Friday, December 03, 2004

Wired, tired, and done, oh my.

I am finished wrapping Christmas presents. That is, I'm done wrapping the ones I have to mail to my family. I'm not done wrapping the ones I bought for The Boy, nor have I even finished assembling the present for a Secret Pal I have through an online forum. But the majority of Christmas present-wrapping is done, which gives me great pride. Even more than that, none of the presents look as though they've been wrapped by a mentally-deficient orangutan with Tourette's. This is unusual for me.

Yesterday was one of those days that every nurse dreads. Nobody coded; nobody had intractable pain...but nothing happened all day.

Nothing, that is, until about an hour and a half before the shift ended, at which point we got eight admissions. That sort of day will make you crazy: You start out well, get into your groove of planning and assessing and running around, then hit a wall. You sit for eight hours with absolutely nada to do, and then all hell breaks loose in the middle of your nap.

I got home so wired I didn't get to bed until after midnight. That's twenty hours out of twenty-four that I was up. It's no surprise I took a two-hour nap today.

Following is an opinion I sent to a pal via email today, included because I'm too damned lazy to think of anything new to write:

I have a BA in music and sociology (double major) and an ADN myself.
Unless you want to teach, research, or be an NP, don't get an MSN. MSNs
are highly specialized and focus on management (ugh) or specific areas
of practice like oncology or family practice or women's health etc.
MSNs are a waste of time for the average floor nurse (which is what I
am) and not a great idea for anybody who wants to stop at, say,
midlevel management. Even for upper-level management in a hospital or
community health setting, an MBA would be a better choice.

BSNs are fine and dandy, but I think they're overrated by the nursing
establishment. The amount of clinical experience you get with a BSN
compared with an ADN is about the same; the major difference is (again)
in the focus on management and decision-making skills. What the
proponents of BSN over ADN fail to recognize in my experience, though,
is that the majority of people getting ADNs are doing so because
they've either already got a degree or three in something else or
because they're 45 and changing careers. Both of those things reduce
the need for extra courses on prioritization, law, and management. We
been there, done that.

My advice, which costs what it's worth, is this: get the ADN. It'll
come near to killing you if you pick a good program, but you'll get
more knowledge in less time than you would if you did it any other way.
After that, work in a clinical setting of some sort for a year or two.
(Everybody says that and I've become a believer myself; there's just
something about knowing what works in real life versus what the books
say.) After *that*, make a decision on what to do with the rest of your
brain. You might decide that eine kleine floor nurse is what you want
to be, or you might have found some specialty that sparks a need to go
further in school.

A word about specialties: everybody ("everybody" being nursing
professors, nursing consultants, and others who haven't worked in the
field for years) says to work med-surg for a couple of years to "build
your skills" before you specialize. Bullshit, in a word. People coming
into hospitals are so sick now, and have so much going on in terms of
different systemic involvements, that even a specialty is broad enough
in practice to learn things. I deal every day with cardiac involvement,
diabetes, arthritis, women of reproductive name it. And I
work in an environment that I lot of people would consider progressive
care rather than an acute care floor.

That, in long, is my sermon to anybody considering starting a nursing career after doing something else.

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