Moved my blog, in case you wondered!

Catch me over at my new URL:

www.careerchangern.com

Thank you!!!!

*sigh* Shouldn't have done it.

I shouldn't have done it. I was looking to see if there were birth announcements from my hospital for New Years babies, and read the obituary.

Mr. Jack died.  He was 69 and apparently died on Friday. *sad sigh.

I'm thankful I got to be his nurse, and I'll never forget him.  I'm so thankful that in between administrations of D50 that I took the time to find him a cellphone charger in our box of abandoned chargers.  I'm so thankful that I could pull up a new book for him on his Kindle to read.

I know his family has a big ol' hole right now.  I'm saying a prayer for him and his family tonight.

In other news, I got called off tonight for low census.  Super rare occurrence.  The order of "call off" is Staff Support nurses, followed by LPNs, followed by RNs.  So I'm last on the list.  Huh, called "off;"  I have to call my House Supervisor at 11 pm to see if I have to go in or not.

Glad I've got paid time off (PTO) accumulated to make up the pay difference.  Wondering what to do with myself now.  I had a 3 hour nap and a big cup of coffee, and like a horse at the gate, was ready to take off in the race...and then I got a call to go back to the paddock and chill.

Actually helped some people in the last couple of weeks.

Sheesh.  I don’t ever remember being as tired as I’ve been this week.  I worked 3 days last week, had a day and a half off, then went back to work 3 days.  And I guess it almost killed me.  I’ve really done little other than sleep since I got off work from Tuesday shift…which is Wednesday morning. (7p to 7a shift).  Last night I finally got 8 hours of sleep in a row, so I woke up feeling like a million bucks.  But I still laid down at 1 and slept for 3 hours.  Helluva nap.  Yaaay, Saturday!

ANYHOO.

Here’s some of the cool stuff I’ve seen recently:

Saved a guy’s life! Non-responsive, took his blood glucose.  So low, the machine told me to get lab back up.  In the toilet, in other words.  Enter my friend D50.  D50, a highly concentrated sugar called Dextrose, comes in a syringe.  A very big piston syringe.  Probably 8 inches long, and as big around as a 50 cent piece, I guess.  My hospital’s protocol is to use half as a life saving measure.  I did 4 syringes!  That’s EIGHT administrations, of this thick, lifesaving, sugar in a tube.  Kinda the consistency of honey.  I was in constant contact with our Hospitalist.  First we started the guy on a D5W drip which is a dextrose (sugar) concentration of 5%.  To no avail.  His body just laughed at that bag of fluids.  Then we increased the concentration.  I hung a bag of D10…which no nurse on the floor had really ever even seen before. Just like you think, it is 10% dextrose.  Comes in a much smaller bag.  Yeeeaaah…NOTHING.  The only thing that worked was the amps of D50. I did this routine every hour (thank God it was at night and I had my other patients all put to bed and no one needed me).  Sugar would test at 40 or below,  I administered D50, either a half or whole syringe, I would check his sugar and in the space of 1 hour, we’d finally climb to 100 (normal) and quickly it would fall again.  Did I mention he was drinking juice boxes like crazy when he was awake?  Throughout the night, he drank 15 juice boxes and two “real” sodas. 

I asked the doc on like my 3^rd or 4^th call and after I had established a little credibility with him, “So what is going on with this guy, doc?  Does he have a tumor sucking up all of his glucose?” (because that could be a real possibility.) But, I’m not an oncology nurse.  I’m a cardiac nurse.

The guy was in for acute exacerbation of Heart Failure.  Turns out, Dr. S told me after googling it (he told me that – cool guy), that heart failure and hypoglycemia sometimes happen together.  Wild.

I texted my boss after I gave report that AM.  I told her that the guy WOULD crash, it was a just a matter of time.  Just a matter of someone not being able to monitor him that closely on Day shift.   He was transferred to ICU, finally.

Jack, my patient, told me “I’ve never been that close to death before.  Thank you for staying with me.”  I’ll never forget you, Mr. Jack.

Then there’s Ms. Juanita.  When your mom, who has never had any mental issues in the 40 years of your life, starts seeing things, falling down, and rambling unintelligibly, you should bring her to the ER.  And once ER gets her all settled, you should admit her to the Telemetry floor where we can watch her heart beat with pretty cool moniotrs.  Because once she gets all nice and tucked into bed, her heart will reach 180 beats per minute and she will be THISCLOSETOHAVINGAHEARTATTACK, and will be even stark-er, raving-er MAD.  Like, crazy.  The new little nurse who admitted her had her on a Cardizem drip.  Cardizem, or amiodarone if you like, is a calcium channel blocking drug.  If we’re giving it as a drip, and especially turned up as high as we had it, it is because we’ve also got the defibrillator pads stuck to her chest, because we’re waiting on her heart to up-and-quit. Because her heart will have to wear out, acting like that.  Now imagine.  That is scary to a non-psychotic patient.  Add a little, ahem, a LOT of psychosis to the mix, and see what fun you have. 

Sodium levels in the blood stream REALLY REALLY affect you.  Sodium shouldn’t be lower than 135. (can’t be higher than 145) Narrow window.  Hers was a very scary 117.  It would seem easy to fix.  Just give her salt, right?  Well, it doesn’t exactly work that way.  We’re also messing with her ICP or intercranial pressure.  Right, the pressure in her head.  And therefore, you have to fix this kind of stuff very slowly.  So she found herself on a fluid restricted diet, and normal saline IV fluids that have potassium added, too.  Because that was screwed up, too.

By the last couple of hours of my 2^nd night, (her 3^rd night in) she was remarkably more “with it.”  Her IV site in the crook of her left arm (ER personnel!  Quit putting IVs there! I love you, but day-um)  was looking very angry, and I was doubting if it was even working properly.  So I yanked it and started an IV in her other forearm.  She had no issues with any of that.  She teased me, when I was unwrapping her AM meds, that I had just better put her pills in her mouth for her, lest these pills go the way of the one last night.  (She had dropped a pill in the bed last night, and we looked EVERYWHERE for the damn thing.  Couldn’t find it, so I just replaced it.)  And now she had a glimmer of a twinkle in her eye, and was teasing me about the lost pill!  How awesome! And she finally was realizing her limitations.  Great sign.  My 3^rd night, another nurse mistakenly walked into Ms. Juanita’s room, introducing herself as the night nurse.  Ms. Juanita was VERY disappointed, and asked where I was.  Because I told her I’d be back and would try very hard to have her as my patient again.  And night 3, she remembered me, the conversation, and even my name!  Turns out, the other nurse had just walked into the wrong room, lol.  But how awesome, Ms. Juanita remembered ALL of that.  She was really getting better.  The last I saw her sodium level, it had come up to 130.  It was evidenced by her being much more alert and oriented. And her heart had simmered down to where she was able to take oral Cardizem, instead of by IV drip to control her heart arrhythmias. 

Ya know, I’m only 5 months in.  And it is very easy for me to already feel like I really don’t do much but give pills every night.  To feel like my nursing is just task-oriented.  To wonder if I really help anyone at all.

I kept one alive and I truly helped another get better.  Happy.

No big New Year’s Eve par-tay for me this year.  I work New Years Day night and this year, I think I’ll just have a low-key dinner with Goatee Man and call it a night.  Happy 2012, ya'll.

11/10/11 Interesting stuff from last night

11/10/11

*Cared for a guy with vaso-Vagal response to coughing, beat up from his fall. 

  So that means he has syncope (passes out) every time he coughs. He finally came to the hospital after he did it 3 times in one day and did a face plant into a coffee table. By the time I'd done my three shifts, he was still there, and no one knew anything more about WHY.  

*Mini emergency : woman in  pain, shaking all over, with an O2 sat in the 30s before we put oxygen on her.  Then 70s and 80s. I was the first to intervene and I did a good job of directing everyone.

*Talked to a doc without sounding stupid, requesting pain medication for one of my patients. 

Grandma went into the hospital yesterday with pneumonia.  Not doing so great today.  Family denied giving her blood transfusions when found out that she had a low 'crit. Guess she's on her way out.

Must be the change in the weather; dropped 40 degrees. We had 3 code blues at the hospital in 1.5 hrs this am, from 4:30-6.  Pretty bad. 

*IV start successful after 2 colleagues failed. 

I just had a flashback to1 year ago in nursing school.  I told my friend who was already an LPN that *I* want to be the person that people come to when they have a hard stick that they cannot get.  In the last two weeks, it has started to happen. * grin of extreme satisfaction

Sent from my iPad

90 days in

11/04/11

It really has been too long since I last wrote about being a nurse.
I'm not sure I've ever really written about being a nurse, now that I
think about it, at least in the real world. As a non-student. And I
just had my 90 day celebration luncheon day before last. It's a thank
you dinner and feedback session with the leadership of Saint Big Dog
hospital that I now work for.

I've gone through my preceptorship already, given nitro pills to acute
chest pain, hung nitro and heparin and cardizem, &came THISCLOSE to
calling a Rapid Response on a patient. I already have patients that
I'll never forget.

Oh yeah, & my dad had a heart attack, had to be defibrillated to be
"brought back," & open heart surgery. CABG x3 or coronary artery
bypass graft...or triple bypass to all my nonmedical readers. That
was a hell for a way to get a lot of first hand experience as a
Cardiac Nurse, I assure you. (he's recovering very well, btw.)

Some of the most outstanding patient stories, good and bad, will be
mashed up, obscured, and details changed so I can retell them here in
this blog.

I just got off my first shift as Charge. Whoa. Oh yeah, AND I work nights now.

I'm holding my own, ya know? *proud. I'm getting good feedback from my
patients (sometimes from my patients to my managers!) almost daily.

I'm gonna try my hardest to live up to that.

Sent from my iPad

Orientation and old

1st day of orientation at Saint Big Dog went very well today. Policies, procedures, HR, & assorted hoopla. A poorly catered lunch of fried food ( this IS the south afterall) that tasted pretty good because it was free was our mid-day break.
Risk management ended our day with a video that made absolutely everyone cry - a med error that killed a sweet little boy. Then we adjourned for the day... Except for nurses. We were all fitted for TB masks.

I don't remember getting that hot and claustrophobic when I was tested in nursing school. But the lady today was WAY more thorough. It was a 7 minute test. If she hadn't kept talking to us, I may have panicked. No kidding, I have difficulty, big-time with even surgical masks. Breathing hot air gets to me somehow.

(Sidenote, my indigestion is ridiculous right now. Can't wait for my insurance to kick in to see if I've got raging H.pylori or what. Anyhoo. Chamomile tea, down the hatch. )

Then I went and had my ID made. I have my trademark extreme-cheese-grin but my eyes are open too wide...total deer in the headlight look. Yay for goofy IDs that I have to wear forever.

But...since my temp license was issued Friday...my namebadge says 'RN.'. Not 'bsns' that I was all last year in school, not even GN for grad nurse. RN.

Happies.

Sent from my iPhone

Pinning! Graduation!

A huge homemade cinnamon roll sits in front of me.  The first bite; disappointing.  Nothing much more than bread.  Thank God I went for bite #2.  Butter rushed out and into my plate for dipping.  MMMM.

What’s that got to do with nursing?  Not much.  But I’m sitting in the coffee shop/internet café that saw me through MANY MANY hours of studying over the last year.

I can’t believe this…GRADUATION IS TONIGHT! (mmm, cinnamon roll!) I’m not walking in graduation.  Really not into that until I get my doctorate.  But my Pinning Ceremony was exactly one week ago, and that was really, REALLY awesome.

I guess I’m really in a state of denial.  I. AM. DONE! (wow, I’m REALLY making short work of this mammoth cinnamon roll…) I haven’t seen any of my friends, except for one that I helped move out of his apartment day before last with an outside temp of 105. Heat index was around 119.  Sheesh.  But as far as my friends go, I guess I just feel like I did during May Interim.  A little isolated, but we’ll all be together again soon…only we won’t.  I’m not depressed right now.  I think I will have to be later, but I’m not yet.

**

There is a group that meets to practice 2^nd languages here in the café.  Today is Spanish.  I understand every 5^th word.  I just looked up to see someone taking a picture of me (well, in this general direction) with an iPhone.  Strange.  LOL  This cinnamon roll is going to give me heart palpitations.

**

Pinning was beautiful.  Most of our instructors were in attendance, so that was nice.  There were only 22 of us, so it would’ve been easy for them not to come.  And the two that our class nominated for awards were NOT in attendance. Lol

I asked Dr. Community Health to do me the honor of pinning me.  My last name is at the end of the alphabet, so she thought she was all done pinning her group and had to come back on stage to get me; dead last.  I told the audience that we were giving her a workout (pedometer counting is a BIG deal to her, so my sister and brother pin-ees thought that was pretty funny.)

Overall a very nice ceremony.  My favorite teacher, the one who kicked off the program with Essentials and Fundies, had one HELL of a time with the Nightingale Pledge she led us in at the end.  That was pretty effing hilarious.  Apparently, most nurses don’t know the word ‘deleterious’ or how to pronounce it. Bwah-ha!

I was in charge of the actual Pins and of course, IT for the whole show.  We had a pretty fun slide show of our pics and random FB quotes throughout the year playing before pinning, with some fun music, like my beloved GaGa’s “Edge of Glory,” James Taylor “You’ve got a Friend,” and ….eh.  Can’t remember the others.  We processed out to a great one though; “WE ARE THE CHAMPIONS.” Funny.

My goofy Goatee Man missed a happy-pill the day before, which always precipitates about 1.5 days of mania.  I’m not kidding.  He showed up late to my pinning.  At least he channeled the energy well.  He had shaven, was wearing nice clothes, and grabbed up my digital SLR camera and shot the whole ceremony as if we’d hired him to do so.  (GAWD, I am too effing full.  Cinnamon roll gone.)

I was so pleased with the people who showed up to share my success; Mom and Dad, Goatee Man, and some really dear friends of ours that live 1.5 hr away, Tim & Michelle.  I can’t *believe* they came, but how cool of them. Also, my niece and her husband came.  My niece is only, like 2.5 years younger than I.  We just celebrated her graduation in May.  She is a history teacher now, and is going to be teaching Special Ed about 30 minutes from here.

I don’t use the word ‘blessed’ too much, because I associate it with some of the hokier sides of churchy-people (a whole ‘nother blog post), but I gotta tell ya; having all those people there for me made me feel blessed.

***

This is another thing about living in a town where there is a lot of bible-belt hokieness…I just took my plate to the counter, leaving my computer, keys, and iPhone unattended here at my table, and they’re all still here now that I’m back.  How ‘bout that.

Ugh.  My strange nurse-ness just came out.  I saw an old friend acquaintance just now who said that they were celebrating their kids 1^st year birthday, and what did I say? “Congratulations, you made it through your first year!”  Ugh.  To self, "What happened to Happy Birthday, you freak." LOL Nursing will definitely change your perspectives.  I really meant it.  I’ve seen a lot of sick little kids this year, ya know?  I at least thought to say Happy Birthday as I walked away.  *shaking my head at myself.

***

After pinning, we went to a local pizza place that really looks and feels like a very upscale club.  A guy named TONY SPINNER was playing.  If you don’t know him, Google the band TOTO, ‘k?  A few weeks ago, my band friends (who are friends with Tony) invited me to their practice room to their little jam session and I got to SING. With Tony Spinner. Too cool.  And way cool to see him out and about a month later and he remembered me.  Don’t know how long he’s in town for.

So Tim, Michelle, Niece, Nephew-In-Law, and [Manic] Goatee Man and I had a decent time at the pizza joint, largely due to Tony Spinner and Gin & Tonic.  I was home, in bed, by 11 pm.  I was exhausted from all the running around I had to do with sound, lights, and computers for the ceremony, but it was all worth it.

I am now a Graduate Nurse.  Better than Student Nurse, fo sho, but marginally.  Going to start studying for boards this coming Monday.  Yaaaaaay HURST REVIEW.

Back to School aka Crap You Need.

Back to School Shopping

or

Stuff that I *NEEDED* to get me through School/Clinicals/Life this past year

Stuff I bought, borrowed, and otherwise acquired, and would recommend you do the same…..

As a Student:

• ·         Netbook computer with added RAM (that’s memory for you non-geek types).
• ·         Open Office (word processing suite) that is a free, safe download if you don’t have free Microsoft Office available to you from your University IT Department. My U also provided me with a free copy of Windows 7.  Ask around and see what your exorbitant tuition might include.
• ·         Smart phone
• ·         Smart phone apps, such as Davis’ Drug Guide (which comes free when you buy the book), Epocrates, and Resident Helper.  Resident Helper has all the normal lab values and what the different labs tell us.  REALLY great.
• ·         Wireless mouse for the Netbook.  Ups your productivity by at least 50%.
• ·         A free account with Dropbox or Box.net   Both of these are online storage in the cloud.  Put another way, quit carrying around your antiquated, easily lost flash drives, jump drives, thumb drives, memory stick, etc.  Store your files in the cloud where they cannot be lost or stolen (well, not too easily anyway) and if you’ve got internet, you can access all your files EVERYWHERE.  You won’t even realize how important that is until you start using them.
• ·         Springpad.  Also free.  This is the best task manager, to-do list, place to upload important documents AND tag them for easily searching for them again later, and it all resides in the cloud.  Springpad takes a second to set up, I’ll be honest, but you can make it as complicated or as easy as you want.  I would NEVER have made it through nursing school without it reminding me of when everything was due.  I set all my reminders to the day before.  They even push notifications to your iPhone, and I’m sure to Droid as well.  Free.  We like free, don’t we, poor-nursing-boys-and-girls?

Stuff you need for Clinicals aka actually getting to practice Nursing:

• ·         Okeeffe’s “Working Hands” hand cream.  A little dab is enough.  Latex-compatible (if your facility is stupid enough to still use latex).  Very important to keep your skin in good shape, just like we do for our patients.  Too many buggies in the hospital, just waiting to invade a split in a fingerpad or abrasion of the palm.
• ·         Littman Lightweight II SE stethoscope.  Cheap. I paid <$50.  I can hear pretty well with it. Doesn’t break my neck when it is resting there, and doesn’t hurt my ears when I’m doing my assessments.  I’m even sticking with it after school.
• ·         Ryka tennis shoes for women.  Very nice for we girls and our typical over-pronation problems.  Check ‘em out.
• ·         DANSKOs.  These aren’t ‘comfy’ shoes.  They have a very rigid arch.  But if I don’t wear ‘em, at the end of the day, my feet, knees, and back are killing me.  They just take a little bit of a learning curve.  Completely different than what Americans are accustomed to, shoe-wise.
• ·         Non-stick bandage scissors.  Look on Amazon.com  About $15.  Wish I’d had them all year long.
• ·         Your own pair of hemostats.  No, you’re not going to be clamping vessels.  But you are going to see how handy they are for disconnecting IVs that have somehow clamped themselves to the pump.  Or taking pesky tubing off the IV still in your patient’s arm when they need “hep-locked” for a bath or for PT. Or Or Or.
• ·         Rewetting drops for you contact lens wearers.  When you are running up and down the halls at top speed as you will be doing during clinicals, your lenses will catch all that air and dry out.  Or invariably, something will get between your eye and your contact.  Have the stuff in your kit. Seriously.
• ·         Burt’s Bees chapstick. Even comes in colors now.  Nice to have a hint of color without having full makeup on.  I’m not against full makeup in the hospital, but…many nurses you work with will look at you pretty suspiciously if you come too ‘pretty-girl.’  A little mascara and a hint of color on the lips is enough, and is professional.
• ·         Imitrex.  That is gold for you migraine-sufferers.  I’ve had ‘em for the last, I dunno, 15+ years.  Keep one in your pocket.  Don’t broadcast it.  If you start to get your warning signs or aura, go to the bathroom and take it.  You can’t miss clinicals, and your instructors don’t need to know you’re taking meds.  It’s not a narcotic, for god’s sake, and it will keep you acting as a safe nurse, instead of a headache-impaired-nurse.

Stuff that I just like, in general:

• ·         Toms shoes.  Aren’t they fun?  And our materialism is slightly mediated by the donations they make, so yay!
• ·         Burt’s Bees Milk & Honey lotion.  Fab Fab Fab!  And any other assorted Burts products are generally on my fav list.
• ·         Germ X hand sanitizer.  I like that brand because it smells good.  Not all of them do.
• ·         My Keurig coffee maker.  Can’t get through nursing school without a daily caffeine infusion.  I love Newmans Own in coffee and Celestial Seasoning’s tea.
•  

And Oh yeah…get an Amazon Prime account!  Totally important.  And they give it to you free or cheap when you start school and sign up with your school email addy.  Do it.  Textbooks are cheaper on Amazon than at your bookstore.  You can have a textbook shipped to you in only TWO DAYS for free after your Prime membership fee.  Or OVERNIGHTED for only $4.  This will save your ass sometime, trust me.

Happy Back to School Shopping!

ICU last week was actually good.

I previously have [nearly] hated the teacher who was our clinical instructor.  She was pretty alright this go around, I must admit.  By the way...her last name starts with an 'A.'  I think it is hilarious that the class sometimes calls her MRSA. (Mrs. A.   MRSA is methicillin resistant staphylococcus aureus.  A really bad infection causing bug. HA.)  Now to see how she graded us last week.

I worked at a different hospital for this clinical and they have a really good team in ICU.

If you've never been to an ICU before, many are set up like this.  Private rooms, secluded by sliding glass doors and/or curtains, with a dedicated table in front of each room for charting and for nurse perching.

My clinical experiences were with a woman who was heaven-bound in the throes of Septic Shock, who was very low on the Glasgow Coma Scale, a woman in CVICU post Femoral-Popliteal graft surgery, and a woman who let bronchitis/sinusitis go too long and ended up very dehydrated which caused Acute Renal Failure.

Thank god this very educated, prim and proper mother started hallucinating and talking about crazy stuff, or her kids may never have made her go to the hospital.

Lets see...what all did I see....
When you're dying of Septic Shock, you may third-space all of your fluids.  That means fluids aren't in the veins (vascular space) and your kidneys no longer work (organ failure), so you're not peeing it out.  So it seeps into your tissues until it weeps out of the skin or splits the skin.  I was glad she was unconscious and had plenty of morphine ordered.

Fem-Pop graft surgery may change your life.  If you have intermittent claudication (pain from lack of oxygen getting to your extremities) ask your doc about this surgery.  My patient who had this was really doing well only 1 day post op.

Dehydration is serious.  SERIOUS.  Please don't kill your kidneys with infection and too little water, thanks.
If you do hurt your kidneys, I'll be forced to give you Sodium Bicarbonate.  Heh, that's the same stuff as Arm and Hammer, you say.  Yes, you're right, but putting that in a vein IV is pretty darn painful.  The sodium bicarb is to help you not be acidic while your kidneys are unable to do that for you.

Not my patient, but saw a woman decompensate before my eyes.  That was full blown Metabolic Acidosis, and she had no blood pressure.  Pretty exciting.  Everything was just like they taught us in class.  Rapid, deep breathing (Kussmaul breathing) to blow off all the carbonic acid from the acidosis.  We put her on her head (in bed, head lower than feet, "Trendelenburg" position) to try and get blood perfusion to her brain.  She had a non-rebreather at 100% oxygen, and as they said, she kept trying to pull it off, saying she was smothering. We had to keep trying to tell her that she MUST keep the oxygen mask on.

The nurses got her going again, after the Hospitalist came down and ordered a couple of code-type drugs to be pushed.  Except she wasn't in a code yet, so there were some questions.  And then there was the almost-mishap in which the nurse pushed the med but did not flush the line after putting the med in the line...So the patient did not get better right away.  Thank god she had fluids going and the fluids eventually flushed the medicine from the line and into her body.
It just goes to show how crazy things can get when a patient is circling the drain.

Oh, also, if you insert a PICC line into a patient, and the tip should be in an Atrium, and it ends up too far in, in a ventricle, you'll have a patient in V-Tach...one very small step away from getting a shock to fix the heart.  7 x-rays later and a pull-back on that line TWICE, the guy's heart quit with all the irritability and beat normally.  Yay!

Also, when your mom was almost dying, treat your nurse with respect, you high-and-mighty-investment-banker types.  You never know...your nurse may have been one, too.

A post to a friend about something I was glad to know I wasn't the only one was experiencing...

Originally Posted by XXXXXXXX
"... I felt clinically and scientifically neutral, I recognized it as a learning experience. However, another part wonders if it was normal for me to feel virtually nothing. Am I in shock, professionally mature, or just plain cold? I should mention that my behavior with new experiences has been very strong and I am always surprising my self. In nursing school I have seen, smelled and done some very nasty and gruesome things. Most of the time I was aware of what I was about to do or witness. I would panic at first and then tell myself its part of the job, just do it. When it came down to it, I have always done the difficult job as if on autopilot. When I was done, I would be surprised that I was not crying, vomiting, fainting, scrubbing my eyeballs etc. Maybe that strength is included in seeing the dead body? I am just confused about my experience. Any thoughts, comments, similar experiences appreciated."

Me:
I really REALLY appreciate your post. I can relate to the question of shock? maturity? cold?

I have recently been questioning myself, too, in regards to an afternoon in the med room with another nurse and an extremely dehydrated 2 month old. I was at first worried about participating in the cath and IV stick, and yet, when it was time to help position and hold him down, I went into auto-pilot, much as you mentioned. I felt nothing. (being honest.)

I came home and cried later...not because of my nursing actions, because I knew getting fluids running had already helped the little fella. I cried because I asked my husband, "What kind of monster doesn't hurt inside when doing a procedure on a baby?" And of COURSE, I didn't want the baby to hurt, but I knew that the end (re-hydration) justified the means (an IV start.)

Anyway, I fought the same feelings you're expressing about seeing the deceased and wanted you to know you're not the only one. It helps to just talk about it and debrief a little. We're not cold; we're doing our job and helping people...and many can't do what we do.
Hugs,

Update 2 of 2

So I got to do 2 12 h shifts in the ER.  LOVED IT.

There is such a swagger, a don't-stress-out-about-this-sh*t attitude there, and I was instantly in love.
When the floor realized they had a willing student, I got 8 IV starts and I hit 7.  What a confidence boost!!!!!  I've not started IVs in like MONTHS, seriously.
I learned how to do blood draws with the vacuum tubes, butterfly blood draws, and set up chest leads for EKGs.  I gave injections, pushed a helluva lot of Dilaudid (super great/strong pain med), I coordinated with CT on people who were finished with their Contrast-Lemondade, and I discharged patients.
A total blast.  I didn't have any patients who had extreme trauma, so I don't know how I would've been in that situation, but I did get to help set people up with severe chest/abdominal pain in the triage, slamming bp cuffs, leads, oxygen, you name it, on folks to determine where we're at.  LOVED IT.
(side note: I also applied to the ER, but they are done hiring new grads there for the minute, and so they told me in my interview that they would be declining me on that. Fine.  I've got a lot to learn; may be best to learn it in a less extreme environment.)
So for ER, they had us do 11a to 11p so we'd get to see lots.  Because a lot of the best stuff creeps up in the night. ;-)
And it did.  We had a tweaker who had rubbed all the skin off of his nose (crank-bugs, anybody?) but was there for a real reason; he'd had abd surgery a week ago, didn't rest after the surgery (tweaking!) and now has probable infection.  That crap gets serious in a second.  This was my miss in the IV department.  Hard to hit a vein when they are all burnt up and gone.
We had another suspected psych/tweaker who claimed to have suicidal ideation...who was bored and decided to put an insulin syringe in her vajayjay.  *sigh.  Really?  The on-call doc spent 15 minutes trying to convince a nurse to do the pelvic exam, lol.
The verdict?  NOTHING.  I know, right?
Anyway, I love the craziness, the crazy people, and the fast pace of the ER.  Maybe I'll work there some day.

Which almost brings me up-to-date.  In between all the good stuff I've posted about, I've been doing Med/Surg on a Bone and Joint floor.  I actually like it quite a bit, but I do not want to do Med/Surg, really.  Heh heh, looks like I don't have to, huh? (though I know that Sainted Big Dog Hospital is really bad about floating nurses from floor to floor, so I may do more than a little Med/Surg afterall...)

I had a day in Simulation Lab to learn how to hang blood and watch for transfusion reactions.  I also got to learn Central Line care and how to do blood draws from Central Lines.  Cool.

Now I'm in ICU.  They save the most critical patients for last, and as you can imagine, that is the smartest way to do it for students.  The crap I thought was hard 7 months ago doesn't hold a candle to 1:1 care of an acutely ill person in  ICU.
My first week of ICU was this past week and my little old lady was pretty much palliative care only. (YES. = comfort care only)  So I got off easy the first week.  No, I'm not happy she was almost dead, I'm just saying I was able to get all of my nursing tasks and my mountain of paperwork that Ms. Acute Care teacher requires each shift.
Poor patient.  You name it, she had it, and she finally just couldn't fight anymore.  She had cancer and the treatments pretty much left her susceptible to the really CRAZY sh*t that only people with full-blown AIDS get.  In a week's time, she'd gone from just ill and confused, to completely unresponsive to anything but pain, and only then would  moan.  She was in Septic Shock, which at that point, you have multi-organ failure...and you usually don't come back from that.  So I kept her weeping extremities dry and bandaged, and kept her morphine coming, and that was pretty much my day with her.  I had lots of time to do the stupid paperwork for my instructor.

PRECEPTORSHIP
So that is the final block in the wall, the final jewel in the crown, ha.  Pick someone in nursing to follow around.  I have a friend who is a Nurse Practitioner, and she was an easy choice.  She works in Internal Medicine and huge practice and it was REALLY neat to follow her Friday.
We saw a crap-ton of upper respiratory/sinus/ears problems (for which I have a crap-ton of steroid shots), a case of Bacterial Vaginosis, a huge mass on a shoulder, and a 40 something woman who is rapidly losing her ability to breathe. She got a CT - hope I get to see the follow up on that.
Monday, I'll follow a doctor's RN from the same practice (thanks to my NP buddy for setting  that one up) as she makes hospital rounds.  I have really wondered about how that works, an RN making rounds...as opposed to a Nurse Pract.

So I've got RN hospital rounds and a pee test to look forward to tomorrow on my 'day off,' and then 3 12 hour days in the 60-degree ICU, followed by another day shadowing my NP friend on Friday.  Busy week.

July 2011, already? Update 1 of 2

Gotta do another 'catch-up' entry.
I helped welcome the new Accelerated BSN class at my university.  Can't believe that almost a year has gone by and now I'm giving info to the next hopeful and excited class. ;)
I gave them good info like BUY A PARKING SPOT (super limited at my university), actually study, etc.  It was fun.
I applied to 6 jobs.  I applied to 2 jobs that are an hour away, one in Respiratory nursing, another in Transplant.  Hey, shoot for the moon and be happy with a star.  3-4 weeks later, got  the ol' rejection email.
I also applied for a job at St. Jude Children's Research hospital.  Super glad that I was "not selected."  I got to spend 2 days at my state's own research hospital, and while is is an AMAZING hospital, and a ridiculously AMAZING with kids, I hate it.  I'll go into the whys sometime. :)
I applied at a local hospital's One Day Surgery/PACU.  It was only a part time position, but I REALLY loved PACU (see above posts) so I thought, "hey, good foot in the door."  Yeah...still haven't gotten a call from them.
Which leads me to Sainted Big Dog Hospital.  They told us in a recruitment luncheon, that they would be actively pursing our class of Accelerated students, and she wasn't kidding.  I applied on a Friday night and received a call Monday morning at 9 am!!!

The Interview
I interviewed the following Friday.  Talked to the HR/Nurse Recruiter lady for an hour about my past work experience, best parts and worst parts of me, times when I was able to work through conflict, yadda yadda.
Guess she liked me.  She had me watch the Big Dog customer service expectation video, and when it was over, retrieved me from that room, handed me a packet of drugs and calcs to know for an exam, and asked if I had time to  meet the manager of the Unit I'd applied to.  ErrrrmYES.

So she walked me up the hill to the hospital and to that Unit and I had another interview on the spot.  This manager seemed REALLY cool.  A really great conversation, even if I *did* get a little excited in talking with her.  She seemed not to mind, and even commented that she thought that I was very much a people-person (indeed!).
The verdict?  She offered me a 7p-7a position right on the spot.  YAY!
I'm going to be working the Clinical Decision Unit.  It is a unit for people who aren't sick enough to still be taking up real estate in the ER, but the docs/nurses aren't comfortable with sending them home just yet, either.  A lot of it will probably be late night chest pain, and holding them until AM for stress testing.  That's ok by me.  Manager says that they TRIED to have this unit in the past, but it really just ended up being an overflow.  They shut it down, did the research, and are trying to do it right this go-around.  I think that is why they brought her on board; to start it.
So yay, I think I'll be able to see a lot and see it fast in this unit, and I'm SUPER excited to already have employment.
Tomorrow, I go in for the obligatory pee test, physical, hand in my mountain of paperwork and copies of cards (cpr, social security, etc) and take my darned meds/calc test.  I am fine at dose calcs but it does make me nervous.
They are giving a huge leeway.  You can make an 80%.  Which I can't believe, because you're technically killing or harming 20% of people, but it definitely is in my favor.
I told my classmates on our private group page on Facebook that I had a position, but I'm not announcing to the world until tomorrow is all done.

Wow, I saw a lot of shit this week.

Week in review

Tues at PACU

*TEE (transesophageal echocardiogram)
*Cardioversion (shocking someone to make heart beat in proper rhythm...in a person who didn't gave fatal arrhythmia.
Should be done in those who could have better quality of life from it. This lady had terrible skin wounds, morbid obesity, & renal failure.  I'm like, really? Funny beats were this lady's lowest priority. We got her out of arrhythmia, alright, but she was so bradyed down (slowed) she wasn't hardly getting blood around. (perfusing).
*Art line (arterial) in wrist
*TURP (trans urethral resection of prostate)
Murphy drip (major irrigation after *TURP)
*Dopplered a lady's pedal pulses after total knee

Wednesday

*Personally tried/failed 2 IVs for lady in renal failure
 (made me feel better when 2 other RNs failed. She's in renal failure for crissakes, & has no veins).
*Miscommunication with primary on meds, gave meds late. Boo.
*Gave 40 meds. FORTY. IN. ONE. DAY.
*Learned more about sickle cell crisis as I cared for a guy w/ it.
Sickle cell guy was *arrested* in the hospital! lmao. What a day.

Thursday

*Discharge on terminally ill guy ( who got the majority of yesterday's 40 meds), who hugged me and said he'd remember me. (aw!)
Pedi experience:
*Post surgery care on girl who just turned 16 & had a near fatal car wreck.
(She had a 'headband' of staples from ear across head to other ear. Way better through the hair than on forehead, scar-wise. VERY important for 16 year old, too.)
* Discharged her home, yay! I think she'll be ok.
*Assisted w/ 2 failed IV starts on a toddler
*Assisted w/ 3 failed in-and-out caths on infant. (on a failure-to-thrive baby)
*Assisted w/ 4 failed IV starts on same infant.
*Saw first hand how well sucrose drops work for pain relief in babies! Short term, but oh-so-helpful in procedures.

(He was bone dry. We fed him 3-4 oz of formula, a LOT for such an itty bitty...& then he projectile threw all of it up. Poor little guy.
Baby's 2nd admission in the last couple weeks. His mom was feeding him sugar water. Only. Not formula.  Grrrr!)

So it was interesting working on & with  children this week. Still sorting out how I feel about it.

Really great week, experience-wise.

I loved PACU!

And today, off to the pediatric/urology/ where-we-put-you-when-you're-dying-huge-private-room Floor today.

I applied for a Pedi job recently, so I'm hopeful I actually get a pedi patient to see if I actually like it.

:-)

At 144 lbs today. Yay!

Nursing school updates and "Scared Straight"

Howdy. :-)  So I'm now in 3 days a week, 12 hr day clinicals.  I have one online course I'm taking ("Professional Role) and lots of papers and paperwork with Clinicals.  I'm SO like...really? on the paperwork with clinical. But whatever.  I graduate in approx a month and a half. Double yay!

I'm applying for jobs too.  And for the life of me, I applied to a Pediatric Oncology position at a major children's research hospital.  I don't know why.  I have never felt like Peds was for me, but when I saw the job, I just thought I had to apply.  I have pediatrics this week in clinical (well, 1 day PACU and 2 days Peds) so maybe that will add some clarity to the whole thing.

That hospital is 1 hour away from home.  I guess I can commute.  My niece lives 35 minutes beyond the hospital. Who knows, maybe she'll allow me to rent a room 2 nights a week?  The husb better get ready to take care of the fur-babies, then, huh? ;-)

Hmm, what else...?  I got an 'A' in both of those horrific online classes I took in May.  WhewThankGod.

Went to our State Board of Nursing to see a hearing last week.  Also required for our program.  Kind like the show, "Scared Straight."  Keeping the new nurses on the straight and narrow, lol.
Well, the only woman who showed up was in contempt of her SECOND probation.  And they did not revoke her license.  They listened to her, gave her stricter criteria, and extended her probation.

Really? You can keep your license after failing a drug test during your probation?  This lady actually had extenuating circumstances.  She is prescribed an amphetamine for her fatigue due to MS, but she did test positive for alcohol, which she explained was Nyquil.  *shaking my head.  I dunno.  That is a hard call to make.

Two other people were 'tried,' but they didn't bother to show up.  So they were suspended.  AGAIN, not revocation, but suspension.  I just don't get it.

So some of our class asked at the end, when we were allowed to talk to the board.  They pretty much just said that revocation is FOREVER and so they are extremely reluctant to revoke.  Wow.

In other news, I'm doing the Dukan diet.  Down 2.6 in 2 days - Yay for me!