him.

Daddy playing PIT with family.

So Graduate School Steals your Life and Soul

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My absence is fully explained by my dedication to family and school.  This journey upon which I’ve embarked is fraught with nonsense and difficult work.  And it will be worth it when I reach that goal.  The other day I had an “oh my gosh” moment when I was gathering information and getting ready to submit paperwork to potential preceptors for my practicums beginning next year in the summer.

‘I’m really doing this! I’m really going to be a Nurse Practitioner!”  Then the self-doubt started.  Chest constricting doubt.  And anxiety.  I think I never felt this as much in my undergraduate studies.  The reason is likely related to the investment, both financially and emotionally.

I’m scared of what I don’t know.  I’m anxious about what I have to learn and how I’ll learn it.  Self-directed study is not as easy as just reading and re-reading material.  During my first week of classes back in June I sent my father, a life-long educator, a message. “I can’t believe how much reading I have to do!”  His return message offered encouragement, but a dose of reality. “Graduate school is supposed to be harder.  But it will be worth it.”  That was his brand of advise…he said something very similar at my wedding reception in 1995.

Which brings me to another sad point.  At the very end of my first quarter of graduate school, my dad lost his battle with Stage IV gastric carcinoma that had spread to his liver, brain, and lungs.  He was hoping to make it to his 60th birthday, January 27, 2015, but he got pneumonia and succumbed to his illness on August 28, 2014.  I am more motivated than ever to stay this course so I can honor him and make him proud.

David Charles Berry on campus at Ivy Tech Community College, LaFayette, Indiana

David Charles Berry on campus at Ivy Tech Community College, LaFayette, Indiana

Here is a link to the school’s site honoring him.

Paths to the profession, classic image en queue

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I know I’m not the only Nurse Who fan (meaning nurse who likes Doctor Who) but I haven’t found that many yet.  That’s ok. I’m doing this for my own entertainment with the hope that someone else likes it too.

I received my new Nurse Day dress in the mail today. I’m not going to spoil it with photos right now, but I’m tickled that I will have a new look to commemorate the occasion and to share the pride and professionalism I have in my vocation.  The email discourse that occurred with my order was interesting. The size I ordered was out of stock and the representative informed me so.  I asked for a smaller size as she indicated they run big.  Lucky me! The smaller size was in stock.  Then she congratulated me on graduation.  (Apparently, many graduates where dress whites to their pinnings or commencement.)  I never attended either. I was uninvited to my pinning because I was failing the on-campus class.  Two years later I graduated from another school and they didn’t have pinning ceremonies.  Nor did I want to travel to the commencement in New York as I lived in a southern state and had two little babies at the time. This was for my associates in applied science of nursing (AASN), which allowed me to sit for my state boards as an RN.

Now I’m a BSN (didn’t go to that graduation either), about to embark on my graduate studies.  I’m what some may call a non-traditional student.  Distance and on-line learning is far more common than it used to be, but it is still looked at with skepticism and incredulity by some.  Quite unfortunate, really.  My opinion is that it doesn’t matter the route, as long as the destination is reached. 

So, congratulations to those whose graduations are upcoming, or who is undertaking their journey (at any level and by any means).  I applaud you and encourage you to keep your spirits high. It’s a tough journey but well worth it.

Dang, but we’d make great companions to The Doctor, wouldn’t we? 

And I plan to do it with a professional style of my own, next Tuesday, May 6th, 2014, as I celebrate the vocation with the emblem of our profession: my dress and cap.

 

 

 

What makes a good day

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I really do love being a nurse

I really do love being a nurse

As a nurse, I have a variety of skills and tasks that fill my days. Seldom is my day NOT full. And if it isn’t, well, you can count on being sent home due to low census. There is ALWAYS something to do.  There was one day when the computer charting and documenting and scanning and troubleshooting became way overwhelming and the server failed.  A coworker started complaining about how was she going to do her work without the computer.  I quipped that I was going to actually spend some time with my patients.

Don’t get me wrong. I really like computers. I love spending my free time on them and reading, playing games, connecting with acquaintances and family. Oh. And blogging. Blogging is cool too. But when it comes to patient care, they can make the interaction impersonal.  My winning and charming personality can only do so much when I haul a mobile computer in front of you to ask you (for the elebentieth time) your name and date of birth and then, like groceries, I scan you and each of your meds. It is my duty and job to explain to you each medication, its purpose, side effects, and answer any questions. I am happy to do so, but it’s complicated by the fact that you either are not interested, have already heard this, or have other needs.  That, or my other patients are also calling me.  It’s convenient in this technological age that there are pocket or mobile hospital based phone systems so that I can carry a means of communication with me everywhere…even the bathroom.  I get it. It’s convenient when I need to call someone or am waiting for a doctor to call back.

It’s a better day when I can perform all of these tasks effectively, efficiently, yet safely while not neglecting the part that makes me a nurse.  The caring.  When I can take the time to hold your hand. Be your confidante, pray with you, sing to you, it is a good day.  Caring and comforting is integral to who I am as a person, and what makes me a capable nurse.  Now, I have learned skills that allow me to perform duties of a registered nurse, sure, but I don’t feel that these tools of the trade are complete without the arsenal of compassion I hold.

It’s what I love about my job. I learn everyday and the techniques I will learn only fortify my practice, but, and this is just how I feel about it, my vocation is the foundation for the occupation.  Does that make sense?

So. I am working tomorrow, which is Easter.  I will take time to spend with my patients because they won’t be home for the occasion either.  I will hold their hand. I will possibly pray with them or sing with them.  Whatever interventions I implement, it will be with love, caring, and passion…the kind that fires and motivates me to be in this field.

I joked that I would attend the sunrise service on the unit tomorrow.  But, maybe it won’t be a joke.  Someone there is missing a real sunrise service.

In all, I hope that all of my patients, despite being hospitalized, will have a good day.  And if I have any part in making that happen, then I will have a good day, too.