Score 1 for the Home Team

So many things have happened recently, I don't know where to start ...

I guess I'll start with the fact that I got a *90* on an exam that was primarily Neurological content. 

 

The Professor has prided herself that she gives difficult exams (she actually teaches a graduate course on how to write exam questions) and the typical class average grade is 75-80 on this particular exam.  Difficult exams, yes, in the manner that the students actually have to think about the content and apply their knowledge (like any good nurse).  I spent most of the summer working on Neuro content just because she gave us fair warning in the Spring - this is the second part of a two-part Senior class.

I do not test well ... at all ... so this exam gave me anxiety like never before.  Neuro is a tough subject no matter who you are.  The next exam will be over endocrine, liver, and pancreatic disorders along with the topic of burns.  The last exam will be cumulative, but primarily cover musculoskeletal disorders and care of HIV/AIDS patients with a particular focus on the elderly.  I am 2, count 'em, *2* exams away from graduation.  Sure, NCLEX-RN boards are after that ... but one hurdle at a time!

On the Partnership front ... I am 5 shifts into 16, and Monday night it all seemed to "click."  That's the only way I can describe it.  Granted, there were still a couple missing pieces of documentation, but I know seasoned nurses who leave holes.  That's why the staff nurses at my ER do chart audits monthly.  It's to help them learn and evolve their own charting.  They audit 2 of their own, and 2 of someone else (randomly).  So, the charting piece will evolve continually, but the care I was giving was nursing care - not just CNA care - and it all FLOWED.  I knew what was needed, I knew what I wanted to do next.  It also was a slow night, so I had every patient that came through the doors (since no one overlapped) from triage to discharge.  My Preceptor would introduce herself to patients, then leave to let me do "my thing."  She would check in with me when I came out of rooms to ask, "What's going on?" and "What's your plan?"  It. Was. Great.  The patients knew I was a student, but they gladly accepted me. 

All the pieces falling into place ...

The highlight of my night was a cardiac patient brought in via EMS.  I ran the "show" with only a couple questions to my preceptor.  Unbeknownst to me, the patient's wife works within the hospital organization.  Prior to discharge, she told my Preceptor that they "need to work on retaining [me], [I'll] make an excellent Nurse and asset to the department."  I always appreciate positive feedback, but I didn't realize how much it made me smile until I was telling my husband about it.  That's the response I'm looking for.  I work my butt off, and have worked for 6 years as a CNA with 5.5 of that while I've been in school.  It's nice to have my hard work appreciated and validated.

The rest of my school work is falling into place also.  I've been writing papers far ahead of their due dates since I love checking things off my to do list.  I have a few more to do, but I gave myself tonight off ... I'll start again tomorrow.

That Was September?

Wow ... time flew and stood still at the same time.  Is that possible?

 

It is now the last weekend in September and I honestly do not know where time went.  At the same time, I spent my days in "hurry up and wait" mode.  For example ........

I spent all of Labor Day Weekend on duty.  I had the open days due to no class and husband gone for work, so why not carry a pager and get paid to do housework?  My daughter and I did a deep scrubbing and reorganization of the kitchen.  The service I work for only got one call from Thursday evening through Monday.  In EMS, I'm known as a "White Cloud" since (as evidenced by Labor Day Weekend) I repel calls, "Black Clouds" would "rain calls."  That means everyone stays safe while I'm on duty, which is NOT a bad thing.  My house receives a lot more attention that way ...

Wednesday after Labor Day, the "fun" began ... 6 FULL HOURS OF LECTURES.  YEAH!  :: insert sarcastic sigh here ::  Every Wednesday through December 12th, that's where I will be ... except for the Wednesday prior to Thanksgiving.

 

Every Thursday, I spend 7.5 hours as a School Nurse shadow.  My preceptor is great and it's at my daughter's school - BONUS.  I specifically asked for this assignment since we've lived at our home for 6 years now and I hardly know anyone in my daughter's "community."  We don't live in the town her school is in, it's 14 miles away, so we hardly get to after school community functions.  My preceptor is an alumnus of my nursing school, unbeknownst to me ahead of time, so that's been funny also.  We have a few scheduled meds to give, deal with the steady stream of aches and pains, plus do teacher education (i.e. epi-pens) and required student screenings for hearing and vision.  There's a lot more, but those are the highlights.  So, Thursday my daughter gets to sleep in, we get up and have fresh fruit smoothies with breakfast, ride to school (passing the bus in the process), jam out to oldies radio (BTO's Takin' Care of Business, most recently), and then she gets a ride home, too.  I didn't tell her about this school rotation until it was confirmed to actually happen.  Now, we're both enjoying it while it lasts.

The randomness of my clinical partnership is the hectic part of my schedule.  For now, I've been spending my Monday nights working in an ER with a Nurse Preceptor.  This is not the ER I work at, another one somewhat close to home.  I've had 3 shifts so far and I have to say that it's all coming together.  My first night was chaos (which I'm used to from working in an ER), my second night was less chaos but still not quite comfortable in my new "nursey-like" shoes, and the third was amazing.  It was like it all clicked.  I'm never going to know everything, AT ALL, but I felt my confidence growing.  I knew the questions before my patients asked them, and I already had looked up the answers (if needed).  My charting is still a work in progress.  My preceptor checks all my charts and has me add things.  "I saw you assess [that], but it's not charted."  Knowing WHERE to chart within this new-to-me program is the issue.  It will come with time, at least I'm doing what I need to be doing skill-wise.  I still have 15 more shifts to get even more comfortable. 

First Exam in Med Surg is a couple weeks into October.  It will be a big one, but it will be one closer to the end!!

11 MORE WEEKS!!

Applying for and getting a job will be the next hurdle.  I can start applying now, but I want to have a few grades back first ... and some exams graded prior to applying.  Plus, budget years are up for approval, so the Directors I have talked to told me to call them in October to find out if they would have positions open. 

The End of Summer

The End (and the beginning) are here.  The end of summer is upon us, the beginning of my last semester of nursing school is about to begin.  It is also the beginning of our daughter's 7th grade year.  It's going to be a chaotic 16 weeks.  Hmmmm, what have we been up to lately ....

I worked pretty much straight out in the beginning of August.  Between EMS and the ER, I've been on duty more than I've been anything else.  We did get a chance to go camping one more time before our daughter returned from Grandma's house out of state.  I spent a day on the road with a friend of mine to meet her return flight at the airport.  We went out to lunch, to a farmer's market, and the mall prior to meeting the flight.  It was a great day ... with a lot of driving.

A few days later, we went on a family camping trip to a private beach on a lake.  Private in the aspect it's a public camping spot, but first dibs gets the use of it and you have to get there by boat.  There are a lot of other beaches on the lake that are not private and a few other private ones.  We lucked out with weather and it was amazing.  No cell phone service either.  Did some fishing, some reading, and lots of swimming.  It was the first time my husband and daughter had been there, I had gone in high school.  We will definitely be making a return trip next year. 

Last night, I took our daughter to the county fair since my husband was working.  She had a bracelet for the rides and met up with some school friends.  They were IN-SANE.  They went on everything that I never went on even when I was younger.  Small county fair = small lines, even on a Friday night.  They got off the ride, and got right back in line.  She felt great and was having a blast ... till the adrenaline wore off on the way home and she started feeling SICK.  A warm shower and sips on some fluids made her feel better.  "I have no regrets, I just don't feel well right now."  She probably will jump at the chance to do it all over again ... next year.

School starts for her the last Wednesday of the month, 1 week ahead of me.  My first Partnership shift will be September 10th.  Some of the class materials have been posted, but not all of them.  So far, I have  couple short papers to write and 3 exams ahead of me.  "I think I can, I think I can, I think I can."

98 Years Young

On August 6th, my Great Grandmother passed away peacefully at a nursing home.  I have mixed emotions about this WHOLE situation. 

First, the last time I saw my Great Grandmother, dementia had set in and she did not recognize me.  I look a lot like my mother, so she tried ... but it was heartbreaking.  I had never been in the shoes of a person who has a relative with dementia/early Alzheimer's.  That day, I understood.

Second, she's been declining for a while.  She had been living in another state in an assisted apartment close to one of her grand daughters.  Unbeknownst to me, she went to the hospital months ago and was discharged to a long term care facility due to her lack of ability to care for herself.  Hmm, I would have liked to been told that.

Third, a text message that said, "The nursing home gave [Grammie] morphine tonight," while I was at work (and not having known the rest) was a shock to the system.  I immediately dialed my mother, hung up, called back when I got voicemail, and she called me at the same time to explain.  That's when I was filled in on recent events.

Fourth, apparently the long term care doctor initiated palliative care orders without discussing anything with the local family (any family, actually).  I'm grateful for the palliative care orders ... but I honestly didn't think initiating them that way was standard practice.

Fifth, again I'm grateful the nursing staff followed the orders and made Grammie comfortable.  Some nurses are afraid to give narcotic medications in end of life care.  Narcotics cause respiratory depression (slowed breathing) which some nurses feel is what essentially "kills" the patient instead of letting them go naturally.  In this situation, though, the nursing staff dosed her THEN called family saying she won't make it through the night.  Hmm, calling prior to would have given at least a little more time for family to wrap their minds around the concept and get there. 

Sixth, not even an hour later, my text message said, "She passed away."  Just like that.  Granted, text messages are convenient for when I'm working ... but I just sat there and stared at my phone.  I had felt it vibrate in my pocket and I walked away from my desk to look at it. 

I deal with death and dying practically every day.  Heck, just on Sunday 20 minutes prior to the end of my shift, we were coding (CPR, IV drugs, etc) a person.  Fifteen minutes after it had begun, his family was wracked with sobs in the hallway when time of death was declared.  On the evening Grammie passed away, a couple hours after that last text message, we were emergently treating and transferring a patient with a STEMI (heart attack) to a heart center hospital in our same town.  The transfer and treatment they received at that facility could stop the damage to the person's heart and possibly "save" them from dying.  I have completed post mortem care on numerable patients throughout my career as a CNA, all with dignity and respect.  There is a level of detachment that makes it possible to complete such tasks.  Yet, on August 6th, I sat there and stared at my phone.  I hadn't seen her prior to dementia for at least 3 years.  Yet, I sat there and stared at my phone. 

I was kind of glad for work after that.  It gave me a distraction.  One of my best friends was working, though, and he automatically asked me what was wrong.  I was "not being myself."  I made him choke when I said, "I was fine until my great grandmother just died."  His face just contorted and he stared at me for a moment.  He ended up staying an extra hour and a half, off the clock, kind of lingering - finding reasons to continue to chat with myself or others near me.  I suspected his delay in leaving was because of me, but I wasn't sure until he confirmed it later on.  He said simply, "I was worried about you."  He was supposed to work tonight, but his schedule was changed last minute.  It would have been nice to have him to talk with. 

After it all, I know that Grammie is in a better place.  She is now comfortable and no longer in pain.  It's just the overwhelming feeling of loss that no previously ingrained ability to detach myself will help heal.  I can only look back on the memories of many lunches spent at The Chicken Coop restaurant, her love of Reuben sandwiches, and her "best" china on display in my china cabinet.  Someday, I'll actually have to host a dinner with that china.  She always wanted it to be used, but she never had the occasion (always used her "everyday" china) and I haven't yet.  Maybe it's time to remedy that. 

Ten Things I'm Looking Forward To After Graduation

Everyone seems to be making lists lately.  I have a list going in my head ... so now I'm going to try and organize it.  I have been in college since the summer of 2007 and I'm looking forward to the freaking END of it.  So official Graduation is in December and I've been asked, "What are you going to do when you actually have free time and no classes to complain about?"  Plus, the statement has been made, "You're not going to know what to do with yourself when you don't HAVE to run ragged anymore."  Hmmm ... here are my thoughts - in list form - about life beyond graduation.

1.  Graduating from Nursing School traditionally involves a Pinning Ceremony.  I'm looking forward to that and I'll probably cry when I see my parents in the audience.  I screwed up my teenage years [long story, hence why I didn't start college until I was 25] and it will be more than emotional that I will have actually earned my Bachelor's Degree in Science - Nursing.

Mine will have my school on it ... but you get the gist.

2.  A whole NEW role.  Currently, I am a highly trained CNA/Paper Pusher.  We joke in my department that I am "trained to every except diagnose and give meds."  I have been a CNA since 2006, before that I worked in home health as a PCA.  I have been doing the dirty work of nursing for 9 years now.  I now do a lot of desk work as a Unit Coordinator and fill roles as necessary due to call outs.  I have learned a lot and I value my time as a CNA/UC ... but I am B-O-R-E-D and ready to move on.  I spend most of my work days working on NCLEX-RN questions to prep for my boards in December/January (whenever I can land a date). 

I already have one of these

3.  Giving an answer to a nursing question and not hearing, "You're a CNA, I better look that up."  Recently, a nurse openly asked a question about a drug.  She'd never heard of it.  We had used it A LOT in my Maternity rotation.  I said, "Oh, it's a pain drug.  Safe for pregnancy [patient was pregnant].  Dilute it in a 10 [ml syringe of saline], and push it over at least 2 minutes, but less than 5."  The answer I got [above] and her look was incredible.  If I'd been an RN, she wouldn't have given it any thought whatsoever and would have just done what I gave her for an answer.  Back to my desk.

4.  A job.  Granted, I love where I work now, but as a New Grad I really won't be able to be picky.  I'd love an ER job while I'm young and can physically handle it, but I'll have to take what I can get.  Everyone asks me where I want to work.  My preferable criteria:  ER or ICU; benefits; reasonable drive from home; and, loan reimbursement.  Some hospitals that are Critical Access [small, rural] offer student loan repayment for each year a New Grad contracts with them.  That would be substantial since I'll have an estimated $400/monthly payment come June 2013. 

5.  Making double the hourly wage I am making now.  I value my CNA experience ... heck, that's how I made it through the cardiac section in both Pharmacology AND Med/Surg ... but CNAs aren't paid what they should be.  Granted, CNAs don't push medications ... but the grunt work we do is amazing.  I don't plan on being the grouchy nurse who's attitude is, "That's CNA work, have them do it," but it will be nice to get paid more.  Nursing scope of practice is everything a CNA can do, and more.  Just because there's an RN after someone's name does not make them better than a CNA, it just gives them more legal responsibility.

6.  Vacation.   My graduation present from my husband ... to all of us ... is a well-earned vacation.  Since the 3 of us have been through (and still have 1 more semester of) a hellish schedule, all 3 of us are going on a Disney Cruise.  One week in the Caribbean in January ... yeah, I'll take that!  When I'm interviewing for jobs, I'll just have to mention it.  It will be without pay since I won't have worked anywhere long enough ... but that's ok with me.  The relaxation, partying, and excursions will all be worth it.

7.  Days off.  Granted, I will need to work at least 3 days a week ... maybe pick up a per diem slot for another day in the week ... but it won't be a 7-day/week schedule like it is now.  It would be nice to be able to say to my daughter, "Yeah, we can do that," instead of, "I'm sorry, but I have class."  Sure, I'll have my shifts, but I'll have a bigger pool of people to possibly trade with, too, if something comes up last minute.

8.  Ambulance Shifts.  My volunteer job that is just down the street [that I am keeping] is rewarding.  More experience is great.  Prehospital care is a realm that I love and want to learn more about.  Plus, I can be home while I'm on call.  Amazing how clean the house is getting/staying with me being home on duty this summer!

9.  "Leveling-up."  I cannot believe I'm writing this, but I will have to go back to college to get my Intermediate EMT license.  I'm going to wait for a bit, though ... give myself a break from studying.  EMT-I will be easier with my RN experience and my last 2 years [thus far] as a Basic.  I plan on staying at EMT-I for a while.  I like my Basic instructor's idea, "Stay at a level for a while and get comfortable with your skills before you pursue the next step.  Good BLS [Basic Life Support] saves lives prior to ALS [Advanced Life Support] even showing up."  She always preached that ALS providers needed to remember their BLS skills if they were going to be effective at all.

10. Traveling ... I love to travel.  I used to do a lot of trips with my mom as a kid and the recent trip I just took reignited the fire.  It was the first time that I'd gotten on an airplane since 2002.  I'm ready to go again.  I'd like to take my daughter to meet her family on the West Coast.  I'd like to do the tourist stuff in NYC [again, for me].  My husband isn't quite the traveler, but I'm sure he'd go on a few trips with us.  I want to go to the Grand Canyon.  Hmmm, maybe I should make a list of travel destinations.

I'm sure with more thought, I could add plenty to this list ... but 10 seems to be a good amount right now.  I hate to wish away time [and this summer weather], but September brings the start of my last semester ... and I could definitely get going right now.

Senior Partnership

Found this ... it describes a Nursing Senior Partnership perfectly ...

I'm Baaaaaaack ...

Well, I've been back since the 17th ... I've just had to work my behind off since I took so much time off unpaid.  Bills suck.

The trip was amazing.  Daylight 20.5 hours of the day, dusk for the other 3.5 hours ... guess where I went.  :)  I will definitely be going back, just FYI. 

A lovely time-lapsed shot

The wonderment after it all was ... I came back to the same crappy attitudes that I left.  I have a few different employers, but one at this point in time takes the cake.  Wow.  I mean, I've encountered pettiness and backstabbing [really, who hasn't?], but this is quite the debacle.  At this employer, we submit our availability within the last week of the prior month and the schedule is made.  I didn't have any availability in July due to my trip and my two other jobs, so I didn't work [this was communicated ahead of time].  I submitted my availability for August, knowing full-well when *extra* people were going to be needed ... and "none of the shifts [I] requested are open."  Really?  I know the size of the roster.  I know how many people are needed/when ... yet, I couldn't get even one of those slots?  On top of that, double the original minimal availability is now required.  I begin back to school on the Wednesday after Labor Day.  With nighttime Partnership schedule, daytime class schedule, family, and my 2 other jobs ... do they really think that I'm going to have time? 

REALLY?? 

This isn't the first time that I've had scheduling issues.  My availability is limited, but they put others in slots that I could have filled - those others have much greater availability [and a ton of shifts].  As much as it pains me, I'm going to turn in my stuff and official resignation this week.  I've worked there for almost 2 years, but it's not worth the hassle and heartburn of wondering if I can make the minimum.

I don't know who I unknowingly crossed, but it would have been better [and much more professional] if they would have approached me about it - rather than squeezing me out of the schedule.  At least, that's my theory as to why I'm unable to get shifts.  I just wish I knew who to confront about it ... we are adults, after all ... or at least I am. 

Onto happier things, I had a good day at my other job [that I'm keeping].  It was busier than it ever has been with me on duty... and I've definitely had enough to sirens for today [and maybe tomorrow] ... but it was a good day with a good partner.  My Chief is really cool, too.  I'm working again tomorrow ... so maybe I ought to get some sleep tonight ... and take some Advil.  My partner tomorrow has been quite the magnet lately.