Civilian Nurse Abroad?

Civilian Nurse Abroad?

April 11, 1978

It seems hard to believe that it has been over one year since I graduated! I now officially have my one year of experience in the hospital as a medical-surgical nurse which most places require before you can specialize. The Lord continues to lay upon my heart a desire to reach the German speaking people with the Gospel in some way, so I decided to book a flight there in June for three weeks. I’m going alone to see what it is like to maneuver in a foreign country as a single lady. It will also force me to speak German more and meet people! I will also be visiting a missionary couple in Austria and another in France who are supported by the Bible church I attend. My German friend gave me the name of her two cousins to visit, so I’m waiting for a reply from my letter.

I am investigating the possibility of being a civilian nurse in a US Army or Air Force hospital in Germany. I met a nurse at the hospital who worked in Germany ten years ago as a civilian nurse. She encouraged me to apply, so I did. I feel very unchallenged at work and am ready for a change!

I was so blessed this morning when I read in John 4 about the woman of Samaria and how God used her mightily!

Come, see a man, who told me all things that ever I did. Is not this the Christ?…And many of the Samaritans of that city believed on Him for the saying of the woman, who testified, He told me all that ever I did.  John 4:29, 39

What a comfort and joy to know that the Lord is able to use the one lonely testimony of a single woman to change a whole city. I keep thinking of living in Germany alone with joy and yet fear and trembling wondering if the Lord can really do an effective work through me who am nothing? And then I remember Hudson Taylor’s statement who founded the China Inland Mission,

The Lord was looking for someone weak enough to use, and He found me.

April 14, 1978

I received this letter three days later from Mrs. K, who labors with her husband who is a pastor in France.

Dear Pam,

These are very difficult countries to live in compared to the USA because of the loneliness. But I know that the Lord has prepared you if He sends you here. I really do not know how to put it into words, because you have to be in this circumstance to understand. Month after month, year after year, without seeing anyone come to receive Christ as their Savior – this is the hardest thing to bear. I pray that the Lord will give you someone to help you if you go. I am so afraid for you alone. Forgive me my earthly concern. We will talk about all this when you come to visit.

Love in Christ, Mrs. K.

I can’t believe that almost the exact time I was writing about the woman of Samaria and rejoicing in going alone to Germany, Mrs. K. was writing this letter stating how much she was praying for someone to go with me. I just feel all mixed up now. My sister, Linda, said no mission board would ever send out a woman alone. I guess I have never heard of one doing that. I will just go forward with the trip and see what the Lord does. I truly just want to follow Him. I am willing to go, and I am willing to stay right here.

Dear Lord, I give my life to You and ask that You use me for Your glory and honor in whatever way You want and wherever You want. Amen.

Reflection – 2014

In rereading my journal, I now recognize the romantic notions I had about the mission field, even though I tried hard to dispel them. But yielding my life to Him at that time still holds true today! It is wonderful to trust in Him and let Him choose the path of our life. The Lord taught me so many valuable lessons through that first trip abroad alone in Europe. Lord willing, I will share those lessons with you on my next post.

Yield yourselves unto God, as those that are alive from the dead, and your members as instruments of righteousness unto God. Romans 6:13

Show me Your path, dear Lord.

Which way to go, dear Lord?


S-O-A-P Notes

March, 1978 – 11:30 p.m.

I had just finished walking rounds with the night shift nurse, clocked out, and sat down beside the chart rack to begin my charting before I could go home. I usually was able to complete some of my assigned five patient charts during my shift, but it had been nonstop all evening so I barely had time to gulp down my dinner. Each nurse was assigned five charts and must chart on two of the patient problems before going home. We were not paid overtime to complete our charting. We used the S-O-A-P format.

S is for subjective- what the patient says. soap bar

O is for objective – what you observe.

A is for assessment.

P is for plan.

I took the heavy 3 inch thick chart and turned to the tab marked “Nurses Notes”. I took out my blue inked pen and began. Day shift charted in black ink, evening shift used blue ink, and night shift used red ink. I remembered my college instructor’s words about charting.

“If it’s not charted, it’s not done. Try to paint a concise picture with words of exactly what you did. If you are ever sued, you likely won’t remember the patient several years from now. The lawyers and jury will scrutinize your every word.”

Mrs. K. in Room 515 had had a below the knee amputation two days previously. I scanned her problem list and chose Pain and Diabetes from her list. I began writing using approved abbreviations:

#1. Pain

S: c/o moderate RLE pain. (complains of moderate right lower extremity pain)

O: RLE incision intact. Moderate swelling, slight erythema. VS (vital signs): 99.2-76-18-136/84. (temperature-pulse-respiratory rate-blood pressure)

WBC (white blood cell count) 7.4. Given 2 Percocet.

A: Moderate post-op pain. Pain relieved with Percocet. No sign of infection.

P: Continue to monitor incision qs (every shift), medicate for pain prn (as needed). Instruct pt (patient) about phantom pain.

I completed my last chart at midnight, put on my coat, and drove wearily home through the black night.

Reflection – 2014

Charting has changed over the years, but the saying of my instructor still holds true in the litigious American society, “If it isn’t charted, it isn’t done.” After Xerox copies were invented, we switched to black ink for charting so the charts were more legible when copies were made.

In labor and delivery, we had to write our initials and time on the fetal monitor strip whenever we entered the mother’s room, and whenever we gave any medication or did a procedure. When I was a visiting nurse in the 1990’s, we used a check list system for the daily visits and left a carbon copy in the home for the next nurse. When I worked in the nursing home as a nurse practitioner, we had a dictation service with secretaries which worked very well. We returned once again to the S-O-A-P format.

In my current job, we have an electronic patient record and no more paper charts. I have machine dictation which is only about 70% accurate, so it takes quite awhile to correct all the mistakes. But at least you can read everyone’s notes and never have to go hunting for lost charts. However, when the computer system crashes, it shuts down the whole system because we have no access to the patient records. Thankfully, that doesn’t happen often.

I recently called a doctor’s office to request a copy of a patient’s records. His assistant said she would fax them over, but warned me we would not be able to read his handwriting! Over the years, I’m afraid my handwriting has deteriorated also as I have spent countless hours writing in patient charts. Charting isn’t the most satisfying part of nursing, but it is necessary for communication and a required part of my job, so I try to do it thoroughly and above all, honestly, to honor God.

“Not with eyeservice, as menpleasers, but as the servants of Christ, doing the will of God from the heart, with good will doing service as to the Lord, and not to men.” Ephesians 6:6-7

When I toured hospitals in China in 1986, I was amazed that they only had one sheet of paper with a few characters on a clipboard hanging on the end of each patient’s bed. The patients were not allowed to sue their provider, so the documentation was very minimal. A Chinese friend told me each person keeps their own medical record in a notebook and takes it with them each time they go to the clinic for the doctor to write in. It sure seems like a much simpler system!


Blizzard of 1978

January 26, 1978 – 10 a.m.

I turned on the TV and watched the weather prediction. They told us to brace ourselves for a terrible storm that was coming with high winds. We usually only get 10-15 inches of snow all winter, so this was very unusual. I have never seen a blizzard. It’s about 50 degrees Fahrenheit right now. The wind began to pick up, the snow began to fall, and the temperature plunged.

The phone rang and I answered it. My nursing supervisor, Marie said, “Pam, pack a bag to prepare to stay overnight at the hospital. The National Guard will be at your house in 30 minutes to bring you in for the evening shift tonight.” I quickly packed a couple extra uniforms, toiletries, and my Bible, and watched out my front window. When I saw a 4 wheel drive Jeep pull up, I put on my warmest hooded coat and ventured out. I had to lean into the wind,because it was so difficult to walk. I climbed in the back seat and said hello to the driver and three other nurses he had already picked up.

We drove slowly through the deepening snow on the deserted streets and arrived safely at the hospital five miles away. I took report from day shift and began my evening rounds. My head nurse, Mrs. H. and I were the only staff that made it in for evening shift. Thankfully, they had cancelled all routine surgeries, but all our 30 beds were occupied. There was a friendly air of comradeship with all the patients that night. Those who were there for their week of diabetes classes helped us pass dinner trays to the patients who were bedbound.

I went down to the cafeteria for dinner, and the hospital administrator was serving our food on the tray line. He smiled and thanked me for working through the blizzard! No charge for dinner tonight!

The Guard brought in the night shift nurse and aide, so I was able to sign off at 11:30. Marie told us there were some empty patient rooms on the 9th floor, and to pick whichever one I wanted. I grabbed my bag, found an empty room, and closed the door. I turned on the TV and watched the blizzard. There were unbelievable pictures coming in of 15 foot snowdrifts from the high winds of 69 miles per hour. The roads were impassable and the temperature had dropped to -30 degrees. I could hear the howling wind as I looked through the window and watched the snow blow sideways in the dim street light. It was nearly a whiteout!

I put on my pajamas and climbed into bed. I had never been a patient in a hospital, so this was a very strange experience. I was too keyed up to sleep. Then I heard a patient in the next room start to scream. I lay awake and prayed.

The alarm went off at 6 a.m. I guess I dozed off at some point. I got dressed, read my Bible, and committed the day to the Lord. I went out to the nurses’ station and asked my nurse friends about the patient next to me. They said he was an alcoholic going through withdrawal, and they had to put his arms and legs in leather restraints while they medicated him. He nearly destroyed the room.

I went down to the cafeteria and ate my free breakfast and then went back to the fifth floor. I was totally exhausted from little sleep and asked the Lord to give me strength for the day and to bring in the evening shift.

Mrs. H and I were the only staff again so we split the floor in half. After we passed the medications and trays, we began the bed baths. We were running out of linens so we only changed the patient’s gown and sheets if they looked soiled.

I was so happy when the evening shift arrived courtesy of the National Guard! I gave report, and then found a coworker who lived near me and volunteered to give me a ride home.

I could barely get in my front door from the drifts. My roommate, Jane, had shoveled out as much as she could. We looked at our cars that were buried in the parking lot and decided to wait until the next day to shovel them out since we were both off of work.

My car was buried after the Blizzard of 1978!

My car was buried after the Blizzard of 1978!

I fell into bed after a quick supper, thanked the Lord for carrying me safely through the blizzard, and fell into a deep sleep.

God is our refuge and strength, a very present help in trouble.

Psalm 46:1


Reflection – 2014

I have never needed the National Guard to bring me to work since then! Sadly, 51 people died in my state in the blizzard of 1978; 22 died when they left their trapped car and froze to death while trying to get to cover.  But I still remember the comradery of the staff and patients as we all helped each other through that terrible storm.

Now that I live in New England, I have been through several more blizzards. Later in the blog, I will share some of my harrowing tales of reaching my patients in the community as a visiting nurse.


State Nursing Boards- Zzzzz…..

July, 1977 – Midwest, USA

It’s hard to believe I graduated in March, over 3 months ago! I have learned so much working on evening shift with my diabetic patients. I’m feeling fairly comfortable now with my skills and organization.  The most difficult decision is if I should call the doctor at home, or if it can wait until morning. In March, I received a 6 month Graduate Nurse permit which I’m working under. Whenever I sign my name on the chart, I follow it with GN1117 which is my permit number. The doctors have started calling me “007”!

The state only offers Nursing Boards twice a year in July and February. If I don’t pass my boards the first attempt in July, I will lose my job and have to work as a nursing assistant which would be a huge pay cut and very embarrassing. Since my sister, Linda, has been a nurse for 3 years now, I asked her for suggestions in preparing for the boards. She said she reviewed her notes from all her classes and asked the Lord to help her choose the right answer. So I have been reviewing my class notes and textbooks an hour a day and more on my days off.

Tomorrow is the big day! The boards are being given at the State fairgrounds, of all places. I hope we’re not in the same barn as the cows….

State Boards – Day One – July 6, 1977

I’m afraid I was so nervous last night that I only slept a couple hours. It is 100 degrees Fahrenheit today, so the heat didn’t help either. (I do not have any air conditioning in my apartment.) I entered the large room that held about 100 single desks. The air conditioning felt wonderful! (No cows in sight!) The moderator instructed us to put our purse under our chair and look straight ahead or at our desk at all times. If anyone was caught trying to look at their neighbor’s answer sheet, they would immediately be expelled from the room and not allowed to take the test again. There were two sharpened pencils on each desk and a blank scantron answer sheet with bubbles to color in with pencil. Each person had a blank white sheet to cover up their answers so no one walking past could see.

There were 3 tests today and 3 tomorrow. Each test lasted 2 hours. Today we were tested on Medical and Obstetrics before lunch, and Psychiatry after lunch. Tomorrow we will be tested on Surgery and Pediatrics before lunch. After lunch we will take a test of sample questions for next year’s boards.

I completed Medical and Obstetrics and began to relax a little. Then I found some of my classmates and we went to lunch together at a nearby German restaurant. We all compared our answers and wondered if we had done well enough to pass? It was good to see them again since I had not been with them since March.

We returned after lunch and the moderator handed out the test and answer sheet for Psychiatry.  The air conditioning felt so good after being outside in the heat. I began reading through each question and coloring in the bubble for the best answer of the 4 multiple choice answers.

All of a sudden I heard the moderator say, “You have 10 minutes remaining to complete this exam.” My head snapped up. Ten minutes!!! I couldn’t believe that I fell asleep in the middle of the test! I quickly prayed and asked God to help me finish on time. I had about 20 more questions to complete. I quickly read the question, chose the best answer and moved on. As I colored in the last bubble, the moderator said, “Time is up. Put down your pencil and bring your exam to me.” There were only a few of us still there. Normally I am a fast test taker, but there was no time to go over my answers.

State Boards – Day Two – July 7, 1977

I am so thankful that I slept like a rock last night! It’s also a little cooler today. I completed all the tests today without falling asleep! The surgical exam seemed fairly easy because I have taken care of so many surgical patients on the diabetes unit. There were about 15 questions on diabetes on the Pediatric exam so I whizzed through those since I could apply the same knowledge from my adult diabetic patients that I had learned. My three months of experience was definitely helpful today. Now I wait about 6 weeks for the results to come in the mail. I pray they arrive before my temporary nursing permit expires! The Lord’s will be done. If He wants me to be a nurse, I will pass.

August 30, 1977

I scanned the mail. There it was! The State Board of Nursing return address was in the left corner of the white envelope. I sat down on my bed and prayed to the Lord to give me a quiet heart of acceptance no matter what the results. I opened the single sheet of paper and scanned the results.


It listed my scores for each exam and at the bottom in capital letters it read PASSED.

I looked at the individual test scores and was amazed that my score for Psychiatry (where I fell asleep) was higher than Obstetrics (my lowest score). I was also amazed that Pediatrics was my highest score. I guess it was because of all those questions on diabetes.

Thank You, dear Lord!!! You gave me the strength and wisdom to get through four years of college and now I am a fully REGISTERED NURSE!!! I commit my nursing career to You, and ask that You would use me for Your glory and honor. Amen.

I can do all things through Christ, who strengtheneth me! Philippians 4:13

I went to work the next evening and proudly wrote RN after my name!

An official Registered Nurse! HAPPY DAY!!

An official Registered Nurse! HAPPY DAY!!


Reflection – 2014

The graduate nurse now takes a NCLEX exam on the computer at a testing center within a few miles of their home at a time convenient to them. It is no longer separated into specialty areas. The GN has 6 hours to complete the test in one day. There are also numerous review programs one can pay a fee and attend to prepare for the exam. A person can pay $7.95 extra to receive the “unofficial” results in 48 hours.

I remember when I took my GRE test for graduate school on the computer at a testing center 3 miles from my house. I received my test results in 5 minutes which was nice! There are certain advantages to computers these days.