Friday, August 27, 2010

Return to Nursing 1988

I left nursing to become a full-time mother, and by 1988 I had three children, a son age 9, and two daughters, ages 7 and 3. I loved motherhood; we spent long hours at the park and library, and made ceremony of bedtimes and snowy days. The children caught insects and had the usual lineup of pets; rats, toads, & an ill-tempered box turtle named Mort. I was a big fan of finding new things for the children to try, especially during the interminable summer breaks. This year was radically different, though; my then-husband had been laid off for several months and after a month or two of dithering I decided I'd better take the nurse refresher course in case I might need to work as a nurse until he found another job.

A nurse refresher course was readily available through my old college nursing department, and with very little ceremony I found myself sitting among 24 peers, listening to day-long lectures on body systems. I did surprisingly well on the tests. I had not wanted to go beyond nursing school in college; this experience made clear that I could do the work. After a month of study, we were required to do 2 weeks of clinical experience, which I also passed, and then I had to do the thing I least wanted to do in life; leave my children and go out to work. Because I was sure I would not stay at any job for long, I didn't apply at a hospital, but chose to work for two agencies. They sent me out to do whatever was available; staff relief, nursing homes, private duty, and home care.

The paycheck was about the only good part of the experience. Despite taking any work offered to me, I didn't make enough to pay all our bills, a fact my husband reminded of every time a bill came in. Rotating shifts was bad enough, but leaving the children in the hands of their father who might--or might not--maintain their daily routine was very difficult. I would call home and ask, what are the kids doing? "I don't know; they're outside." "Where outside, what are they doing?" I don't know," he'd say, "I'm working on the porch."

The children hated the whole idea of me working, and their natural energy demanded a response I couldn't give. It seemed to me that they were all lined up with their hands out; one wanting to play, or tell me a story, or show me a picture, or ask me when is payday. I remember coming home from work one night so tired and depressed all I wanted to do was have a shot of whiskey (make that several shots) and go to bed, to find we had drunk all but the last three drops. There was no money to buy more. I broke down and cried.

I worked 3-11 so I could spend part of the day with the children, but found it hard to get up in the mornings with any enthusiasm. I worked 11-7 when it was all I could get, and even did a few 12's, which I found utterly draining. Oddly, I didn't have the energy then that I have now. I also worked staff relief in a hospital gynecology/oncology unit, which was the first place I ever used an automatic BP cuff and O2 saturation monitor. The patients tended to be frequent fliers, and many of them had perfectly horrific fistulas, obstructions, and non-healing infections.

I recall one of my favorite patients returning with a possible bowel obstruction. I got the order to put in an NG tube. I laid out the equipment, explained things to the patient, handed her an emesis basin, and began to pass the tube--whereupon she hosed us both with about 500ml of stomach contents! I managed to get her a wash basin for the second round of emesis, and between heaves the patient apologized profusely. "No apology needed," I said, managing a smile, "Looks like you really needed that tube!"

I also worked the general surgical floor, which was a nightmare of heavy patient assignments. One end of the floor held oncology patients who were admitted for chemotherapy, which was administered with much cautious preparation by a harrowed RN named Stella. Many of her patients had nausea and were generally miserable, which kept Stella running. I did a number of shifts in orthopedics, which I liked. It took no more than a few overwhelming evenings on the GU floor to understand why they had a chronic staffing problem; the patient load was heavy and the patients' conditions subject to rapid change. Oddly, it was there that I met my first Cystic Fibrosis patient. On most units where I floated the staff was happy to see me arrive because I was filling in, but no unit seemed like a place where I would spend one shift longer than necessary.

Home care was a bit better. I found my natural empathy went a long way toward calming patients and most of them liked me. I remember heart patients and chronic kidney patients, and a bowel-obstructed oncology patient whom I connected to TPN every night. I once arrived to start an IV infusion for a troubled young woman and I needed to take vitals first. Damn; that day I had left my nurse bag containing the BP cuff etc., at home. I knew I was in trouble when I phoned then-husband and asked him to bring me my nurse bag, and got the truculent reply, "What do you need it for?" I was on the patient's phone--which was in her room--trying to maintain a calm, professional, demeanor while I wrangled with him and the minutes ticked by. Finally convinced of the importance of having my equipment, he consented to bring me the bag. As always, his attitude was that his work, whatever that was, was "important" but whatever I was doing was not.

In home care I met Luke, my first AIDS patient, who was being cared for at home. Luke had a Hickman catheter, and I recall spoiling more than one Tegaderm trying to stick it to Luke's chest and not itself. After awhile, we became something like friends, as much as could be expected considering neither of us was where he wanted to be. I often thought I did more for his family than for the patient, for I was able to provide them emotional support during that difficult time. I had cared for Luke for several months when I stuck my finger trying to close a sharps box in his room. I went to the bathroom, poured bleach over the finger, and forced it to bleed. I forced myself to breathe slowly, remembering a prayer someone once prayed in extreme circumstances; I prayed, "Jesus."

The needle had been on a saline flush syringe, which greatly reduced the chances of me coming in contact with an HIV virus. I couldn't go back to Luke's after that. Everything was a haze of HIV testing and months of gut-wrenching worry. Luke's family was devastated. That was when the irritable bowel syndrome began in earnest. "All I wanted was to earn enough to feed my children; I can't believe I could die for it!" I said to myself, although it never came to that.

Catastrophe always goes in threes. At the same time I thought I might be pregnant, and not long after, our Aspen wagon caught fire in the parking garage. Fortunately, a security guard saw it and called the fire department. The catalytic converter had burned itself out which only happens once, so don't worry, our auto mechanic said cheerfully. Two weeks later, in the same parking garage, the Aspen caught fire again and this time it burned out the entire auto interior; no one noticed.

There was a steady stream of chronically ill home care patients, including two children under the age of 3. Both had been born prematurely; one was expected to live, and I spent long nights caring for her. The family living room was overflowing with the baby's crib and equipment which included apnea monitor, continuous humidified O2 to her tracheostomy, and G-tube feedings. She was an irritable child who would not suck or feed or do much else except grasp occasionally and stare at tv; she never smiled and had an eerie noiseless cry when displeased, which was often. Some nights I looked at her and wondered whether the parents, who had gone so far to save her life, had not saved her for a life of abject misery.

My other patient had obvious developmental deficits incompatible with living to school age. Obvious, that is, to everyone except his mother, who had given up everything including her marriage to "save" her baby. I stood in this child's room where he was surrounded with soft colors and beautiful plush animals, listening to Mom explain his care. Her unresponsive son was an edematous respirator baby, about the size and consistency of an oversized doll. His world revolved not around his furry menagerie but the tubes forcing air into his unwilling lungs. Despite Mom's chipper narrative and affectionate attentions, his response never advanced beyond blank, open eyes. Through experiences like these, I came to understand that medical science has a long way to go and while it knows how to prevent death with devices that can perfuse the body's tissues almost indefinitely, that is not at all the same thing as living.

The year 1988 ground on as I redeveloped nursing senses & saw all sorts of patients. It was my personal opinion that I still lacked some element of knowledge or attitude that would have made me a good-enough nurse. Add to that the fact things were going no better at home, I was chronically exhausted, and I was just holding on until my then-husband got a new job so I could go back to motherhood. Over the few next years, I enjoyed some aspects of nursing, but had an abiding animus against nursing as a career; it took me a very long time to understand that nursing was not really the problem.

Wednesday, August 25, 2010

"Camp Nursie Here"

If each area a nurse works leaves its mark on the nurse identity, then I have amassed a dozen identities over the years; my favorite was Camp Nurse. You haven't lived until you've managed health care for 125 Girl Scouts and a score of adult staff for a full week. I agreed to my first week of camp nursing because I could bring my girls for free, and I was promised the only cabin in camp with air conditioning. (I’m a real wuss when it comes to camping out.) What a week it was! Homesick campers, asthmatics, international staffers with allergies, hyperventilating adolescents, dehydration, and Camper's Complaint (constipation-induced stomach ache) filled my camp nurse days with drama.

As I recall, this is an outline of camp nurse duty: the week begins with Sunday afternoon intake, an event that fills my Infirmary wall-to-wall with excited campers and nervous parents. I and a helper wade among them, taking temps, checking medical forms, and examining for head lice. I organize camper medications and write out MAR’s before supper and prepare for the week's routine. Medicine call begins with before breakfast ac meds (which the sensible nurse administers clad in bathrobe and slippers) and ends after evening meds at bed time...if the campers show up on time. Be aware that the camper with the heaviest hs meds always signs up for Night Owl Stargazing.

A camp nurse learns to say things and make them stick. "No, you can't have a nurse excuse to avoid diving practice." Not even if you pretend to have the following: the 45-minute flu, excruciating pain related to a microscopic cut, unnatural dread of horseflies/menstrual cramps/garter snakes, or you think you might have poison ivy. Homesick campers are gently but firmly denied a tearful phone call home to be picked up . The remedy for most homesickness is getting involved in activities; campers are encouraged to pair with a counselor "buddy" for moral support, write distraught notes to the camp mascot if they like, and check in with the nurse twice a day. The goal is to stick it out for three days, after which the director will phone home, but by Wednesday it seldom comes to that.

Campers at risk of dehydration and heat prostration must be taken seriously. "You may spend 60 minutes in the air-conditioned nurse's office; I want you to drink a glass of Gatorade and then plain water, and sit quietly. After that, you'll (almost always) return to your unit," (not lie here in a bunk and quiz the nurse.) “Counselor, while it's this hot, make sure you have extra fluids for campers to drink, and watch everybody drink a glassful every 2 hours.”

The change to a new diet is enough to throw some campers’ digestive tracts off. Remember root dietary causes when dealing with "homesick stomachache" which is constipation that manifests as generalized stomachache and homesick feeling. During assessment the nurse should ask, "Did you poop today? Yesterday? Not sure?” and after ruling out something more serious, “Eat this apple and drink a glass of water. Counselor, remind her to eat fruit at lunch and drink fluid every time it's offered. Feeling a bit better? No, lying in the nurse's office will not help, but exercise will. Come tell me how you're feeling at lunch. Bye!"

There are serious issues in camp, as I learned when an intractably homesick camper was picked up by her (at least verbally) abusive father. In the absence of abuse evidence we had to let her go with him and her totally cowed mother, but I regretted having to do it. I watched racial conflict play out before my eyes, between a white camp staffer and the family of a black camper who had acted out and was going to be sent home. As camp nurse it was my job to second the director in cases of campers or staff who needed to be disciplined; many discussions took place with me as observer. I was the second line of emotional support for staff as well. One quiet afternoon I was working at the Infirmary, Rimsky-Korsakov's "Scheherezade" on the stereo when the director came in, shut the door, and blurted, "Take my blood pressure; and turn down that music, it sounds way too much like my life right now."

Then there are the things you will learn nowhere else. Camp nurses learn to announce at the weekly dance, "Campers who insist on head-banging to 'Bohemian Rhapsody' will NOT receive Tylenol for headache after the dance!" then make a show of watching the campers dance for awhile. This should be continued at least until the first emergency sprain draws you away. In anticipation of minor emergencies, I found that a military surplus medic's pack makes a fine nurse kit, if stocked with band-aids, thermometer, adhesive tape, ace wrap, bandage scissors, and so on. I also figured out how to sweet-talk the grounds keeper into handing out replacement shower curtains, a thing he was inexplicably reluctant to do.

The camp nurse is relied on for advice on all things medical. Utter annoyance compelled me to tell staff at a week's end meeting not to hover over the girls so much. The campers in question, aged 11-13, had been doing glass art all week and a few of them had suffered minor cuts. Staff was concerned that the activity was too risky; should staff handle the glass for campers to prevent future lacerations? Having observed activity in the craft house, it seemed a controlled risk to me and I said so. "When DO we let the girls take risks, if not here under supervision? Let's empower them to get cut occasionally, if that's what it takes to help them explore new things."

Bear in mind that camp life is not quite real compared with everyday standards and those who survive it get a sense of proportion and humor right quick. I didn't have a sense of humor when I started out, but I began to develop one after my friend Maureen insisted I participate in Costume Night. She fixed me up with an over-sized, deflated, mylar fish balloon (in shocking pink) which she affixed to dangle from my bandaged forearm...and called me a shark bite victim.

Camp life can also be a grind—long stretches of wet weather or heat bring on health problems and snappish tempers. Even in good weather, mental health among campers and staff can go awry, and since our reason for being there is all about girls under the age of 18, staffers need a firm grip on themselves. Everyday camp survival for me involved carrying a travel mug, learning the hours at which dining hall coffee would be fresh, and cultivating what I considered a MASH-casual look. T-shirt, shorts, stethoscope, and a pink name badge. Regardless of the badge, someone jestingly called me "Nursie" and it stuck like super glue. In the end I resigned myself to being called Nursie and gamely answered the phone in my cabin, "Infirmary, Nursie here." Whatever you’re doing at camp, you just can’t be too careful; one morning I entered the bathroom to find gigantic cockroaches climbing the mirror. They were no less horrific for being plastic! Another morning I was arrested by the Fashion Police and cited for passing meds in my unfashionable bedroom slippers. So much for the dignity of the adult.

Somehow, I enjoyed the unpredictable quirkiness of camp nursing. Girls who started out as strangers and argued over caper duties all week became the closest of friends by the end of Friday night campfire. Over time I watched girls grow into young ladies; I was amused at their squabbles, and touched by the way they'd come to the Infirmary in a noisy, untidy flock, bringing an injured or ailing friend and watch over my shoulder with terrible concern as I went about the examination. I wasn't so much treating a camper as treating the lot of them and educating them as I went. We had many daft-but-serious talks at evening meds and treatment time. Life is never so glorious or so crisis-filled as it is for teen aged girls who feel they are among friends. For obvious reasons, camp nursing is not for the faint of heart, but in many ways it’s the opportunity of a lifetime.

Tuesday, August 24, 2010

Encore Nurse - September 2009

Trust me, you don't want to know how long ago I left nursing, or how little I have missed it since then...

I had grown to despise the shifts and rotation, the post night-shift dead feeling, and never knowing whether my relief would come in at the end of my shift.  I was not unhappy to bid acute care nursing farewell and enter home health care, and then toss the whole thing over when the children came along. 

Mostly the problem was about me; I had a lively family of three children and an overgrown toddler at home, a husband who was also frequently out of town on short notice, and no reliable babysitter.  On going back to nursing at the height of the AIDS epidemic in 1988, I found things changed but essentially the same; more IVACs, higher patient acuities, more responsibility, and little support for nursing.  I had plenty of that back at home!  My then-husband *loved* the idea of a two-income family and made a case for me staying in nursing.  However, he did not make himself useful in family management, so his grand vision for me, in practice, meant I’d have two full-time jobs: nursing and family management.  This was often reflected in his attitudes about work; his work was Serious Business and nothing took priority over it; my job was Just A Little Pin Money and was something to be disparaged when my shift fell at an inconvenient time.  Seeing all this, I was determined to work for awhile and then get out again, and I did. 

Some things are worth waiting for, I guess.  I was surprised to find I have interests and experience that are of value in the world of nursing after all this time.  Of course I'm going on the word of a BSN and an MSN, but I'm taking their opinions as authoritative. 

At the center where regional nurses go for continuing education, their interview centered around my past experience as an RN and my current computer savvy, which I had thought pretty marginal until I told them about my experience.  No, I'm not afraid of computers, I can do email, have a Facebook account, and in general can run the Microsoft Office suite.  How did I learn this?  Try running a small business without them!  I completed a course on Computers for Educators as part of my Education degree.  Did I mention having lived in a house where we had 1.2 computers per person?  Computer literacy, check.

I've always considered my lack of BSN a liability; I never especially wanted to study for one, but I did want to explore areas of practice beyond patient care in a hospital or nursing home, and back in the day nurses needed a BSN to do that.  I explored motherhood instead, then small business, then college; the next thing I knew I'd been out of nursing school for 30 years and in my absence they'd moved all the furniture.  Today I see things like holistic approaches to nursing, healing touch, magnet hospitals, a “culture of safety,” and spiritual dimensions of care, that remind me of why I went into nursing to begin with.  Maybe there's a place for me here after all, I mused.

The re-entry process for RN's is not simple.  We are required to study and pass exams on 24 modules of material involving all aspects of nursing.  Then we have a choice of independent study or classes on physical assessment, IV therapy, central venous lines, and delegating patient care.  In addition, we need a physical exam, criminal background check,  updated immunizations, and malpractice insurance, all before we can begin 160 hours of clinical practice.  A person couldn't do all that in a hurry if she wanted to; so I've entered the process.  I'm going to let it flow and go with it to its end.

Five years ago I was afraid I was too old to re-enter nursing, but now I'm returning to a workforce composed of a significant number of "gray-hairs", the experienced people like me with gray hair.  The average age among RN's in my state is 46.4 years, which means returning to work ought to be like a nursing school reunion.  I remember it all, right down to the glass IV bottles and metal bedpans; when discharge planning meant calling a cab to take the patient home with extra dressings, 10 days post-cholecystectomy; and our "gray-hairs" then could tell you how (and why!) to administer a turpentine stupe.  I hope this leg of the journey proves as interesting.

Tuesday, August 10, 2010

Graduate Nurse, 1973

Thinking back...

There was no shortage of graduate nurse positions when I graduated. I was hired without fanfare to work in the rehabilitation unit at a large teaching hospital at the munificent rate of $4.11/hr. Orientation, such as it was, lasted two weeks and centered around hospital issues such as how to charge a patient for use of equipment. The white nurse's cap with its black-velvet ribbon declared you an RN to one and all. Add to this a crisp white uniform and a four-color ballpoint pen, and you were ready for duty.

All nurses wore dress uniforms (no pantsuits allowed) with white hose and shoes; if we weren't clean and tidy, we heard about it immediately from the supervisor. One thing every nurse had in her work locker was hairpins; no nurse could go onto the floor to work without her cap pinned snugly in place. I was taught to pin a folded kleenex to the top of my head with crossed bobby pins to anchor the heavy cap, which was then also pinned behind.

Graduate nurses wore caps with a school-designated ribbon (not black), and were required to sign themselves Jane Doe, GN, and were supervised by an RN until they passed state boards. We spoke in a hush about what might happen to one who failed state boards, but as I recall all my cohort passed on the first try. The board exam prep we got must have been good; I ranked in the 99th percentile on the boards and still use their test-taking techniques today.

After passing the state board I dribbled a narrow bead of KY jelly along the back of my new black velvet band and affixed it to my nurse's cap with cap-tacks. I think my pay went to $4.23/hr. Eventually I transferred to a medical-surgical floor. The work was difficult, repetitive, and there was little nurse autonomy. We did team nursing, with the RN as med-passer and overseer for LPN's and Aides who gave care to a group of 8-12 patients. In practice it was a difficult juggling act to pass meds on time, keep the IV's running on time, check patients for critical changes, call doctors for orders, and take care of smaller details. Sometimes patients waited for hours for a meal tray or equipment.

IV fluids came in glass bottles with a straw inside to vent; venous access was made via metal needle with two wings called a butterfly. More often than not the patient's movements spoiled the site by puncturing the vein or producing a localized phlebitis. There were several kinds of IV tubing, with three different drop rates, which we calculated by hands. The Buretrol, a rigid plastic chamber which one could use to infuse a controlled dose of meds/fluids, slowly moved from pediatrics to the med-surg floors where it was considered high tech. IV's were regulated by roller clamp and counting drops timed with your wristwatch. Not a shift went by when all the IV's infused according to Dr's orders.

All medical equipment came from Central Supply. Most of it was reusable stainless steel, thus the reputation for cold bedpans. A bedpan thrown to the floor had served as an emergency signal for help in the era immediately preceding mine. Those high, bulky, bedpans were hard to get onto and off of, and the very devil if your patient was helpless or had back/hip pain. They could be emptied in the patient's toilet but had to be taken down the hall to be cleaned in the bedpan washer; thus the necessity for a small linen bedpan cover. A lower, scoop-shaped fracture pan was standard issue only on the orthopedic ward. Like everything else, you could requisition one via pneumatic tube to Central Supply and after a time it would be sent up on the dumb-waiter.

Most pliable medical equipment was made of rubber; gloves (sterile only), suction catheters, and tubing (except IV). Kits for procedures, such as lumbar puncture and chest tube insertion, were made of durable equipment wrapped, sterilized, and sent to us from CS. The only things we didn't return to be re-sterilized were needles, which were all disposable. No sharps boxes in patient rooms, though. No Hazardous Waste bags, either; anything especially nasty was double-bagged and went with the usual trash.

Kardexes were done by hand in pencil, and changed as orders or patient needs changed. A long-term patient could be identified by his grey-smudged Kardex. There was no such thing as "nursing orders" so literally anything you wanted to do for the patient, for whatever reason, required a Dr's order. Standing orders were few; we called the docs for just about everything.

Narcotics were counted...endlessly counted...dozens of sleeping pills, pain pills, and injectables had to be counted at the start and finish of every shift. The outgoing nurse couldn't go home until the count was right, or the discrepancy reported and written up. We carried the keys to the narcotics cabinet (another sign of a full RN) and occasionally were called back to work for having carried them home in a pocket.

Each and every medication had its own 2"x3" med card, listing patient name, start/stop date, drug name, dose, and time of administration. Usually they were legible. We were required to check med cards against the Kardex at the start of every shift for accuracy and order changes, which meant we began every shift behind time. Nurses with strong visual perceptual skills were deemed "good" nurses because they were quick to identify transcription errors and they worked fast. Fast was good.

Meds were supplied as patient bulk, floor stock, and emergency types. It was a rare shift when all the med cards were accurate and the patient's meds were in his box; calls to docs to clarify orders, and to pharmacy for missing meds were frequent. There was no med administration record, and much was left to hopeful memory. With all the "holes" in this system, med errors were all too frequent.

Patient charts were all paper, bulky, and the purview of doctors, except for the Nurses' Notes section. We were expected to note all the features of a patient's day in ink, without spelling error or time discrepancy. Day shift wrote in blue ink, 3-11 in green, nights in red. If an error was made, we lined through it just once and wrote above it "error" and a signature. About this time, lawyers popularized a way to impeach the testimony of a nurse under litigation, out of which was born the phrase, "If you didn't chart it, you didn't do it." We did our work under terrible constraints of time and staffing...and prayed. After a year on the job, I developed a case of irritable bowel syndrome that still flares up occasionally today. After six years in nursing, I was downright grateful to stay at home with my firstborn, and I never really wanted to go back to it after that.

Monday, August 9, 2010

Future Nurse 1965

Nursing seems to be one of the strongest threads of  my life.  As a child growing up in the 1960's, I can't recall a time when I didn't tell people, "I'm going to be a nurse when I grow up."

I had a great curiosity about all animals and medicine.  The library held a fascinating training manual for Practical Nurses with graphic pictures of equipment and describing the proper procedure for such things as the Harris Flush, which I tried on my dolls. My favorite reading at the time involved stories of children with cerebral palsy and leukemia (Mine for Keeps, Karen, The Blood of the Lamb)  It never occurred to me, as it did to my squeamish friend Liz, that I might one day be afflicted so I kept on reading.

I found that adults were a good source of ersatz medical equipment, but a poor source of information on things medical.  Mother counted among the ultra-squeamish and except for the Family Home Medical Adviser she kept, which had beautiful color plates of internal organs, she was not helpful.  I once asked my grandmother, as she explained that the neighbor had died by heart attack, "What happens when you have a heart attack?"  "You clutch your chest and fall down," she answered. I put the question in another way; no luck.  In other words, I thought, you don't know what happens inside the body when a person has a heart attack.  I thought this a great loss of what promised to be some thrilling information.

Like most children, I bandaged the dog and had a doll hospital.  I read every student nurse book series available; Sue Barton was my favorite.  One solitary afternoon I occupied myself by fashioning a pair of leg braces and crutches for my doll, Mary Van Heusen.  My fascination spread to the other neighborhood girls, who joined me in reading the PN manual and setting up an isolation room for another of my hapless dolls.  For a time I thought we would all go to nursing school but I was the only one who actually did.

I was a dedicated candy striper, a creature rarely seen now, in a large teaching hospital run by Grey Nuns. Wearing a carefully ironed pinafore and blouse and shod in white nurse shoes, I felt ready for anything.  I had a history with this hospital, having been born there and back again at age 5 to have my tonsils out.  Each unit had its own atmosphere, and some like the Burn Unit and the Newborn Nursery had a distinct smell. I stocked whistle-tip rubber suction catheters for the Burn Unit, made identification cards (the size of old-fashioned charge cards) in Admitting, pushed dozens of wheelchair patients, and sorted computer keypunch cards in the Lab.  I explored every bit of the hospital's eight floors, including the tunnel to the nursing school and the chapel.  I loved that the sisters created beauty (albeit with religious theme) in every corner of the hospital.  Those experiences allowed me to see a wider world, but I also saw how woefully inexperienced and prepared I was--for anything.

Nothing else seemed to hold my interest, or feel like a real career the way nursing did.  Still, it was my mother who found a nursing school for me.  Ever a "C" student, I assumed that my grades were too poor to get me into the nursing school of my choice.  After high school graduation, decades of clerking at the department store yawned before me; I slept late and made no moves.  Mother awoke me one morning with the announcement that she'd had a lovely conversation with the dean of nursing at a local community college.  You know what it means when your mother says that; the adults are in league against you.  Their ADN program was still taking students for its first class starting in the fall, she enthused.  At that point I wasn't sure I wanted to go to nursing school; I was scared and lacked confidence.  Without so much as a cup of coffee under me, Mother propelled me toward the phone; before I could protest I had an appointment to meet with the dean and take the ACT.  After I passed the ACT, there sat a brand-new nurses' cap on the sideboard in the dining room, and it looked like I was going to be joining the ranks of Sue Barton after all.