Teaching Licensed Practical Nurses

May 1, 2003

I had crushing chest pain on Saturday, so I called the ambulance and went to the emergency room. They diagnosed me with pleurisy and pneumonia, put me on antibiotics, and sent me home. How I thank the Lord for the perfect peace He gave me during the hours I lay on the stretcher. “For me to live is Christ, and to die is gain.” Philippians 1:21

The job is going better, by God’s grace. I like teaching the students at the nursing home. The staff is very helpful, so that makes for a pleasant learning environment. I discovered that my new neighbor works as a nursing assistant there. Her first language is Portuguese and she only speaks minimal English. I think I’ll check some tapes out of the public library and try and learn a little Portuguese so I can talk more with her.

May 16

I am sick at home again with a fever of 101 degrees. This is the fourth time I have caught an infection since I started working at the school and the nursing home. I asked the Lord to make it clear if He wants me to work again as a Nurse Practitioner or keep teaching. I am required to work 2000 hours as a NP over a five year period to keep my certification, or I can take the board exam again which would be grueling.

June 7

“Teaching is not effective without a good example. You can easily discourage others by being impatient with them. The more forceful you are, the more you need to learn gentleness and kindness.” – Fenelon

The first clinical session has ended at the nursing home. At first, I hated working in the nursing home. But after I became better acquainted with the staff and the alert patients, I thoroughly enjoyed it. I watched in amazement as the students progressed from being frightened to touch a patient to being able to care for several patients confidently.

June 13

For I reckon that the sufferings of this present time are not worthy to be compared with the glory which shall be revealed in us.” Romans 8:18

Yesterday morning I asked the Lord to help me depend on Him alone and not a paycheck or a job, which He answered very quickly. An hour later, Mrs. D. called me into her office and told me that my position was eliminated because over half of the first module class failed. I asked her why she chose me? She said my student evaluations were not good, and that I was not a team player. She also announced that C. would be the new director. C. has a very foul mouth, smokes, and cohabits with a man, so I know that it would have been difficult for me to work with her. I always felt like a fish out of water in the teachers’ communal office because I did not swear or tell off color jokes like all the others.

I can’t sleep from this head cold and can’t stop my tears of exhaustion. But on the brighter side, because I was laid off, I can collect unemployment while I look for another job. I thank the Lord that I don’t have to get up at 4:45 a.m. to go to the nursing home or prepare lectures at night after teaching all day. Perhaps God will improve my immune system so I don’t keep catching all these viruses.

“Don’t let your work either excite you or depress you too much.” – Fenelon “When we sit under Christ’s shadow with great delight, everything else becomes so small, and loses its hold upon our hearts.” CAC “Nearly all God’s jewels are crystallized tears.”

“Weeping may endure for the night, but joy comes in the morning.” Psalm 30:5

June 24

I had an interview at a children’s residential camp an hour from home today, but it wasn’t a good fit. The pay is too low and the camp is closed for three months in the winter. The atmosphere is so much different than Bible camp. God knows the way I should go.

Dear Lord, I ask You to give me a job where I can freely share the gospel, attend all the services at church, be within a 20 minute commute from home, and have a manager who is kind, fair, and supportive. I ask for a job that is not too stressful where I can use my Nurse Practitioner skills four days per week with good health and retirement benefits. Help me to wait quietly upon You. Thank You for this extra time to study Your Word and draw near to You. Thank You that You own everything and that nothing is too hard for You. Thank You for this measure of health. I love and adore You. Amen.

July 5

The Lord gave me a wonderful week of vacation with another lady from church at Yosemite National Park in California. The rock formations and water falls were breath taking. This is one of the most beautiful place on earth that I have ever seen, but I know heaven will be so much better!

God refreshed my heart at beautiful Yosemite National Park in California.

July 16

Yesterday I had the most difficult interview of my life at the college where I received my Master’s degree in nursing. The position is for Director of Health Services which includes treating the residential college students in the clinic. Four women conducted the interview in the board room with me seated at the head of a long table. Unfortunately, every time I looked up, I saw my reflection in a gigantic mirror on the wall. They took turns asking me about 20 challenging clinical questions from their typed list. My brain kept freezing from the stress, so it was a grueling 90 minute ordeal. After I left the room and closed the door, I heard them all burst into laughter. I walked down the long hallway feeling totally humiliated. This is definitely not the right job for me.

I had another interview today at a large inner city hospital 20 minutes from my home. Because my interview went so poorly yesterday, I spent several hours studying rehabilitation medicine last night to prepare for today’s meeting. I made a professional folder with my resume and business card to give Dr. S., the medical director of the ten bed unit. Dr. S. was delayed in a family meeting, so I quietly observed the unit while waiting. It seemed like a calm, well organized unit. The huge windows in the nurse’s station made it bright and cheerful.

Then Dr. S. took me on a tour of the unit while he explained how it functioned and what my role would be. He asked me a few easy questions about myself in the hallway. He seems like a genuine compassionate person who is board certified in physical medicine. Most of the patients have had strokes, joint replacements, or organ transplants. In acute rehabilitation each patient must be able to do a total three hours of physical, occupational, and speech therapy daily. Some advantages of having rehab in the hospital as opposed to a nursing home is that a patient can be quickly transferred back to the intensive care unit if needed and all their specialty doctors can assess them daily.

Dr. S. has been looking for a NP for eighteen months, so God has been keeping this position open for me! If I am hired, Dr. S. would like me to work from 11 am to 5 pm except on Tuesdays when I would start at 8:30 a.m. so I could participate in weekly team meetings. On Tuesdays, I would leave at 2:30 p.m. Initially, I will be paid for 30 hours weekly with full time benefits. If I want to increase to 40 hours per week, I can do research, inpatient consults, or see outpatients in his office, so there is room to grow professionally.

I will need to work every third weekend and come see all ten patients on either Saturday or Sunday and write a progress note, but it only takes a maximum of 90 minutes. I will also need to make rounds on two holidays, but Dr. S. said I can have first pick of which holidays I want to work. Next, I will need to meet the Chief Executive Officer, Chief Financial Officer, and Medical Director of the entire rehab network.

I spoke with my former classmate, Kim, who has been a NP on the transplant unit for the past year. She was excited for me and said the rehab unit has an excellent reputation. She makes rounds there after they transfer their post transplant patients to the unit. She told me about the hospital benefits and how she negotiated her salary, so I will see what the Lord does.

Reflection

Job changes are never easy, but I thank God that He went before me in every situation. As I reflect on this part of my career when nothing was stable and each month was rocky with constant change, I can now see how the Lord was teaching me to lean totally on Him one day at a time. He always provided my every need and still does! I pray that you will know the joy of leaning on Him also, the only One who is the solid Rock and never changes.

 

Why am I so weak?

Occupational Health Nurse Practitioner – August, 2002

I have now been working in this very busy clinic for 4000 employees of the insurance company for several months. One of my duties is to give routine vaccinations to employees when they request them. During an unusually slow afternoon, I checked my vaccine stock to see if I needed to order any more. I am praying about doing some medical mission trips, so I decided to give myself a Hepatitis A vaccine. Hepatitis A is common in many developing countries and is transmitted by unclean food or water.

The next morning, my alarm awoke me at the usual 5 a.m. I tried to move and get out of bed, but I ached all over and was overcome with weakness and dizziness. By 6 a.m., I felt the same so I called my boss and said I was too ill to come to work today. I knew there was no way that I could survive a busy clinic day.

The terrible weakness, dizziness, and aches continued, so by the third day I went to see my personal physician. He drew blood tests and said my blood pressure was low and to try and drink more fluids. I was thankful my friend from church could drive me to and from the appointment.

These symptoms continued day after day, until a month had passed. After the first week, I had no paid time off remaining since I had only worked for the company a short time. My physician could not determine the cause of my symptoms, so he sent me to a neurologist, chiropractor, and endocrinologist. I became very discouraged and cried out to God for mercy in my weakness.

September 17, 2002

On September 17, my doorbell rang. The postman had me sign for a registered letter from my employer. I sat down on my couch and opened it with trembling hands. “We regret to inform you that due to your prolonged absence, you are no longer employed at this company. You may begin collecting unemployment after you recover from your illness….” Because I had not worked for the company for 12 months, they were under no legal obligation to continue my employment.  The tears flowed as I asked God to help me and teach me all the lessons He had for me. I asked Him to give the doctors wisdom in finding out what was wrong with me, heal my body, and provide my every need.

Why art thou cast down, O my soul? And why art thou disquieted within me? Hope in God; for I shall yet praise Him, who is the health of my countenance, and my God.” Psalm 43:5

I began reading books by other Christians who went through their time of suffering with victory. Corrie Ten Boom was imprisoned in the concentration camp during World War 2 because she sheltered Jewish people. She suffered from starvation, cold, beatings, and watched her sister die. After Corrie was released due to a clerical error, she wrote a book called “The Hiding Place” and traveled the world telling people that no matter how deep the pit, the love of God was deeper still. She also said,

Faith = Fantastic Adventure In Trusting Him!

Joni Eareckson Tada, who has been confined to a wheelchair because of a diving accident when she was a teen, wrote, “People with disabilities are God’s best visual aids to demonstrate who He really is. His power shows up best in weakness. They persevere. They love, live, trust, and obey Him. Eventually the world says, “How great their God must be to inspire this kind of loyalty!”

September 30, 2002

“Show me Your ways, O Lord; teach me Your paths. Psalm 25:4

God encouraged me with this verse.

“Your weakness will be your strength if you accept it with a lowly heart. Trusting in God is a simple resting in God’s love, as a baby lies in its mother’s arms. The point of trusting God is not to do great things that you can feel good about, but to trust God from a place of deep weakness. Nearly all God’s jewels are crystallized tears. All I ask is that you rest in faith with a teachable spirit.” Fenelon

“Lord, give to me a quiet heart that does not ask to understand but confidently steps forward in the darkness guided by Thy hand. Mercifully, God does not leave us to choose our own curriculum. Let the Lord of the Universe do the worrying! Wide soaring gives wide seeing! Keep looking down from your heavenly position.” – Elisabeth Elliot (widow of Jim Elliot who was martyred in Ecuador)

“Godliness with contentment is great gain…. Having food and raiment (clothing) let us be therewith content.” I Timothy 6:6-8

Reflection

And so began the most difficult time in my nursing career and in my health. After many tests, my endocrinologist finally determined that I had developed adrenal insufficiency from the Hepatitis A vaccine. The adrenal glands control all the hormones in your body. If a person does not produce enough of their own natural steroid, they experience low blood pressure, severe weakness, and dizziness – all my symptoms. I had to take a low dose of steroids for the next six years. How I thanked God that I finally had an answer!

I called Dr. A., my former coworker at the psychiatric hospital who also conducted vaccine research. He confirmed that in very rare instances, vaccines can effect the adrenal glands like this.

After much prayer, I decided to sell my dream house that I had built a few years previously. By God’s grace, I made enough profit on the sale of the house to pay cash for a small condominium where I lived for the next four years. It was a huge financial relief to be rid of a mortgage and a good lesson to hold everything with an open hand to God. My real home is in heaven above with Him for all eternity! After six months, I recovered enough strength to seek employment part-time. Next post, I will tell you how God wonderfully provided again.

Will God Provide?

October, 2001

Dr. T., my manager, called me into his office. “Pam, I’m afraid I have some bad news for all of us. The parent hospital has decided to close this campus in the next few months because they are losing so much money at this facility. Next month, they will decrease our hours to 20 hours per week. They have offered us positions at the parent hospital on the psychiatric unit, but we will need to be on call at night and weekends. Let me know what you decide to do. I think I’ll be looking for another job closer to my home.”

This news took me by surprise. I knew the hospital was struggling, but I didn’t know it was this dire. Three years ago, I built my dream house because Dr. T. told me my job was totally secure. I so enjoy living here because it is close to church and work and I host guests frequently. But I will not be able to pay my monthly bills on half my salary. I think this is a good time to leave psychiatry since I don’t want to work weekends and night shift again.

When I arrived home, I opened my Bible and asked God to show me the next step and to provide for me. Certainly God, who created the universe, can supply my every need. This is my time to trust Him and see His provision.

God calmed my heart as I read Matthew 6:25-34, “Therefore, I say unto you, Be NOT anxious for your life, what ye shall eat, or what ye shall drink; nor yet for your body, what ye shall put on. Is not the life more than food and the body than raiment?…For your heavenly Father knows that ye have need of all these things. But seek ye FIRST the kingdom of God and His righteousness, and all these things shall be added unto you. Be, therefore, NOT anxious about tomorrow; for tomorrow will be anxious for the things of itself. “

“Be anxious for nothing, but in everything, by prayer and supplication with thanksgiving, let your requests be made known unto God. And the PEACE of God, which passes all understanding, shall keep your hearts and minds through Christ Jesus…. But my God shall supply all your need according to His riches in glory by Christ Jesus.” Philippians 4:6-7, 19

God encouraged me with Philippians 4:19

Dear Lord, You know all about this situation and my finances. Show me the next step. I’m trusting You to provide my every need. Use me for Your glory and honor. In Christ’s Name, Amen.

December, 2001

I have had a desire to teach nurses again in some way, so I applied to teach at a Christian college 1000 miles away. I visited the campus for ten days  to observe the classes, speak with the nursing professors, meet with the Dean, attend several different churches, and look at a few houses to buy. The Dean said they would love to have me join the faculty.

I returned home and asked God to show me His will. If I joined the faculty, I would not have time to keep working as a Nurse Practitioner and would eventually lose my NP license. Because it took me so many years to become a Nurse Practitioner, the Lord did not give me peace about giving it up. So I wrote the Dean and declined their offer.

I applied to a home care agency and was hired as a RN to do psychiatric home visits after I finish my four hours daily at the psychiatric hospital. I drive to the worst parts of the city, enter smoke filled apartments with blaring TV, assess the patient, and fill his locked med box for the week. Some of the patients are quite unstable mentally, so I ask God for protection as I quickly work. The agency said I can leave a patient’s home at any time if I do not feel safe. I always keep myself between the patient and the door and keep my cell phone in my pocket. How I thank the Lord daily for His protection! I continue to look for a full-time job as I know this is not the right job for me long term, but I thank God for His provision in the interim.

May, 2002

I interviewed for a job as a Nurse Practitioner to run the employee clinic of a large insurance company. The manager grilled me on how I would handle emergency situations. She said I answered all the emergency questions correctly and offered me the job. The pay is more than I made at the psychiatric hospital, but I’m a little hesitant about the 45 minute commute. I will need to leave my house daily at 6:30 a.m. to arrive in time. But since this is the only NP position God has opened, I accepted the offer.

August, 2002

I was trained at the downtown office by an experienced NP, and then was sent to the suburbs to run a busy clinic alone for 4000 employees.  I have a receptionist, but no medical assistant to help me with vital signs or electrocardiograms (ECGs). The supervising MD comes to the office once a week to review my notes. He is also available by phone whenever I have an emergency.

I am amazed at all I am expected to do. For every new employee, I do an ergonomic assessment of their desk, chair, phone, and computer to make sure it is in proper alignment for them to prevent carpal tunnel syndrome and other repetitive use injuries. The majority of the employees work in a cubicle and are on the computer and phone eight hours daily. We also hold health fairs for the employees periodically where we check their blood pressure, cholesterol, and glucose.

And then there are the daily clinics. Sometimes I have a line of 15 employees out the door waiting to see me. They come to work so sick because they don’t want to use any of their sick time or waste time going to their own doctor. If a Vice President comes in, they get to go to the front of the line. In the four months that I have been here, I have had to call the ambulance about a dozen times for emergencies ranging from chest pain and asthma attacks to hemorrhaging.

I also draw routine labs for patients who bring a prescription from their regular doctor, give vaccinations, and run and interpret ECGs. Since I did not need to read ECGs in my other job, sometimes I need to fax them to my supervising MD to have him confirm the interpretation. But if I don’t have time and it is an emergency, I just call the ambulance. “When in doubt, send them out” is what my boss told me.

Every morning I ask the Lord for wisdom in every decision and a quiet heart in the midst of whatever emergency situation walks through the door. I don’t enjoy the stress of this job. I have never worked in the emergency department or intensive care unit. Some days, this feels a little too much like that.

Reflection

How I thank God for carrying me through that challenging period of job changes and providing so wonderfully for me. Little did I know that an even more difficult trial lay ahead of me where I learned to trust Him in the midst of utter weakness.

The Psychiatric Hospital

December, 1998 – New England, USA

I have now completed my first six months as a Nurse Practitioner in a 120 bed psychiatric hospital. I thank God for my boss, Dr. T., who is a Family Practice Physician and an excellent teacher. The hospital has an adult unit for acute psychiatric problems, a second adult unit for detoxification of patients from alcohol and opioids (heroin and oxycontin mainly), a teen psychiatric unit, and a pediatric unit for ages 5-12. I thank the Lord that He closed the door four years ago to the Adult Nurse Practitioner (ANP) program and redirected me to a Family Nurse Practitioner (FNP) program. Otherwise,  I would not be qualified for this job since I need to treat the medical problems of the children and teens.

When patients are admitted here, Dr. T. or I must do their admission physical examination and record it in their chart within twelve hours. We have a full time MD who works all night and does the exams of patients who are admitted after we leave. I am becoming an expert at doing a neurological exam of the twelve cranial nerves. I am also improving in my examination of ears and eyes with the otoscope and opthalmoscope.

Image result for nurse using otoscope

I developed my skill in using an otoscope for ear, nose, and mouth exams.

In addition to being certified in cardiopulmonary resuscitation (CPR), I also had to be certified in handling violent patients without hurting them (Nonviolent Crisis Intervention). I learned how to break a strangle hold in case a patient tries to choke me. I never wear a necklace or scarf to work since a patient could use it to strangle me. If I feel uncomfortable about being alone with a patient in the exam room, I request one of the aides to be present with me for safety. I always keep myself between the patient and the door so I can escape the room if I feel threatened.

The hospital is under investigation from the state because a child died last year. The staff did a face down restraint when the child came violent, and he suffocated. Tragically, they were unable to revive the child. So the state investigators come every day and read each providers’ progress notes, including mine. How I ask God for wisdom in my job! It is sometimes difficult to work under such scrutiny.

“If any of you lacks wisdom, let him ask of God, who gives generously to all without reproach, and it will be given him.” James 1:5

Dr. T. and I write the admission orders for the patients going through alcohol and opioid detoxification. The nurses use a scale to measure the patient’s withdrawal symptoms which guides them to administer the correct amount of medications to prevent the patient from having a seizure or dying.

It is so sad to see patients’ lives wrecked by alcohol and drugs. Only the person who receives Jesus Christ as his Savior can truly be delivered from these deadly addictions.  I pray for each of them to look unto Jesus Christ and be saved. How I thank God that He has put a song in my heart and prevented me from ever using alcohol or drugs by His grace. By following Him, He has spared me so much heartache and grief.

“And be not drunk with wine, in which is excess, but be filled with the Spirit, Speaking to yourselves in psalms and hymns and spiritual songs, singing and making melody in your heart to the Lord.” Ephesians 5:18-19

Reflection

I thank the Lord for all I learned while working in psychiatry for those four years. It was sometimes difficult to see lives so broken. But my experience with psychiatric assessments was  extremely helpful in every other job I had the remainder of my nursing career. A person’s mental condition often strongly impacts his physical condition.

 

My Nursing Thesis Published!

September, 1998 – New England, USA

After I completed my thesis in graduate school, my advisers encouraged me to submit an article summarizing my research findings for publication. The unwieldy title of my thesis was, “Coping Strategies of Successful Caregivers of Nonambulatory Family Members”. Nonambulatory means that the person is unable to walk.

My parents and one of my patients that I had followed as a visiting nurse inspired me to do the research. After my mother had a major stroke which left her paralyzed on one side and with the mind of a ten year old, my dad stepped up to the plate and cheerfully became her full time caregiver. He had to assist her in the shower, dress her, learn to style her hair, do the grocery shopping, cooking, driving, and pay the bills. Prior to her stroke, my mother was an avid artist and gardener. She grieved that she could no longer do these hobbies. The Lord took her home to heaven to be with Him five years after her stroke. I thanked God that she was no longer suffering.

“…Death is swallowed up in victory….But thanks be to God, who giveth us the victory through our Lord Jesus Christ.” I Corinthians 15:54, 57

My parents were my inspiration for my research.

Another patient I visited at home was an elderly lady who was paralyzed from the waist down from a blood clot that went to her spine. Her husband faithfully learned how to provide all her care and purchased a van equipped with a wheel chair lift. He struggled at times with sadness over his wife’s loss of many abilities, but he did all the household tasks and driving. Other patients with similar disabilities ended up being admitted to a nursing home because their caregiver simply couldn’t cope with all the extra responsibilities.

During my research, I interviewed nine caregivers of family members who were unable to walk and then summarized their problems and coping strategies. I repeated similar research that was done with caregivers of home hospice patients to see if they had the same problems and used the same or different coping strategies. Comparison of the two groups showed they only had one problem in common (stress) and three coping strategies (social support, cognitive reformulation, and respite). I developed an educational handout for nurses to give new caregivers of family members who were unable to walk.

I submitted my research article to The Nurse Practitioner journal and was thrilled when they accepted part of it for publication.  They condensed my year of research and 48 page thesis into THREE paragraphs. Such is the world of publishing… They included it under Practice Pointers and named it Lending a hand to caregivers.

If you need to counsel a caregiver of a family member who has recently lost the ability to walk, use these suggestions to ease the load. First, tell him not to try to give care alone, but to ask for and accept help from family, friends, and health care professionals. To relieve stress, suggest that he try exercise, massage, eating out, music, prayer, reading, and napping.

Make sure he asks a physical therapist for assistance in choosing a wheelchair, if his family member can use one. Suggest using cordless and cellular phones, a lifeline necklace, and a pager to communicate with his loved ones when the caregiver is out of the house.

Finally, when traveling, recommend the caregiver pack a travel kit with a list of medications, provider phone numbers, straws, wipes, and other supplies.”

Reflection

I can’t recall the last time I saw a lay person use a pager, and cordless land lines are disappearing rapidly. Cell phones are commonplace now, but they were rare in 1998.

After I entered the full time work world as a nurse practitioner, life seemed to become too busy to continue to do research. However, I have participated in the Nurse’s Health Study 2 since 1989 conducted by the Harvard School of Public Health. Their findings collected from surveys every two years of thousands of nurses have contributed significantly to women’s health. http://nurseshealthstudy.org If you are a nurse and you were born after 1964 and live in the USA, they are looking for participants to join Nurse’s Health Study 3. I hope you will do so and continue this wonderful research that was begun in 1979!

Which Nursing School????

“Trust in the Lord with all your heart, and lean not unto your own understanding. In all your ways acknowledge Him, and He shall direct your paths.”  Proverbs 3:5-6

March, 1973, Midwest, USA – High School Senior

Ever since last year when the Lord gave me peace about becoming a nurse, I have struggled in deciding which nursing school to attend. I visited two small Christian colleges here in the Midwest that I really liked, but neither has a nursing program. So I would have to earn a bachelor’s degree in some other major and then continue on to get a two year associate degree in nursing. Six years total sounds way too long to be in school! I wanted to attend a  Christian college in the south where I could major in missionary nursing, but my parents do not want me to go there, so they refused to sign the admission form. It was heartbreaking, but I know God closed the door for a reason.

Where Should I Go?

Where Should I Go?

I left the Protestant Church where I was raised because the Bible was not taught verse-by-verse and I wasn’t growing in knowing the Lord better. My sister also left, which broke our parents’ hearts, especially Mom. We became members of a Bible church led by the Pastor who Marsha met at the University her freshman year. A group of students from another University drive an hour every Sunday to attend. The pastor teaches a weekly Bible class on this University campus which is really growing!

They have a good nursing school at this University, so I decided to apply there as well as a three year hospital diploma nursing school in the same city. I have my interview tomorrow at the diploma school and will tour the University while I am in the city. The diploma students work many more clinical hours in the hospital than the University students, but it is more difficult for them to obtain nursing leadership positions after graduation.

The next day I nervously entered the office of the Director of Admissions at the diploma hospital school of nursing. Mrs. L. greeted me warmly and gave me a tour of the nursing skills lab, classrooms, and dormitory. Afterward we sat down in her office and she asked, “So tell me why you would like to become a nurse?”  I replied, “I like science and I would like to help sick people get better. I enjoy learning new things, and I think it would be fascinating to learn all about the human body and how it works.”  She asked if I had applied to other schools, and I told her I was also considering the State University in the city here.

She advised, “After reviewing your high grade point average and ACT/SAT scores, I think you should go to the University Bachelor of Science (BSN) program rather than our diploma program. Our program will probably be closing in the next few years, and I think you have real potential to go into management or research in nursing. You could then earn your master’s degree or even a doctorate degree in nursing!” I thought to myself, I am amazed that she thinks I have real potential to go so far in my nursing career! I would be satisfied to be a regular staff nurse, work a few years, marry a godly Christian man, quit work, have children, and be a stay-at-home Mom like my mother did. I thanked her for her time and drove across the city to tour the State University.

I joined the walking tour led by a student. This campus has 55,000 students, which is as many people as my entire city where I grew up! It has over ten libraries, 30 dormitories, and countless classroom buildings. The 1000 bed University Hospital is one block from the School of Nursing, so that would be convenient for clinical days. Despite all the buildings, it has green space and many beautiful trees, so it doesn’t appear to be a concrete jungle. After living in the country my entire life, I hope I can adjust to living in a huge city.

State University

State University

When I returned home, I asked the Lord to make it clear to me which school I should attend, and He gave me perfect peace that He wanted me to attend the University. I  was accepted, and am so excited to start in the fall! It will be so wonderful to have fellowship with the other Christian students in the Bible class, and give the gospel to American students as well as the the international students who attend from all over the world. In addition to the prerequisites for nursing, I’m looking forward to taking electives in a wide variety of areas since they offer so many majors.  The class catalog is fascinating to read.  I also hope to become very fit from walking all over the huge campus to my classes!

Reflection

The director of the diploma nursing program gave me excellent advice in steering me toward the BSN program at the University. As she predicted, the diploma school closed a few years later.When I was 39 years old, I returned to graduate school to become a nurse practitioner. I was thankful to receive my Master’s of Science in Nursing after four grueling years of working full time and going to school part time.

In God’s great sovereignty, He never gave me a husband or children. Little did I realize when I was in high school that I would have a 40 year full time nursing career, but God knew all along!

One of my favorite hymns is:
Tis’ so sweet to trust in Jesus, Just to take Him at His word,
Just to rest upon His promise, Just to know, “Thus saith the Lord.”
Jesus, Jesus, how I trust Him! How I’ve proved Him o’er and o’er!
Jesus, Jesus, precious Jesus! O for grace to trust Him more.
-by Louisa M.R. Stead

The Final School Year

September, 1997

I completed my one on one research course this summer with the Director of the Nurse Practitioner program, Dr. K. I learned about the different types of research broken into two broad categories of quantitative and qualitative research. Our small school does not have the staff to support doing quantitative research with labs and statistics, so I have chosen to do qualitative grounded theory research. The topic I chose is “Coping Strategies of Caregivers of Non-Ambulatory Patients”. I know it’s a mouthful!

I chose this topic largely because of my observation of how wonderfully my Dad took care of my Mom after her massive stroke. She learned to walk again slowly with a quad cane, but her left arm remained paralyzed, so he had to help her with her bath, dressing, and style her hair. I thought it was so sweet of him when he took Mom to the beautician and asked her to teach him how to use a curling iron! I don’t know of too many men who would do that. He also did all the cooking, cleaning, driving, and grocery shopping. My Mom became his full time job which he did the last five years of her life. Thankfully, he was retired and in good health. He also traveled with her by plane and in their trailer home across the country on vacation.

During my years as a visiting nurse, I took care of a dear elderly couple. Ruth had a blood clot that went to her spine and left her paralyzed from the waist down at the age of 70. Her husband, Ray, learned to do everything for her much as my dad did, and bought a van equipped with a wheelchair lift to make it easier to transport her.

Most caregivers at home are women rather than men, so I think Ray and my Dad were the exceptions. Most people would have placed people like Ruth and my Mom in a nursing home because they simply could not provide 24/7 care for them. So I asked myself, how did people cope at home with providing care for a family member who cannot walk? I noticed that when a person can’t walk, their care could become totally overwhelming.

I completed my review of literature and found an oncology nursing study with a similar theme, so I will repeat it to see if I get the same results. At the Master’s level, we are not required to do original research, but only repeat what others have done to see if we get the same results. My proposal was approved by  my two thesis advisors. My goal this semester is to find caregivers to interview and tape record them to gather all my data. Next semester, I will analyze the data and write my thesis. It was so nice to concentrate on nothing but research this summer and not have to work full time! I thank God for my Dad’s financial support to make this possible.

January, 1998

Last semester was very busy, but I really enjoyed it. My clinical assignments were so interesting as I spent two full days a week working in an Internal Medicine office with two physicians. Dr. R. established his private practice about 20 years ago. He grew up in Costa Rica, so he is fluent in Spanish. He moved to the USA when he was 16 years old, but still returns to Costa Rica annually to visit family there. He is a very kind gentleman and an excellent teacher. He just hired an associate, Dr. G., who recently completed his residency. Dr. G. likes to tell me all kinds of interesting stories about patients he saw during his residency. I see the patient first and take the history and do the physical exam. Then I present the patient privately to Dr. R. or Dr. G. and tell them the plan of care that I think would be best. We discuss it and they agree or disagree with me and tell me their reason so I learn how to treat the next patient with a similar problem. It is working out very well!

One day, a lady who was originally from Jamaica, came to see us in near hysteria. She had coughed up a foot long worm that she put in a bottle of water to show us. I immediately recognized it as a round worm which I had learned about when I was in Dominican Republic. She last visited Jamaica two years ago, so it had been growing inside her all that time. Neither Dr. R. or Dr. G. had ever treated worms before, so I told them the medicine to prescribe and calmed the lady after telling her we could easily treat it. She thanked me and said she felt relieved to learn about it. It was fun to teach the teachers that day!

On my third clinical day, I worked several weeks in a clinic seeing adolescents with a Pediatric NP. Rich was also an excellent teacher. The other half of the semester, I shadowed a Neonatal Intensive Care NP. I was too scared to touch the premature babies who looked so tiny and fragile in the incubators on ventilators. I watched her do a lumbar puncture on one of them where she stuck a needle gently in his spine to withdraw cerebral spinal fluid. I also watched her work in a general Pediatrician’s office. I’m just not too comfortable taking care of babies because they can’t tell me what’s wrong!

I found enough caregivers to interview for my research. I tape recorded each session, then took the tapes home and played them back. Whenever the person stated a coping strategy, I stopped the tape and wrote it on an index card. After listening to all the interviews, I took all my cards and separated them into different piles of coping strategies that were repeated. I’m really enjoying doing this type of research!

Graduation, May, 1998!!!

I completed typing my thesis and both my advisors approved the final copy. It was 120 pages long! I am so glad I didn’t have to hire someone to type it, and am thankful for my high school typing teacher. We each made a poster about our research results and presented it a week ago. All my preceptors came to look at it, so I was grateful for their support. I submitted a summary of my research to the Nurse Practitioner Journal, so I will see if it is accepted.

I am amazed that I have had ten job interviews. The job I chose is to work as a Family Nurse Practitioner at a psychiatric hospital. I have never worked in psychiatry before. I will have all weekends and holidays off, and  don’t have to take call at night since a physician stays on grounds each night. The salary is excellent, so maybe I will be able to move to a one story home in the future.

 

1998 Pam MSN

I was so excited to finally receive my Master’s of Science in Nursing and become a Family Nurse Practitioner!

I thank God that my entire family came to my graduation to help me celebrate. I dedicated my thesis to my Dad and read it to them with my theme verses for graduate school:

I can do all things through Christ who strengthens me….But my God shall supply all your needs according to His riches in glory in Christ Jesus! Philippians 4:13, 19.

The school placed a copy of each graduate student’s thesis in the school library for others to read.

Reflection

How I thank God for carrying me through four long years of graduate school. I know I only had the strength to complete it because of Him. I enjoyed working as a Nurse Practitioner in a variety of roles over the next 16 years.

The Nurse Practitioner Journal published a few paragraphs about my research. As I recall, the caregivers that did best were those who used wheels to help transport the patient, took respite from care, and recruited/accepted help from others. My thesis is currently in storage, so the next time I look at it, I will see if my memory is accurate:)