June 1, 2017

And the megacode was....

Ventricular tachycardia.  First with a pulse, then after cardioversion, it went pulseless.   Great...I figured I was going to go 0 for 5 and prepared for my inevitable asystole (CPR, push epi, CPR, push epi, H's & T's, CPR, push epi, call it and offer condolences).

It didn't happen.  Did. Not. Happen.

For the first time in 5 ACLS classes, my patient lived...well, lived long enough for me to transfer him out to the CICU.  But the patient was alive when I was done with him!

May 23, 2017

It's that time again...

ACLS renewal time.  Time to get the latest guidelines out and remind myself what third-degree heart block looks like.

I am 0 for 4 on my patient surviving megacodes, because I am 4 for 4 on getting the asystole megacode.  Something about me must tell the instructor, "give this one the flat liner." Perhaps it's because I'm usually the only psych nurse in the class, probably the only one they see all year.

I am a pro on the asystole megacode.  The problem is that most patients are not pros at surviving asystole.

I did get a chance to run a second megacode during one renewal--it was supraventricular tachycardia, and that patient did make it.  But as it was after my official (asystole) megacode for the class, and the instructor did it to give other students a chance to perform in different roles, it doesn't really count.  Though since it wasn't asystole, I wasn't used to the fact that my patient was actually responding to treatment, and it kind of threw me...so it wasn't my smoothest megacode performance to date.

Anyhow, here's hoping I get a megacode with a shockable heart rhythm this year.   Then again, being 5 for 5 on getting asystole megacodes is kind of a bragging right in itself.

May 22, 2017

Surgery stuff

Recovery will be up 2 weeks, so that's what I'm putting in for.  This is going to run into the Labor Day holiday, but I can't help that.   I would like to try to be back on Labor Day so I can get a day of holiday pay, but that's up to the MD.  I have to get the paperwork in June and get the process started.

May 15, 2017

The bane of my existence...

In the last week, I attempted 23 IV starts.  The one I managed to get in was later determined by the MD to be not good enough for his purposes...so essentially, I batted .000.  I did get one successfully started the week before, and on a psychotic hallucinating patient, no less.  So for the whole month, I'm 1 for 24, or 4.166% percent successful.

My IV skills are not improving despite hell AND high water.

I decided that it's time I broke down and took a LVN IV Therapy course.  So I went to the BVNPT website and found local approved course providers, and messaged them for more information.  I suppose since I'm not going for BVNPT certification, I could take a course that wasn't approved by them.  But I consider the fact that a course has BVNPT approval as meaning that the course content is up to snuff.

That is the downside to working in psych:  we almost rarely start IVs.   Psych-medical sees more IVs than the rest, but even then, it's nowhere as many as you'd see on your typical med-surg floor.

IMs are no problem:  I can give an IM to a patient under pretty much any conditions.  And have.

So while I wait to hear back from the courses about enrollment, I'll be pulling out all my IV books and reading them...again.   I wish they sold an IV practice kit that didn't involve a human body part.

May 4, 2017

Typing this while wearing high heels

I have a social event to go to in a few days, so I finally bought a new pair of party shoes.  The last pair of high heel shoes I have is more than 20 years old--they're still in good condition since I wear them so infrequently.  I just can't find them, so I decided to get a new pair.  I'm currently wearing them over a pair of red wool socks to break them in.  The following day after the social event is a work day, and I want to minimize the inevitable blisters.

I don't usually wear high heels as gracefulness is not one of my strong suits.  That, and wearing high heels puts me into the "rather tall female" category.  I also don't usually wear dresses but I will be that day, and I am now debating whether to get some Dermablend to conceal the leg ink.  I'm not ashamed of my ink, but I also don't want to commit a social faux-pas.

24 pounds down.  Some of our long-term patients have commented that I've been losing weight.

I don't really see it, though.  I mean, I can tell from the fit of my clothing that there's less of me.  In fact, I had to break down and order some smaller scrub pants, since a lot of the ones I own were unable to be cinched tight enough at the waist (I'm all about the drawstring) to prevent them from dragging on the floor.  But I don't look at myself and say, "you know what, I do look thinner!"  I guess because I look at my face and body every single day so I'm not noticing the subtle changes.

Anyhow, this loss means I'll have 22 pounds to go before I hit my minimum ideal weight--27 until I hit my maximum.  145-150 looks good on me; any less, and I start to look ill.

I'm hoping to lose the rest, or at least most of it, before the eye surgery in August...yes, a date has been set.  Late August.  I have already informed my manager that I will be having some minor surgery (didn't say for what) and will be off work for up to 10 days.   I asked if I should put in for time off now, or just wait and see.  No response yet and it's been a couple of weeks...I think I need to remind them that I will be off for surgery starting on that day regardless of what they say.

April 22, 2017

My weight loss stalled.  I'm not gaining though, which is a good thing.  But I'm holding steady at the 20-21 lb mark.  My shift in sleeping schedule--and thus my shift in and laxity of intermittent fasting and what I'm eating--is probably the reason behind it.   Plus Easter chocolates.  I've improved on the wake-up bag of Doritos though I did have one this afternoon...I was a charge nurse last night, it was a wild night, what can I say?  My soul craved Salsa Verde.

I'm sure once I'm back on my usual schedule and meal plan, the loss will resume.  I need to get back into exercising as well.

Work has been...work.  I thought about calling out tonight or at least requesting a cancellation.  But given that both the little one and I will have various medical expenses coming up, it's better if I work and get my full pay with weekend diffs than just the PTO at my base rate.

I successfully started 2 IVs in the last couple of weeks, bringing my EVAA (estimated vascular access average) up to around .300.

Acuity has been high on every unit since before the full moon.  There are lots of little changes going on to help prepare us for various site visits.   New staff are going to be starting soon, including a new grad (someone who wanted into psych, no less!), so there's been some shuffling around of who is working what unit, who will be doing what, and what schedules will be changing.

Come to think of it, that shuffling has been happening for a while.  It seems like TPTB are into floating staff around and people are working where they usually don't.  I think part of this is due to new staff coming on board, as well as the budget--they want to fill in the coverage gaps so they don't have to pay people to stay late or come in on OT.

I'm eyeing all of this with a little apprehension and concern.  I thoroughly enjoy where I work and I don't have plans to leave anytime soon.  I'm glad to have new staff come on board.  It'll be nice to have staff more evenly spread so there's fewer gaps.  I'm excited we have a new grad that appears to be want to be here and not just wanting to get their mandatory first year over with to leave for more medical pastures.

But I also wonder with all this shuffling, where I will fit in.  Yes, I know some of this is my well-known (well-known if you've read this blog anyway) anxiety/insecurity.  I know the union means they can't just fire me without cause.  I know they can't change my schedule without my consent.  But I'm hardly on my home unit as it is, so I wonder where I'm going to be stashed with all of these changes...especially since some of this new staff is coming to my home unit.

I'm trying to be Zen about it and take a "wait and see" approach.  See what's going to happen to me--if anything--before I make my concerns known to the TPTB.   It could be that I'm getting rattled over nothing, and everything will be the same as before or better.  Or not.

April 20, 2017


The little ones are on Spring Break, which means I've had to adjust my sleeping schedule.  I now sleep in the evenings, go to work, then stay awake to do things with them.  It's been working out so far...its a nice change to stay up after work, and I'll admit that it's easier to fall asleep when it's starting to get darker out as opposed to brighter.  But this won't work when they're back in school, so in a couple of days, I need to return to my regular schedule.  I may shift back to this in the summer, we'll see.

I've been enjoying the last few days off.  I've caught up on sleep.  I'm spending time with the family.  I've turned down requests for work.  I'm just recharging the batteries, getting ready to once again tackle all of the Axis II that seems to have infiltrated the patient population.

The tough thing about personality disorders is that they are how a patient is wired, meaning that nothing is going to cure it.  Sometimes I do wish it was like psychosis, where a shot of Haldol will make the pink elephants go away...at least for a while.  Alas, it's not.  Medications may help them manage their symptoms, but the patients need some good old-fashioned therapy--usually CBT or DBT--to change how they think and respond.  But because they are wired this way, it's also incredibly hard to effect change.

All the Axis II can wear a nurse out after a while.

I'm debating if dealing with Axis II disorders is more exhausting than working with patients in mania.  Both can be challenging, frustrating, and have medications end up with little to no result.

But a manic patient with Axis II...now THAT'S a hurricane!