To the Psycho Farm and Back

I survived the Psycho Farm. That is, the first Psychopharmacology exam. It was actually more like a quiz, it was only 10 questions. I think I aced it but not sure, there's always the possibility I could have missed something. She'll go over it next week. Next week we have 2 exams, one in Pharm and one in Process.

School felt like the Psycho Farm today! A lot of people are still suffering from major anxiety. On our lunch break before the test, people were doing their usual frantic last minute study drills and I always try to avoid it, my mind gets jumbled and I feel better if I stay calm before I go in. I saw Anne going over her notes and I did talk with her, I can handle the calm people. As we stood there several people joined us and it was a nice quiet group of 5 of us, and it happened to be 5 of us from our original Block One clinicals group. We went over stuff and I was trying to get them to not stress about all the little details. They would worry about these obscure anti-Alzheimers drugs and which neurotransmitters are affected by certain drugs that aren't used often. I said not to worry about that stuff. Then the one student who is driving me crazy- Miss Anxiety, wandered over to the group. I thought, it's time to leave. I slowly excused myself, but before I got away she started in on this whole tirade about the half lives of these drugs and stuff. I said, I wouldn't worry about that. She only wants us to know the commonly used drugs. As I went back into the trailer, I heard her freaking out. The test turned out to be exactly what I thought, the benzodiazepines and alcohol withdrawal, and major side effects of the common drugs.

I feel like on the surface I am okay, but I have not been sleeping well all week. I have so much on my mind between all these papers to do and appointments to set up, tests to study for, and life in general. I found myself lying awake last night at nearly 11:00 and I got in bed around 8:30. Then I woke up early. It was hard to concentrate through the day. But I made it.

There's a ton of work to do, but I think I have it organized and if I keep plugging away at it I'll get it done. Not everyone feels that way and there are a few people in my class who are starting to get on my nerves because they spend more time bitching about our assignments that they could use to get work done. Plus I don't want to hear it. I've found that there are a few people who like to bounce things off me because they know I've been through a lot of school already, for some reason they seem to think I possess some kind of wisdom and might be able to go to the faculty on behalf of their grievances. I put a stop to that real fast. I told them I am not taking on any more stress and I have to set limits because I have my own limits on energy, time, etc. I also tell them that they need to stop worrying about the minute little details, and not use up energy stressing about it. I do empathize with the students' time limitations and I also believe the faculty is a bit unreasonable when it comes to their expectations that students not work at all, but it is possible to get through this. There is a lot to do but so far everything I've done has been a worthwhile experience and I am looking forward to most of the remaining assignments, community events, etc.

Today at the end of class a few people spoke up about their problems with the workload and were up front with COS about it, but I felt they should have talked to her individually or in a small group and not in front of the entire class. That kind of irritated me. I felt sorry for COS. I guess I can see it from the perspective of the students and the teacher. The only thing I can say is that her instructions are not the best organized, it would help if she made her instructions more concise. I have had to take a lot of time to decipher what we're supposed to do. Our class seems to be exceptionally anxiety-ridden. This has been a theme every semester, so I know it's not COS and her expectations. Our class needs Xanax gas piped into it.

We picked our group projects for Assessment today and I am going to work with Christine and Patti on a case study on Valley Fever. That should be interesting. It will be a good group too because we're all on the same page as far as being able to focus on the task without too much anxiety. There are a few people in the class who might contribute to my developing homicidal tendencies by the end of the e at the rate we're going. Miss Anxiety now sits behind me and she's a basket case. She's 50 years old and you'd think she could put things in perspective, but I guess age has nothing to do with that. She's supposed to be going to Sunrise Center on Friday when I do, and she was freaking out about it. Simple. We go on Friday and then write a 1-2 page paper about our experience afterwards. She looked at me with this wild-eyed, scared look. I don't understand. You show up, and go with the flow. That's my plan anyway.

One of my classmates was talking with me on a break and said she's been having headaches. She went to the doctor and he was afraid to write a prescription for her when she told him she was in nursing school. From what I've heard, nursing students and medical students are some of the worst prescription drug abusers. I know a lot of nurses who take sleeping pills and diet pills and all kinds of stuff. I see people biting their nails, tapping their feet, drinking tons of Starbucks coffee, breaking out in rashes, gaining weight, getting sick, all kinds of stress-induced behavior. So much nervous energy. When I see the hyper-anxious ones, it reminds me of this one patient I saw last week on the psych unit. She had her hands all bandaged up. She'd been scratching and picking at her hands. I found out it was from the crystal meth she was doing, it causes them to feel like there are worms crawling out of their skin. I don't know why but it reminded me of a nervous student.

I don't know if I can stand to listen to the monkey spewing and tripping over his Spate of the Union address. I think I'll find a diversional activity. Like sleep.

Peace, love, and Xanax gas,

Towanda, RN2B

Shocking!... and not so shocking

Yesterday was our second Psych clinical day and it was a long one. So much happened, opportunities to do all the assignments we have to do for the semester all came up for me at once. I arrived in the morning and only 7 of the 10 in our group were there. I forgot that two people each week go to that agency downtown that works with low income mental health patients, and I go there next week. The other person in our group who was missing, turned out she didn't pass the Block 3 math test on her third try, so she's not going to be allowed to do clinicals. I don't know if she'll stay in school for the other classes this semester or what. I'll find out when we go back to class next week. I feel bad for her, it's easy to miss something in those tests. It would be hard to get to this point, 6 months away, and have to stop. The good thing about this program is that you can stop and do LPN at this point.

I was sent to one of the Adult Psych units. I didn't have anyone in my group with me, I was the only student there. They were short-staffed on the unit, the secretary wasn't there, so the nurse had to do a lot of that work. The tech is a nursing student who took a break from her program after Block One. The two of them were nice to me. Most of the patients there were self-admitted and several had been transferred up there from the chemical dependency unit. There was one patient I had already met last week down there. Most were in for mood disorders, bipolar or unipolar depression, some with psychotic features. Report was quick, but the nurse went through each patient with me. They even had pictures, which was helpful in putting names and faces together.

It was quiet on the unit early in the morning because out of 15 patients, 7 were going for ECT (electroconvulsive therapy) in the morning. I was hoping I'd get to see that but at this facility they don't let students watch it. People in our class at the other facilities have been able to see it. The tech was busy trying to get people ready who were going down, so I helped her round people up and get their morning vitals and took some time explaining to this one guy that he wasn't going for surgery but he couldn't have his morning coffee because he was going to have anesthesia. He kept asking if he was having surgery. I told him that he would be asleep and wouldn't feel any pain, and that when he gets back he can have whatever he wants to eat or drink then. Then I got all the charts ready for the nurse for the people who were going for ECT. The patients who weren't going came out and ate their breakfast.

ECT is no longer done the way you might think, they get light anesthesia and a muscle relaxant so they don't have those grand mal seizures. They use a bite block and keep a blood pressure cuff on their arm, and they get oxygen until they start breathing normally again. It's a quick procedure, only a few seconds, and then they recover. The recovery time is maybe an hour, and they go back to the floor. People who are not hospitalized can get it as an outpatient procedure. Like going to the dentist. Easier than a root canal.

I asked the tech about her schedule, there was the goals group in the morning, and the education group at 10:30, and I thought it would be a good opportunity for me to lead a group session. The tech looked so relieved, like she was going to hug me for offering. The timing turned out to be good because the first ECT group was going to be arriving during the education session and she'd be busy re-orienting them and getting them what they needed. I had to think quickly about what would be a good topic, I asked if medication compliance would be a good topic and she said sure. I quickly made a list of about 10 questions I could ask the group about medications and compliance, so I could keep it interactive. The tech did the goals group quickly, there were only 6 patients present for it, so I tried to remember the names and then went out and started talking to patients. I had conversations with two of them.

The first one I talked to sat down and put her legs up, she had to elevate them because she was having some kind of renal problems and her feet were swollen. She moved slowly and responded slowly but she was willing to talk. I asked her questions about how she came to the facility, about her home life, her feelings, her goals. She cried a little when we talked about her pets, she misses them. This was her first hospitalization and she'd been medicated for depression for over 20 years, but she got to the point where she couldn't function at all. Her medications weren't working right and she had gained a lot of weight lately too. She was getting all her medications changed and was being observed during this time. Our conversation went for a good 15 minutes, and I was afraid to get up and leave her, wondering if I did, if she'd feel rejected. But it worked out smoothly. I went back and looked at her chart and made some notes.

The second one I talked to was in for bipolar and she was guarded in her conversation, at first she seemed like she didn't want to talk and I told her t was okay if she didn't feel like talking, but then I couldn't get away from her! She didn't say much, mostly repeated things but I did get her talking about her family and her feelings about things. She wasn't happy with her diagnosis, and felt like there was no one she could talk to for support in her family. I finally used the excuse that I had to get ready for the education group, which was true because it was almost 10:30. I went back and looked at her chart and then my mind started racing.

Both of these women were in their mid-40s and both had to go on permanent disability, could no longer work. These two had something in common when I looked at their charts, both had thyroid problems! I had to try hard to keep myself out of it! I couldn't help looking at their lab values and thinking, what the hell, the one who was so blunted and slow to respond, she was so hypothyroid, no wonder none of her medications were working! The other one had hyperthyroidism, and based on her labs it looked like her treatment wasn't working yet, so it makes me wonder, what are the factors involved in the mood swings and manic behavior. Other than thinking about that, there were lots of other issues involved, histories of abuse and neglect, multiple stressors in their lives. I wish I could have seen a bigger picture of all the people involved in their care. I wonder what the doctors are thinking when they treat people with psychiatric medications, how well do they collaborate with people involved in the medical diagnoses?

I went out and announced the education group and the same 6 people came out, and sat in the couches and chairs around the middle of the room. I stood out in the middle of the floor and they were all receptive, all 6 of them participated and gave their input, the one woman I had the long conversation with would say something, then nod off for a while, then wake up and participate again. It was interesting because they talked about their fears with certain medications, one guy had started on lithium and was having a lot of dry heaves, and another patient was three days into her lithium treatment and reassured him that she only felt like that for the first two days. They talked about ways to remember their medications and how to read the label, major side effects, who to call if they have side effects. It was a lively conversation and we went over the 30 minutes, but everyone seemed to be engaged in the discussion. I wrapped it up and thanked them, and they thanked me, the lithium guy said it was helpful to him. Like last week I found they are so appreciative of anyone who spends time with them and talks with them.

After that the nurse and tech thanked me profusely, the people were starting to come back from ECT and their trays were waiting, things got hectic so I helped the tech by taking vitals and re-orienting a couple of groggy patients. I had to ask them if they had a headache because sometimes when they come back from ECT they do get a headache and they can have pain medication for it. I got them their trays and it was interesting to see some people who appeared to bounce right back after the treatment, while others were completely out of it and I had to say their name several times and repeat the questions. They lose some short-term memory, whatever happened right before the procedure, and sometimes you have to remind them where their room is.

Then I went back to write a few notes to myself. The tech told me it would be quiet on the unit during the afternoon because most of the ECT patients will sleep for a few hours after they come back and eat. Bobbie came in to check on how I was doing. Every time I asked her about something, she took the time to explain it to me, she's good about that. She told me to make sure I write down as much as possible from my conversation that I will be writing up and analyzing for out therapeutic communication recording. I made some notes, but was busy with the group and everything else on the unit. Looking at my schedule I realized I needed to gather some information for my care plan because I won't be there next week, and after that I will have a week in the pediatric unit. It's hard to get much done on the peds unit because they keep you so busy, so I figured I should choose a patient now, and work on gathering information in the afternoon. I decided it would be interesting to use the first patient I talked to, because our conversation gave me more insight into her needs.

I sat back in the report room with the chart and started writing down the basics of her meds and labs, then got to the other psychosocial information from her assessment. I was getting hungry, I ate one of my energy bars right before teaching the group session. It was 11:30 and I figured I would work on the care plan until noon, then go to lunch and meet our group at our 12:30 meeting in the cafeteria. Around 11:45 they called me to the main office of the facility because they had an intake evaluation at the front desk and we are supposed to observe an admission, Bobbie said she would be calling us down there to see one on the day we were at the unit I was on. I went down and sat in on a nurse and social worker who did two different interviews with this little old lady who needed help finding a nursing home that would take her. She had some substance abuse issues and basically they determined that she didn't need to be admitted, but she was no longer able to take care of herself. It was hard for me to concentrate, I was so hungry and felt shaky. Finally the social worker got done at about 12:25 and I followed her out and told her I had to be at a meeting at 12:30, I asked her if there was anything else that would happen with the admission. My brain was feeling overloaded and I needed food.

I went down to the cafeteria and got some enchiladas, beans & rice and scarfed them down, the whole group was already there and we talked, my blood sugar wasn't quite recovered enough to focus on the conversation but by the end I managed to remember what I needed to ask Bobbie. I told her I was feeling like a little too much was happening all morning and I needed to catch up. She suggested I skip the afternoon group session and sit back in the report room and do my assignments and organize my thoughts. I still had to write my self-reflective journal and our other weekly planning assignment. I knew my productivity was headed downhill since I'm still having a hard time staying awake in the afternoons.

When I got back on the unit, the nurse had some relief. They sent an LPN up to take over the secretary work so the nurse could get something done, and the social worker was there. The LPN opened the door for me and snapped, "They're already gone to art therapy." As if I was supposed to be there. I said, "I'm going to miss it today." Hello, Nurse Ratched. I wondered if she was going to strap me down to a table and give me a shot of Haldol in the butt. I got the chart and the LPN glared at me, and looked at the stack of charts afterwards, like she was guarding the charts. I can remember COS telling us that there are a more than a few people with control issues working in psych.

I sat down at the table as the social worker made phone call after phone call, working on different patients discharge plans. Occasionally she'd look up from her charts and make some comment about crazy people (referring to the people on the other end of the phone.) I worked through my assignments slowly and my concentration was terrible. Probably falling asleep after lunch plus my usual 2:00 brain shut-off, plus all the interruptions with people coming in and out of the room. Plus the phone ringing and the social worker talking and my head felt like it was going to explode again. I did manage to get through a lot of stff, and Bobbie checked on me and she helped me find the things I was missing for my care plan. The social worker was going to lead a process group at 3 pm on forgiveness and dealing with resentments. I still had a ton of work to do and I was afraid if I spent an hour in that group I'd never get stuff done. I felt like I had a busy enough morning, I needed to take it easy on myself. The social worked told me she'd give me a copy of the outline she uses and let me know how it went afterwards. She was nice. She left and forgot to turn off her cell phone, which rang about every 3 minutes and had this crazy ring so it sounded like we were in a casino the whole time she was gone!

The shift change took place after 3 and the new nurse came on. It was a guy and he didn't seem like he was as happy about having a student around as the first nurse was. I sat in on report. When the tech showed up and stood there pulling things out of her purse to get ready for her shift. Some keys, a lighter, one pack of Winston cigarettes, another pack of Winston cigarettes, a pharmacy bottle of Lexapro (which is an antidepressant). She said, "I better take my Lexapro or they won't like me much tonight." I looked up at her. She was older, but probably not as old as she looked. She looked like she was going to be in the next bitter beer ad. She had this string with plastic beads on it around her neck that her glasses were on, and she looked thoroughly disgusted about being there. I offered to help with afternoon vitals or anything they needed before I left. I only had about 30 minutes worth of work left and the class was meeting for postconference at 5. She didn't accept my offer, but she said, "you can open the door for me, that damn doorbell drives me nuts." The doors are locked on the units so everytime someone without a key wants in, you have to go unlock the door. Visitors were starting to arrive so the doorbell was ringing constantly.

The social worker came back and I asked how it went. I saw some of the patients coming out and saying things like, "that took so much courage" and "I admire her for sharing that" and "I couldn't have done that". Turned out that the patient, the same one I chose for my care plan, told the group about her resentment toward her parents, who abused her throughout her childhood, and she told them some personal details of it. The social worker sat in there and did a brief therapy session with the patient after the rest of the group got out and I saw them talking behind the glass door after group and was wondering what happened. I am amazed that she was able to share this with the group, talking with her earlier she seemed like she was having such a hard time processing her thoughts into conversation. Maybe it was early in the morning when we talked. When she came out of the group, she had a big smile on her face. She was still moving slowly but her face was lit up and her eyes were all the way open. This gave me even more insight into her, I was glad I chose her for my care plan.

I went around and talked with a few of the patients for my last hour, and wrapped things up and headed to postconference. I ran over to the cafeteria to grab a snack but it was closed, so I had to go to the gift shop and got juice and pretzels. I don't think I would have made it home without that! We all talked about our experiences at 12 step meetings during the past week, and that was it. I have a ton of work to do but I did gather the data for a major assignment, and I am going to be shadowing an Occupational Health nurse on the 8th. Now I have to write up everything I did.

As I drove home, traffic was much better being on the freeway at 7pm. I was able to think and process some of what I learned. It's important to stay objective but it's also interesting to think about your own experiences. I couldn't get it out of my mind that here are these ordinary people who have these chemical things going on in their brains, and all the other genetic, environmental, situational, behavioral, physical, and other factors that, by luck of the draw, can result in a person becoming so disabled and unable to cope with everyday things. I know that some people are luckier than others. You look at how hard it is to change behavior and the stresses we are faced with in our lives and it's amazing that all of us aren't hospitalized in a psych facility at some point. Listening to these patients describe how they became more and more isolated and the fears they have about reaching out to others, even their family members for support, and for good reason, because the patients and the family members are afraid of the stigma of the label of "mental illness", and the rejection and ridicule they fear, and how vulnerable they are when they are out there trying to get through life on a day-to-day basis. Basic things like getting out of bed in the morning, remembering to eat, dealing with the mail that come each day, answering the phone, can be completely overwhelming. A trip to the grocery store, even making a list beforehand, is impossible.

I see that the average person you meet on any day, how many more similarities they have to the people I meet on the psych units, than differences. Everyone has some degree of the behaviors and personality traits that are found in mental disorders. It's sad that we have such a separation, labeling, and lack of support. There is so much lacking in our support for people when it comes to functioning well. I don't even know what is adequate functioning. I suppose if you can get through day-to-day without undue anxiety and feeling generally positive about the state of your life, and feeling confident that you can handle most of the things that come your way. The people who are on these units are your co-workers, your family members, your friends. They experience the same things and some unfortunate thing happens that puts them over the edge in terms of being able to make it through everyday life. It's about whether their coping resources have been exceeded. Any of us could be there, any time.

I think that the more stressful our lives become, the more important it is that people have learned ways to cope with stressors, and not your generic lip service stress management seminar run by someone in a suit who has a nifty power point presentation and can recite deep breathing techniques. Unfortunately that's hindsight. Kids need to be protected and nurtured and taught coping skills early on, and people need to learn that they have choices in how they live their lives other than the lives they see portrayed on TV as "success". Perhaps "success" needs to be eliminated as a construct used for relative comparisons, because it sets up all these impossible expectations and gets people caught up on that rat wheel. Right now what we have going on with the haves and have-nots is not going to do anything to help our collective state of mental health. The rat wheel and the flocks of sheep who step onto it are not only contributing to escalation of these mental health problems, but are a convenient excuse for not even examining them. Denial is such bliss, until you wake up.

That's enough philosophizing for now. I have a shit load of homework, and I need to take these dogs for a run!

Peace, love, and be grounded,

Towanda, RN2B

Expanding the Mind...and Body

This week has been busy and challenging. First Pharm class with Denise (the sociopath from last semester) was Monday. Denise teaches for the first eight weeks, then the Amazon for the second 8 weeks. When we registered last semester, they told us Pharm was only for 8 weeks, but SURPRISE! it goes through the whole semester. These guys are unbelievable when comes to organization. You would think that a school that's been doing this for so many years.... But the Pharm class is low-key, minimal reading, minimal work. That's good, because the other classes are killers.

Then we had our first Assessment class on Tuesday morning. The teacher, Kate, is a psych nurse and a climber and cyclist and she is from Missouri and is proud of that (being from Missouri, that is.) The last person I met from there called it The Great State of Misery. Kate was nice, she gave us a ton of reading and work to do, and unfortunately for her she got to hear the bitching of several members of the class who are so frustrated with the COS. We spent the first hour of class going around to each student and introducing ourselves and telling where/if we work, and what area of nursing we want to go into. It was interesting listening to everyone, a lot of people have changed their minds since we did this in Block One.

I caught Christine during one of our breaks and asked her if she wants to pair up for our group projects. I needed to find someone I can work with who won't suction off me like a leech and will get down to business. Christine has the same attitude as me, let's get this crap done and over with and not spend half an hour gabbing and bitching. I realized in class when I looked around me that I was surrounded by people I do not want to get stuck with when the time comes and we are put in the awkward position of having to choose partners in 30 seconds.

We had our second process class with COS in the afternoon. We did our psychopharm review for the first hour. I felt like I have a pretty good grip on the meds but some of the things they use for antipsychotics and mood stabilizers are labeled for other uses and I get confused on some of them. We have our first test over that material next week. Then we got into mood disorders. Yeah. She passed out more handouts. So much more stuff to do. I have about 7 more chapters to read before I'm caught up to this week, then I have to get ready for next week. Plus now with our assessment stuff. It's supposed to overlap but it's more work.

This Friday we have clinical again and I wonder where I'll be. I have so much work to do. Care plan, admission paperwork, communication analysis of a conversation I have with someone, planning a group session. I am looking forward to it though. The only part I'm not looking forward to is the pediatric psych unit. I will probably understand why after I get in there.

Last weekend I watched One Flew Over the Cuckoo's nest and wrote my paper on that. I had never seen it before though I've heard about Nurse Ratched forever. I can think of a few I know right now. I can also pick out a few future ones in my class.

Wednesday I went to the AA meeting. There was a noon open meeting in Paradise Hills. I've never attended a 12 step meeting before but I have done some group things in the past, support groups, group therapy things, and I found it to be similar in some ways. I drove up to the church and parked and was surprised at how many cars were there. There were about 30 people in the meeting. Paradise Hills is a small town and I dreaded running into someone I knew. I did recognize a few faces but I didn't know anyone by name. The group was receptive to us as visitors and I didn't introduce myself as a nursing student except to the group leader before the meeting started. One of my classmates, Mike, met me there, he was afraid to go by himself and lives nearby so he asked if I would go to the same meeting with him.

My impressions were that this is an excellent support network for those who are ready for it, it's obvious that a lot of people come and go as they reach the point where they are ready to benefit from it. And after listening to the people talk, I thought it would be interesting if we had a nationwide 12 step group program, for Americans, something like oblivious consumers anonymous, to help people wake up from their habit of going to work, watching TV, buying things, not getting in touch with themselves, and basically ignoring everything (politics, legislative processes, corruption, greed, irresponsible leadership of the institutions that govern their lives) that goes on in the world that is affecting them but they are in denial of it. You know I could go off on a tangent here but basically, I think our country needs a serious 12 step recovery program RIGHT NOW! Of course we haven't hit bottom yet but we're working on it, aren't we! I think this country needs some serious soul-searching recovery work. Like what Randi Rhodes calls Republican Rehab. But the Democrats would need to be in the codependency group.

One of the people in the meeting was talking about compliance vs. recovering and I had thought about that last week when I was in the clinical, how there are people who are going through these treatments because they know it's what they need to do to comply with the court order or whatever, and once they get a little freedom they are back out there using whatever it was that's killing them. This guy said he used to comply but he wasn't committed to it and hadn't bottomed out and realized he had a choice to make. It was interesting listening to the individual variations on the themes of having a choice, forgiving themselves, and some of the "steps".

At the end everyone got up and held hands in a circle and said the Lord's Prayer and being the agnontheist (I made that up) I am, it was a little weird, should I have crossed myself first!? but I stood silently listening to everyone recite it there and I wondered if the 12 step can ever work for atheists and other people without a "God". Something else to think about. After the meeting Mike told me he doesn't like Psych because he doesn't have the patience to listen to people. Meanwhile I was totally into it, I was listening to every word and fascinated by what I was hearing. I think people are interesting to listen to, even those who are full of shit.

I called Occupational Health where I work and asked the nurse there about shadowing them one day. The regular nurse was out so I need to call back but the nurse I talked to was enthusiastic and told me they not only work with Desert Valley employees but contract the work from other employers who use them for Occupational Health. I've always been interested, even in my doctoral program, in the workplace stresses people deal with and how it affects their health and lives in general. It always manifests itself in their on the job injuries, absenteeism, and mental and physical illnesses. The failure to achieve work-life balance is a huge thing and getting worse in this country. I am interested in the psychological aspects of that and how to effect some kind of change in attitudes toward work and the whole "work ethic"- what *should* be called the slave ethic thing- in this country. It destroys quality of life for people and they don't even realize it until they are retired and are so screwed up physically and mentally that they can't even enjoy their retirement years. My dog nazi neighbor is a perfect example. He worked all his life for the post office and drinks and refuses to deal with his problems, he's recently had a DUI that landed him in jail, he's a jerk to his neighbors, he's had a stroke and has high blood pressure and is only in his mid 60s.

No matter what I go into with nursing I hope that I'm able to do people some good. I hate to be part of a system that harms people and our healthcare system does that in a lot of ways. I also realize that self-preservation and sticking to your own principles is part of mental health and my personal threshold for bullshit and corporate hogwash is not all that high. I hope that through creativity I can find a way to achieve benefits for my future clients and preserve my own mental health too. Anyway I am much looking forward to shadowing an occupational health nurse and I am going to have a ton of questions for her.

On my runs I'll be thinking about something I heard someone say or learned in class, and putting some pieces of things together in my mind. They say you learn a lot about yourself in psych. I remember one of our profs in graduate school telling one of my psych classes that it's "sick-ology" and only the truly sick people go into it. It's cool to be able to revisit things you've thought about before and piece them together from a different angle, after you have learned something new in a clinical application.

I went to the doctor Wednesday and according to my lab results my thyroid was off a little. Not that much, but my TSH was not where I feel best. I got a little higher dosage of meds and will re-test in about 8 weeks. This doctor is my family practitioner and he's young and smart, we were talking about nursing and he said he thinks the average medical floor nurse in a hospital is a slave, they give meds and take orders and wipe butts. Interesting that he would have that observation too... He said don't go into OB either because you'll be bored. I have no interest in that. We talked about my interests, critical care, endoscopy, possibly psych. He thinks critical care is where nurses get the most respect. That would make sense from a physician's perspective. I wonder if you talk to most critical care nurses if they'd say the same thing.

The other thing I found interesting was how much weight I've gained. I only weigh myself at the doctor's office so I only find out once or twice a year. When I started nursing school I was hovering around 120 pounds. That's where I've been for the past few years. But last summer at some point I can remember weighing myself, I can't remember why or where, maybe it was on the floor in clinicals, but it was the first time I'd been on a scale in a while and I was surprised to be down by 3 pounds since September. Maybe it was the scale.

But today I was up by another 5 pounds! EEK! That is the most I have EVER weighed in my entire life! Even when I was in my fat chick phase in high school I topped out one pound lower once. I am going to chalk up the 5 pounds to Block 2. I was so stressed last semester. So THAT's where all that chocolate went! My butt and hips are definitely larger than they used to be, my pants are all tight. I do feel rather expansive these days. (no that's not part of my delusions or psychosis) Let's see what Block 3 does.

I'm not giving up my chocolate though. I'll deal with my big fat butt after I graduate. Stress reduction comes in all flavors, and mine is chocolate. I wonder which drug class that's in?

Peace, love, and chocolate,

Towanda, RN2B

Mad as a Hatter...and first Psych clinical!

I'm not referring to the patients, I'm talking about myself.

Sometimes I wonder how far past 11 they can crank the stress before students start to be admitted to psych units themselves... I think these professors attend a special conference at School of the Americas for torturing students.

Even Bobbie, our clinical instructor, is confused and says her head is spinning trying to keep track of all our assignments. She didn't make up the assignments, the COS did. (short for Chihuahua On Steroids, in case you don't remember)

This week sucked until yesterday, when we had our first clinical.

Thursday I had so many errands to run I had no time to do any homework, so I'm getting behind. Plus I'm brain fogged. Grrrrr. One of our assignments is to attend a 12 step meeting. I had to find an AA meeting to attend (I'll go next Wednesday here in Paradise Hills with one of my classmates, he called me and asked if I would go with him because he is afraid to go by himself!), and I went to down to campus to buy my IV meds book, 20 minutes in line and $40, a bargain! Plus I turned in my math assignment to the Amazon and watched a video on psych medication side effects that we were assigned to do in the lab- got one thing out of the way. I also got my blood work at the lab and had to wait 20 minutes there too listening to a screaming baby who was getting tortured.

I tried reading through all the assignments we have to do for the clinical class OUTSIDE of clinicals, and it's like 10 different things that involve out of class visits and shadowing nurses and writing papers. It's almost impossible to decipher her instructions. I talked to two of my classmates today. Both of them told me they were confused and lost and one said if it wasn't 6 months to graduation she would quit now. It's all busywork and I have zero tolerance for that crap. I’ve been through this academic bullshit enough times, can’t I skip it now?

Enough bitching..

My first psych clinical was Friday! I woke up a few minutes before my watch went off at 4:35 am (had to get that extra 5 minutes in there) and I had major guilt over the dogs, even though the dogsitter comes on clinical days. I cooked a big breakfast to eat on the way down but I wasn't hungry. Nervous, I guess. I left the house at 5:40 am and drove downtown, actually arrived in 35 minutes. Driving down the little streets near the hospital is interesting, seeing the early morning "night life" on Washington Street. I parked and saw that some of my classmates were already there, waiting for everyone to arrive so no one would have to walk alone to the building.

We all got there on time and Bobbie was happy about that. She gave us a little introduction talk and then one of the administrators came down and gave us another talk and then went over HIPAA regulations again and then took us on a tour of the facility, and into some of the units we'd be on. Then we went to the cafeteria and they have great food, it kicks butt on Desert Valley’s cafeteria. We ate some breakfast and Bobbie went over some of the stuff in the handouts and gave us our assignments for the day, sending us in groups of 2 or 3. I got the chemical dependency unit with Miss Anxiety. Bobbie took each of our small groups on to the units and introduced us to the staff, and then we were on our own until the 1:00 meeting. We were told we'd have post conference at 4:00 today and that we were going home early!???

Get this...they let us out early because half the class (literally) had to re-take the math test. Out of both Block 3 classes they had so many people who didn't pass that COS had to reschedule it for Friday evening when they had enough classroom space. What does that say when 33 out of 80 students fail the test? Even after they had us take a class over the break to prepare for it!

We started out on the unit by getting a tour from one of the techs. He showed us the patient rooms and the report room and how to find our way around the unit. There was a group session starting at 9:30 and we were encouraged to attend as many groups as we could. There were about 20 patients on the unit. Most of them were there for detox or had a dual diagnosis- both substance abuse and depression, bipolar, or some other psychosis. The patients gathered around a long table and the psych tech led the group and wrote on the board. He went around the table to each patient as they told everyone their name, how they were feeling today, what their goals for the day were, and what hobbies they liked to do. I paid attention to what they were saying and how they expressed themselves both verbally and nonverbally. That was interesting in itself, besides finding out a little about them. There were people in there for suicide attempts, domestic violence, dependency associated with chronic pain, people who were highly educated along with uneducated, homeless people along with middle class professionals. About equally male and female, and ranging from about 20 to 60 years old. I could tell right away the ones who were heavily medicated or maybe having side effects from medication, the way they moved and spoke.

They were encouraged to set goals for themselves for the day. After the group they had free time and some went outside to smoke, some wandered around the kitchen or the TV area, and I set a mental goal for myself to talk with at least 3 different people during the day enough to where I'd understand a little more about their history, what they were doing there and goals they had. First I talked to a guy who sat there in a chair with his head down, looked sad. He was a new admit who was a health care professional who had been caught helping himself to opiates at work. He was losing his job and possibly facing criminal charges. He was younger than me but looked a lot older. He was dealing with some chronic pain from other health problems. We talked for about 15 minutes, I listened to him and asked him what he wants to work on while he's there, I was able to identify some areas that might help him and he had been thinking the same thing. He had participated in competitive sports in the past which kept him focused and disciplined, but had drifted away from that as he was working and raising kids. We talked about goal setting and finding the things about his past involvement in competition and training that he could use now to help him re-focus.

One thing I was reminded of by that interaction was how vulnerable we all are at different times of our lives and how random situations and events can take us off in so many possible directions, and how easily I could see myself or anyone I know, the same thing could happen to any of us. I spoke to the nurse about him and got her input, it helped to see her perspective on the patient and compare that to the impressions I got.

I also talked to an older man who had been on the unit several times, he's now homeless but has drifted from one group home to another and was in for alcohol, he seemed to be pretty comfortable with the place. He initiated the conversation, he noticed I was looking around not knowing who to approach, so he took it upon himself to talk to me. That's how these people are on the unit, many of hem are happy to have someone to talk to. I got the impression from some of the patients that what they were telling me in our conversation wasn't necessarily going to be the same thing that actually happened, and that the story might change if I talked to them in another hour or so. And I was right about that with some of them.

Later I attended a session with the recreation therapist and we took a group of four patients to the gym where they walked, played basketball, and stretched. It wasn't a structured session, they did what they wanted to do, staying in the area. I walked with two of the women, one immediately asked me if I was a runner. That was another thing they did, asking me questions about myself, and I had to keep turning the focus back to them. This woman used to run and now she walked, she asked me about upper body work and stretching, so I showed her some stretches. Some of them had to be on restricted activity because of their medication and weren't allowed to exert themselves.

We went to lunch with the class and then had a little meeting, everyone seemed to be having a pretty good day.

What I thought was amazing was the way the entire staff worked together, the nurses, techs, secretary, physicians, social workers, volunteers, they all had such an amazing rapport. They do work as a team. Also, they are all real people. It was such a different feeling than the hospital and med-surg. They dress in regular clothes and look like regular people. There isn't any pretense. In psych I can see how you'd have to be grounded in yourself to a certain extent and be able to be yourself. I'm not sure if this is how psych facilities differ from medical hospitals or if it was the fact that we were in the inner city and not in Desert Valley. It was a huge relief and I found the environment to be so much less stressful. It was just as busy, but it wasn't constant running around or stressing out the way the hospital nurses do.

After lunch we attended a group meeting on the unit with a social worker. About 15 patients participated, and the social worker did an interactive lecture/discussion about theories of addiction, and concentrated on environmental theory of addiction. She was talking about fairly complex concepts but was able to communicate with everyone, and I knew the range of education levels in that room had to go from about 3rd grade through PhD. The social worker briefly told them that about 20 years ago she was an inpatient for substance abuse and depression, right where they were. She talked about the process people go through as they work on their problems from an environmental perspective on addiction, and she was able to engage everyone in the group (a few people dozed off during the meeting because of their medicated state) and talk to them without going over their heads or talking down to them. It was interesting to watch the reactions to what she was talking about. She drew pictures on the board and listed things that the patient talked about, and she was able to reach the entire range of people without boring them or losing them.

Afterwards we it was time for report at shift change so we went into the room with the nurses and listened to the taped report. Since we weren't there for morning report it was interesting to hear the nurses talk about each patient and get their take on everyone, after forming our my impressions all day. On some of them I was right on with my gut feeling and on some I was way off.

We had postconference in a south facing conference room with big windows that overlooked the parking lot and Washington Street and it got hot in there. I had a killer headache and was uncomfortable and tired so it was hard to concentrate. We talked a little more about our assignments and everyone is still confused and overwhelmed. COS needs to do a better job of explaining things and spreading out the workload. I don't know what I'd do if I had to juggle work on top of this right now. A few people in our group are still trying to work a couple of days a week and they are going crazy over having to change their work schedules because of all the outside visits we need to do in the next 6 weeks.

I have no idea which unit I'll be on next week. The peds unit sounded like it was the hardest. I think I'll have a hard time knowing the stories about these kids. The stories of the patients are hard to hear and to think about. Bobbie said that over time as you work in psych there a kind of detachment that occurs, so you are able to hear these things without it always causing such an emotional response, so you're able to work with the person and keep yourself out of it. I wonder how long that takes. You find that there are certain things that get to you, where others don't bother you. For example one of the students in our group got upset when she saw a child in restraints. After our little afternoon session with the social worker I found myself tearing up over a few of the patients stories.

The nurse to patient ratio is a lot bigger here, there were about 8 to 10 patients to each nurse, and the techs each have half the unit. It's a lot of work and the stays are short due to managed care, and there isn't a lot you can do for them in that short stay except to prepare them for going back to whatever is out there for them. You have to work with the team to do whatever you can to find them a better situation to go back to, if you can. There isn't much time for one on one work with them.

The drive home was hard in rush hour traffic. Normally we will be leaving later so I will be able to take the freeway. I took Washington Street all the way to the east freeway and it took me a full hour to get home, but I looked over at the north freeway and it was crawling the whole way. Traffic was so bad that I wasn't able to reflect on the day's events while I was driving, and I think that will be good once we get on our normal schedule.

I felt a lot less exhausted after a day of psych than a day of med-surg. The nurses work 8 hour shifts at this place. I can see how 8 hours would be enough though, mentally. I am looking forward to next week, not dreading it at all. I wish I could relax a little but I have a ton of homework.

6 months and 21 days to graduation!

Peace, love & emotional stability,

Towanda, RN2B

It's getting warm in here...

Psych! Thought you were going to get the first psych clinical report? Wrong. That will happen on the next one. There's too much going on to try to include it all in one e-mail. I'll include the report on my first clinical this Friday in psych after this one. I am totally brain-fried now after two half-days of being tossed more expectations than I can handle as a responsible adult. I believe I will have to resort to delusions after the past 2 days, because I am unable to cope with the reality of Block 3. So much for being refreshed after a break. Welcome back to hell! Even the classroom was warm...

Tuesday we returned to Desert Valley Trailer University for our first meeting of the semester, our first Nursing Process class of Block 3. The "chihuahua on steroids" professor, so named by a previous Block 3 class, as I understand, greeted us and spent about a half hour on general business for the semester, telling us we will have so much "fun" in Psych clinicals! (Error. FUN not found.) As far as I’m concerned, FUN=August 11th. She blew through the 20+ page syllabus like it was a sticky note and immediately launched into a warp speed lecture on schizophrenia and thought disorders. Five handouts later we got to go home. I need therapy now.

She told us that by the end of our psych rotation we will be able to easily pick out people in our midst who fall into diagnostic categories of mental illness. I can't wait. I'll be in Safeway watching the other shoppers do repetitive, compulsive behaviors like picking their noses and then touching every apple in the pile until they choose the one they want and I'll be saying to myself- OCD! The people with the W stickers....Delusional!

Hey, Chihuahua, I already got this down...can I skip Block 3?

One thing I can say about the chihuahua is that she initially seems more approachable and personable than our last teacher. If she's a chihuahua, she's a docile one. It's not because she's been overfed with tacos either, she looks healthy, younger than her age- and she told us today she's a hiker and loves being outdoors, she was talking about how good that is for the mind, body and spirit. She scored points with me on that. Our last teacher recreates- with steak, wine and cigars...

Given that easily one half of the people in our class are noticeably overweight, it's nice to see there are teachers who take care of themselves and set an example.

It sounds like a lot of the things we'll be doing in the assessment class will overlap with Process, so that will be good. Not that they'll give us any less work, evidenced by the 18 or so chapters and 2 case studies and five fat handouts I have to read and do to be caught up for next Tuesday's class.

Wednesday was pure and total absolute hell. They are so disorganized. You would think that a school that's been doing this nursing program for so many years would have it down. These teachers are spazzes! The chihuahua on steroids is living up to her name. I found her extremely annoying by the end of the day. They brought us in for the math test and clinical orientation. In the past, they have always given us our math test first so that we can get the anxiety-provoking part out of the way. Not this semester. The Chihuahua (I'll start calling her C.O.S) passed out about 10 huge handouts and launched into this whirlwind pseudoexplanation of all the crap we need to do. Basically she glosses over it and tells us to read it on our own. That would be okay if it wasn't so confusing. We had to sign up for our community service experiences, and they didn't leave enough slots for all of us, so we were all competing for slots and I figured since I'm not working I'll wait to sign up so that the people with the tight schedules can get their choice first. Actually it wasn't a bad idea because I ended up with a good assignment- outdoors at a park for some health fair all day in late February. Not bad for around here.

But she went on and on about our assignments and they can't present this stuff in a way that's concise and easy to figure out. It's all confusing and in different parts and spread out all over the place, in different handouts, different due dates, and it all is a big mess. I don't do well in the afternoon with my energy levels and I am super crabby. I was ready to crawl out of my skin by 2:00. Then she decides to tell us about our med-surg clinicals, which is another huge set of handouts and going on about our multiple care plans and those don't even start until March so why waste our time since we'll forget it all by then anyway! Besides, Roger will make it much easier to understand when we get with him. I hope I make it through the first half with Dr. COS.

We did meet our psych clinical instructor, Bobbie, and she seems like she will be cool. I am not thrilled about driving down to 18th St. & Washington Street and dealing with that part of town in the dark when we're arriving and leaving, but I'll deal with that. Bobbie seems laid back and understanding of our anxiety as students. She also seemed like she empathized with our looks of utter confusion after listening to COS for 2 hours. Our heads were all ready to explode. First day of clinicals will be low expectations, she said. I am not feeling anxious about psych clinicals though. I am looking forward to it.

After that, we got our math test, finally, and she made us go outside after we were done and wait until they were all graded and then she would let us know. The test was so easy, it was a joke! I couldn't even believe they had us take that class, that was a waste of time for me. It was all covering Block 4 stuff, so now we'll have to go back and review it in May. This program is so unorganized.

The test was too easy and I went over all the problems again before turning it in, and then I got outside and listened to the anxiety-fest while we waited for everyone to get done and the results. I kept thinking, Should I have read that question more carefully? Did I understand the wording correctly? Finally COS came outside and said, there's no way to do this privately, so I'll list the names and tell you yes or no. If you didn't pass, you have to take it again tomorrow at 6:30 pm. I thought, great, I might have to go down to VCC at 6:30 pm the night before I have to be at clinical downtown at 6:30 am.

But I ended up passing! Even though she tripped over my name and started out sounding like she was going to say I didn't pass. I probably looked like I was going to strangle her if she said I didn't. But I did! About half the class didn't pass though! Holy crap that's a lot of people! Then I needed to go to the lab and get blood drawn but there was no parking and I was totally stressed and exhausted and pissed off with the traffic so I said screw it and I'll go to the lab tomorrow. AAARGH!

It's going to take me a week to decipher all the crap she threw at us in 6 hours. I think the entire benefit of last month’s break is GONE. The Chihuahua also warned us today at the beginning of class, that we should not try to work as much as we did in the past semesters, because the time commitment will be greater.

Over break, as I ran and hiked in the desert, I started thinking more about where I'm going with all this as I start looking for my first nursing job. I want to be able to run and paint and have time to have fun. The first 1 to 2 years I might have to work full-time putting in some weird hours, but I don't need to make it harder on myself than it has to be. Certain areas of nursing will require night shifts, 12 hour shifts, and I'll be using my days off to recover from work. Not a good way to go. I need to seriously think about this as I finish the last few months of school. What jobs will allow me the freedom and flexibility I need, and not use up all my energy?

The whole point of doing nursing is to have a job I can live with. I need family time and dog time and running and painting in my life. Not work, work, work. I am not looking to "be" a nurse. I am not my job. I am going to work as a nurse so that I can more comfortably live my life. Most ICUs require 12 hour shifts for sure. Maybe I'll look into a step down unit that is not as acutely ill patients and doesn't require 12 hour shifts. Or there's always endoscopy. Actually it might not be such a bad job. I think I need some med surg or critical care experience first, but I'll have to "scope" it out!

Speaking of energy and health care, I got an unfortunate little surprise in the mail last week. Apparently my endocrinologist has closed her practice. BUMMER! She was so good. I've been going to her for 3 years and she was the one who finally got me out of my brain fog and actually worked with me to get back to feeling like a normal person again. It took over 2 years to do that and I imagine if I didn't find her I might still be staring into space. Not in nursing school, that's for sure. It is going to be hard to find another endo, it took me 5 doctors before I found her. So many arrogant jerks who waste your time. I guess I better sharpen my "that's R.N., B.I.T.C.H. to YOU!" skills this time and get ready to pull that out of my butt if I need it. It's the only language some of them speak.

For now I will have to have my family practice doctor take over my labs and prescriptions until I find another good doctor. He's pretty cool though so it might work out okay for a while. I might have to wait until I know if we are moving back to Colo. for sure before I find a new endocrinologist. I remember she was talking about how expensive it was getting to keep her office going and not getting reimbursed- endocrinologists get lots of diabetics, lots of people on Medicare, etc. I am sure it's tough. I knew it was coming eventually but I didn't think it would be now. Finding another doctor who won't treat me like a lab value, THAT will be a challenge. I've been feeling sluggish lately and afternoons have been rough- wanting to fall asleep after 2:00 pm usually means my thyroid is off again. Gotta get some blood drawn ASAP and hopefully a little boost of my meds will get me feeling good again in a month or so!

Omigod. Did I tell you about the Amazon?

Yes, we have an Amazon for a teacher. Last week I took a half day math class to prepare for the math test. It was taught by our Block 3 and 4 critical care teacher, The Amazon. She's about 10 feet tall with 8 foot long legs, and has the barbie doll figure to match. This is Desert Valley, so you guessed it- she recently took advantage of our world class surgeons in Desert Valley's cottage industry...for which Desert Valley is in competition with Hollywood. Except her hair is real, and so is her face. No fixes there. Other than the eye popping proportional fixes she's totally for real and she is so nice to the students. She's gorgeous in a Hollywood kind of way. She has a perfect Hollywood body now, legs, boobs and butt perfectly proportioned. She probably causes car wrecks everytime she goes outside... It's a good thing she's an ICU nurse.

Anyway I can see how it would be hard for anyone, not to mention most straight men, to be able to concentrate in her class. All she had to do was change positions, turn slightly to the side, slightly to the right, it was like looking a statue in a museum. How does a human body get to be like that! I would say the incidence of neck pain will go up sharply in many nursing students when she lectures.

Oh and did I mention that she happens to be a good teacher? She was easy to listen to and nice to the students. You could tell that she treats the students with respect. One thing that is lacking in most nursing school faculty, from what I've seen. We have her this semester after Psych is done, in the second half. And then we have her a lot in Block 4.

Well that's all for now. I'll fill you in on my impressions of the psych facility sometime this weekend. Right now I need to get to work on my first assignment...finding a 12 step meeting locally that I can attend. My name is Jane and I'm a nursing student... I'm serious about the 12 step thing, we do have to attend one before next Friday!

Peace, love, & until hell freezes over,

Towanda, RN2Bsoon, but not soon enough!

The Agony

My break so far has just started to feel a little like a break and things are starting to slap me in the face again. I painted two days this week, had a little "me" time, and have been able to go outside and walk with the dogs- not much running yet due to recovering from running 57 miles on a desperately undertrained body. The backs of my knees took the worst of it.

Here it is the 5th and I have 12 days left until it all starts up again. And so far I have some kind of obligation or appointment taking up way too much of my time on too many of the remaining 12 days. I feel like crying. I need to tough it out for 7 more months of this. I'm starting to get the jitters- pre-graduation jitters. Something about the calendar turning over to 2006 and I realize I'm going to be out on my butt in 7 months and I better have a plan!

There is confusion about the math class, the one we take in order to pass our pre-Block 3 & 4 clinicals math requirement. I squeaked by last semester by doing it on my own, but I'm too tired of motivating myself to read stuff over my break. First they scheduled it for Monday afternoon the 9th. Then after a bunch of the people in the fast track Pharm class whined, they changed it to the 10th. Then they changed it to the morning of the 10th. Then they said it was the afternoon of the 10th. Today I saw Kelly, our class president, at the extern interviews and she told me it's in the morning. I have a dentist's appointment that morning and don't feel like changing it because after that it will be during school and it's a pain in the ass to schedule things. Anyway now I am trying to find out about a class they have listed on the 11th in the afternoon. I am so confused. Let's see if the teacher replies to me.

So far this break I have been to two nurse recruiters and one job interview for an extern job, which I didn't get. I would have taken it but it wasn't what I wanted and there wasn't a good vibe the whole time throughout the process, so just as well. Plus it was a far drive from home. Today I went to a group interview and met a different nurse recruiter, different hospital, different extern position. I will wait to see if the manager calls me for an interview for this one. It's at another hospital that's closer to home. They have more of what I want, it's an ICU-type of environment. They also have 60 applicants for 17 positions and I think they would want me and my brain but I look around and see a lot of young, fresh energetic faces of these young students and I don't know... I feel so...gray.

My hair is brown, mostly. But it's not blonde and I don't have the barbie doll look down, which seems to be a requirement in local hospitals. The barbie doll nurse clone in scrubs. It's that Desert Valley pretense thing, if you're not blonde they come up to you in public places and touch your hair- they want to feel it- they've never seen hair like that before! And then you have to have the right shade. Platinum blonde. Like Clairol's new line of hair dyes for Desert Valley women. There's Desert Valley blonde. And then there's north Desert Valley blonde. There IS a difference, you know. And then there's the lipstick...big. Did people used to have lips that big? Is this some kind of DNA thing where the environment has been altered to produce female children with big lips? Or could they be fake, like the boobs? Or is it a makeup trick, something I never was able to understand or master- like putting on mascara or gift wrapping. I went to high school in Desert Valley and I don't think makeup application, hair coloring and boob enhancement were part of the curriculum, but maybe they are now.

I am kind of impatient with these hospitals, dragging their feet over hiring externs. This is a huge hospital corporation and I don't like that whole idea of the behemoth corporation in the first place, makes me feel like I'll be processed as a clone. Who knows maybe they'll run a background check and find out I gave money to the Democratic Party and I'll be thrown out in the shredder with my application. Maybe they don't want me and my brain. Only 7 months to graduation and I'm starting to worry. What if I don't get hired. What if no one will hire me. What if I get done and can't get a job.

I have to go to work tomorrow. I have two more scheduled days as a CNA and then I don't have to work there if I don't want to. I go on-call as of the 8th. No more benefits, but no more forced 2 shifts a week when I'm exhausted. I do hope I get the extern thing so I won't have to force myself over to the hospital to wipe butts a few more times. I can't even tell you how much I dread going back to work even for this weekend. I am so over it. I am tired of lazy whiners. The thing is, I don't even mind the butt wiping. I don't mind being at work when the nurses are on top of things and the other aides are halfway competent. It's the lazy whiners- nurses who can't lift a finger to do anything that might get their hands dirty, and aides who sit on their big fat butts and surf the dating websites and ignore their call lights all day.

I realized, going through this interview process, that there are other hospitals that don't use travelers to the extent that we do. There is also less turnover. Of the entire staff on my floor, I am the aide who has been there the longest, 16 months, and there are only 2 nurses who have been there longer than me. Everyone else is new or a traveler. There is so much turnover, and our boss SUCKS! She needs to retire. Dale told me today he saw my boss get called down to the Human Resources office and when she went in the door, she said, "What is it NOW?"

Maybe I should say to hell with it and go into endoscopy and deal with scoping the orifices of unconscious people. And there's always psych..which will be the focus of the first half of Block 3. I am terrified I won't be able to find a job by graduation and I'll be stuck with my only option working on the floor I worked on as an aide with my dinosaur boss and the daily lazy whiner chorus! WAH!

I am working on a letter to the nurse recruiter at the hospital in Colorado where we used to live. I don't want to come off as too much of a nerd, but then, I want to get the point across. I'm going to make a trip to Colorado in May and I intend to comb through the possibilities until then so I can talk to every nurse recruiter in every decent size hospital from Pueblo to Cheyenne if I have to. And the western slope too.

Some advice I got at the new years run from a friend who's a physician: He said, when you go to the nurse recruiter, it goes like this. You say, "Do you want me? If not, you're stupid."

Maybe that's a strategy I can try at one of these downtown hospitals sometime to see if it works.

The regular journals will be back soon.

Peace, love, and happy new year,

Towanda, RN2Bsoon!