Nursing School Lessons

NURSING SCHOOL LESSONS

So, TINS, TIWFDASL, years and years and years ago. I was in nursing school clinicals, and working for EMS in Da City. This was so long ago, that HIV/AIDS was not even on the horizon.

One day in clinicals, I was cleaning up an incontinent patient, and my instructor motioned me outside once I was done and the patient tucked in to a nice clean bed, and he, himself, was clean and dry and in a clean gown.

She began: “Mr. McFee, You did very well keeping the patient covered so that he would not get chilled as you bathed him. There is, however, one item I ought to call to your attention.”

“Yes, ma’am? What is that?”

“I noticed that you were wearing gloves. That concerns me, because your patient might feel insulted at your wearing gloves for personal care.”

I responded, “So, you are telling me that the fact that I am wearing gloves to clean a patient who has been incontinent, of stool at that, might be seen as insulting?”

“Yes, Mr. McFee, that is exactly what I am telling you.”

“Well, ma’am, I worked last night, on the ambulance. I spent the night crawling in and out of cars, and over broken glass, removing injured people. I probably have a thousand little cuts on my hands alone. I am pretty certain that any patient of mine will get over their hurt feelings way before I recover from Hepatitis B. But, you are the instructor, and I am the student. Let’s write down your directions for me in this matter, and make a couple of copies. We’ll both sign each copy. That way you will have a copy, establishing what you directed me to do, I will have a copy and therefore cannot claim that you never told me to do what you told me, and there will be no questions moving forward what I am to do.”

She looked aghast. “I am not going to write that down! No way!”

I smiled. “Thanks for the counseling session. I will certainly keep your words in mind, moving forward!”

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“Engendering Collectivity In Nursing”

So, TINS, TIWFDASL, and I had been admitted into the BHSU College of Nursing. I had moved on from Da City’s EMF (“The ‘Mergency Muthafuggers!”, as we had been so colorfully denominated on so many occasions), and was nursing in the ED of one of the nearly dozen small (at that time, around 300 beds) hospitals dotting Da City. I went from being chief steward of the union representing the medics, to a staff peon working nights.

Another of the nurses working with me was also pursuing her BSN, and so we study buddied up. We both had been old schooled in The Wisdom Of The Student, as so found ourselves in the rear 1/3 of this cavernous several hundred seat lecture hall, where the Blue Hive State University held it’s class on “Transitions in Nursing”. This was aimed at those of us entering the BSN program. The instructor of this particular class appeared enamored of Florence Nightingale, the Victorian English woman whose work caring for wounded and ill British soldiers in The Crimean War laid the foundation of contemporary Nursing.

This infatuation was reflected as this instructor read to us all from a book of Nightingale’s life. Amusingly, from time to time, she (the instructor) would hold the book above her head, turned towards us so that we could “see” some illustration or another, and detail the citation accompanying the illustration. (“Did you bring your binoculars?”)

From our seats, some 50 or more meters away, this was not as informative as our instructor appeared to consider it.

Once she had exhausted her store of Florence Nightingale trivia, she (the instructor, not Ms. Nightingale) moved on to instruct us in the advantages to be found in group efforts to improve the workplace. She described these efforts as “engendering collectivity” (and, do we not all wonder if, forty years later, in The Enlightened Twenty First Century, if the Thought Police would allow any of us to speak in those terms?), and appeared to believe that this was an unmitigated Good! Thing!.

Let me follow a tangent, if you please, for a brief intermission. I had mentioned that I had been a steward for the union representing Da City’s EMS. Interestingly, my father in his own youthful years, had had a hand in the formation of the American Newspaper Guild, which was a union for (surprisingly) newspaper folks.

So, I kinda grew up steeped in old school, Democrat political world view (think Scoop Jackson and Jack Kennedy, Not Occasio Cortez or Gavin Newsome), including the value to be found in an organized workplace. In that world view was the “real politik” perspective of the cost paid by the organizers initially struggling to create that organization. Examples such as The Fight Of The Overpass as the UAW attempted to unionize the Ford Motor Rouge Plant, or the Homestead Steel Strike, and other struggles as folks attempted to start, and foster, unions, including organizers being blackballed, being intimidated or outright assaulted.

So, as the instructor droned about “engendering collectivity in the workplace”, I eventually let my boyish enthusiasm overcome my naturally shy nature.

I raised my hand, was called upon, and stood. “Ma’am, I was a steward for the union representing EMS in Da City. My father helped organize the American Newspaper Guild. In the professional labor circles with which I am acquainted, we have a technical term for those who seek to engender collectivity in a previously unorganized workplace. That term, is ‘unemployed’.”

I sat down. Oddly enough, I was never again called upon, for the balance of that semester!

Paramedic School Stories, Part Two:

Which brings us to STORY NUMBER TWO: (remember the grading scheme outlined last week) In the fullness of time, the second semester ended. I calculated the point total for each student, compared said total to the pre established thresholds for each grade, and, based upon this calculation, assigned grades.

I posted these grades, after turning them in to the program director, who was my immediate superior.

Shortly thereafter, I received a phone call from one student, let us call her Little Mary Sunshine. She was upset at her grade.

“Mr. McFee, you gave me an A minus, and I think that I deserved an A”

“Oh?”

“Yes. I think that you should have given me an A.”

“I agree with you.”

“Oh? You are going to give me an A?”

“Nope. I agree that you think that you should be given an A. On the other hand, you earned an A minus.”

“But, I checked my scores! I only missed an A by a single point!”

I checked my grade book. Yep, needed 920 points, earned 919 points.

“I agree with your calculations. You missed it by a single point.”

“I think that you should simply give me that point!”

“How interesting. I however, do not.”

“But…but…it’s not FAIR!”

“In what way?”

“I think you should just give me that point, and then I’d have an A!”

“If I were to give you that point, you would, indeed have an A. On the other hand, you, indeed, EARNED an A minus.”

“But..but..It’s Not Fair!”

“May I ask you a few questions?”

“Uh, OK.”

“You were present in class the first day of class, correct?

“Uh-huh.”

“As well, for the midterm, and the final that first semester, correct?”

“Uh-huh.”

“Likewise, the first class of the second semester, and the mid term of that second semester, correct?”

“Uh, yeah.”

“Did you hear me talk about extra credit, on each of those 5 occasions?”

“I suppose so.”

“And, did you speak to me one solitary time about any sort of extra credit of any sort?”

“But…but…I never imagined that I’d need any extra credit!”

“Yet, here we are. Had you turned one solitary extra drug card, and the only things on that drug card that were correct were your name, the brand name of the drug, and the generic name, you would have earned that extra point. You did not do so. If you do not care about your grade that much, why should I care any more than you demonstrably do?”

Sometime later I received a call from the director of the program, who asked me about Little Mary Sunshine’s concern. I related the conversation, as related above, and summed up: “Bob, it’s your program. You run it, you are responsible for it. If YOU want to give her that A, go ahead. Simply understand that I will not be signing any other grade form for her. You want to do it, be my guest.”

I heard nothing further on that topic.

More Paramedic School Stories: The First:

Years and years ago, before I left Da City’s employ as a medic, I had completed nursing school, written my boards, received my license and was living large. For certain values of “large”, that is.

I had been offered, and accepted , a position teaching pharmacology, part time, for the program that I had graduated from. The textbook we used (Nancy Caroline MD: “Emergency Care In The Streets”) was outstanding, and provided a clear template around which to build my lesson plans.

One of the innovations that I introduced, from my own nursing school days, was a particular format for drug cards. The point thereof was to have, on a 3 x 5 or 4 x 6 card, the names of the drug in question (trade and generic), the common dosing and route of administration of the subject drug, indications for using the drug, contra indications for using the drug, the mechanism of action of the drug, and the class (often, these last two overlap: a drug classified as a “Beta Blocker” worked by blocking beta agonism on the sympathetic nervous system. If you had mastered that point, you knew that the drug would serve to slow heart rate, mildly constrict arterial muscles (net effect of lowering blood pressure due to slower heart rate and decreased strength of contraction leading to diminished cardiac output), CONSTRICT bronchial muscles, and reduce intra ocular pressure. Or, you could write all that stuff out. For every beta blocker you encountered. Fun times. I simply earned what beta agonism tickled, and knew that blockade thereof reversed those effects.)

In addition, the cards noted nursing considerations (things the nurse, or paramedic, ought to have in his/her mind when employing this medication. Like, Beta blockers: check and recheck heart rate, blood pressure, and monitor the EKG, looking for slowing conduction of the electricity that controlled things).

Now, some of my students were first timers. They were folks who, as you might imagine, were taking paramedic classes for the first time.

In The Un-Named Flyover State, the licensing drill went something like this. You successfully completed the course, and took the exam. Pass it in one, bingo, license in hand, go out and fight disease and save lives.

If you failed the exam, then you got one chance to re take the test portion that you had failed.

If you failed the retest, you had to successfully complete a refresher course, whereupon you could re-test, again.

If you failed THIS test, you had to take the entire generic paramedic program, from step one, all over again.

As it happened, a couple of students had, indeed, found themselves taking the paramedic class, in order to qualify for a FOURTH retest.

So, TINS©, I laid out my expectations, had conjured up a 1,000 point, two semester grading scheme, wherein around ½ of the grade (250 points each semester) would come from the midterm and final, combined. Another 25 points came from each quiz, administered each week in class. 16 weeks in a semester, no quiz on mid term or final weeks, and two other weeks off for review for the mid term and finals, 20 quizzes.

I announced at the beginning of each semester that I would consider extra credit in the event that any student came to me in advance, suggested something that would reflect additional pharmacologic study, and be pertinent to paramedic practice.

So, STORY NUMBER ONE: Somewhere around mid terms, one of the students rose in class, and delivered a pronouncement: “Reltney, paramedics don’t need to know all this stuff. Nurses, yeah, I get that nurses need to know this stuff, but paramedics don’t!”

I invited him to hold that thought, and we could speak, in detail, after class. After the end of class, this fellow, along with a couple of his work mates, all met with me, eager to set me straight.

As it happened, all of these folks were of the looking-at-a-fourth-retest group.

I invited my correspondent to state his case. He did so, as outlined above, with no new explicative material, no new rationale for his position.

I deliberated a moment, and fact checked myself. “So, you have taken the paramedic exam, correct?”

“Yep!”

“And, you failed it, is that correct?”

“Uh, yeah…”

“Then, you took it again, did you not? And, failed it, again, am I correct?”

“yeah…”

“And, again, after a refresher course, you took the paramedic exam, and, again, you failed it, is that also correct?”

(much more quietly) “yes…”

“So, I’m confused: you are not an RN, are you?”

“Uh, no…”

“So, let me see if I am understanding you: you are telling me, who has taken, and passed, the paramedic exam, and who is, also, an RN, that you are in a position to have an opinion that I ought to find persuasive, regarding what it takes to successfully take and pass the paramedic exam, based upon your experience in taking the exam, and failing it, what, three separate times?, did I hear you correctly?”

He mumbled something indistinct, and found somewhere else that he felt the need to be.

And, I did not hear THAT particular argument again.

Hazards of Immobility

So, TINS©, TIWFDASL©, working full time and going to Nursing school full time when not in the firehouse. Oh, and sleeping. When I could.

As you may have surmised from the foregoing, I was acutely-on-chronically sleep deprived pretty much entirely through school. I have previously revealed what the director of the program thought of my first pass resolution of that problem, wherein I skipped lectures and slept in, however briefly. (Review: NOT MUCH!)

Therefore, I showed my happy academic ass up for every lecture, and attempted to take notes and generally avid snoring and/or drooling. In order to assist with my camouflage, I typically sat around 2/3 of the way back in the lecture hall, and about 40 degrees off axis from the lecturer’s line of sight. One particular failure of my strategy still stands out in my mind.

The subject was “Hazards of Immobility”. Unfortunately, one of the hazards of immobility, that the instructor did not enumerate and then explain in PAINFULLY elaborate detail, is somnolence. For those sleep deprived, as I was very much so in those days, sitting still was nearly a death sentence. I was wedged into my seat, and getting more comfortable, and more comfortable, and finally felt my pen slip from my fingers. I woke up at that, and retrieved my pen, again settling myself into my wedged-upright position.

I shook myself kinda sorta more awake, and resumed taking notes. Sleep crept up on me, again, until I heard our instructor asking, “Perhaps Mr. McFee can tell us about calcium and immobility. Mr. McFee? Won’t you join us?”

Without opening my eyes, without moving, I responded, “Well, patients who are immobile long enough, began to mobilize calcium from their bones, and excrete it via their kidneys. This places them at risk of both renal lithiasis, as well as pathological fractures.”

I heard the pause. She sounded surprised. “Mr. McFee, I was convinced that you were completely asleep!”

Still eyes closed, still unmoving, I cleared things up for her. “Ma’am, I understand how you might think so. In contrast, I find myself in an advanced state of relaxed alertness. Ma’am.”

I managed to stay awake enough to take notes for the balance of that hour.


“School Daze, School Daze, Dear Auld Golden Rule Daze!”

My parents had moved from one of the suburbs of Da City, to Some Unnamed Eastern state. Once there, they met the neighbors. One of whom was married to a meteorologist on Da TeeWee.

He (the meteorologist) found himself, from time to time, changing jobs, and this generally involved moving to an altogether new city. Of course, once they had moved, the children would have to be registered in the new school system.

I have, previously, suggested that not every functionary associated with our public schools is, shall we say, the best and/or the brightest. Indeed, from time to time I have wondered if some of these folks are alumni of The Short Bus.

Mrs. Meteorologist told a tale that supported this theory.

It seems that, after one move, she was undergoing the interrogation customarily associated with registering one’s children at the public school. The clerk was presenting questions, and my mother’s friend was answering them.

“Name?” asked the clerk.

My mother’s friend responded with “Name (whatever)”

“Address?”

The response, “(Address)!”

“Telephone number?”

“(Telephone number)!”

“Mother’s occupation?”

“Home maker.”

“Father’s occupation?”

“Meteorologist!”

(Clerk, without missing a beat, steadily typing away:)“What hospital is he on staff at?”

“(Huh?)”

Verbal Judo and Parenting

So, TINS©, There I was, standing in line and idly looking about at the cattle call that was parent-teacher conferences. As I moved from one slowly moving line to the next, I found myself in line in front of one of the officers from our small town police department. I recognized him from his visits to the ED wherein I toiled , FDASL© (Betcha you were wondering if I’d slip that one in there, amirite?), and he recognized me from nursing in our small town’s ED.

We were talking about parenting, and I observed that my children had, from time to time, suggested that due to the “fact” that “Billy”’s parents allowed him to (do whatever, something The Wife and I did not want our children doing), therefore we should facilitate our own child doing the same (stupid) thing.

I observed that we did not fall for that gambit, and our response was “Hmm, that is too bad. Your parents are ogres, and “Billy”’s parents are nice. You are stuck with ogre parents. Oh, look at the time! Off to bed you go! Night-night!”

The officer looked reflective. “Yeah, I can see how you effectively communicate that you aren’t gonna be buffaloed into things that you think are bad. My wife and I take a little different approach.”

“What is that?”

He smiled. “I tell my kids that whatever their revelation is, it makes me sad. Then I shut up. Of course, they ask me why it makes me sad. I simply gaze upon them mournfully, and tell them, ‘I’m sad because it is obvious that Billy’s parents, do not love him as much as I love you!”

I chuckled. “That’s sneaky! I like it!”

“Yep. What are they gonna do, argue that I do not love them? Leaves them with no place to start their argument!”

How Adults Roll

Many years after I was FDASL© in Da City, I was a Dad. (In my opinion, my most important job). I had four children with my wife, She Who Would Become The Plaintiff. Our daughter, referred to herein as Brenda, was a lovely girl, but, unsurprisingly, was a typical pre-adolescent.

One fine day, The Wife received a phone call from the school, relating that Brenda was failing Science class. We interviewed Brenda, attempting to understand what might be preventing this child from comprehending the material in her class that, to be honest, was not all that complicated. I mean, it was fifth grade science, in a podunk little school district.

We learned, after The Wife had detail-searched Brenda’s book-bag, that she, Brenda, had not been turning in her homework assignments. Oh, Hell Naw! That simply would not do! The Wife and I decided that, since I worked midnights, I would be the nominated for the role of Science Class Homework Monitor.

I phoned the school and learned that Mrs. Science Class was in her classroom yet, and would be happy to discuss Brenda’s failing with me. Off Brenda and I went.

I asked Mrs. Science Class if our appraisal was on target.

“Well, yes. Brenda has not been handing in her homework assignments.”

“Do you have these assignments? I mean, in a form that I, her father, could use to have Brenda perform this homework?”

“Well, yes I do. You do realize, Brenda is not going to receive credit for this work, do you not?”

“Yep. I don’t care about credit. Brenda, here, is going to perform these assignments, and I will check them for accuracy, and completeness. Then, I will check her spelling and grammar.”

Mrs. Science Class informed me, gently, “I do not check spelling, or grammar.”

I smiled. “How interesting. I do. Once I have corrected those items, Brenda, here, will do the assignment over again, until she gets all that correct. Then I will grade for neatness.”

Mrs. Science again offered, “I do not grade on neatness.”

Again, I replied. “How nice. I, however, do, and Brenda will repeat the assignment until she meets my standards of neatness. Then, she will do the next assignment, meeting all those standards, until she had completed every one, in it’s entirety, to my thorough satisfaction. Then she will deliver them to you for final grading.”

Mrs. Science Class looked at me, her head sort of half-cocked to one side, as if she were a beagle watching me cook something in the kitchen, and she repeated herself. “You know, Mr. Stretcher Ape, Brenda is not going to receive credit for all this work, don’t you?”

“Yep, you told me that, and I really do not care.”

“You do not care?”

“Nope. So, Mrs. Science Class, do you assign homework simply for your own entertainment?”

“Oh, no!”

“You have a plan of instruction, and homework is a part of that plan? Homework is part of the process by which children acquire an education, correct?”

She nodded. “Correct.”

I leaned forward, intensity in my speech. “Mrs. Science class, my daughter may or may not get the credit: I really do not care. What I care very much about, and what her mother agrees with me completely on, is the fact that our child is going to get the education. Full stop.”

She leaned back. “You know, I do not have this sort of conversation with parents, very often at all!”

I showed her my wolf grin. “That, Mrs. Science Class, is not Brenda’s problem. If she ever, again, so long as she breathes, fails to turn in her homework, in full, on time, and satisfactorily neat and legible, then every single assignment that she may have, I will correct. For completeness. For accuracy. For correctness. For neatness. For spelling. For grammar and syntax. And, she will do those assignments that I find unsatisfactory, over, and over, and over again, until I am satisfied with them.

Or, she could simply turn in her work, to you, on time and complete, to be graded as you see fit.

You see, I am willing to be Brenda’s problem, for so long as she desires it. She will let me know she desires it, by not doing her damned work.”

For those of you who care, my daughter finished high school, and then worked her way through her baccalaureate degree, working full time, with a child, as a single mother. And worked her way through her MBA degree, working full time, with three children, as a single mother. I take some, small pride in her accomplishments.

But, SHE did all the work. In full. On time. And completely. Because she is an Adult Woman.

Again, with not fitting the mold!

Remember my fun filled interview for Nursing school? So, nearly 30 years later I applied for PA school. Among the requirements was 500 hours of patient contact experience. So, I had worked as an RN for (shockingly enough) 30 years at that point, and had accrued, with overtime, something on the order of 63,000 hours of patient care.

So, I went to interview for the incoming class, and they asked me if I had 500 hours of patient care experience. I had included my resume detailing my schooling and work experience as part of my application, so I assumed that my work history was not a surprise.

I asked, “Do you mean, in the past 3 months? or overall?”

“How about, overall?”

“Well, something like 60,000 plus hours, I guess.”

The reply? “Well, alright then! Let’s move along!”

I succeeded, and so got to deal with the financial aid office.

I filled out the form, complete with the birthdate revealing that I had been born some 50 + years previously. I ignored the part where they sought my parent’s tax forms.

When I turned in my application, the gosling behind the counter reviewed my papers,  and looked my elderly ass right in the eye, saying, “You don’t have your father’s tax form in here!”

She sure was quick! “No, ma’am, I do not.”

She was, albeit, persistent. “You have to include your father’s tax forms.”

“Ma’am, I am not going to submit my father’s tax forms. For one thing, he has not filed in 13 years. ”

“He hasn’t filed in 13 years? He has to!”

“Ma’am, perhaps you could call him up, and let him know that. But, it’s going to be kind of a long distance call. And, when you reach him, please tell him that I love him, and miss him every day.”

Perhaps, she was not so quick. “Huh?”

“Ma’am, my father died over a dozen years ago. You will not be receiving his tax forms.”

Undeterred, she demanded, “Well, we will need your mother’s tax forms!”

I was over this. “Ma’am, you are not going to receive my mother’s tax forms, either. She is pushing 80 years old, I have lived on my own for 30 years, and the only tax forms you will receive are those belonging to my wife and me. Perhaps I should talk to your supervisor?”

After several minutes, an adult appeared. I reviewed my position. “Ma’am, this young lady insists on my providing my parents’ tax forms. That is not going to happen. I have supported my own family for nearly a dozen years. I am not about to provide my parents’ forms, nor have they supported me for longer than this nice young lady has been alive.”

The adult looked at me for a moment. “And, you are Mr. McFee, correct? And, you are the student? Not one of your children?”

“Ma’am, if you look at the applicant’s birthday on the application, you will see that it matches my apparent age.”

This soul indeed perused the applicant’s birthday, and regarded me. “Uh, sir? I think we have everything we need here. You will not be asked again to provide your mother’s tax forms. Thank you, and have a nice day!”

Not Fitting The Mold

So, TINS. I decided after several years as a nursing assistant, that I wanted to be an RN when I grew up. By the time that things lined up, I had already started working for EMS in Da City. So, I set to knocking off the pre-requisite classes I had not already collected, and waited for my Nursing school application to be processed.

Now, at this time, there were very, very, very few men in Nursing. The school I applied to, a community college, had a decidedly  problematic academic tendency among the population from which they drew their students.  So, since I had attended Tremendous State University for a couple of years, it seemed that I was a good candidate to handle collegiate level studies. For these reasons, it developed that I was accepted to this school.

In the course of the intake, I had to interview with an admissions officer. We talked about coursework, and finances. She asked me about what financial aid I had lined up. I admitted that I had none, and planned to pay for school through Da City’s tuition reimbursement program, as well as my earnings.

She did not think much of that idea, for some reason. “Mr. McFee, we do not allow our students to work.”

I was surprised. This was, after all, nearly 1980, and I had thought that liberated women, and various movements to remove barriers had changed things. Simply to be certain that I had heard her correctly, I asked her, “Er, ma’am? you do not ‘allow’ your students to work?”

“That’s right, Mr McFee. We do not allow our students to work.”

“Uh, ma’am, you do realize that I am working full time, have a house, and am my own only source of support, right?”

“Mr. McFee, you need to plan for that. We do not allow our students to work while they are in school.”

“Uh, OK. Uh, ma’am, so, where do you live?”

“Why do you ask me that?”

“Well, I support myself and you are telling me that I cannot work. I suppose that means that I’m moving in with you.”

THAT got her attention! “Mr. McFee! You are NOT moving in with me!”

“Hmm. So, how about you document that you have told me that your experience is that students who work while in school do not perform as well as those who do not. You could note that I have acknowledged that warning, and the school’s extensive experience behind that warning. You could write down that I will elect to work while in school, and therefore, any failure on my part will be in spite of your vehement admonitions. Do you think that will work for you? It is a chance that I am willing to take.”

“Uh, Mr. McFee, please sign here, next to my notes to that effect. Thank you. Welcome to Un-Named Community College School of Nursing. You have selected a challenging course of action, both academically as well as because you have chosen to work. Good luck!”