Its a Rural World

It’s Monday morning and I am enjoying a cup of tea by my computer as the sunlight hits the window. School has been out over the holiday break, and I enjoyed Christmas at home with my family.  This week we start our “final semester”, which just being able to say is a great feeling.  When I originally took on this endeavor of becoming a Family Nurse Practitioner I was told that going to a rural clinic was mandatory. This did not surprise me, New Mexico is a beautiful state with many hidden treasures but health care is not one of them. I volunteered to go to Bloomfield; my preceptor is a PhD and is highly recommended by her peers so I decided that being in slight control of my fate was better than no control at all.

Bloomfield is a small town outside of Farmington a bigger city in New Mexico, which by some standards is still small. Both Bloomfield and Farmington have primary industries of mining of petroleum, natural gas and coal. Farmington is also known for its baseball tournaments. I don’t know much more about either city accept that when friends ask “where are you going?”. The replies I often get when I tell them include:  “that’s way out there” and “really?”. However, you have to remember that in what I call the “Albuquerque Culture” driving to Rio Rancho is considered far in some of my friend circles.

I spoke briefly with my preceptor on the phone. She gave me a list of hotels and recommended I stay in Farmington and let me know which hotels may or may not have bedbugs. It seems that as far as lodging is concerned my best bets are places that are $90 a night, which obviously won’t happen on my budget. However, one thing I did deduct while talking to my new preceptor is that she is a very busy woman. I hope that transfers to my clinic days and the experiences I will gain while being there.

I decided the best way to approach my final clinic rotation (consisting of 305 hours or 38, 8 hr days) was to jump in the car and do a “recon” of the area. (Don’t judge me but after 13 years Army the least I can do is incorporate the skills they thought me into my civilian life). I invited my man friend (I call him affectionately Mountain Man) and he surprisingly came along for the drive. I grabbed a bag, pen, paper and my trusty ipad and two bottles of water and jumped in the bat-mobile (that’s what I call my little car).  After getting a full tank of gas and some Starbucks I was caffeinated and ready to drive. And drive, and drive and drive.

One thing many people perceive when thinking about long drives through New Mexico is that is desolate. Sad to think anyone would ever use that word when describing my home state, but many think big trees constitute beauty. And I guess it is all in the eye of the beholder. My drive along NM 550 is majestic. It runs through Bernalillo and passes through San Ysidro, and Cuba before Bloomfield. The view is painted with shrub and various sandstone formations in soft hughs that engage your brain.  The drive was about 3 hrs (I was not speeding and made some stops due to my high caffeine intake lol).

When I arrived at the clinic I have to say I was taken aback. The clinic is nice, surrounded by a fence and a very small reservation. The only thing that concerned me was the sign on the gate “The health center is temporarily closed there are no providers”, not sure what to think about that. But to be honest I am nervous.

After driving to the clinic we bypassed Bloomfield and had lunch in Farmington.  We scoped out the various hotels and amenities available.  My concerns are to find a place to stay for a month, not get bed bugs and hopefully have a hot shower and internet? However, I have lived in worse areas and at least I get to work without carrying body armor daily. I am not sure yet what to think about my next challenge but hopefully a month away from Albuquerque will bring some enlightenment and experiences that I can grow from. Soon I will be starting a new career, so this next step is just another leap forward in the process. Funny how our past colors the lenses in which we see the future.

I will write more soon.
~m

NYE Thoughts from my iPad

I forgot that on NYE you were suppose to contemplate the past year and make future plans. I guess I should start with what my goals where last year: Do well in school (done I think with the help of Autum and some awesome preceptors that are helping my future as a Nurse Practitioner), be there for my family; for the family I call my family done as well. I can honestly say that my TRUE Family has tough me many life lessons and given me the opportunity to be a SISTER and Daughter with the true meanings of those words understood and expected. I said I wanted to be involved and join the board for Cuidando Los Ninos, I did that and worked to be on the executive committee, which means a little more responsibility but lots of rewards through mentor-ship. Have an Art Gayla at the film festival to raise money for Cuidando (done with amazing rewards of seeing involved youth increase awareness about the faces of homelessness and receive the wonderful support of my friends. I also decided I would "put myself out there" and start dating again. I completed that and was in the Albuquerque Magazine "Hot Singles" issue. With that hurdle jumped I also started dating an amazing man. What was not on my list, and came as an amazing surprise. These include the new friendships I have made this year. Also my trip to NYC with Beau which gave me the opportunity to meet Stella, Olga and Genevieve from American Women Veterans, you ladies are inspiring. Also important to me are my DIY projects at my home. Thank you dear roof for leaking, and teaching me more about my responsibilities as a homeowner. One thing I also learned is that friendship is a word often thrown around, worked for or even miss-used. We can often say that someone is our friend, but to be a friend you have to be "present" and not in the physical sense but definitely in the emotional sense.  We have the advent of FB that truely makes it appear as though you have hundreds of friends. But I often wonder if I was at the same coffee shop would they say hello? Probably I would, becuase I love saying hello. But like many social outlets (FB), it at times become a tedious chore rather than a true expression of friendships. So at the end of this thought, I would like to say, I have amazing friends whom inspire me in different but amazing ways and many acquainceces who will either stay aquantences or evolve to friends. What are my goals for next year: 1. Graduate with my Master's in Nursieng as a Family Nurse Practitioner. 2. Work more for Cuidando Los Ninos in developing out program, gaining my grants and raise more funds. 3. I can't wait to help more Veterans 4. Work to start a AWV Chapter in NM 5. Start working as a FNP in a great learning environment. 6. Build Assets, and probably the most important one: 7. Continue to love and cherish my Family and Friends. I would like to thank them for their support over my lifetime, appreciate the lessons they teach me and for each of my friends be "present".

Being Present

I have always known that it is important for nurses to be present, or should I say in the present? Life it seems can pass you by and decisions can be made that may not seem to have a huge impact, however like the "butter fly effect" not being present can have unknown consequences and impacts to the health of your society.

As many know, I believe that we are all more than "just a nurse". Our hard work impacts health care and the various jobs that we have chosen to peruse and develop. These accomplishments are just the tip of the ice berg in terms of our success. I love being a nurse and I believe it is that perspective that gives me insight on even the most random of subjects. Take for instance the "employee handbook".

In addition to being a veteran, an ED nurse, a full time graduate student, sister, daughter, girlfriend and friend, I am a board member for a wonderful non-profit that seeks to help children and their families that are experiencing homelessness. Check out: Cuidando Los Niños if you want more information: http://clnkids.org/

I usually work on advocacy and out-reach, and serve as a "connector" (read http://www.gladwell.com/tippingpoint/tp_excerpt2.html ). I give the elevator speech and work to get donations, sponsors and anything else I can for Cuidando, but in addition to being aboard me member I serve on the Executive Committee. Our task from the interim Executive Director was to review the employee handbook.  So in-between triage classes, an advanced EKG workshop and case studies I sat pen in hand and poured over the handbook. 

I have yet to write an employee handbook, however I am skilled in "the joint commission" , "OSHA", "preventive medicine” as well as "infection control" "Evacuation plans and Fire Drills" (thank you OIF and OEF).

As I started to pour over each section I found myself actually having input on several areas: credentialing, performance evaluations, reimbursements, holiday schedules, PTO, leaves of absence, property books, dress codes, attendance and illness. Not too bad, if I do say so myself.

I also took the liberty to change some verbiage from physician to provider. Yes it may seem small in terms of grammatical ways, however it terms of the education I am about to complete (at least at my Master’s Level)and  it is important to me that an employee be able to see a mid-level provider (NP or PA) in addition to a physician.  

I clarified the emergency evacuation program, and to tip the entire butterfly effect off I asked for specific verbiage regarding employee health and vaccinations. Warning to all you who do not believe in vaccines I do (.) If we can prevent out breaks of pertussis and the flu (to name only a few) and save lives as well as prevent costly hospital stays, especially for children and infants (who when sick are not only high risk but incur potentially worse outcomes and health discrepancies) then not only will I take the Flu shot that I don’t like, but I will ensure my immunizations are up to date as well. (Wow that was a long run-on sentence…I will step off the box now…)

The thing is, in retrospect none of these items are huge by any means, however being present at the meeting, having that knowledge and insight is what is important. So to all my friends who are amazing nurses and think they are “just” anything, remember you  ARE Nurses and that is why they should always be present.

Windows

Windows can be the openings to your soul, or even just the space in which to let light reflect upon your heart. As of late I have traveled to various missions and Native American sites around New Mexico and Colorado and my mind has started to ponder. I spent my time enjoying some inner peace and reflecting upon the past. It made me think that all around us in life there are windows of opportunities.

I can remember as a little girl looking out the window of out small trailer and thinking of all the things I wanted to accomplish. The window served to inspire my dreams. I never had small dreams, or unattainable goals. In my dreams I wanted to help others, serve as a mentor and leader and ultimately one day move to a place where I could enjoy the calm breeze from the mountains. My window served as my inspiration, my dream builder, and my launching point for life.

A few weeks ago when I traveled to the Abo missions at the Salinas Pueblo Missions National Monument, I glimpsed at windows that over-looked tumbling hills. I sat and wondered if others used this window to look out and day dream. If I were at a mission as a Native American in 1629, what would I dream of? The sun good, the mother of life, of wild flowers and tumbling rain showers, possibly yes, but probably more.

The invention of windows can be linked to as early as the 13^th century and in various languages the word “window” has been described as the “wind eye”. I think that they were invented to open your inner soul, to allow for daydreams and to shed light on our hearts.

-m

The fear of suffering is worst than suffering itself (The Alchemist) Funny, but we fear many things in life. But, when we take action that fear can inspire us to do more. ♥

Sometimes you just need that solitary day to yourself for some inner reflection. Lately my plate has been so full that I have feared not accomplishing anything. But fear can be a funny thing. It can take hold of us and stop us from moving forward, or it can cause us to push farther and make plans for our next opportunities in life.

Last week was “The Faces of Homelessness” Donor Breakfast benefiting Cuidando Los Niños. I was anxious to make my guests feel comfortable and welcome, even fielding last minute invites form guests. I planned their seating arrangements and spent a few sleepless nights anxiously awaiting the breakfast event. Waking up early the morning of the event, I was ready and out the door eager to make sure everything was perfect. Fear of course stood next to me, waiting for me to get anxious and slip in with waited opportunity. I arrived, got the best gift ever (my name tag!) and found out that my planning was slightly lost as my seating arrangements were not perfect. I had a moment of impatient frustration: why not how I planned it? It took me only a moment to see that others had worked so hard, my need to perfection was seriously silly. I kicked fear in the shin and as it walked away from me I figured out that no matter what happened that morning, everything would work out.

The breakfast was wonderful, we had a articulate speaker Diana Sauceda and she kicked off our morning with style and grace. We heard life stories from two of our mothers, and an amazing video presentation about our children and families who work towards changing their homeless experience. My mom came and was able to see the organization I donate so much of my time for.  My friends all came to support Cuidando and that made me feel so proud of them. I didn’t see fear at the breakfast table; he must have decided to walk away.

I still have too many things on my plate. I do fear not getting everything accomplished: school work and case studies, clinical hours, and a very important Youth Creating Change Film Festival June 25^th, and of course some family events. I heard fear ringing my doorstep just now, ready to come hang out again, but I think I will use this time wisely and catch up on some projects to that I can hang out with my new friend: Wisdom 

Remember we are all more than JUST a nurse.

My birthday gift

Getting older actually does get easier. I honestly can say this year feels fabulous. I have celebrated all week, but last night I had a low key evening with a small group of friends. Everyone gave me amazing gifts. Mia drew me a picture (she's a talented pre-kindergarten gal) and then there is the wine, gift cards, and my favorite just spending time with amazing women who inspire me. Oh those beautiful qualities my friend (of over 23 years now OMG!) made a frame and a type of letter/reflection if you will. I can't stop thinking about it. I re-typed it so everyone can read it. Amazing Kellie. I love being a nurse, and I love that so many of us, help so many people everyday!

"My Angels on earth…

When my great grandmother was ailing and suffering from dementia and Alzheimer’s, it was a nurse who would come to the house and care for her, making her last few months on earth comfortable.

When my little sister was born with Down syndrome, it was a nurse who comforted my family after they rushed our new baby to the NICU.

When my brother was in the hospital after a tragic event, it was a nurse who reassured my family that he was going to recover.

When I was in the hospital having my own babies, it was a nurse who held my hand, reminded me to breath and helped me deal with the aftermath of a C-section. It was a nurse who wiped my post-partum tears and told me it was normal to feel anxiety. I felt so comforted and never alone.

When I was worried about my son’s pneumonia, it was a nurse who gave me piece of mind and told me everything was going to be alright.

When I visit many families through my charity work, its nurses who give the kids and families the hope, strength, and motivation to overcome obstacles.

I think God put angles on earth to take care of all of us throughout different times in our lives. These angels are called nurses, Throughout my life I have been touched by nurses and I am so blessed and proud to have a friend who is one.

Love, your friend,

Kellie"

Kellie is an amazing woman who inspires me daily. Truly a great moment in my life. Thank you!

Emerging from the white coat

This semester is coming to an end. Today is my final day at women’s health clinic. I have to say I entered in to this semester with some trepidation. Evaluating my own health I would give myself a B+ on the good ‘ole score card, but does that give me the right to advise other women on her health?  Headed into a patients exam rooms I hesitantly started each day the same: notebook (check), white coat (check), pen (check), ROS card and screening sheet (double check) and off I went.

My preceptor, being the beautiful soul she is, set aside one hour per patient. This in itself is wonderful fore thought on her part. Even thinking about it now I have to laugh, the first 25 minutes I would ask every single past medical history, family medical history and review of systems question under the sun. Then came an intently focused physical exam, final “assessment” and detailed plan of care. 

For each patient I was concerned about the same aspects: LMP, last pap, partners, safe relationships, type of birth control, satisfaction with birth control, vitamins/ exercise, diet, last pap, etc. I perfected answering my patient’s questions in a manor that made them feel normal. However, none of us are “normal” and who even had the audacity to event such a word should probably consult with their own “specialist”.

Somewhere in the middle of my rotation I lost my precious white coat. It served as my shield and protection against unknown answers to all my patients’ questions. To say they varied across many spectrums would be an understatement and at times I wondered how I had the tenacity and tact to answer them. However, I did believe they were due the respect and courage to ask any question they wanted.

As the white coat became part of my history, so did the need to wear it. When the lab coat went away, so did my imaginary barrier between my patients and I.  I took on a feeling of being more “humanistic”, in deed more myself. I want to be Michelle the FNP student that cares. I want them to feel comfortable calling me for test results or for advice. Their appointment should make them feel relived and informed. I can’t tell them everything about being healthy, nor are there such things as the magical “normal” in the realm of women’s health. However, at least now they know to check their Vitamin D, take a daily mutli-vitamin, exercise at least three days a week for thirty min, and that open conversations about their health are all important aspects of their care.

In the end this rotation has thought me many important lessons; some learned by chance, others on a daily basis. I couldn’t have asked for a better learning environment. I have two hopes: 1. that I can cultivate a caring environment for my patients in the future, 2. that my next preceptors and staff are just as amazing at my next clinical rotation.