Nurse's Watch: Conversations on contemporary nursing,
nursing education, leadership, spirituality and blogging.
~Start date February 2010~

Saturday, August 17, 2013

Finding the answers...

Though I haven't yet posted the news, I recently was accepted to the PhD in nursing program at the Medical University of South Carolina (MUSC). Whoooohooooo!!!

For months I have been so excited I could hardly stand it. Because, as a self admitted nerd, nothing smells quite as alluring as the pages of a textbook. Nothing is quite as inspiring as meeting new people with original ideas and grand dreams and then mingling with these idealists to study, question and dare to improve upon our little corner of the world. This, in addition to the joy of procuring new knowledge and exercising the opportunity to test oneself, is so fulfilling. Why, could there be anything else so exhilarating?

So what's up with this... the nervous tension, the pressure I am feeling. After all isn't this what I wanted? What I have dreamed of...? 

It could be that teaching pediatics first summer session was exhausting. It could be that I am drained of all creative thought after teaching a new class the week I came back from residency. It could be that I feel behind on a grant I am completing. And it could be that looking at my student loans undid me. Or it could be that I am questioning my sanity to be starting a PhD program at age 55. Yes, there I said it. I admit to it. I worry about my age.

I sure could use a Book Of Answers about right now. However, after compiling a list of all my questions ... what in the world, whats wrong with me? How do I know if I am to do this? How do I know I am not crazy? How do I know anything? The answer revealed itself when I realized ...

If I don't do this, I will forever regret it for the rest of my life...
 and regret is an awful life partner...
 and so that is enough...

Life, after all, is a grand adventure, one we must traverse with a great deal of faith. We cannot know tomorrow but we must still give our all today and everyday, or life becomes meaningless and mundane.

So, it is not about how long or short my life will be but how fully engaged I am in the process of consuming authenically the time and resources that have been given me. God said it best, "To whom much is given, much is required..." While I may not have immense wealth, I do have passion for the profession I love. And so I am off to school once more...

Thursday, May 30, 2013

That old lab coat...

Often when students first begin nursing, the concepts can be rather difficult. I always try and encourage students because nursing is hard, very hard. Benner's work addresses the levels of nursing expertise and the arduous path one must take to become a nurse as she describes the novice, the advanced beginner, the competent nurse, the proficient nurse and the expert nurse (1984).

I love using word pictures to help explain ideas and concepts. So with students I equate this quest for knowledge and experience to having a brand new lab coat. Now, most people would think that a new lab coat would be nice. However, the truth of the matter is that a new lab coat is often stiff and uncomfortable. It takes wearing and washing the lab coat to 'break it in', much like a new pair of shoes, for the lab coat to become an accepted and desired part of nursing attire. The more this item of clothing is worn the more it is stained with experience! Of course, it will be washed but traces of the stain and the experiences that contributed to the stain remain.

So it is with nursing. In the beginning, the student is inexperienced and the tasks are new and difficult. The material seems heavy and cumbersome, combining this heavy material with stiff new tasks make wearing this coat hard. Then it begins, the change is almost in perceivable at first. You get the lab coat dirty in the process of caring for a patient, you wash it, but the next time you see a similar patient you realize you are familiar with the experience, you have a stain of knowledge in this area of nursing. Aha!

Over time the more the lab coat is worn, used, stained, washed... the more comfortable this coat becomes. The more experiences we stain the coat with, the more comfortable we too become. Time passes, knowledge expands... and that lab coat becomes drab but suddenly it is comfortable.

Now be forewarned, should I move to a new area of nursing, alas, it is as if I have purchased a brand new lab coat in some respects. I must wear it, wash it and gain experience in it also; only using the lab coat will produce the stain of experience...

So ladies and gentlemen, buy your lab coat, wear it, wash it and in due time it will become comfortable and familiar to you. And remember one day, before you realize it, you will find that slipping it on is like rejoining an old friend and you will feel proud and confident ... I promise.

But your lab coat, well it's going to look really nasty...

Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park: Addison-Wesley, pp. 13-34.

Thursday, March 14, 2013

A Letter to my students...

Well, after reading a letter to my professor, I felt it only fair if I added one addressed to the students. I am a fairly new instructor so I hope I am not yet jaded and can post things that will indeed help students and also may express how many instructors sometimes feel. So here goes, a little advice...

Students Please...

Believe it or not, I am on your side, however, I cannot help you if you don't tell me you are having trouble. Email, call or text as I have instructed you but don't wait until the due date of the assignment.

I am not an ogre. I do understand that emergencies happen but because some students have taken advantage of this, I now may require that you have proof of the 'ticket, death, or illness'; do not take it personal.

I do not have 'pets'. The students who participate are easier to engage in classroom discussions.

Teaching you takes a lot of preparation and time because nursing is changing everyday. Respect my investment in your future. Do not text, shop or visit Face Book in my class.

When you critique my class in student opinion polls offer constructive criticism that is relevant to teaching. I do read them. Complaining about my hair, face, wrinkles or clothes, does not contribute information which can help me be a better teacher.

I am less likely to be sympathetic to your failing grade if you did not attend study reviews, class, or turn in required work.

Writing a care plan by hand may be acceptable but only if I can read it! Neatness counts...

I cannot offer extra credit. This isn't fair to the other students. Also, believe it or not I too have missed an A by less than 0.5% of a point. I do know what it feels like and I'm sorry.

I love creative ideas that could help me in the classroom; technology is constantly changing and it is hard to keep up with it all. If you utilize something like Flashcards by StudyBlue, Evernote, or relevant YouTube videos please share; I appreciate this.

If you want to 'rate' me at that is fine just be truthful and kind, but please do not put a red chili pepper by my name, while I may be flattered, it's embarrassing.  

Remember the chain of command and follow it. Before you go to the Chancellor or Dean you must come to me first, otherwise they will simply dismiss you until you do. I may seem harsh due to years of dealing with various student attitudes but I will not bite your head off, I understand the courage approaching me may take, so I promise to try and respect your concerns. 

Come back to see us and share your adventures and successes with us. We are interested and proud; you are the future of the profession we love so much!

Lastly, remember that over and over in polls nurses are rated as one of the most trustworthy professions. Learning never ends. The patients' and families you care for trust that you know best, don't disappoint them.


Tuesday, February 12, 2013

A letter to my nursing instructor ...

As a nursing educator, I have watched students struggle with the numerous challenges modern day education exacts upon them. These students often have jobs, families and an abundance of responsibility, in addition to their life as a student. I watch and pray as many of them groan under the weight of all these pressures, tasks and deadlines.

Since it was not so very long ago that I was a student, I tend to feel a great deal of empathy for their plight. I find I can still see many things through the eyes of a student, even though I now peer through the lens of an educator.

In support of these aspiring nurses, many who are working diligently to attain their degree, I have written the following suggestions to nursing instructors everywhere entitled...

'A letter to my nursing instructor':

Please do not call me out in a class of thirty people and tell me I am ‘wrong, wrong, wrong’. I am an adult. In other areas of my life, I am secure and confident. People trust me and come to me for advice and assistance. In this new environment, I am insecure. Calling me out in front of others does not teach me anything except to trust you less and to take fewer chances.

It helps me when you organize yourself, your class and your time. You are the teacher; I am the student. I often juggle 12-18 hours’ worth of classes each semester, while simultaneously working a job and caring for family. If your class is well planned and organized, I am able to plan and organize my time appropriately as well. 

Give me a chance before you label me a whiner, lazy or a cheat. I realize there are students who whine. I also realize that there are lazy students and students that cheat; I am not one of them! However, you will never know this because you assume when I have a question, suggestion or complaint that I am trying to get out of work or find a way around the system. It could be you are missing some excellent suggestions for improvements for your class because you will not listen. 

Be mindful of my student level. As a first semester junior, I may be afraid to touch a patient. I have not seen a lot of naked bodies. Changing an occupied bed and giving a bath is still huge at this point. I understand that you may have been doing this for years and thus are way beyond this apprehension but I am not.

As a senior level student, I may no longer break out in hives at the thought of giving a bed bath or emptying a catheter but I may be freeze up when dealing with a patient in critical care. I have a long way to go to become confident in all these settings but rebuking my anxiety will not lessen it.

Could you refrain from intimating you are ‘babysitting’ and reminding me I am ‘not in kindergarten anymore’. I am painfully aware of this; kindergarten was safe. Here, I feel I am experiencing lateral violence firsthand. 

May I suggest you major on the major. Do not pull insignificant facts from a textbook to test. The NCLEX will not do this. Licensing boards expect me to be able to provide safe, effective care. They will assess my ability to critically think, not my ability to memorize. Testing for non-relevant information is akin to jumping through hoops. I can do it but will learn nothing from it, information in, information out.

Please do not say, “You know what I mean….” I absolutely do not know what you mean or I would not be sitting here…

Remember that I am paying to be here. Take the time to explain and teach; do not waste my time. If you are simply reading the text, PowerPoint’s or posted notes, I can do this at home. Understand that I may be paying a babysitter so I can attend your class. If you were in my shoes would you be pleased with the service you are providing? 

If you teach an upper level class, investigate and be aware of the content in previous courses. Communicating with fellow instructors will help ensure a smooth continuum of learning for me. 

It would be best not to teach the class on the fly. If you are not committed to me and this class, may I suggest you find an alternate livelihood? In nursing I hear you speak about evidence based care, how about evidence based teaching? Do you revamp and improve? Have you kept up with current research? Do you know what it says about creating a strong, well-prepared student? I hope so because I am depending on you and so are the patients that I will care for someday. 

Do you realize I am going to be your colleague one day. I will look back on these days with either fondness or loathing. If you treat me the way you would like to be treated, I will do the same should I come across you as a patient one day. Remember, it could happen; be careful what you sow.  

Lastly, I am so excited to be on this journey to become a nurse. Help me to be successful. Share your wisdom and passion. Don't extinguish my fire for learning, squelch my enthusiasm for caring or smother my idealism for humanity. Life with all it's difficulties will do this soon enough; please help me be successful. I am the future of the profession you hold so dear. 

Deanna Hiott MSN, RN 2013

Sunday, January 27, 2013

A death occurred...

A Death Occurred...
A death occurred on the unit today. I had just given my brand new students' their assignments and the code rang out eerily close to where we were standing. I took them to the break room which unfortunately was right across the hall from the code, so the inconsolable cries of the loved one's mother were unavoidable. 

I tried to explain in teacher language what was going on, who responds in a code, the different duties and about the debriefing that will occur. Finally, I hurried them off to care for the other patients but not before the students' eyes were filling with tears. How callous I must have seemed...

As I entered my office this afternoon, my mind wanders back to the floor. I hear the wails of the poor mother, the hustle of nurses, doctors, pharmacists. The wheels of the crash cart. The overhead intercom announcing the code... and I am alone and silent, facing the death of a child I did not know, bearing the sorrow of a mother I did not know, trying to make sense of this moment in life with student's I did not know. 

This is the harsh reality of nursing and caring for people. We step into their life for a moment to minister to them and their loved ones and no matter how smart we are or prepared, there will always be those moments that no matter what happens, we feel so inadequate. But really, who could be adequate for such a situation?

My thoughts and prayers go up for this mother... As nurses we often encounter the extremes in life. The highs and the lows, and we are programmed to handle it and we do, or so we think. Often it is when we are alone that the realization of what has just happened hits us. The realization that a mother just lost her child and it is sad, very sad. 

So, how is it that nurses are able to work under these conditions and still show back up the next day? A friend and mentor once told me that in an emergency, "it is the patient's 'crisis'; we can help them through it with our skills, knowledge and caring or participate in it." 

So, I choose to try and help. At that moment we are their best earthly hope; God has placed us there, then, for a reason. And I am left with the realization that I am thankful for my faith, which guides my thoughts, heart and mind because sometimes there just are no answers....

Tuesday, January 22, 2013

~Teachers who inspire realize there will always be rocks in the road ahead of us. They will be stumbling blocks or stepping-stones; it all depends on how we use them. ~Author Unknown

As a nurse, I have often had to comfort patients and their families when life is difficult to understand. I have tried to help patients grapple with the difficulties of an illness or loss. I have comforted people and often, yes, very often simply been there when words are not possible or seemingly appropriate.

As a nursing instructor, I have found that this element of nursing is still essential. Life continues to be difficult and hard to understand. Students are left reeling from illnesses, accidents, family difficulties and failures. Words seem to stick in my throat. My heart breaks for them. I too have struggled. I have felt the anger, betrayal, sorrow and heartbreak. I too have questioned my sovereign Lord's intentions and purposes.

The Bible tells us we are to comfort as we have been comforted, offering hope and encouragement... I hope to be found faithful...

Fortunately, our school also offers counseling services for students.
This is vital.
Though I try to comfort, guide and support, the most important thing I can do is try and steer them in the right direction. I try to provide them with the resources they will need to survive the current crisis and move into the future. This is where the experts come in...

Ultimately, though, they have my prayers and a reminder:

Sometimes God says yes,
sometimes God says no
and sometimes He says wait...

Waiting is hard but prayer can reveal the stepping stones to His plan for your life...

Wednesday, January 9, 2013

'If you can't say something nice, write it!

As I look back on the blog which I wrote after graduating, I see an idealistic and appreciative new instructor. I see optimism and hope in the words I wrote; and I sense the trepidation I felt.

Today, however,  I quite possibly shot myself in the foot... or fell on a sword as a kind mentor once cautioned me. "Deanna you can not fall on every sword, as you think about it, was this issue so important..?" At the time, I concluded yes, yes it was. It involved an unkindness toward someone else that was defenseless, I would do it again I concluded.

Well, today I spoke my mind. I am still pondering the wisdom of this but I believe that it was worth the sacrifice. I love the school where I teach because this is my alma mater, twice over. Each time I had excellent teachers who came along side me and taught me to be a great nurse...if I do say so myself ;-) I have been dismayed over the last year to see lateral violence toward students and even more disconcerting, incivility toward each other among the faculty.

Lateral violence in nursing is not new and we love to blame it on being a suppressed group working under dominating physicians. Well, there are no physicians here on this campus, so I feel that we must place the blame squarely upon our own insecure and haughty shoulders. Where does it come from?

Why do instructors belittle students and treat each other in less than professional ways. The back biting and catty chatter is disruptive and demeaning. I do not know the answer to these questions but I do know that if God allows I hope to be active in nursing education for quite sometime and I for one refuse to tolerate it. So I hope that as I reminded everyone of the great instructors I had enjoyed and concluded that while I am so proud of my school the display of incivility is disappointing, hopefully it will encourage others to refuse to be a part of this type of behavior. What would happen if we all refused to participate and tolerate this type of behavior? Would those bitter, angry souls wither away?

No, I know that they would not and I know fair well that I fell on another sword but I don't care. At least as they meet, confer, gossip and engage in their intellectual snobbery they know in the depths of their souls that their deeds are known. And it is my belief that no great person ever had a mind so small.

Oops, in the back of my mind I hear my Mama calling, 'Deanna, ... If you can't say something nice, just don't say anything at all...'

Well, alright then; I'll write it!

 I'm done.


Saturday, January 5, 2013

A good dose of reality...

Well, it has been quite some time since I have posted. This first full year of teaching has been incredible and insightful in so many ways. I am pleased to have survived!

While, there have been many highs and lows, lots of work, laughter and tears, I remain hopeful and inspired. It is funny as I look back on what I 'thought' teaching would entail and compare it to what I have found. There are huge differences!

As a floor nurse, I often would observe teachers and think they had such a 'cushy' job. Seriously. They were not actually responsible for patient care. They simply surpervised students. How hard could this be?

Well, first of all, as I address my misconceptions, I apologize to all educators. What I thought was a 'cushy' job is actually quite grueling... fulfilling and invigorating, but grueling.

I have been reticent to divulge much about this first year as I have struggled through it, however, I am now ready to offer insight into the world of nursing education, doctoral applications, programs, grants, research and the like.

This has been an amazing year. It is clear that God has directed my paths and I look forward to His plans for the future. I wonder what is in store?