Wednesday, September 8, 2021

 

 

 Next Steps 

December 2020


 Graduation is looming, years of preperation and hard work done.  Now the real work begins.  But what does that look like after you graduate from a Nurse Practitioner program?

 

 

 

 

 Reflections on the Cusp of Graduation

By Rebecca Holdsworth, RN


We are out of our depth,” said the boy.

“Just breath,” said the horse, “and hold on.”

(Mackesy, 2019)

 

I began this reflection with the intention of discussing the science, the learning and other general aspects of school. I have spent the last semester growing my own clinical thinking, diagnostic schemas and assessments. I hoped I could use this knowledge as a shield against the fear of uncertainty around graduation. I feel the burden and privilege of taking on a person’s health care. My stethoscope feels heavy around my neck, a constant reminder that the choices I will make can have real consequences, risk and benefit. I am not ready. I am not sure I will ever feel ready. Learning has had the opposite effect for me. Rather than a comfort, each time I learn and grow I become increasingly aware of what I still do not know. How will I learn it all? How will I recall at will?  I feel out of my depth.

 


I can’t see a way through,” said the boy.

“Can you see your next step?”

“Yes.”

“Then take that,” said the Horse.

(Mackesy, 2019)

 

I have lived my life around “next steps.” When I was younger, worrying about tomorrow robbed me of much of Today’s joy. When I began nursing school, I was forced to live in the moment to survive. Everything was new, intense. It all felt like life and death. I had to slow down and approach the next three years one day, one assignment, one shift, one topic at a time. I could not sustain the amount of energy it took to keep up my usual type A personality. I wanted to know it all but today I focused on arterial blood gases. I wanted to do it all but today I would wake up and work one shift. Tomorrow would take care of itself. That began almost three years ago. Three years.

Today I am thinking about my next steps once again. What programs do I apply to? Do I concentrate on peds, emergency certification or family practice? Rural or urban? Choices are a blessing, but I feel as if every step I take is on a thin bar suspended over an abyss of unknown consequences. My decisions are not just mine. I have a family, a home with children growing and entering adulthood. I must consider how my choices will affect them. Then there are always the logistical ramifications of choices. Money, housing, travel, and mentorship all equal in their roles in “the choice.” I cannot see a clear path, but age and experience has gifted me faith and trust. I slip up. I forget, but at some moment I will remember. All I must do is take the next step. The step after that will figure itself out.

 


“Sometimes I think you believe in me more than I do,” said the boy.

“You’ll catch up,” said the horse.

(Mackesy, 2019)

Humans learn by watching. We spend lifetimes looking at others. We watch and listen, sifting through people, behaviors, and qualities. We unconsciously or consciously choose who we are and who we are not. Children learn to eat, talk and communicate by watching and doing. The basics of how we learn to be human as children translates into adulthood. I believe the ability to visualize a future for yourself depends on two things: seeing someone like you in that future and faith in yourself to work towards that goal. I know it is much more complicated than that but having a mentor, someone who can shepherd you along is so important. I must be my own cheerleader. However, when you, my mentor, says those words: “I know you will be a good provider. You are doing better than you believe,” you motivate me more than I have words to express. Mentors can help you move mountains, even if those mountains are only in your mind.




One of our greatest freedoms

 is how we react to things.”

(Mackesy, 2019) 

I promised myself I would be someone who held others up. I would work to see even the smallest spark of light in every human I met. This past year has challenged me in ways I could never imagine possible. How is it possible to find love amid so much willful ignorance, hate, bigotry and selfishness? As an EMT we gave the drunk driver the same level of care as the innocent bystander to bad decisions. I see this each clinical day. There are those patients who do not care about the current pandemic, will not wear a mask, and openly mock the efforts of healthcare workers. They call us a collective “chicken little.” Yet we care for them. We ask the same questions and offer solutions just the same. It is hard to not take those people and their blatant disregard for the current climate personally. It feels personal. I must remember what I tell my own children. I can only control the square I stand in. I may not control other people, only my reaction to other people.

Recently the American Medical Association made a call to action against what they termed “scope creep.” Social media outlets were clogged with physicians denouncing the safety of AANPs and PA’s without physician oversite. A year ago, these same physicians were comparing dog groomers to NP’s. These individuals were distraught that the person who cut their schnauzer’s hair had better training than the providers they were supposed to call colleagues. The vitriol was and is amazing to me. I must admit I am apprehensive to wade out into the waters of healthcare with these sharks lurking, hoping I fail. On the other hand, I cannot change the minds or anti-maskers or anti- AANPS. I can only stand in my square, show up every day ready to work. It is how we react to events that shapes the path.

 


“So much beauty we need to look after.”

 (Mackesy, 2019)

It snowed last night. It is cold today, windy. The birds surround my feeder in a busy cloud of color and movement. I have applications sitting to my right for multiple residency programs. I do not know if we will have our hours in time. I do not know when we will be able to take our boards. I have no idea where I will be this time next year.

What I do know is I am here now. I am listening to Christmas music and my children laughing downstairs. I am warm. I am the careful caretaker of this amazing privilege- I will care for others.

 I was 10 when I first thought of healthcare. I had thought my only option was to be a physician. thinking back, I am amazed at how often my elders told me I was not enough- smart enough, strong enough, tough enough.  In many ways them may have been right.  I had a lot of growing to do, toughening up through lived experience.  As life moved by me, children grew, and houses changed, and time passed.  I thought that dream was gone. But one day a voice in my ear whispered “now,” and I jumped almost blindly.

 I was accepted into school. I have remained competitive and successful. I am toeing up to the edge of the next “next step.” I do not know what that step is or if other healthcare professionals respect APNPs. I know I will not stop. I know my drive, curiosity and heart will carry me. I am enough without knowing it all at once. My dreams are so big I can barely hold them and there is so much I need to do. I do not know how or when, but I know I can, with some help and faith, take each step as it comes. That will be enough.

 

                                                                         (Mackesy, 2019)

 

References

Mackesy, C. (2019). The Boy, the Mole, the Fox and the Horse. New York: HarperOne.

Macksey, C. (2020). charliemacksey. Retrieved from Instagram: https://www.instagram.com/charliemackesy/?hl=en

 

 



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