My MEPN Journal: Fall 2018

Med-Surg Nursing

During our first summer together as MEPNs, our whole cohort of about 70 students attended the same core classes Monday to Wednesday and then we split up into smaller groups for our clinical rotations on Thursdays and Fridays. In the fall, the cohort was split into two groups, A and B. Each group ends up taking the same courses over the remainder of the year, but in a different order. 

The As take two classes in the fall: Effective Communication and Medical-Surgical Nursing. Med-Surg also has the notorious back-to-back 12-hour clinical shifts on Thursdays and Fridays. The summer was hard, but I didn’t think there was anything too challenging. It was exciting being back in school and getting to know everyone in my class. The training was fast paced but manageable. My biggest hurdle was figuring out the new commuting and parking situation for drive into school from Napa 5 days a week. This quarter was different. 

Clinical

Because I was in the A group, my clinical experience in the fall was a smooth continuation of Intro to Nursing. After a short two week break in September, I went straight back to the same Neurosurgery floor at UCSF, working with the same nurses that I met over the summer. It was nice to have some familiarity and comfort in the hospital environment given that the demands on us as students were about to skyrocket. The students in the B group went on to different locations for their labor and delivery and community health placements. 

As a MEPN, the Medical-Surgical nursing experience is heavily influenced by your clinical placement. Students in my group were assigned to various units at the San Francisco General, UCSF Mission Bay, Stanford, and UCSF Parnassus hospitals. I was assigned to a neurosurgery unit at UCSF Parnassus with two amazing clinical instructors. From talking to classmates, it sounds like we all had very different experiences which helped us develop different strengths. It was frustrating at times hearing that some students were way ahead of me in a certain set of nursing skills (like wound care), but it was helpful to remember that I have also developed strengths in other areas (such as neuro assessments). I just need to remember that this is the beginning of my journey into nursing and I will have many more years of education and on-the-job training. A nurse’s education never stops, right? 

Despite the smooth transition from summer into fall, there were growing pains. The first was the “12-hour” shift (actually 13.5 to 14 hours long). The shift begins at 7:00 am and goes until you give report and hand off your patients in the evening around 7:30 pm. However, as students, we and are expected to be there early to “pre-lab” or research each patient, their condition, medications, care plan, etc. I was usually at the hospital an hour to an hour and a half before the shift to do the research and compile the reports. Although they go by surprisingly quick, back-to-back 14-hour days in the hospital were sucking the life out of me. 

I wasn’t able to find the time or motivation to study on clinical days, so schoolwork, studying, and exams spilled over into the weekends. During the summer, I was able to block off my Saturdays and spend them with my partner or relaxing. Sunday mornings were set aside for the online exams. The afternoon was for household tasks, meal-prep, laundry, and other fun stuff like that. Free time on the weekends this fall was a lot harder to find. 

UCSF also set the bar much higher for us this quarter. I felt a tremendous amount of pressure trying to get my pharmacology knowledge up to par. Medication administration is a nursing practice that carries a huge risk of error and patient harm. The consequences are high, and as a student, this is drilled into you every single day. For each medication we handle, we are required to know the name, class, mechanism of action, regular and max doses, indication, contraindications, time of onset, side effects (common and dangerous), interactions, nursing considerations, and the specific reason it is prescribed to the patient. In addition, the administration procedure for each drug has to be understood and followed exactly. Many of my patients received up to 15-20 different medications each day. Meeting and exceeding the medication administration requirements was hard, especially with the accelerated pace of this program. It was possible, though, with a lot of extra work outside of class and clinical hours, and with the help of my classmates and clinical instructors. 

I felt like everything was finally starting to sink in by the end of the quarter. It took some time to adapt, but it was a great learning experience. The time management, leadership, and nursing skills were all starting to take root. For the first time, I am starting to feel and think like a nurse. I’m excited to see how I will grow from here. 

Theory

The theory or classroom portion of Med-Surg was a rollercoaster of its own. The instructor is great and she has a special way of connecting to her MEPNs. The material is exciting and directly relevant to our experience and patients in the hospital. The exams were hard but fair.

Tests are written to simulate the NCLEX. Doing well requires a specific style of studying and thinking, which can take some time to master. I understood the concepts we covered, but was not performing as expected on the first two exams. I guess it takes time and experience with nursing to think like a nurse. 

Immersing myself in the whole nursing experience this quarter, both inside the hospital and out, helped some of these concepts take shape. I was also able to find the study techniques that worked for me. Study groups, sharing study guides, talking about the material with classmates, nurses, or pretty much anyone who would listen, as well as practicing a lot of self-care helped correct my early setbacks this quarter. I know I’ve said it before, but teamwork and grit really are key to this program (and nursing).  

What’s Next? 

It is a huge relief having this quarter behind me. It will be an important foundation for things to come, particularly psych/mental health nursing and pediatrics next quarter. But I’ve got three weeks to decompress and recover from the mental and physical beating I’ve endured these last several months. I can’t wait to hang out with friends and spend some quality time in the mountains again. Maybe take a few photos again too!