Reasons For Hope

Since we need a little optimism I was doing some thinking and thought of a few things that I should to keep in mind to be hopeful and excited for the future.

#1: I am probably going to graduate from NP school in May

Back when I met Hubbin I was working in research but research doesn’t make very much money. My original plan in college was a career in research which would require me to get a PhD and move on from there — only after working in a lab for a few years, while I liked it, and still miss it sometimes I decided the PhD business wasn’t for me. I couldn’t pick a concentration and didn’t want the rest of my life to be defined by grant writing. I made the decision to go back to school but wasn’t sure for what. Medical school, which is probably what I would have done if I had some better advising in high school and college, was kind of out of the question because of my GPA from college. I never really wanted to be a nurse, but was interested in being an NP or PA to be sort of a mini doctor. So the breakdown went as follows: PA program for 2 years and done but I couldn’t work during it and would need to take out loans for school. OR NP school. To do NP school though, first you need to go to nursing school and a bachelors in nursing is required for entrance. So I needed to do nursing school, get a BSN, then go to the masters program, which would take a lot longer but I would be able to work the whole time.

Since Hubbin and I were engaged and getting ready to start out lives together, I made the decision to go the nursing route, mainly for financial reasons. We didn’t want to take on huge debt for school at the same time we were trying to buy a house and everything. Which sucks. Because I’ve been working full time and going to school part to full time since 2005 (really, with the prerequisites for nursing school – Nursing school actually started in January about 6 months after we got married)

So just think: The ENTIRE time we’ve been together I’ve been working and going to school full time. How nice is it going to be when I will just have 1 job! We both talk about how the best part of being on vacation together is getting to finally spend time together. The thing to be excited about is that the more time I spend with Hubbin the happier I am and the more I love him. It might just feel like vacation all the time once I’m out of school!

#2: I’m going to graduate loan free

Which I consider to be a HUGE accomplishment in and of itself

I have completely busted my butt and dealt with a lot of comments from Hubbin but this is totally going to pay off. I don’t mean it like that per say I mean we both agreed it was the route to go, but it is hard for Hubbin to 100% avoid reminding me that he pays ALL the bills. He pays EVERYTHING, my pay check goes towards fun activities, vacations, dates, and a weekly allowance for both of us. Otherwise I squirrel it away in my savings so I can write a check for a few thousand dollars each and every semester.

Between my tuition benefit from working full time, and choosing to go the cheapest route possible for nursing school (community college) I was able to finish nursing school by paying cash. While I was doing that I took a slight pay cut moving from research to being a nursing aide. But I thought the experience would be important to job hunting (and it was, because I was offered my nursing job in my same department about 5 months before I graduated). THEN I started my job as a nurse and got about a — $13,000 a year raise by moving from an aid to a RN. I enrolled in a BSN-MSN program the soonest start date after I graduated and paid about $15,000 in tuition to get my BSN. So we never felt that raise. The month after I finished the BSN I started the nurse practitioner program and I’m just ending and my bill is $33,000, so the entire time I’ve been working as a nurse we’ve still only been getting the same income as from when I was an aide really…. When I start working as an NP I’ll get an approximate $20 – $30,000 a year raise from my salary now… SO if you add that on to the raise I got when I was a nurse that we’ve never really felt the benefit from me finishing nursing school in the first place. So:

#3: It’s going to feel I’m getting a roughly $50,000 a year raise when I get a new job. (Holy shit!)

And

(Which I am both excited and nervous about): One of my coworkers in the ER who is a PA now is encouraging me to apply to jobs over Christmas break because the ER company is hiring lots of PAs & NPs right now. EEK! So:

#4: There is the potential to have a job lined up for me before I even graduate.

My friend who graduated last year said no one was too interested in talking to her in interviews until she had passed her boards, but my friend who is encouraging me to apply says they hired her before she passed her boards. My original plan was to leisurely take boards maybe around August after I graduated since I have this awesome weekend only gig at work now which I’ll be sad to leave. BUT this is causing me to need to seriously reevaluate this and really just the thought of taking boards makes me a little nauseated, I’m not going to lie. The plus side is if I can get a job lined up to start in August then I might be able to quit my current job in July and Hubbin and I could take a nice long vacation or just enjoy a long time together (since he’s a teacher).

and PS:

I believe we are a ‘go’ this month for the first unmedicated IUI. I called the clinic to let them know we were planning on doing it. The only issue would be if it needs to be a weekend. The clinic is open but my mandatory 12 hour shifts would prevent me from going in at all. So. Cross your fingers for a nice Sunday- Thursday positive OPK.

Nothing Left to Give

So there were 10 patients when I got there and we quickly filled the whole way up with patients in the waiting room. I had a busy day because I had a chest pain patient (elderly black male, dialysis pt) who got admitted. Then an 60-some yr old woman cancer patient that had to get a picc line(which shouldn’t have been but was a huge ordeal) and was admitted. Then an 80yr old uterine cancer patient who was bleeding heavily (mostly becuase her doctor had WAY over done it with the blood thinners- her clotting lab was supposed to be below 2.5 and hers was 9) I swear all my patients got admitted. Then we had all sorts of stuff like an acute appendicitis that went to the OR. There was a cardiac arrest in the hospital. I had this other guy who had a lengthy medical history and was there with his mother and sister who would not let this 52 yr old adult male answer anything! For himself! They had to be Italian or something the way they were smothering him. He had prosthetic eyes and when I was trying to ask him questions His sister was going on and on about his eye condition in 1985 and I said as nice as possible “but he doesn’t have eyes anymore so I think it’s probably irrelevant to his current complaint of LEFT HIP PAIN!”. We were jammed full the WHOLE day with two of the slower doctors and the patients just kept coming. the second side was still open when I left! let me tell you that when “Princess” -real name!- checked in with abdominal pain and “menstrating”I had ZERO patience.

Iko Iko

I was recently offered the opportunity at work to switch from rotating days and nights (7a and 7p shifts, both 12 hours) to rotating days and evenings (11a-11p) instead. I debated for a good while about it because A: I really like the people that work nights and B: Nights (in general) aren’t as busy as days or evenings so that leaves free time for fun conversations, homework, or crochet projects. I ended up taking the offer and switching to evenings because working days and nights I felt like my whole life revolved around when I was sleeping.

I will also miss nights because of some of the bizarre shit and fantastic stories that happen when the world is sleeping.

For instance I was working the other night and about 3 or 4am (4am seems to be a general witching hour I think) a 27year old boy signed in with “palpitations and shortness of breath” He was a thin boy, well groomed and gave off a distinct vibe of gay. Not that that’s important I’m just trying to give you a visual and so you can hear what he sounds like with this ensuing conversation. So one of the other nurses went out to get him and I went to help her get things started. He was sitting in the waiting room in a wheelchair and there were two girls with him.

We brought him back alone and started following our chest pain protocols which among other things involves starting an IV. I was starting his IV while the other nurse was asking him all the triage questions. He said he was feeling very anxious and thinks he might be having an anxiety attack. I was at his bedside opening all my IV equipment and had the tourniquet tied around his arm getting ready to start when he says “Wait wait! Can we talk about something else while you do this?! I’m afraid of needles!” The other nurse says “Sure, what do you want to talk about” and he says “Quick does anybody know the words to Iko Iko?” and the other nurse says “Maybe if you start singing we’ll remember the words” So he’s laying there in the bed, tourniquet tied arm straight out to his side and his eyes clamped down tight and he starts singing in this weak tight voice “your grandma and my grandma were sitting by the fire…” I turned to look at the other nurse and we both started laughing so hard. It was just the funniest scene I’ve ever encountered. Of all the songs to randomly bust out with for a 27 year old but this random 1950s/60s song… and he was so serious about singing it and so scared that we couldn’t help but laugh. (not to worry, he joined in too)

While we were getting him settled another older (creepy) guy signed in and the third nurse brought him back and while she was asking him about his medications he was changing into a gown and came over to “take a look” at the list of medications she had in the computer already for him and proceeded to invade her personal space and bump up against her while wearing only his underwear.

Meanwhile, one of our 27year old’s female companions signed in with “possible abscess” so I brought her back to a room and she was telling me about this abscess she had on her back and how she knew someone who had an abscess and it had to be drained and treated with antibiotics… so I say “well let me see”. She takes off her shirt and shows me this spot on her back that she has covered with one of those small circle band-aids. So I’m thinking “welllll, maybe it’s worse underneath” so I peel it off and reveal underneath a very unimpressive ZIT. No honestly. A zit. I had no idea what to write on my triage assessment sheet because is “zit” really a medical term… no, but that’s what it was “pustule” was way too dramatic sounding for what it actually was. The doctors sheet later was even better. She drew a little black spot on the diagram of the back and drew and arrow with the words “single pimple”. It is part of our standard procedure during triage to ask patient’s about substance use, people tend to be surprisingly honest and it’s hard to impress on you how little the nurses actually care what you’re using at home unless you come in unresponsive. I don’t care if you smoke marijuana every weekend, I don’t care if you experimented with cocaine back in the day… and if you tell me you quit heroin three months ago I’m certainly not going to believe you. Anyway so I’m asking her (with her zit) if she’s ever used any substances, and I always suggest “like marijuana, cocaine, or heroin” just so there’s no confusion. She said “noooo” very slowly (but come on, you were clearly up to something tonight) and then closed her eyes, did a whole body cringe and blurts out real fast “okay, I’ve tried cocaine once!” lol. I told her that was fine and then promptly went into the nurses station and reenacted her response for everyone’s amusement.

We had not had any patients for hours and all of a sudden we had three total nutcases. Someone said “Is there a full moon tonight?” I said “I think what happened was the cloud of whatever these people were smoking has parted and the full moon started shining down on them”

Nurses not Magicians

Our ER is a small ER 14 beds and here or there in the hallway when necessary. The hospital has been making some big changes over the past year or so moving from mostly OB to more than 50% medicine patients. This has understandably led to some growing pains. While other hospitals and areas of medicine are down with the recession our ER is up 16%. Where we used to average 30patients a day. Now 50 is not unusual and we’ve been as high as 86. Of course while we’ve added services and added patients, we haven’t added space. Which would be okay but our directors are obsessed. OBSESSED with the patients length of stays.

The other day I was working and it was a perfect storm of mess. We had a doctor, who I like very much and think she’s very good, she’s just not so great at moving patients. Which leads to long lengths of stay which leads to a backed up ER which leads to patients in the waiting room which leads to unhappy suits. And in charge that day (we just sort of arbitrarily assign charge nurse) could definately be described as an airhead.

We were incredibly backed up to the point the suits kept “stopping by” to see if there was “anything they could do” because there were 7 patients in the waiting room. Well I mean seriously, there’s 23 patients on the board and it’s a 14 bed ER. Do the math, I mean. I didn’t major in math but it seems to me with those numbers, someone HAS to be in the waiting room. We’re nurses, we can only work so much magic for $21 an hour.

I Almost Said

I was discharging a patient who is perscribed seroquel (an anti-psycotic) with a prescription for seroquel and the patient said:

“This seroquel perscription is supposed to be 200mg not 100mg”

And I almost replied:

“You haven’t taken it for three weeks so what does it matter anyway?”

A Rare Follow up

Twice this week the man who had a cardiac arrest right under our noses a few weeks ago stopped by. He’s back to work now and looks amazing. I still couldn’t believe it. He said he wanted to come by to thank us, tell us that he thanks god for us every day as does his wife, daughter, and grandson. Then he stopped by a second time, later in the week to give my preceptor who had been his nurse a big hug.

I’m hoping to get back to blogging a bit more soon. My statistics final is this week and my pathophysiology final is next week. This summer I’m taking advanced assessment and then an online class: intro to sociology. Hopefully these summer classes won’t be quite so time intensive. I was looking at my schedule for the fall though and had one of those “what the fuck was I thinking? ….I thought I was doing this part time” oh well… I think this fall might be even worse than this semester. It will included advanced pharmacology 😦

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.

Nothing Left to Give

So here I sit, the end of night shift, the sun is rising and the sky turning from black to navy blue and so begins: The Hour of No Compassion.

The ongoing joke of the steady night shift nurses is the last hour of their shift is “the hour of no compassion”, where they may take care of patients, but they are no longer required to care about them.

I really think we need to implement this on day shift AND somehow need to integrate that with our one nurse’s idea of having one day a month where you’re allowed to tell everyone exactly how you feel about them -no consequences attached- patients included.

For instance today I would have liked to say: “you mean to tell me you’re 3.5 months pregnant and you’re taking not one, not two, but three medications for constipation and you don’t know the name of a SINGLE one of these chemicals you’re putting into your body? Are you eating ANY fiber at all? Ever? Or are you subsisting entirely off McDonalds and KFC? …because with a BMI of 57, it’s awefully hard for me to believe you’re really eating ‘a variety of foods’ like you claim”

-just sayin’-

Still in Awe

Awe:
1: An emotion variously combining dread, veneration, and wonder that is inspired by authority or by the sacred or sublime “stood in awe of the king”, “regard nature’s wonders with awe“

Yesterday was one of those days when everything falls magically into place and someone lives because of it all. I really don’t work in a major emergency room, we only have 14 beds and like I’ve said before there is a level 1 trauma facility mere blocks away. If something really bad was happening, where would you go? Yeah, me too. Yesterday we had a body in each bed when a man on the cleaning staff of the hospital came in the back door of the ER to the nurses station diaphoretic, clutching his chest, and looking a bit grey (and he’s a black man, so that’s saying something). Our charge nurse was in the process of kicking a patient out of her bed (I’m not even joking, she walked in and said “I need your bed NOW” lol) when one of our cleaning staff grabbed her and said “wait, I just cleaned room 4! It’s open” They started the chest pain protocol, performing his EKG, putting him on the monitor, oxygen… and really, his EKG didn’t look too bad. Some t-wave elevations, which not knowing anything about him could be an electrolyte imbalance, and some PVCs which aren’t the worst thing ever and aren’t totally abnormal in a 57 year old man anyway – at least not nearly as bad as the dreaded S-T elevation.

So everyone proceeded as normal our charge nurse took him as a patient (and at this point I had two patients, one who was with us for NINE HOURS and totally crazy -not even kidding: munchausen– Who was ringing the call bell every 10 minutes. No exaggeration. -I was so exhausted by the time I got home, she sucked all the caring right out of me) Our guy had been in the ER for maybe an hour or so when our secretary went in to talk with him, because she knows him from around the hospital. He told her he felt so terrible earlier he just left his cleaning cart in the middle of the hall and didn’t even tell his supervisor he was coming. So she offered to move his cart.

When she came back into his room and was talking to him, telling him she’d moved his cart, he pulled his arms into his chest and went totally unresponsive. She came tearing out of the room shouting our charge nurse’s name and the doctor’s name. I happened to be standing in the ambulance bay -I don’t even remember what I was doing now- but I immediately turned to my left and grabbed the crashcart pushing it into the room.

He was in Ventricular Fibrillation on the monitor, more commonly referred to in the medical world as Vfib. And when you click on that link you can read “Ventricular fibrillation is a medical emergency. If the arrhythmia continues for more than a few seconds, blood circulation will cease, and death may occur in a matter of minutes.”

We did a full code, called our equivalent of “code blue”, it was the first real-honest-to-god-cardiac-arrest I’ve ever participated in. (There was that one heroine overdose that arrived blue, but we got him up and alert real quick with some narcan) The charge nurse was doing chest compressions and I personally defibrillated him 3 times. Let me repeat that: I shocked someone. He got a couple doses of lidocaine we started a drip, and after the third shock his heart started beating on it’s own again. He was combative and disoriented for a few minutes after coming around, but then was alert and oriented. We repeated his EKG which showed he had just suffered a massive heart attack right under our noses. That S-T elevation showed up like a big waving red flag with blinking lights around it.

Our hospital doesn’t have a cardiac cath lab so we had him transported a few blocks away to the bigger hospital so he could have the blockage cleaned out emergently. Our medical director came by later to tell us that the cath lab said his coronary artery was 100% occluded.

So really if he had been anywhere else yesterday (home, in bed, in the car, at a store) he probably would have died. He was lucky enough to be scheduled to work, working mere feet from an ER, friendly enough with the people at his work place that our secretary went in to say hi to him… I’m just totally in awe over the whole thing. I had a long chat with my mom last night about the whole thing on the drive home as she’s a nurse anesthetist in the same hospital and she’s a firm believer in the philosophy of “when it’s your time, it’s your time regardless of all else”.

Yesterday just wasn’t his time.

So long MySpace

I finally joined Facebook in 2005 after much harassment from college friends… it took me a long time after that to join MySpace, maybe only last year, I wasn’t a fan of MySpace to begin with and now Facebook has finally won out totally and I deleted my MySpace account. I was just never really comfortable with the privacy on MySpace, plus I got a lot of trashy spam I never got through Facebook.

It’s a rainy gloomy day and I wish I could spend the whole day in bed, alas I have to present my community health education project to whatever teenagers Hubbin can round up for me after school. It’s such a stupid project but it’s got me all in knots A: because it’s stupid and B: I don’t like presenting things even in class let alone out of class.

I’m also miffed because I got a call from work today that they had a call off so I COULD be at work earning overtime right now *grrr* which is so rare right now because of all the extra staff. I did get an email from my boss that apparently a patient that we had down in the ER earlier this week that’s now in the ICU tested positive for flu and wanting to know if we had contact with her. First flu patient I’m aware of… let the fun begin!

*** oh no! it just occurred to me it’s Weigh-in Wednesday! I even feel heavier today! Shoot! I knew I should have resisted that crunch bar last night… it just looked soooo good!