Lame

So essentially I’m very lame and have no very good excuses as to where I’ve been for the past few weeks. School has been totally kicking by butt time commitment wise (and therefore emotion wise) Today I spent no less than 10 straight hours on this beautiful sunny day hunkered down in Panera typing up THIRTEEN pages of notes for my midterm in Pathophysiology which is on Tuesday. Pathophysiology is a little overwhelming as I expected and I’d like to meet whoever had the bright idea to make this class into an “accelerated format” class and make the students responsible for 14 weeks worth of lessons, including 14 separate online tests, the mid-term, final, class presentation, and online discussion board questions in an 8 week time period. Our mid-term on Tuesday, 4 weeks into the class, covers the first 600 pages in our text book. Nice. And the final… 4 weeks from then our final will be covering the next 8 online tests and 800some pages in the book.

Make my statistics class accelerated — we’ve learned nothing in that class!

I’ve also been working nights because they’ve decided we should work 6 offshifts each month now. Out of a total of 12. I also had a traumatic shift one of those nights where I made my first major med-error as a nurse. Hopefully last, although a few people have assured me that’s just wishful thinking. I had a patient who was being boarded in the ER for the night because there were no beds. She was a sick cancer patient who was in for pain control. Very sweet, I tried to take good care of her and everytime I walked in asking her how her pain was an reinforcing that I had her narcotics in my pocket and could give them whenever she needed them (probably better for her than being admitted to a floor room because she was my only patient for most of the night). Anyway. The floor doc came down and wrote orders for her sometime around 3/330am. I looked them over, morning labs, regular diet, PRN (as needed) med, Daily med, Daily med, patch to get changed each sunday. She was assigned a bed about 630am so she left before change of shift.

I was driving home about 8am and I got a call from the daylight charge nurse asking if I had given her metformin in the middle of the night because the floor was “all fired up” about this med not having been given. I said “nooo, I only saw daily meds” – anyway long story short, apparently one of the meds was ordered “daily with a dose now” and I totally missed it. And to make matters worse I found out the next week that it wasn’t metformin (oral diabetes medication) but atenolol (blood pressure medication). I felt like the worst person alive. Her pressure had been up through the night but the ER doc had finally written for some nitropaste which brought it down, plus she was in pain which can elevate pressure too. I mean nothing bad happened, when she went to the floor her pressure was about 130/80… but I still felt just AWEFUL. It’s totally inexcusable regardless… but it’s not even like I was busy or doing something else. I just didn’t see it? I looked through the list and just never saw it. Oh god, I was in tears for days. Plus I was convinced I was going to be fired.

I had a long talk about it with my preceptor, which I think was good for her too because she was having a lot of guilt about that cardiac arrest patient from the other week, but the summary of her advice was “You have to look at how your patient was, what was her pressure when she went to the floor?” I said 130/80, and she said “well then it doesn’t matter, shit happens and no one died” and my mother kept telling me “it’s bad, but it’s a learning experience, it would have been worse if you had given her the WRONG med, or too much of something… nothing bad happened to the patient”. Ugh, I hope to never go through that again! The guilt was terrible… for weeks! Everyone has assured me I won’t be fired. The charge nurse that day said she was pretty sure our boss was most upset that the floor called him at home, on his day off, at 730am. It’s been a few weeks, and I haven’t got a pink slip yet, so hopefully I’m okay.

I also totally fell off the shrinking-jeans wagon for ahem, all of March… which is now spilling over into April. I’ve just been too busy to go to the gym, and have been induldging my food wants just a LITTLE too much. A little because I want to, but I’m sure a little has to do with stress… I need to get back on that. Of course, then there’s this mid-term.

Indecision

I’ve been doing lots of thinking. I know I’ve mentioned that I’m currently in an RN-BSN program and on track to roll that over into an MSN program to be a Nurse Practitioner in a few years… I’m pretty sure I’ve also mentioned that my mother is bribing me to apply to an anesthesia school of nursing (her profession) by paying my application fee. I’m also pretty sure I’ve mentioned that they get, oh, 600+ applicants for 25 or so spots. So I’m not exactly holding my breath about getting in, nor am I putting anything on hold for the nurse practitioner program, because I’m kind of just assuming I’m not going to get in. In the past 6 months or so Hubbin and I have been seriously discussing trying for a baby this summer. I’m starting to get to the point that I just want one. And thinking about it all the time. I’m sure it’s more logical and everything for me to wait a few years to finish school first… but it’s just that I want one. I’m starting to be attracted to all things baby. It used to be maybe once a month I’d be drooling over other peoples babies, but now I’m thinking about one on an almost daily basis.

It’s still a debate in our house whether we’ll have 1 or 2 children, Hubbin and I are both only children (he wants 1, I want 2), but there’s part of me that wants one now… to give me more time to think about a 2nd later… and I’m a little worried that if I wait till I’m 32ish and totally done with school for the 1st I won’t have enough time to fully consider a 2nd.

I didn’t realize how much I was looking forward to trying this summer until we had a serious discussion about waiting to see if I got into anesthesia school before we tried. Because Hubbin fully believes I’ll get in. I’m working on my application now, but I still might not find out one way or the other until next winter, to start in the fall of 2010… and I was a little disappointed thinking about it. I had an afternoon off this week after my yearly gyne appointment, where we briefly talked about “maybe” and I spent a good hour in Babies R Us just wandering around thinking about it. My friend is having a baby in April and her shower is in two weeks so I went looking for a gift off her registry, but ended up just wandering around thinking… “baby, no baby, baby, no baby”, for not even kidding, an hour and a half.

Part of the issue is this nurse practitioner program I’m in is part time, and at least until the end of the program is only one day a week… which isn’t too bad… Three days a week in the ER, and one at school… and while I’d prefer to be done with school before having a baby so far this program doesn’t seem overwhelming enough to completely talk me out of waiting till I’m done. The anesthesia program however, would be extremely time intensive for about 2.5 years. …so that if by some long shot I got into that program… I guess truthfully I’d rather not have a newborn at home to be worrying about or feel like I’m neglecting.

Sometimes I wish Hubbin and I were both just content to not have extra money. We’re doing just fine, but we both want me back in school so in the long run I’ll have a much better income potential, but sometimes I wish we didn’t care about having extra money to do fun things or buy nice things…

Lots of pros and cons and unknowns to all of it. And sometimes I just can’t help it, rational or not, I want a baby right now.

Special Emergencies and Copious Rudeness

I work in a hospital with a reputation for female issues, we get lots of pregnant ladies all the time. I’d say 1/3 of our ER cases are pregnant bleeders and maybe 1/5 are pregnant pukers followed by another 1/3 of “abdominal pain”. We don’t -under normal circumstances- handle babies or deliveries. Since I started in the ER as a tech back in November we’ve had maybe 3 ER (or ambulance) babies that I’ve been present for. Always an accident because if we can AT ALL help it, we get the woman up to labor and delivery before it gets to that point. With a whole lot of “no no, deep breaths, no pushing in the hallway! In through the nose, out through the mouth”  There was the one lady that came in by ambulance in labor and the ambulance hit a bump pulling into our parking lot and whoops out comes the baby in the ambulance bay. Then there was another one who wheeled in on the stretcher making that specific grunting noise that forces you to take a laboring woman seriously and we lifted the sheet covering her and quickly put the stretcher in a room before the baby could pop out in the ER hallway.

Last night made number 4 and 5. I was in a room triageing my patient (a pregnant puker) and I came out and noticed the other two nurses and LPN were wearing gloves in the hallway -not normal- and there was that peculiar vibe of anticipation. The charge nurse got a call saying we were getting a woman who gave birth at home, no prenatal care, she swore she didn’t know she was pregnant til last week and they were guessing the baby was about 30 weeks, they’d be here in about 10 minutes and were coming by separate ambulances, the baby was pink and breathing on it’s own. I missed the stats but I think they said she was a G5 So we begin making preparations, clearing the patient currently occupying our “trauma” room waiting for admission into another room. Plugging in the infant warmer, getting the baby stuff out, getting warm blankets. And calling the NICU team to come stand by. T-7 minutes.

NICU team arrives (like 12 people- all running) and three of them upon hearing the ambulance isn’t here yet glare at us throw their hands up and turn around. (that’s the spirit ladies…)

The charge nurse’s phone rings with an update. – that almost never happens either

The ambulance carrying the mother reports there is now a baby #2 (what they thought was the placenta delivery was actually baby B. Then they tell us they had to cut the sac open and the baby is not breathing and they’re starting resuscitation, they’ll be here in 2 min. This presents a bit of a logistical issue as we have everything set up for 1 baby. We have but one warmer in the ER. We now call a code blue and cut the locks off the neonatal crash cart. There’s now about 15 people assembled in the trauma room waiting.

Ambulance #1 shows up lights flashing siren on (which SO never happens in our ER) One of the NICU nurses has a gown on and goes out to meet the baby with warmers, scoops baby #1 up (the pink baby) and we pile warm blankets on top of the baby and she takes off scurrying for the NICU with about half the team in tow. We wait. Ambulance #2 arrives lights and siren on, we again go out to greet the ambulance with warm blankets. This baby is taken to our trauma room where they begin to do serious resuscitation as opposed to neonate CPR. Epi, epi epi. I guess it’s a good thing the steady night nurses I was working with just took their neonatal resuscitation refresher course last week!

Then they wheel the mother in, and the EMTs take her into the trauma room, and someone suggests “mmm maybe mom should go in a separate room” as they’re attempting to intubate the baby.

As much as I desperately wanted to go in and watch the action in the trauma room on the baby since it’s something you don’t see every day, that’s where all the other nurses went so I went into the room were we put the mother. I was at a bit of a loss as to what to do. The EMTs were in the hallway giving report to one of the nurses and the doctor came in for literally a minute with the mother then left (if I hadn’t gone in she would have been alone) With a lack of any direction I decided, “hey why not start an IV and draw labs, I assume they’ll need one or both of those?” Then one of the older nurses finally came in and started cleaning the mother up and helping me try to keep the mother in the bed. She was still having contractions, sitting in a pile of blood and was begging us to let her go sit on the toilet to pee.

I took a moment to just take the mother in, I’d guess she was in here late 30s but she looked a disaster with rotten teeth and balding, she was a little heavy but I was really trying to see how someone 30 weeks pregnant with twins might miss the fact that she’s pregnant.

We got her cleaned up and the dad came in the room looking just totally shell shocked and detached. I was trying to imagine them finding out the week before that she was pregnant, having a handful of kids at home and then having surprise twins.

They got things straightened out a bit, we had the IV running labs were drawn and we started a pad count and were waiting for them to get her a room in labor and delivery. Then the NICU doc arrived, asked if they had names before he started talking. They said no. Said baby A, a boy, had good color, normal vital signs, that they were going to keep him in the NICU but he expected he would be fine. Baby B, a girl, required a lot of effort and medication to get her heart beating at a rate it should be, they had to intubate her to get her breathing, and that if he had to make a guess, he would guess the baby isn’t going to make it. It was hard to even read what was going on in the family’s head. The dad looked a little pained when he heard the baby wasn’t going to make it, but he just overall looked shell shocked and detached.

At that time they got her a room in labor in delivery so I wheeled her up with the older nurse that had been cleaning her up.

We take her into the room in labor and delivery where we were met by this excessively rude nurse. We were helping the mother move from the ER bed to the L&D bed and the nurse was standing in the corner, not even looking at the patient. I gave her the like 2 sentence report that pretty much summed up my entire knowledge of the situation: “She had twins in the ambulance en route to the hospital, the babies are in the NICU” The nurse says “Where’s the LD report” I said “Excuse me?” then she starts wagging a piece of paper at me, I handed her a summary of the events on the “code blue” report form and said “That’s all I have”, she has a 20 gauge IV in her right wrist and..”  the nurse interrupts me “What time was baby B born”… I said “is it on the sheet? That’s all I have” and I go back to trying to give report about the mother and ask the nurse if there’s an IV pole in the room and she walks out. Doesn’t say anything, just walks out.

The nurse I was with starts to get WAY pissed off at this point. The nurse returns about 2 minutes later with an IV pole, at which point the nurse I’m with and the L&D nurse start trading attitude and the nurse I’m with says “Well we had no way of knowing where you went since you just walked out and didn’t say ‘oh I’ll get an IV pole’” Then our aide arrives with a bag full of placenta and can’t get the L&D nurse to tell her where she wants her to leave the placenta.

I mean honestly, if someone dropped a patient like that in my room who’s obviously been through a lot and there’s not clear details, the first thing I want to do is look at MY PATIENT. The babies are in the NICU, the NICU is taking care of the babies, concentrate on YOUR PATIENT lady, instead of being rude in front of the patient. This family just had surprise twins in an ambulance, were just told their newborn daughter is likely not going to make it and you’re more concerned about filling out your chart on the baby. This goes back to how the most important thing is patient assessment, the paperwork can always be handled later.

I’m a real RN!

I finally broke down this morning before work and paid the $8 to find out my results. All my other friends had their results posted on the verification site the next day but I must have checked 30 times at work the next day (yesterday) and NOTHING! So when I got up at 10 this morning and saw I was still just a graduate nurse I was not happy at all. So I broke down and paid the $8 to find out I passed! What a racket! Anyway I couldn’t do that another day plus I had no way of knowing they’d be up this afternoon, oh well. So I’m done! Horray!

NCLEX

I took it this morning. I either really passed or really failed because the computer turned off at 75 questions. (there is no grade only a pass or fail, so it doesn’t matter, but you catch my drift)

We joked in the hallway before the let us in that they should provide barfbags in addition to earplugs because more than one of us commented we may vomit. (myself included)

I was photographed, finger printed (4 times to be exact) and stripped of all belongings. (I was glad they stopped short of a full body cavity search)

I checked my pulse twice during the test and on both occassions it was hovering around 110. I tried to control my breathing and read s-l-o-w-l-y and read each question twice and each answer once. I’m pretty sure my heart actually quit beating while I was trying to answer #75.

It took me less than an hour to do the whole thing, I hope it’s for the last time! And I don’t have to quit my job from embarassment. Or be demoted (not just cause I got rid of my aide colored uniforms already). Or confess to snidey coworkers I failed.

*crosses fingers*

My grandma broke her hip. My dad took her to the ER last night. Could have been as long as two weeks ago. She has moderate-advanced alzheimers disease so we don’t know exactly. She lives at home with my half-blind grandfather still but weighs about 80lbs soaking wet so who knows where this will go. She’s supposed to be in surgery now (scheduled to be anyway) I’m heading to the hospital with my dad and g-pa in about an hour.

Severe Brain Death

I’m currently experiencing severe brain death. I can feel my brain cells slowly dying off one by one due to the repetative and boring nature of preparing for this damn NCLEX. The past, 6?, days off I’ve had I’ve spent literally hours either studying something I feel might be important (peak insulin times, childhood vaccine schedules, DKA, normal ranges of common lab values, arterial blood gases) and taking practice tests.

The books tell me I should prepare for the NCLEX as though I’m taking the NCLEX. In other words, sit in a quiet room at the computer with no beverage or food and answer 265 questions in a row without looking up the answers.

I maintain that is no way to learn, I still feel like part of doing practice questions is looking up the answers and see why you missed it or why you got it right, and if I’ve gone on to answer 150 questions after, I can assure you I will have totally lost my train of thought about why I picked that answer incorrectly. So I’ve been taking short little 20-odd practice questions at a time instead.

But now my brain is dying.

And I know I can’t have anything to eat or drink during the NCLEX, but I’m fairly confident during the actual examine my adrenaline will be enough to keep me focused, where as right now, I require sips of diet coke or McDs iced coffee. mmmmmm, sugar free vanilla…

I came downstairs to bake some enchiladas I’ve had sitting in the fridge for three days before they totally spoil and I’m to the point where I’m taking off the foil while stareing intently at a kitchen tile without blinking.

*mind blank*

*stares*

Saved

Saved by the Hubbin! Hubbin just returned from Starbucks with a gift of iced coffee, bless his little soul!

I’m taking practice tests on my computer right now with my Mosby’s NCLEX CD. I can feel my brain slowly shriveling up and dying. I don’t know if it’s because I was up too late last night (1:30am), had a glass of wine after work (we were swamped and I barely sat down all day at work so I deserved it), or if its because I overslept (is that even possible?) til 11:30am. Anyway…

I’m not doing so well on the practice tests this morning, there’s part of me that feels like these practice tests are almost counter productive because they make me stressed like “holy shit I just got 50% on that section, I’m going to fail the NCLEX for SURE” or “The lady said to regularly get over a 75% before taking it and I’ve only been regularly scoring 74%, should I cancel the test?”

It’s a weird combination of being terrified of failing and at the same time not really honestly believing I would….

More questions.

Yikes!

I got my authorization to test today! Now I’m officially freaked out because there is a concrete time frame… I’m authorized to test from tomorrow through Nov 17th. Holy shit! I better start studying! :-/

I finished basic arrythmia today and only missed 1 on the final! 99%!

Next up advanced cardiac life support! (little nervous about that too!)

Boards

Genuinely I was not too worried or worked up about boards. In our NCLEX prep class they told us you should consistently get above 75% on your practice tests before taking it. I’ve always done at least that well on our big ATI tests, and I got middle-high B’s the whole way through school, so it’s just something I wasn’t too worked up about.

However. Now that I’ve started my position as a GN in the ER, along with another GN and I’m going through orientation with all the other GNs I’m getting more freaked out.

I took basic arrhythmia this week and in that class were two other GNs I knew, one from school and one from research. They both took their boards last week and both passed and both were absolutely bursting about how they could not believe how many choose-all-that-apply questions they got. I HATE choose all that apply. Those are my WORST questions. They give you a little scenario and then 6 or 7 options and if you miss one of the 7 then you get the question wrong.

For those of you non-nursing people who read this blog, the big deal about the NCLEX is it’s a “smart test” so every time you get the answer correct, it choses a harder question until you start getting them wrong. You have anywhere between 75 and 265 and it keeps asking questions till it’s sure you’ve got a passing or failing score. For both of these girls it shut off after 75 and they were both sure they failed because they had so many choose-all-that-apply (both went out to their car and cried). My ER friend took her test monday and she also passed but was completely freaked out because she counted FORTY choose all that apply in her test of 75 questions.

So now I’m all up in arms.

If you’ll recall my original goal was to take the NCLEX at the beginning of June so that I could go on our honeymoon knowing I’d passed. I couldn’t even pick up my graduation letter from the school till the middle of June though, and I picked it up when we got home from our honeymoon. Obviously I didn’t study on the honeymoon so I didn’t want to take it right when I got back. Then I decided I should wait till after all the orientation classes figuring taking PALS, ACLS, Basic Arrhythmia, and Basic ER Nursing might offer even just a glimmer of extra knowledge I could use on the test. So I decided I wouldn’t even bother till after orientation (not to mention I’m a little overwhelmed at work with all the new stuff I’m trying to get the hang of). Then, while I’m sure I could if I had to, I think it will just be a lot easier to study after Hubbin’ goes back to work next week and I’m home alone some days… Now though, I’m totally regretting not taking it before everyone else so they couldn’t be freaking me out with their stories!

I’m trying to keep confident like I was before they all started telling me about having 40 choose all that apply and keeping the right mind set. But when I think of how much I’d rather die than go to work and have to tell everyone I failed….. I start getting worked up all over again.

Right now I’m still waiting for my Authorization To Test (ATT) from the state so I can’t sign up for the test even if I wanted to. I think the way to go about this though is to start studying now so when I get the ATT I can pick a date that’s really soon (preferably like the next day, lol) and not give myself time to work into a frenzy.

PALS Certified

So I’m on ER orientation for 6 weeks and for those 6 weeks there are all sorts of classes I need to take. So for the month of August I’m only actually working with my preceptor about 7 times. (obviously I’ve negotiated to extend my orientation period)

Last week I got certified in PALS which is pediatric advanced life support. I was really nervous before I went A. because I heard it was hard but also because B. our educator sent out this terrifying letter (which she swears was a form letter from the heart association) with a whole pre-course checklist that we had to complete. You had to know this -or you might fail- you had to know that because they weren’t going to teach it -or you might fail- and so forth.

Plus I was pretty sure that my score on the pretest (a 68%… and I took it twice) indicated I shouldn’t be working with children regardless.

Overall the class wasn’t as bad as I thought, I really felt like I learned a lot. I passed the case study portion where you’re the team leader and direct the team during a code. I was also really proud that I did so well on the written portion getting about the same scores as some of the vastly more experienced nurses. Considering I still haven’t had basic arrhythmia training (that’s next week) or ACLS (advanced cardiac life support, that’s next month)  I thought that was pretty impressive because some of the information from those was in this course. For instance, all the cardiac drugs you really only ever give in a code situation… no experience there.

So I am now PALS certified and I do feel much more prepared to handle an emergency involving a child who may happen to wander in off the street, which is really rather empowering!

(Although in all seriousness people, a world renowned children’s hospital is 5 blocks away, please take your sick kid there)