Yikes

I don’t even want to look at the date of my last post. Thankfully, Orthogals is still going strong, and strong enough that Ancient Faith Blogs picked us up! Woohoo!

Where have I been instead of online self-publishing? Well, you know about this:

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Which lead to this:

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And during that time I worked nights:

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Around the time I got to switch to days, we found out this was coming:

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Props to my 6-year-old niece for thinking of this all by herself!

And in late October, she came!

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Sigh. I hadn’t even finished changing my legal name on my accounts…

For the time being, I plan on keeping up TRS. I’m blogging about different things now, but then again, this wasn’t supposed to be a one subject blog. It’s my thoughts and ponderings on life, and those have changed a lot too.

One Day at a Time

I’m a new nurse.

I have to keep reminding myself of this. I’m new. I’m going to make mistakes.

Thankfully, none of my mistakes have resulted in adverse patient reactions. I haven’t overdosed anyone on their narcotic pain medication. If my assessment found an abnormality or something new, I reported it.

But I’ve been late on timed lab draws. I didn’t get a “Keep Vein Open” order with a patient controlled analgesia (PCA). I charted something on a patient, only to realize after signing that it was the wrong patient. And I’ve certainly handled a few interactions with less grace and clinical judgment than I would like.

I hate making mistakes; I hate knowing that I’ve failed or been under par. I worry that I will never get this nursing thing figured out. It’s these days that I cry.

But after a day or two off, I pull myself back together. Double check my care plan, make my list, and set out to improve one patient at a time.

And then I come home. And I’m new to marriage as well. We’re both new spouses. We’re going to make mistakes.

Some days, he’s helpful and a wonderful shoulder to cry on when work goes horribly wrong. Other days, he doesn’t see that I’m tired and asks for my help with tasks that, in my opinion, he should be able to figure out by himself so that I can sleep. There have been times where we are both oblivious to the ways we hurt each other. And then when the courage is mustered up to say, “____ really hurt,” it isn’t met with the response wanted but with more fuel for the fire.

Then the time comes where we say, “I’m sorry. Forgive me,” and keep working on this one day at a time.

What I learned in nursing school

In the aftermath of graduating from nursing school, I had a little bit of time to think about all that I’d learned. I would like to emphasize “little bit.”

In my prerequisites, I learned a few more parts of the body (or at least the scientific names for them), the intricacies of how our bodies work, and the microorganisms that both help and wreak havoc on our world.

In nursing school itself, I was presented with the basic tasks of nursing care, the most common diseases and the nursing role in treatment and management of that disease or condition.

In finishing nursing school, after everything I’d learned medically, I really could say one thing:

Nursing school taught me how hard it is to see and love people the way Christ sees and loves them.

I can’t look on the multitudes of patients and have compassion on them the way Jesus did. In fact, most of my patients, their social and family situations, and the diseases they have anger me. They are lost in a world that most have created for themselves and think that modern medicine will wave its magic cure-all wand. Most of my patients see a problem and drink their livers to oblivion before middle age or claim horrible pain in order to get heavy-duty pain meds.

The videos healthcare organizations produce that show CLEAN and HAPPY patients in a well-lit, freshly constructed hospital room are lies. I’m sure there are some fantastically happy patients. Mine tend to have odor and hygiene problems, emotional disturbances coupled with medical issues, and placed in rooms that are showing their age.

So, if you’re going into nursing, know from this new nurse and the vast amounts of seasoned veterans – it is a worthy profession. You see “the stuff of life” as Call the Midwife says. And it’s not all brow sponging and baby kissing. It’s hard emotionally and physically. And you learn more about yourself and your limitations than you ever thought possible.

…And I’m DONE

On Mother’s Day, I graduated from nursing school.

It was my mom’s 40th anniversary of her nursing school graduation as well. As you can see, student nurse uniform styles changed…

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And on June 11, the final step occurred. NCLEX. I am prevented from publishing any information about the test, so you won’t get what type of questions, the topics, or any tips here. I will say one thing about nursing school and NCLEX: it taught me a lot about myself. How do I approach difficulty? What do I see as life priorities? What patient care priorities am I best at identifying?

And so next – moving and getting married. Because if life is changing in one aspect, let’s just be efficient and change some others!

 

Emergency

First, a little terminology. In a hospital, you do not go to the Emergency Room, you go to the ED – Emergency Department. Also, what the public knows as “intensive care” or “ICU” is now referred to as “critical care.”

During my critical care rotation, my classmates and I got to experience several days of emergency simulations with medical students and residents. And we also experienced a day in a Level 1 Trauma ED.

I loved it.

I saw one major trauma patient, one stroke patient, but mostly confused older adults. Confused older adults get an ambulance called on them because they fell and now have altered mental status or they had a UTI that went undiagnosed and now they are septic. Again, big symptom is altered mental status.

The ED didn’t impress me with their amounts of drama and excitement. I liked the pace. I liked that after 4-6 hours, patients were discharged or sent elsewhere. I know nurses are thought of as compassionate, but sometimes, it’s nice to not deal with your patients for very long. The priorities of an ED nurse are to assess the patient, keep them safe, and if they are admitted, call a complete report to the receiving unit. They keep up to date charting (as in, every hour at the minimum) and need to know their stuff in order to tell the new interns and residents what is really going on with patients.

In my last semester of nursing school, I spent my management clinical in a slower paced ED. While there was no blood, the patients were exciting in their own ways. Some were still fall risks that were trying to climb out of bed; others had code browns or code emesis. And some just had pain or uncontrolled diabetes flare ups. Still safety, quality assessment, and critical judgement were needed.

I doubt I’ll start in the ED – those positions go fast and tend to be limited in my geographic area. It’s nothing like the show, so don’t get your hopes up, but for those people whose personalities like lots of action with some downtime – it’s all you, baby.

Floating

Lately, several people have heard my lame joke, “I’m floating so much, I should be a duck!”

I started my student nursing adventures on a urology floor. I really wasn’t that picky when it came to this first job – I had heard from multiple advisers that getting on “a good med-surg floor” was the best introduction you could have to the world of nursing. Medical-Surgical floors (i.e. med-surg) is the basic care a patient needs in a hospital – they have some condition which needs attention through drugs (medical) or surgery. If anything else goes wrong, they can be transferred to a Progressive Care or Critical/Intensive Care unit.

So, I my first steps as a student nurse were spent tracking down a patient’s vital signs, making sure they get out of bed post-surgery, measuring urine and other fluid output (if you only knew how many forms this took other than pee and blood…), and my favorite – trying to keep track of how much they put in.

After 3 months on my home unit, I was eligible to float to others when my unit’s tech staff was overpopulated and/or the patient census was down. Thank goodness, I have been able to keep some of my working hours! At first, I heard from most techs and nurses “Ugh, I have to float!” Honestly, I don’t mind it.

Rather than being in the world of kidneys and bladders, I’m getting to see other medical-surgical and progressive care floors. I’ve been on liver, orthopedic, or digestive disorder units. One of my favorites to work at is the Organ Transplant unit. I’ve also been to an Oncology unit – that’s a post all on it’s own.

And it can not be said enough, ALL nursing is psych nursing. Some of my more interesting floats this summer were patients with alcohol withdraw or other substance withdraw issues. Definitely kept me awake on those 3 AM sitting/supervising shifts!!

My most memorable experience in floating happened in late June. I had settled in to a sitting shift with a patient, when my charge nurse appeared. She explained that one tech coming on could only float to sit and another unit needed a tech to work the floor. So, I pack my things and head to the new unit. I step off the elevator, introduce myself to the charge nurse, and am greeted with these words: “Do you speak Spanish?” Oh, dear.

Apparently, it was a sitting shift; my charge nurse was misinformed. The patient did not like the current sitter whom I was replacing, however, some quick thinking on my part got the patient to trust me. My two years of high school Spanish, one year of Latin, random study of words from my singing past, plus Google Translate helped me communicate to this freaked out patient. He/she went from unwilling to sleep, have vital signs taken, and allow blood glucose checks to resting comfortably in an non-paranoid state. All because I looked up, “Go to sleep. Everything is good. The nurses are taking good care of you.”

Floating has allowed me to see what sort of nurse I might want to be and the sort I do not want to be. I have met patients, families, support staff, chaplains, and a host of others in the system. I have found units that I would consider working on as a nurse and those from which I will run far, far away. It can be frustrating, but as I’ve found out, also rewarding. Both in circumstances and the fact that I am getting paid.

Quack.

My New Favorite

Not my original today, folks. This is for my fellow nurses and nursing students.

My new favorite blog: Nurse Eye Roll

If you don’t get the humor, might I just say, nursing school isn’t for you.

Nurse Eye Roll is my therapy. Thank you.

The Questions

I’m in an accelerated nursing program. It is geared specifically for people who already have a bachelor’s degree in another field and want to receive their bachelor’s in nursing rather than an associate’s degree. A common question in the first semester is, “What was your previous degree?”

But then, people decide they want to know you more. They now have two options:

1. “Why did you leave ______?”

2. “What lead you to nursing?”

I know that I’m having a bad month here in Ray of Sunshine Land, but for the love of God, these questions are getting on my nerves.

So, let me answer them for you –

1. I didn’t like teaching; I liked interacting with the students, and I liked singing. Teaching those concepts was draining the life out of me. Oh, might I mention a few colleagues made my life a living hell? Yes, teachers can eat their young as well. I found that I was selfish with music – I need it to be my relaxation. I don’t see music and arts as the first thing that people need for their lives. Public education bad days

2. I had a quarter-life crisis. Got tired of doors slamming in my face. Wiped the slate clean of my options, looked at my skill set. Thought about nursing, pursued it and doors opened. Loved the opportunities. Most every clinical I end thinking, “Maybe this career track is for me?” It fits my preferred M.O. as I like to be at a place and just go. I’m not an 8-5 for 5 days person.

And last thing while wrapping this up, I’m tired of hearing, “you’ll always have a job” from people who think they know healthcare because they had their immunizations. Kind of like the people who think they know education because they were students. Nurses are generally the biggest part of an organization’s budget. We are generally the first to feel budget cuts. Yes, there are always healthcare jobs. There are always teaching jobs. They just might not be what the person prefers to be doing in their career.

End rant. Back to studying.

When The End Comes

Sorry that I’ve been absent for so long. There has been so much to juggle the past few months, and since I have a few people with whom I can verbally process my life, I guess blogging hasn’t been a top priority. I have plans to fill in some of my thoughts and experiences from the summer, but they will have to wait.

The reason for this entry, however, is that last night I received word from Stewie that The Brain finished his battle/war with ALS.

While I hate that a terrible disease has taken yet another person in such a cruel way, my emotion is not so much based on anger or depression or bitterness. I am actually relieved to know that he fought his battle in the only way he could and was able to let go. I am relieved to know that Stewie will have the opportunity to sleep through the night for the first time in over 2 years. I am relieved to know that The Brain was able to let go of this life and not give up hope.

I’m sure there will be more writings and musings of my grieving. But they will be dampened as I do not feel my life will make as much of an adjustment compared with others.

I have been struck the past few months in how complete the prayers of Orthodoxy are for the human experience. When we let go of our pride that says only extemporaneous or spontaneous prayers are best, we find a vast wealth of wisdom. So, I leave you with several of the prayers available in the Orthodox Prayer Book published by Holy Protection Monastery in Colorado (aka “The Blue Romanian Prayer Book”)

Oh good Lord, remember Your servant(s) _______ and forgive them all in which they have transgressed in their lives, for only You are without sin and can grant rest to the departed. In Your divine wisdom and love for mankind, You bestow all things and provide for all the needs of man. O Creator, rest the souls of Your servants _____ who have placed their hope in You, O Lord, the Fashioner, the Creator and our God. Amont the saints, O Christ, rest the souls of Your servants where there is neither pain nor grief nor sighing, but life everlasting.

In one of my conversations with The Brain before I left for nursing school, he expressed to me his fear of being forgotten after his death. So, I now can pray the words I reassured to him that day: Memory eternal.

 

How to Be a Good Patient

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While I understand this picture of Grumpy Cat is more the patient’s view, I would like to point out the power/authority that a nurse has and that maybe, just maybe, we have some ideas that you know, deep down, are good for you.

I don’t want to be Nurse Kratchet/Ratched. The summer was long and hard to schedule work around class and being cancelled due to low hospital census. I had some delightful patients and good learning experiences. This is a compilation of not-so-great experiences. A rant, if you will. It DOES NOT mean that I do not value a patient’s opinion or experience. It only means that some patients annoyed me with their similarities of crappy attitudes towards those of us lower on the hospital totem pole (the CNA/Student Nurse).

1. Don’t talk or move excessively during vital signs. Health care workers and providers need to listen and watch for various things, such as your breathing. Movements in the arm while taking a blood pressure can make the final pressure appear too high. Your talking and yammering about how this doctor or that nurse from previous experiences is of no concern to me, especially at 3 AM when all I need to do is count how many breath cycles you have in a 30 second time span.

2. Hospitals hate falls. Hate them. We don’t want your stay extended because someone was unable to standby and ensure your safety. That being said, just because you know who you are, where you are and where the bathroom is in your room, does not mean that you are not a fall risk. We don’t put people as a fall risk because we want to imprison them to a bed, it’s because we don’t want you to get injured from your own stupidity or because you tripped over your own IV.

3. Having been a CNA does not mean you know my job or the entirety of the medical field. Taking Psych 101 and Abnormal Psych doesn’t make you a therapist. Giving a meal or a few dollars to a homeless person doesn’t make you a social worker. Answer our questions truthfully, ask questions (write them down when no one is in the room). The person there to take your temperature is not the person who orders your discharge.

4. Don’t complain that your beeping IV hasn’t been taken care of for 3 hours when I can prove by the time stamp on a monitor and through the electronic tracking system that I was in your room 45 minutes ago and nothing was abnormal. Also, these situations are when you use the call light.

5. Most units I have observed or worked on are post-operative, and most people are focused on one thing: leaving. As one of my nurse preceptors told me, “All patients need to poop, pee, walk, and eat before they can go home.” The faster you do these things, the faster you go home. Cooperate.

6. Don’t assume we are out to get you or that we intend to forget you. Unless you are an ICU patient or labor and delivery, your nurse has other patients. We might have been answering their questions.

Yes, everyone has their personal horror story or has heard of someone who experienced a series of complications only rivaled by a House episode. We know you don’t like the hospital, and our goal is to get you out of here as fast as possible.

Let the barrage of comments begin…

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