It's been so long since I've posted. I don't even really journal any more since I've been with Nate like I used to when I had so much time alone. There's a liberation in knowing this blog is private, and I don't have to worry about what people might think. I'm itching to write, to let go of some of these pent up emotions that have been lurking inside for so long. I feel a little lost...but I also feel like I'm being called to look deeper into my spiritual side.
So much has changed. Bought a house, a dog, adopted two cats, started working in a sub-acute rehab as an MDS nurse, worked there for a year and a half, and one night I'm sitting at work, it's late and Sue is still there in the office with me, but I feel compelled to put in an application for the ER and for L&D. I sincerely doubted anything would happen with it since I've applied in the past, and I'm not even ACLS certified, but I did it and sent if off to HR.
The next day I have a missed call from HR. Of course my voicemail isn't working but I call HR back and they want an interview for the ER position. I'm ecstatic and in disbelief. I go to work and dread telling Marci and Gaye. I tell Marci first, and she looks at me and doesn't say much. I wait a few days and then sit down and tell Gaye. She tells me exactly what she thinks, one of the things I love most about her. "We finally got everything the way you wanted it and now you're leaving." I tell her how much I appreciate her and everything she's done for me and Dillon, and that it has nothing to do with her. I'm just not cut out to be a desk nurse, wearing out the seat of my scrubs. She looks at me and then says, "I understand completely" and then tells me she knows I'll get the position.
I'm in the interview, and they ask me questions, then ask how I deal with difficult doctors. I tell them about Dr. Grams, everything I've learned by working with her and basically sometimes I just have to have a thick skin and realize their temperament doesn't necessarily have anything to do with me.
I get the position, starting in Minor care (soft 3's, 4's, and 5's) and hopefully will be able to advance into the ER once I'm ready (which won't be for a while!). I started last Tuesday. Twelve hour shifts passed by quickly, and the more I work and study the more I realize how much I have to learn. I start two IVs effortlessly my second day, and then miss one on a 30-something dialysis patient in the main ER (floating with my preceptor to help them out while we were slow) and miss an AC lab draw. I watch the lab tech do it so effortlessly (pretty much made it look like he was sliding the needle into butter and got flash immediately). I follow him out of the room and tell him he just put me to shame (with a smile) and beg him to teach me his secrets. He smiles back and gives me some pointers.
My preceptor is young but amazing to work with and smart. She doesn't talk a whole lot about herself, but is fun to be around. After our final shift last night we walk out and she asks me what she could do more, what would help, etc. I told her I feel like she could yell more. She laughs and I like her that much more because she gets my sense of humor.
The nurse practitioners change and it's challenging to get their quirks down. They're both down to earth and willing to teach and I like that I can approach them without getting yelled at instantly.
The patients come in, the revolving door of the ER. Flu season is upon us, and we see a lot of pediatric patients. We have a little boy with a raging ear infection who seems to be older than his age (5 going on 25) and tells me he gets his flu shot every year. I give him ear drops and cotton balls and he looks at me and tells me, "You're a good nurse". This makes my week and I know that I'm where I'm supposed to be.
I float over to the ER with Chris for a bit and while I love the chaos and they're so incredibly busy and short and I'll be honest and admit I was overwhelmed, but not in a bad way. We help triage a pt brought in by ambulance who slipped and fell on the ice, now with a fractured ankle. I learn to always put on gloves when removing pants as she was incontinent. Gross...
We get drug seekers but no one really rude yet. Our providers really don't give out narcs for anything...just recommend Motrin and Tylenol. One 20-something fractured his clavicle in a snowboarding accident and he actually got a script for Lortab, but that was pretty much it.
I'm trying to get the charting system down, and getting there slowly. I realize I'll have to do things differently then my preceptor, and start using a blank piece of printer paper folded in fourths. Whenever I do anything, I put the time, room number, and pt initials, along with whatever I need to chart. Put in an order for x-ray, I write it down; give a med, I write it down. Then I highlight it when I chart it.
I've given so many IM Toradol and Phenergan shots. Still trying to figure out the dorsogluteal vs. ventrogluteal thing.
I experienced my first patient(s) that had media involved with their situations. They were fine, but reading the news on my iPhone local news app makes me realize sometimes the news blows things out of proportion.
I have a patient who is in a Fed Ex truck accident and treat him. Then I see his truck on my husband's Facebook. Friend of a friend. Only in Montana.
I go to sleep and I dream of work. I feel a little guilty, missing time with Nate and Dillon. As Nate puts it, we're passing each other in the sheets. I come home at 1am, he's up and gone by 6am. Dillon is talking more and more, and the animals continue to drive me up the wall. The dog is so hyper and stubborn (whose idea was it to get a lab puppy, seriously?).
Taking it one day at a time, looking forward to learning and growing. Trying to ignore the doubt that springs up in the back of my mind at times. The what ifs and fear of making a mistake and being a failure; of not being able to "cut it". One thing at a time.
Friday, January 11, 2013
Wednesday, March 24, 2010
ltc...the good, the bad, the ugly
I've been off work for the last week or so after my ear surgery, giving me a lot of time to think...I loved this job when I started it last August. I loved the residents, and still do. I knew from the beginning this wasn't what I wanted to do forever, and already made plans to go back to school in May for my RN.
What is it about LTC that makes it so difficult? The CNAs, as I mentioned before, don't like being told what to do. Completely understandable. They're overworked and underpaid. But when so and so needs to go to the bathroom and I'm treading water to keep up with my duties, I'm going to pass it on to the resident's CNA. What about co-workers? I've decided that I need to work on my Poker face, and to withhold my opinion on anything and everything. The night shift LPN couldn't get her suppositories done because she was too busy solving the residents' puzzle? I won't say a word. She knows her job. The treatment nurse couldn't get her treatments done? Fine. Let it go...I don't really care any more about staying late and making sure absolutely everything is done. I make sure my stuff is done, charted, give report, and swipe my badge. It actually got to the point where I realized that I'm starting to not even care anymore because I'm so fed up with it. I do care about the residents, and I will keep doing my best for them. But it's discouraging when others don't seem to care for them nearly as much. =(
I've said more than once that I would love to open up a Victorian bed-and-breakfast type of house, but instead of a bed-and-breakfast I would take care of 3-4 people, working with maybe one to two other nurses. I wouldn't have to trust the CNA who says they changed so and so, because I would do it myself. In a perfect world, maybe.
Right now my saving Grace is going back to school. I'm tired of the politics and the burnt out nurses and CNAs....
What is it about LTC that makes it so difficult? The CNAs, as I mentioned before, don't like being told what to do. Completely understandable. They're overworked and underpaid. But when so and so needs to go to the bathroom and I'm treading water to keep up with my duties, I'm going to pass it on to the resident's CNA. What about co-workers? I've decided that I need to work on my Poker face, and to withhold my opinion on anything and everything. The night shift LPN couldn't get her suppositories done because she was too busy solving the residents' puzzle? I won't say a word. She knows her job. The treatment nurse couldn't get her treatments done? Fine. Let it go...I don't really care any more about staying late and making sure absolutely everything is done. I make sure my stuff is done, charted, give report, and swipe my badge. It actually got to the point where I realized that I'm starting to not even care anymore because I'm so fed up with it. I do care about the residents, and I will keep doing my best for them. But it's discouraging when others don't seem to care for them nearly as much. =(
I've said more than once that I would love to open up a Victorian bed-and-breakfast type of house, but instead of a bed-and-breakfast I would take care of 3-4 people, working with maybe one to two other nurses. I wouldn't have to trust the CNA who says they changed so and so, because I would do it myself. In a perfect world, maybe.
Right now my saving Grace is going back to school. I'm tired of the politics and the burnt out nurses and CNAs....
Sunday, March 14, 2010
last 12 hour shift...thank God!
just finished my last 12 hour shift. what i was thinking when i agreed to work two 12's every other Saturday and Sunday, I don't know. I finally decided it wasn't worth it to me and told my boss I'd like straight 8 hour shifts. I like my family, and my boyfriend, and I'd like to see them once in a while.
i also got a letter in the mail, letting me know i got into the lpn to rn program, starting this may and finishing this december (only two semesters!). i'm excited, but nervous...back to school, bills to pay. but it'll be more than worth it once i'm done. i'm hoping to write more about it. i enjoy going back and reading what i wrote. going from full-time to registry is scary, but i know this is what i'm supposed to do. i just hope for everything to fall into place.
i'm a little frustrated with the CNAs at work. most of them, the vast majority, are great. i love them and appreciate how hard they work, and i try to thank them for doing such a thankless, emotionally and physically challenging job. i try to get in there with them and help them with the residents. there is more to nursing than passing pills, thank God.
but then there's the few that frustrate me to no end. i floated to the Alzheimer's unit for the last four hours of my shift yesterday and today. no big deal...it's a change of pace. after i left yesterday, a resident was fighting with another resident. i get this in report and read the nurses' note. i go on throughout my shift, and as i'm passing my 1800 dinner meds, i look up to see the CNA put these two residents right next to each other. in my mind, i'm thinking, "this is just asking for another incident..." so i ask her to please move one away from the other. she looks at me and says, "he's fine." seriously? so i look at her and tell her i can see that, but i'd rather he not sit next to this resident. she continues to insist that she was here for the incident and that he truly is fine where he is. finally she moves him away from the resident. i thanked her and continue with the med pass.
after dinner, i asked if i could talk to her one on one and explain my rationale for not having these two next to each other. her response? "they don't remember anything." i'm trying to be professional, but inside i'm getting mad. she goes on to say, "so we should care plan that these two can never be next to each other?". i told her that she is more than welcome to give me suggestions, but when i ask her to do something, she needs to do it. end of story. i didn't ask her to do anything that would put anyone in harm, or would risk her certification. i made a decision based on my thinking.
on the other hand, i was the float over to that unit. she has worked over there for 2 years. apparently the nurses that work over there let the CNAs run the show and hang out in the computer room away from all the action. so this CNA resented being told what to do. (all of this was explained to me by the NOC LPN who relieved me). I completely understand all this, and am glad she is taking ownership over her job. but part of my job is making sure the residents are taken care of and safe, as well as overseeing the CNAs.
i don't care that she's upset with me. i understand that's not the way it's usually done, and maybe i should just put in my four hours and keep my mouth shut and spoon their pills in and go hide in the computer room like a meek little nurse would do.
i might look i'm easily intimdated, but i'm not. especially when i'm mad. there's a reason my dad's nicknames for me growing up were either "princess" or "mouth" depending on the situation.
maybe i'm picking the wrong battles. maybe i should just keep my mouth shut and let it be. laissez-faire. but at the end of the shift, the resident was eating peacefully by the window, and there were no incidents.
i also got a letter in the mail, letting me know i got into the lpn to rn program, starting this may and finishing this december (only two semesters!). i'm excited, but nervous...back to school, bills to pay. but it'll be more than worth it once i'm done. i'm hoping to write more about it. i enjoy going back and reading what i wrote. going from full-time to registry is scary, but i know this is what i'm supposed to do. i just hope for everything to fall into place.
i'm a little frustrated with the CNAs at work. most of them, the vast majority, are great. i love them and appreciate how hard they work, and i try to thank them for doing such a thankless, emotionally and physically challenging job. i try to get in there with them and help them with the residents. there is more to nursing than passing pills, thank God.
but then there's the few that frustrate me to no end. i floated to the Alzheimer's unit for the last four hours of my shift yesterday and today. no big deal...it's a change of pace. after i left yesterday, a resident was fighting with another resident. i get this in report and read the nurses' note. i go on throughout my shift, and as i'm passing my 1800 dinner meds, i look up to see the CNA put these two residents right next to each other. in my mind, i'm thinking, "this is just asking for another incident..." so i ask her to please move one away from the other. she looks at me and says, "he's fine." seriously? so i look at her and tell her i can see that, but i'd rather he not sit next to this resident. she continues to insist that she was here for the incident and that he truly is fine where he is. finally she moves him away from the resident. i thanked her and continue with the med pass.
after dinner, i asked if i could talk to her one on one and explain my rationale for not having these two next to each other. her response? "they don't remember anything." i'm trying to be professional, but inside i'm getting mad. she goes on to say, "so we should care plan that these two can never be next to each other?". i told her that she is more than welcome to give me suggestions, but when i ask her to do something, she needs to do it. end of story. i didn't ask her to do anything that would put anyone in harm, or would risk her certification. i made a decision based on my thinking.
on the other hand, i was the float over to that unit. she has worked over there for 2 years. apparently the nurses that work over there let the CNAs run the show and hang out in the computer room away from all the action. so this CNA resented being told what to do. (all of this was explained to me by the NOC LPN who relieved me). I completely understand all this, and am glad she is taking ownership over her job. but part of my job is making sure the residents are taken care of and safe, as well as overseeing the CNAs.
i don't care that she's upset with me. i understand that's not the way it's usually done, and maybe i should just put in my four hours and keep my mouth shut and spoon their pills in and go hide in the computer room like a meek little nurse would do.
i might look i'm easily intimdated, but i'm not. especially when i'm mad. there's a reason my dad's nicknames for me growing up were either "princess" or "mouth" depending on the situation.
maybe i'm picking the wrong battles. maybe i should just keep my mouth shut and let it be. laissez-faire. but at the end of the shift, the resident was eating peacefully by the window, and there were no incidents.
Thursday, January 14, 2010
back again...
I stopped writing after spring semester, for whatever reason. Nursing Leadership and IV therapy came next, and then i was done. Much thanks to Doughboy for letting me practice IVs on him!! (especially for pretending he had Tourette's...nice). Graduating was surreal. Just because of everything that had happened in my personal life, it felt like a chapter being closed, and I was more than ready to move on. Somehow, looking back now I remember nursing school with fondness, and the only thing I would change now if I could would be to enjoy it more as I was learning. And I ran into one of my teachers yesterday, and thanked her. She taught Maternal-Child Nursing, a class that made me uncomfortable from the beginning. I've never dreaded going to class like I did that one. The idea of having children made me so uncomfortable...and then I realized it wasn't the idea of having children itself, but having children with the person I was with. So I made some changes, said my good-byes, and let him go. I hope he finds someone whom he can have an amazing relationship with, and I wish him nothing but the best. It just wasn't meant to be. So I ran into my teacher, and I thanked her as I explained to her that it was never her, or her class, that made me so disinterested. I guess I learned a lot more in nursing school than I bargained for...
So now I'm working as an LPN in a long-term care facility. At first it was the last thing I wanted to do after graduating, but with the recession, full-time jobs weren't plentiful as an LPN. And the way everything worked out...to me I knew it was where I was supposed to be for the moment.
I'm learning everyday just how much I don't know. Every time I start to think, "Hey, maybe I'm getting it..." something happens to make me realize just how much I have to learn. I've actually wanted to call my LPN instructor and ask her if I could just repeat those classes again...maybe then I'll feel like I'm more competent. But instead I ask questions. About everything. I remember Lindy, an Ortho nurse..."when in doubt, scream and shout." And I realized there are a handful of nurses I can go to who will point me in the right direction. Yes, some eat their own, but I decided to live and learn and just ignore their rudeness and try to learn from what they're nitpicking about.
I love the residents. Even when I'm in the worst mood, I could never be upset with them. They yell sometimes, spit their pills out all over me, but it's okay. And it's the crazy ones I love the most. The resident who asks me to put a blanket on her daughter, pointing at an empty chair. The resident who yells at me because now I'm her niece and I'm not dressed to take her to Mass. The resident who makes faces at me while I'm trying to chart on the computer. The resident who tells me the dirtiest jokes I've ever heard with a dead-pan expression (jokes so horrible they even gross my brothers out...). It's not about the money, because before I thought I'd be rich after I graduated. Not so much... It's not about self-gratification, because sometimes I go home and feel like I didn't do enough. It's simply about them.
I wasn't planning on blogging anymore. But lately I've had trouble leaving work at work, thinking about work while I'm trying to fall asleep, waking up, thinking about what I should do for the upcoming day. So maybe if I just write it down, I can leave it where it's supposed to be.
Today wasn't a bad day. It was just so hectic. Thank God another nurse was orienting with me, so she could focus on passing meds and I could try to keep up with everything. We suspected one resident had an URI (green, pasty/sticky phlegm coming up every 30 seconds, low-grade temp...). I called the MD yesterday, he ordered antibiotics. Trouble is, this resident refused to take anything by mouth, food, water, and especially meds. (When I speak of residents spitting their meds all over me, she comes to mind). We check her blood sugar (noting she hasn't eaten in several days) and at first it's too high for the glucometer to read. Which means it's over 600. (Normal is between 70 and 120/130). I repeat the reading, and it's 599. Yikes. Time to call her doctor. He orders blood work...so I draw the blood, send it down, and once we get it back, realize her white blood cell count is pretty high. I faxed that to the doctor, and his nurse calls back, tells us this resident just bought an all-expense paid trip to the hospital. She just came back three weeks ago, after getting pumped full of antibiotics for a suspected UTI, and looked great for a while. Hopefully she'll feel better soon...
Another resident complained of leg pain. I rub Arnica gel on her muscles with no relief. I give her her PRN Percocet, and an hour later, the CNA comes to find me, telling me the resident isn't responding. Not something you want to hear from a CNA about a resident. I go over to her, and see that her eyes are open, but her pupils aren't following anything. The expression "The lights are on, but nobody's home?" I never saw someone who fit that expression as well as she did. I check her blood sugar. Nothing unusual. I check her oxygen saturation and other vitals. Fine. The LPN who's orienting today brought her dachshund. And this lady loves dogs. So I put the dog on her lap. Slowly, she lifts her hand up and pets the dog and smiles. She's fine, but to describe it, this resident looks stoned. I left a note for the doctor, wondering if she needs something less potent. The doctor takes her off her Zyprexa instead, so we'll see how she is the next couple of days (by the way, the resident who asked me to cover her daughter with a blanket...this was her).
I didn't realize how much responsibility this job is until lately. I hate making mistakes. I catch so many little mistakes, and sometimes it's just highlighting the MAR to point out that hey, this person gets 40mg of Lasix at 8am, and 80mg at noon, so that the right blister gets pulled and used. And I make mistakes, too. I hate making mistakes, but I learn my lesson so well from them. A resident on Coumadin got orders to re-draw his PT/INR on a date. I chart it in Meditech, put it in the MAR, and forgot to order the lab to be drawn by the lab. So the PT/INR goes undrawn for over a week. But now you can bet the first thing I do is put that PT/INR lab order in. I don't want to be that nurse that insists on running to the boss and showing every little mistake so and so made. I will if there is a genuine, obvious med error. The day I found out about the PT/INR mistake? I realized the evening nurse prior to me forgot to give two different residents their pain pills. I did let my boss know, and she told me that nurse wasn't comfortable working that unit, and was actually the nurse who oriented with me today to get to know the people better. Everyone makes mistakes...including me. We're only human. It's just how we can prevent them in the future. I would love to have a stamp to use on new doctor's orders. Faxed to Rx? Check. MAR changed? Check. DC'ed blisters pulled from med cart? Check. Nurses' note in Meditech? Check. New labs entered in Meditech? Check. New labs on calendar? Check. But for now, it is what it is. Until I can convince my boss that we really do need that stamp so things don't get lost in the process.
I applied for school, to get my LPN to RN. I think I missed the deadline by a few weeks, so I don't know if I can get in. But I think now would be better for me to get my RN, before I get married again, and have kids. I actually met someone who I can't wait to have kids with. And I can't believe the difference...But everything happens for a reason, and if I get in, I'll be happy. If not, I'll continue to work, gaining my experience, and try again next year.
So now I'm working as an LPN in a long-term care facility. At first it was the last thing I wanted to do after graduating, but with the recession, full-time jobs weren't plentiful as an LPN. And the way everything worked out...to me I knew it was where I was supposed to be for the moment.
I'm learning everyday just how much I don't know. Every time I start to think, "Hey, maybe I'm getting it..." something happens to make me realize just how much I have to learn. I've actually wanted to call my LPN instructor and ask her if I could just repeat those classes again...maybe then I'll feel like I'm more competent. But instead I ask questions. About everything. I remember Lindy, an Ortho nurse..."when in doubt, scream and shout." And I realized there are a handful of nurses I can go to who will point me in the right direction. Yes, some eat their own, but I decided to live and learn and just ignore their rudeness and try to learn from what they're nitpicking about.
I love the residents. Even when I'm in the worst mood, I could never be upset with them. They yell sometimes, spit their pills out all over me, but it's okay. And it's the crazy ones I love the most. The resident who asks me to put a blanket on her daughter, pointing at an empty chair. The resident who yells at me because now I'm her niece and I'm not dressed to take her to Mass. The resident who makes faces at me while I'm trying to chart on the computer. The resident who tells me the dirtiest jokes I've ever heard with a dead-pan expression (jokes so horrible they even gross my brothers out...). It's not about the money, because before I thought I'd be rich after I graduated. Not so much... It's not about self-gratification, because sometimes I go home and feel like I didn't do enough. It's simply about them.
I wasn't planning on blogging anymore. But lately I've had trouble leaving work at work, thinking about work while I'm trying to fall asleep, waking up, thinking about what I should do for the upcoming day. So maybe if I just write it down, I can leave it where it's supposed to be.
Today wasn't a bad day. It was just so hectic. Thank God another nurse was orienting with me, so she could focus on passing meds and I could try to keep up with everything. We suspected one resident had an URI (green, pasty/sticky phlegm coming up every 30 seconds, low-grade temp...). I called the MD yesterday, he ordered antibiotics. Trouble is, this resident refused to take anything by mouth, food, water, and especially meds. (When I speak of residents spitting their meds all over me, she comes to mind). We check her blood sugar (noting she hasn't eaten in several days) and at first it's too high for the glucometer to read. Which means it's over 600. (Normal is between 70 and 120/130). I repeat the reading, and it's 599. Yikes. Time to call her doctor. He orders blood work...so I draw the blood, send it down, and once we get it back, realize her white blood cell count is pretty high. I faxed that to the doctor, and his nurse calls back, tells us this resident just bought an all-expense paid trip to the hospital. She just came back three weeks ago, after getting pumped full of antibiotics for a suspected UTI, and looked great for a while. Hopefully she'll feel better soon...
Another resident complained of leg pain. I rub Arnica gel on her muscles with no relief. I give her her PRN Percocet, and an hour later, the CNA comes to find me, telling me the resident isn't responding. Not something you want to hear from a CNA about a resident. I go over to her, and see that her eyes are open, but her pupils aren't following anything. The expression "The lights are on, but nobody's home?" I never saw someone who fit that expression as well as she did. I check her blood sugar. Nothing unusual. I check her oxygen saturation and other vitals. Fine. The LPN who's orienting today brought her dachshund. And this lady loves dogs. So I put the dog on her lap. Slowly, she lifts her hand up and pets the dog and smiles. She's fine, but to describe it, this resident looks stoned. I left a note for the doctor, wondering if she needs something less potent. The doctor takes her off her Zyprexa instead, so we'll see how she is the next couple of days (by the way, the resident who asked me to cover her daughter with a blanket...this was her).
I didn't realize how much responsibility this job is until lately. I hate making mistakes. I catch so many little mistakes, and sometimes it's just highlighting the MAR to point out that hey, this person gets 40mg of Lasix at 8am, and 80mg at noon, so that the right blister gets pulled and used. And I make mistakes, too. I hate making mistakes, but I learn my lesson so well from them. A resident on Coumadin got orders to re-draw his PT/INR on a date. I chart it in Meditech, put it in the MAR, and forgot to order the lab to be drawn by the lab. So the PT/INR goes undrawn for over a week. But now you can bet the first thing I do is put that PT/INR lab order in. I don't want to be that nurse that insists on running to the boss and showing every little mistake so and so made. I will if there is a genuine, obvious med error. The day I found out about the PT/INR mistake? I realized the evening nurse prior to me forgot to give two different residents their pain pills. I did let my boss know, and she told me that nurse wasn't comfortable working that unit, and was actually the nurse who oriented with me today to get to know the people better. Everyone makes mistakes...including me. We're only human. It's just how we can prevent them in the future. I would love to have a stamp to use on new doctor's orders. Faxed to Rx? Check. MAR changed? Check. DC'ed blisters pulled from med cart? Check. Nurses' note in Meditech? Check. New labs entered in Meditech? Check. New labs on calendar? Check. But for now, it is what it is. Until I can convince my boss that we really do need that stamp so things don't get lost in the process.
I applied for school, to get my LPN to RN. I think I missed the deadline by a few weeks, so I don't know if I can get in. But I think now would be better for me to get my RN, before I get married again, and have kids. I actually met someone who I can't wait to have kids with. And I can't believe the difference...But everything happens for a reason, and if I get in, I'll be happy. If not, I'll continue to work, gaining my experience, and try again next year.
Friday, April 24, 2009
running for that special place...to find that saving grace...
It's been a while...life gets crazy, but everything happens for a reason and inevitably works out for the best.
Only a few more days of class left. Mental health is over, only one more exam next Thursday for Adult Nursing, and plowing through Maternal Child to finish in time (a class that went from being 5 credits last year to 3 now). I'll probably pull through with B's in each, which I am more than happy with (especially when the nursing adage is "C's get degrees...").
I'm finished with clinical for the semester, and my last clinical went out with a bang. Lessons learned...don't tell an adolescent girl who came in with a compound tib/fib fracture that your more than happy to entertain her, especially because she is the only patient and you have nothing else to do. Not thirty minutes later, she seized and a code blue was called for her...(Another lesson learned: crash carts are plugged in...so it's advantageous to unplug them before you try to fly down the hall with them!!) Her twin sister had epilepsy, but her family never knew the patient may have it also. (They were doing a work-up when I left clinical that day to rule out electrolyte imbalances, etc.) She was a sweetheart, and I hope everything turns out well for her. Taking care of teenage girls in the healthcare setting, you either love them or hate them.
There was one other patient on the unit, but she was a 1:1 because she'd try to kill herself with Tylenol a few days prior. Her boyfriend had gotten into some serious trouble and landed himself a nice, long-term, all-expense paid trip to prison, and she didn't know how to cope. This is so tragic to me...I could never fathom suicide, but this was an older girl with a crappy home life, parents that argued over who got to "deal with her" because they were "too busy", no idea what she wanted to do with her life, and who based everything in her life around her boyfriend. Once the Mucomyst clears up her liver function tests, (if it will, completely) she's supposed to go to a mental treatment facility out of town, to which she adamantly refuses. Tylenol is such a horrible way to die...people don't realize how horrible it is on your body, and how badly it screws up your liver, followed by so many other health problems.
So that was Peds...definitely not boring! I loved observing on labor & delivery, much to my surprise. the nurses were great, and when they found out I was contemplating eventually becoming a nurse anesthetist, hooked me up with Jeff, the CRNA for the floor. He went out of his way showing and explaining what he was doing with the epidurals. I also got to watch three C-sections. I'm not sentimental, but watching the babies come out and take their first breaths was pretty cool. The last patient had a severe case of gestation diabetes. The surgeon was literally elbow deep in her abdomen, and the baby ended up weighing over 11 pounds!!
I also got to walk through the NICU with my instructor, and saw this tiny little baby who weighed one pound when she was born. She was so incredibly tiny. I talked with her nurse, who noted that it was the "feisty" ones who seemed to have the best prognosis.
When I was observing in the newborn nursery, we had a newborn detoxing. The mom admitted to using marijuana, but who knows what else she took. She said she smoked three times a week to help alleviate the nausea. The nurse mentioned that since the medical marijuana laws went into effect, the general public had seemed to believe that it wouldn't have any harmful effects on pregnancies.
I wish every high school girl could spend an hour with this poor baby. He was clearly agitated, with a high-pitched cry that reminded me of newborn puppies. He couldn't be comforted, and only wanted to self-comfort by sucking on his hands. I found out a week later that he ended up in NICU. I wondered what kind of life this baby would have, and couldn't help but think about hat anti-drug commercial, where the boy is supposed to be watching his little sister, who is about 4. He gets high, and eventually realizes she's drowned in the family pool. I asked if the social worker would be contacted, and the nurse said she would, but the SW was so tied up with meth babies that nothing would come out of his case.
Don't judge the parents...educate them. Easier said than done sometimes...
Post-partum was my least favorite clinical, because there really wasn't anything to do. I definitely don't want to work in OB. The nurses were good, but it was a little too relaxed. Maybe I saw a down day, but it also seemed repetitive. It would be great for a nurse who liked educating parents, but it's not for me.
I had another observation at a local peds clinic. I don't think that would be my thing either, because I hate giving shots to kids. There was one girl who had to come in over three days for IM antibiotics, and she took one look at the nurse and screamed.
Losing my social life over weekends spent doing patient work-ups, bibs for diseases, and making med cards, getting up at 5:00am to make it to the hospital by 6:00am for Monday and Tuesday clinicals, cramming Tuesday, Wednesday, and Thursday for the three consecutive Wednesday, Thursday, and Friday exams, and repeating this crazy schedule every weekend...it's torture, but you're almost too busy to even notice how stressed you are. You just focus on the next thing that needs to get done, and try to stay away from the people who chronically complain about everything.
And then all of a sudden it's over, and you have five days all to yourself, and you're so bored you don't know what to do... =) (not that I'm complaining!!)
Only a few more days of class left. Mental health is over, only one more exam next Thursday for Adult Nursing, and plowing through Maternal Child to finish in time (a class that went from being 5 credits last year to 3 now). I'll probably pull through with B's in each, which I am more than happy with (especially when the nursing adage is "C's get degrees...").
I'm finished with clinical for the semester, and my last clinical went out with a bang. Lessons learned...don't tell an adolescent girl who came in with a compound tib/fib fracture that your more than happy to entertain her, especially because she is the only patient and you have nothing else to do. Not thirty minutes later, she seized and a code blue was called for her...(Another lesson learned: crash carts are plugged in...so it's advantageous to unplug them before you try to fly down the hall with them!!) Her twin sister had epilepsy, but her family never knew the patient may have it also. (They were doing a work-up when I left clinical that day to rule out electrolyte imbalances, etc.) She was a sweetheart, and I hope everything turns out well for her. Taking care of teenage girls in the healthcare setting, you either love them or hate them.
There was one other patient on the unit, but she was a 1:1 because she'd try to kill herself with Tylenol a few days prior. Her boyfriend had gotten into some serious trouble and landed himself a nice, long-term, all-expense paid trip to prison, and she didn't know how to cope. This is so tragic to me...I could never fathom suicide, but this was an older girl with a crappy home life, parents that argued over who got to "deal with her" because they were "too busy", no idea what she wanted to do with her life, and who based everything in her life around her boyfriend. Once the Mucomyst clears up her liver function tests, (if it will, completely) she's supposed to go to a mental treatment facility out of town, to which she adamantly refuses. Tylenol is such a horrible way to die...people don't realize how horrible it is on your body, and how badly it screws up your liver, followed by so many other health problems.
So that was Peds...definitely not boring! I loved observing on labor & delivery, much to my surprise. the nurses were great, and when they found out I was contemplating eventually becoming a nurse anesthetist, hooked me up with Jeff, the CRNA for the floor. He went out of his way showing and explaining what he was doing with the epidurals. I also got to watch three C-sections. I'm not sentimental, but watching the babies come out and take their first breaths was pretty cool. The last patient had a severe case of gestation diabetes. The surgeon was literally elbow deep in her abdomen, and the baby ended up weighing over 11 pounds!!
I also got to walk through the NICU with my instructor, and saw this tiny little baby who weighed one pound when she was born. She was so incredibly tiny. I talked with her nurse, who noted that it was the "feisty" ones who seemed to have the best prognosis.
When I was observing in the newborn nursery, we had a newborn detoxing. The mom admitted to using marijuana, but who knows what else she took. She said she smoked three times a week to help alleviate the nausea. The nurse mentioned that since the medical marijuana laws went into effect, the general public had seemed to believe that it wouldn't have any harmful effects on pregnancies.
I wish every high school girl could spend an hour with this poor baby. He was clearly agitated, with a high-pitched cry that reminded me of newborn puppies. He couldn't be comforted, and only wanted to self-comfort by sucking on his hands. I found out a week later that he ended up in NICU. I wondered what kind of life this baby would have, and couldn't help but think about hat anti-drug commercial, where the boy is supposed to be watching his little sister, who is about 4. He gets high, and eventually realizes she's drowned in the family pool. I asked if the social worker would be contacted, and the nurse said she would, but the SW was so tied up with meth babies that nothing would come out of his case.
Don't judge the parents...educate them. Easier said than done sometimes...
Post-partum was my least favorite clinical, because there really wasn't anything to do. I definitely don't want to work in OB. The nurses were good, but it was a little too relaxed. Maybe I saw a down day, but it also seemed repetitive. It would be great for a nurse who liked educating parents, but it's not for me.
I had another observation at a local peds clinic. I don't think that would be my thing either, because I hate giving shots to kids. There was one girl who had to come in over three days for IM antibiotics, and she took one look at the nurse and screamed.
Losing my social life over weekends spent doing patient work-ups, bibs for diseases, and making med cards, getting up at 5:00am to make it to the hospital by 6:00am for Monday and Tuesday clinicals, cramming Tuesday, Wednesday, and Thursday for the three consecutive Wednesday, Thursday, and Friday exams, and repeating this crazy schedule every weekend...it's torture, but you're almost too busy to even notice how stressed you are. You just focus on the next thing that needs to get done, and try to stay away from the people who chronically complain about everything.
And then all of a sudden it's over, and you have five days all to yourself, and you're so bored you don't know what to do... =) (not that I'm complaining!!)
Sunday, March 8, 2009
musical directions for a nurse...
i found this just now from http://www.impactednurse.com/?p=793 , and love it:
Nursing, like music, is a science best served as art.
But unlike musicians, we often loose our way. We are not very good at finding our voice, or for that matter, in providing direction to our nursing kin on the subtitles of timbre and pace that flux and dance across our shift.
Is it any wonder that some wards end up resonating with dissonance and disharmony?
Lets have a look at some of the notations used to guide the musicians through their own score and transpose them into out own profession.
Anima Soul
Appassionato Passionately
Oh gosh, don’t just be a 9-5 nurse. Be a Beethoven. Be a Bono. Be a Miles Davis.
Look at what you have. Nursing can move and lift and heal. How many other professions can make the sort of differences to people that ours can. You know what I mean. Find your instrument and find your muse.
Nurse with bravura.
Bravura (With) boldness and spirit
Colla voce (lit. with the voice.) To follow the solo instrument or voice
There are times when you will have your own solos, and there are times when you must follow others. Whether it be senior staff, doctors, hospital policy, or patients wishes.
Appreciate the talents of your fellow musicians. Learn when to listen, and when to provide an expert accompaniment to the voice.
Dolore Grief, sorrow
Managing grief whether it be a patients or your own, is yet another skill you will need to play the piece well. The secret is, that it is no skill at all. As long as you are authentic the right music will come. And in its own time, the grief will fade.
Duo A duet
Dont forget to buddy. Two of you is far more powerful than one of you. Drawing up drugs, debriefing, planning care, performing interventions. Always look for the duet.
Legato . Smooth
Lento Slow
Smooth and slow, some of the best direction you will get. Even when the situation calls for rapid, urgent response the trick is to stay in the music. Smooth and slow will ultimately be much quicker and far more effective than hurried and rough.
The ability to remain focused and calm as others around you blow up in an uncontrolled crescendo, is one of the hallmarks of a great nurse. It is a skill like any other. And with practice it will improve. That’s what separates a great musician from a hack. Practice, practice, practice.
Lontano As from a distance
There is time for getting in real close, squeezing the juice out of every note. Pressing your cheek against the ink of the staves. But there are also times when it is important to maintain a little professional distancing from your work. There are instances when the best thing you can do for your patient is to remain off stage. Dont get caught up in their drama, even when its particularly…er…dramatic. By keeping some internal perspective, the correct course of action will be far more evident.
Of course, there are times when you need to maintain a very physical distance from the music. The orchestra can be a dangerous place. Exit stage left.
Lunga pausa A long pause
Perhaps one of the most powerful communication techniques there are. When talking to your patients or taking a history make sure you give them space to tell you what they want to say as well as what you want to hear.
If a patient is trying to tell you something important, or if your own gut feeling is that there is something else going on that for whatever reason has remained unspoken, wait till they have finished speaking and then leave a long attentive pause. If they don’t speak, remain with it. Just wait quietly.
Alternatively, ask them if there is anything else they need to say and then pause at the end of their reply.
Often this space will open a much deeper level of conversation, cutting through to the important stuff.
Its not easy to do, and shouldn’t be used all the time, but just as in a piece of music: the space between the notes can sometimes be more important than the notes themselves
Misterioso Mysterious
There are great mysteries within the hospital. They run quiet counterpoint, often far below the dense chords of science and technology that pulls at our attention with all its sharps and flats.
Being open to this mystery is an important part of the art of nursing. Listen carefully.
Obbligato Indispensable, cannot be omitted
There are things that you must do or must know that are indispensable. Know them and do them.
Prestissimo As fast as possible
This is the way you are going to have to eat your meals, ’cause there are twenty other things you need to be doing.
This is the way you are going to have to empty your maxed-out bladder, ’cause there are five patients all wanting a bedpan….now.
It has always been this way. It always will be.
Scherzando Playful
- Nurse soft. Play hard.
- Swap densities as required.
Senza Sordini Without mutes
Now, more than any other time in its history, nursing needs a voice. Speak up. Step up onto the rostrum and conduct.
Find your own drum and do not be afraid to hit it loudly with a big mallet if a strong beat is what is required. Gather your best players and go out into the world and show them your art.
Troppo . . Too much
Going Troppo is a real risk for nurses who fail to care for their instruments. You need to look after yourself and find your own balance point. Just like the strings of a violin, if the tension is too loose, everything sags, your work becomes sloppy. And it quikly effects the strings around you. But if you wind yourself too tighly, your sound becomes harsh and sctatchy, and at a very real risk of breaking.
Volti subito (v.s.) Turn the page quickly
You can never play the same sheet of music exactly the same twice. So, play the phrase and then move on. There is probably going to be something even more interesting just over the page.
surgical day care, palliative care rotations
i just found out it's daylight savings time, already! (that might explain how i slept in so late!) =) luckily chris is more on top of these things than i am...
i'm in the middle of my "community" clinicals, which has been like a vacation since we don't have to do our lengthy work-ups before we go. (for orth, surgical, medical, etc. we have to do a full patient work-up, which takes about 2 hours, then complete the bibs of all their medical diagnoses and highlight, which can take anywhere from 2 to 4 hours, do two care plans, which takes about 45 minutes to an hour each, and pull and highlight med cards for each med they're taking. if it's not in the nursing med deck, we have to make one. finding all the information is torture. so the weekend before clinicals (on monday and tuesdays) i do nothing but patient work-ups.
aaaand, if your patient leaves (either celestial discharge or goes home) before your two-day clinical rotation is up, you are lucky enough to get to do one of these for another patient. overnight. knock on wood, i've been lucky enough to not have to do this. (i try to pick patients who are obese and/or diabetic, because they seem to have longer hospital stays. so yes, i am greatly appreciating my two weeks of community clinical. :)
last week i went to the surgical day care at the community clinic and watched the ENT surgeon perform two tonsillectomies and two septoplasties. it was a pretty slow day, but i was happy to get to see something besides fifteen cataract surgeries in a row. the surgeon was awesome. "you can't see anything back there. get up here and take a look..." he explained what he was doing, and i enjoyed watching him with the patients. i was really impressed with the surgical tech. i thought the RN would be doing more, but she mostly did computer charting, away from the table. the surg tech however, seemed as if she could read the doctor's mind. she'd pick up an instrument and hold it out to him without him even asking for it. i'm sure she's probably assisted on so many of these cases she could probably do the surgery herself, but it was still impressive.
i heard several horror stories about people passing out in the OR, and i really did not want to be one of those people! one girl told me she passed out...right into the surgeon's sterile field. (she was a primary nurse on my ortho rotation). how embarrassing! i never eat breakfast (my stomach is not awake at 6am!) but i did eat three pieces of lunch meat, (very nutritious...) just to have something in my stomach. looking back i'm not sure if that was such a good idea. once the surgery started, my curiosity overtook my paranoia and i was fine. i like watching surgeries, but i don't think an OR nurse would be the job for me.
one thing that amazed me was watching the nurse anesthetist. he'd complete his assessments (about every 15 minutes) and then go back to his Sudoku puzzle. i didn't think it was that big of a deal really, because his machines would beep periodically if something was out of range. i started to wonder if he was really paying attention to his job though, when i noticed the patient's bag of LR was getting low. the nurse got a new bag and put it next to the old one so it'd be right there when his old one needed to be changed. i watched the bag drain from the "9" mark, to the very bottom, and decided i wouldn't say anything unless the bag was completely emptied. which...about five minutes later, the last drop had been squeezed out of the bag and the drip chamber was slowly draining. i asked the surgical tech if the bag was okay, and she looked at it, and told the CRNA to change it.
on tuesday i went back to the hospital to shadow the palliative care coordinator. i had no idea what to expect from this clinical, but i love the nurse who oversees it, Edie. I got to the hospice house at 8:30am, and we set off for rounds. she goes to the ICU, CCU, CICU, and PCU rounds, and is available for patients to speak with regarding hospice care, if their prognosis is poor, or for palliative care, if they have a chronic disease or condition. i don't think people really understand what the difference is between palliative and hospice care, and tend to freak out a little when someone comes into their room from palliative care.
I thought the ICU rounds were the best. the doctor truly seemed like he was the most organized, and arranged for multidisciplinary walking rounds. it was a crowd, but everyone was on the same page and knew what they had to do. it was the physician, the dietitian, Edie, the pharmacist, the chaplain, the respiratory therapist, speech pathologist, social worker, and two unit managers. i loved being on ICU, and still think that's where my calling is. being in the patients' rooms and actually seeing how much equipment they're hooked up to was a little daunting, but i really like the critical thinking aspect of it, trying to figure out what's going on, and how it's affecting other body systems.
once rounds were done, Edie had an appointment with a patient's wife. he wasn't doing well, and was being kept alive by the machines. his wife was in her mid-fifties, at the latest. two physicians were in the meeting, along with an RN, the chaplain, and Edie. she wanted to take her husband off life support on friday, when her family could be there. she seemed so calm, almost stoic for the first part of the meeting, and i started to wonder about her. halfway through the meeting she broke down, which was hard to watch. seeing other people cry always makes me tear up. she pulled herself together shortly, and we finished the meeting.
i asked Edie about her later on, because i was curious about her coping mechanisms and what Edie thought of them. she mentioned that she'd be worried if she hadn't broken down at some point during their conversations, but seeing that she had, and how well she pulled herself together made Edie think she was coping and not denying the whole ordeal.
it made me somber friday morning, writing my paper about these two clinical rotations for my instructor, and realizing that a couple blocks away, this woman was saying good-bye to her husband...
i'm in the middle of my "community" clinicals, which has been like a vacation since we don't have to do our lengthy work-ups before we go. (for orth, surgical, medical, etc. we have to do a full patient work-up, which takes about 2 hours, then complete the bibs of all their medical diagnoses and highlight, which can take anywhere from 2 to 4 hours, do two care plans, which takes about 45 minutes to an hour each, and pull and highlight med cards for each med they're taking. if it's not in the nursing med deck, we have to make one. finding all the information is torture. so the weekend before clinicals (on monday and tuesdays) i do nothing but patient work-ups.
aaaand, if your patient leaves (either celestial discharge or goes home) before your two-day clinical rotation is up, you are lucky enough to get to do one of these for another patient. overnight. knock on wood, i've been lucky enough to not have to do this. (i try to pick patients who are obese and/or diabetic, because they seem to have longer hospital stays. so yes, i am greatly appreciating my two weeks of community clinical. :)
last week i went to the surgical day care at the community clinic and watched the ENT surgeon perform two tonsillectomies and two septoplasties. it was a pretty slow day, but i was happy to get to see something besides fifteen cataract surgeries in a row. the surgeon was awesome. "you can't see anything back there. get up here and take a look..." he explained what he was doing, and i enjoyed watching him with the patients. i was really impressed with the surgical tech. i thought the RN would be doing more, but she mostly did computer charting, away from the table. the surg tech however, seemed as if she could read the doctor's mind. she'd pick up an instrument and hold it out to him without him even asking for it. i'm sure she's probably assisted on so many of these cases she could probably do the surgery herself, but it was still impressive.
i heard several horror stories about people passing out in the OR, and i really did not want to be one of those people! one girl told me she passed out...right into the surgeon's sterile field. (she was a primary nurse on my ortho rotation). how embarrassing! i never eat breakfast (my stomach is not awake at 6am!) but i did eat three pieces of lunch meat, (very nutritious...) just to have something in my stomach. looking back i'm not sure if that was such a good idea. once the surgery started, my curiosity overtook my paranoia and i was fine. i like watching surgeries, but i don't think an OR nurse would be the job for me.
one thing that amazed me was watching the nurse anesthetist. he'd complete his assessments (about every 15 minutes) and then go back to his Sudoku puzzle. i didn't think it was that big of a deal really, because his machines would beep periodically if something was out of range. i started to wonder if he was really paying attention to his job though, when i noticed the patient's bag of LR was getting low. the nurse got a new bag and put it next to the old one so it'd be right there when his old one needed to be changed. i watched the bag drain from the "9" mark, to the very bottom, and decided i wouldn't say anything unless the bag was completely emptied. which...about five minutes later, the last drop had been squeezed out of the bag and the drip chamber was slowly draining. i asked the surgical tech if the bag was okay, and she looked at it, and told the CRNA to change it.
on tuesday i went back to the hospital to shadow the palliative care coordinator. i had no idea what to expect from this clinical, but i love the nurse who oversees it, Edie. I got to the hospice house at 8:30am, and we set off for rounds. she goes to the ICU, CCU, CICU, and PCU rounds, and is available for patients to speak with regarding hospice care, if their prognosis is poor, or for palliative care, if they have a chronic disease or condition. i don't think people really understand what the difference is between palliative and hospice care, and tend to freak out a little when someone comes into their room from palliative care.
I thought the ICU rounds were the best. the doctor truly seemed like he was the most organized, and arranged for multidisciplinary walking rounds. it was a crowd, but everyone was on the same page and knew what they had to do. it was the physician, the dietitian, Edie, the pharmacist, the chaplain, the respiratory therapist, speech pathologist, social worker, and two unit managers. i loved being on ICU, and still think that's where my calling is. being in the patients' rooms and actually seeing how much equipment they're hooked up to was a little daunting, but i really like the critical thinking aspect of it, trying to figure out what's going on, and how it's affecting other body systems.
once rounds were done, Edie had an appointment with a patient's wife. he wasn't doing well, and was being kept alive by the machines. his wife was in her mid-fifties, at the latest. two physicians were in the meeting, along with an RN, the chaplain, and Edie. she wanted to take her husband off life support on friday, when her family could be there. she seemed so calm, almost stoic for the first part of the meeting, and i started to wonder about her. halfway through the meeting she broke down, which was hard to watch. seeing other people cry always makes me tear up. she pulled herself together shortly, and we finished the meeting.
i asked Edie about her later on, because i was curious about her coping mechanisms and what Edie thought of them. she mentioned that she'd be worried if she hadn't broken down at some point during their conversations, but seeing that she had, and how well she pulled herself together made Edie think she was coping and not denying the whole ordeal.
it made me somber friday morning, writing my paper about these two clinical rotations for my instructor, and realizing that a couple blocks away, this woman was saying good-bye to her husband...
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