The Downfall of the Perfectionist.

It's not surprising that in nursing school you learn a ton of new things. You start with how to talk to a patient, how to properly make a bed, wash a patient, give a medication. Then, you move onto assessing patients, creating plans of care, and working together with other health care providers to improve patient outcomes. Then, during your Master's, you begin to learn how to properly diagnose, manage and treat patients. But there's one thing that isn't in the curriculum, syllabus or course description...what you end up learning about yourself.

We all have our strengths and weaknesses, and sometimes our strengths are our weaknesses and vice versa. For me, that seems to be the case with perfectionism. It doesn't manifest itself in the way you might imagine. For instance, my apartment is a disaster: dishes piled up, papers everywhere. The nice leather couch has a chic new layer of bulldog hair adorning it. Nor is my perfectionism in my appearance: I would venture to guess I am maybe 10 lbs. heavier than I should be, and anyone who has met me is likely to find me in sweatpants, hair desheveled and smudges all off my glasses. My perfectionism lies in me. Perhaps one of my greatest strengths and my greatest challenges, I put a ton of pressure on myself. I have always demanded perfection in my performance: whether it be school, plays, sports or whatever I commit to. I simply cannot do less than my best. While one might argue this is a strength, boy does it get tiring! The constant self-inflicted pressure to be the perfect kid, the perfect student, the perfect girlfriend, the perfect person is a losing battle. The fact is, NO ONE, including me, is, or will ever be, perfect.

So what does this have to do with nursing, you ask? Umm, just about everything. As nurses and nurse practitioners, we work with people on a daily basis. We get to know them intimately: their fears, their goals, their bodies. And they turn to us for guidance, expertise, professionalism and, many times, perfection. The fact is, we are not God. Nor are we perfect. We will not always be right, or be sensitive enough, or quick enough, or in depth enough. We will not always be careful enough or focused enough. For me, this has been something that is very difficult to grasp. At the beginning of each semester, I find myself scrambling, drowning in fear

I am a new student again! I don't know what I'm in for. How will I know what to do? What if I mess up? What if I just don't know? What if I fail? What if I bomb that one test that matters most?

The fact is, nursing school has taught me so much more than nursing: it has taught me how to live an honest, calmer life. I constantly work to remember that I am not suppose to know everything, nor could I! If I did, why would there be a need for school? Why would their be a licensure exam? We can't start at the finish line, we have to start at the start. And more, embrace being at the start. So wherever you are today, if it isn't your goal, embrace that discomfort. Remember that those remarkable doctors, nurses and nurse practitioners you strive to be like once were you: struggling to see ear drums, questioning lung sounds, forgetting drug treatments.

And most of all, thank you all for giving me the chance to remind myself of these lessons. With that, I am going to go prepare for tomorrow, which promises to be a day of excitement, challenges, and oh so precious uncertainty.

Oops!

I vowed it wouldn't happen and it did! I let 11 days go by without a blog post. Bad bad, Rachel. And while I could go on and on, giving excuses as to why I let my blog duties fall by the wayside, I will instead let you in on what the last week and a half has looked like for me by telling about 3 experiences of the last 11 days:

1) Midterm (dun dun dun)

Well, first accomplishment of the last 11 days... I SURVIVED AND PASSED MY MIDTERM EXAM! Haha, I know I know, dramatic again. But really, I was so nervous! It's crazy how 7 years after beginning my post-secondary education I still get nervous picking up that #2 pencil, double checking everything: did I put my name on? Did I spell my name right? Did I skip any numbers? What if I mismark one question, thus throwing off the entire exam? What if my pencil isn't a #2 and the scantron machine doesn't accept my test? What if my pencil runs out of lead? HAHA. Don't lie to yourself and say you never ask yourselves the same questions :)

The exam was challenging, some questions more than others, but as is the case with nursing school in general, I truly believe you get the results of the work you put in. Although I didn't do as well as I hoped, being the OCD student I am, I am happy to report I did well and can breath a (brief) sigh of relief until the next test!

The midterm covered components of the well adult, well child, respiratory disorders (asthma, COPD and pneumonia), the well woman and normal pregnancy. Unlike nursing, where the questions focus on assessment and nursing interventions, advanced nursing focuses more on patient management through medication, education, and follow up interventions. It is a lot more to think about: based on someone's age, gender, family history, medications, allergies, social history, symptoms...ALL OF IT...you base someone's plan of care. It is a lot to have on one's shoulders, but also really rewarding and challening!

2) The Massachusetts Association of Registered Nurses Conference (MARN)

As a part of my graduate assistantship in the graduate admissions office, I am usually asked in addition to composing this blog and helping with mailings to attend graduate information sessions, speaking about my experiences at Regis, Regis nursing programs, etc. However, this past weekend, I was asked to represent Regis at the MARN conference! I was so excited at the opportunity to attend my first professional conference, network and represent Regis to the greater Boston community. The conference was nothing less than what I expected. I met so many people that have been so influential in the nursing arena and nursing education, women and men from the ANA, Curry College, Emmanuel College, Boston College, Mass General, the Brigham,  Beth Israel...it didn't end! It was so amazing to be able to talk with other fellow nurses about nursing practice, policy and the future of the profession.

The keynote speaker, a highly accomplished and respected nurse, spoke to us about the 2nd ballot initiative that we will be voting on next month when we go to the polls: the "Death with Dignity" act, or, also known as "Physician Assisted Suicide". I had entered the conference feeling very strongly that I would be voting for the initiative without question. After learning more about physician assisted suicide and what the initiative proposes by listening to the experiences/viewpoints of people in the field (palliative care nurses and physicians, a chaplain, a lawyer, etc.) I was forced to really challenge my preconceived notions and think about it differently. Although I still plan on voting for the initiative, it was amazing to be challenged intellectually in such ways. I think this is really the way in which we grow as people and health care providers: pushing the boundaries of comfort, and really asking yourselves the tough questions.
With that said, I will take this opportunity to inform you that today is the last day to register to vote next month in the state of MA. Your voice is vital. It is not only your right, but your responsibility to vote and have a say in your society. SO GO OUT AND VOTE* okay, back on track :)

3) GRENADA!

So, for those of you who don't know, each spring Regis College sends 5-6 nurse practitioner students to the island of Grenada to provide care to the people there. I feel so incredibly honored and blessed to have been chosen to go to Grenada! Not to mention, some of my very closest friends were selected as well, so it is even more special. Since I heard about the trip last year, I have wanted to go! It really is like a dream come true for me. I have always wanted to go abroad to do service work, and simply never have had the chance to/always was to scared to go alone. Now, I can go with people there to support me and experience it with! The only issue is that I don't know if I can afford it. I am sure many of you can relate when I say money is SO tight right now. Unfortunately, we are each responsible for funding our portion of the trip, and although we don't yet know how much it will cost for each of us, I have a feeling regardless it is over my budget.

Luckilly, Regis has a new grant program, and I will be helping to compose our application, so hopefully we will get approved and get some funding! With that said, if any of you know if any scholarship/grant/funding opportunities we can utilize to help us go to Grenada this spring, PLEASE do not hesitate to email it to me. We need all the help we can get! :)


In other news, for those of you who were wondering (as I'm sure you all were DYING to know, ha) Bella is doing fantastic since her ACL surgery last month! She is starting to put weight on her leg, and we are now able to walk her twice a day for 10 minutes at a time!  You don't realize how much you miss walking your dog until you can do it again. God, I love that little mush.

Well folks, I'm here at Health Services ready to precept for the day! Remember, you can email me any and all questions/comments at RFran430@regiscollege.edu and I will be thrilled to share them on my blog next week!

Until then, keep on trucking, keep warm and have a great week!

Intellectual. Smart. Classy. Bulldog.

Sanity Progress Report: Surviving

Hi, everyone! Thanks for checking back in with me on this crazy, amazing journey! It definitely was a sigh of relief this week to have the campus be a bit back to normal. By no means does that mean that everyone is okay. Even just pulling into campus this morning I see students dressed up in suits and ties, preparing to go pay their respects to Darner, one of the 2 students we lost in the past 2 weeks. I feel so incredibly heartbroken for the undergraduate community who have had to deal with so much tragedy, right at the beginning of the school year none the less.

Amidst the chaos, classes and clinicals go on. I am absolutely in LOVE with my 3 clinical placements. I have been learning so much. Before starting this year I use to wonder how someone could possibly learn how to be a patient's primary care provider in a short 9 months. Now that I am living this life every day, I kind of get it. Every single day, every single MOMENT at clinical, you learn something new. I imagine a bunch of folders in my brain, and each patient case I am putting knowledge into the respective folder for later. It's unbelievable what you learn! 

Our midterm exam is this Thursday (already!!!!). I can't believe how fast time is going, but that is what always happens! The exam is worth one third of our final grade I believe, so needless to say I am a bit nervous. The exam covers a LOT of material: the well child, the well adult, the well woman, community acquired pneumonia, COPD, asthma and normal pregnancy. This includes all normal and abnormal findings, guidelines, medications, education, etc. It's a lot.

I just got off the phone with my grandma who always dreamed of being a nurse and she said something that stuck with me. She said, "Honey, I am so proud of you. You are so focused on your goal and work so hard. You never complain, you just do what you need to do." Sometimes in the midst of your work you forget the focus, determination, discipline and sacrifice it has taken to get you where you are. Never forget it. Nursing is truly a way of life that requires these very things. And it is no different when you get to the third year. I don't really have weekends. I can't go out with friends or my boyfriend as much as I'd like. Nor can I exercise, eat as well or do laundry as much as I'd like. But you simply duck your head and carry on. Even when it feels like you can't do work another day, or you can't study another minute, simply stay focused on go on. Before you know it, that test is over and you did just fine.

Well folks, the post is a bit boring this week, I'll admit. With class today from 9-4, studying all day tomorrow and a midterm on Thursday my brain is simply fried. Stay tuned next week for another post, but until then, remember you can submit any/all nursing related questions to Rfran430@regiscollege.edu and I will answer them on my blog!! 

Rach

                                                           Bella and I on warmer days :)

Inconceivable.

I had it all planned out. I was going to write about pain. My darling Bella-boo got ACL repair surgery on Monday. I had been dreading it for months, knowing the intense amount of pain she would be in for such a long amount of time. On a selfish level, I dreaded the pain I would feel both emotionally and physically: seeing her hurt, seeing her scar, having to wake up in the middle of the night, having to carry her down the stairs to the lawn to pee, having to do physical therapy, ice, meds. But then the unthinkable, the inconceivable happened...

Thursday, 7:14pm. Another email from President Hayes:

It is with a heavy heart that I tell you that late this afternoon Regis College suffered  the loss of  Michael Kaplan ’13  and serious injury to  Peter Leighton ’15 as a result of a motorcycle accident.

 No. This can't be happening. Not again. Not 6 days after Darner. Not the same way...but it did.

It's times like this that you wonder what it all means. Why do horrible things happen to good people? Young people? And though there's no answer to be found, there is so much to learn.

I realize that this blog entry still is, and should be, about pain. The pain we feel as classmates of another student gone too soon, of another still in the hospital. The pain we feel when imagining the pain Michael's family right now. The pain we feel when we think of the worries and fears of Peter's family now. The pain I feel when I think of both of these families, and more, the pain I feel for all of you: Michael, Peter and Darner's friends, classmates and neighbors. In some ways, one can wonder: is emotional pain even worse than physical pain?

In nursing school, they teach us that pain is the 5th vital sign, just as important as temperature, pulse, respiration rates, blood pressure and oxygen saturation. Pain effects everything: immune status, mood, appetite, sleep, motivation, physical activity, nutrition and even longevity. Pain is truly the proof of the mind-body connection. When we feel pain in our hearts and minds, we feel it in our body: that stomach ache, that head ache. And in turn, when we hurt in our bodies we feel it in our hearts and minds: ACL surgery, a motor vehicle accident, a death. We are truly in pain.

So what can we learn from pain? First off, and probably most importantly, we have to remember that pain is subjective, meaning, it is different for everyone. I could go bang my baby toe against the corner of the door frame (something I have the joy of doing practically on a weekly basis), and rank my pain as the worst I've ever felt in my life. While, if Bella could talk after major orthopedic surgery, she'd probably say, "Oh, stop your worrying, Rachel, I feel just fine." If I were to talk to the family and friends of Darner and Michael, their pain would probably be inexpressible. And in turn, because pain is subjective, everyone deals with it differently. Some people cry, some act out with violence, some scream, some eat until they puke, and some may do or say absolutely nothing. The fact is, as long as you are safe to yourself and others, you can and should do absolutely whatever it is you have to do to deal with the pain you are feeling. However, because I am a nurse after all, here are some healthy suggestions of how to cope during these sad and difficult times:

-Talk to your friends

-Talk to a teacher, parent or someone else you trust

-Write in a journal

-Exercise

-Organize a memorial fund or memorial service

-Become involved in public health initiatives that help to fund/promote motor vehicle safety

-Bake something for Michael, Peter or Darner's family...send them a letter

-Cry cause you miss him. Laugh at the funny memories

There is no wrong. Be kind to yourself.

So what is the take home message here? It is to know that sometimes things in life just don't make sense. Most importantly, we have to stick together. Remember that there are people on campus who are in terrible pain right now, and we, as members of the campus community, hurt for them. Be patient with each other. Be there for each other. And may we strive to be the people Michael and Darner would want us to be: proud to be Regis students united in a time of pain, loss and tremendous hope.

Perspective.

I can't take it! I'm so busy! I have a cold! I don't have time to do anything! I don't have time to eat, to shop, to visit with friends! I can't find my keys! Ugh, this paper is taking so long! My car needs gas!

Those are just some of the usual complaints coming out of my mouth on a daily basis. The life of the nursing student. The chaos, the stress.

But sometimes, it takes a tragedy to put things into perspective.

This morning, President of Regis College Dr. Antoinette Hays sent an email out to the Regis community, informing us that a Regis College student, Darner Alteon, had died last night in a car crash, while he was driving home.

S.T.O.P. Perspective.

In life it is easy to believe that things are really 'that bad'. And sometimes, all it takes is a dose of reality to remember what life is really all about. It is about living. About learning. About a friend, classmate, a son, a cousin. A young man full of promise that doesn't have a tomorrow anymore. That doesn't have a chance to be stressed, or to lose his keys or to have a cold.

My heart breaks for Darner's family, friends and classmates. The Regis community mourns a student who I never had the privilege to meet or to know. But, as anyone who goes to Regis knows, probably would have been one of the people holding the door, letting someone with arms full of books get into the elevator first, waved hello for no reason at all...because that is what Regis College students do. They look out for each other, they support each other, and now, they mourn each other.

May the soul and spirit of Darner Alteon rest in eternal peace. May the family, friends, classmates and Regis community who knew Darner gain strength from the many prayers that are being said for him today. And today, more than ever, let us take a minute to gain a little perspective. Thank you, Darner, for reminding me what life is really about. May you rest in peace.

Week 2...check.

September Madness

Pediatrics clinical. Virtual clinical group. Health Services clinical. 4 hour class. Adult primary clinical. Sleep. Eat. Wake up. Do it again.

The chaos has ensued, people, and your girl Rachel is still standing...well, sitting, but it's better than being found laying supine (if you don't know that, look it up in your nursing book people!) in a puddle of her own slobber after a long night of writing these case studies. Ok ok, dramatic moment over. For now. But really, things have been absolutely insane. It hasn't changed my love for nursing though, but wow, this is different.

It's funny, I feel like in the last 2 weeks I went from nursing school to medical school. The information we are learning is definitely still nursing: the patient-centered care, the patient education, the patient counseling. All of the things I love so much about nursing are still there, but now instead of learning how to administer meds, we are learning how to prescribe them! Watch out world, Rachel Frank will be writing your prescriptions. Everyone take cover.

Last week was my first full week of my preceptorships and class. What really is taking up most of my time, however, are the case study assignments that we have each week. Each week, depending on the topic covered in class, we have to complete a case study assignment. The cases will consist of a patient who is coming to the office for a particular reason, and then various questions are asked. This week, I wrote up my case study for a well child visit! It was really hard work, but felt so good to hand in. I will let you know if I still feel good once I get my grade ;-) No, but I really do see despite the hard work how they will be worth it in the end. They force you to put your mind into what you learn in class. I find myself shutting my eyes, and imagining I have this patient in front of me. I can tell you from being in clinical and doing physicals on patients, it is much harder than it seems! My mind tends to go blank when I am staring into the eyes of a living, breathing person that is looking to me for guidance, advice and knowledge. And even though I'm just getting started, I find myself being super overwhelmed by the idea of being someone's provider. What a huge responsibility, honor and priviledge!

On that note I got my first offical email from an FNP student asking me a nursing question to have posted on the blog!! Thank you to this person for being the first (and hopefully not the last) questioner!

Anonymous writes:

Hi Rachel,

I stumbled upon your Regis 3rd year nursing student blog.
I am in the same position you are - in an accelerated FNP program and starting my first FNP clinical at a family practice next week! I am quite scared though. I'm frantically trying to read everything I can to be prepared. My preceptor is a MD so even more pressure. Do you have any advice on how to survive the first few weeks?

Also did you work as a RN at all during school? I feel that I won't really have the time to and that I'd be better off focusing on learning the FNP role...

Thanks for any advice you may have!
So, first off, thank you for writing and I wish you good luck beginning this exciting journey! Good luck at your first clinical. My best advice for you on surviving the beginning of this chaotic time is the following:

-Take deep breaths: remember that you do not, and are NOT expected to know everything! This is something I have to remind myself very often, because I always want to feel like I am on top of my game. But, the truth is, everyone has to start somewhere! Even that cool MD you are precepting with! There was one day lonnngg ago when that MD was petrified like us, overwhelmed, scrambling to figure out which end is up!

-Have faith: I find myself reminding myself to have faith... that I don't need to know everything now, and more, that I don't need to understand how you will know everything you need to know to be an FNP in 9 short months. I just have to have faith it can be done, because, well, it has before! If anyone else can do it, so can we!

-Be confident: remember that you have already come this far! You are an RN! And THAT is a huge accomplishment! Remember all those nights of studying when you didn't know how you would pass that test? Or wake up that early? Well, you did. And here you are, going even further. That is what will happen here too. One day, you will look back and laugh at the chaos. Be confident, and remember the times in the past when you felt this way too. How did you get through it? Use those skills here.

-Take care of yourself: no, you won't get the sleep you need. You won't eat as healthy as you hope. You won't see your friends/family as much as you'd like. BUT, make sure you give yourself time here and there to have fun and be well. Go eat at a restaurant. Have a beer (assuming you're of age!). Go sing karoke! Take a long hot shower even when reading is waiting.

To answer your second question, truth be told, I applied to probably 80 RN jobs and was not too successful in that endeavour. However, I must say, I am thankful now it didn't. I am just so busy running around and trying to stay on top of my work that it really was a blessing in disguise. I really do wish I could get some nursing experience. However, nurse practitioner practice is completely different than registered nursing. I think that there is definite value in working as an RN. However, if you don't have the chance to, I strongly believe it is okay! Just focus on working hard and really making the most of your clinicals. That is where the most learning happens I've found.

Well, that's it for this week! See you next week (if I survive... muahahahaha) :)

Rachel

Strike a pose!

Success!!!!!!

Well...big news people...I SURVIVED MY  FIRST WEEK. You know you are back in the nursing school mayhem what that is a mark of achievement. Don't worry, I am exaggerating a wee bit...but only a tiny bit. But I'll admit it, I still love nursing as much as when I started 2 years ago if not more.

So now that I have gotten through the week, I can fill you in a bit more on what this 3rd year will look like for me. On Tuesday, I have my first full day at my pediatric rotation. That experience is going to be extra special since I am precepting with my childhood pediatrician! When I went there to orient to the office a few weeks back, I couldn't help but tear up looking at the old halls I use to walk and paintings I use to stare at when my doctor said, "Oh my! I can't believe it, but I see an elephant in your ear! Can I look in the other one?" Oh man...that means...no... there was never an elephant in my ear? I have been living a lie ;-)  Then, on Tuesday evenings (from 7:45p-9:00p) I have a virtual class, which is the craziest and coolest concept to me. I will literally be looking at my clinical faculty and classmates in the face from the comfort of my own home. Let's hope Bella doesn't try to add her two cents!

Then, on Wednesdays, I precept at Health Services on the Regis campus. I had my first day of this rotation last Wednesday! Honestly, I was SO incredibly nervous firstly, because the college health services environment is essential where I see myself working as a Nurse Practitioner when I graduate (so I want to make a good impression!) but also because I saw some patients there who I know personally from being in the nursing program. I was blown away by how incredibly flexible, understanding and patient they and the other patients who I saw last week were to me. So to you (you know who you are): Thank you!

Regis Health Services is going through some really amazing changes, so I encourage you to go over and have a look during your free time, if you have a concern or question, or a health issue you need to address! The staff are a group of incredible people and it is now available to staff and faculty too (in case you are reading)!

Then, on Thursdays, I spend the morning working as a graduate assistant in the Graduate Admissions Office with the fabulous staff and then head off to prepare for class from 5:30p-9:00p. This week we had an orientation to the basics of nurse practitioner roles, the class expectations, schedule and structure. I am blown away by the professionalism, flexibility, optimism and support of the Master's staff. Each bring their own special expertise and viewpoint to the program, which makes it all the more special and applicable for practice. This past week, I learned the basics of the child well visit (aka yearly physical). We reviewed pertinent growth and development along with assessment strategies and areas for education. I loved that our class was able to ask questions and discuss challenging issues that arise in advanced practice. 

Tired yet? Well, we got more! On Fridays, I precept with an amazing NP in Everett at a small private practice that I ADORE!! I feel so lucky and blessed to have found this placement thanks to my good, good friend who graduated from the program last year (and, who also has a JOB, which is super exciting!). I spent only 5 hours with him on Friday because he had to leave early, but I already learned SO MUCH: how and when to prescribe a Steroid taper, how to irrigate a cerumen (wax) impaction from an ear, how to do a patient intake, and how to initiate/educate a patient beginning a chronic pain management contract. All 3 of my clinical placements for this semester are incredibly different and I am grateful for that. Honestly, I think the more experience with different office settings, colleagues, preceptors, coding, note taking, etc, I can get the better! I do hope I get to practice my Spanish at some point as well.

And that brings us to Saturday! Believe it or not, I am here at Regis at 3:16. Today I had a GREAT class called Concepts in Nursing Leadership which meets from 9-4 one Saturday a month. I already have learned so much about myself, my goals and my strengths/challenges as a leader. I think it will really be an enlightening experience.

So then tonight, my boyfriend and I are off to dinner at his brother and girlfriend's apartment and then for the next 48 hours it's off to case study land. Where is case study land you ask? Somewhere in between panic, caffeine and isolation island. Every week or so, we have to complete a case study where we are given patient scenarios and have to tell what we would do/assess/question based on the most pertinent, recent nursing research. I am so nervous because I really want to do well. I just have to remember I'm only starting and it will be a steeeeeep learning curve! 

Well, I guess that is it for this week. Hopefully this will give you future NP students an idea of what a normal week in the life MIGHT look like for you year 3. However, it is totally worth it. Every day when you walk into that clinical setting, you have to have the faith that somehow, some way you will be the one achieving your goal. It's hard to believe it's less than a year from that finish line, but we will get there somehow together!

Happy Saturday and talk to you next week! Remember, feel free to email me ANY and ALL nursing/Regis-related questions and I will post them on this very blog at Rfran430@regiscollege.edu.

Rachel :)

Bella Photo of the Week

 

"Look at me! Look at me!"