Monday, September 15, 2008

Rosie Boldly Goes

So last I mentioned my work, I was gearing up to become a full-time home care nurse. Then I disappeared from my blog for 2 years. The two are not entirely coincidental. Case managing as a nurse in home care was fulfilling and satisfying in some ways; intellectually challenging, interpersonally rewarding. It also ate my life.

I was working consistently between 50 and 60 hours a week, spending all stray moments (during Cassie's swimming lesson, while Emerson napped, and every night from children's bedtime to the moment when I was so sleepy I couldn't keep my head up) with my electronic charting (or occasionally on the phone with the medical supply company, or e-mailing physicians, or making up next week's patient schedule, or something). I know that there are nurses who manage to do the job in less time than that--maybe not in quite so little as 40 hours a week, but nearly. But it's a mystery to me how. Even on good weeks, easy weeks, I didn't come close.

When you hardly have two spare minutes to rub together, it takes a little while to get yourself mobilized to make change. Just maintaining the status quo takes more than you've got, really. But I did finally manage to start a job hunt, after a fashion. I also went in and talked with some of the managers and directors in my own agency. I brought a resume that showed all the nice administrative things I can do. I wrote out some hypothetical job descriptions for positions that could be created... for me. I said that I love home care, and I think that this agency really does give good patient care in addition to good customer service, and I would love to stay, but this job is killing me. Financially I have to work full-time. Is there anything we can work out?

It took them a couple weeks to get back to me, but ultimately the news is good. My role has been evolving over the last year, but at the moment I am doing no patient care. I am full-time coordinator and clinical instructor for a new educational program for nurses who just graduated from nursing school but want to do home care. (Usually new nurses don't do home care because you have to have quite a bit of independence to make the whole alone-in-a-house-with-a-sick-person thing work out well.)

It frankly feels a little--I don't know. Odd. Eerie. Friggin' weird. Clinical instructor? Somehow that implies... well, expertise. Doesn't it? And not grammatical expertise. Not vegetarian chili-making expertise. Not jollying-a-two-year-old-into-getting-his-diaper-changed-without-screeching expertise. No. Clinical expertise. It's truly slightly insane. And yet here I go, doing it. I consulted people and read a bunch of stuff, and then what did I do? I made a curriculum. Unmitigated chutzpah. And then what did I do? I made a two-day training for the experienced nurses who are acting as year-long preceptors. Me training them--that's rich. But we all go along acting as if it's perfectly normal and the accepted order of things.

And so then, a couple weeks ago, the new nurses started. Six of 'em. And now I give lectures, and make them do all kinds of hands-on exercises, and give them assignments. They have to write a clinical journal on the patients they see with their preceptor. They have to do readings I assign and answer little discussion questions. Their very first day, I made them draw my blood.

It's weirdly easy. I mistrust it, it's so easy. Because in my recent experience, real work goes against my grain. I have to be continually fighting my true nature to do my job. Doing patient care requires such an iron grasp on the details, dozens and hundreds of details, that it takes all the teeth-gritting concentration I can give it. Plus there's continually battling my sense of ignorance and inadequacy (in the context of clinical nursing, anyway).

But teaching is so strangely effortless that I have repeated unprovoked, irrational little bursts of dread--the reason being, I guess, that if work feels this easy, it is a lead pipe cinch that I am forgetting something very, very important. And so I have that lead stomach sensation of being just about to remember... remember that I never sent in my passport renewal and I have to catch a plane tomorrow; remember that my driver's license is expired just when I see flashing lights in my rearview; remember that I was supposed to pick up Emerson today and it's already 5:50; remember that Mr. S needed his potassium drawn two days ago. Something. But I never do remember the thing, the horrible thing that is going to make me feel like a total loser miserable worthless screw-up. I just feel like I'm about to remember it. Over and over again. (Ever so pleasant. Somewhat reminiscent of repeatedly hallucinating the smell of vomit.)

But you know, besides the dread bursts, it's actually going pretty well. I think. I don't know. Everybody seems engaged and happy, and they're learning stuff. And other people think we're doing a good job. And I'm getting to make up these clever little ways of teaching things and reinforcing good clinical habits. It truly is total fun. The actual stuff of it.

Plus I'm only working maybe 45 (or, well, maybe 48) hours a week. Sweet deal.

1 Comments:

Blogger elswhere said...

Having seen you lead a first-year French practice session many many years ago, I have no doubt whatsoever that you are a kick-ass teacher.

12:38 PM  

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