Called to Study, Called to Serve

This week, I started grad school, and Pope Francis was visiting the United States. I came home at night exhausted - cramming 40 hours of work and a full-time grad school course load even in the first week, began taking its toll on me right away. I feel asleep every night this week nearly in tears (sometimes actually in tears) wondering what I had gotten myself to.

The greatest sense of peace I felt all week was when I listened to Pope Francis speak - to Congress, to church leaders, to laypeople. The audience was not as enthralling as the message he imparted upon the people in his peaceful, soft spoken way. The string throughout all of his homilies and speeches was simple, but planted a seed in my heart that reminded me why I am where I am - I feel called to serve.

As a nurse, it almost goes without saying that I 'want to help people'. It's the answer everyone gives when they ask why they become a nurse. But in listening to Pope Francis, I have realized that there is a difference between wanting to help and being called to serve. 

This past week, for all its difficulties, has rekindled my faith and reminded me that I am a nurse - a public health nurse - and a grad school student because I want to use compassion and knowledge to serve the people in my community who most need it, and to serve them with both my head and my heart.

Don't Be Such a TEAS!

The Test of Essential Academic Skills, or TEAS, is one of the exams used as admissions criteria for nursing programs. It is a multiple choice exam with four sections: English, Language, Math, and Science. While many of the questions are gleaned directly from material you covered in prerequisite courses for nursing - possibly even in high school - it can still be potentially overwhelming trying to figure out what exactly to study. So, here is a brief breakdown of what you might expect to see when you're ready to take the TEAS.

• Reading - Very rudimentary reading comprehension skills are really all you need in this section. One of the best skills you can pick up as you review is to be able to pinpoint topic sentences and conclusions, and to be able to recognize them when they are paraphrased. When you get your score report, you'll see that the Reading section is called "Informational Source Comprehension", because it is not about reading through an entire passage that they give you. It is about picking out the information you need when a lot of distractors are placed in front of you. From the TEAS study manual, some of the TEAS skills you will need to use are:
• Identify from an index or table of contents where information may be found
• Identify which product information supports a conclusion that one product is the more economical buy
  
• English/Language - Brush up on your grammar and punctuations, especially the different times in which you would use periods, commas, and semicolons. Know your homophones (your/you're, there/they're/their, etc.) and proper verb tenses. As far as vocabulary, if you're able to read through the Harry Potter books without a dictionary in your lap, you will be absolutely fine. From the TEAS study manual, some of the TEAS skills you will need to use are:
• Apply subject-verb agreement rules.
• Identify and use different parts of speech.
  
• Mathematics - Brush up on your algebra and trigonometry, and also make sure you haven't gotten rusty with fractions and order of operations. Review and practice old math skills. This section isn't necessarily difficult if you have taken math before, but it can definitely be one of the more time-consuming sections of the test. From the TEAS study manual, some of the TEAS skills you will need to use are:
• Determine the quantity of material needed or cost of planning an event
• Estimate the solution to a problem.
• Use mathematical reasoning or computational procedures to solve one- or two-step word problems with fractions or decimals.
  
• Science - Keep your focus on chemistry and biology - many people are surprised that they don't see as much anatomy or physiology on the exam. You’ll want to know about how ionic and covalent bonds work, different compounds and their characteristics (alkynes, alkenes, alkanes, etc.), and how different types of chemical reactions work. Definitely know about glucose metabolism. Know how to balance chemical equations. Know the functions of the organelles, and about organs. Also, brush up on part of biology you may have overlooked, including the material on photosynthesis, and physical science such as layers of the earth and its atmosphere. This section is a fairly large grab bag of things you may not have seen for a fairly long time, depending on when you are taking the TEAS. From the TEAS study manual, some of the TEAS skills you will need to use are:
• Describe the general anatomy and physiology of a human.
• Explain the biological classification system.
• Balance and identify important chemical reactions.
• Identify the Sun as the major source of external energy.
• State the chemical properties of water.

Keep in mind as you study for the exam that this is not about learning new material. This is about dredging up facts that you may have forgotten years ago already. Some people may find this comforting, as they may be able to recall this old learning faster than others. Some may not feel very comfortable with the material. Whichever category you fall into, know that time and repetition are helpful for a lot of people when taking this exam. Don't make the mistake of delving too deep on any single topic - remember, this is a test of essential academic skills, so focus on building a strong foundation of the basics.

Your Ideas Aren't Bad Ideas

I find the smallest new experiences in clinical rotations exciting - enlightening, even. This week, I was taking care of a young patient on the peds floor who was losing weight because they simply hated hospital food. They would have no part of the macaroni and green beans, or the pepperoni pizza, or the chicken sandwiches. What this patient did like, however, was sweets.

The dietitian was working on trying to figure out how to get some nutrients into this child - to put some weight back on their bones. She ordered a new multivitamin, but was more concerned about working with the child's eating habits to get some real nutrition in. Where do you even start with a picky eater who needs to gain weight to get better?

While I was listening to the dietitians recommendations as we were chatting at the nurses' station - something which I finally, in my third semester of nursing school, had the confidence to do with other members of the care team - an idea hit me. Should I bring it up? I almost started tuning out of the conversation and tuning in instead to my own internal debate of whether or not I should mention it. I'm a student. A nursing student. I took one nutrition class, what could I possibly have to say of substance to a dietitian? Just keep quiet. Don't make a fool of yourself.

But I've been taking care of this patient all day, the angel on my shoulder says. I know what this patient likes, what they are willing to do, and how they like to be approached. Maybe I should just mention it. Very casually. What's the worst that could happen?

"How about a milkshake?"

At first, the dietitian seems to be a little taken aback, and I realize I needed to qualify my statement a little.

"I noticed with another patient, they mixed a can of Pediasure with some ice cream and called it a milkshake, and the patient loved it," I say, still feeling incredibly unsure of myself. "Our patient really likes sweets. It could be a start."

There's a moment of quiet, and I feel awkwardness start to creep up. I'm probably blushing at this point. I'm never going to speak to anyone ever again. I'm a student, of course it was a silly idea --

"We could try that," the dietitian says with a nod of approval. "Maybe try it once a day and see if it helps our patient keep some weight on."

And sure enough, later in the day, I open the patient's chart and my Pediasure milkshake has been added in the orders on the dietitian's note. My idea. My silly idea about a milkshake is in a note.

Of course, inside, I'm disproportionately excited. I suddenly feel so validated that my recommendation, based on what I know about a patient, was something that a professional felt was worth mentioning, and better yet, worth trying out.

The moral of the story is that you're going to have jitters. You're going to have hesitations. But don't let the little devil on your shoulder saying, "Don't say it, you're a just a student!" keep you from being a real part of your patient's care team for the short time that you have with them. Trust your knowledge, and trust what you have learned from the time you have spent with your patient. Part of being part of the team is engaging in that back-and-forth. Sometimes your ideas will be on the right track. Other times, someone else's ideas will be on the right track. If you just insist on keeping quiet, then you'll never know - your ideas could be the ones that make a difference for a patient in your care.

A Sliver of Life on the Side

Being a nursing student is hard enough - going from being purely academic to being able to jump freely between science/academia and practice at a moment's notice. Add on top of that the responsibilities of having a family, having children - even harder, having young children - and even the thought is almost enough to make you want to pull your hair out.

Like a lot of my classmates, I'm married, though I don't have children yet, and I put forth my best effort to have one day a week that I'm just a normal person and not a nursing student. I have dinner with whatever family I can. I don't pull out my textbooks and bury myself in them while I blindly swipe for finger foods.

I try to come home and cook dinner for my husband when I'm not too exhausted, so we can eat dinner together before crashing and falling asleep once he gets home. Sometimes, that doesn't happen.

I try to be awake enough at the end of the day to go out to dinner or go on a date with him once in a while. Sometimes, that doesn't happen.

 I try to take breaks and do things on the side - because as much as I love nursing school and the idea of being a nurse, I have to think of other things once in a while. I love writing, and I love to knit and crochet. I love taking care of plants in my mini-garden which is really just the cement patio of our apartment.

There is no way to exaggerate how important it is to have a life during nursing school, even just a slight semblance of one on the side. If you think about it, when you're a nurse, you get off work and it's not nursing school anymore. You're not carrying them all home on your shoulder. You're not writing down and analyzing their lab values until wee hours of the morning, or killing trees printing out pages and pages of care plans. You come home, and you have your life back. Sometimes, your life will consist simply of plopping down and sleeping. Other times, you have time to do as you please - remind your spouse and your kids and your relatives that yes, you still exist.

It may seem far away while you're still in nursing school, but just remember - keep a little bit of your own life, so you don't forget how to live it outside of your job as a nurse.

Don't Stress, Assess!

Head to toe assessments are a huge part of your job as a nursing student, and when you're just starting out in nursing school, they can be intimidating. Did I just hear crackles? Did I check all of the pedal pulses? Are these pupils 3 mm? Can I check them again?

When you're just starting out in nursing school, your head will probably be buzzing with background chatter about what you did and didn't do while you're performing assessments on patients, because this is one of the first points in nursing school that you really need to pull everything together and ask yourself a large succession of questions at once:

• What am I seeing/hearing/feeling?
• Is this a normal or expected finding?
• What does this mean for my patient?

And you're thinking these things over and over again with every little thing you assess.

Knowing that, walking in to do your first few assessments can be awkward, even scary, because on top of asking all of these things to yourself, many times you're also trying to build rapport with your patient and keep them comfortable - you're trying to hold a real conversation while having an internal conversation with yourself.

Here are a few tips about easing in to assessments:

Small-talk first. Ask about how they're feeling. Ask their pain level, you'll need it anyway. Ask how they slept, how they liked breakfast, if they had water or coffee with breakfast. All of these things are also part of taking your assessment and help you just as much as pulling out your stethoscope and listening to bowel sounds in a lot of cases.

If you can, ask your patient if anything seems "off" to them. This gives you guidance to where you might want to do a more focused assessment.

Assess often. Ask the nurse you're working with if you can help perform assessments on their other patients. Get report on those patients to get a little background about what you would expect to find, then go in and find it. Get over your fear and listen to those lung sounds. You don't know adventitious breath sounds until you've heard them on a real patient - you don't just hear stridor or wheezing. You see them having a hard time breathing. You have them telling you what it feels like for them. No single part of the assessment stands alone. The more you practice, the more you pick up.

Discuss what you find with your nurse outside of the patient room. If you can find time that works for your nurse, let them know what your assessment findings were, and ask if there was anything you may have missed. Read more about the patient to see if there's anything you could look at in more depth for your next assessment.

Assessment skills are something that grow and evolve with you as a nurse once you get hands and stethoscope and eyes on more patients. Don't let the fact that you haven't done many assessments stop you from assessing. Jump right in, and remember that your patient isn't just a source of different sounds - they're a resource of information. You're there to treat them, in order to treat the, you need to know how they're feeling, and if you want to know anything they feel that you can't pick up with your own senses and your patient is able to tell you, by all means, ask.

Making the Leap: Providing Care and Truly Caring

I was skeptical at the possibility of being truly moved by a clinical experience. I have been touched deeply by experiences in clinical - by a man at the veterans' hospital who was told his condition was worsening and only had a few weeks to live, and asked me to spend time with his wife to comfort her because he was fine, by a woman recovering from a brain injury after an accident because I was there the first day she was getting into a cardiac chair and I was the first person to bring her to the window and see the outside in months. I have been deeply touched by being part of moments like these in clinical rotations, but when I heard stories of other students actually being moved to tears by their experiences, I thought, Well, I'm sure they just cry easily. I don't think it gets much more intense than this.

Yesterday in clinical proved me wrong.

I was on the Pediatrics Unit, assigned to work with a very young patient who had suffered from a traumatic brain injury that left him with hemiparesis, loss of his ability to speak and respond, and do all of the things a kid his age takes pride doing - running and playing, using the bathroom on his own, eating his own food. The morning was a slow one - I struggled to figure out how I played into things. His parents were so on top of it, they were involved and active and aware, and hopeful above all else. The patient's mother, I found out, was less than a month from giving birth herself and still coming in and tirelessly spending time with her son. The patient's mother was always smiling, always positive and praising her son's ability to pick up his head, to roll, to kick his foot. She was just so full of love.

I felt somewhat awkward coming into the situation because this was actually what had caused me the most anxiety about starting my rotation on the pediatrics unit - having to be a nursing student, learning my way around things in front of parents who knew all of it already and would no doubt shake their heads at me for being such a newbie. I was terrified of not being confident in front of parents.

But these parents were amazing, the kind of people you could feel comfortable around. Even as I was acquainting myself with the tubefeeding equipment, they were happy to say how other nurses they had worked with managed to get the tubing around the special bed and hidden so that the patient wouldn't be able to swipe at it with his good hand.

After a particularly tough physical therapy section, I asked the mother how she was holding up as we walked back to the unit - simple things like if she was able to rest, or if she'd had time to herself to really process with what was going on, or if they had been able to talk as a family about how they could help each other through her son's rehabilitation journey. She talked about how she was tired but coping, and about all the things her son used to do before his injury. I got her some cereal, and checked up on her whenever I came in to do assessments or feeding with her son.

When my shift was about over, I went in to say my goodbyes, make sure tubes were flushed and tucked away until the next feed, and see if there were any last minute things I could help her with. She simply smiled, a little bleary-eyed, and said "Thank you for talking to me."

Thank you for talking to me.

The fact that something so simple had actually made a difference to someone got me right in the heartstrings, and I felt it - the familiar prickly feeling behind my eyes that meant if I didn't skedaddle soon, I would be bawling right in front of a patient's family.

I suddenly realized that something about clinical is truly, truly validating - more than just practicing skills and checking tubes, the act of genuinely caring and being involved with your patients gives you a reason to chug through nursing school, even at points when you feel buried under exams and deadlines. Days like this make you realize that it's truly more than just work.

Everyone's Your Cheerleader

Maybe this isn't universal. Maybe this is just a phenomenon in "nursing towns" where a bulk of the students in the universities are trying to get into nursing programs, and few of them ever actually get in.

I started off my pre-nursing/nursing journey in San Francisco, where universities are littered with jilted pre-nursing majors who were wait-listed or changed majors somewhere along the way and had to change paths. Actually being allowed the honor in a state university of changing your major from pre-nursing to nursing was something akin to a Nobel Peace Prize. I was accepted to two programs once I finished my prerequisites, but opted to move to Sacramento for nursing school - another "nursing town", as it turned out.

Nursing students have a few identifiers at my university - our scrubs, our name badges, and our sweatshirts with the word "nursing" emblazoned across the front, ten times bigger than the name of our university. What I've found since being a nursing student is that when I wear any of these on campus, or to the store for a quick something after clinical maybe, a lot of people put aside the fact that they don't know you personally, because they know nursing.

"Oh, you're in nursing school! You must be really smart!"

That one makes me really uncomfortable, because... well, yes, I've gotten good grades. Yes, I like to think that I'm smart and capable. But how do you respond to this compliment without sounding like an overblown pufferfish? My usual answer is normally, "Well, I study really hard all the time..."

Then, there's the obligatory, "When are you graduating?"

Now, I can answer that it's going to be within the year, and there is always a huge, bright-smiled congratulations that gives me immense warm fuzzies, but also a feeling of pressure. No screwing up now, I tell myself. I've already been congratulated for graduation, so I better deliver, even if I am never going to see this person again.

My favorite story, however, is about a Wal-mart cashier I met last year who was quite frankly intimidating. She was tall, a bit burly, with tattoos and a piercing stare as she rang up the yarn and groceries I was buying with my grandmother. No conversation, no small-talk, just awkward silence and no eye contact.

Then, all of a sudden, she happens to glance at my sweatshirt, and as she's ringing up the ten Yoplait yogurts that I'm buying, she mutters, "You in nursing school, girl?"

"Yeah," I manage to say in my surprise that she's actually speaking to us now.

"Graduating?"

"Next year," I say with a small smile. "Still a little way away, but I'm getting there."

"Man, I tried those prereqs and I couldn't even hack it for a semester. Get it, girl!" she said, suddenly beaming at me and offering a fistbump, which I return with pleasant surprise. She manages a "Have a nice day!" for my grandma and I before plastering her business face back on for the next customer.


Being a nursing student is something amazing, just as an experience. It feels like everyone's rooting for you, even when you're just stepping out of your house. You hold doors for old ladies at the store, they get a glance at your scrubs or your sweatshirts, and they smile and say they hope you take care of them one day.

It's amazing how people just come together and support others, and being a nursing student has been one of those amazing chances to experience that kindness and support from people.