Online classes; no stranger.

I've taken a disproportionate amount of online classes. My first BS and MS degrees (bs...ha!) were from the best online college, Western Governors University.  (they really are the best; they keep winning awards to substantiate that claim.)

So I knew that these classes, Health Care Admin and Research, had great potential to be huge pains the ass.

Well, they are. :-)

You really end up doing a LOT more work in most online classes. Where an in class discussion would suffice in the brick-&-mortar world, online you get a project.
X 5 days a week (seriously) & then X 2 classes. A lot of it is busy work, too.

But I do like Health Care Admin because it is the business side and, well, up until this year, I've known nothing but business.

I was asked to take the Myers-Briggs personality test. (its a Carl Jung test, really.)

I LOVE stuff like this, and I've taken it before, so I couldn't wait to see who I was NOW.

I took it twice. *blush
I was ENTJ and then ENFJ. ENFJ is what I was the last time I took it. I feel like that is probably me.

I'll post info on what that means next. I'll post a link to the test, too.  REALLY cool for self discovery and for understanding others. I really believe in the stuff.

Well, I'm off for now to look up a clinical research article, write a paper on the ORID method, and join discussion board debate on delegation of an LPN.

Bored.

So as predicted, after a few days of luxurious NOTHING TO DO, I'm bored/depressed. Boo. Class, albeit ONLINE, begins again tomorrow.

So posted next will be a photo of my rescue doggie, LoLLie the Bichon, wishing me a Happy Mother's Day and trying to cheer me up.

Mini Break!

No class until Monday! And then no GOING to class for a month; two online courses for May Interim.

*Exceptionally happy at the moment.
In a couple weeks I may be depressed from not seeing my nursing buddies, but today I am super happy to be downloading wonderful World music, drinking Diet Mr Dew, and re-polishing my "now-that-I'm-a-nurse" resume.

I've had a low-lying headache for the last 3 days (I get one every month, mid-month.) I wouldn't categorize it as migraine, because I get those, too, complete with photophobia and phonophobia (light & sound sensitivity) for you non-medical types put there. But lasting headache it is, and Imitrex (migraine med) usually fixes it. It just exhausts me to take it. Yay for days off!

I have an appointment with the Dean o' Masters level nursing at my local university tomorrow. I really want to go straight through to grad school. To be completely honest, I want to do the very minimum of beside nursing possible. (subject to change this summer...when I actually get to act like a nurse instead of a patient care tech. PCTs are fab in their own right, but that's another post. ;-)

I could totally do clinic nursing, though...I'd love that as an RN. But what I *really* want to be is an advanced practice nurse...& I'm seeing Dr. Schmidt to figure out if it would be best for me to be a Nurse Practitioner or a Clinical Nurse Specialist.

See my next post for an examination of the two roles. :-)

OB Rotation 1

Here’s my paperwork that I had to turn in to give you an idea of what it was like.  Forgive the bullshit and the formality, won’t you?

       I arrived shortly after 07:00 and was assigned the patient mentioned above.  By 07:45, I had written down my patient’s history and started working with my assigned primary nurses.  One of the two nurses, Carlee, is a new orient herself, so she was very good for me to learn from as a nursing student; she was great at showing me things and teaching/explaining things to me throughout the day.

     At 07:45, I started patient care with my primary nurses.  I introduced myself to my patient, and then Carlee showed me how to increase the Pitocin running through my patient’s pump. We went in and increased it by 2 milliunits every 15 minutes all day.  Carlee allowed me to increase it all morning with her observation.

     The patient’s doctor broke her water with a fetal scalp monitor and then placed the monitor.  I was told that this doctor prefers to do this on most of his patients.

     The patient planned for an epidural for pain management and was ready for one midmorning.  We hung a Liter of fluid before the anesthesiologist administered the epidural. (I’ve learned that this is to help avoid a major hypotensive episode.)  Anesthesia doctor was great to the patient and was an incredibly good teacher to me, as well.  He talked me through his whole procedure and showed me that he did a combination spinal/epidural.  He explained the spinal portion gave more immediate relief; the epidural was for long term and had a catheter for administration of more meds later.

As far as support for the patient, the patient’s husband stayed at the bedside all day, though he slept most of the time.  He was also unable to stay for the spinal/epidural, but I think that was more out of being squeamish, and not a lack of support.  One set of the grandparents-to-be visited for a short time as well.

     The patient seemed to be coping well all day.  In the afternoon, she requested more pain medication which was administered by a SRNA.  When we asked her a pain scale, she said that she wasn’t experiencing pain, but much more pressure than she had earlier.  I also observed that she had a cough, but she wasn’t on any antibiotics or other meds for it while I was in clinical.

     I got to do an in-and-out cath on her!  I have only done ‘foley’ catheters, but my primary nurses assured me that the procedure was the same, just no balloon and removal of the catheter right after the bladder empties.  I was really glad they allowed me to perform the procedure. 

     I explained to the patient that it should be done because she wouldn’t feel the urge to void.  I also assured her it would not cause pain, (it really shouldn’t have for her because of the epidural) what the procedure consisted of, and that it would take longer for me to set it up than to actually perform the procedure.  (in the patient’s chart, she stated she learned best from 1-on-1 instruction.)

     I pulled the curtain for privacy, put on the sterile gloves, and felt great to be doing something that would keep the patient safe from bladder distention.  Christy, (the other primary nurse) talked me through it and really helped when I had a bit of difficulty. (side note:  I got to do another right away on the walk-in patient we were also assigned to and I felt really good about it.  No problems at all with the 2^nd one!) Christy also explained to me that this could possibly help the patient with her lack of progress in dilation; it would keep the bladder from potentially adding pressure that her body would have to work against.  I measured her output in the ‘hat’ in the commode, and Carlee charted it on the computer.

     I brought my patient ice throughout the day, since that was all she was allowed.  I changed her pads on her bed several times throughout the day.  Several times during the day, I asked her what I could get or do for her, and only one time did she request anything; more ice.  She was a quiet and reserved patient.  It was hard for me to tell if that was her personality or if she was a little unsure of having a student involved in her care, but she seemed to come around a little more after the nurses allowed me to do her cath.  I completely understood.

     At the end of the day, I observed Christy checking the progress of the patient’s cervix.  By the time I left the floor, 15:00, she had changed very little and was around 2.5 cm dilated. 

     I was also involved in the care of two walk-ins:  one was sent home, and one who came in dilated to 4. It was a busy, great day!

So, the patient I was assigned to was a bitch, but whatever, I cath’d her anyway, LOL.  She may have just been apprehensive, or maybe she was snotty because she was a speech pathologist who was already secure in her career.  Who knows?  I was terribly nice and helpful to her, so I have no regrets at the end of the day.

What I didn’t get to talk about was my walk-in.  This girl was FUN-NEEEE.  She works in the cafeteria in the same hospital.  She came in dilated to a 4 already, membranes ruptured!

She had a party going on in her room there at Hospital-of-Changing-Church-Affiliations.  There was a conversation going on around me and the two primary nurses I was working with. Something along the lines of, “Well, it’s gonna be a boy, because she was on TOP.”  And much laughter.  And I didn’t know if I could laugh with them or if I was supposed to maintain my professional distance, but my GOD, you can’t write this stuff.  The girl was like, “Can all ya’ll be quiet until my 3 nurses leave, please!”  She was laughing.

And I was smiling.  Her *3* nurses; me included!

I hope she ended up ok.  We had meconium by midmorning and we started amnioinfusion.  And when I took her temp at 14:00, she had one at 99.1.  Hope that little baby boy ended up ok.

That was a good day.  A good day indeed.

Do I really want to go into nursing?

So I’m traveling with the bank today…well, tonight.  I was pissed as hell yesterday.  All day, I knew that my overly sanguine boss would not think of making plans for this sub-region of our bank until the last minute. 

I have chemistry due every other night since I am taking a freaking summer school class.  I was hoping to fly under the radar and stay home.  Not so much.

At 5:45 last night (yes, unplanned working late because no one was prepared with the presentation we had to start using the NEXT DAY) she, in her passive aggressive way, told me that she wanted me to go to one of our sub-regions.  Tomorrow…which is today.  GOD that pissed me off.  I like to plan things at least a day ahead--at the least.  With chemistry looming and a very sick little Taterdoggie (started heartworm treatment yesterday) I did not want to make this trip.

But last night, I got all of the Chemistry work done that was due today. That changed my attitude MUCH for the better. I got up extra early this AM and showered, got ready, and packed.  Very low key.  My first two training sessions I held today went very well.

So I am traveling on the banks dime, by myself, and feeling pretty satisfied about it all.  And I have had a couple of dissenting thoughts about my future plans.  What if I just stayed in my current job?  What if I did not go to nursing school?  I am really having a good time right now, having a place of influence.  I’ve been in this position for almost 2 years, so people are starting to trust my work and my word.

Even in this crazy line of thinking, I couldn’t convince myself to back out of nursing.  But I couldn’t convince myself completely to NOT back out.

Why would I do this to myself?  All I’ve been working towards, just to up and stop the process?

I drove to the nearest wet county so I could have a couple of drinks with dinner after work.  To Goatee Man, in a very dry voice, “Help, Help, I’m spending the night in a dry county!!!’  I actually had to drive 35 minutes to get into another county so I could eat at a Chili’s with a bar! Craziness.  But, my chemistry is done, so what else did I have to do? 

So I drove, listened to ReachMD.com podcasts, and had some surprisingly yummo salmon and broccoli, with a skinny margarita and one Miller Lite.  Nice and lowcarb…until I got back to the hotel.  Chocolate cake happened.

All of that to say this:  I saw a PBS special on African women and fistulas.  These women are extra tiny, short, and small due to hard work and little food.  They said it was decent food, but not nearly enough.  So they are very small in stature.  And they are married at 8-10 years of age.  And of course, that means babies as soon as they start menstruating.  Which is anywhere from 10-14 in these poor girls. 

All THAT adds up to babies that are next to impossible to birth, due to cephalo-pelvic disproportion.  They will be in birth for 5 or 7 DAYS.  And all of that pressure leads to tissue damage in their urinary bladder and their rectum.  They are plagued with insatiable incontinence.  Once they have a fistula, they are then banished from their community.

These poor, poor girls.

What was wonderful about this documentary was the nurses and doctors who formed a makeshift hospital and started surgically repairing these women.  Once they are restored, the women are allowed back into their communities.  Learn more about fistulas here:  http://www.fistulafoundation.org/aboutfistula/

These are the types of things that called me to study public health and now that call me into nursing.  Thanks God, for the reminder.

A day in the life of a Trainer turning nursing student...

5:00 am - Rise.  No shining allowed.  Fumble for iPhone to snooze alarm.  Resist urge to throw ridiculously expensive glass gadget through the wall.

5:30 am - actually get out of bed.  ADLs for the 2 fur-kids: to the exercise pen for potty, back in for breakfast, and general running around, Bichon-style, happy ruckus.

5:40 am - Drink the first of several cups of coffee.  With half-and-half, no sugar.  Thanks!

6:00 am - remark to myself that it is time to get away from the computer.  No seriously.

6:15 am - remark to myself, SHIT, now I'm going to be late.  Quick shower, and no time to shave. Yuck.

6:35 am -  hopefully fully dressed in business attire at this point.  Pour a travel cup of coffee, a travel tumbler of tea, pack a low-carb lunch, school books, casual clothes for class, 2 sets of keys (car/house), and purse.

6:45 am - loading vehicle

6:48 am - cursing profusely, grabbing one set of keys to go back to the house to retrieve my iPhone I left charging on the 'puter

6:50 am - hit the road, listening to NPR

7:10 am - arrive to my bank Training job a full 10 minutes late.

8:35 am - change pants and shoes into school attire

8:40 am - clock out and drive to class

9:00 am - Chemistry class begins.  So does the utter confusion.  Wish this guy was a TEACHer, not just really knowledgeable about the subject.

10:00 am - walk across campus.  Sit with Chem book, try to teach myself everything the Prof just didn't.  Wait on Statistics class to begin.

11:00 am -  Hand in Stats homework no later than 11:01.  Big penalties for turning in assignments late in this class, even by more than a minute.  To the tune of 20 points.  Listen to slightly strange, slightly animated, slightly growing on me Sociology Prof teaching Stats.  I can't believe I actually kinda like this class.

12:15 pm - trek across campus to over-priced parking place. (I thank God every day for the $250 spot.  It isn't a matter of getting a good spot to park on my campus...it's getting a spot at ALL.)

12:20 pm - Drive like a banshee back to the bank.  

12:35 pm - Clock in, change back to dress pants and shoes, eat lunch while catching up on work email.

1:00-4:00 pm - Teach new-hire orientation for new tellers.  Attempt to be enthusiastic, interesting, and a TEACHer.

4:00 pm - Change BACK into school clothes (jeans and snowboots), pee before looooong commute.  Long to me, at least

4:10 pm - Clock out, load up SUV, hit the road

4:12 pm - Dig on some more NPR or whatever I've recently downloaded on my iPhone

4:55 pm - Arrive at secondary campus of college.  Catch up with my secondary campus friends, pee, and arrange all my note taking paraphernalia.

5:00 pm - Anatomy & Physiology II 'til 6:15

6:15 pm - walk down to A&P II Lab. Get ready for sheep eye dissection. Cut up with my lab partner who likes to cuss as much as I do. (cut up with lab partner, huh-huh!)

6:30 pm - 8:20  AP II Lab.  Cool shit.

8:20 pm - pack it up, haul ass to SUV, turn on NPR, and hit the road.

8:45 pm - arrive home.  Greet 14 & 9 yr old 'puppies.'  Greet hubby who has come up with something for dinner.  Go to bev fridge, pour up a tiny bit of well-deserved Barefoot Pinot.