nurse-patient relationships (and the ambiguous line)

I had a patient going in and out of afib yesterday. When she was out of afib she was generally bradycardic (in the 50s), however this was quite dependent on her positioning. When lying in bed, she would get down to the 40s, when walking she would be up in the 70s. Cardiac consult came in and ordered a dig load and an increase in her beta-blockers. I was looking at her heartrate (53 at the time) and thinking NO WAY am I giving a digoxin LOAD and a beta-blocker! I clarified this with them, they wanted it given. I discussed it with the charge nurse. I ended up giving the dig load first, and having her stand/walk for about an hour after. Her heartrate stayed over 60. I gave the beta-blocker several hours later, and she again brady'd down to the upper 40s, but was asymptomatic. I had her get up, she was in the upper 60s. Craziness!

So that was my first experience with Afib (and with hesitating to follow a medication order). But another issue arose when it turned out that the patient and I got along very well. We chatted a lot and found out that we knew a lot of the same people. But I felt the eyes of the other nurses on me every time I was sitting down and talking with her. I did not neglect my other patients nor did I reveal any information about anyone else to her. But I felt the pressure of carrying on as a professional at the same time I was becoming someone's friend. Where is that ambiguous line drawn? She wanted to give me her email and I did feel ambivelant about that, too. When is it ok, if ever, to develop a friendship with a patient? Is it ever ok to continue a friendship after the professional relationship ends? I suppose this is left somewhat up to individual judgment. I just did the best I could.

I had to re-evaluate my loan payments. There is no way I could make the monthly payment they were requesting... I am going down to 4% of my monthly income. Tough break! Maybe I should go back to school so I can defer...

debt and trouble, trouble and debt

I was a float nurse during our nursing check-offs for LVADs. I covered the other nurses and worked my ASS off for the hour or so that I had their patients. I walked them, cleaned them, passed meds, tried to make them feel like things were finished when they came back. And I got recognition for it which rocked. Also got in trouble twice, once for no gown in a contact precautions room (I wasn't touching the patient!), and once for a chest tube becoming disconnected from suction. Actually, the charge nurse and I had a good laugh about all of the really ridiculous things people were throwing fits about that day!

I went to an EKG class that rocked my socks. It was 12-lead interpretation, and it lasted all day. But I feel about 10x smarter!

Then I felt about 100x dumber when I made a stupid, potentially dangerous calculation error at work. It scared the hell out of me. I guess that's what will make me a better nurse, in the end, making mistakes... you just have to hope you catch them before it hurts someone.

michigan's economy coming down on nurses

I guess I never dreamed that the economy was going to affect my job. I'm a nurse, right? Everyone told me that no matter what happened, I'd always have job security. Maybe they were right, but maybe they're wrong.

This month the hospital's census has decreased dramatically. Michigan families don't have health insurance because of lost jobs, and Michigan families aren't going to the doctor or the hospital. So many nurses have been called off of work at the children's hospital that they are scrambling to find them temporary positions at the main hospital. They have promised that nurses will be the last employees laid off.

Last week, out of 36 hours, I was cancelled 20. This week, I've only worked 24. As much as I love to sleep in, I love paying the bills more. I have used up a lot of PTO time and been mandated off. The union is trying to figure out how to give nurses all the hours in their appointments.

Let's hope the Big 3 pull through. Let's hope people are scared to go to the hospital and they soon feel better enough about finances to come in. Let's hope the Obama administration can pull of something in the way of health insurance for the unemployed.

Or the nursing shortage is already a thing of the past, at least in this area.

into the frying pan

Today I overheard another nurse talking about a seminar on Advanced EKG interpretation. I mentioned that I would love to go to it, and she said "you want to go advanced EKG? Shouldn't you do a regular one first?" Hells no, she did not just say I'm not knowledgeable enough on interpreting EKGs to attend the seminar! I registered for it an hour later. See you there, biotch.

The LVAD guy came to our conference room for an inservice. He told the whole roomful of nurses that if they had any questions, this young lady (pointing to me) was excellent. Same nurse said "oh really? She knew that much?" So there.

A patient of mine today was put on comfort care only. The family flew in, and everyone was standing around with tears and lots of questions. I felt very inadequate but tried to show my compassion. What else could I do?

blind leading the blind

Yesterday I was given a student again. The instructor told me that the students really like me. She said they identify with me, but also, I'm good. I was flattered. I think having a student is a big help, and it's fun to show them new things.

A few days ago I had a elderly patient whose 60-year-old daughter was at outside in the hall, looking teary-eyed. When I asked if she was alright, she told me that her partner of 31 years, who recently passed away, spent some of her last days on this floor and it was terribly difficult for her to be there. She didn't know I was gay, but I decided to let her know by the end of my day. When she prepared to leave, I pulled her aside and said "I think you are incredibly lucky to have spent 31 years with a woman you love. I hope I find a woman to spend so many years with like that." She gave me the biggest hug and thank you.

I also experienced things from a patient's point-of-view when I went into the ER one morning with a terrible migraine. The gown, the IV, the wristband... it felt like a bad dream. Next thing you know, a nurse is going to come in and say "hey hey, time to get you washed up!" Yikes! They gave me compazine and toradol, my headache got better but I slept for 24 hours but fitfully. I don't think I'll go in for a headache again. My BP bottomed out and I had to be bolused with 2 liters. Man I peed constantly for days!

My grandma was recently in a nearby hospital, smaller of course. The nursing care was horrendous, or should I say, nonexistent. The nurse-to-patient ratio there is 1:8, for starters, and neither my grandma or her roommate, who needed a lot more help, were offered washcloths, walks, or even a drink of water. The food was late or the tray was wrong or nothing came at all. Meds were either skipped or given only at my existence. Before she went in, she had heartburn. After coming in, she had a BP in the 70s, she was over-anticoagulated, had restless legs because they didn't give her her medication, and because no one helped her to the bathroom, she was terribly embarrassed that she'd had an accident. What a crock of shite! In my hospital, where a lot real shit is flying around, that shit would never fly!

feeling exposed

Things have gotten a little hairy at work. I was made two mistakes- Y-ing two incompatible meds, and not watching someone swallow their narcs. I also got a call yesterday at 7:20 asking where I was. They said I was written in for overtime- I think not. I didn't sign up for no stinkin' overtime! Wednesday at work I got blood in my eye while discontinuing an IV, and had to go through the whole shibang of reporting a body substance exposure. Luckily, the guy is clean.

I hope the coming month is better. I hope to make less mistakes, and I hope I can try harder not to be so hard on myself when I do.

see it, do it, teach it

I forgot to mention that I had a nursing student put with me last week. Talk about the blind leading the blind. But I told her she could see what it's like to be a new nurse. She really ended up helping me out because one of my 'easier' patients started going down the tube and while I was trying to figure out why suction wasn't working for his brand new NG tube, she and her instructor took care of my other patients.

I figured out yesterday that I make up to $37 per hour for overtime, which definitely is an incentive for me to stay over another 4 hours after an 8 hour shift. I did that yesterday, but had an ill-timed visit from Aunt Flo right at the end, and needed the help of a couple co-workers to fetch me new pants and give my last meds. I love my co-workers!

old nurses speak out, new nurse speaks up

I attended my grandmother's nursing reunion today. I discovered a sort of animosity for new nurses hidden under all of those flowered shirts and trifocal glasses. One by one they stood up and bemoaned the current state of the nursing profession, with the fact that we no longer wear white uniforms topping the list of reasons that we, as a profession, have trotted too far off the beaten path for professional redemption. Nursing is not respected. And certainly won't be as long as you aren't traipsing around with white uniforms and huge, wing-ed hats.

I had to disagree. I may be new, but I'm also a lot closer to remembering the pride I felt the first time I held my license in my hand, the first time I introduced myself as a nurse, the first time I scribbled RN after my name. I was proud, not just because I passed a test, but because I was a nurse, and my whole life I, along with everyone else I knew, held nurses up with great esteem. I was one of the them. Nursing is very respected to day, which is why I chose to go in this direction. I've never met a patient or their family who didn't think our jobs were important and hard. I've never met a person who didn't say 'wow' when I state what my profession is. I've never heard (yet) a physician or PA say 'what do you know'. In fact, they consistently ask me for my opinion, for my knowledge, for my take on everything.

I'm sorry that older nurses can't see that. I'm sorry that they have been made bitter by their experiences as nurses and as patients. I'm sorry that they feel good nursing care cannot be given without a white uniform and hat. I'm sorry that they feel like nurses only like to sit around and gossip, rather than bathe their patients or turn them or whatever. I was like, no... we do all of these things, still. Oh you should've heard the groans around the room when I said we don't lift our own patients! What is nursing coming to, after all? Well, I don't have time to find 4 other nurses to strain and huff and puff with me, nor do I want to injure myself. I make sure it gets done and I oversee the process. That's the beautiful thing about nursing today, I'm not just a grunt worker. I'm a professional, with decisions to make. I'm not there to haul patients up by their draw sheets every two hours. But I will make sure it happens.

In other news, I had a patient for four days with trisomy 9-q, a 33 year old with the mental capacity of an 18-month-old. I had some long, trying days, let me tell you. The parents came in the first day and ripped me up and down for everything under the sun. I listened, calmly. Let them vent. Then I addressed every single concern they had and followed up with it the next day. I felt the importance of that next day weigh down upon me walking into the building that morning. I had made some promises, and I had to deliver. When I was able to locate a speech therapist, arrange a swallow study, and bring in PT all in the same morning, completely bypassing the medical service, I was thrilled with myself. This is nursing!

high times

I've had several good days at work, after my return from a long weekend off. My first day back was only four hours, and amazingly, they didn't need me to stay another four. That day was also an "ice cream social" for employees. Another nurse and I went down in the middle of our shift to check it out. They had a ton of ice cream, good ice cream, with all the toppings. It was delicious. They had a lot of other booths and fun stuff, like a booth where money flies around and you have 30 seconds to catch it. The news was there, filming.

Yesterday most of the nurses tried out my brand new electronic stethescope. It's an ADC, cost about $150, and miracle of miracles: I can hear! It amplifies the sound and zooms in on it, it's a million times better than regular stethoscopes. I think it went on everyone's christmas list.

what you get for being BORED

Monday night I was bored. I had two patients who didn't need much of anything. I took it for granted. I thought in my head 'this SUCKS. I'm not learning, I'm not challenged.'

So we all know what's going to happen, as soon as you start thinking that way. Tuesday I came in, and my admit came rolling through the door before I was done with report. Not a good way to start. I had to untangle two chest tubes, the oxygen, the SCDs, the IV lines, the PCA and epidural and get them all on a pole, which got me behind to start out with.

Then another patient, an adult failure to thrive post-gastrectomy, needed albumin. He was supposed to have a PICC line placed in radiology while his dophoff tube was being placed, but they sent him back up without putting it in. Now guess what, he has no IV access because his peripheral had stopped working. He was supposed to go back down at 2:30. At 3:30, he still hadn't gone. At 4:30, I started trying to figure it out. I got on the phone with the vascular access team, who said they had nothing to do with it and don't put in STAT PICCs. I talked to his SGI service (his docs), who told me to call radiology. Radiology said he wasn't on their list. I told them, I'm staring at the order right now, how is it that you don't see it? Sorry, was all they said, we can't do it. Re-submit the order. So I resubmit the order. Still nothing, they say they don't have time.

By this time I'd given up on the PICC. I decided to just go with a STAT peripheral for the time being. I page the STAT vascular team. They don't show up. I page out to the floor and get two people on our unit to try. They have a hard time because both of the guys arms are so swollen, they are third-spacing and weeping and he's dry as a bone. Finally, vascular access shows up. The first guy has no luck. The second woman who comes brings an ultrasound, and she can't get it with that. By this time, it's 10pm. I tell service, sorry, no go. What do you want to do? Charge nurse is saying that an MD has to do it. I can see that the MDs aren't going for that. We're basically just SOL until morning when they do the PICC.

While all of this is happening, I'm frantically trying to do my vitals, because my tech? She apparently didn't feel the need to do anything last night. I try to get meds out at least an hour after they're due. I have to restart this guy's tube feeds, and there is no order to use the dophoff. Finally I say, fuck it, he's got no IV access and he needs pain meds, so I use the dophoff, which luckily didn't become an issue later. Now he's got to get this aluminum gunk down the dophoff and it keeps clogging it, but luckily I get it all in and flushed.

My first patient, the new admit, keeps calling for little things and is being whiny. I simply don't have time to be a waitress that day. I have a tech page lift team to boost her up in bed. My friend K, a new nurse, went to help me and oversee lift team. The guy from lift team is a total jerk and says he won't boost her because she's going to slide right down. K tells the tech she'll take care of, to leave me alone because I'm busy. The tech runs right into the med room, with the lift team guy behind her, and both of them stand there telling me they aren't going to boost the patient. All of the other nurses in the med room are just staring at them, and looking at me in disbelief. We've never had issues like this with lift team. Yeah, she's going to slide down again, eventually, just do your fucking job and BOOST her UP! But the guy continues to give me attitude, and we all tell him to get out then and forget it.

Meanwhile, a million other things are flying at me and I feel tears come to my eyes. I'm hungry, tired, and way behind. I don't want to cry though. By the way, I have a third patient who has an LVAD that's not working properly and I haven't given her any attention. Her docs are also trying to find me, so is pain service who wants me to order toradol for my first patient. I have call backs waiting for me and docs who are pissed that I'm not standing by the phone. It all gets very overwhelming and I'm still pissed about lift team.

The end of the night does not let up. My LVAD patient needs two units of fresh frozen plasma. I ruin the first bag they send because I don't clamp the saline, and the whole thing has to be re-done. The other nurses are so nice to me about it though, they tell me they also ruined their first bag. The patient is nice too, luckily. She has been teary all day because she wasn't expecting to need her LVAD replaced, and I feel bad that I have no time to give her any emotional support. My no-IV-access patient has been nauseous, and I basically have to tell him, nicely, to deal with it because we can't give him nausea meds. We asked service about something IM, but they said no.

My last 45 minutes I do all of the stuff no one else would probably bother to do on this kind of day. I post my strips (which I usually do first on my shift), I do my SOAP notes, my care plans, the admit's paperwork. I review my charting. The only thing I didn't do that day was read my patients' histories and labs. I hate that I couldn't do that. I have a headache, my feet ache, and I want to go home.

I guess I did as well as anyone could have, under the circumstances, but if every day was like this one, I'd quit.

day in, day out

I wake up at 6am. It's my fifth day in a row, out of seven. Second twelve hour shift. My work clothes are in the dryer but I still tear the dresser apart looking for another shirt. Sometimes I eat cereal before I go, sometimes I use the milk at work and eat it after report. Once, I tripped on the bottom step on the way to my car, and tore a hole in my pants. At 7, I'm trying to figure out if my assignment is ok, and usually I just say "ok whatever, I'll take it". Now I'm thinking about a cup of coffee, if I can get one off the patient cart, or if I'll try to make some myself. Sometimes it's ok, sometimes I burn it. I don't know how I do that, because I do it the same way every time. I just push "start brew" and sometimes it burns. What a mystery.

I post my strips, I do my assessments, I dole out pills, I fill out care plans, I get walks and baths finished. It's usually nine or ten when I sit down to chart. But no one else is there. Am I just fast? Or am I forgetting something? I answer my lights. I read my patients' histories and labs. I think about more coffee. The rest of the day is meds, walks, and damage control.

Report is when it all comes clear. Did I really tke care of everything? Make things easier on the next nurse? When I get home my feet are achy, despite the ted hose and extra support in my expensive walking shoes. I sometimes still smell c-diff stool. I take off my clothes first thing, but I'm too tired to shower. I feel too tired to eat, but I usually do. I try to stay awake for a while, for Saba's sake. But sleep comes easy, after days like this. I don't need to take anything, or stay up reading long.

I got to sleep in today, ahhh the joy.

work was never so easy (dot dot dot)

A few of my coworkers had some stressful days, but mine were pretty easy. I tried to help by answering lights, walking their patients, getting vitals, buying them bagels, etc. Still, I felt like I wasn't really sharing an equal workload.

I have worked far too many days in a row, and it's starting to feel like home there, a home I don't exactly want to live in but don't really mind, either. There's coffee, afterall, and $1 cookies from downstairs. That's something.

Someone from work just called and said 'can you bring your camera? We are all wearing pigtails today and want to take a picture!'

battling headaches, battle on!

I continue to try to find my niche on my unit and among my peers. I also continue to learn and grow with every patient I take. Today I had two Trans-hiatal esophagectomy (THE) patients. They are a specialty on our floor as well as in our hospital. They kept me hopping today, along with a post-op CABG admit from the ICU.

I battled a migraine all day, and I was happy to be only 8 hours.

sooner or later

I had had too many good days, and my confidence was too high. Last night, with not much reason for it, I felt incompetent. I guess it might have had something to do with the code.

An older man recovering from an aortic dissection repair suddenly became bradycardic, and then went into asystole. The code was called. It lasted a half hour before they called it. Then the nurse came out, looked right at one of us who was standing there, burst into tears and said "it's all my fault". Then she ran off.

I felt like crying, too. That could've been me. That can be me anytime. I wanted to go check on my patients, assure myself that they were alive.

My report to the night shift was disorganized and incomplete. It made me feel like a failure, incompetent, a poser. And deep down, it was the code and the tears, and the knowledge that when or if it is me, I would have nothing to offer, and no way to help.

training the residents

It's been pretty calm at work the last few days- with the exception of some chest pain from a rule out MI patient, which resolved itself with one nitro. I had this nightmare the night before, about a patient who went into v-tach, I pressed the code button, and only a few students came to help me and they had no idea what to do. That was the dream. At work, my R/O MI patient says he's having chest pressure and left arm pain, and suddenly throwing PVCs every which way. I got a bit panicky, but soon I was focused and fine.

Yesterday I had a patient who choked on some chicken, went sky-high tachy, desatted, and who was on an off service who came and said if his BP drops, we're going to shock him. We're going to what??? Sure, his tachy rhythm might be mistaken for Afib, from a distance, but after showing the strip to a few more experienced nurses, the concensus was just tachy. Not to mention, the patient already has a pacemaker and AICD! I was like, uh, excuse me boys? Let's not shock the patient, ok? He's going to be just fine. They looked up at me and said 'ok... well, we're still going to do an EKG and troponins'. Cool, go for it. Then the real physician came over later, and cancelled all that crap. What a day!

The balance beam final came on RIGHT at 11, when I had to give report. I beelined it back to the break room and everyone said "You missed Shawn Johnson!" Shit. But when she won, I was jumping up and down, and everyone was laughing and saying 'get her an ativan!'

Another fun fact- there are blue pads all the way across my couch at home now, just in case my cat pees on it again.

psych nursing 101

I had three mentally ill patients yesterday. One of them had a trach, which she managed to pull out, and kept biting me and the sitter. That was a scary moment, when I came in the room and that trach was sitting in her lap. I couldn't figure out the obturator, so I put it back in without it. Luckily, it went back in easily. I spent the majority of the day giving the patient lectures about biting and trying not to threaten her with restraints.

My other crazy patient escaped from the hospital in the morning. She had a sitter, who was let go right after, and took off. She was located later outside of the ER.

My third patient I have had for a while. He refuses to move. Refuses to get out of bed, turn, reposition himself, etc. So I enlisted the help of PT for that particular lecture, and it worked. He sat up in a chair for about 45 minutes out of the 12 hours.

I never felt overwhelmed though, I always felt I was on top of things. And we had NO techs. I feel pretty good about it all, although I'm hoping for a better lineup next time.

a gold medal day

If nursing was an olympic sport, I think I would've given one of my best performances yesterday. I took four patients, something we rarely do on our unit. With my eye on the clock (I didn't want to miss women's gymnastics), I had everything done by 10. Everything being- meds, patient walks, insulin, care plans, SOAP notes, charting, dressing changes, etc.

It felt like I just stuck a difficult landing.

learning on the spot

Yesterday was another good learning day. I got to hang blood by myself, for the first time. I was busy, busy, busy. No one can say that nurses don't earn every penny we get, it just kept coming and coming. I had a discharge and an admit. Admits are way easier with the MAR online, though.

Tonight is the women's all-around final on the olympics, and I will have to find an empty room to sneak into to watch.

I have to admit that I feel a little lonely at work now. I don't really have any friends, just a couple but our schedules are hard to match up. I hope it changes but I'll just be as friendly as possible to everyone until then.

my many skills

Yesterday was my first day back after four days off. Actually, I was supposed to go in Monday, but when I got there, I wasn't on the schedule. Their mistake. But they sent me home, they were all set. Then, 45 minutes later, when I was already back in my pajamas, they called me back and said 'uh, can you come back?' Uh, no.

Anyway, I took on the hardest patient there was. I figured, what the hey, no better way to get back into things than to jump in head first. But she wasn't bad at all. I got trach experience, so that was good.

The highlight of my night came when one of the techs came to me and asked me to come translate for a patient down the hall who doesn't speak English. She speaks Hindi. I said no way, my Hindi is nowhere near that good! But he convinced me, and I managed it, and I was sooooo freakin' high! That rocked.

growing up and out

My first day off of orientation was Sunday. It was a strange feeling, but also such a feeling of pride in myself. My first two days on my own were uneventful. I felt as if my head was held high, as if something inside of me was standing taller every day. I have never felt such a sense of accomplishment, such satisfaction with myself.

My third day brought all the learning experiences I could ask for, including a plugged J-tube, a THE leak, and a patient returning fresh from cath lab. I learned to use hot water, coke, and above all, muscle for the J-tube. I learned to wash it off and jam it back into the hole when it falls out. I learned how to do dressing changes for the leak, by having the patient swallow water while I use a Yaunker to suction it out. I learned how to hold the leak closed while the patient eats. I learned the standard orders for a patient post-cath lab, to take vitals every 30 minutes x2, then every hour x4, checking the pedal and tibial pulses, ambulating the patient 4 hours after sheath removal, and checking the groin site. I overheard a patient's wife saying, as if just realizing, 'Edith is a good nurse!' and felt my heart swell.

The next day, I was called at 11:30 and asked to come in and be assistant charge. What a sense of self-importance I had as I changed out of my pajamas and into my compression stockings! How I walked into that building, as if I alone could do the job, as if I had not just happened to be the only RN they could find to do it!

I was given the A/B side pager (it alerts us to dysrhthmias from the monitors) and instructed to take our brand new Dura Heart patient down to X-ray. This is the first patient to receive a Dura Heart, the fourth and newest LVAD, implanted for the first time by our very own cardiac surgeon. It's magnetic pump reduces damage to red blood cells, reducing the need for anti-coagulation. It has the potential to replace heart transplants, it lasts so long. Our first patient is doing fine, and we're all feeling a sense of pride at having him on our floor.

I took patients at 3. I had two aortic dissection patients, one pre-op, one post-op, and in my spare time I educated myself on the diagnosis and the surgical repairs. I also went up to 5 to visit my friend D, on her first day off of orientation on the ortho-trauma unit. We talk excitedly about our successes and our 'learning experiences', the ups and downs of our floors, our co-workers, our hours. We have been together through nursing school, through every step of our new careers.

The other orientees that started with me did not get off of orientation early. Last night was supposed to be their last night, but one orientee has not done so well. I feel bad for him, but the secret smugness I feel inside at having done better than someone else shames me. I feel like he has not had all of the learning opportunities that I had during my orientation, either, and this has only hurt him more. I wish him every success.

welcome to 4BC

I got a taste of a nurse's life on 4BC for real yesterday. 12 hours of nothing but running. My new preceptor let me take care of everything on my own, which was good, but daaaamn. My patients were coming and going all day, pharmacy was screwing everything up, service was complaining, I was giving amio boluses and mag boluses... stat orders coming out of my ears. I managed two have time for two small cups of coffee and a frozen lunch. Otherwise, I was running all over the damn place.

Oh but it's good.

on shaky legs

I got new preceptors... again. But it turned out to be kind of a good thing, because the one who I was dreading working with most, she let me go pretty much on my own and had some really good ideas for me. I had a meeting with the educator, who had only good things to say about me. I will be off of orientation on August 4th. Hoo-rah!

I have overheard some of the night preceptors complaining about their orientees. I am surprsised that none of the people I started with are doing anything on their own yet! I mean, seriously? I guess I don't know everything about them, though. I'm just surprised.

ready to be on my own... or not

My preceptors say I'm doing great and I'll be ready to be on my own soon. Thursday evening really put that to the test. My preceptor needed to run downstairs for 15 minutes, and I was alone with my 3 patients for a while. In that time, I gave Morphine IV push, I talked to service on my own, and I sent a patient down to X-Ray with the SWAT team. I was sweating, and nervous, and suddenly I really felt my newness, even though I tried to cover up for it.

I think I did ok, though, and it was good experience. I've never been so nervous about giving Morphine in my life, though!

I've also done a driveline dressing on my own twice, now, and I'm feeling good about that.

dreams come true

I passed. My results went up yesterday afternoon. It was an amazing feeling, to see that tiny little word: 'pass'. Tears nearly came to my eyes. Everyone was saying 'congratulations! But we knew it already'. The pressure was enormous, thank god I lived up to it.

I started signing my name with 'RN' right away. Then I stood there, grinning stupidly at it. It looks awesome. Someday soon I'll take it for granted, but I just want to sign 'RN' all over the place right now.

I just have to wait for them to post my license number on the website so that my nurse educators can give me a password to take out meds. I feel like I'll finally be a trusted and equal member of the team. I have been so lucky to find my unit, where all of the nurses are so close and comfortable with each other, where there is so much respect and teamwork amongst everyone. I never expected to have this much fun at work.

so that was that

I did it. I took the NCLEX-RN. I got the minimum number of questions, which means I either did super well or really bad. I wasn't nervous until a half hour before. Then I sat down at the desk and finished all of the introduction stuff, and it hit me. My hands started to shake and I had to take deep breaths to calm myself down. I kept thinking, these are the answers that really count, and freaking out.

Now I think waiting will be the hardest part. There is no peace until I know that I passed.

full of crap

Yesterday my nursing friend popped open a colace and put the liquid in my ear. One of the MA's told us it would help break up an impaction I had, which she saw with her otoscope. A few hours later, my hear was throbbing and I left for urgent care to get it irrigated out. This big scab thing came out in the basin, ew, very gross.

I had a good day with lots of laughing with my new nursing friends. I never imagined it would feel this good to be "one of them". I never imagined I would get along with so many people so well.

Tomorrow is THE BIG DAY.

not what I signed up for

I wanted an insulin drip. What happened was the insulin drip was continued and I was left with a raging penile yeast infection. So I dealt with it. The coolest part of the day was when we went to take out a patient's sutures, and they were so healed over that we had to dig into the skin and wrip them out, with blunt tweezers no less! Blood was running, we kept pouring saline over it and blotting it up. I felt so bad for the guy who was a total trooper.

Sometimes I feel so far away from my other friends now. All I want to do is talk about blood and gross infections and cool rhythm strips, and they are SO not interested. When I'm a real nurse, will I ever be able to connect with them like I used to?

when the night shift snows you

We got report today, and went to check on our patients. We found Mr. N with resps of 40, heart rate 110, fever of 102.7, sats 70% on room air, A&O x 1. We came close to calling rapid response, but we got his sats up and his resps down, notified the service, and gave a tylenol suppository for the fever. Then we felt the "rice krispies" over his anterior lung fields... that was the first time I ever felt crepitus. Cool... I mean for me, not for him.

By the time we got all that worked out, we were way behind on morning meds. We asked for some help, but we still didn't get lunch until 1:30. I got to watch a driveline dressing (next time I'll do it) and dress a stage 4. So a good learning day. I got a headache at the end though.

My nursing school friend, C, started on the floor today. She was nervous, but I gave her one of my "brain" sheets for organization and told her she'd be great. It feels strange to be ahead of her.

I took my EKG test yesterday, and passed with only two points missed. I feel pretty good about EKGs now. Two of the new nurses who are orienting in my group failed. It sucks for them, but I hate to admit that I felt even more proud of myself because they didn't pass.

Wednesday I made up for my absence on Tuesday. When I got there, I saw that I was orienting with none other than the nurse educator, the one who is strict and who I've never felt liked me (or many other people). All the other nurses kept telling me "good luck" sarcastically, with doom in their voice. I was nervous as hell, but I told myself "maybe I can impress her and win her over". And I did my damndest to do just that. By the end of the day I felt like I'd been a success. She didn't criticize me and even told me 'good job' a few times. I felt like I'd passed my NCLEX... awesome!!! I think I made a good impression on my hardest sell!

sometimes it's all I've got

I went to my third EKG class today with the chills and a sore throat. Later on, I was warm, according to nursing friends, and I debated in my mind whether to go to the floor afterwards or not. I almost went, because I wasn't feeling SO bad. But then I thought about all of the transplant patients and surgery patients, and I ended up calling and asking if I could come in tomorrow instead, if I'm afebrile. It sucks.

This whole thing takes its toll more than people think. I've given up a lot of things, temporarily, to make my career begin successfully. I sometimes wonder if it will cost me friendships that I worked hard for in the past. I hope to get back to my usual activities later in the summer, when my NCLEX is behind me and I successfully transition off of orientation. I just have to remember that I'm fighting for this like anyone else who wants to win something. I'm putting in hours of work, determination, and dedication. But I worry that in the meantime, I'm disappointing the other people in my life.

where's my valium drip?

I survived my first three-day-in-a-row stint at work. And I had lots of fun discharging my patients yesterday. I totally remembered how to do it from my externship, and my preceptor was surprised when I took the reigns and did it without even asking her. In reality, I can feel myself sort of kicking against all the supervision. I just want to do my job, and ask questions when I need to ask questions.

I'm learning a lot about how to deal with pain, and how to get pain dealt with. It's not a joke when people are in pain, and it's important to get it taken care of immediately. I feel like I'm growing a lot more, a lot faster, during my orientation than I ever did in nursing school. This is fun!

my lunch smells like tube feed

I have experienced the joys of gunky empyema tubes, the smell of leaking tube feed, spilled j-tube meds, and stomach contents all over my bare hand. Oh let me count the ways I love being a nurse!

I finally got my test date- July 11th! I'm going to be the happiest NCLEX taker they've ever seen!

they're turning me into a nurse

My days on the floor have been good, but I get impatient with having a preceptor. I especially hate having to wait for her to get meds. I only have one preceptor who won't even let me give oral meds. This is bad news for me, because the state STILL hasn't received the correction from my school and I'm still waiting for my authorization to test. I'm dying of jealousy of the other new grads who are testing next week. I want my damn license already.

I have taken a lot of classes as part of my orientation, too. Mostly med surg, but now I have started my EKG series, and there will be a big test at the end on reading strips.

I hope that I can do this job well, that I can become someone who is respected on my unit, someone who can make a difference not just with patients, but with my co-workers. I do want to be involved with the unit, I want to be a leader (eventually) and someone people think of as hard-working and contributing. I really care about our floor and our patients, and I don't think of it as 'just a job'. I feel like someone who really contributes to society. Maybe it's a puffed-up image of nurses that I have, but when people stand up and take off their hats when I enter the room and say 'I'm your nurse', I don't know... it's a good feeling.

My world has been infiltrated by chest tubes, wound drainage, monitor strips, and multiple choice questions.

news from the front

I survived my second and third day on the floor with minimal damage to my fragile self-esteem as a new nurse. I was finally with one of my regular preceptors, a nurse about my age, and we had a couple of very laid-back days together. I took a CHF patient waiting for an LVAD work-up, a THE patient suffering from complications of her surgery, and even squeezed in a final admit with a lobectomy right before the end of the shift. I felt like I had more of a routine going on, and I'm getting a little bit more comfortable with the documentation systems and my assessments.

I heard some crazy adventitious lung sounds, and a heart murmur, and I was really proud of myself for *finally* hearing something out of the norm!

This week was my med-surg series. More lectures and demonstrations on IV therapy, drains, ostomies, chest tubes, and trachs. Friday I have an all-day class just on using our brand spankin' new online MAR.

Today I received my first 'real' paycheck. WOW! I can pay all of my bills with one paycheck!

survivor mode

Well, I survived the long and boring central nurse orientation and happily looked forward to this week: my first week on the unit as a nurse, not a tech. The first day was more orientation. But yesterday was my first day on the floor with patients. I was scared to death. I felt like I had no idea what I was doing, I was way, way, WAY outside of my comfort zone, and the title 'nurse'? Yeah, I felt like a poser. What do I know about being a nurse???

My regular preceptor couldn't be there, so I was handed off to another relatively new nurse. She is a great nurse, excellent at everything, except maybe... precepting. She flew threw everything so fast in the morning that I got incredibly frustrated, just trying to figure out what was going on. Later in the day I got a handle on things, though, and did better. I'm not used to working for twelve hours, and until about 5:30, when my circadian rhythm kicks in, I was exhausted. My eyes were burning, my feet were aching, all I wanted to do was go lie down somewhere. But I kept plugging on. This was no joke... now it was up to me (well, me and the other nurse) to take care of these people!

The patient I was primarily responsible for was mitral and tricuspid valve repair, post-op day 8, with a chest tube, a dophoff, an NG, glucose checks, and basically everything else you could think of. Getting her to eat was the hardest part. I helped out with the other patients as well, and I'd have to say the highlight of my day was getting to remove staples from an abdominal incision.

I definitely figured out how to organize my notes and my day a little better, and got a minimum idea of the charting systems and routines... but if nothing else, now I know that I really have a long, long way to go before I feel like a 'real nurse'.

it's under my belt

So I did it, I graduated! I am now a graduate nurse with a bachelor's of science in nursing. But I'm not getting too excited yet... the NCLEX and getting through my first six months as a nurse looms on the horizon. Scary changes. I'm not sure if my education has prepared me for most of it, but I have to keep in mind that I'm as prepared as anyone else ever was.

I found out who two of my preceptors on the floor will be, and I'm pretty happy. One is a more experienced nurse, V, who has always been very friendly and helpful to me on the floor. I told her she would be precepting me and she said she was really glad, that she likes me. The other is a younger, newer nurse who is gaining experience as a preceptor. She is pretty cool and seemed happy that I'll be her preceptee.

Graduation was a good time. I felt proud of myself and glad that my parents and grandma can finally feel like all of their support has paid off. Three of my fellow nursing students will be working with me on my floor, but I'm the only one starting in May. I'm especially glad that I'll be with my nursing buddy C, we have fun together. Ok, we complain together, but it's fun!

I got an A in statistics, an A in community health clinical, and a B in lecture. I graduated cum laude.

And I start nursing orientation a week from Monday... so, welcome to a new blog, the title is changing to: "The Life and Times of a New Grad Nurse!"

falling behind

I have neglected this blog pretty badly. But I haven't exactly been immersed in nursing school the way I was last semester. I never went to my community health lecture, except to take the tests, and I missed four of my clinicals due to traveling. But I did get to make that up with a two hour presentation on community health care in developing countries. It was awesome and I rocked. The instructor told me I should become a teacher, I should apply for a fullbright, I should present to all these groups... etc etc. Nice to be so complimented on my academic strengths!

Today I took my student loan exit interview. I am $35,072 in debt, and I will be making payments of about $250 per month. Doesn't sound too bad... except that it's going to take 20 years to pay it off! But I accepted that responsibility a long time ago. I'm just eager to get started. A real job, a real income, and finally able to pay all of my own bills. I mean, my dad is still paying off his college loans! I only plan to defer my loans or whatever if I'm in grad school. Because I'll have to work a little less.

Today is my very last final of my undergrad education. It's for statistics and I'm confident I'll do ok.

I graduate on the 27th and I start nursing orientation on my unit on the 19th of May. I barely work at all until then, because hours have been severely slashed for temps. But I will be studying like crazy for my boards.

In hospital work related news- nothing. I got to suction a trach for the first time with the help of M, another graduating nursing student working just down the hall from me. She has all the trach care, I have all the heart monitors. We should be able to help each other out. I'm also exciting that my friend C from nursing school is starting on my unit one month after me. It's so great that I'll be around familiar faces, especially since I was given a days/eves rotating position. Now I'll know everyone and that will make being a new nurse just a little easier. Easier to ask for help, anyway, and less shy about sounding like a moron.

And thank GOD I don't have to work nights... I'm disoriented enough during the day!

muddling through the last semester

I have been very lazy about updating here, for those of you following my career. Community health is very disorganized, and for the most part a big waste of my time. Everyone is complaining about it, but I guess there's nothing we can do but slog through it. I work at headstart for the morning preschool class once a week. I basically... hang out with the kids. I measure how tall they are, how much they weigh. But it's not like I can do that every time. I guess things could be worse.

up to my elbows in sh*&#

News from the teching front: I spent my day trying to keep the poop off a guy whose rectal tube was falling out because it had been in so long his anus had stretched out too much to catch the stool. Plus, he is ARP (antibiotic-resistant precautions) which means I have to glove and gown every time I go near him. Makes for a sweaty and tedious day. I've been 'sitting' with him for two days in a row, so I told the charge nurse to give me a break!