Time and Patience

Today I stopped by my nursing school to drop off a couple things and as luck would have it there was a faculty meeting and so I waited a bit and got to see a handful of my instructors and the program director. It was really good to see them!  They asked about where I was and how I was adjusting. It made miss having people in my life that care about my success. The faculty do care, despite what students think.

There are days when I wish I was back in school and enjoying the slower pace and low pressure environment. I am far happier on night shift because things are a bit less hectic and whirlwind. I've had a couple doozy nights. On night shift, we are pretty much non-stop between 7 and 11p but after that the work ebbs and flows depending on our patient load, acuity and any admissions, but usually there's another nurse that can come help when needed. There are still plenty of things I have not seen before or dealt with. In those instances, I HAVE to find help. Last night I administered blood and it was my first time. I printed out the hospital policy and procedure and with help and coaching from my Charge Nurse, things went well. Last week I had my first NG tube-fed patient that required me to do flushes and meds according to hospital policy. Every week there's something new to learn. Obviously learning is good, but I really hate asking for help (but of course I do). It's inexperience, and I hate it. One of the instructors that I saw today said that it's usually at 9 months where you start feeling a bit more confident and less insecure.  Guess I need to start another countdown timer.

Those who know me know that I don't lack self-confidence or strength. I am strong. I am confident. I just HATE feeling out of control. And honestly, that's probably the hardest thing for me as a new nurse. I have NO actual control over my patients and what happens next. I can certainly plan how I will go about my shift, but hypoglycemia, fever, arrhythmias, delirium, vomiting, chest pain, stroke, bleeding, and pain can totally disrupt those plans and I must respond accordingly while also still managing to get everything done that I must get done. I will become more proficient - more efficient. But it will take time and practice. So daily I am practicing patience with myself and others. 

The BEST part of my job is the opportunity to make a difference for a patient. Just this week I had a patient who was having trouble sleeping because of his shortness of breath combined with claustrophobia. He was a handful at night as he was uncomfortable and needed to move around but was not physically strong enough to move himself safely. He rotated from in the bed, to side of the bed, to the chair and back around and around.  At one point he said, "I'm sorry that I keep calling and needing your help... can you tell me why is it harder to breath when I'm laying in bed and a bit easier when I'm sitting on the side of the bed?" So while he was sitting on the side of the bed, I just sat down on the stool and sat with him and took the opportunity to spend time with him and explain how positioning makes a difference for people with heart failure and/or COPD. He was so grateful for my explanation. No one had ever validated his feelings or explained this in a way that helped him understand. Fortunately, I was finally able to get him some medication ordered that took the edge off his anxiety and shortness of breath so that he could sleep. In the morning I came by to check on him before I left for the day and he said "I want you to know that I really appreciate you taking the time to  explain things and your help last night. Thank you." Yes, he was a lot of work for three nights, but it's so satisfying to come alongside a patient who is really struggling and to not only help them with their physical needs, but to also see the light bulb go off after providing just a little bit of education about their situation. 

When I look to the future, I don't see myself doing bedside care for the long-term, but rather I see myself in a patient education role or working in a clinic where I can spend more time with patients. Perhaps a cardiac device clinic? I think I'd be happier in a position that is a bit more predictable, consistent and is less "in the moment" acute care.  But who knows - maybe with time and increased experience, I will grow to love bedside care such that I can't imagine being anywhere else. Time. And. Patience. Oh joy!

Missed Me?

Yeh, well, returning to work full-time has certainly reduced my leisure time. And working twelve hour shifts has certainly taking some getting used to. Last week I switched over to nights and tonight is my last shift on official orientation. I still have so much to learn and there are plenty of things that I haven't seen before that I will need assistance with.

Last weekend I officially moved in to my new apartment. Well, I'm not exactly moved INTO my apartment as there are boxes and piles of stuff that I need to find homes for. I still have flower pots outdoors and a few things in the garage at my previous location, but the homeowners are not chasing me out - yet. It's nice to be in my own place and allowed to decorate and organize as like. But I have too much stuff and yet it's hard to let go of perfectly good stuff knowing that ONE DAY I might want it!

Two weekends ago I flew to Michigan for the 20th highschool reunion for the school I attended through 9th grade. Since I was in touch with most of former classmates they invited me to attend even though I didn't graduate from there. It was really great to go back and catch up with those friends!  A week from tomorrow I will drive down to South Carolina to attend my actual 20th highschool reunion. I've been to SC within the past five years and have seen a few classmates during those visits, but I haven't seen the majority of my graduating class since our 15th-- which was before my trip to Liberia (I think). My night shift brain is kinda unreliable with that sort of information. While I'm looking forward to my SC trip, I will be glad to have my big travel plans and events (moving!) out of the way for a while. I'm ready for normal for a while.

I will eventually get around to writing about my orientation in a very general way. Eventually. Won't promise when! :)

Until next time.

RN Orientation: Week Three

I have survived five shifts and have completed my third week of orientation (first 1.5 weeks were classroom orientation). My unit is absolutely hopping! In one day my preceptor and I discharged all five of our patients and then admitted another four (in those same rooms!) before our shift was up. My head was spinning!

One thing I'm really struggling with is feeling hypoglycemic (hungry, tired, weak, irritable, unable to concentrate) during late morning and mid-afternoon and late afternoon. My preceptor and I will be in an alcove charting and discussing stuff and my eyes will glazed over and I know I'm not really absorbing all that she's saying. It's really frustrating. I am really trying to get to bed early so that I'm getting at least 7 hours of sleep. My unit really does encourage nurses to take their lunch break (30 min), but my body needs food much more frequently than every 5-6 hours, but it's tough when I'm not in control of what happens next (my preceptor does) and I'm afraid I'll miss something if I take a quick break. 

 I'm researching and thinking through what I can take to work food-wise that will help keep my blood sugar up that won't require any food prep (like heating up) and that I can possibly have in my pocket for those moments when I start to feel that edgy feeling. I've never learned to like coffee, so any caffeine would be a diet soda...which I really don't want to consume on a regular basis or in large quantities. I know caffeine is not the answer and neither is sugary food (although it does help short-term). I can feel crappy with a blood glucose of 80, which is not considered hypoglycemia. However, someone suggested that it can be the rate at which the blood glucose falls that can make a person feel crappy. My blood glucose tests have always been fine and my doctor has never been concerned, and the advice is always to eat several smaller meals throughout the day to keep glucose levels relatively consistent. That's easy when you can stop what you are doing to grab something to eat, but now I'm working 12 hour shifts and don't always have the convenience of stopping what I'm doing to go grab a snack!

So I probably need to go see my doctor and find out if there are further tests or recommendations. But first I think I'm going to start doing a better job of writing down when I eat, what I eat and when I start to feel crappy...and what helps or doesn't help... and maybe I'll even get a glucometer to keep track of my levels throughout the day.

I'd like to drop some pounds and I'm hoping that with the increase of activity (36 hours a week on my feet), that I will be able to. Unfortuately, there's no time to hit the gym on the days that I work - there's only time for sleeping, eating (barely) and working. But that means that I will HAVE to get to the gym on my days off and pay attention to what I'm eating...and not eating crap (sugar) when I feel like crap. Easier said than done.

Hopefully in time I will adjust to twelve hour shifts and figuring out what works for me. Right now it's just tough because I'm paired up with another nurse who has grown accustomed to shifts and knows what SHE needs to do to keep her energy up. We were a bit disorganized this past week for a variety of reasons and I'm hoping we can be a bit more organized this week. Here's hoping.

Aside from the above, I'm getting to see and DO a lot and learn a lot of new stuff! There is no way for nursing schools to teach us everything. Every hospital and every unit, has their own way of doing things (admissions, discharges, charting, etc...). I am fortunate that my hospital moved in to a nice new facility and really thought through the design and made really smart decisions about patient rooms, and access to meds/supplies, which can significantly cut down the amount of trips (and wasted time) to/from the supply room!

Aside from my patient care, I also have a number of classes that I have to take during my orientation period that are related to my unit. Since I'm working on a Telemetry unit, I am scheduled to take classes on topics such as EKGs and dysrhythmias and a handful of other classes that are cardiac and neuro (stroke) related. This coming week I'll be taking a class to prepare for a change in how physician orders are entered and retrieved (we currently work with electronic and paper charts and will soon go to just electronic).  It'll be a very good change and hopefully will save time for everyone...not to mention saving money and trees and counter space at the nurse's station!!

I've been adding some more links to articles on the side bar. I decided to break down the topics into: New Nurse General Tips, 12 Hr Shift Tips, and Night Shift Tips. When I find articles that I want to come back and read, I will link them there...but reality is that I haven't necessarily read them in their entirety (or even followed the tips). As I get time to read them, I may end up removing some if they end up repeating each other or end up useless.

RN Orientation: Week Two

My First Twelve

It's going to take a while getting used to twelves! By the end of my first twelve hour shift all I could think about was my feet. Now that I'm home and my feet are up, I'm now thinking about my knees. Maybe when I go to bed it will be my ankles. Ha!  I've not done anything about shoes. I wore my Danskos today, but since there always two of us together (my preceptor and me), she's often the one sitting and I'm left standing... so maybe I'll wear tennis shoes on Friday and see what the difference is.

This morning I was set to wake up at 0430/0445  (to leave the house at 0600), however at around 0300 I woke up and sneezed. It wasn't until I got up at 0430 that I realized my nose was running and I was probably dealing with a head cold!  It's been two years since I've gotten sick...and my first day on the unit and I start coming down with a cold! Sigh. So I'm going to treat tomorrow as if it was a sick day (even though I'm not scheduled). I'm going to get up at 0430, get a shower and then I think I'll go back to bed as if I'd called in sick. So much for getting to the gym tomorrow.

My main preceptor typically works Monday through Wednesday, so in order for me to get my hours this week, they put me with another nurse for my first day (and again this Friday). I was basically thrown into the mix of everything. Doing vitals, meds, discharges, admits, charting, calling dietary, etc... The best part was being told I can sign or co-sign something because I'm RN!! Such a strange, but fun, new experience.

The most awesome part of it all... I leave my work at work. No homework, no studying, etc... Sure I will have things I will want to review and look up at home, but I'm thinking that for now the majority of my learning is going to take place on the job. Which is how I best learn anyhow.

Overall a great first day on the unit.

RN Orientation: Week One

First day of work, er, orientation. I'm so thrilled to be at this hospital. Having been through orientation in other jobs...this has been well-organized, well-staffed, and everything has tied together well and feels pertinent to my role. Class act!

I think the most thrilling part of the day was the end when they took my picture and handed me my ID. To see the RN tag attached was a really cool moment. I've been envying everyone else's RN tag for years. Now I have my very own!

Tomorrow will be another day of basic hospital orientation. Then Wednesday through Friday and Monday and Tuesday of next week I will be in the simulation lab getting trained and tested on a variety of nursing skills and related information. Then next Wednesday and Thursday I will hit the unit for 12 hour shifts! Wow, it's been a LONG time since I've worked a 36+ hour week!

I stopped by the unit this afternoon and learned that my preceptor primarily works Monday through Wednesday. So it seems that I will be working few, if any, weekends during orientation. I'll take it! Working 12 hour shifts is definitely going to take some getting use to! I'll wake around 5am, leave house at 6am, work 7am-7pm, then have two hours to drive home, eat dinner, & chill out  before heading for bed at 9pm so that I can get eight hours of sleep. Whew. I'm not sure it's even realistic to think that I could squeeze in a quick trip to the gym after work...I'm thinking that it might wire me up if I work out and then shower right before going to bed. Oh well...something to try a few times to see.

Last week I ordered up a bunch of scrubs on-line and they are scheduled to be delivered tomorrow! Can't wait! I bought a variety of top/bottom styles and I'm hoping that I'll like the majority. I decided to go with solids and skip printed tops all together and the local shops did not offer options that I liked. I'm not all that inspired by the scrub top prints that are out there these days,and it's also recommended that I wear monochromatic tops/bottoms to make me appear taller and leaner [prints/color blocks make your look short and wide(r)]. We'll see.

Well, I am exhausted and about to fall asleep. Guess I need to take a short nap to revive for another couple hours.

The End (of the semester) Starts Here

Just finished my last clinical assignment of the semester: self -evaluation. I know I've been counting down clinical days all semester, but it's finally here. Tomorrow is our last clinical day of the semester! We're all bringing in breakfast foods and will share with the unit staff tomorrow as a 'thank you'.  Then we'll be on the floor for 3.5 hours, leaving about 11 AM. Then we're all headed to lunch together...which should be fun. Hopefully no major disasters in the morning to sober our celebrations! 

This Thursday and Friday are the last "new content" days of the semester in my lab skills and lecture classes. The timing of it all is really perfect, as this weekend I'm headed to Pittsburgh for a family wedding and since I will have entire week of Thanksgiving off (just the way my class schedule worked out), my family will end up staying an extra day or so and come back early next week. So nice not to have to worry about school stuff over the weekend or holiday week! (Some people DO have class on Monday--just NOT me!) However, I still have to go next Tuesday for my final clinical evaluation with my clinical instructor--but nothing really to prepare for that (that's what I'm turning in tomorrow).  

The Friday after Thanksgiving I will get trained for my seasonal job which will start the following Monday. Looks like I will work M/Tu for couple weeks while I finish up tests/exams in early December...but as soon as the semester ends I will work the early shift 3 days a week. Will be nice to earn a little extra cash to help pay for this upcoming trip to PA (hotel room), purchase C'mas gifts, buy much needed clothes, and throw a chunk back into my dwindling saving account!

I have already started my "to do" lists for my holiday break. I will have to be a bit more organized since I'm working, but this will be the longest break that I will have had since I started taking classes the summer of 2009. Last year I had 5-6 weeks off between semesters but I was still working full-time, so I really didn't get a break. But this time I will have 4 days off a week while I'm working and two full weeks off in January. And because I'm working the early shift, I will get all my evenings off (which tend to be my most productive hours anyways). I'll be staying in the area for C'mas--hanging out with my parents and two of my sisters, and then the rest of the family arrives for our main family event over New Years weekend. The homeowners will be home just before C'mas and we'll overlap some, especially the days I'm working, but we get along great. It's such a great arrangement. I might lose my room over New Years but since I'll be doing family celebrations at my parents, it won't really matter.

Well, off to gather my bits for clinical tomorrow. Cheers.

Preparing for Semester Two

Grades are back and I am grateful to have managed an A in the Dosage Calculations class. There was no certainty about it--as we left our last class with only one known grade (which for me was a B on our first quiz). So I was pretty giddy when grades were posted this past week).  So...another 4.0 semester. Yay!

I attended and passed the CPR certification (for healthcare professionals) this past Saturday. So I've FINALLY jumped through all the hoops of the initial stuff. Please do not stop breathing. That would not be good.

Fall semester (Semester 2) starts the week of August 23rd, with my first class on August 26th. I still need to buy textbooks and the "nurse in a bag" thing with all our supplies for the semester. Feeling oh-so grateful for my scholarship!! Still need to buy petite uniform trousers and sew on patch to the top. My to-do list is a mile long. The first thing on my schedule (the day after my last day of work on Wednesday) is a Dentist appointment...next thing is to get my car to the mechanic (exhaust issue, idle issue, oil change, state inspection...). Nothing urgent...just ideal time to do it. I also need to go shopping to pick up some "business casual" clothing items for the fall semester. My closet it rather bare--as it's currently more casual and less business...but then again, it IS SUMMER! And I'll also need to be enrolling in health insurance (I'm looking at doing it through the National Student Nurses' Association--accessible via www.studentinsuranceusa.com). I'll also probably be obtaining liability insurance through NSNA too.

My last day of work is Wednesday of this week. I have a friend who has invited me to dinner on Wednesday night--so it's a GREAT excuse to not work late my last night (& to celebrate a little). It's going to be a crazy week. I feel for the new hire--just too much to absorb. He'll do great--he just needs to get to know people and get a few Sundays under his belt. God is good.

Later.

What a Week!

This past week was a tough one, probably the toughest in a very long time. Primarily stems from the fact that it was Holy Week and with my job as assistant for worship ministry... the majority of planning & logistics is on my lap (plus we have serious crowding issues that we were trying to alleviate). It's not that we wait until the last minute to do the work--because actually I've been working preparations since January! But it's all the stuff you can't really do ahead of time--because you are waiting on other people--so that ends up consuming the majority of my time during Holy Week...plus making sure everyone (staff, officers volunteers) are on the same page. I can't even estimate the number of emails I have sent out about Easter. Probably 20x as many as for a normal Sunday service! But things went great this morning and the hard work paid off.

BUT the hardest element of the week was managing school work within the crazyness of Holy Week. I'm not sure WHY exactly, but the school scheduled our last day of laboratory to fall on the Saturday before Easter! It's a holiday weekend and many people travel--so not sure why they did that. Worse though is that because it was our last lab class of the semester, we had 3 assignments to do, one of which was worth 20% of our grade! Plus still had to do the reading for the day's lab experiments.

So basically 4 assignments due for lab on Saturday...a weekly lecture unit deadline due Sunday evening (tonight) PLUS a micro lecture exam hanging over my head (due tomorrow) all week. I had planned to take lecture exam last weekend, but it was not posted when it should have been and then Monday came and I realized I wasn't ready for exam and that the Lab Report deadline was my priority--since my lecture exam isn't due until tomorrow ( a week later).

So with work crunches and school scrunches I had to find extra time in the day. So I somehow managed to get up and get to work by 7am each morning--which afforded me luxury of leaving work early to go home and work on school stuff for 6 hours. Well, I planned to get to bed by 10pm each night, but that didn't happen...so I was getting about 4-5 hours of sleep each night last week. The Lord has certainly sustained me and given me the energy and health needed to get through the week. I still need to take the exam tomorrow and then I will have a bit of breathing room. Yay!

Two great things: learned at Lab yesterday that I scored a 98% on my first lab exam. After taking exam I just wasn't sure how I did--so this was great news! Then today, the attendance for worship services worked out great--we were worried that we'd have to tell people that the middle service was full and to come back for the last service. I had been praying for "supernatural distribution of people" and that is certainly what happened. God certainly blessed us and our preparation work. So very thankful.

Should know something within the next two weeks about nursing school.