SIM: Invaluable Learning Experience, Or Completely Pointless And Super Annoying

It's a tossup, at this point.

So, SIM (short for, of course, Simulation), is a mock up of a hospital with mannequins that blink and breath and have heart tones. So, pretty neat. What is not so neat is that the entire time you're "taking care" of the patient, who always has unexpected complications by the way, they're recording you and critiquing your every move.

So fine, why not? I'm a student and I should be challenged and critiqued. Better to kill a mannequin and learn my lesson than a real person and get sued and lose my license. So in theory, this SIM thing seems like a great idea that we should all be very excited about. Yeah.

But here's the deal. Simulation is not real. We know it's not real, the instructors know it's not real, and so every action we take in SIM, every decision is filtered through this realization that none of it is real. Adding to this realization is the fact that, though they mean well, the people in charge of creating these scenarios have not been practicing nurses in quite some time. They've never been doctors. They haven't even been patients, most likely, in a while. So here are people playing all these parts, the nurse (in that they are predicting what we should be doing), the doctor (on the phone when we call for orders) and the patient (the voice behind the mannequin) when in reality they've been none of these things for a quite some time, if ever.

This creates an environment where everything is exaggerated, just like things in a textbook are exaggerated from what they will be in real life. Any nurse will tell you that once you get out of nursing school you realize that you don't know anything and that there are two different realities: the way you were taught in school, the way it really is - the real world.

So you enter the Simulation with the full knowledge that you must now separate everything you know of the real world of nursing from what you know the instructors want to see you do during the SIM. This is confusing as crap. Add to that the fact that you're paired up with two to three other students who may or may not know what they're doing, then put the one who you're pretty sure doesn't know what she's doing in charge. Go.

For example, in this latest SIM we were nurses in an Emergency Department. A 2 month old is brought in with perioral cyanosis and no crying. The father has brought the baby from an urgent care, and somehow we have lab results that confirm the baby has RSV.

So here's how this SIM should have gone:

Baby comes in, blue in the face. Get the clothes off, listen to lung sound as another nurse suctions the nose and mouth and applies oxygen per nasal cannula. Get O2 sat, weigh the baby and get respirations and pulse rate and temperature. Call the doctor for Tylenol order to manage fever, educate the father about the disease and encourage him to hold the baby in an upright position to assist breathing and to calm baby. Monitor.

Here's how it went:

Baby comes in, we all stand there waiting for the primary nurse to delegate. She doesn't, so I grab the baby from dad and start getting respirations. They're fast, so I slap an oxygen mask on the kid since I can't find a nasal cannula. I go to pump the oxygen up to at least 5, but then the primary nurse tells me to start out at 1, and since I don't want to argue on camera, I do it. At this point the babies clothes are still on, and for some reason the kid gets weighed with all these clothes on. Well, that's not going to give us an accurate Tylenol dosing, so right there we've already potentially overdosed this baby.

Then we have one of the nurses call the doctor and ask for an order for Tylenol, which the doctor refuses to give until we have a blood pressure reading (a blood pressure on a 2 month old, by the way, is almost pointless. In fact, it is pointless unless the kid has a cardiac history, which this one doesn't). So now we have a feverish baby, fully clothes with an O2 sat at 88% and only 1L oxygen per mask! This kid is going to die, and there's nothing I can do about it because I'm so frustrated with everything that I can hardly speak without spitting.

Respiratory therapy gets called to administer an albuterol treatment so this kid can breath, and when she gets there (it's one of the instructors), she spends five minutes introducing herself to the dad and listening to the baby's lungs (which we've already done like six times by this point). This kid is blue in the face and she's taking her sweet time about it. Really?

Simulation basically ends due to time restraints, but we pretty much know that we've either killed this baby or given it permanent brain damage. All because we can't communicate in this environment where we know every decision is being watched, the actions taken by the instructors are unrealistic and the patient is plastic. It's just hard to take it seriously.

Then we go to post-conference where we watch ourselves acting like idiots while this baby is basically suffocating. Plus I look horrible on camera, due in part to terrible lighting and in part because I just look horrible and often slouch. Excellent.

Here's the takeaway, I suppose: SIM is not very good at representing a believable scenario that will ever be duplicated in real life. It is, however, a good practice in working through stressful and frustrating situations without completely losing it, which will come up again in real life for sure.

Clinicals, on the other hand, are a whole different story.

School Started Yesterday. What Am I Doing?

There's a mindset you get in before the first day of school. You pack your little school bag with brand new, fresh smelling paper and pencils and folders with birds on them, your head swimming with all the wonderful things you're going to learn and all the great things you're going to do with that new knowledge.

Then you show up and they suck all the fun out of it. I mean, really, is there anything worse than the first day of school? Anything? I can't think. Everything in my mind was so clear, my calendar was completely empty, my Awesome Notes assignment folder had one solitary thing in it. Now all of these are bursting at the seams. Do you know how depressing it is to look at your calendar and not have a single blank space on it, except Sunday, and that'll just be all taken up by "the Lord."

I realize that this is complaining, and that I shouldn't complain because aren't I so lucky to be in a nursing program such as this, and wouldn't other girls my age love to be in the program instead, and really shouldn't I be so happy to be here? Yes. I agree. Moving on.

I'm just trying to wrap my head around it. I know that every semester I look at my assignments and claim there's no way I can get it all done, and that somehow it does all get done. But this time, I swear, I really don't know how it's all going to get done. Pile onto that my online Sociology class, which started yesterday and yet there's no message from the instructor, not even any lectures posted, and I'm a little on edge. I should have done my yoga today.

And I'm eating terribly. I started out well, with a healthy homemade smoothie this morning, but I chased that with about ten pretzel M&Ms. I know I shouldn't even have them in the house, but there they are, sitting in a mug on my desk, all their pretty colors singing "eat me! Eeeeeeeeat me!" Mmmm. Orange one.

I will do this, however. I will get it done. I will go to SIM, and get my lab hours done, and do well in clinicals, and complete all my papers, and get A's on every test, and do my ATI exams and attend every lecture.

I will eat a vegetable today!

Tomorrow and Tomorrow and Tomorrow

Last week I was here:

Tomorrow, I'll be here:

Okay, not exactly there, but you understand where I'm going with this. I start my final year of nursing school tomorrow. As long as I don't completely screw up, I'll be a nurse by June. Yeah.

I'm trying to sound excited here, but I just can't. There's so much to do before I get to June. Peds, OB, Management, skills lab, SIM, ATI, N-CLEX - AAAAAH! When am I going to get all this done? Not only that, but how am I supposed to get all this done well? Overwhelming.

What I need is a plan. I need to go-to strategy that I can continually reference, even in my darkest and most depressing hour. Well, I have a few tricks up my sleeve that I think may make this year better than the last.

1. iPhone + Awesome Notes App

This year I have an iPhone, which is not only the most awesome thing in the world for anyone to have, but especially us busy students trying to keep track of every little class, clinical, assignment, etc. Add in Awesome Notes, an app that allows you to take notes during lecture, keep track of assignments, write quick sticky notes and almost anything else, then upload it all to your Google Docs, and you've got maybe the best nursing student tool ever. I got a small external keyboard which connects wirelessly to my phone, so I don't have to lug my laptop to class. This is going to be so awesome.

2. Cherokee Maroon Scrubs

Okay, so my school has specific scrubs they want you to buy, not just a specific color, but a specific brand. I'll not mention any names (you know who you are Landau), but the scrubs they want us to wear, the scrubs I wore all last year, are uncomfortable, ill-fitting and overall just make me look like a slob. The pant leg is straight down and there's no elastic to it, just a drawstring that's either so tight it cuts off my circulation at the waist, or too loose so that every time I bend over there's a peep show for all to see. The top is horrible, billowing out at the waist and then coming in so tight at the hips that some girls had to cut slits into the sides just so they could pull them all the way down. And the only pocket on these things is directly over my left boob. Scrubs without pockets = worthless.

Well, this year I'm not having it. I bought Cherokee scrubs that fit, have three pockets for the top and three pockets in the pants (which have elastic backs and drawstring fronts, with a flared leg as God intended). I realize they're not "school-issue," but they are maroon like the rest, and so help me if anyone tries to challenge my scrub selection I will lose it. I'm not going to clinical looking like a complete mess any more. I simply won't do it.

3. Dansko Shoes

No more back ache, no more throbbing feet. I have Danskos!

4. A Light at the End

Yes, I can see it. The light is June, and the tunnel is everything leading up to that. I think I will make it.

Wish me luck.