I think we all have something to add to this list…one of my personal ones: man presented stating he was unable to stop crying after chopping onions.
I despised writing reflections as a student nurse. Despised it! And I’m not the only one. Writing reflections while on placement was one of the biggest things my student colleagues and I complained about during our informal ‘debriefing’ sessions.
For those of you who don’t know what I’m talking about or who haven’t written one in a very long time, reflections are short pieces of writing, vaguely a report, vaguely an ambiguous pain in the neck that many students have to churn out around once a week while on placement. The idea behind them is to, you guessed it, reflect on our placement with respect to personal professional development.
The reflection process has a couple of flaws though. In short, I believe the current structures are ambiguous, there is a culture of ‘marking’ and correcting reflections, and they are encouraged to be too long and overly complex. I will discuss my thoughts on each of these in turn and then have a discussion about what we should do to fix the reflection process so that people actually do it.
The 5 R’s of Reflection
At my uni, we were encouraged to use the “5 R’s” of Reflection (not to be confused with the “5 R’s” of medication administration). The 5 R’s of Reflection were these: reporting, responding, relating, reasoning, reconstructing. This reflection process is supposed to encourage you to break down an event into these headings in order for you to explore want went on in more depth, or perhaps, more broadly than you would do just thinking about it in your head. I dutifully wrote my reflections every week of placement using the 5 R’s and have actually used a number of them to write previous articles for Bed15. They did allow me to think about specific events and I often enjoyed exploring those events to work out what went on in depth.
As I have mentioned though, I’m not sure the 5 R’s are the answer to reflection from a nursing perspective.
Before I continue, the 5 R’s are not a random, made up structure from my university, it has been used and re-shaped in a number of forms in many professions but you can find a bit about it in a book titled “Reflecting on Practice: Student teachers’ perspectives” by Bain et. al.. It is a book aimed at student teachers and has very little to do with nursing. However, the 5 R’s are sound and can be applied generally as they are in many professions.
For me though, and not to knock down the hard work of the original authors of the 5 R’s of Reflection completely, I found the process far too ambiguous for what we need them for in nursing. Think about nursing as a profession, from student to advanced practice, and you will know that nursing, while not an exact science, is all about being precise, direct, provide structured answers and to do so in a timely manner. The 5 R’s does not do this.
While writing a reflection using the 5 R’s, I always had to have the sheet out telling what each R is because I became confused each and every time. They ask you to first Report what happened, then how state how you Responded to it – basically making you think about the event without your input at the beginning and then how you initially dealt with it. You then go on to Relating which asks you to link personal and theoretical knowledge to the event – I never really knew what this actually meant, especially when you go on to the next R: Reasoning. Here you explain the situation or issue…I thought I did that at the start! Sigh. Finally, you get to the end where you Reconstruct, drawing conclusions and thinking about the future where you may come across a similar situation.
I hope I’m not alone in my thoughts on this – but in the end, I believe the 5 R’s are too ambiguous for the reflection in nursing. There is too much overlap and you shouldn’t need a detailed handout to remind you of exactly what each of them means when you are writing a reflection.
Length and Complexity
Each reflection I wrote using the 5 R’s were approximately three-quarters of a page long. It took me between 30 and 60 minutes to write one (sometimes longer) and I struggled to break the situation into each of the R’s. Each facilitator had a different idea of what they wanted in your reflections and that added another level to the complexity as you tried to pick something that would yield a page of writing.
At uni, my classmates and I were usually encouraged to write reflections beyond uni throughout our careers and use them as learning points. I think this is a great idea, however, what nurse is going to get home after a long, hard, awful day and write a reflection on it – even on the next day? It was bad enough as a student when it was mandatory! I can’t think of anything worse to do in such a situation. The problem is, reflection is best done soon after the event else you lose clarity of the specifics.
Part of the problem writing a decent reflection using the 5 R’s is that you need a ‘meaty’ event to be able to write enough. If you try and write one on how you accidently put the blood pressure cuff on upside-down, you’re not going to get far…unless the patient became critically ill because of it. However, coming across decent events doesn’t happen every day, or every week – we are encouraged to become proficient and that means you probably won’t come across too much that needs a good reflection. I used to want to write reflections on things that went really well for me where I would get to the end and say “Therefore, due to my brilliance, I will never change practice because this worked absolutely perfectly.” Facilitators would not like that.
When I say facilitators, I use their title because they are the ones most likely reading our reflections. But I also include tutors, lecturers and other educators you may come across who wants to see them.
Some facilitators tended to ‘mark’ our reflections rather than, well, facilitating them. More than once I received a reflection back with some red strokes on it indicating grammatical errors, spelling mistakes and, more importantly, how I should spend more time talking about ‘this’ and discussing ‘that’ and how I got the third and fourth R’s mixed up (again) and that I should try harder next time to provide meaningful references to back up my ‘research’. My view is that facilitators should not even put a pen on your work even if you’ve completely missed the point and written a poem detailing your first day (yes, I’ve seen that happen before – and it wasn’t me before you start guessing).
I believe the role of facilitators in reflection writing is to ensure that your reflective technique is actually allowing you to reflect. They should be talking to you about the event itself and ensuring that they are asking the right questions that encourage you to reflect on it appropriately so that you may learn. Too much emphasis is given to the piece of paper and ensuring it is in on time rather than on the reflection itself.
How do we fix it?
If I was an educator in charge of placements, I would refurbish how reflection is done. I would still make it happen, but it would be done differently based on my discussion so far. The problem is, facilitating reflection one on one is not always found easy by people and providing training to every person who may be helping you reflect is expensive, time consuming and probably won’t help anyway. So that means it’s down to us, as nurses and nurses to be, to get our reflections down pat for ourselves.
I will now detail my own ideas on how we can do reflection (these are just ideas and easy to ignore if you don’t like them). I believe they will make reflection easier for students and more accessible to continue the practice into our professional lives post university.
The Bed15 Approach to Reflection
First we need a simple structure. I see no need in a thoroughly researched collection of terms that all happen to start with the same letter in order to reflect. Instead, I like to use a structure from my old days as a counsellor, one used in debriefing from time to time as seen below. Remember, use whatever structure works for you as long as it allows you to explore the issue and allows for some learning.
Asking questions makes it easier for people who are not gifted writers or for those who can’t be bothered. People will argue that it makes reflection too easy, but for those serious about their professional practice, they will add what they need in each of their responses to make it a beneficial experience. When answering, think about asking yourself why a lot and think about looking up practice points as you go – have a text book or Google handy, but remember this is not about writing an assignment, don’t stress about referencing if you don’t want to.
Answering these questions can be done any way you feel comfortable. A reflection is not an assignment and is not actually supposed to be read by anyone else, so use point form if you need to. Write a paragraph if that works for you, whatever it may be, keep it simple. Another important point is to keep it short. Many students make the mistake of trying to impress with detail at the start of their degrees – only you are likely to read your reflections in the future so keep it short and sweet, no more than a page at most so that the entire event is summarised in a small space.
One thing that I tend to add to reflections is just a few notes down the bottom of where I found information if I looked it up. Include the names of books, links to useful web sites and anything else. There is no need for recording this information in Harvard style format or anything like that – it’s yours, do it how you feel. If something similar comes up again or you’re doing some more research, you have a start point. However, remember that reflections are not research assignments, there is no need to reference if not specifically asked by your university.
When should you reflect? It can help to write a quick note somewhere to remind you to think on the event later, as reflecting straight away is often difficult due to time pressures, tiredness or being a bit over the event that the very thought of it upsets or irks you. Don’t write a reflection straight after the shift either if you’re tired or worked up. Go home, relax and go about having a life. Writing a reflection should happen several hours after when you have had time to relax and process things, or even the next day after a sleep. It shouldn’t take long so make yourself do it sooner rather than later.
How do you keep your reflections? Together is the correct answer, but how is up to you. A folder with binder paper, a notebook or as documents on your computer, whatever is easiest for you. Just write your headings and fill them in, but keep it all together. That way you can easily flick through in the future. Keep them in specific categories, by date or however you like, that’s the joy of reflections.
There you have it, my thoughts on reflection for professional practice as nurses – the Bed15 Approach to Reflection (one day I’ll summarise it for people to have on hand instead of this giant document). Yes, it dragged on a little long and yes, I may have upset some university educators but I like being able to say how I feel having actually had to write a gazillion of them a couple over a couple of years. If my ideas look they will help you then definitely use them. If they clash with specific requirements from your education institution, you probably have to suck it up and do what they say for now until you finish…sorry. If you don’t formally reflect at the moment, try one out and see how you feel – keep it short and simple and it might just work.
If you have ever worked in an Emergency Department, you will know how quickly an ED nurse learns the chest pain protocol. It’s an ED nurse’s bread and butter, they can recite it in their sleep, and it becomes so much a part of them that they often have trouble actually reciting it rather than doing it. I know I do. That’s why I thought I’d share the very basics of some of what I have learned about looking after chest pain as a nurse. Dealing with chest pain can be a stressful situation for a nurse due to the time pressures protocols put on you, so I will be keeping this simple and I will try to explain rationales of each step of the basic chest pain protocol. The aim is to not heavily educate about the anatomy and physiology, more about the actual front line tasks of the nurse in dealing with chest pain.
Usual Bed15 Disclaimer: This is my own research from work protocols, text books and some old-fashioned web searching. If your workplace does something different, ignore what I have to say! If I have said something wrong, get some research to back it up and let me know!
Chest Pain: an introduction
Chest pain in the community is widely a known thing due to public service announcements of various kinds. Generally it is understood to get yourself checked out if the pain is out of the ordinary (or you have never had it before), particularly if it does not abate quickly – the exact parameters of this advice varies depending on which organisation is giving it (Australian Heart Foundation, Better Health and various other organisations all have same basic message). Pain in the chest can be a result from a number of conditions such as chest wall trauma (pulled muscle, fracture rib etc), indigestion, lung infection and a host of other things. The problem with chest pain is that sometimes it can be something rather serious: a heart problem.
The nurses among us should know what the heart does, where it sits and vaguely what it looks like. If you need a quick refresher, try here: http://www.youtube.com/watch?v=ifPY0hy5ZiY (or search any number of sites available to you – I won’t try to re-explain everything, I’m no lecturer).
Case study time!
This is a real-ish case of a gentleman I looked after last year. I have changed some details to protect his identity. Any similarity to a real person is purely coincidental and indicative that I would be an okay psychic if I put my mind to it…or believed in it…
This 79 year old gentleman arrived via ambulance into one of my allocated bays. I was in the corner of ED often saved up for typically long presentations, such as chest pains of course, so I was not surprised to find the man clutching his right arm to the left side of his chest, breathing heavily, borderline tachypnoeic, pale, and diaphoretic. He had a large history of cardiac issues such as hypertension and hyperlipidaemia and took medication for these.
That’s about the limit of a handover you will get from a paramedic – they work fast and give you enough to know where to start so that you can work fast. The handover and a quick visual of the patient told me that this one was potentially serious and I had already commenced the chest pain protocol for my workplace while I was getting handover – who said guys can’t multitask?
I will now outline chest pain protocol basics as well as some other helpful items that I have found along the way. I will do this with reference to my patient in italics.
ED educators will always ask you “what is the priority nursing intervention to perform for a person with chest pain?”, the correct answer is “perform an ECG and show it to a senior doctor”. The informal correct answer is this: take at least the top half of their clothes off +/- put a gown on them, depending on urgency/decency. Patients always ask why they need to be in a gown in ED. The basic answer is to allow the team to assess them easily – the secret answer is so that emergency procedures can be instigated quickly with minimal fuss if things go pear-shaped. Putting a gown on the patient is usually not detailed in a protocol and you may get a point for being a smarty-pants if you say it, but if an educator asks you, stick with ECG.
My elderly gentleman had been in hospital many a time and was removing the top half of his clothes before I had finished the sentence. He required a bit of help due to the pain and breathlessness.
A 12-lead electrocardiogram, or ECG, is the number one most important thing to do for a patient with chest pain. Do it before obs, before bloods before anything (except getting their shirt off of course). This usually has to happen within ten minutes of arrival and should be conducted without confirming or clarifying any other details other than what we have heard already. The ten minutes also includes actually showing the ECG printout to a doctor so that they may quickly assess it, so do not tarry! (Yes, I said “tarry”). Also note that most organisations require a set number of repeat ECGs within a set amount of time (my last hospital stated three ECGs, 20 minutes apart from each other).
The rationale behind an ECG is simple: it is one of the quickest diagnostic tools available that can be used to make an early diagnosis, hence to act more quickly. ECGs measure the electrical impulses produced in the heart across the frontal and horizontal planes of the heart. They specifically show the polarisation and depolarisation of cells from the movement of ions caused by the concentrations of potassium and sodium in the myocardial tissue (phew! That sentence was hard!). Basically this means that the ECG can show if this process is happening efficiently, which it won’t be if there is structural damage to the heart (ischaemia, infarction, enlarged chambers, electrolyte imbalances, and so on). ECGs are also used to assess cardiac arrhythmias. In the end, you get a lot of information from a fairly simple diagnostic test which does not harm the patient in any way.
A note on reading ECGs: the best skill you can have as a nurse regarding ECGs, other than how to perform one, is to know when one is grossly abnormal. Don’t feel that you have to know the detailed ins and outs of every squiggle on that paper straight away, it is not often a priority in your education. Certainly if you’re interested, book in for a course and take copies of ECGs to analyse, but don’t stress yourself about it.
My patient was also accustomed to having an ECG, he needed no instruction on what to do and waved off any that were offered to him, simply laying back and putting his hands by his sides. He was not particularly hairy so did not need a hasty shave from a nearby razor (a student I had with me once managed to shave a patient’s entire chest while I wasn’t looking…don’t do this). The first ECG was printed and shown to the consultant who was not immediately concerned by it, but based on the patient’s history, agreed that the standard protocol should be followed. Two more ECGs followed in the next 40 minutes. None of the ECGs showed any new changes, as confirmed by the consultant).
Emergency Departments are notorious for sticking needles in people and taking bloods, sometimes unnecessarily. When it comes to chest pain, bloods are extremely important. With any patient that is having a potential cardiac event, bloods are required to be sent to a lab for urgent testing. The gold-standard test is a Troponin level.
When cells are damaged they release their contents into the circulation. One of these contents is troponin, which is specific to myocardial muscle. Normally troponin does not circulate so presence of it denotes damage to heart tissues. Troponin is present in circulation after approximately one hour, generally best tested between three and six hours and peak within 12 hours. This test is seen as more accurate and faster to run than other markers used in the diagnosis of cardiac damage.
Other tests should also be taken at the same time to reduce the number of times the patient has to be stuck by a needle. These tests should include a full blood count, electrolyte levels and liver function tests. Some organisations may require more or less tests, and of course, a doctor may require other specific samples as required.
Intravenous access is extremely important for the purpose of giving medications/blood products/fluids etc as required, so get a cannula in quickly. An IVC inserted in a patient with a risk of a serious complication should be inserted into a large vessel if possible to allow for fast push medications that may be required in an emergency situation. ED nurses get to ignore some rules in IVC insertion rules such as starting lower in the arm and working up as required. (Ward nurses: this may be why IVCs are often found in the patient’s cubital fossa when they arrive on the ward from ED – I often wondered before I worked in ED).
The required blood samples were collected and sent to the lab in the special urgent bag reserved for units such as ED, CCU and ICU. This means they get priority in the lab for time-sensitive conditions. The results were returned to show a very small troponin rise and some slight changes to other blood levels, none of which pointed to any specific, life-threatening case at the time. A repeat troponin came back negative.
Obs! Finally! When I was a student asked about chest pain protocol, I often volunteered ‘obs’ as the first response to someone with chest pain. On reflection – what are you going to get from a set of obs that will assist in specifically identifying what is causing the chest pain? You will get hints only, hence why other interventions come first. The good thing about attending to this in a large ED is that there is usually some pretty impressive monitoring equipment right at the patient’s bedside that you can hook up very easily, set it to autopilot, and write down all the obs later after the intensely busy period. If you only have the basics at hand and only one nurse, work on the ECG and bloods first.
The basic obs are good to have an ongoing record of and should be taken regularly in intervals of five to ten minutes initially. Aside from any obvious figures that are out, you should be very carefully looking for trends. The lovely line graphs that most obs charts have now are wonderful for seeing this, so use them and use them accurately. Report any abnormalities to a doctor immediately such as brady/tachycardia, brady/tachypnoea, and hypoxia. Also remember to keep asking the patient about their pain. Remember PQRST assessment and keep re-assessing. If the patient is extremely distressed, attend to their pain quickly or get someone to help while you continue other interventions.
A note on hypoxia: many previous protocols included the immediate application of supplemental oxygen via a hudson mask. Recent studies have shown that oxygen is only beneficial in patients who demonstrate hypoxia. Scratch ‘give oxygen’ from your list of responses to the educator and add it at the end only if they look for it: ‘give oxygen IF HYPOXIC’. The people at Life in the Fast Lane summarised the Cochrane Library findings here: http://lifeinthefastlane.com/2010/07/oxygen-in-acute-myocardial-infarction/.
My patient was still tachypnoeic but was not hypoxic. He was tachycardic but steady with no arrhythmia visible on the monitor or ECG. In one hour, his observations had settled as pain abated.
When you receive an order for medication or treatment, prioritise it as appropriate. Things like giving aspirin and other cardiac drugs can be considered urgent and when you see “stat” written, assume “stat” like in television shows. Similarly, pain relief can be considered an urgent priority. Ensure appropriate pain relief is charted and question it if you think it inadequate or overkill. For example, a patient who is not distressed with only mild achy chest wall pain probably doesn’t warrant 5mg of IV morphine. My patient who was distressed and gave numbers like eight and nine out of ten probably needed something stronger. Don’t be afraid to question an order, but also don’t be afraid to back down if that order is appropriately justified by the prescriber.
After a stat dose of morphine and some paracetamol, my patient’s pain was reduced to a mild ache only, he stated it was “less than one out of ten pain”. The aim was to get him pain free, but the patient declined further morphine and stated that he felt far better than when he arrived and that he would tell us if the pain became at all worse. He was also charted some IV omeprazole which was used to abate any symptoms that may have been caused by reflux or similar conditions.
Aside from the clinical interventions, your job as a nurse is to ensure the patients receive the treatment they require. If a doctor does not appear soon after arrival to ED, then you are responsible for finding one and asking them to attend. If further investigations are required such as an Exercise Stress Test or bedside echocardiogram, you are responsible to ensure they happen as long as the patient is under your care.
At some point in this patient’s presentation, you will be required to give a detailed handover to another nurse, such as at shift change or if the patient is transferred. Be prepared to give handover at any time and make it a good one.
All of this is just business as usual so make it part of your work practice and you’ll be fine.
After a few hours of investigations, doctors were unable to find any significant issue with my patient apart from the obvious concern that he had chest pain and had some risk factors. As a result, he was admitted overnight for observations and in case of further pain and was booked in for an echocardiogram and EST the following day. I looked him up the next day and saw that he was discharged with a referral back to his cardiologist and a recommendation for investigations with a halter monitor.
One that you may notice I left out: Assessment
Two reasons why I didn’t include it specifically: 1) I was rambling on and it was assumed my assessment was completed by reading the patient notes, and 2) fast physical assessment of a patient is an upcoming piece coming to Bed15 soon – keep your eyes peeled!
There you have it, the bare basics of what an ED nurse does for a patient with chest pain. If you’re in a ward, the interventions are much the same with the differences being mainly in reporting practices (such as how to report to an MO after hours or which member of their team to report to within hours etc).
I deliberately chose this case due to how similar it was to the many other chest pain presentations I have encountered, not because it was particularly standout or medically impressive. You can learn a lot more from studying case studies of common presentations than from strange, rare or extreme ones.
I hope you have learned something about the role of a nurse in chest pain and trust it will assist you when you next encounter it in your workplace. If you encounter it outside the workplace, remember the recommendation from the Australian Heart Foundation: Stop and Rest, Call an ambulance. Easy.
Until next time,
It was harder than I ever imagined to get started writing for Bed15 again. I rewrote the first line almost thirty times and I have read a number of old posts just to get me motivated again. I know the title is a little depressing, but I figure, if I’m going to start writing again, it can only get better from ‘Unemployment’. If you’re an existing reader of my work or if you have just joined me, here is a brief update of what I have been up to in the last year and a bit.
I graduated nursing at the end of 2011 in Brisbane and promptly upped and left for Darwin to complete my graduate program. There, I did two rotations, the first in an acute medical ward focused on two specialties: oncology and neurology, the second in emergency. Personally, I think that as far as graduate nurse rotations go, this was up there with the best, I feel like I can work anywhere after a year like that. The end of my program rolled around and I wanted to be back in Brisbane – partly to work where I trained, partly because I missed my friends, partly…a bit more partly, to be with my girlfriend.
I have been back in Brisbane for just over a month now and have spent the entire time being unemployed. For those of you in Queensland, you’ll not be surprised by an RN not being able to be employed (if you’ve been living under a rock, or are unaware of Queensland’s current public service issues, here’s a couple of places to start: here, and here… )
So there you have it, a brief story of where I’ve been. My existing subscribers may have noticed that I have not posted since October last year, and, in fact, the entirety of last year was rather sparse in posts. I’ll admit it’s because I was rather too immersed in pretending to be an amazing, experienced nurse in front of my patients, and not looking like an idiot in front of my educators – this took most of my available brain space. Now that my brain space has been slightly freed up, here I go again.
Unemployment sucks. I have never been unemployed (unwillingly that is, ignore the couple of expected gaps between jobs and a long trip overseas in my early twenties). It’s been a month and a half and I have not worked a day. I spent some time enjoying my relaxation but began to feel un-useful. As a result I make up for it by doing the dishes for my temporary housemates, occasionally cleaning, going for walks and sleeping. Every other minute of my day is spent on writing applications and procrastinating writing those applications.
My old business degree loves kicking in at the moment as it draws expenditure graphs of my slowly declining savings balance almost daily. Living off savings is not an entirely fun thing to do, it means I’m not saving any money, and that I can’t actually justify buying anything that I don’t immediately need such as food or for things specifically conducive to securing gainful employment. I am reducing my luxuries, except for one bought coffee a day as required and I am doing all I can do not spend too much money. Of course, I’m not entirely in dire straits but I do find myself listening to their music more often now (I mean, Why Worry?).
During my unemployment, I have realised a few things, but the big one: I miss nursing. I know I have my moments at work sometimes and wish I was sitting in the corner office of a tall building with an assistant to remind when to do things, but generally, I love nursing. In the last year I have narrowed down areas that I’d like to try more of and a few that I shall avoid as much as possible, and knowing this has made me rather more passionate about the whole thing.
I miss it so much that every few days I allow myself an episode of “24 Hours in A&E” (the best reality show about a hospital I have ever seen – purely because it is reality. If you’re curious about what happens in ED – watch this, it’s as close as you’ll ever get to the real thing without working there or being a patient). I have also caught myself watching snippets of “Grey’s Anatomy” and other similar shows, silently picking apart the medical elements in their storylines. Sad? Yes, very. That’s why I need to get a job.
We have all probably had a few applications to write in our lives. If you have, then hopefully you can agree with me that it comes with the same feeling that writing assignments gives you – extreme procrastination. In fact, writing this now is a form of procrastinating writing applications. Have no fear, the applications always get done eventually. Admittedly, I have been doing some self-guided research on my applications by trying to narrow down the best format for my cover letters and how to best present my CV. One day soon, I will put my findings together and share them with you.
Finding jobs to apply for has been another challenge – there are very few coming available that I am suitable for, and the ones that are suitable are jobs that I would be easily beaten to based on how likely it is that someone else will have slightly more experience than I. With so few jobs, this means that each application has probably resulted in a huge number of applications in which I have to somehow stand out among. I must say, it’s very hard to do this with two documents sent via a centralised website and no initial face-to-face contact.
The one application that I have sent that resulted in an interview was the closest I have come to getting a job. I guess you could say I was beaten by one person, or five, depending on how competitive you are: I was sixth in an order of merit list for five jobs. I didn’t take much pleasure in knowing how close I came, and still hold on hope that someone will drop out so I may take the job. This game is a tough one, and exhausting.
Now, when I say unemployment, I admit I have signed up with an agency, however, I have not made a cent from them as I have not had any shifts. This is partly due to an administrative error early on but mainly due other reasons.
From the hospital side, generally (and in very simplified terms) there are new grads and other new staff starting meaning the wards and units are well stocked with staff. There is also pressure on public hospitals to reduce spending (see the earlier linked articles), agency nurses are among the first to go from ward budgets and only accessed in extreme circumstances. This is largely because agency nurses are expensive compared to even casual nurses in hospitals.
The other reason I haven’t had any shifts is due to my experience. With few jobs and reduced hours to previously full time nurses, many are joining agencies, meaning I’m among the bottom of the barrel in experience. If I were a hospital sourcing an agency staff member, I’d take the 10 year experience in a required specialised area over me, an RN with one year experience as a new grad. This leads to the use of ‘new grad’ beyond the mandated year that it applies. I have been termed a new grad twice in the past week and it irks me. I’m inexperienced, yes, but not a new grad, there is a difference. I just have to work on proving that to my potential employers. Yet another challenge to combat during my unemployment.
A large part of being unemployed and applying for jobs is the wait. I find myself reminiscent of ‘The Lull’, of which I wrote about some time ago (read it here). ‘The Lull’ is the wait for results following assignments and particularly following exams. It is excruciating, it is prolonged, it is one of the most frustrating things you can go through as a student. Well, I have now decided waiting for word on jobs induces much the same feeling. I am in ‘The Lull’.
So, what do I do while I wait?
I get back into this writing business.
I keep on hunting for jobs and applying for as many as possible.
I continue being poor but enjoying my forced time off, and;
I assume I will be imminently employed.
See you again soon.
Immunize: The Vaccine Anthem by ZDogg MD
Hey, want a catchy tune to get stuck in your head this Monday? Check out this funny (AND OH SO TRUE) video! :)
(Thanks for Cranquistador kittenisjunebuggin for the link!)
Let’s just start posting again with this awesome gem :)
Is anyone still there to read this? Because I wrote something….want to see??
Some patients need to think harder about the statement “…worst pain you can imagine”…