BY LESLIE STERNLIEB
PHOTOS BY RICHARD PATTERSON

They rise before dawn, run on adrenaline, get by on next to no rest. They sacrifice family time to build crucial skills in a career whose complexity and variety they are still discovering.

Day after day, week by week, they juggle a demanding class schedule with clinical rotations that expose them to the full spectrum of human experience. They take part in the challenge of diagnosing serious disease, the drama of treating victims of accidents and injuries, the bedside care that helps people heal, and the behind-the-scenes activities that make the caring possible. Their patients may thank them profusely for their efforts or be too grievously ill to notice. And even when they’re utterly exhausted, they persevere out of a deep commitment to a profession that stimulates the mind and engages the heart like few others.

Here, we offer a glimpse at the lives of three nursing students at different stages of their careers, complemented by candid journal entries that paint a vivid picture of the challenges they face and rewards they reap as they pursue their chosen paths.

Tiffiny Wilson

Accelerated B.S.N. Student

Tiffiny Wilson checks a nutrition bag with assistance from UM lecturer Deborah J. Riquelme.
When Tiffiny Wilson, 27, was pursuing a bachelor of science degree in graphic communications management from Florida A & M University, her mother, a B.S.N., urged her to become a nurse. “I was headstrong,” Wilson says. “I wanted to do something different.”

Then her daughter was born prematurely. Weighing just 4 pounds 7 ounces, little Kennedy faced a gauntlet of nearly fatal complications. “The nurses were angels,” Wilson remembers. Inspired by their dedication, she signed up for her nursing prerequisites.

Now in her final semester in the school’s accelerated B.S.N. program, Wilson handles her multiple responsibilities as a student and mother with the logistical support of family members. She also works many weekends as a home health aide.

"My patient is an 83-year-old
orthopaedic post-op patient.
When she said that she looked
horrible, I offered to do her hair
and makeup. It made her feel
much better, and it made me feel
good too. The nursing profession
is all about remembering that
the patient is a person.
This semester, Wilson asked for, and received, the clinical rotation in the I.C.U. “It’s a great learning experience,” she says. “I really want to learn the dynamics of dealing with critical patients and their families.”

My first day in the I.C.U.
was very busy. One patient
was a quadriplegic and totally
vent-dependent but conscious.
I monitored the vent settings
every hour and tried to soothe
his anxiety. Another patient
was critical. My preceptor—
a charge nurse—ran off a
list of things for me to do;
I wrote as fast as I could. I
used my textbook skills and
the concept map for assessment.
Before today, these
things were assignments;
now they are tools.
As a mother of two young children, Wilson finds that her pediatric clinical rotation hits too close to home.

Some of these children were
very sick and by the end of
the day I left the hospital in
tears. One 18-month-old girl
has a transposition of the
great arteries, so blood backs
up into the lungs. It’s a miracle
she’s lived this long. I now
know that I can’t work in
pediatrics.
A recent rotation on a psychiatric unit brought further revelations.
One of my patients was
described by a colleague as
“nuts” because he was jumping
on the bed and pulling off his
clothes. “The clinical instructor
sat me down and said, ‘That’s
not the correct terminology.
Anything can happen to someone,
given the right amount of
pressure.’ She taught me that
we don’t form conclusions from
someone else’s biases but from
data we gather ourselves. When
I went in to see the patient, he
was calm. That’s what being a
nurse is all about: taking the
best care of the patient based on
the evidence available to you.
Even more than unpredictable patients, Wilson’s biggest challenge lies in squeezing everything in. After graduation, she’ll pursue a master’s degree, perhaps to be followed by a doctorate. She thinks about working in the I.C.U., where the pace never flags, and doing research to discover ways nursing can help prevent the health problems she sees every day. “When you do research,” she says, “that’s how things change.”


Raymond Rodriguez

M.S.N. Student
In his quest to earn 280 hours of clinical rotation for his M.S.N. in acute care by December, Raymond Rodriguez, B.S.N. ’07, puts in three clinical days a week at two different hospitals. He also takes three classes and serves as a teaching assistant for associate dean Rosina Cianelli. A husband and father, he keeps track of it all with neatly printed, computer-generated schedules.

Raymond Rodriguez updates patient charts with Myrna Vidal, patient flow coordinator at Jackson Hospital.
Not long ago, Rodriguez, now 33, was an undergraduate at FIU, playing the occasional game of racquetball and planning to become an accountant. One day, he realized the world of health care was where he wanted to be. So he bulked up on biology coursework, finished his bachelor’s in business administration, then earned his B.S.N. from UM’s accelerated program. Once he earns his M.S.N., he plans to sit for the acute care nurse practitioner boards, then pursue a doctorate.

“I went into this field because I love both the science and the patient contact,” says Rodriguez, whose father is a general practice physician in Hialeah. He has worked with his dad for years; when he graduates, he plans to join the practice, where he hopes to add an urgent care component.
A patient came in with chest
pain and difficulty breathing. I
thought: My first patient is
a cardiac patient! But it
turned out he was a smoker
and had chronic bronchitis. I
educated him about smoking
and told him to see a primary
care physician. I think I did a
nice job of assessing, diagnosing,
and treating him—and
that was a good feeling.
Between caring for his patients, Rodriguez helps out with his ninemonth- old son, Jonathan. After midafternoon babysitting sessions, Rodriguez may dash off to the ER for the night shift. Recently, he had a rotation at the Metro West Detention Center.
I assessed my first patient with
atrial fibrillation, a young guy in
his early 20s. I auscultated his
heart, and his heartbeat sounded
like an irregular drumbeat—a
really bad arrhythmia. I did an
EKG and administered oxygen
and called 911. We gave him the
works. I got a little nervous, but
followed the textbook and tried
to stay calm.
His experiences have taught Rodriguez that good assessment skills frequently elude the obvious.
I did my first suture on a lady
with a small but deep laceration.
Even though it felt great to do
the suturing, the best part was
talking with her about her other
problems. It turned out she had
been dizzy three times in a
month so I insisted that she see
a primary care physician. When
things like this happen, I feel like
it’s all worth it.
For Rodriguez, medicine and family often form a poignant connection.

At Jackson Triage this morning,
one of my patients was a former
patient of my father’s whom I
hadn’t seen in about eight years.
We ran a bunch of tests and
diagnosed his problem: cystitis.
Funny; even though we hadn’t
seen each other for so long, we still
remembered each other. The relationship
you build in health care is
like no other.

Susan Watson

Ph.D. Student
During a clinical post-conference, Susan Watson discusses the day's activities with students.
The career path of doctoral student Susan Watson, B.S.N., R.N., began in the 1970s, an era when student nurses were capped by candlelight and took the Florence Nightingale pledge. As she raised two sons, Watson moved from bedside care to nursing management. Then she felt the tug to return to clinical care.

Watson left California and the house she had lived in for 25 years to enroll in UM’s family nurse practitioner program—then fell in love with teaching. Associate dean JoAnn Trybulski encouraged her to pursue her doctorate, which she hopes to complete in three years.

This spring, Watson taught clinicals at the inpatient psychiatric units of UM Hospital and Jackson North to students in their final semester.

We are met by a patient who
crows with delight over all of the
beautiful ladies! The students
smile. I have been teaching for
three semesters and have never
gotten such a lovely, enthusiastic
reception. We talk about appropriate
attire: nothing revealing,
because mentally ill patients lack
boundaries; and no high heels,
because sometimes we need to
run! We talk about Maslow’s
Hierarchy of Needs, which
actually boils down to being
prepared for anything.

I accompany a student as he
talks with his first patient—
a paranoid schizophrenic who
believes there are aliens trying to
kill him. The patient is very
loosely associating in “word
salad”—nonsense words strung
together. Unfortunately, what he
says is a bit shocking and the
student is obviously taken aback.
We end the conversation and
discuss it with the other students
who have been watching nearby.
“It gives me great pleasure to help students master skills and see them grow as individuals,” Watson explains. Her work with her students both draws on and stimulates her own process of self-discovery.
As we eat lunch together, the
students all want to know:
Should they gain experience
before they pursue more education?
I tell them that it depends
on your goals—and your goals
may change at various stages
of life. I certainly didn’t know
how much I would enjoy teaching
psychiatric nursing.
Watson was profoundly affected by her work at community clinics in California’s agricultural Central Valley. She expects her dissertation to explore migrant health care or intimate partner violence in Latinas, an area she is pursuing in her current research practicum.

At our clinical post-conference, we
talk about the patients and the
impact of culture on illness. We
talked about how a patient may
perceive their illness and where it
comes from—is it given by God,
a cellular event, a curse? It’s a
great discussion and we actually
go over our 3 p.m. deadline.
Once she completes her degree, she plans to teach and work part-time as a family nurse practitioner in an underserved area. For now, her week is divided into research practicums, clinicals, and coursework, leaving just one day off—to study.

Arrive at home start reading
the assignment for Qualitative
Research. It’s tough going, and
I have to look up words I don’t
know. I feel really challenged. I
read until 8:30 p.m. and go to
bed early. Ahhh….sleep.
Pursuing a doctorate in midlife, Watson chose a challenging path. Now, for her, it’s all about teaching. “I believe,” he says, “in passing it forward.”