zOMFingG eeeeeee!!!!

I tried to sleep in a bit this morning since I had two days off this week and the first one I got up early to go to spinning with one of my friends/coworkers. I woke up earlier than I would have liked (but after my alarm went off, cause that’s how I roll on my days off) because the old people taxi driver was knocking on the front door for my MIL. *sigh* So while I’m laying in bed someone calls me from a number not in my contact list so I didn’t answer. Yes, I screen calls routinely. They left a message and it was from the person I mailed my resume and cover letter to on Jan 2nd at my first choice company to work as a nurse practitioner in an ER which is also my first choice of job. In her message she said that she wanted to talk to me about an opportunity. EEEEEEEEEEE! (and that’s really what I said too, while I listened to the message in bed, in my pjs with my night time chew toy still in) I was glad I hadn’t answered it because I would have sounded like a moron with my mouth piece in and still fuzzy and somewhat asleep.

So I got up and called Hubbin. And my mom. And was still flipping out excited, and I hadn’t even talked to her yet. I know you’re supposed to be like all tough and negotiating and whatnot when you job interview, but what if it’s at your first choice company in your first choice location that’s half the distance to your house from your current job, and you know who your boss will be, and the starting salary is posted online. I mean, there’s not much really to negotiate?

Anyway, that’s how this went down, when I finally talked to her on the phone she said she spoke with the director at the hospital I’ve been offered about bringing me in for an interview, and he was formally the director at the hospital I’m at now and she said he said (I know, I’m sorry, all convoluted but necessarily vague) “Interview? I don’t need to interview her, I know her, and she’s excellent, and I want to offer her a position immediately” — I about died with excitement and butterflies when she told me this. I mean seriously, she had me at “hello” (lol) but then to go on about how my future boss already thinks I’m fabulous — alright, no negotiating, I’m a sucker, sign me up.

There is a catch though. I’m signed up for a review course in the middle of June and was planning on taking my boards at the end of June, but this position would start July 1 so I’d need to be ready to roll. certified nationally and licensed by the state and who knows how long all that paperwork takes to go through. Which is going to require me redoing my whole boards review plan I had somewhat vaguely worked out. The lady I talked to today advised me to take boards immediately after graduating in May. So essentially I’ve gone from, not really planning on applying until after I had taken and passed boards at the end of June. To applying in January. Getting a job offer in February and now trying to redo my whole entire leisurely summer plan to make this all go down & taking boards at the beginning of May. sheesh. This is intense. The problem with working steady weekends is I’m not able to take a different weekend off for a review course other than what I signed up for in November (That’s when nurses pick their vacations for the following year incase you didn’t know, planning planning planning). I did get as far as calling the review company after I spoke with the lady and they’ll switch me to an online review course for a $25 fee, so that’s not all that bad actually. My head is just totally spinning with all the changes and possibilities right now.

How am I supposed to concentrate on writing a paper now?!?!?!?

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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.

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.