ALL ABOUT NURSES: the real story about nurse careers

By DeAnne Nevarez RN, PHN, CSRN, MSN

This is a must read book for anyone considering a career in the Health Care field. Written by a Registered Nurse with over 35 years experience, it contains real life stories that are both heart rending and informative. This book is an inspiration to future Nurses.

• Language: English
• Publisher: Lulu.com
• Release date: Sep 2, 2023
• ISBN: 9781312154995

Book preview

ALL ABOUT NURSES

The real story about nurse careers

DeAnne Nevarez RN, PHN, CSRN, MSN

Copyright 2020

All rights reserved

This book may NOT be re-printed without permission from the author.

All the information in this book is true from actual experience working as a Registered Nurse. The places and names of people have been changed to protect privacy.

DEDICATION

This book is dedicated with extreme gratitude to the following people:

All the wonderful Nurses, Assistants, Clerks, Pharmacists, and Doctors I have worked with over the years.  You are all such an integral, irreplaceable part of the Healthcare Team. You are not appreciated enough.

In memoriam, thanks to Juan G. (Jerry) Nevarez RN, PHN, MSN; Rolf Lyon MD; Barbara Stavrinadis RN; Rose Scialdone RN, BSN; Lynda Davis RN; Irma Zamorano RN, MSN; Beverly Berliner RN, MSN; Wendy Hamilton RN, FNP, CSRN.

Thank you to Kenneth John Grant MD for your amazing kindness and compassion. You gave me the strength to continue.

Thank you Nancy McDougal LVN for saving my sanity. Thank you Maria Lawrence, RN, FNP, CSRN for being the calm voice of reason. Thank you Lynn Massey, RN, FNP, CSRN for showing me how to be strong. Thank you Windy Hwang RN, CSRN, and Sharon Lip RN, CSRN for leading me through the darkness. Thank you Nikki Lange RN, CSRN for always brightening my day. Thank you Brandy Bennett RN, NP, CSRN for showing me the truth; Thank you Marcus Funchess EdD, for showing me how to lead. Thank you Abby Sarmiento RN, BSN for showing me true courage. Thank you Kerry Loretta Mayhew LVN, for showing me the realist side of thinking. Thank you Rosalva Rodriguez, and Liz Rodriguez Carreon for being steadfast friends in turbulent times. Thank you Adrian and Mona Rodriguez for saving my life and showing me how honest people live. Thank you Susan Clark, the best neighbor and friend.

I am sure I missed some of the wonderful people who helped me throughout the years. Please forgive me for this oversight. This in no way minimizes your contribution to my life and career.

This book is dedicated to my grandchildren, for you are the future.

Table of Contents

What is a Nurse?

Introduction

CHAPTER ONE: Why?

CHAPTER TWO: Community College

CHAPTER THREE: H-South Nurses and Patients

CHAPTER FOUR: Residents and Attendings

CHAPTER FIVE: The E-4 Experience

CHAPTER SIX: Specialty Units

CHAPTER SEVEN: After Hours Clinic

CHAPTER EIGHT: Home Health Nurse

CHAPTER NINE: AIDS Unit in San Francisco

CHAPTER TEN: Outpatient Dialysis Unit

CHAPTER ELEVEN: College Faculty

CHAPTER TWELVE: Supervising Nurse

CHAPTER THIRTEEN: CCS Casemanager

CHAPTER FOURTEEN: Parrish Nurse

CHAPTER FIFTEEN: School District Nurse

Epilogue

What is a Nurse?

There is some confusion about the title Nurse. Sometimes Nursing Assistants will introduce themselves as Nurses, but they are not Nurses. Public Schools hire clerks with First Aid training and label them as Nurses, but they are not Nurses. Those who provide personal assistance to people who cannot care for themselves might refer to themselves as Nurses, but they are not Nurses.

Nurses have licenses. Nurses have specialized education that might include a college degree. Nurses also have an elusive, unique, quality that can easily be recognized by other Nurses.

Here are some of the Healthcare Providers found in Hospitals:

CNA: A Certified Nursing Assistant has completed a course of study on how to check blood pressure, check a pulse, count respirations, empty a bedpan, provide CPR, and change sheets on a bed. They can transfer a person from chair to bed and back, provide a bed bath, and spoon-feed a patient. Being a CNA is NOT the same as being a Nurse, but it is a good experience.

LVN or LPN (Licensed Vocational Nurse or Licensed Practical Nurse) This person has had a minimum of nine or up to eighteen months of training that included all that the CNA has been taught. In addition, the LVN has been taught to give medications by mouth, on the skin, in the rectum, and by injection through the skin. An LVN can provide certain types of intravenous hydration, but not intravenous medication. The LVN can draw blood, place a naso-gastric tube (A tube going through the nose and into the stomach), place a urine catheter, suction a tracheostomy, provide mouth suctioning, provide wound care, perform CPR, remove an intravenous catheter (IV), check blood sugar, give an insulin shot, give vaccinations, and call a Registered Nurse (RN) when things go wrong. An LVN must be supervised by a Registered Nurse in certain circumstances.

RN (Registered Nurse) the RN has had a minimum of three years of College and an Associate of Science in Nursing degree. Many RNs also have a Baccalaureate of Science in Nursing (BSN) or a Master of Science in Nursing (MSN). An RN may do everything except diagnose a medical condition, perform surgery, and prescribe medications.  However, in some third-world countries, an RN might do all those activities.

The Registered Nurse license is a gateway to other specialties. Some of the specialties are Nurse Anesthetist, Nurse Midwife, Advance Practice Nurse, Nurse Practitioner, and Nurse Supervisor, to name a few. The RN might be seen wearing a lab coat that extends halfway to the knees.

PHN (Public Health Nurse) an RN may become a Public Health Nurse (PHN) after completing a BSN and a certain number of hours working in Public Health. An RN with a PHN usually works with specific populations and the focus is on disease prevention. The PHN is an attachment to the RN license. The RN license is still in effect. A PHN might wear a lab coat that extends to the knees.

CSRN (Credentialed School Registered Nurse) This is a sub-specialty. Entry level requires a BSN and a preliminary School Nurse Credential. There is a requirement to complete college units leading to an MSN (Master of Science Nursing) Degree, and then a ‘clear’ School Nurse Credential can be received from the State Board of Education. The Credentialed School Nurse is required to keep an active RN license and PHN certificate. In some states the Credentialed School Nurse must also be a Nurse Practitioner. Also, must have an Audiometry Certificate from the Department of Consumer Affairs. This specialty generally pays less than an RN position in a hospital, but it is less stressful. 

NP (Nurse Practitioner) Nurse Practitioners normally have a Master’s (also called post-graduate) degree and sometimes have a Doctorate degree. Some of the early Nurse Practitioners had Baccalaureate degrees. A Nurse Practitioner can do just about anything. Their scope of practice is constantly expanding. They also have a ‘Furnishing License" that allows them to prescribe medication. An NP might wear a lab coat that extends to the calves.

A Medical Student may wear a lab coat that extends past the waist, but not past the hips. The short coats have no authority in the hospital and are there to learn. They may review patient records and make recommendations in the progress notes, but they may not write orders. Sometimes a Medical Student WILL write orders in the patient record, but the Registered Nurse will not follow the orders unless they are co-signed by an Attending.

First Year Resident has completed college courses in medicine and possesses a Baccalaureate Degree. They normally wear a coat that does not reach the knees. These residents have book knowledge, but not practical knowledge, and they can write MD after their name. The RN knows it is best to question the orders they write.

Second Year Resident has one year of experience working in a hospital and prescribing treatments for hospitalized patients. These residents have learned to trust the Registered Nurses.

Third Year Resident has a good grasp of patient care and can be trusted to make sound decisions most of the time. The Lab coat may extend beyond the knees. These are part of the team working with the RN to ensure good patient outcomes. They are trusted by the RNs. In turn, they are smart enough to depend on and ask the RN for an opinion.

The Attending MD has authority over the Residents. Attendings are the actual Doctors in charge. They trust the RNs and will ask for their opinion. They support the RNs, are a vital part of the healthcare team, and wear lab coats that extend to their calves.

CHAPTER ONE: Why?

It was 1982 and the Prime Interest Rate was 19%. The United States was in a recession, and it was difficult to find a job. I was unemployed and wondering what I was going to do with my life, then my mom became severely ill.

The Doctors believed that the amoeba causing the abscess on mom’s pancreas had been ingested when she was vacationing in Acapulco and ate shrimp that tasted ‘a little off’. Mom recalled vomiting and feeling sick the night she ate the shrimp. 

A month after her trip she was admitted to the hospital. The Doctors tried numerous antibiotics to cure her, but she just became worse. The amoeba-filled abscess was removed via surgery and then mom started to recover. Mom spent three weeks in the ICU, and I came every day to massage her arms and legs. The daily massage was her only relief from recurring muscle spasms. An ICU Nurse noticed my frequent visits, and after a week, said that I should consider Nursing as a career.

I decided to investigate this ‘Nursing’ career. I called three different hospitals and asked them if they needed Nurses, they all did. Then I asked them a hypothetical question: If an LVN and an RN walked into your hospital and put in an application at the same time, which one would you hire first? all three hospitals said they would hire the RN first. Okay, I said, Which one earns more money? They all said the RN.

Next, I went to the local Community College to see how long it would take to be an RN. They said two years of Nursing School, but it must be preceded by two years of pre-requisites. This meant that I would have four years of college to earn an Associate of Science Degree in Nursing, and I STILL had to pass State Boards to work as a Nurse. A counselor gave me the list of classes that were required as prerequisites for the Nursing Program and said, There is a waiting list to get into RN school, you might not get in. 

‘Well,’ I thought, ‘I am not really doing anything now, not earning money, barely getting by. I guess I could just start taking classes and see where it leads.’

I visited the financial aid office to see if I could get tuition assistance. I was qualified for five different grants and a small student loan. This would give me vouchers to pay for tuition, books, and meals at the College. I did not have a car, but I still had my ten-speed bicycle from when I was in High School.

The College was nine miles away and it was mostly downhill from our home. My classes were Monday, Wednesday, and Friday. I could ride the bike to school, and easily arrive on time.

CHAPTER TWO: Community College

I was not yet finished with my pre-requisites and thinking about ways to speed up entry into a Nursing Program. I learned from one of the other students that there was another college that would let people into their program before the pre-requisites were completed. I went there to apply and was called back for an interview.

The interview consisted of completing a gauntlet of activities. There were skill stations at each table where the students would have to show their skill at math, dexterity, and critical thinking. Dexterity was measured by threading a sewing needle.

I was so nervous that when I went to the needle-threading table I picked up the needle with my right hand and tried to thread it with my left. I failed at the needle threading table. They would not let me make another attempt. Just like that, I was disqualified. I went back to my regular College the next day.

The science classes required for the Nursing Program were fascinating. In Microbiology we learned all about germs and diseases. I learned about Malaria largely because the teacher had Malaria and missed a week of school due to an attack. We cultured germs from all over the college campus. Then we took samples from our cheeks and grew fussy bacteria on a petri dish.

My all-time favorite was when we grew staphylococcus on a petri dish of agar, then put paper dots carefully spaced apart on the bacterial growth. Each of the paper dots had been soaked in a different antibiotic. After 48 hours in the incubator, we removed the petri dishes and wrote a report on which antibiotics had the largest circle of dead bacteria surrounding it. Almost all the students found themselves disinfecting their homes with bleach after a few weeks in Microbiology.

In Anatomy, most of our time during the first half of the Semester was spent memorizing bones. This did not make sense to me, at least not until we started learning the muscles. Knowing the bones lent a directional map to the rest of the body. It allowed everything to have a clearly identified landmark, a place, and an organization.

Later, we dissected cats that had been soaked in formaldehyde. The cats were full of stinky, grey, flesh that needed to be separated with thin metal probes. I thought it was funny that the cat’s grey flesh looked much like the liver served in the College cafeteria on Wednesdays. I would eat the liver anyway and I swear it smelled just like formaldehyde. This was the beginning of my learning to tolerate gross things. 

After a few weeks of dissecting the cats, we got to see the one and only cadaver on campus, a dehydrated looking shell of a body. At least the organs were in all the right places, and they fit easily since the body cavity had expanded and the organs had shrunk from exposure.

Physiology was my favorite class. This was the class that taught how everything in the body worked. All the organs were in harmony with one another and strived to maintain a balance called ‘homeostasis’. We took samples of our blood to do a complete blood count under a microscope. Then we did a white blood cell differential with blue dye. We spun down a sample of our blood in a centrifuge and did a hematocrit. I could have done these experiments for the rest of my life and been happy as a scientist or lab tech.

When I finished all the prerequisites, I applied to Nursing School. I was third runner-up and would only be admitted if three people who were accepted decided to not attend. If I did not get into the Nursing Program now, then I would have to wait until Fall 1984.

I did not have to wait long for an answer; the Secretary at the School of Nursing called the following week and told me that I was the last person to be accepted in the Spring Semester of the Nursing Program. I was at the absolute bottom of the eligibility list but being last did not matter to me at all; I was IN!

The training started in the Skills Lab, where we practiced procedures on mannikins. The mannikins were not like real people, they were stiff and unyielding. The goal was to learn the procedure without mistakes, and I found it easy to learn new skills, I just had to remain calm and relaxed, it all flowed so easily. After three weeks practicing in Skills Lab, it was finally time to start caring for patients in the hospital.

The Nursing Students were only permitted to do personal care tasks at this point. This included taking vital signs, bathing the patient, changing bed linens, helping the patient use a bedpan, oral care, transferring a patient to a chair or bed, turning a patient in the bed, and feeding a patient. Vital Signs are the blood pressure, pulse, respiration, and temperature of a patient. We had learned all the skills used by a Certified Nursing Aide.

The first day doing a clinical rotation in the hospital was scary. I had to give my first bed bath to a total stranger. It was an elderly man who was only too happy to have a young lady bathe him. I covered him with dry towels, then uncovered one section at a time to bathe. I frequently rinsed the washcloth in scalding hot water, and by the time the washcloth reached the patient it had cooled off to be pleasantly warm. When it came time to wash his face, I invited him to take the washcloth and do that independently. Finally, it was time to wash the private area, and I also invited him to wash that himself.

Then it was time for the linen change. This patient could not get out of bed. I made a bedroll by placing the sheets, in order, on a vacant bed, then rolling them up from the side. Then I helped the man turn on his side, rolled up the old sheets then placed the fresh bedroll on the bed. I helped the man roll over the