Let’s try again: Heidi’s nursing journey journal

[Floatzel98]

Excited for you that you are back doing this! You seem super prepared and are obviously doing really well! (besides stupid referencing issues hahaha)

P.S. I wonder how much more cheating occurs in remote online exams (invigilated closed-book) than in on-campus exams.

I'd have to imagine so much more cheating occurs. Based on some of the stories I've heard, students will go to great lengths to cheat in online assessment

[The Cat In The Hat]

Having just updated my journal, I see Heidi's as incredibly informing and well written.... I should go hide under a rock again.

Probably a lot of cheating.

Also, Heidi, did I ever tell you you're scary?

[heids]

Well, since I received results, I guess I should round out the semester with another post.  It actually feels like a really long time since the semester finished, as I've been absorbed in work.

Results:
NUR1111   Global health and cultural competence in nursing and midwifery practice   89   HD   (6CP)
NUR1112   Fundamental skills and knowledge for nursing and midwifery practice 1   97   HD   (12CP)

WAM   GPA
94.333   4.000

This is by far the highest my WAM will ever be - no other subject will ever let me get anything like 97, no matter how hard I work (I need something to be mostly test and exam based to be able to score that highly, as essay-type assignments always have a cap of 90% or so).

NUR1112

Most excitingly, my unit coordinator emailed me to ask if I would consider running PASS classes for NUR1112 next year.  I had kind of set myself the goal of achieving that at the start of the year, but didn't expect to be offered it without asking.  While I'm slightly terrified about the idea, I really want to develop my public speaking and teaching skills, which aren't amazing.  It would look pretty on my resume, and hopefully I'd make good connections with other PASS tutors and faculty members.  And, y'know, hopefully help people learn.

I was very happy with everything in 1112 except the clinical skills assessment.  Even though my score was fine (38/40), I was terribly ashamed of my performance.  100% was a very common mark as they marked very liberally and ignored small errors.  It was a simple matter of taking vital signs and then performing a handover.  I'm completely competent to do this confidently.  But for some reason, my hands started shaking uncontrollably, I fumbled things, and I couldn't talk, even though I didn't think I was nervous.  I walked out of it convinced that while I look like I'll be an excellent nurse on paper and based on academic marks, I'll never be a good nurse in real life.  I think my poor performance and then acute emotional response to that poor performance was because I had taken a huge confidence dent at work.

NUR1111

Assignment 1: I previously complained about this assignment, with the class average of 53%.  Clearly enough other people complained, as the faculty stepped in and gave us all a blanket 15 marks extra (out of 100, so 15%), which took my mark into very comfortable HD-land.  (I'm happy to know that I still would have got an HD for the subject overall even without this adjustment).

Assignment 2: Two of my group members were great, and we worked together and got everything done thoroughly ahead of time.  One of them I really hope to stay friends with throughout the degree.  The fourth group member did essentially nothing except read out my script in our video, but at least they showed up... at one point I sent an email to the unit coordinator flagging that there could be an issue and we just wanted a documented paper trail for if we needed to kick her out of the group, but she ended up doing juuuuuuust enough to scrape by.

We got 74.5, which I was really happy with (group work is HARD).  However, last post I complained about the amount of feedback I got on assignment 1.  I take it back!  The unit coordinator sent out an email to the cohort saying they gave "comprehensive and extensive" feedback on assessment 2.  We got... 2x "reference needed" (where I again made the stupid mistake of thinking a citation can cover two consecutive sentences) and one tweak to an in-text citation.  That was it.  Everything.

I'm fine with the mark we got, but surely you could give us some idea of how to improve the content, research or writing?

Exam: The storms took my power, wifi and reception for a couple of days before the exam, so I wasn't really able to study until the morning of the exam, when I went on campus.  However, it appears I got about 95% on the exam so studying more couldn't have changed much.

To prepare for the exam, we had a multi choice quiz we could do an unlimited amount of times, which randomly selected 10 question from a bank of 200 each time.  As a result, you frustratingly had to keep going over the same questions again and again in the hope that you'd get a new one.  They heavily implied that it was preparation only, not that they would actually be in the exam.  It turns out it was worth my effort, as a) a very large percentage of the exam questions were from this bank, typos and errors and all, and b) they were terrible and often ambiguous questions or with multiple correct answers, so it paid to know what they wanted me to say was the right answer.

It was really an awfully written exam - people who are bad at writing multi choice questions shouldn't be allowed to write them!  At least with short answer (only 35% of this exam) you can justify your response.  If multi choice asks you for the "best intervention", for instance, you can only pick one, and you're often guessing "which one do THEY want", which is hard in ambiguous questions or ones with two reasonable answers.  In short answer, you can show real-life critical thinking, and demonstrate how two answers are possibly both right depending on the exact nuanced situation - you get a chance to explain your thinking rather than get a straight-up "wrong". 

Multi choice can also be so ridiculously easy it's useless in testing what you've learnt.
e.g. Which of these should you do if a patient annoys you?
a. slap them into submission
b. steal another patient's benzos and secretly mix them into this patient's food
c. spend some time supportively listening
d. "accidentally" email their bowel charts and sexual health documentation to their entire list of contacts

I bet I didn't really need to study so hard to answer that one.

Next semester

Work is getting a bit better, as I'm becoming more competent, but I still don't feel as far ahead as I thought that I would.  I also somehow thought that full time work would be a "break" compared with balancing both work and uni, but it's been surprisingly exhausting.  It's definitely getting a bit easier, but I'm still going to be on a learning curve, which I was hoping I would have hit the top of by now.

I have 3 subjects:
NUR1114 Fundamental skills and knowledge for nursing practice 2 (12 points)
NUR1113 Law, ethics and leadership in nursing and midwifery         (6 points)
NUR2447 Clinical concepts                                                                 (6 points)
(2447 is an elective about wound and pain assessment/management)

My in-semester schedule, covering rostered work and on-campus tutes/practicals:

M: uni (4h)
T: uni (2h fortnightly)
W: work (7h)
T: OFF
F: uni (5h)
S: work (7h)
S: work (7h)

Around that, I'll fit in recorded lectures/pre-learning, study and assignments.

[beep boop]

Well, since I received results, I guess I should round out the semester with another post.  It actually feels like a really long time since the semester finished, as I've been absorbed in work.

Results:
NUR1111   Global health and cultural competence in nursing and midwifery practice   89   HD   (6CP)
NUR1112   Fundamental skills and knowledge for nursing and midwifery practice 1   97   HD   (12CP)

WAM   GPA
94.333   4.000

This is by far the highest my WAM will ever be - no other subject will ever let me get anything like 97, no matter how hard I work (I need something to be mostly test and exam based to be able to score that highly, as essay-type assignments always have a cap of 90% or so).

NUR1112

Most excitingly, my unit coordinator emailed me to ask if I would consider running PASS classes for NUR1112 next year.  I had kind of set myself the goal of achieving that at the start of the year, but didn't expect to be offered it without asking.  While I'm slightly terrified about the idea, I really want to develop my public speaking and teaching skills, which aren't amazing.  It would look pretty on my resume, and hopefully I'd make good connections with other PASS tutors and faculty members.  And, y'know, hopefully help people learn.

I was very happy with everything in 1112 except the clinical skills assessment.  Even though my score was fine (38/40), I was terribly ashamed of my performance.  100% was a very common mark as they marked very liberally and ignored small errors.  It was a simple matter of taking vital signs and then performing a handover.  I'm completely competent to do this confidently.  But for some reason, my hands started shaking uncontrollably, I fumbled things, and I couldn't talk, even though I didn't think I was nervous.  I walked out of it convinced that while I look like I'll be an excellent nurse on paper and based on academic marks, I'll never be a good nurse in real life.  I think my poor performance and then acute emotional response to that poor performance was because I had taken a huge confidence dent at work.

NUR1111

Assignment 1: I previously complained about this assignment, with the class average of 53%.  Clearly enough other people complained, as the faculty stepped in and gave us all a blanket 15 marks extra (out of 100, so 15%), which took my mark into very comfortable HD-land.  (I'm happy to know that I still would have got an HD for the subject overall even without this adjustment).

Assignment 2: Two of my group members were great, and we worked together and got everything done thoroughly ahead of time.  One of them I really hope to stay friends with throughout the degree.  The fourth group member did essentially nothing except read out my script in our video, but at least they showed up... at one point I sent an email to the unit coordinator flagging that there could be an issue and we just wanted a documented paper trail for if we needed to kick her out of the group, but she ended up doing juuuuuuust enough to scrape by.

We got 74.5, which I was really happy with (group work is HARD).  However, last post I complained about the amount of feedback I got on assignment 1.  I take it back!  The unit coordinator sent out an email to the cohort saying they gave "comprehensive and extensive" feedback on assessment 2.  We got... 2x "reference needed" (where I again made the stupid mistake of thinking a citation can cover two consecutive sentences) and one tweak to an in-text citation.  That was it.  Everything.

I'm fine with the mark we got, but surely you could give us some idea of how to improve the content, research or writing?

Exam: The storms took my power, wifi and reception for a couple of days before the exam, so I wasn't really able to study until the morning of the exam, when I went on campus.  However, it appears I got about 95% on the exam so studying more couldn't have changed much.

To prepare for the exam, we had a multi choice quiz we could do an unlimited amount of times, which randomly selected 10 question from a bank of 200 each time.  As a result, you frustratingly had to keep going over the same questions again and again in the hope that you'd get a new one.  They heavily implied that it was preparation only, not that they would actually be in the exam.  It turns out it was worth my effort, as a) a very large percentage of the exam questions were from this bank, typos and errors and all, and b) they were terrible and often ambiguous questions or with multiple correct answers, so it paid to know what they wanted me to say was the right answer.

It was really an awfully written exam - people who are bad at writing multi choice questions shouldn't be allowed to write them!  At least with short answer (only 35% of this exam) you can justify your response.  If multi choice asks you for the "best intervention", for instance, you can only pick one, and you're often guessing "which one do THEY want", which is hard in ambiguous questions or ones with two reasonable answers.  In short answer, you can show real-life critical thinking, and demonstrate how two answers are possibly both right depending on the exact nuanced situation - you get a chance to explain your thinking rather than get a straight-up "wrong". 

Multi choice can also be so ridiculously easy it's useless in testing what you've learnt.
e.g. Which of these should you do if a patient annoys you?
a. slap them into submission
b. steal another patient's benzos and secretly mix them into this patient's food
c. spend some time supportively listening
d. "accidentally" email their bowel charts and sexual health documentation to their entire list of contacts

I bet I didn't really need to study so hard to answer that one.

Next semester

Work is getting a bit better, as I'm becoming more competent, but I still don't feel as far ahead as I thought that I would.  I also somehow thought that full time work would be a "break" compared with balancing both work and uni, but it's been surprisingly exhausting.  It's definitely getting a bit easier, but I'm still going to be on a learning curve, which I was hoping I would have hit the top of by now.

I have 3 subjects:
NUR1114 Fundamental skills and knowledge for nursing practice 2 (12 points)
NUR1113 Law, ethics and leadership in nursing and midwifery         (6 points)
NUR2447 Clinical concepts                                                                 (6 points)
(2447 is an elective about wound and pain assessment/management)

My in-semester schedule, covering rostered work and on-campus tutes/practicals:

M: uni (4h)
T: uni (2h fortnightly)
W: work (7h)
T: OFF
F: uni (5h)
S: work (7h)
S: work (7h)

Around that, I'll fit in recorded lectures/pre-learning, study and assignments.

It's good to hear that you're doing rlly well. Congrats on getting the results! I'm sure u spent countless hours on studying and clearly this paid off!

I cracked up when I saw your example of multiple choice question. Clearly, this person isn't their job properly.

I hope your second semester is as good as your last one.

beep boop over and out

[heids]

Week 4 and I'm starting to feel a little out of my depth, but also feeling like we're starting to genuinely get into useful nursing content, especially with medications.  On the whole, I'm really enjoying it and feel like there is just SO much to learn.

Initial subject impressions:

NUR1113 (Law, leadership and ethics) - same teaching team that took our cultural competence and global health subject last semester, so it's pretty unpleasant so far.  I've submitted part A of the first iSAP assignment* and have to complete the reflection part by this Friday.  It was a stupid assignment, where we had to analyse the leadership of students in this situation (brief summary): Two students do someone's vital signs.  He says he doesn't feel well and doesn't look well.  Only notable vital sign change on chart (imo) is decreased BP.  They decide that one of them will stay with him and the other will go on break.

Essentially, they did almost nothing, and we had to write 1500 words on the leadership they displayed in that single situation (okay, including a section on how to develop leadership skills, which was the easy part).  Writing it was like pulling teeth. 

On the plus side, several of the articles I read actually did get me thinking about leadership and reflective practice in nursing.  And I've realised that I actually do take the lead at uni a fair bit.  I don't at work yet, but that's because I'm still much less competent and familiar than everyone else.  Also because I'm really not a natural leader; if someone else takes the lead, I'll always be the follower.  However, at uni there's often a void where no one takes the lead, and in that situation I take over.  I've realised that I need to push myself to speak up a bit more at work.

*iSAP = a clinical case study with questions/discussion to complete.  After the submission date, they release an "expert response".  In part B, you compare your writing with the expert response, and then discuss what you could improve on and what you've learnt for your practice by doing the whole exercise. 

Frustratingly, their expert response was a vague and generalised video.  A lot of it reflected things that I had thought but that had been torturously difficult to find citations to support.  They also ignored what the assignment asked - for instance, they spent ages discussing the leadership shown by the ANUM (charge nurse) in the case study, when we were told to discuss the STUDENTS' leadership.  I feel like writing, "I learnt that I can ignore what the assignment says and discuss something else if I feel like it."

NUR2447 (Assessment/management of wounds and pain) - I am IN LOVE with this subject.  I wish it were two units, one on wounds and one on pain, because I want to go into twice the depth.  It's relatively content-heavy, and the lecturers are clearly extremely experienced in the area.  By week 2 I was already looking up Monash's masters' degree in wound management...

I'm currently writing my first assignment, a wound case study.  We assess the whole person and their wound, and then create a holistic management plan, dressing plan etc.  Today I got so absorbed in it that I lost track of time for hours - I really enjoy reading the literature.  Definitely my most enjoyable assignment to date.

NUR1114 (Fundamentals of Nursing 2)

This subject covers the anatomy, physiology and very basic nursing assessment/management of the systems we didn't cover last semester - musculoskeletal, endocrine, renal, digestive, lymphatic, reproductive.

We're also doing more medication administration content - IM/subcut injections, venepuncture and IV fluids.  I have been practicing injections on my soft toy   We're also starting to learn basic information and mechanisms of action etc for various very common meds.  I feel like everything we're learning is really foundational, valuable knowledge.

It's good to hear that you're doing rlly well. Congrats on getting the results! I'm sure u spent countless hours on studying and clearly this paid off!

I cracked up when I saw your example of multiple choice question. Clearly, this person isn't their job properly.

I hope your second semester is as good as your last one.

beep boop over and out

Thank you!  I'm sorry I didn't respond!

Well, I'm sorry to say that that multiple choice question was my own creation... mimicking the pointlessness of their style, but in a more generalised sense.  I really wish I had saved some of them though, to show you that I'm barely exaggerating

[ThunderDragon]

Hey heids

Great to hear that you're enjoying Semester 2 so far! NUR1114 and NUR2447 sound really interesting. Jealous of the clinical stuff 

[heids]

Another insanely long update I really should have split up

In new developments, I have decided to underload, and my course coordinator approved my suggested course map!
(This degree isn't very flexible, and I have even less flexibility, because I have an 8-year window to finish this course, and their records say I started in 2017.  I actually started in 2016 and only did one semester, but because the course code/structure changed in 2017 and I was still technically enrolled at that time to keep options open, they're counting it as from 2017.  So this is stretching things as far as I'm allowed).

My new course schedule will be:
- 2022: 3/4 load (year 2 subjects, 2x 3 week placements)
- 2023: 3/4 load (years 2&3 subjects, 1x 3 week placement)
- 2024: 1/2 load (year 3 subjects, 2x 5 week placements)

Background as to why I'm doing this:

I'm working a lot of hours, and work is really important to me.  It's not just an irrelevant part-time job I'm slaving through to get through uni.  It's where I feel like I'm making a meaningful difference, where I'm genuinely caring for others (which is after all why I'm doing this degree), and a job that I would happily do full time if I weren't studying.  (Plus finances, of course).  I don't want to have to cut back to successfully manage a full time study load.  I'm balancing it okay right now, though it's definitely overwhelming at points.  But years 2-3 have 19 x 40h weeks of placement.  Hopefully, I'd also lead PASS and do peer mentoring as well.  I'm also going to try to be voted for the Student Representative Group, but that's unlikely.

I could also manage it more easily by going for a credit average, or only doing uni + work with no extras, but I can't seem to stomach that.  The only way to fit in all my goals is to stretch things out a bit to give me some more space. 

I also hope to try a RUSON (registered undergraduate student of nursing) job in 4th year: working in a hospital within a limited scope of practice, and thus getting more exposure to the acute setting.  I could balance this alongside my current job with the 1/2 study load; RUSON jobs expect that you have lots of placement.

It's funny: in 2012, when I was in year 9, I was obsessed with moving places quickly.  I made a mental plan.  If they wouldn't let me skip year 10 (which they eventually did), I would follow this pathway:
1. Certificate in Aged Care (6 months)
2. Diploma of Nursing (18 months)
3. Bachelor of Nursing (Diploma entry, 2 years)
and therefore be a graduate RN in 2017.  Not a realistic pathway for many reasons, but a funny contrast with my current plan of starting as a graduate RN in 2025, 11 years after I finished VCE (!!!).

My semester and assessments so far

Well, it's actually mostly finished.  My classes finished yesterday, even though it's only week 9.  I still have one assignment, one clinical skills assessment, exam week (x4 exams), and a 2 week placement.

NUR1114: I haven't lost any marks yet, but I still have 85% of the unit's marks to complete (10% skills assessment, 20% placement, 15% anatomy exam, 40% physiology/nursing exam).  The content has been really enjoyable, and we've learnt a lot of basic nursing skills - IM/subcutaneous injections, setting up IVs, venepuncture, urinary catheterisation, focused physical assessments.  However, since I only get 1 hour a week of simulation, I wouldn't be at ALL confident doing it in real life. 

In anatomy/physiology, we covered (on a very surface level) musculoskeletal, endocrine, renal, gastrointestinal, immune/lymphatic and reproductive systems.  I enjoyed the renal system most; it works so closely with the cardiovascular system and is so key in maintaining fluid, electrolyte and acid-base balance - all elements that nurses work closely with.  I'd love immunology in more depth, but it was basically relearning what I did at VCE Bio level, so nothing exciting.

Coming in last was the reproductive system and pregnancy - I just don't feel super interested.  It feels less closely interrelated with the other systems, even though I know issues cause people a ton of physical problems (e.g. cancers, endometriosis) and psychological distress (e.g. sexual dysfunction, infertility, dysphoria).  I obviously don't have much interest in helping continue the human race lol.

NUR1113: I got 79 on my 30% essay.  Feedback was much more valuable than I received last semester - it wasn't more thoroughy, but actually addressed my content, rather than nitpicking on tiny valueless errors.  Since I thought my assignment was worse than what I wrote last semester, I'm very happy with 79.  I'm still frustrated by the apparent 80% cap on any given part of a rubric, but maybe there are things I should do better that would get me over that line.  I just don't know how to achieve them.  Honestly, I have been marked far more harshly this year than I was in 2016.  I don't know if my writing has gone downhill, or 2016 involved marking flukes, or if marking standards have genuinely changed.

We submitted our group essay + video presentation yesterday.  I'm relatively happy with it.  My group members were all nice and we mostly approximately met our agreed due dates.  I'm mildly concerned about academic dishonesty or plagiarism in other students' sections.  When I started looking at the referencing I got frustrated enough that I decided to close my eyes and ignore it entirely.  However, I edited their writing on a surface level enough to draw the whole piece together.   It's really tricky to find the balance - I don't want to upset people or be super arrogant, saying "yeah I know you wrote that but I'm turfing it all because I know how to write better than you".   At the same time... I probably lift our group marks by doing so.  I'm going to estimate we'll get anywhere from 65-75 for this task, probably high 60s.

Once we got past leadership nonsense, workshops have been interesting.  We've mainly gone through case studies around consent/refusal/withdrawal of care, advance care planning, voluntary assisted dying, negligence, coroner's court, etc.  I don't think I've really learnt much content, but it's been interesting to reflect on what is appropriate practice and some of the legal and ethical issues. 

NUR2447: I haven't yet received marks for my first assignment.  While my content was good, I'm worried that the format I chose was poor; I presented it mostly in dot points (which they stated was acceptable), but I since think essay-style paragraphs would have been better.  While I really enjoyed early research for the assignment, pulling it all together into one coherent piece, and ensuring that everything was thoroughly referenced, was a much larger headache than I expected.

My second assignment - a pain assessment and management case study - is due on 4/10.  I only started today, 24/09, and I'm working 5 days a week the next couple of weeks, so it's really going to suffer.

Exams

Between Nov 1-5, I have 4 exams.  Three are closed book, one has two double-sided A4 sheets of handwritten notes allowed.  This semester, exactly 50% of my marks come from exams, which is the highest it will be across my entire degree - so I should get HDs in all units this semester unless my remaining assignments are marked unexpectedly harshly.

Work

I know this isn't uni, but it's an equally large part of my life.  Even though my contract is only 41 hours a fortnight, I've worked more hours than that every fortnight since I started in May.
 
Work has been getting progressively easier and more enjoyable.  There's much less crying to or from work, though I still get home absolutely exhausted.  Some days are still full of self-doubt, as I watch far other staff work far more efficiently and communicate far more clearly.  (L, your hands are MAGIC.  How do I make mine work as precisely and quickly as yours?!  You literally do everything twice as fast as me!  And you're incredible at getting residents to do what you want and stop yelling at you!)

But some days are delightful, especially evening shifts, which often have long stretches with no task list apart from "answer call bells".  I like to keep busy, but as I get to know the residents better, I've found I can easily manufacture my own task list when it's quiet.  I can do someone's nails, or take them for a walk, or sit and have a chat - none of which are requirements, but I know can make a difference for people.

For instance, one evening last week we had extra staff due to single site employment rules, so I decided that my goal for the shift was to do any necessary work, but otherwise to sit and chat with residents about their lives.  So I went and sat in their rooms, not paying attention to call bells because other people were there to do that and knew they could call me on my work phone if they needed help.  It was delightful.  People have amazing stories, and in lockdown are often starved of chances to talk.  I just get this burning feeling like my heart is swelling and overflowing and it's hard to breathe with how much I love my residents.  ​I remember feeling this when I worked in aged care previously, but I didn't feel it much for the first couple of months because I was so overwhelmed learning the basic skills and being stuck in my head.

I've been having some really positive things over the last few weeks, e.g.
- A very closed-off resident who has started saying "I'll miss you, Heidi" when I leave, and "I'm so glad to see you, Heidi" when I come into her room the first time in a shift
- A daughter came to me and said "my dad has been talking about you and how you sit and listen to his stories, thank you so much"
- A very independent resident I haven't spent much time with said "I always see how you go round and chat to everyone in the dining room at meal times while other staff stand back and chat to each other"
- I knocked and walked into someone's room as they were talking on the phone and I literally heard them say something like "I have this carer called Heidi who is really lovely..."
- A nurse said, "I wish that other staff were like you"
- A resident said yesterday, "You really went the extra mile for me this shift. Thank you."

On the other side of the coin, this article about professional boundaries really gave me pause.  I do need to take care, not just for myself (which I'm bad at believing is important), but also for those I look after.  Obviously, compassion fatigue is deeply important, but I feel like it'll take me being burned several times before I get the balance right in my career.

I've also re-discovered that, like when I worked in 2015-16, high care is definitely not for me (different from high dependency in acute care).  At first, I liked high care shifts, because you don't have to learn individuals' routines when they're mostly non-verbal and non-ambulant, and you typically work with a 2nd staff member (as high care residents usually can't follow any commands and need lifting machines), so I was less scared of messing up.  But now that I know my lower care residents well, I enjoy caring for them so much more, because I can build that relationship, and feel like what I'm doing has meaning.  I find very little meaning in high care and unnecessarily prolonging life.

I've started wondering if nursing will give me such a close level of contact as my current job - rising through levels over time usually takes you further away from close patient care.  However, finances, skill growth, influence, and flexibility matter.  Just because I like this now doesn't mean I will always have the inner resources to care for people the way I do now - I will probably have to take a step back or direction change several times throughout my career, and as a personal care assistant (PCA), I don't really have those choices or options.

So ​I'm going to have to make sure that I pick the avenues within nursing that fit my strengths and goals.  I often have this mental tug-o-war between "prestige" and "where I actually want to be".  I've definitely internalised the nursing hierarchy bullshit.  My brain goes "you'll have to work on an acute floor and then move to ICU to prove you're good enough and have all the advanced skills", but maybe home care or chronic health or case management is more my thing.  It's important that someone has advanced skills, but I don't know if that's the most important thing for me.  Maybe I'd enjoy ICU, but maybe I'd enjoy home care or chronic care or case management more.  I could see myself working for a rural primary nurse practitioner role (so kind of like a limited GP role in areas where they struggle to get enough doctors).

[Orb]

I've been having some really positive things over the last few weeks, e.g.
- A very closed-off resident who has started saying "I'll miss you, Heidi" when I leave, and "I'm so glad to see you, Heidi" when I come into her room the first time in a shift
- A daughter came to me and said "my dad has been talking about you and how you sit and listen to his stories, thank you so much"
- A very independent resident I haven't spent much time with said "I always see how you go round and chat to everyone in the dining room at meal times while other staff stand back and chat to each other"
- I knocked and walked into someone's room as they were talking on the phone and I literally heard them say something like "I have this carer called Heidi who is really lovely..."
- A nurse said, "I wish that other staff were like you"
- A resident said yesterday, "You really went the extra mile for me this shift. Thank you."

On the other side of the coin, this article about professional boundaries really gave me pause.  I do need to take care, not just for myself (which I'm bad at believing is important), but also for those I look after.  Obviously, compassion fatigue is deeply important, but I feel like it'll take me being burned several times before I get the balance right in my career.

I've also re-discovered that, like when I worked in 2015-16, high care is definitely not for me (different from high dependency in acute care).  At first, I liked high care shifts, because you don't have to learn individuals' routines when they're mostly non-verbal and non-ambulant, and you typically work with a 2nd staff member (as high care residents usually can't follow any commands and need lifting machines), so I was less scared of messing up.  But now that I know my lower care residents well, I enjoy caring for them so much more, because I can build that relationship, and feel like what I'm doing has meaning.  I find very little meaning in high care and unnecessarily prolonging life.

I've started wondering if nursing will give me such a close level of contact as my current job - rising through levels over time usually takes you further away from close patient care.  However, finances, skill growth, influence, and flexibility matter.  Just because I like this now doesn't mean I will always have the inner resources to care for people the way I do now - I will probably have to take a step back or direction change several times throughout my career, and as a personal care assistant (PCA), I don't really have those choices or options.

Must say it's the first time that i've read your journal in a long time Heidi and just wanted to highlight some gems (in the quoted text) that i've observed from your various bits of reflection that really resonate with me!

Finding the balance between creating meaningful experiences and looking after personal well-being is difficult at the best of times - it's super inspiring to see the various anecdotes that illustrate how you've really been able to make a difference to the lives of many.

Thank you very much for sharing - I have so much respect for you!  

[heids]

Must say it's the first time that i've read your journal in a long time Heidi and just wanted to highlight some gems (in the quoted text) that i've observed from your various bits of reflection that really resonate with me!

Finding the balance between creating meaningful experiences and looking after personal well-being is difficult at the best of times - it's super inspiring to see the various anecdotes that illustrate how you've really been able to make a difference to the lives of many.

Thank you very much for sharing - I have so much respect for you!  

Thank you, Orb - I really appreciate it.  Good to see my little brag is getting positive results

One of the things I really want to remember from this is that it took me a solid 3 months of doing this job before I felt like I was able to contribute, and at 4 months into a comparatively unskilled job, I still feel I have a way to go.  It's probably going to take me longer than that when I graduate as a nurse, because there are a lot more skills to consolidate and a lot more patient turnover (there's no way I'm working in residential aged care straight out of uni).  That's so important for everyone to remember - starting new jobs is a huge learning curve, and it's kind of normal to feel like you're useless, incompetent, drowning and a bad fit at the start.  Even though I knew this, I still thought I was taking too long and would never get there.  And I bet it really sucked for the other staff that had to work shifts with me.  But that's what learning is.

[K888]

^ I don't think there's ever an end to learning and I don't think you'll every feel like you know it all, and that's a good thing - it keeps you ready and eager to learn and makes you a better clinician.
I'm now 6 months into my job and still feel like I know absolutely nothing! I think everyone has a level of imposter syndrome and it never goes away haha. But you definitely will have times when you reflect and realise that you aren't absolutely clueless and you do actually have some expertise.

So glad you're feeling more comfortable in your job, Heidi! I can promise you that you're making a significant difference to your residents lives, and I feel like in healthcare, if we can positively impact even one person's life, we're doing our jobs well

[heids]

^ I don't think there's ever an end to learning and I don't think you'll every feel like you know it all, and that's a good thing - it keeps you ready and eager to learn and makes you a better clinician.

Unfortunately, you have to actively make each mistake at least once* before you can learn to anticipate problems and avoid them.  This means that you make a string of mistakes that gradually decrease over time, but that really HURT when you make so many of them so consistently.  Mostly these mistakes are just minor inconveniences or inefficiencies, e.g. "I didn't bring an extra towel so I have to walk down two corridors to get one", but sometimes they actually cause harm, e.g. "Unless I keep saying 'don't sit yet, a few more steps, a few more steps, now you can sit' when a particular anxious resident is turning around to sit on the bed, he sits prematurely and has a fall", or "I forgot they were on thickened fluids, and they choked".  When I become a nurse, the harms I can cause will be more significant, and that's scary.

*Some of them you have to repeat at least 200 times before you get the message.

[heids]

Honest update: I haven't got far on the assignment, and I'm really struggling.  It's an interesting topic, with a pain assessment and management case study.  But I want to give up so badly.  I already got an extension so that it's due on Friday, rather than tomorrow.  I literally had no particular reason apart from "I'm overwhelmed" (okay, I gave them detailed reasoning, but the truth is I could have finished it in time if I had to).  I haven't applied for an extension before, and I felt a bit of a fraud.

You know, I feel like from the outside I look like I manage things pretty well.  Like, I'm balancing full time study with 25 hours of work a week, while still scoring well.  If I were looking at an identical me from the outside, I would definitely feel insecure and jealous.

But from the inside, I feel a combination of lazy and overwhelmed.  I spend very large chunks of time doing literally nothing (e.g. if I do a 7-3 shift, I often do no uni work that afternoon/evening), and I get a tonne of sleep, so it's not like I'm as busy as lots of other people seem to be.  (And I have no CLUE how parents balance work and parenting.)  But I often feel so overwhelmed I find it hard to focus.

Honestly, I could do nothing from here on in except sit my exams and attend my placement, and I would still pass with a distinction average for the semester, but I still feel like I have an absolute tonne I need to do.  Obviously, I'm lucky that I don't have any fear of failing or anything. 

But I keep thinking "if I don't work harder now, I won't be able to manage in future when things are busier than this". (e.g. with more regular events when lockdowns cease, which definitely take up time).  I've been noticing a strong self-perception that I'm weak, unable to cope with challenges or mild suffering, and not resilient.  I feel like my default is to quit rather than push through.

I'm very torn between two competing narratives:
-->"mental health is important and trying to do well for the sake of it is egotistical rather than valuable"
--> "you should work hard and strive to improve yourself and perform well at all times"

Of course, the answer is most likely "BALANCE", but my brain is fighting about it minute by minute right now.

And in the background, I'm still signing myself up for things.  There's such a mismatch between my idealism and my reality.

[The Cat In The Hat]

If I were looking at an identical me from the outside, I would definitely feel insecure and jealous.

*waves*



You have no idea how stupidly motivating it was knowing that I helped a little bit with the stuff about the assignment. Sounds stupid, doesn't it (oh well).

I enjoy your updates. I should update mine, I really should.

[heids]

It feels weird that I'm still in the middle of my semester.  Since classes finished in week 9 to accommodate placements, I've shifted to working a lot of hours.  It's been overwhelming, combined with a couple of personal life stressors; uni is at the absolute bottom of my priority list.

UNI

1. NUR2447 assignment results (wounds): My marker missed the memo that one section wasn't part of the word count, so I lost a bunch of marks.  (My last couple of hours on an assignment usually involve painstakingly rearranging sentences to cut out single words here and there, until I get it down to EXACTLY word count + 10%.)  Unit coordinator reviewed my score, so I got 89%.  There's definitely a mismatch between marking standards in NUR2447 and NUR1113; "perfect" in NUR1113 gets 8/10, while they're happy to give 10/10 in NUR2447.

2. NUR2447 assignment submission (pain): I submitted this 2 minutes and 7 seconds before the deadline (already extended by 5 days).  I've never cut time as closely as I did for this assignment.  I just struggled with having enough energy and willpower to write it at all.  It was finally coming together the day before my extended deadline, and then I worked a 7-3 shift on the day of the 5pm deadline.  So I finished it during my lunch break and after work.  When I went to submit at 4:30, it looked like I had lost all of my changes since my lunch break.  I wrestled with it for 20 minutes before I realised it was a syncing issue because I was using hotspot at work (apparently once I've saved and closed a document, the latest version doesn't show on my computer unless OneDrive has synced, which it doesn't on a metered network).  Then, I had a repeated "server error" for the remaining 10 minutes.  I managed to get it sorted jusssssst in time.  Heart was racing.

3. Study for exams: ha ha ha funny joke

WORK

A staff member at work tested positive, so we've temporarily shifted to Tier 3 PPE, resident isolation in rooms, and a bunch of changed processes.  It's been eye-opening.  I knew these processes took a huge toll on HCWs, but I was astounded by the reality of it.

I actually should be at work right now, but I called in sick for the first time because I was throwing up after work last night with nail-through-the-head headache.  I think it was cumulative dehydration.  You sweat like crazy doing intense physical work under waterproof gown/N95/face shield/gloves.  The workload also grows, making it harder to take breaks, and "quickly grabbing some water" is actually quite a process in full PPE/N95s.  I can't believe how quickly it knocked me out.  Honestly, I think I would faint regularly if we had an outbreak in summer.  (Excellent heating at my workplace, terrible air conditioning).

So I'm now going to prioritise staying hydrated no matter what.  It's just hard when you keep seeing buzzers and tasks piling up, and know that if you don't do them, your other coworkers will work even harder to pick up your slack, and maybe exhaust themselves in the process.

Other ways this situation has made work harder:
- We can't hear each other in N95+face shield --> miscommunication+++ and shouting
- Processes are constantly changing, and directions contradict each other, which is stressful
- Rubbish, laundry and meals have different processes
- Only care staff and cleaners are allowed in our wing
- Residents are upset with isolation, loneliness, routine changes, meal errors, etc.
- Exhausting --> staff call in sick --> inadequate staffing or agency staff --> more exhausting --> vicious circle

It's hard to balance batching care with making sure residents are okay.  You want to avoid going in and out of rooms so often, because it's time consuming and tiring.  (Changing gloves is minor compared with the level of don/doff we did on the first day, but it's harder than you'd think.  Ever tried putting gloves on sweaty hands?  Our hand sanitiser is sticky, so you have to walk down the corridor to wash and dry your hands fully, just to pop a cup of coffee in someone's room.)  At the same time, our residents are stuck in their rooms and often very lonely, so you want to pop in and out more frequently just to provide some human contact and reassurance.

On the plus side of work, I projected that I earn nearly $55,000 a year (gross) while a full time student. (Admittedly, a 1st year student - this would decrease if I stayed full time in 2nd/3rd year, with more placements).

[heids]

I feel oddly vulnerable posting this update.

Work has been exhausting, and I'm up for a longer week ahead.  The weird thing?  I feel like I've earned my initial badge as a Real Healthcare Worker by going through this, even for a brief time.  This is a problem.  Why is my view of this career one of suffering for others?  Why does it only seem legitimate in intense, unpleasant working conditions?  Why do I feel like I needed to go through an initial rite of passage to really "count" for the first time?

It's messed up.

Historically, I feel working in unsafe conditions with an unmanageably high workload has been a badge of honour in healthcare, and nursing typically attracts people who like to serve, help, protect and care for others.  With the pandemic, the industry has been framed in a more militaristic light: people who put their lives on the line, who suffer for others, who sacrifice themselves for others, who do their duty to protect others, etc.  It seems a dangerous narrative.

You know, I hate suffering.  I come home and I lie down and do nothing and hate all the commitments I've made.  But at the same time, I take pride in being short-staffed or working over holidays or having a schedule that looks hectic; I get a kick out of it.  I like to feel like I'm stepping up to the plate and taking on extra responsibilities for others, like I'm important, special, indispensable, hardworking.  I kind of like to be short staffed... when I'm competent at what I'm doing.


I've been reading the independent reviews of the severe outbreaks in aged care homes in mid-2020, the ones that were heavily publicised in the media.  About two paragraphs in, I was riveted and couldn't stop reading.  I was choking up the whole way through as I recognised how easily something like this could happen, and how unbelievably traumatising it would be for residents, families and staff.  I could visualise a fraction of the horrible picture, and it was terrifying.

The review was describing all staff being suddenly stood down, and completely inexperienced new grad PCAs/nurses entirely taking over the care of 100 residents with minimal handover, and often no clue of how to undertake basic tasks.  In the best of cases, that would be terrible; when combined with PPE and donning/doffing, sick residents, contradictory instructions, fear and chaos, key tasks being missed (e.g. ordering food), lack of translators for non-English-speaking residents, and a huge array of other problems, it's no surprise that many staff never returned after one shift.  Further depleting staffing, of course.

Quote and link to report

"At St Basil’s, 94 residents and 94 staff members were infected, and 45 residents died with COVID-19.  At Epping Gardens, 103 residents and 86 staff were infected, with 38 resident deaths.  These stark numbers do not begin to convey the trauma and grief suffered by all residents, whether or not they developed COVID-19, and the enormous impact on their families. They do not account for the distress of staff members, who knew and had cared for residents for long periods but were quarantined and obliged to leave them in the care of “strangers”.  Many of the agency workers who replaced quarantined staff came with little, if any, preparation or experience in aged care and were also deeply traumatised by the experience."

Independent Review of COVID-19 outbreaks at St Basil's and Epping Gardens Aged Care Facilities

I'm imagining many of my teenage co-students trying to navigate a situation like that report details.  It would be a complete failure.  And I'm very little better, though I think I have a bit more resilience (just because I'm a bit older, have 'adulted' and worked full time, and have now worked in the industry).  I mean, I've successfully ticked off PPE training at uni and work, but I still had completely inadequate knowledge the day we started full PPE.  I still feel like I've been hit by a bus, physically and emotionally.  But I think it's not just the actual stressors of these two weeks - it's the fact that I suddenly and properly got my head around what has happened to millions of healthcare workers and patients worldwide, and I'm feeling a bit stunned.  I've been reading extensively about the collapsing nursing system in the US particularly for a while, but this brought it home in visceral terms.

I feel like something inside me has changed very quickly.  And I feel ashamed of how much this comparatively small experience has impacted me.  It shows my naivete, weakness, lack of experience.  I feel like a good healthcare worker would be unfazed and brush this off as "minor" and show that they're up to anything, like stoic military personnel or something.  (I know that's bullshit, of course, but I've really internalised the narrative I described at the start of this post.)

And I'm scared that when we relax restrictions, and for most people life is getting brighter and everything is behind them, things will get so much worse and darker for the healthcare workers here.  I want to help, but I can't.