Nursing for Guys

Smoking for Nurses

noreply@blogger.com (Rick) — Thu, 10 Nov 2011 01:59:00 +0000

Ok, so being a nurse, let me first say that I know better. I really do. However, for the last 11 years, I've been a pack a day smoker.

It's been pretty easy to keep it up: at first I had nursing school as an excuse. I told myself that I'll quit right after nursing school. However, right after that I was dealing with my divorce. I'll quit right after my divorce. Now it's a paternity/custody battle with my son. I'll quit right after that. Also, my job is really stressful at times; I'll just smoke when I'm stressed out. I once had a COPD patient go into respiratory distress, desat to about 68%, get put on a full-rebreather, and sent to the ER; the entire incident stressed me out so much I had to take a break and go burn one. Oh, the irony of that situation is epic.

I definitely recognize this behavior as self-justification. For God's sake, I learned about it psychiatric nursing. Anyhow, since no time will be a good time to quit I decided to just dive right in.

Having several failed attempts with patches and gum, I decided to go with a medication. First of all, let me state that I personally am very skeptical about medications and their long term effects on the body, so it has to be a pretty extreme circumstance for me to consider medication for anything. Especially if the medication works on the brain.

My reasons for quitting are pretty much "DUH!" at this point, but I think the real kicker that got me moving is that I'm sick of hacking up copious phlegm every morning and I really noticed that I've been getting winded easily when I exercise.

I decided on Chantix because it seems to have a general consensus (among websites like WebMD; I refuse to pay $30 for the actual research) to have a higher success rate than Zyban. I liked the more attractive pricing of the Zyban, as well as the antidepressive properties (after all, it is just rebranded Wellbutrin). However, I decided to go for broke and get the newer, supposedly more effective drug (ignoring the research that links depression and suicide to its use). So far, I'm about a week in, so I can still smoke.

My experiences thus far has been pretty positive. I've had no disturbances in sleep and I don't believe that I'm feeling any more depressed than normal. Sure being in the middle of a court case, apartment hunting, and having bill collectors call 24/7 for debts from my marriage that my ex has no intention of paying makes you feel pretty rundown, but I don't believe anymore so than normal. I'm certainly not thinking of offing myself either, so worries there either. (By the way... not me in the photo!)

One thing I've noticed is that I don't have the urge to smoke as much. At the end of my first week, which would be tonight, I've noticed about a 75% reduction in the amount of cigarettes I'm smoking. Sometimes I just forget to, even though I can. I'm smoking about 5 a day instead of the normal 20. When I smoke, it doesn't have the same appeal that it used to. The way the action of the medication works is that it supposedly inhabits the receptor cells in the brain that nicotine used to. I immediately think to compare it to narcotics and narcan. It seems to be doing a decent job so far.

We'll see tomorrow when I go smoke-free. Fingers crossed!

Angry Nurses

noreply@blogger.com (Rick) — Wed, 09 Nov 2011 01:01:00 +0000

Okay, so I got screamed at by an incoming nurse during report. I decided to write a little post about this, and maybe I can get some feedback.

First of all, you probably want to know what major offense caused this particular nurse to go ape-shit, banshee-screaming wild on me. In a nutshell, I forgot to put multi-podus boots (MPB) on someone. Normally, I agree that this is a big deal, however, as explained to her, due to the fact that this particular patient's skin issues were known to me, I repositioned this patient hourly, making sure heels were floated on the pillow each time. Skin issues were abundant. This patient had at least 5-6 pressure ulcers, poor nutrition, tube feeder, wound vac, foley, spongy heels... just the works.

As a sidebar, I don't feel this patient is appropriate for a rehabilitation hospital such as ours; our focus is being the bridge between hospital admissions and home. A prerequisite of our facility is that the patient must be able to physically endure three hours of physical, occupational, and/or speech therapy daily. A big focus is on recovering lost ability or learning to live with a disability. A newly appointed marketing team has been sending us incredibly inappropriate patients. One of last week's patient had dementia so bad she couldn't even finish a sentence because she couldn't recall what she was saying midway through.

Back to the issue at hand, in my defense, I simply didn't have a chance to run across the paperwork stating that MPB were ordered until late in the shift. I have 10-12 acutely ill patients nightly and reading every physician order since admission (it didn't appear on the kardex) is simply not feasible. I was the first one to even notice the order and reported it to her. So, I believe I acted to the best of my ability, and while MPB are great, repositioning hourly I feel would be more effective anyhow, especially since the heels were elevated.

Well, this nurse basically turned into a screaming banshee and laid in to me, called me lazy, and embarrassed me in front of a bunch of nurses in the large report room. The one thing I hate about this field is simply working with women sometimes... I feel like I'm cruising on a hormonal highway sometimes; this is something I'm definitely not used to. This particular nurse has had this incredible hulk issue before with others. I don't think it's so much what was said, it was how it was said. I think I had ex-wife post-divorce screaming match flashbacks. Horribly unprofessional, in any case. I did handle the situation well and remained composed... though in the back of my mind I wanted to ask her if perhaps her Paxil prescription ran out.

My point is this: can't we just assume in most cases that our colleagues aren't incompetent or lazy next time someone doesn't have a last bowel movement or other similarly important, yet not immediately crucial, piece of information?

Refresher

noreply@blogger.com (Rick) — Thu, 03 Nov 2011 02:18:00 +0000

Okay, so I'm back, my blog has a new name and a new domain!

If you haven't already figured it out, I passed my NCLEX-RN boards! Two clues would have been that number one, I can afford my own domain name now, and two, I haven't really had any time to post.

My divorce with my cheating bitch of an ex-wife is done and over with, now we are just fighting out custody for my son. And get this... three months after the divorce, this dumb ass is married yet again, to the same douchebag who she was with while I busted my ass in nursing school and managed to pay our bills. Oh well, you live and you learn. I'm happier now that I've completed nursing school than I've been in a long time. Get my son out of that weird ass Jerry Springer white trash situation and I'll be doing fantastic.

Nursing school was definitely worth it. Definitely. It was the hardest thing I've ever had to do, but now that's it's done, I've got a really great career. That's a good thing. That's not to say it's not without its downfalls though. It's stressful.

I see a big difference between LPN and RN, even though at first it didn't appear to be a big difference. Speaking about technical skills, it's not very different. However, the big difference comes in with the paperwork. Apparently, there are many... many forms that require an RN signature. There are careplans that need to be done (GAWD I hoped I'd seen the last of those; no such luck). It's just a stressful bitch of a job at times. At least the LPN to RN pay raise was worth the extra schooling.

Hopefully in a month or two I'll have saved up enough into a nice, new apartment. I'm currently rooming with two graduate students who smoke a ton of pot and watch ESPN all day long. It's been a fun ride, but I think I'd rather get a new place with a little more privacy and a little more kid-friendly for my son. Extra privacy for my awesome girlfriend :)

Anyhow there's a little personal update about me. I got a ton of responses regarding my personal issues I made in previous blog posts, so I figured what the hell. I'll be probably posting some stuff that's actually nursing-related in the near future, so keep reading!

New website, same posts, still in the works!

noreply@blogger.com (Rick) — Thu, 03 Nov 2011 01:44:00 +0000

I've been trying to find the time to get this site back up and running! New look, new domain... but I retained all the same posts from the past and will have a bunch more new ones upcoming.

Oh, the horror!

noreply@blogger.com (Rick) — Wed, 10 Aug 2011 18:43:00 +0000

Most horrible thing witnessed in my nursing career thus far..

So after my confused patient had a very uneventful night, his bed alarm sounded. By the time I responded, he is in the middle of the room. Normally, this wouldn't be too big of a deal, however, there's a catch. He had a foley in, and apparently while walking, pulled it out.

After this incident, which had me cringing from the thought of pulling a foley out, I of course had to inspect the site. Apparently, on the underside, his penis had split...

This was quite possibly the most gruesome thing I think I'd ever seen. I've seen ripped off arms, dehisced surgical wounds, but I think I was about green for this one.

Anyways, in response, it turns out his penis was partially split anyway and this just finished the job. Either way, there wasn't any blood. You could still see the urethra further back from the split, and since the patient had a urology appointment today anyway, we just decided to have a doc take a peek until the appointment.

Most horrendous thing I've ever seen... and especially if your relieving nurse is a male, if your patient's penis looks like a split hotdog at the ballpark, let him know so he's not walking into it blind!

Paper Charting

noreply@blogger.com (Rick) — Wed, 03 Aug 2011 09:16:00 +0000

Making my first graduate nurse post, I'd like to give my thoughts on the EHR, or Electronic Health Record for those nursing students. In comparison to paper charting, I only have one comparison:

BETTER.

In my current job as a nurse, at an acute inpatient rehabilitation center, we use strictly paper charting. I can honestly say I'm pretty happy with getting this experience, however, I just gotta say it totally sucks.

It's not the pre-carpal tunnel pains I'm feeling in my penmanship hand that's my primary reasoning; it's efficiency. I'm paid a pretty penny to take care of my patients. I'm sure that my corporate office would like to see all of their monies they kick my way go for patient care, however, that's just not the case. I spend nearly half of my time each night creating worksheets from scratch, or filling in daily or weekly forms.

Whether I'm writing a report sheet, or filling out multidisciplinary conference forms, I feel that all this paperwork could be easily generated with some decent EHR software. Why should I spend as much time as I do chart-diving when EHR software would easily generate these forms for me?

I think the key to this is training, training, training. I work with a bunch of older nurses and I think there may be a few hold-outs. This is more of a rant that a full blown article, however, I'd love to see an even wider range of use when it comes to EHR software.

For clinicals, I participated in a pretty sweet McKesson software based acute hospital. It was awesome, quite frakly. Well...not really, but in comparison to the documentation methods I use where I work now, it's like comparing tin cans with string to high-speed cable internet.

Here's to hoping rehab and LTC facilities start to see the light. Less paperwork time means better patient care. Better patient care means more of those sweet 100% score satisfaction surveys.

Any readers care to share their thoughts on the EHR?

Blog Change

noreply@blogger.com (Rick) — Wed, 03 Aug 2011 09:04:00 +0000

New career. New blog style, new blog name. Look for a new domain with redirect coming soon! All student blog posts will be retained and archived.

Finally made it...

noreply@blogger.com (Rick) — Wed, 03 Aug 2011 08:14:00 +0000

First post in six months... I know, I know, so sue me.

Well quite a bit has happened. First and foremost, I passed my class. I did it, I graduated nursing school! We had quite the party and the local drunk bus had to come pick me up. It was a fairly epic evening.

However, I still need to complete the NCLEX-RN. Mailing in my papers tomorrow. Then I get to sit. Then, hopefully, I'll be in RN mode :)

Dying Good

noreply@blogger.com (Rick) — Thu, 20 Jan 2011 15:56:00 +0000

This new class is really something else. Now let me start by saying I don't even think it does it justice to call it one course; it's really four courses.

Community Nursing
Advanced Pediatrics
Advanced Mother-Baby
Leadership

Each section has it's own clinical sites. Each has it's own APA-style research paper and associated online tests I need to complete. There's also a massive group teaching project as well. This course really feels like they are cramming about one year of a Bachelor program into 12-weeks.

I did my clinical yesterday at an inpatient hospice facility. I thought it was really awesome. I mean really awesome. Patients were comfortable, not stressed, and it was very peaceful with the exception of family members not coping with their impending loss well. I mean seriously, if I'm gonna go, this is how I want to go.

I've seen patients, even some at my work, that I truly believe need this kind of nursing. I had a 90-year old patient with a gangrenous leg a few nights ago who was a full code status. The only reason she still had the leg was because she wasn't a surgical candidate... she would have died during the amputation. So instead of placing her on hospice care, the family felt it was best to admit her to a intense in-patient rehabilitation center where she was forced to complete 3 hours of physical therapy a day. She'd cry and say she just wanted to stay home and drink coffee and watch talk shows. I'll be damned if someone 90 years old in that poor of a condition shouldn't be able to do whatever the hell they want to and spend there last weeks or possibly months in comfort. You gotta love idiot MPOAs that can't see anything beyond their own selfish needs to hang onto someone's life with no regard for the quality of it.

I'd never seen hospice before yesterdaty, but I'm telling you, my patient from the other night could have drank all the coffee she wanted and watched all the TV shows she wanted and not had to deal with the ridiculously intense pain of muscle death in her gangrenous leg. If you're going out, that's how you want to go: pain-free, but not sedated, with plenty of time for inner reflection and meaningful goodbyes to your friends and family. Truly an amazing thing hospice is.

As far as the class, it's fairly insane the rate at which it goes. One thing after another, and another, and another... But I'm actually kind of used to it and not really shocked at this point.

Anyhow, until next post!

Arrangements for Next Semester

noreply@blogger.com (Rick) — Wed, 05 Jan 2011 10:05:00 +0000

Ok, first and foremost, I got out of my living situation. Left the wife and now am living with my mom, who needs a little extra help due to some health issues. This is great in some respects, kinda crappy in others. Basically, I miss my son...

Continuing on and beginning to think about school again, I had to have a damn background check done (again) to have clinicals in a particular retirement home. Passed with flying colors!!

This semester really will be the last of the RN portion and I'll done! Complete with a degree, an RN license, and all that. I really want to get back into night school for my BSN and eventually MSN in FNP. I can't hardly wait.

This semester is essentially my "miscellaneous" course. There's going to be rotations in school nursing, advanced peds (NICU), and taking over an entire wing of a nursing home. This one is historically much easier than the class I just passed which was the advanced med-surg class.

I really feel like I'm on the home stretch. This is great all my work seems to be paying off; I just hope my living situation doesn't cause too much of a distraction for me; it's a tough situation to be having going on while wrapping up nursing school.

Until next post, and thanks for all the great advice I received last post!

Ok, here's the scoop...

noreply@blogger.com (Rick) — Sat, 25 Dec 2010 15:10:00 +0000

Since this blog has become a forum for both my relationship and school now, I figure I can just lay out there what's been going on. I warn you, this gets very Jerry-Springer-ish...

First of all, when I began nursing school this year, my wife had a male friend who was a mutual friend. They talked all the time on the phone and it bothered me, but he was married so I figured it was fine; I'm really not the jealous type at all.

As nursing school progressed, she became better friends with him. Then it came to light that his wife had been cheating on him. So, to make a long story short, he left his wife and had nowhere to stay but with us. At this point, I was actually cool with everything since he was a mutual friend.

Everything was going pretty much fine except for that nagging feeling something was going on. When I would be at work or school they'd go to dinner or out to the bar. Then one day at the bar and got beat up pretty badly. He landed in the hospital with a closed brain injury and my wife stayed with him for like three days, leaving me to take care of kids as well as somehow continue to work and do nursing school.

When he came home, he was still in pretty bad shape. She then said she needed to stay with him in his room because she needed to wake him up every so often because of his concussion. I hadn't really covered head trauma in school yet, but I had a sinking feeling you didn't really need to wake someone up every hour three days after the initial injury. So I was pretty much like whatever. I mean I had a full-time job, full-time school, and I didn't really have the time or the means to even monitor what my wife was doing since I was doing 70 hour weeks, not including at least 10 hours of driving weekly.

Well, she never actually came back into "our" bedroom. She's pretty much just been staying with this guy while I go to school and work, and in my house nonetheless. She says that she knows our marriage is over, but I need to stay for my son. I, like the mother of all dumbasses, agreed, not only because of that reason, but because during 20-30 hours a week of nursing school and 40-50 hours worth of working, I just do not have the time to coordinate a move.

It's been this way for damn close to a year now. My wife still denies that there is a relationship going on, and they are in fact, just good friends. This insults my intelligence and pisses me off about the situation even more. To show her appreciation for me staying for "our son", which in her language translates into "I need someone to pay the bills", she has done the following:

Had her name put onto her "good friends" checking account.
Had her "good friend" co-sign a car loan.
She went on vacation to West Virginia for five days... during our fourth wedding anniversary.
The kids, with the exception of my son, often call me by his name.
Frequently goes to bars with him and forbids me to come.

Now comes the best part... the double standard. My Facebook account, cell phone, and pretty much anything else, she used to check like daily for fear I was cheating on her with someone from nursing school... months after she began sleeping with her "good friend" and moved out of our bedroom. Anytime I make time to go out and attempt to have a life, she says I need to spend time with my son. Anytime I go out a grab a few beers she begins texting me wanting to know when I'll be home, telling me my son is asking for me, etc. etc.

Now I don't think I am wrong in taking a day every now and then and doing what I want to do... whether that be having a few beers on gameday with my buddy or even at this point taking a girl out for a dinner or something. It's just not right that 100% of my time be spent working, sleeping, at school, or taking care of my son.

It's just a horrible situation and I can't wait to get out. I'm getting an apartment as soon as I can and getting out of this situation. My wife states that we are just "roommates", yet I turn over a god awful amount of money to her every two weeks and my whereabouts and my business is constantly monitored.

I can't live like this any longer, but I think I'm going to try to make it through one more stinkin' nursing class before I get the hell out of here.

Professional Successes... Personal Failures

noreply@blogger.com (Rick) — Tue, 21 Dec 2010 16:58:00 +0000

Well, in case everyone is wondering, I made it through my advanced Med-Surg nursing course by the skin of my teeth! I was literally four questions away from having to repeat the class!

Next is my community nursing course. I will be starting this mid-January and completing it in May. Then I have a 6 week microbiology course to take before I can sit for boards (again...) Time really flies... I feel like I literally just sat for my PN boards and I'm gearing up for the RN boards.

Work has been getting better as I become more accustomed to the paperwork system. I'm starting to get much better and much more confident when giving medicine and calling the doctor about certain issues. All in all, the experience is more positive than it has been.

Well it's also official that I'm getting separated. My wife's male "friend" has helped set up Christmas lights and done all sorts of other family type things that I should be doing but can't due to work and school. I feel that this is a major crossing of boundaries. Christmas at this point in time doesn't even feel like Christmas; it feels like a problem I just need to throw money at until it goes away. It's sad that we live in a day and time that the final word is on a relationship is your relationship status on Facebook... Mine is now, unfortunately, separated.

When I have a little more time I think I'll post the entire marital issue I'm having just so I can get it off my mind and see what all my commenters think, since I get quite a bit of blame from my wife even though I just don't see it.

May my next post be much prompter! :)

Pushing Onward... Hopefully Upward

noreply@blogger.com (Rick) — Fri, 26 Nov 2010 04:22:00 +0000

Ok, I'm convinced that I am suffering from burnout. Nursing school so far has really pushed me to my breaking point, and I'm at least happy to report that I think my breaking point might be a bit further than I thought.

I think the weight of everything really has me down. My mom is sick and in constant need of a ride here, there, and everywhere. Operations, procedures, followups, denture places... She's a very needy woman at this point in time and thankfully, she has some good friends to help her where I can't. However, I still make every effort to take her where she needs to go when I have the time. What would have really helped here is a good marriage... a good partner to help me with my mother, however, my mom absolutely loathes my wife and won't even let her in the house.

Speaking of my marriage, it continues to suck worse than anything I've ever experienced. Basically, I've agreed for my son's sake to remain in the house until he is out of school in June, although I have a sinking suspicion that I'm needed primarily for bill-paying. Today was Thanksgiving and my wife let me sleep through it. When I woke up, everyone was leaving. Unfortunately, I am on a flip-flopped sleep schedule due to my overnight shifts as an LPN. She is very overbearing, controlling, and vindictive. She still checks my phone, my Facebook account, and pretty much everything else because she is convinced I am cheating, which I recognize as the sign of someone who is, in fact, cheating themselves. I think I'll have to make a special post with just how effed up I've allowed this situation to get, but it's a little more than I care to post right now, but let's just say there's little doubt about her extramarital relationships at this point.

School continues to be totally relentless. Somehow, I've managed to pass my drug calculation final with nine out of ten questions correct. If I pass this course, I will never have to take a drug calculation test again, thank God. Being the final drug calculation in the entire nursing program, this is the one that they pulled out all stops to try and trick you. All the critical care calculations, mcg/kg/min with x mg available in x mL, were on this one and it's thankfully a done deal. I also got back my third (out of four) skills quiz in which I passed with an 87%.

This small bit of good news doesn't mean I'm out of hot water though. I'm still carrying a 74.3% in theory which is failing. I have a fourth theory exam and a final exam to bring this up. If I can get my theory grade above a 75% with those two tests, I'm set.

In addition to this, I am taking Sociology and Speech. I will say this: the absolute piss-poor quality work I am turning into these classes amazes me that I continue to pass with low As and high Bs. I'm on the computer tonight to essentially stamp out the rest of what is due for my speech class. These, I feel, are unnecessary "gimme" credits that you'll get simply by showing up.

Work is going well. The twelve hour shifts are perfect for me. I can get 36 hours in three days, and then have off Monday through Thursday. The work itself is pretty hard though. I feel that my facility may have the world's worst paperwork system. It seems, at first glance, thoroughly disorganized. I've already been talked to about not signing a nursing note and not following up with a pain scale on the chart. No biggie, but I need to be really careful about it; the paperwork is long, involved, no-joke, and someone thoroughly is checking behind me.

During my days off I sleep. And I mean sleep. I've been getting between 9-11 hours of sleep a night: I just don't want to wake up. Maybe it's a touch of depression setting in based on all these concurrent situations occuring, maybe it's just my body attempting to recover sleep debt from all these weeks I've just been going sleep deprived. Who knows... but no matter how much I sleep, I'm still feeling run down and feeling totally ready for this class to be over: whatever the end outcome be that pass or fail.

Squashed

noreply@blogger.com (Rick) — Fri, 12 Nov 2010 17:00:00 +0000

My little issue with the blood transfusion got squashed. I was not in trouble for the miscommunication, however, I did get a verbal warning for not reporting off. There were no points deducted off my grade, thankfully. I do agree with the verbal warning about failure to report and the instructor at least understood why I didn't think I had to. All in all, I'm happy it is resolved. I mut admit I did tell my instructor I was dropping the class if I got point deductions (which was totally a bluff) but hey, at this point, I'm ready to play dirty to get done.

Now that this is resolved, I really need a good grade on the next exam. I don't want to have to study furiously for a final to bring my grade above failing. The next exam is going to be easier than the last, which included 11 different diseases. This one is essentially just cancer and spinal cord injury. I've been telling people that to ensure passing I will do the following:

Read all the chapter in the book pertaining to cancer.
Make an outline from the book.
Study note cards.
Hang out with people who have cancer.
Volunteer at the oncology ward.
Attempt to give myself cancer to better understand it.

Seriously though, it's really freaking me out. However, in the first medical-surgical nursing class the final was fairly easy. I got a 95% on it. Hopefully, the final comprehensive exam is not quite in-depth as the chapter ones... this has been the general trend.

We lost another student yesterday. This class is starting to dwindle just like the first Nursing 101 class.

Also, tomorrow is the last day of my corporate job. I'm very excited to be changing careers, but a little nervous as well.

Until next time... I'm stressed to the max!

Hot Water

noreply@blogger.com (Rick) — Thu, 11 Nov 2010 19:09:00 +0000

Ok, so my whole nursing career has pretty much taken a turn for the worst. Here's what's happened so far...

First of all, I did majorly bomb that endocrine test. A 63% dropping my test average to 74.3%. That sucks, because I am technically failing; I need a decent grade on exam # 4 and the final exam to get through. However, that's doable and I'm not too worried. But wait, there's more and it gets even worse....

I was at clinical with the new clinical instructor (yes, same one that failed me on skills check). I'll give you a little background on how she's been teaching. First of all, she manages her time poorly. All of our meds and treatments end up being late, even though our clinical site policy leaves us an hour before up to an hour after for administration. In my opinion, there's no reason to be late. Second thing, she wants us to know everything before administering a drug. For example, she's asked me what someone's LFT is before administering 650mg of Tylenol. It drives me crazy. I understand where she is coming from, I really do, but there's just not enough time to do this: she has eight student and thus eight patients.

Well, the problem was this: my patient was due a blood transfusion. I was all excited, because as an LPN, I cannot perform this skill. I was getting real-world practice on an RN level skill. Well between all her questions and running from room to room, it took me 30 minutes to administer two pain pills and some eye drops. The blood had arrived from the blood bank, so there was a 30 minute time-limit to hang it. Since I can't even get a Tylenol administered in 30 minutes with this lady, obviously the staff nurse had to administer the blood so it didn't expire. If I wasn't in the room, I would have had no idea the blood was hung. I was then supposed to administer some low-dose lovenox as prophylaxis for DVTs. That was going to be late too so the staff nurse did it. The staff nurse did nearly everything because she, understandably, didn't have time to wait. Irritated that I had done virtually nothing all shift, I left the floor with the students to complete my paperwork.

However, I get called after clinical by the instructor. Apparently, I was supposed to do the q15 minute vital signs on this transfusion. No one asked me to; I guess it was just assumed I was. My instructor was nowhere to be found. I had no part in hanging the transfusion, no it's only natural that the person who hung it in this situation would take the v/s or at least delegate them to assistants.

Nope... totally my fault for not doing it. And I technically didn't report off to my nurse. I'm actually in trouble for not reporting that there was nothing to report. With all the stuff the staff nurse had to do, she should have reported off to me; I actually didn't do anything except an assessment, two pills, and some friggin' eye drops. The only reason I didn't formally report off was that the staff nurse was better informed of the patient's condition than I was because the tasks I was supposed to do had to get done by her so they weren't late.

What can I do? I dunno... I wrote a journal entry stating that I could improve my communication skills. Maybe I'll get off the hook with that. I just hope whatever gets done it doesn't boot me out of the program. Anyhow, I have to meet with her later so I'll post up what the resolution is.

Interested to know... what do you guys think? If you are a nurse, and you hung a transfusion, and you patient had a student, would you assume the student was going to take the q15m vitals without ever asking them? I can see where better communication on my side could have prevented this, definitely, however I don't feel the blame falls squarely on me because of two simple reasons:

My instructor should have been present so I could have hung the blood. Crisis averted.
The staff nurse should have asked me to check vitals. Crisis averted

This week has pretty much sucked... Until next time with more stressful and depressing news!

School sucks

noreply@blogger.com (Rick) — Tue, 09 Nov 2010 05:40:00 +0000

Title says it all. I'm feeling pretty run down this week. I can't help but feel like I have some horrible disease that robs me of all my energy. I'm thinking non-Hodgkins lymphoma; nursing school and this disease seem to have the same set of signs and symptoms.

I took a theory test today that made me feel like someone punched me in the gut. The endocrine system. It was a real bear. Study, study, study... and then to get socked with a test this hard just sucks. A ton. I dunno if I even passed it. I'd have to fail pretty horribly to have my average go below the required 75% although after taking this exam I'm thinking that's a distinct possibility. I felt the same way about the liver/immune system test and I ended up with a 76% on it. In nursing school, a 76% is cause for celebration, so don't confuse that statement with me bitching.

Tons of diseases on this test. Hyperthyroidism, hypthyroidism, hyperparathyroidism, hypoparathyroidism, Addison's disease, Cushing's syndrome, diabetes insipidus, syndrome of inappropriate secretion of anti-diuretic hormone (SIADH), chronic renal failure, hyperglycemic hyperosmotic non-ketonic coma (HHNK), and diabetic ketoacidosis (DKA). Wow. That's a ton of diseases, syndromes, and other stuff that can go wrong. I'll guarantee you that each one of those was well represented on the test. I'll also guarantee that each one of those diseases messes with multiple lab values, electrolytes, and all sorts of other fun chemicals and I found it nearly impossible to memorize it all.

I got back my five page research paper on C.Difficile and I got a 90%. Would have had a 100% if I would have cited five sources instead of four. I'm such a dumb ass. I could have used that 10%!

So with a research paper with such a good grade why am I freaked out about these tests? Simple. Every project, paper, and care plan you do and get a good grade on (or a crappy grade) does not get counted in your grade until you average a 75% on the tests alone. You get a 76% final test average (all four unit exams plus the final) and all this other stuff gets calculated in pushing the majority of students to a 'B', even an 'A' if your test average is a bit higher.

I'm also taking two online classes to fulfill my general education requirements: speech and sociology. I hate to say it, but in comparison to Advanced Nursing, these classes are a complete and utter joke. Sociology I spend approximately 20 minutes on weekly and speech class I typically show up for once every two weeks, deliver a speech, and then leave. Does this adversely affect my grade? Hell yeah it does, but who cares... With minimal effort I can easily get a 'B' in these classes and at this point, I'm just not willing to put in the effort for an 'A'. Oh, and even more great news; I'm supposed to deliver a speech tomorrow, but I had to call out.

I found out two days ago my mom needs to get a colonoscopy in the morning. What's this mean? No time tomorrow for my care plan, so I gotta do it all tonight, get up early, and drive 50 miles away to take my mom to and from her colonscopy, and then drive another 50 miles back to sit in clinical with a patient who will more than likely be discharged by the time I get there. Not to mention she had a gallbladder removal on Thursday that totally jacked up my schedule.

This sucks. It just does. There's so much I gotta do and tons of shitty time limitations. Not to mention I need 13 online tests done and a teaching project. Sometimes I wish I could just take a time-out and continue with my education a little later.

There's a problem with that though. The way I figure it, there will always be some family emergency, some function with my son, or some other thing that's always going to be getting in the way. Might as well get it done now because the "catastrophes" that always seem to happen always seem to happen during nursing school. Not just during nursing school... always during critical weeks. I sometimes think I was born with shitty luck.

Tomorrow is my clinical with the instructor that didn't pass me on skills check. She's very detail oriented and I'm finding that my care plans need to really be up to par for her. I feel like they've been fairly lenient on us this semester (until now) because I really only have two or three more care plans for the entire RN program.

Until I write again, I'm signing off exhausted and overwhelmed... And not even thinking about a Bachelor's (for at least another six months after graduation, that is.)

Anticlimactic

noreply@blogger.com (Rick) — Sat, 06 Nov 2010 16:31:00 +0000

Talk about anticlimactic... When I got my first LPN paycheck, seems that the HR director forgot to put in my new pay rate, and, you guessed it, I was paid as a nursing assistant. I also might add that my LPN pay rate is more than double a nursing assistant rate, even without any job experience.

The instructor that flunked me on my skills check for a ridiculous reason is also being overly critical, in my opinion, of my concept maps. I literally have two nursing care plans before I'm completely done with them altogether for the RN year, and all of a sudden there's issues with them. The care plans and concept maps have been fine for the previous 15 months, however, this new instructor is finding issues with them, which is pretty much pissing me off even more than the skills check issue. I mean the first part of this semester I turned my work in to the primary instructor who has 30+ years of experience and has a Ph.D. This girl is a newly graduated clinical educator. I also am doing very well in class; nearly 3/4 of the class got academic warnings at the mid-semester point and I did not. Why is she giving me (and others) such a hard time? Couldn't tell you.

First Night as LPN

noreply@blogger.com (Rick) — Sun, 31 Oct 2010 17:52:00 +0000

One thought sums up my first night as an LPN.

Wow... That's a ton of paperwork. A TON.

I never realized exactly how much. There is at least three ways we are required to double (I guess, technically, triple) check our MARs. Handwritten orders which I can't read. Double-checked against MARs that may or may not accurately describe what is on said order. I have to make up info sheets for my CNAs with information pulled from the chart and kardex.

I have to handwrite notes on each and every patient every 3 hours; even overnight. I have to document medication administration and teaching. I participate in planning a my patients' interdisciplinary careplan with other people (ST, OT, and PT).

It's quite a bit of work; more than I initially thought. However, I do have a thought to all current nursing assistants: nurses really aren't just lazy; the paperwork really does take all friggin' night to get done!

I also got to do my first official sterile procedure: a straight catherization of a female patient with over 700mL left in her bladder according to the bladderscan machine. I missed. I didn't feel so bad that I missed because even the other nurse that was orienting me couldn't get it in. We had to get a more seasoned staff nurse to insert it. The realization is pretty obvious to me now that all that anatomy and physiology I learned doesn't mean jack; gravity is pretty cruel because later in life, anatomically speaking, things just ain't where they supposed to be. A little tip I learned from the "pro" was that the urethra on a female blanches white when hit with the betadine swab.

All in all though it was a good night. I got to do some basic skills, get some stuff signed off as competent, and I'm going back tonight for round two.

Things I'm Going To Do When I'm Done

noreply@blogger.com (Rick) — Sun, 31 Oct 2010 00:02:00 +0000

I've decided to compile a list of things I'm going to do after I'm done with my ADN and after NCLEX boards are complete. These thoughts are what is helping me through this life-consuming program:

Sleep 8 hours a night.
Eat three meals a day (healthier too; McDonald's has been a staple food this year.)
Take vacations every year.
Buy clothes from a place other than Wal-Mart.
Have at least one day with no work and no school.
I'm going to find and participate in some sort of hobby.
Attend everyone's birthday party; I've missed more than my fair share these last two years.
Attend family functions. See #7.
I'm buying a Playstation 3 and/or X-Box 360. This is non-negotiable.
I will watch television, with family members, while drinking coffee. This is one thing I miss incredibly, even though it seems so simple.

Some of these things I might even be able to accomplish when I begin full-time work as an LPN. However, since I do work for a pretty big corporation in the sales department, the LPN pay increase is substantial, but it's not like I'm going from $8 to $22; it's more like I'm going from about $15 (plus commission) to $22. I'm under no assumptions I'm going to get rich... just a little more comfortable.

This year has been tough so far; makes no mistake, you will certainly have nearly your entire life consumed by nursing school (don't get discouraged pre-nursing students). I got a bunch of buddies with Bachelor's degress in crap like 'communication', 'leadership', and 'liberal arts'. I don't recall them saying school consumed their life! In fact, I remember hearing more stories of drunken escapades than of anything educational. Of course, most of them are still couch-surfin' at Mom and Dad's also...

OH! And more great news. I no longer have to do "care plans". They feel we are proficient enough to create 'concept maps' without any rationales. SCORE! Workload decreased by about 60%. That's great news. I'm going to post a really great hypothyroidism concept map I did for feedback.

BSN?

noreply@blogger.com (Rick) — Sat, 30 Oct 2010 22:49:00 +0000

I got to sit through a lecture from a professor, and the head of my nursing program, about doing a BSN program at the local university.

My thoughts? Too soon... way too soon! Talking to me about a BSN right now is like making fun of your friend who got killed doing something retarded... it's funny, but not for at least a year after it happened. Same general idea with this BSN degree; it might happen, just not for at least another year.

Although it peaks my interest... imagine... me... with a Bachelor's degree. Even better, another two years and I get a Master's. The local university has a family nurse practitioner track. That would be sweet. Real sweet.

For now though, I'm just thinking about getting this ADN done and the NCLEX-RN. But it doesn't hurt to think what that actually makes possible. Me... as a primary care practitioner. It boggles my mind! The more I think about it, the more I think I made a really good career choice!

Networking

noreply@blogger.com (Rick) — Fri, 29 Oct 2010 23:28:00 +0000

I just happened across a member of the organization that gave me a $1000 scholarship for school. And guess what? He also has pull at the nursing home I'd like to work at per diem. Says he'd like me on board. Funny how things work out! Moving from a corporate atmosphere to a healthcare one, I'm seeing quite a few similarities. Like this for example: It's not what you know; it's who you know.

Only problem with nursing homes, in my opinion, is, well, that they are homes. Essentially, these people live there and you take care of them. Not really my cup of tea, however, I like those types of facilities more than I thought I would. Not to mention they pay bank compared to hospitals; however, since your patients are stable, you typically have more patients than acute or subacute care. Quite a bit more! However, per diem, you can make a nice bit of change on the side and that's always a plus.

My real love is acute care. I like taking a really, for lack of a better word, jacked up person and make them better. I like seeing that whole transformation; I loved my ED rotation!

Skills Check Passed

noreply@blogger.com (Rick) — Fri, 29 Oct 2010 17:16:00 +0000

Another gripe I forgot to mention about the other day's bullshit skills check was that the room was double-booked and I got to do my skills check in a room with an entire class of overweight, loud, sweaty, redneckish EMS students migrating in.

Today, I redid the procedure in front of my instructor, who I might add agrees that I have reason to be pissed. Anyhow, she apologized for the crappy situation and while it certainly doesn't add the two points back to my grade, it's at least nice to know that my frustration was recognized and that I am not being unreasonable.

It is what it is. I'll get over it. I've got grade points to spare... for now.

In other news, I will be officially starting my orientation as LPN tomorrow night at the subacute rehabilitation facility. I feel pretty lucky getting a job that is essentially like working on a med-surg floor. I'm so excited, I decided to buy a new sport watch from eBay and a pair of scrubs from Uniform Advantage. When you are cheap as hell like me, you'll enjoy these websites for a variety of things.

Next semester, I think I'll use any leftover scholarship/Pell grant money to get a decent stethoscope. I'm thinking either Cardiology III or Master Cardiology. Can't decide which is better; I'll probably just check the forums at allnurses.com for the general consensus. If you are a nursing student reading this or a pre-nursing student, a big piece of advice is to get a good stethoscope. The difference is absolutely amazing. Superior equipment is no substitute for inferior skill, however, the difference is more than noticeable. Sometimes those damn crackles (damn, I mean rales, my nursing instructor would kill me) are just not easy to hear!

Until next time!

PISSED!

noreply@blogger.com (Rick) — Wed, 27 Oct 2010 14:57:00 +0000

So I failed my friggin' skills check. And it was bullshit.

First, let's start off with what I did right. I interpreted an ABG based on a case study. I selected the probable cause of my tracheostomy patient's respiratory acidosis as an airway obstruction and selected suctioning as my intervention. Passed.

After selecting this intervention, I gathered the required suctioning supplies, established a sterile field, and suctioned the patient with no issues. Passed.

After suctioning, another skill I had to demonstrate was tracheostomy care. Basically just cleaning the neck, cleaning the inner cannula, replacing the gauze, and replacing the ties. I set up and performed tracheostomy care perfectly. Passed.

So where did I go wrong? When I set up my drape, I accidentally covered a pair of scissors. I told the proctor, a new instructor that's approximately my age (28), that I broke sterility and needed the scissors so I needed to restart. I lifted the drape, moved the scissors, and redid everything. Perfectly. So what happened?

The instructor stated that I moved the scissors with my sterile hand, broke sterility, and continued anyway. Really?

I mean when I said I had to restart, I feel that it was implied that I was regloving. I mean, I knew that I touched these damn scissors, but I kinda thought I was like on a "time-out" if you know what I mean. I didn't know she expected me to completely reglove. In the past, calling your sterility break, moving things around the table, and then restarting has been acceptable. I think it's just petty. I mean I did the procedure perfectly.

So what does this mean? Not too much fortunately, but I'm still mad. I need to redo the sterile setup of tracheostomy care; that's all. I also get minus two points from my lab grade, which I'm not too concerned about because I have points to spare. I've gotten an 84% on nearly every test except for one.

I feel like it was just petty. A few students have gone so far as to think that maybe they are trying to weed people out so that the school gets a higher NCLEX-RN pass rate. I've even suggested that the particular instructor who got me on such a stupid technicality needs to get laid; just not by me.

Anyhow, sorry for vent/rant. It's just that when you put in hundreds of hours in a class (since September) you get a little pissy when you think someone takes points off a grade you've worked your ass off to get.

P.S. I'll never be a nursing instructor! I don't care if you are an instructor, or you are a student, why in the hell would you ever want to come back to this nightmare!

A Big Step

noreply@blogger.com (Rick) — Wed, 20 Oct 2010 22:11:00 +0000

Well, I was officially hired as an LPN at the facility I worked at as a CNA. The hourly amount was $22 an hour plus shift differential, which means I'll be making $24.50.

Needless to say, this is a pretty big improvement over what the telecommunications company was paying me; I was left with little choice but to resign today.

I've been here for nine years. It's taken me nearly three years to complete the first part of my nursing education. It's still hard to leave my co-workers, who in time, became really good friends. There are, however, things I won't miss by changing careers:

No dress clothes!
No commissions!
No quotas!

These are three big things I won't miss! It's still a very scary step for me, and was really hard to muster up enough backbone to actually send that resigaation letter.

Mock Code

noreply@blogger.com (Rick) — Sun, 17 Oct 2010 20:13:00 +0000

After getting my LPN license, I start to drool at some of the things the RNs can do, and after having some practice, really can't wait.

I had a great ED experience with plenty of skills practice, but I got to do a mock code the other day and it was awesome. I really want to get ACLS certification (Advanced Cardiac Life Support). It would be really cool to "run" a code, which is essentially the person who watches the monitor and gives orders.

Cool thing is, in a situation like this, it's usually a nurse that runs the show and not the doc. Codes don't wait for doctors to be on the unit, and it's up to the RNs to respond. I love the idea of running a code; reading the EKG monitor, interpreting the rhythms, and ordering particular drugs to combat particular rhythms, or ordering a shock.

I never realized so much went into a code. For example, you always see people on TV getting hit with the defibrillator paddles after they are flatlined on the monitor... this is totally wrong, as you can't shock no rhythm. You'd probably give epinephrine and see if you could induce ventricular fibrillation, or v-fib, or ventricular tachycardia, also known as v-tach. These are shockable rhythms.

We ran a mock code at school. It was ugly; really ugly. Glad it was ugly on the dummy and not on a real patient.