December 28, 2009

Holidays

They say the holidays are slow in psych...yeah, right.  The place is packed as though they are giving stuff away for free inside.  They also say that PRN time tends to dry up during the holidays...again, yeah right.  HR is calling me perpetually to see if I can come in for any extra shift or even part thereof.  I had a rollicking evening the other day:  we have a full house (and then some!) on detox with a complete range of characters and personalities...including two borderlines, which makes things challenging at times.

No codes though, so it's all good.

Christmas was nice.  The child was very much spoiled by the grandparents.  I got one thing I really wanted (a Zelda game for my DS), and one complete surprise (a diamond--small but one nonetheless).  I finished the shawl for my mom, who loved it.  Dad loved his Monty Python DVDs.  Lots of good home cooking too.  I don't know if I gained any weight from the first set of grandparents...surprisingly, I held steady over the Turkey Day holiday:  didn't lose but didn't gain.  I think what's been helping me is sticking with my usual breakfast and lunch routine, so even though I may indulge a bit more at dinner, I'm still doing decently overall.

December 20, 2009

Mini vacation

I had taken a couple of days off for the visiting family, but it expanded into a mini vacation once my preschooler got sick. I faxed over the requisite doctor's note and felt bad...for a few minutes--then I had my arms full with a fussy 5 year old. 

It's funny (but not surprising): HR is all sweetness and light when they're asking you to come in for extra work, but tell them you're calling out and it's "give us a doctor's note." Or ask for a day off within the proper guidelines and yet it somehow doesn't materialize on their calendar. Mind you, I'm not expecting HR to be on my side--after all, they've got a job to do and that is to ensure there is staff on the floor. 

They'll probably still be cross with me, but I followed every P&P to the T when I called out.

So I have nearly a week off. I'll be entertaining family, tending to the sick child and catching up on some knitting. My Raynauds has been very bad this winter, and I'm perpetually wearing socks just to keep the circulation going to the toe. So I need to make more wool socks, because cotton doesn't cut it. Cotton doesn't instantly warm up my foot, whereas wool acts like heating pads on my feet.

I realized that the first four months of my "first year" is almost done. Wow. 25% of the first year...it seems like I've been working there forever and also like I just started. I don't have any plans to flee once I hit the one year wicket though...though working for this facility has its ups and downs, it fits into my long-term plans perfectly. I'll probably stay through the BSN, and then see what happens. Occasionally I do think about med-surg, but not with any real longing. I'm enjoying psych nursing far too much.

December 7, 2009

Random stuff

My most recent shift at work was much better. I went into it saying that I wasn't going to let the growing pains hold me back, that I'd go in and do the best damn work that I could. Of course, for a census of 9, I was incredibly busy. The problem is that if it's less than 10, there's only one nurse staffed for the shift, or possibly a RN/LPN combo. But it was just me and the tech on detox...and since he's running all the groups, I'm doing the rest of his duties as well as my own. It's all good though.

I had the last day of my BSN class today, thank God. It wasn't horrible...but it was a lot of work for 6 weeks. As I said, I'm going into the end with an A, so unless I really dropped the ball on my final presentation, I'll likely keep it. I'm ready for a break until Statistics, which is this spring's excitement.  I do worry a bit about many of my classmates though.  All but one are just starting nursing school, and they're all in that idealistic "rose-colored glasses" stage of nursing school, where it's all perfect and they're all Florence Nightingales in training.  The first clinical course is really going to knock them upside the head.

My stethoscope arrived...it's pinkish, not really the raspberry I thought it would be. It's still nice though...and it has Meriwhen, RN lasered onto it, which is the best part. It's the first thing I bought for myself that had "RN" on it.

My son's birthday is today...5 years old. The little scamp isn't so little anymore!

Meanwhile, my birthday is Thursday. I'm trolling the yarn website, deciding what I want to order as a gift for myself. I have a pattern for a coat that I've been eyeing for a couple of years now. It is supposedly super-easy to knit (though being a coat, it will take a LONG time to knit!) and I'm thinking that now I graduated, I may just get around to doing it...

And also knit some more socks. I need wool socks. I have Raynauds in my right foot, though for three years I never knew it was called that--I always called it "attack of the white toe" and attributed it to the fact that I wear sandals every month except January, and that I constantly walk around barefoot on a marble floor.  When I was in Med-Surg IV, I learned its proper name, and now that I know what it is, what causes it, and what it can do to my toe if I just let it sit numb all the time...I have to give up the sandals in the winter and wear socks more often. And hand-knit wool socks are the bomb.

December 5, 2009

New graduate growing pains

Work has been rough lately. I had the week from Hell.

First day of the week I’m floated to another unit to help for an hour, during which three codes happened. Medical, elopement, out of control. Two of those three were on the unit I was on…guess which two. Yep. At least they brought him back pretty fast, and I learned that an IM cocktail of Haldol + Benadryl + Ativan = SLEEP for even the most gigantic and violent of patients.  It was a frightening experience because it all happened so fast...but overall, that day wasn’t too bad.

Next time I’m in, they put me as the charge nurse of the intensive care unit and only left me with an LPN. I’ve worked ICU before but usually as med nurse with one of the unit’s regular RNs with me. I did charge there once during orientation, with both a med nurse and the nursing supervisor (whose job it was to orient me that night since that was her home unit anyway) keeping me company. The overnight supervisor apparently thought well enough of my work that she thought I could hack it with just an LPN.

Except that I’m not used to the ICU in the daytime. I’m used to the evening ICU. Everyone had to go to court for their hearings, and I didn’t know what I had to do to get them sent off to court. Everyone came back involuntarily committed and was angry. Now THAT, I knew how to handle: have the med nurse get the PRNs ready. Then two actively psychotic patients come in (one violent), four more admits are on the boards, one patient on 1:1 for suicide, another on eye view, all these assessments to do, staffing wants to take my techs away since we “only” have so many patients, I’m not familiar with the medicines the unit favors, the treatment plan, the patients, the psychotic patients…

I called for help a lot–I think the nursing supervisor was sick of me by 10am. Still, all the stress kept building up, the workload kept getting larger, and even though I had a team of techs that knew this wasn’t my home unit and kept me on track, I was getting really frustrated and anxious…I was ready to scream and/or walk out of there. When the DON asked me if I wanted her to come over for a while to help, I was going to say "no" because I felt like her offer was a vote of no confidence.  But she must have heard the stress in my voice, so I came to my senses, got over the ego and said “sure”.  She came over, sat with my 1:1 for an hour, got her to eat, stayed another hour or so afterwards, and also got another RN for me for part of the shift to help with assessments.

I survived. No one died, no codes were called. So by my own standards, it was a good day.

When I finally wrapped up my paperwork (an hour late), I stopped by the DON’s office to drop off one of my forms, and it ended up being a debriefing. She said that I handled it well considering everything that went on, my lack of experience (both on that unit and because I’m a new grad) and that it was a sign of growth that I knew I needed help and asked for it. She was actually very encouraging--in fact, she even thanked me for giving her an excuse to get on the floor because she rarely gets to do that anymore.

Last day of the week. I’m back home in detox. Low census so it’s just me with a tech. I know the faces, I know most of the turf. Most. Apparently not all, as I goofed up on a taper order–I misunderstood what the doctor had wanted, and she got an extra drug that she didn’t need. Plus, the admissions department got a crazy use and medication history from the patient, so when she got up here, we’re not sure of why she’s here and what she should be on.

So on my fourth call to the doctor as we try to get this all sorted out, I tell him what she’s received so far today…and found out I got the order wrong. Surprisingly, I didn’t get raked over the coals for it. He was actually pretty sympathetic to the fact that I’m a new grad still learning the basics, and was quite encouraging in his pep talk. He asked me what training I had had in detox and I told him what they covered in orientation (which isn’t a lot), but I’ve been reading up on most of it on my own because I find the field fascinating and that I wanted to get more involved in it. He said he wasn’t upset with me for the order mix-up–though issued a new order for me to discontinue that drug–and that he was going to look into getting an in-service for those of us who work there regularly, so we can learn more about the protocols. He also thanked me for my dedication and work there, and that he was glad that I had called him because it was better I did call when I needed to than not to call and wonder if I’m doing the right thing.

Of all the people to tell me to keep my chin up and offer help, it was a doctor. Go fig.

The tech and the LPN who visited me at the end of the shift told me I should relax, I shouldn’t stress so much over my work. I told them I knew that but that’s just how I’m wired, but I am still going to try. Funny enough, both of them said to me the things I say to myself and to others. The tech told me that no one died, so it’s all OK; I echo those sentiments every shift. The LPN told me that what doesn’t kill me makes me stronger; I had said that to someone after my day in the ICU.

I guess I just felt frustrated these days because I feel like…well, like a new grad. Stumbling and bumbling and not knowing my ass from my elbow…and yeah, the fact that I was valedictorian just makes me feel that I should be the last person stumbling and bumbling. I should know this stuff cold–I did on the tests. I did in class. And I know that really practicing as a nurse is a world different than what I did in class and on the tests. I still felt incompetent though, even though I know I’m not.

I’m hard on myself though. Sometimes too hard. I was like that in school too…still am. For my talk of not caring what grades I get in the BSN program as long as it’s at least a B, I’m going into the final week of the class with a 99%.

Well, if I’m smart about this (and I plan to be), I’m going to take all that happened this week and see how it can help me grow. And not go into my next shift with the attitude of ”I’m going to stumble and bumble again” but that I’m going to do the best I can. After all, if no one dies and no codes are called, it really is a good day at work no matter what happens.

November 25, 2009

I bought a new stethoscope while I'm speed-defrosting a turkey

I brought a Littmann Classic II SE for myself.  I needed a smaller steth than my CD-27 (which I love but damn, is it heavy!) for going to the clinic as well as for work, especially since they're going to be spreading the physical assessments over the entire day now instead of leaving the bulk of them to the night shift.   I will actually need to have a steth that works pretty well instead of the behemoth steth we keep in the drawer.  Plus, I'll need it for clinical when they start up.

It's also personalized with something important:  RN.  Meriwhen, RN.  Well, my real name plus RN...I don't think I'll be advertising myself as Meriwhen at work anytime soon.  Though I'm sure a few classmates have figured out who I am by now...but like I tell people when they call at the nurses station but don't have authorization to talk to the patients:  I shall neither confirm nor deny my identity on the board.

I forgot that Turkey Day is tomorrow and I didn't take my turkey out to defrost.  So I got a bucket from the garage, put it in, and filled it with cold water.  I'm changing the water q1h until I leave for work, then it goes in the fridge, then my better half will resume defrosting until I get home.  I hope it comes out OK.

Happy holidays!

November 16, 2009

So I call for the nursing supervisor...

and ask her to come on up to my unit whenever she has a chance, no rush.  She appears pretty fast, considering that it's the end of the shift.

I tell her I discovered that I made a med error yesterday:  when I was doing my nightly check of the MAR, I noticed that I missed signing off on an entry the day before (the day I didn't do a nightly check since I had a late admission).  I was about to sign it when I figured that since it was a narcotic (not really--it was Tramadol, but we do keep it with the narcs since it's usually given with Phenobarbital), I'd check the narcotic log to see if I did give it.  And I didn't.  That was a busy night:  I'm trying to pass meds and someone's knocking on the med room door q5 minutes to ask/tell me something.  It was very distracting. 

"So what are you going to do about it," she asks. 

I hand her a completed medication variance form and incident report.

"Oh," she says.

"You need to fill out the back part," I tell her, "since I was the only nurse here that night as well as tonight."

I think she was a little shocked that I wrote myself up.  In her day job, she's a nursing instructor, and I think she was preparing to lecture me.

To be honest, the odds are that the error never would have been discovered unless they decided to audit that particular chart.  I could have signed it and let it go, and I'd be a liar if I said that never crossed my mind because it damn well did...but my conscience would have gotten to me.  And once I start down that road of not reporting errors...pretty soon I'll be falsifying documentation, diverting drugs and barking at patients, "you're crazy, just deal with it".   So I did the right thing.  

Now I'm up to 2 reported med errors, but this is the first that is 100% my fault (the other was the one due to another nurse transcribing the order wrong then altering the MAR after I gave the dose--I was the one who filed the variance/report.  The unreported one was also due to another nurse's error in transcribing, but since it helped get the patient's HTN finally under control, the charge nurse and I got a one-time order to cover it).  

"Am I going to get fired for this?" I ask...not entirely in jest.

She laughs.  "Please...if only more people here did this."

I probably won't get fired, I take it.

I don't like making the errors though...the problem is when I'm the only nurse on the floor doing both charge and meds, it can be distracting especially when everyone is coming to me because I'm the resident RN.  I think I need to set a policy that, if I'm the only nurse on the floor, unless copious amounts of blood are involved or a patient is about to go off the psychotic deep end, that I'm not to be disturbed during the med pass.  Either that, or I need to get the nursing supervisor down here to cover charge for the 20 minutes.

November 13, 2009

Nurses do not get snow days

Or rain delays.  Or bad weather days.  Or holidays, really.  Hospitals can't just up and close for the day because there's three feet of snow or a ton of flooding or because it's Christmas.  Patients need care 24/7.

I say this because today I must set out and face the remnants of a tropical storm as I slog my way to work.  The brunt of the storm hit on my day off...though that didn't stop them calling me at 5am to ask if I could work anything at all.  I told them that my preschooler's school was closed due to the weather and unless they wanted to babysit him on site, I can't come in.  I think they were desperate enough to consider saying "yes."

My street is flooded.  Not horrifically:  the house is dry, nothing has floated off, and my car is high enough that the water never reached it.  But I know the roads are a mess everywhere and so driving in is going to be quite the trek.  I have a SUV, so now I'll get to see if purchasing one was worth it. 

I had to put in my holiday choices for the schedule.  Everyone has to put in for two of three winter holidays and two of three summer holidays.  We're not necessarily going to end up working them, we just have to be available for them.  I put in shifts for all three--two of them ended up on my regularly scheduled day (Friday) anyway, and I figured I'd put down for Turkey Day as well, in case I change my mind about working Christmas (I will gladly work New Year's Day, I think it's the most useless of the three days.  After all, the big event for the day is pretty much over by 12:05am--the rest of the day is football and parades). 

I don't want to work all three, though getting all that double-time would be nice.  But we'll see what happens.  They do try to divvy them up evenly so no one person gets slammed (or makes a killing, depending on how you look at it).

It's been busy at work.  For all of these new nurses they've hired, I've only seen a couple of them.  Nearly every day they're calling me to see if I can work or work extra, and all week I've stayed late per their request, so much so that half of Saturday will be overtime pay.  Unless they decide to send me home early...and given the weather conditions here lately, I doubt they'll have enough coverage to be able to do that. 

Detox has been jumping too:  I don't know if it's linked to the holidays or what, but it's been full all week.  Of course, that means a ton of paperwork for me...but it's the unit I know best, so I don't mind it.  I've got it down to a science, in fact.  I wonder if I'll be there tonight...lately, they like sending me to stepdown on the weekend evenings.  I'd rather be in detox, but I go where I'm told and make the best of things. 

Oh, what happened with my group....the other group person was out due to illness:  her doctor had her on bed rest.  At least she wasn't slacking, so I don't feel as bad over having to do the whole thing.  The instructor also posted that she had liked the group (my) assignment, though I haven't gotten the official feedback yet.  I turned this week's assignments in early, since with the bad weather I'm not sure if I'll lose my internet connection.  No more group stuff for a while though.

November 6, 2009

*sigh*

I got my first week's marks, and I didn't fare as poorly as I thought I did.   Actually, I did very well.

The next two homework assignments were turned in on time.  One assignment is utter crap though.  It was a group project...except my group wasn't really there.  They sort of got started, but one member had a family emergency of the life and death rank.  One member went AWOL. 

So that leaves me. 

I didn't mind--I'm not getting a zero by not turning anything in so if I have to do the lion's share, fine.  Also, family emergencies trump schoolwork, so I can respect that.  So all night I kept posting drafts and asking for input when possible.  All night I got nothing.  I wrote a few drafts on the board and countless more in Word.

Finally, with 5 minutes to go before the deadline, I had to call it a game and post what I wrote.   After reading it, it's crap compared to everyone else's, but I didn't have a choice.  One of the other groups pulled together beautifully.  The other group managed to capture the assignment beautifully.  Meanwhile my group...er, I...am trying to stay awake after being up for almost 24 hours. 

Then I found out after the fact that the group area we were supposed to work this in is visible to not only to the teacher, but to the other students.  I had thought the groups were private...so basically, everyone knows I did all the work.

*sigh*

What could I do?  Rock to the left, hard place to the right.  I'm going to sleep now.

November 5, 2009

Going to enjoy the ride this time around

As an ADN, it was all about grades:  I finished with 3.923.  I had one B--I missed the A and thus the 4.0 by 2 mere points...and I know what question I stupidly answered wrong too.  Yeah, it burned for a while.  But on the other hand, it taught me an important lesson:  the world didn't end when I didn't get the A.  People didn't think me any less smart.  People thought no less of me...hell, my classmates were still proud of me for what I achieved--and what I did to help them--that they let everyone know it at pinning.

Getting that 3.923 was exhausting work--I went above and beyond in studying for those two years.  My health suffered, my social life suffered, my family actually didn't suffer because my better half was/is a champ at picking up the slack when it comes to the preschooler.  My mind suffered though.  It was emotionally draining.  Everyone said I made it look easy; I tell them they should see the ulcer it gave me.

Now that I'm a BSN student...I still want to do well.  I don't know if my future includes a masters degree so I don't want to become an entire slacker.  But I'm not as stressed anymore over the grades I'm going to get.  If I get an A, yay.  If I get a B, yay.  If I get a C...ok, I have to put my foot down there--I will not willingly be a C student.  I already was once in my life, thank you.  Point being:  I'm going to focus less on getting the GPA and more on the class itself.  Slow down and smell the care plans and concept maps.  Look at the whole picture and not just the tests.  Enjoy more of what I'm doing.  Not let it consume as much of my life...and it being a part-time program, that should be easier for me to do.

Speaking of which, I better get cracking:  my homework is due this evening but I still want to go out with my friends tonight.

November 2, 2009

Mental note: read the syllabus

The first week of my first BSN (pre-BSN) class drew to a close.  It had a rough start as I got my dates mixed up and ended up turning the first assignment in a day late (thank God I decided to log in--I noticed all of the postings).  Participation-wise, I fell short too.  I thought I was participating enough but then I counted up my postings and was one post short of the minimum guideline.  Of course, had I bothered to read the syllabus fully on day 1, I would have had the answers to A and B and therefore no problems.  But I didn't because I thought I had several days before the first piece of work was even due.  I thought about telling my teacher about being sick and pleading for leniency, but you know what:  it's my responsiblilty to know what's going on in class.  I just have to suck up whatever grade I get for the week and do better next week. 

Lessons learned. 

I've combed through the class calendar and added the due dates to my Outlook, printed out the next two assignments and when they are due (end of this week), and today I plan to go through every inch of that syllabus to make sure I understand it all. 

I'm looking forward to going back to work.  Despite being sick and all the stress, the week off has been nice.  But I'm also bored and itching to get back on the floor.

October 30, 2009

I now understand why so many at-home moms drink

I'm not being facetious.  

My being under house arrest due to illness means the preschooler is also under house arrest because I'm not supposed to leave the house to take him to school or anywhere.  For the past three days he's been hounding me like the plague...I can't get a moment's peace to relax or do my reading for class.  What's worse is that  he's developing the 4-going-on-40 attitude and everything is "I want!" or "No!" or "Mommy, do this!"  He deliberately disobeys me when I tell him to do/not do something, and when he does something wrong he gives me that laugh, that laugh that says to me "I know I'm ignoring you and I don't care!"

I've tried everything from being nice to being a bitch.  Nothing works.

Add to this the fact that I'm feeling much better (ah, Theraflu, how I love thee) and would love to be out and about right now--hell, I'd even like to be at work if I could!  But I can't because I'm still contagious...nor can I go visit friends.  So I'm trapped in the house with a demanding preschooler.  What's worse is that tomorrow my better half will be gone until Sunday, so it's not as though I have someone in the house that I can hand him off to for a while as I go and hide.

It's all I can do to grab a bottle of wine and up-end it in my mouth.   But the Theraflu is keeping me from doing that.

I don't spank either--I had it done to me as a child and I don't approve of it.  But I'm beginning to understand that "why" feeling too.

Oh well.  This too shall pass...I hope.

Oh yeah, I'm officially a BSN student now.  Pre-BSN student, actually...it's kind of confusing how the program is all set up.  But I'm taking a 6-week online class that so far is a throwback to my Fundamentals and Management classes.   I'm one of two RNs in it--the rest are all brand-new nursing students.  I better not let myself get too cocky about it.

October 29, 2009

Minutiae

I was complimented the other day. I'm back on detox; one of the clinical instructors was showing her students around the unit, pointed to me and told her students "that nurse explains detox really well."

Wow.

I've been mastering the basics but I didn't think I was "really well" at the topic. I was flattered. That compliment makes me want to learn even more about detox so I can really be thorough in explaining it to patients and students.

I'm a firm believer in consistency, meaning that if you're going to enforce a policy, you should do it for everyone regardless. Like every other hospital around here, alternate weekends are a must. One of the policies in my place is that if you call out sick over a weekend you're scheduled to work, you may be asked to produce a doctor's note as well as have to work the next "off" weekend you have. Apparently too many people have abused taking weekends off, so they started cracking down.

Now while I don't mind at all being asked to fax my doctor's note (I am indeed sick: I had to call out this weekend because my doctor wants me home recovering until Monday) because I approve of the consistency on their part, part of me couldn't help but feel a tiny bit peeved as I work EVERY weekend. I don't have a "off" weekend coming off--I'm in for at least one, usually two shifts every single weekend since the day I was hired. And it's not as though I'm abusing the weekends: this will be the first one I am off, and only because I am highly contagious.

Go fig.

So yeah, I'm on an enforced vacation from work. I'd like to say I'm home relaxing...but I can barely keep my head up. I'm chugging Theraflu q4 just so I can breathe, and I'm buried under down comforters while it's 70-something degrees outside.

October 26, 2009

Money money money

I've been on stepdown for so long lately I'm not sure if I should call it my new home. 

There have been staffing cuts all throughout the hospital, and a lot of good people (including nurses) were let go.  This means we're now even more short-staffed.  The official reason is "budget cuts" and "our census is low".  I don't know about the budget, but I know that we don't have a lot of empty beds...in fact, I get admissions trying to admit people to the unit even though I've told them we have no free beds.

I really don't know why I stress over not getting enough hours.  Nearly every day I am asked if I can come in early/stay late/come in at all for any amount of time.

I still have a job, thankfully.  And one would think that with the number of people let go from detox that they'd send me back up there.  But no, I've been banished to stepdown for reasons unknown.  I'm not sure who to ask...I'm not sure if I even want to ask, you know?  And it could be worse:  I could be in the high-functioning unit or the kids' unit.

Oh well, what can I do?  I just go in, smile and do my job.  The techs wonder why I don't complain about it.  I tell them that it wouldn't do any good because I was hired to float, and that bitching about it would just make my mood darker.  Instead, I can accept and make the best of it, and get some joy out of the day.

Now that I seem to have taken care of the household emergencies, it's time to turn a lot of my paycheck towards my credit card and my retirement fund. 

I transferred my balance to a card via a 0% APR offer (and with no transfer fees, how rare is that?!?).  The offer only lasts until May, but I figure I could make a pretty decent dent in it if I give up about 300-500 per paycheck towards it.  Then come May, I'll transfer it back to my original card--they're constantly giving me balance transfer offers so no worries there--and keep chipping at it.  My goal is to get it paid off by this time next year...I think I'll do it  far earlier than that, but I'm leaving myself some wiggle room just in case.

I have two IRAs.  One is a 403b that I got from my last job pre-nursing school.  The 403b is just like a 401k except it's for non-profit and educational institutions...and since I'm not at a school nor am I getting benefits at my current job, I can't do anything with it except watch it grow and shrink.  Then there's my Roth IRA, which I send 50-100 a month to.  I've got a good mix of mutual funds and stocks in there and while it's miniscule (it'd last me about a month should I need it today), at least I'm contributing something. 

The stock portfolio is also small.  That did well because in 2001, I bought Apple at 12 a share.  It's now trading at 180.  I wished I had sucked it up and bought Google at 85 a share when it launched, but I was in nursing school and couldn't afford to do it.  Now that's still trading in the 500s.  I do own part of a share though, so I made like 30 dollars on it.  But I'm trying to purchase about 50 dollars' or so worth of stock each month in solid stable companies like Coca-Cola, Pfizer, Avon, etc.  I read somewhere (the Motley Fool?) that the best stock picks were based around common, everyday things, since they're not likely to be going anywhere anytime soon.

I am trying to put money in the savings account...easier said than done.   This last month has been a rather costly one for us with household stuff; also, I will admit that I've become a bit of a splurger lately.   Once I sat down and did the bills for the month I realized that though we are now a two-income family who until now had gotten along on one income rather OK, that is no excuse for me to spend my income carelessly.

I was up two pounds at weigh-in today.  I know why:  I'm forgetting to eat at work again.

October 24, 2009

Assault and battery by Gatorade

I knew it was bound to happen sooner or later:  a patient threw something at me.

I was back on stepdown the other night.  The report said that the patient was involuntary, psychotic, delusional, a pussycat in the AM but once it got dark out, she would get all worked up.  True to form, she did.  She started slamming doors, spitting in the hallway, and getting into it with her roommate who was otherwise peaceful all day but told me in no uncertain terms that if this patient got in her face again that she'd "fuck her up". 

So we separated the two, thinking that having a private room would help the agitated patient calm down.  But now it's the safety checks that were getting her agitated, and she started complaining, throwing things, getting into it with other patients, and slamming doors even more.  She was reprimanded several times, and even reminded that this behavior is not going to work in her favor at her court hearing, but she disregarded it.

I'm peacefully in the med room doing my med pass when she got me with the Gatorade.  I yelled, "Hey!" and it took all my willpower to keep my mouth shut after that. 

I went to my charge nurse, who thank God is on the ball.  She arranged for an immediate transfer for the patient to the intensive care unit.  Then she tells me to see if she has any PRNs that I can give the patient.  Sure enough, she does:  Ativan PO or IM.

"Should I offer it PO?" I ask.

"Do you think she'll take it PO?" says the charge nurse.   Both of us know how this is going to end.

I point to my wet head and shirt.  "Probably not."

"Draw it up."

"It would be my pleasure."

So I prepped the needle, and though we had one male tech on the floor, we called for another tech to come help me give it.  Thank God they found me the biggest one on duty.

Charge nurse sends our two techs in, and tells the patient that we've got medicine for her, and would she lie down.  She keeps saying, "I'll be quiet, I'll behave," but when she sees me and then the needle, she starts glaring daggers.  I stare back with no expression (I'm still fighting to keep my tongue holstered and succeeding).  They asked her if she wanted it in her arm or her thigh.  She didn't answer, so I said she'll get it in her arm.  She didn't fight it--the two techs weren't going to let her.

God help me for saying it, but giving her that IM injection felt so damn good.

In the five minutes between that and her transfer, she kept walking the hall and muttering threats at me.  I didn't flinch and I damn well didn't take my eyes off of her as she passed.  She kept telling the techs that she'd behave now but they told her "you had your chances, we offered to help you, you need to go."  So now she's over in the intensive care unit, where they take no crap from any patient.

Afterwards, I took a few minutes in the lounge to breathe, curse her out (to the amusement of the techs), and then write the incident up.  The techs were impressed and said I handled it all very well, better than they would have.  The charge nurse understood how I felt when I gave that IM--such things have happened more than once on this floor.

Unfortunately, because of all of this, I had forgotten to give one patient all of her meds--I was in the process of doing that when the Gatorade attack happened.  She refused the remaining two meds, so I had to square that away with the night nurse, and I might be written up for a med error.   Maybe I got lucky and the night nurse was able to persuade her to take them. 

Can't win them all.

October 23, 2009

Code

In psych nursing, most of the codes called are not code "blues" (i.e., the patient physiologically crashing).  Most of the codes are for out-of-control patients.  Which means that my ACLS and soon-to-be PALS certifications don't get much of a workout, but my "standing there looking incredibly tough and ready to take to you the floor if I have to" skills do.

Codes aren't all too common as a whole.  All of us are well-trained in heading off patient problems before they happen, so I can work for a week and not hear a single code called while I'm there.  Then again, I can also hear four codes called in one day. 

Most of the out-0f-control codes are called for the kids' unit.  The peak time is right after school vacations, just before or on the same day that school starts.  The rest are on the intensive care unit.

Generally, when you hear a code, available staff from whatever unit comes running.  If it's a medical code, then you'll see more nurses than anything else.  For out-of-control codes, you'll see everyone from administration to medical staff to maintenance...and yes, that includes those big burly guys that were there backing me up when I had to give those court-ordered IMs to the uncooperative patient a while ago.

The last time I was at work (a few days ago), they didn't have me on my usual unit.  I had been there for the past week, and I think some of the other PRNs whose home unit is there complained about being floated elsewhere, so they floated me to stepdown...whichwhile it is in an intensive unit, compared to all the work I have to do if I'm on detox, going was like giving me the day off with pay:  a lot less paperwork, a lot less meds, and less needy patients.  Though I felt bad for the two nurses who ended up on detox:  when I went to the floor on an errand, I saw the two nurses swamped off their feet with no supporting staff.

Floating was also a nice change of pace, both in patient population and coworkers.  They asked me if I'd like to transfer my home down to stepdown, but they've hired so many nurses for that unit I'm not sure how easy it would be for me to get hours if I was in that pool with them.  Plus, even though it's a hell of a lot of work, I'm learning a lot about the detox process and I'm really starting to find my groove there. 

Though in the end, it really doesn't matter where my home unit is because I'm hired to float--I can get sent off anywhere.  Which is fine by me because I do appreciate the change from time to time.

October 20, 2009

Handling med errors

The nurse that I'm relieving asks me if I gave this patient his medication the day before.  I tell her I did. 

Well, she tells me she wrote the order incorrectly on the MAR.   He should have received a higher dose.

Oh, I said. 

I was the one who double-checked it, so I went to look at the original order.  Yes, the MAR was written wrong...but in checking, I missed the error and OK-ed the entry.

I went back and told her that.  Meanwhile, she's editing the MAR to reflect the correct order...which anyone in a Nursing Fundamentals will tell you is a big NO-NO. 

So I went to my charge nurse and asked for an incident report, and then took the matter to the supervisor.  I did sign off on an incorrect order and take full responsibility for that, so I had myself written up.  But I wanted it on record that not only did she transcribe it wrong, she edited the MAR after the medication was given.  I'll fully own up to any mistake I make, but I'll be damned if I'm made to look the fool by an edited MAR.  Fortunately for me, said nurse had told the charge nurse she wrote the change in on the MAR, so it's not a "my word against hers" thing; also, the night nurse who first discovered the error also knows what the MAR originally read.  Last, the supervisor told me that said nurse has been making a lot of med errors lately.

I don't know what came of all this yet, as I've had a few days off.

The supervisor told me that should I encounter an incorrectly written order during a double-check, I should rewrite it and then file an incident report about it.  To be honest, if I had come across the incorrect order while double-checking, I probably would just correct then sign off on it, then leave a note for her instead of writing her up.  I think to tell her about what she did wrong would be just as effective as filing a report...at least, if it was the first time I came across it.  If I had corrected 5 prior orders from her already and this was #6, I may get the form first.  But I'll be damned if I let her get away with changing the MAR so it looks like I'm the only one in the soup on this when she started it.

It was also a reminder to me to be more vigilant about transcribing and checking orders.  As I said before, I'm culpable in this too, and if I had noticed the error when signing off on the order all this could have been avoided.

Fortunately and most importantly:  no harm/no foul to the patient from this.

October 16, 2009

Ups and downs

It's amazing how I can go from feeling like I've got a handle on things to feeling like a nursing student on her first clinical and then back...several times in the same shift.  I was on the ball when it came to dealing with two patients going through bad withdrawal, but then when we had a patient fall, I did everything except probably one of the important things:  get her vitals. 

I went to my first code.  I was cool, calm, I was collected, I got the code cart, I didn't know how to work the oxygen.  I also couldn't find a rebreather but in my defense, that wasn't my fault--there wasn't one there.  Patient is still alive AFAIK.

I taped report:  I did much better on the patient reports themselves but forgot room numbers.  And after going to check census twice because I wasn't sure, I still got it wrong during the taping.

Such is the first year.

On the brighter side, no staff tried to split me today (and I was on my guard much more for it).  And one patient thought he was being cute by doing a magic trick with his Trazadone because he wanted to take it later.  I told him I was impressed with the act, it did look like he swallowed it, but please take it out of his pocket and take it now or give it back and get it later.  It was in his left pocket.

Learned some more about facility politics too.  I'm doing my best to stay out of it.  And as far as work goes, I've told them I'm just trying to cover all my bases as I'm a new grad so yes, my charting's longer than average and I do tend to stick to the P&P and how I learned to do things in school, instead of "how it's usually done" but I'm not going to be going around ratting people out because they do "the usual way"--as long as patient safety isn't compromised, that is.

I'm not as stressed about all the new nurses anymore.  Like I said, I can't put in for hours I can't work, and I'm sure they'll try to find what work they can for me--it's pretty much out of my control.   There's plenty of units I can float to so it's not as though I'm only competing for hours in one spot.  In fact, they asked me twice if I could put in extra time:  they wanted me to stay late yesterday (I had to decline), and they wanted me to come in early on Sunday (in a lapse of sanity I accepted).   I'm not sure where I will be, but it doesn't matter.  As I tell everyone:  I just show up for work, I go to whatever unit I'm told to, I do whatever I'm assigned to, and I'm cool with it.

Though lately, floating is something I have not been doing:  they have apparently taken a liking to me in detox.  Which is fine with me, because I do like working there a lot.

I need to read up on Librium today.

October 15, 2009

First year bumps

I learned the hard way about staff-splitting yesterday...I didn't recognize it until after the fact.  Oh well.  There wasn't any harm done and my manager took me into the office to explain a few things about it to me.  Again, I didn't take it personally which still puzzles some of them.  Though I will admit that after I left work, I did feel a little stung because I made a mistake...but I reminded myself that I am in the "first year" and this is a time of experience and learning.  I'm probably brooding over it far more than everyone else is.  And mistakes happen:  everyone makes them.  As far as mistakes go, this one was rather minor--it had the potential to be major though, so I need to be more careful about how patients behave.   I think I was getting a bit too comfortable and letting my guard down...I need to tighten up my performance.

The facility hired more nurses:  most are PRN, though a couple were permanent.  Every time they do that I worry for a day or so if I'll be able to get enough hours each week.  Being PRN, I'm not guaranteed any hours period.  Then I remind myself that most of this is not under my control:  I give scheduling a list of what hours I can work and if they find the shifts for me then that's all well and good.  After all, I can't put in for hours I can't work.  And if they can't find work for me for the hours I do put in, they just can't and it's not worth stressing over.  Financially, we're all right if I don't work full-time, and if we did need extra cash I could pick up PRN work somewhere else. 

What is in my control:  my work performance--I'll just keep doing the best that I can so when they look at me they'll keep in mind my performance and that I'm a hard worker, and hopefully use me more.  Also, once my better half's own work schedule improves, I can start putting in for more of the odd hour shifts.

Actually, considering how often they ask me if I could work extra shifts, as well as the turnover rates here--many people just stay for their year's experience and then move on--I don't think there'll be any problem with me getting at least some hours every week.  So I'll finish stressing over it today, then let it go until the next batch of hires comes through.

October 13, 2009

Puttering along

Two days off in a row is nice.  OK, I am the first to admit that my current schedule is 97% my doing, and if there's anyone to blame for not getting two consecutive days off, it's myself.  But a shift swap at my director's request has resulted in the last two days being free, so I've been catching up on sleep (well, trying to), reading some non-nursing books and cleaning a bit here and there.

I'm not usually a fan of "chick lit", but for some reason I've been inspired to read them lately.  The nice thing about them is that they're fast reads:  for example, I went through Confessions of a Shopaholic in about three hours, and I'll probably read The Devil Wears Prada and At The King's Summons at the same rate.  I'm also on an Amish tear, so I've been reading a few factual books about their society.  Don't ask me why or how I get into certain subjects that I feel compelled to read up as much as I can on them.  I'm not sure how it works myself.

I've been on the detox unit for a few straight days, which is helpful as I get to be able to put faces to names as well as to their conditions, and I can see the progress or lack thereof over time.   Mind you, the variety of going to other units is nice too, especially since detox can be such a hectic place--with the exception of the intensive care unit, the other units generally tend to run less intense as far as meds and paperwork goes.  On the up side, the atmosphere is a bit more smooth on detox, at least I think it is.  They're all walkie-talkies, there's minimal psychosis, and the days are far more structured.  It has its moments, true...so do all of them.

So the new fridge is great--it actually keeps food cold.  Next paycheck will go towards new towels and sheets.  We've decided that whatever is left over from my check after all bills and expenses are covered should go towards doing things around or getting things for the house.  You know, the stuff that we keep saying we'll do but never get around to doing because of time and/or cost, such as window screens, getting rid of ratty towels, fixing the AC, etc.

The endocrinologist drew blood for more specific thyroid tests.  I should know something in a week...at least I've started losing some more weight though.  I'm down nearly 6 lbs since starting Weight Watchers.  The only problem:  I forget to eat while at work...which is actually not a good thing.

October 9, 2009

Tolerance and help

It amazes me what the human body can tolerate, and how much tolerance that the body can build towards something.   I admitted two patients who if going by the numbers, should have been comatose at the least, if not dead.  But both were walkie-talkies and in decent condition given what drugs they were on.  Both were also cooperative, though assessing them was a test of my patience.

They threw me up as charge nurse the other night, with only partial help with the medications.  I think I rose to the challenge well--I stayed calm, did everything the best I could, and I did the most important thing:  I called for help when I needed it.  And boy, I did need help during that last hour with the admissions.  I know I missed a few things on one of them, but the following nurse was going to go over the chart, and I told her I'd come in tomorrow to make sure everything was all squared away.

I feel no shame in asking my coworkers for help.  I'm not WonderNurse; I'm a new graduate nurse who's on a steep learning curve.  This is the "first year" and I am developing.   I would rather ask for the help, do the job right and let them think what they will of me for asking...than to say "I'll do it myself," refuse to ask for help and muck things up, because they'll think a lot worse of me if I do that.  They may be impressed when I have the good day and nothing goes wrong, but when the bad day happens--and it will happen...

I also have no problem asking for and receiving feedback from my coworkers, and I tell them to please tell me what I'm doing wrong--I won't take it personally.  I don't think they're used to that attitude because one of them looks at me like I'm crazy when I say that.  I don't think she believes me...oh well, she'll get used to me :)

It's been nice getting paid.  Our fridge went on life-support yesterday and it was my salary that got us a new one immediately instead of having to wait until his next payday.  It'll be here tomorrow and I can't wait--until then, I have to cram as much as I can into the mini-fridge and pray that doesn't give out.

October 6, 2009

Fun day

They put me on the intensive care unit.  Let's see...

  • We had the delusional patient who spent the day walking up and down the hallways giving oratories.  Some were really good speeches, especially when the nursing students were on the floor and he had an audience.  Others, not so good--apparently we're all not qualified staff in his opinion and he wanted a court hearing to discuss his rights.  This was before he got into a 30-minute long heated argument with the security camera.

  • There's the one that was refusing their meds PO...but they were legally mandated, so had to get them IM.  He was not happy about it--in fact he was verbally abusive and his agitation was escalating, so along with the charge nurse, they called in 5 male staff to help me give it.   Talk about a show of force:  they managed to pull up the burliest staff we have for this.  After a lot of cursing, swearing, and threats to come after us if anything happens because of this--much of this directed at me as I was the one with the needles--he got his shots and within an hour was sleeping.  It was all I could do to keep my knees from knocking the entire time. 

  • The other mandatory IM was rather cooperative.  I also outweighed him by 100 lbs (seriously, he was skin and bones).  I still brought a male counselor because I had to...but after that first experience, this was easy.

  • Bad news:  my first needle stick.  Good news:  it was a sterile needle--it happened as I was drawing up the meds for the preceeding patients.  I know why it happened--I was nervous about having to give the first patient described the shots.  After taking a minute to refocus, I started over with a new syringe.

  • One patient went south on his new meds, and I had to play track down the doctor while we scrounged for more male staff to help him in the bathroom.

  • Several patients were seeing and/or hearing things that weren't there.   Fortunately, most took the haloperidol I offered.   One didn't want it, but that was because the voices were only playing music and he was down with it.

  • And it must have been national No-Shower day. 

Overall, I think I met the challenges pretty well.  I definitely can't say it was a dull day....I hope I don't have another day like it for a while.  And FYI to the nursing students who may read this:  if, when taking vital signs, you get abnormal results...retake them.  Then if they are still abnormal, tell a staff member about them.  Don't let us find out a couple of hours later from the vital sign sheet that someone's Stage 2 HTN but who shouldn't be.

In other news,  week 1 of Weight Watchers is complete, and I lost 5lb.  I'm still following up with the endocrinologist though because of the abnormal labs.

October 5, 2009

It's official, I'm an employee now

I did pretty well overall with orientation:  plenty of good feedback about my performance, lots of tips for improving myself, one med error d/t my not understanding a part of the MAR, and he only got half of his antibiotic dose.   It'll be kind of frightening flying on my own--really on my own this time, without the "orientee" safety net under me.  But I'm sure I'll be OK.  Just keep to the P&P, remember the 7 rights of medication administration, and yell for help before a crisis occurs and not during/after.

I need to work on creating a medication nurse cheat sheet, since that's what I'll probably be doing a lot of in the near future.  Then I'll make one for charge nursing.

I also got exposed to the office politics.  In my defense, the two nurses talking were sitting on either side of me at the station, so it's not as though I was creeping around corners and listening at closed doors.  But anyhow, I learned a few things about the place and some people, some good and some not so...of course, anything I heard I've taken with liberal doses of salt, as I prefer to find out more facts myself and make up my own mind about matters, instead of just going along with whatever I hear in passing.

I'm also intending to stay out of the politics as much as possible.  I'm really just there to be a nurse.

September 30, 2009

Long time, no update

When I was job-hunting, I was spending long periods of time on the computer, which gave me many opportunities to update this.   Also, I wasn't too exhausted by 6pm to get on the computer to surf the web and/or update.  Now that I'm working, I'm on the computer about 1/4 as much as I used to be...and when I get off of work, I do the home bit.  Once that's done, I'm too tired to fire up the computer.  I just want to have a glass of milk or wine (depending on the mood) and call it a night.

Work is going very well because  I didn't realize how much I'd enjoy psych nursing.  It's fascinating.  It's one thing to read about all of these mental conditions in a book, but to see them up close in person is amazing--the books don't fully describe how these conditions affect the patient every single day of their lives, nor do they fully explain what the experience of caring for these patients is like.    I--half of my nursing class, actually--would joke about how we were all OCD.  Well, I had a patient was truly OCD.  Answering a question was a minute-long process for her as she'd have to go through her rituals...and then when she was done, she'd look at you as though nothing happened and answer the question.  And she' would do that for EVERY single question, even Yes/No ones.   Though it goes against most therapeutic communication rules, I learned to pack as much inquiry into each question possible, even asking two questions at once if I had to...especially after it took 15 minutes just to pass meds to her alone.

I had a severely hallucinating patient who was convinced "they" were here to take her to prison, and were waiting in her room for her.  What "they" was changed frequently.  She wanted me to talk to them at one point, and though it was tempting to do it and humor her (and I guess humor myself), that would not have been therapeutic.  Instead I told her I didn't see anyone,  it must be difficult feeling so scared and that we were here for her, and would she like some PRN haloperidol?

She declined the Haldol...which was all right because two containers of chocolate milk seemed to be far more effective in resolving the evening's psychosis than her haloperidol has been all day.  Go figure.

I deal with a lot of detox patients.  I didn't realize how much people were capable of drinking, and how bad DTs can be.   I was doling out Librium like candy to one patient, who had such bad tremors he kept dropping them.   I also didn't realize how many medications a patient could have prescribed to them until I came to this unit...I thought the elderly were bad when it comes to the meds.  It makes one want to swear off the booze...almost.

There's a lot of depressed people too...in fact, it's a popular dual-diagnosis.  A lot of suicidal idealtion is there as well.  Those are the hardest for me to deal with because...I don't know, I guess I'm still getting over the mindset of "it's a mood, snap out of it and you'll feel better!"  But I'm learning patience, both with myself and with them as I talk to them.  Depressed people function at slower rates cognitively and I'm very much a "hurry up and spit it out!" person because I have 20 other things that need to be done yesterday.

It's all quite the learning curve.  I'm doing better than I thought I would be, though.  It helps that I've been looking stuff up in my textbooks when I get home.  I've also started studying one or two drugs per day:  the names, uses, common doses, side effects, etc.

I'm working out my own routine, and I'm learning the best way to do things...and some ways not to do things.  I'm also learning how different real-world nursing is from the ivory-tower textbook world of nursing. 

I still have pangs whenever someone talks of a med-surg job, but those pangs are decreasing as time goes by.  Plus, there's a lot of things in med-surg that I don't miss...such as Code Browns, various tubes and catheters, decubitus ulcers, immobile patients, and the extensive exposure to blood and body fluids.  I do get some med-surg stuff at work, mostly due to side effects of medications and medical problems they had before they got here...but any heavy medical care has to be sent out to a medical hospital.  So I'm not doing any Foleys or stuff like that.

My hours are pretty good.  I decided to work full-time (just) and I've been happy with the days/shifts I've gotten so far.   They've also been happy with my performance, so I think I'll come off of orientation with no problems.  Right now, my schedule is set through October.  I know they hired a bunch more nurses so I don't know if I'll still be getting as many of those days/shifts as I am now...but I decided that I won't worry about that because it will all work out in the end.  And if it doesn't, I'll pick up a PRN job somewhere...now that I'm actually getting acute-care psych experience, that is now a real option.

It seems like forever since I've been a student, especially since I now see nursing students come through the units.  I heard that a few more classmates got hired...I think nearly all of us are working now.  Most got into the hospitals in med-surg spoth, a bunch landed in nurseries, some are doing dialysis, and there's a couple at SNF.  Then there's the handful of us in psych.

In non-nursing news, I finally got the appointment with the endocrinology specialist set up.  I also joined Weight Watchers.  It's Day 3 and so far so good...though tomorrow will be the real test--that's when I'm going out with some friends.

September 12, 2009

First week over

It's been a busy week.  I've been on a few different units so I'm getting to meet more of the patient population as well as staff.  So far, all the staff have been good to work with.  The patients are interesting:  there's a wide spectrum of personalities there from very high-functioning to...well, the not very high-functioning.  Many of them liked to talk to me, probably because I was new.  One patient tried some staff splitting, but fortunately I went to talk to the tech about his request first.  Another patient made me nervous when I was assessing him since he went from completely out of it to completely coherent in mid-sentence and jumped up (so I couldn't help but bounce back a bit).  But overall I'm going in with a good mixture of bravery and caution.  And I'm getting very good at ensuring that doors are always shut behind me.

Nothing beats on-the-job training.  They may have explained the job to me in orientation, but to see it in action really makes me understand how all of the pieces of it fit together.  I'm learning a lot about what to do...and what not to do.  Not that the "not to do"s are doing anything wrong--it's just I'm seeing particular methods of doing things that, while they work for others, don't sync with how I know I work.

Right now, 95% of my job involves passing meds.  New nurses start off with passing meds, then they start charting, then they progress up to charge nurse roles.  I really need to get cracking on refreshing my medication knowledge, especially side effects and how fast they take action, because in the last unit I was on there were a lot of medications given out that needed to take action fast.  I also need to learn brand-names because most of the orders use brand-names while I know the generic names.

I've also seen how manipulative some of the patients can be, especially when it comes to meds.  On the first day, some thought that, with me being new, they could pull one over on me and ask for extra doses "because that's what they always take/that's what the doctor changed it to/so they don't have to come back in an hour/whatever."  To which I smile and reply, "I'm sorry, but I can only administer medication as ordered in your record."  Repeat as needed.  After a couple of days, that stopped.

Next week I'm on the higher acuity units, so I've started thumbing through my psych textbooks just to refresh myself on the basics of the common psych conditions.

In the non-nursing world:  I see the endocrinologist next month.  Until then I've been doing the DVD, working out on that treadmill and watching what I eat, and it's still a losing battle.  I won't step on the scale--I'm going by the fit of the clothing.

Right now, I need a nap.  Horror movies + Dr. G, Medical Examiner = strange dreams and a none-too-restful night's sleep.

September 6, 2009

LONG week...and the "First Year" begins.

Every night after orientation, I'd do the home bit, stay awake only as long as I had to, then pass out because I had to get up at 5:55 the next morning.   Most days had working lunches, few breaks, didn't follow the schedule...and often ran behind schedule, so there were a couple of days that ran late as well.  So the last thing I could bring myself to do was sit at a computer and type...sorry about that.

Lots of videos and slide presentations:  customer service, OSHA, therapeutic boundaries, blood-borne pathogens, CPR,  fall prevention, documentation, deescalation techniques, crisis management, safety, breaking holds and physical maneuvers...and lots of tests to accompany each educational session.   I've signed my name on sign-in sheets and test papers so many times my hand hurts thinking about it.   There was a lot on restraints and seclusion...and understandably so, given the nature of the business.  And there was a lot about drugs, and again, understandably so.  I realized on the last day how little I really know about medications used in psychiatric nursing.

Then there was also a ton of administrative stuff too: P&P, scheduling (that was a fun day as at first we thought we'd be competing against each other for shifts...not the case, thankfully), benefits (for those who got them), rules, regulations...every night, I carried home a small tree's worth of paperwork for my records.

By the last day of orientation, we were all punch-drunk from being in the same classroom for 40+ hours that it was hard to focus on anything.  Thank God I am getting paid for it--I don't think I'm that desperate for work (or masochistic enough) that I'd have done that week for free.  I meant to review drugs and the P&Ps this weekend, but I was so wiped from the week that I slept 11 hours  each night for the last two nights.   

My first day is today...in a few hours, in fact.  For the next month, I'm on another orientation so I'm not expected to do everything by myself from the get-go.  This month is all about learning on the job.  Then after this month I'm still on orientation for another 5 months but they'll expect me to work just as any other nurse would.

It was on the last day of orientation--and again this morning--that the enormity of what I'm doing hit me, that I wasn't in Kansas...er, school anymore.  I am no longer a student with a safety net.  I no longer have my ignorance or instructors to fall back on.  The excuse "I'm just a student" or "I didn't know, I don't work here" will no longer fly.   I am going to be working as a licensed registered nurse.  I'm going to have serious responsibility.  I'm going to have a lot to learn and a good portion of it I will have to teach myself.  I'm going to have to be very independent.  I am going to have to know what the P&P are as I do "work here" now.  My license in on the line from here on out, and the one and only person that is responsible for protecting it is me.

It kind of makes me want to throw my hands and say "maybe I should wait a while longer before I start."

But I know that the first year of nursing will be a learning curve--it is going to be rough no matter what area of nursing I went into...but I'm not going to get through it until I actually start it, you know?  After all, all of the nurses there went through the first year--it's not as though they emerged from the womb like Athena, with DSM-IV-TR in hand and ready to hit the floor like a seasoned pro.

I guess I'm a little nervous about beginning so soon.  I had no choice--I have to get a certain number of hours in during the first month so I had to put in for a lot of shifts.  So wish me luck tonight, as I will need it.

In other news, I'm still trying to get the endocrinologist appointment set up.  My little one starts school on Tuesday...the poor guy will be plunked there at 0600 as I have to work that day shift.  I hope he'll be all right...I took him there on Thursday to show him around and meet his teacher.  He seemed pretty excited about it, but I'm also not sure it's sunk into his mind yet that he's not going to his usual provider but to school.

August 31, 2009

First day

Nothing much to tell, really:  it was your typical orientation.  Lots of videos, lots of speakers, lots of paperwork, lots of food (yes, they fed us), and a PPD...also a refresher on EPS symptoms and treatment.  Tomorrow promises to be more of the same sans PPD and EPS.  I did learn that you need a sense of humor to survive as a psych nurse...not necessarily with the patients though.  It's more for dealing with the other employees.

I did a little research into my thyroid test results:  a high T4 and a low TSH could be hyperthyroidism...or it could be due to excessive iodine consumption.  They really want me to see an endocrinologist so I told them to go ahead and start the referral, and I'm still off of the salt.  It's been a challenge--I couldn't eat some of the food at work today because it was too bland even with a ton of pepper on it.  I know, my taste buds will readjust eventually.

Of course now that I'm employed, a hospital calls wanting to set up an interview.  It's a 12's position, so I had to decline.  But I explained why, they understood, and they're going to forward my application to the recruiter who handles the 8's--the office positions and such.  Still holding out hope for #1 hospital to get to me, but I can't wait on them forever.

August 30, 2009

Moving onto weightier topics

Now that the job is sorted out, this should leave me more energy to focus on my weight.  It's not pretty.

I stepped on the scale the other day to see that the first two digits were about to change in the wrong direction.  I was alarmed since I have been spending the last couple of weeks exercising and watching what I eat.  And though I have fallen victim to late night snacking, I doubt that that alone would cause a 5lb weight gain in one week, especially with exercising and watching what I eat.  So I got myself to the doctor to talk about weight loss.

I know, being a nurse I should (and do!) already know this stuff--in fact, I counseled a few patients at the clinic about it--but I guess it's kind of hard to see it when the patient is yourself.

He told me that they do not prescribe diet pills and I told him that's just as well as I do not trust diet pills nor do I want to take them.  With my family's health history, I have always had an intense fear that I'd be one of the few people you hear about that try a diet capsule for the first time and die from cardiac arrest.  I'm not kidding--I won't even consider taking Alli and all that one does is block fat absorption.

He did a diabetes screening and a TSH test.  The blood glucose is flawless, but the TSH results are not in yet.  We talked exercise--he said that I'm doing good there, but to try to get some more aerobic exercise in (the workout DVD is more sculpting).  Then we talked about diet and even more changes that I could make.  He suggested that I go to a 1200 calorie diet.  I think that's a bit extreme for myself and my activity level, but it couldn't hurt to try it for a couple of weeks and go from there.

We also discussed sodium since my blood pressure was high at the visit--this was the first time in my life that it was in the Stage 1 HTN category.   I like salt.  It's never affected my blood pressure before--all my life, my BP has always been normal or low normal until now.  I guess it's finally catching up with me, so I had to honestly fess up about my sodium usage.  Since one HTN reading does not a HTN diagnosis make, he didn't want me to do a radical sodium diet overhaul (yet) but he did suggest that I get rid of my salt shaker.

So since the visit, I have not used extra salt on anything.  My God, is that going to take a lot of getting used to!  I hauled out all the Mrs. Dash bottles that I have, and have been trying them out.

Update:  the doctor called.  TSH is normal, T4 is...elevated.  He thinks this is likely not the cause of my weight gain.  I was told that I could make an appointment if I wanted to discuss the T4 further or get a referral to endocrinology if I wanted.  I might do that after orientation--the doctor didn't indicate it was at a critical level or that I had to come in stat.  For now, I'll dig out my nursing school textbooks and read up on it.  Perhaps all of that iodized salt I had been eating has something to do with it...

So it's official

I've been feeling pretty good since I accepted the offer (though still mourning the loss of med-surg).  Immediate and extended family are all happy because they didn't want to see me separated from the little one for such long days...though it's been the target of good-natured jokes because both sides of my family have warped senses of humor--I've heard enough "the inmate's running the asylum now" and "do they know you're crazy?" quips from them to last a lifetime.

My coworkers at the clinic were also happy to hear that I got hired, and happier to hear that I'll still be volunteering there for the foreseeable future.

The paperwork is signed, and the scrubs and PsychNotes clinical guide have been purchased.  I started soliciting "new grad starting out" advice from a couple of nursing forums that I visit, and I've dug out the nursing magazines so I can start reading some of the psych articles.   Oh yes, I better find the drug book and start committing those to memory.

The fun begins next week with orientation, then I can start scheduling when I want to work.  They really need 2nd and 3rd shifts, which are a minor childcare problem...though not as bad as the ones I'd face when dealing with 12 hour shifts.  I have to work a minimum number of shifts per month, but I can schedule many more than that if I want to.  So if I turn out to really like psych nursing, I can work more often.  If I don't like it or if I need to scratch the med-surg itch, I can work less often while look for a med-surg job somewhere.  Heck, I could have both the psych job and a med-surg  job (both being part-time or one full/one part) if I wanted.

Let me take it a step at a time, though.  The opportunity to go into med-surg will always be there.  I'm in psych nursing now, and I intend to go in giving it my all--that's the only way I will ever find out if I'll like it.  Also, I take every job I have seriously, and this one is no exception.

It's been weird not having to job hunt anymore.  I still glance at listings and what comes into my mailbox, but now out of curiosity.  I'm still keeping on good terms with local hospitals (especially #1 hospital), to see if anything comes up in the part-time and/or 8-hour shift realm that I may be interested in.  But for the most part, I wake up in the mornings feeling very peaceful.   I'm feeling a little strange as I'm one of the only ones in my class not going into med-surg...but I have a classmate already working where I will be so at least I'm not the only one in psych.

I received a rejection from the HR person at the  SNF that I applied to a few weeks ago (and which hired my friend for another shift)--at least they finally gave me some closure.  They never said why I wasn't accepted nor will I ask.  Funny though:  in today's classifieds, I see they are still recruiting for RNs...and now for a HR person.  Go fig.

I also need to get my stuff sent off to the Mollen clinics.  Also, the clinic asked me if I want to volunteer for their flu clinics--you know I'll say Yes to them.

Since this post is getting long enough, I'll start another one for the weight.

August 26, 2009

It looks like life wants me to be...

a psych nurse.  I accepted the long-shot job.  

I decided that the long hours at the other one would not be fair to my little one, and as much as I'd have loved to worked med-surg, what the little one would have had to go through was just not worth it.  Down the road, when he's older and my better half's schedule is more stable, then I'll be able to go and work 12 hour shifts.  But for right now, this is best. 

And as a couple of nurse friends pointed out to me:  I'm young (fairly) and my career has just started.  There's plenty of time ahead of me to change specialities and put in the long hospital hours....whereas my little one is little only once.

So here I am:  Meriwhen the Psychiatric RN.  I have to go in tomorrow to do the paperwork and schedule orientation. 

At least this job will leave me enough time to look for another part-time job somewhere if I need it.  I can still keep volunteering as well.  Also, this can keep me in consideration for that job at that unit in #1 hospital should it ever become a reality...and which I happen to know would be 8s.

Heartbreak?

The interview went well...really well, in fact. I'd love to work there. The problem: it's 12 hour shifts, not 8 hours as I was lead to believe.  Weekends are not a problem--it's the weekdays that are: there's a gap of 2-3 hours that I'm not sure I can arrange childcare coverage for. I have a couple of friends that I have thought about asking if they'd want to make extra money by sitting for him those days--I'd keep the arrangement strictly business so impact on our friendship is minimized (i.e., I don't want her to feel like I'm using/taking advantage of her for childcare). I'm debating if I want to ask them to do that.

I'm trying to see what I can come up with, as well as take some time to think it over and see if it's the right decision for me and my little one. But I'm having a feeling that I will have to say No to an offer I get from them...and that's killing me.

August 25, 2009

Well damn...

No matter what happens tomorrow, I could be a hospital-employed RN by Monday:  the long-shot job came though.  They made me an offer for part-time.  I didn't accept yet--I want to go on tomorrow's interview first and see what happens.  But we agreed that I will give them an answer either way on Friday.

 It's all go today, isn't it?

The reason long-shot job was long-shot was that it's in Psych...which I have zero experience in save for clinicals.  But psych's an interesting field and I figured I had nothing to lose, so off I went and applied.  No way in hell did I think I'd even come near an offer...but now I have one.

 To be honest, I'm more a med-surg sheep at heart, and tomorrow's job has that advantage (it's PCU).  Long-shot...er, Psych nursing job has the advantage of being part-time and fascinating enough that I'd probably enjoy it very much. 

 We shall see what happens tomorrow.

Interview scored

On my last night of job hunting vacation, I had a couple of glasses of wine (large ones, but in my defense, I was upset over the verification mess), watched "A Night in Casablanca" and "Top Secret", and had to rip out the heel of my sock twice because I wasn't knitting it right.  I also vented long and loud to my better half, who was just as outraged as I was over it.   He was wise enough to leave me to brood afterwards, especially when I started fighting out loud with my sock on the second rip-back.

Today I went back to "work."  I have to admit that as frustrating as it can get, it feels good to be back on the job hunt.  I feel productive.

This morning was spent calling every place I applied to in order to let them know about the lost work record at former job and that they can now contact former job for the correct employment history.   Basically, I've spent a lot of time talking to voice mailboxes.   Overall, this snafu with my prior job is turning out to be a blessing because when it comes down to it, my having to call has reminded employers that I do exist...and it's a pretty damn good reason for me to be calling to, so I don't feel any nervousness or hesitancy when calling, as I might feel if I were calling to "follow-up on my application status."   I just confidently explain what happened, that they can verify my employment now, and that I was sorry for any inconvenience.

It also got some results:  one hospital I spoke to said that I'd be the first new grad they refer when more positions come up--they had gotten my message and re-reviewed my file, and it seems both volunteering and getting my certifications has now been a boost to my marketability.

Even more surprising:  another hospital offered me an interview.  Again, the cincher for their manager to interview me was the certifications and volunteer work.  I was stunned, especially since this hospital rarely calls me (and when they do, it's usually to reject me).  I told the recruiter I could be there in 20 minutes--I just had to iron my pants and feed the cat.  But we settled on tomorrow.  I know there's no guarantees and I'm certainly not going to suspend the job hunt over it, but I damn well am going to do my best tomorrow.  I've just ironed the outfit and I'm going to really rehearse my interview questions today.

Long-shot job (to whom I will always be grateful for bringing this to my attention) is having issues getting another position verified though...but that's because no one's in the building right now:  it's a school.    And I need to call #1 hospital:  the manager of one of the units invited me to come visit her floor, so I'd like to set that up. 

If it ever came down to between the hospital tommorrow and #1 hospital offering me on the same day, I'd take #1 hospital. But since there is nothing definite at #1 hospital...if I got it, I'd take tomorrow's job with no regrets. First, I'm afraid that the longer I'm out of work, the rustier my skills will get and the harder it will be for me to get into any job. It's not a horrible unit that I'm interviewing on...it's very nice one, in fact.  I'd learn a lot there, and having done clinicals on that type of unit, I'd know what to expect in general.  Overall, I'd probably be very happy if I got the job from tomorrow's interview and worked for them.

Plus, it's not like I'm being flooded with job offers or even job interviews, so I should grab what I can get, eh?

But let's see what happens tomorrow.

August 24, 2009

At least something good came of the mess

I called Mollen to let them know they may need to re-verify my prior employment, and they offered me an immunization clinic job.

I've still bummed though. It's just so frustrating to have put so much into my job hunt and having no luck, then to find out my old job misplaced my employment records. That plus hearing that yet more classmates got offers did my emotions in...

I feel like crawling under a rock to hide for the night.

Well, this f*****g sucks!

Long-shot job called me today.  They went to verify my employment, and my former job told them they had no record of me working there!   So long-shot job asked me to call former job to see what I could find out.  Which I did...and was told the same thing:  I didn't exist. 

Now, I know I did, as I had saved every performance evaluation and paystub (don't ask me why) from my 4 years there, plus I have the 403b that they opened for me.  Plus, I designed one department's entire intranet website which I'm told is still in use. 

I tell former job this, as well as provide them with every single bit of identifying information that I can.  They say they'll see what they can find.

Meanwhile, I call long-shot back:  they said that they'd consider the pay stubs and evaluations as proof of employment if I bring them in. 

An hour later, former job calls:  yes, they did find my file--it was in the wrong place.  The director of HR is putting it back in the system personally.  I apologized for being sharp with him but explained that it was distressing to learn that they are telling people I never worked there.

Now, I am fuming because who else has my former job told that I don't exist?  Maybe this is why no one is calling me back after these interviews?  And why hasn't anyone else besides long-shot called me to say, "hey, we had a problem verifying your employment with one of your past employers, so you may want to check it out."

I started leaving messages at a couple of places that I had applications put in it, letting them know what was up and that they may want to call my former job again to re-verify my employment.  I'm anxious to talk to #1 hospital tomorrow so they know what happened; I don't want anything to possibly ruin my chances there.

I was going to end my job hunting vacation on Wednesday, especially since PALS was rescheduled:  I was the only person who is registered for the class this week, so they asked me if I wouldn't mind moving my enrollment to the class next month.  I told them that was fine--I don't need it right away, and so I'd hate to put them through the inconvenience of having a class just for me for no good reason.   I figured I'd take today and tomorrow and just veg a bit more, maybe start on the next book in the pile (The Oxford Illustrated History of Britain...which is NOT going to be a 90 minute read).

But now given this mess, I think it's best if I get back to "work" tomorrow to straighten this out.

Yay me.

August 23, 2009

Sleepy

I took today off from the DVD workout...the soreness has improved, but I apparently did something to my knee during the night.  Ibuprofen isn't working either.  In addition, since Friday I've done little but sleep.  I put in 10 hours Friday night, napped on Saturday, put in another 9 on Saturday night, and have only been awake for a few hours...but I'm ready to crawl into bed for more sleep.  Unfortunately, it's just me and the little one today, so I can't really nap until he naps...and he's given up napping.

Studying for PALS has gone by the wayside.  I'll try later after I get even more coffee in me, but think I'll have to dedicate all of Monday to prepare for it. 

I did manage to finish Girl with a Pearl Earring though.  I knew it was going to be light fare--I went through it in about 90 minutes.  It was a really good book though...I haven't seen all of the movie so I don't know how closely the two run together.  I don't know what's next on the reading list...I think that next time I pass by the stack of books, I'll just grab one and see what it is.

I cheated and read the classifieds today.  There's a few new things that I'll have to consider applying to on Thursday when the job-hunting vacation ends (if they're still there, that is).  But that's all I've done is just read them.

Must...try...to...stay...awake...

August 22, 2009

Ow ow ow

My workout DVD guarantees visible results in 10 workouts.  So far the only visible results are a steady stream of "Ow" as I walk, bend, sit, and breathe.  It's not debilitating, but definitely not comfortable.  Ibuprofen 600mg is fast becoming my new best friend.  I think I may need to skip the workout today.

This body is definitely not bikini-ready or even appears the slightest bit different...but in all fairness, I'm sure they meant 10 complete workouts.  Yesterday was the first day I finally managed to get through a complete workout, so I need to start the countdown from there.    And no, I'm not stepping on the scale yet, not until I'm certain the first two digits of my weight has changed.

The vacation from job hunting is getting easier.  I've been less stressed lately than I have in a long while.  It's nice to only have to deal with the loose ends instead of knocking myself trying to find places, sending out applications and trying to score interviews.   I didn't even look at the classifieds in the last couple of days.  I have had to avoid Facebook, MySpace, and other social sites though, as I didn't want to have to read about the latest person getting hired or how their new jobs are going. 

Speaking of loose ends, I never did call that SNF that I had the second interview at.  As I mentioned before, she didn't sound too thrilled with me calling last time, so I decided that since they have my correct phone number (and they do--their HR called me at it once), they know where to find me if they need me.  Meanwhile, still no word on the long-shot job, but I'm not expecting to hear from them for a while.

I went to the job fair (the other loose end)...me and a ton of other new graduates because guess which table had the longest line?  Again, they told us that they have a large pool of new graduates and they are trying to place them as soon as they can.  But at least I got to talk to managers, give them my resume, and let them put a face to my name.  A few managers said that they'd ask for my file, which is encouraging.  But everyone was really nice, even if they weren't planning to consider a new grad for their department...and this is the reason that this is the #1 hospital I want to work for:  they don't treat me like new grad slime.  They may not be able to give me a job ASAP, but they're nice about it and treat me with respect.  That's something I remember--after all, how they're going to treat me in the hiring process usually reflects how they'll treat me as an employee.

There was one unit that I'm really interested in and their manager was very impressed with me and my resume, and I think that meeting went very well--we were talking for at least a half-hour and it never flagged.  She told me all about the unit and that I'd fit well on it, and from what she said about it, I'd have to agree.  That's all I'll say right now as I don't want to jinx it, and there are certainly no guarantees...but please pray for me that something comes through with it so I can die happy.

But you know what?  Even if nothing comes from it or from the job fair as a whole, I am pleased with how it went, because at least I had a chance to talk to managers.  My application wasn't just tossed aside without a single word because I was a new graduate without that year's experience, or because I wasn't a graduate of their own program.  I was given a chance to sell myself, and if I blew it, then it was on my own merits...but I at least had the chance.  Which is more than what a lot of places--hospitals and otherwise--have given me lately.

As a non-nursing friend summed it up when I told her about how I felt:  "I'm not a monster!"

Friday was at the clinic.  Training was over, so I flew solo for the first time and overall performed well.  My time there is truly the happiest part of my week.  Friday night, I went to bed at 10 and slept 10 hours.  I'm still tired but I feel better.  Also, I ache in a new way because when I went to bed at 10, it was because I fell asleep on the floor with the little one.  So in addition to the soreness from the workout, I'm also stiff from spending 5 of those 10 hours on a hard floor.

Mildred Pierce the book doesn't end the same way as the movie, by the way--in fact, how it ended was definitely a twist from what was expected.  It's still a good read.  Girl With a Pearl Earring is next on the book list, as I've apparently checked that one out too.  That one's a thin book, so I'm thinking it's a day's read. 

But before I need to do anything, I better start a coffee IV in my arm stat.

August 20, 2009

Rough first day off

No sooner did I get off the computer and open up Mildred Pierce did a hospital recruiter call to reject me from two positions. That must be a form of progress: usually they never call me to let me know I'm rejected--they just let me wallow in limbo and I hear it through the grapevine.  Either that, or they're dropping hints for me to stop applying.

Then a classmate/friend calls up with a possible lead--unit manager position coming up...except that they want experience and I have none.  Still, she tells me to go over and try because she thinks that the lady she spoke to will give me honest feedback.  I tell her I'll see.  Maybe I will go see after my vacation because there is something about the job that isn't calling me to drop everything and apply to it.

Then another classmate messages me to tell me her unit is hiring.   I thanked her and said that I had already put in for the opening online, so unless she wants to tell her manager about me, there's not much else I can do.  She's not as close to me as my friend is, so I feel no discomfort in telling her to tell her manager about me.  And yet I can't say that to my friend, who I know who would try to pull out all the stops she could with her manager on my behalf, because I feel like I'd be using her.   That's how it is...go figure.

Then my father-in-law called, and I had to tell him that I didn't want to hear anymore about how they're running after nurses with job offers where they live--I said to him that I'm not up there, I can't be up there, and to hear that isn't making me feel any better, but makes me feel like even more the reject so for the love of God, please stop.  He took the rebuke well.

Then Mom called asked if I heard anything and when I told her that I'm used to being rejected, she kept saying "oh, you can't think like that, you did so well in school".  I told her that this was reality--there's too many graduate nurses out there who "did so well in school" if not better, that rejection is my reality and and me thinking happy thoughts alone is not get me a job.  She did not take the rebuke well.

Then I get a message from another classmate: she just got hired at a hospital. I'm very happy for her--she deserves it-- but it still hurts to hear it, especially since this was her very first interview.  Again, I couldn't help but think what was wrong with me.

It was all I could do to throw myself at the computer and call the whole vacation off.

But I resisted.  Instead I finished Mildred Pierce, colored my hair, dug out some yarn, and watched an old movie--"Carry on Cleo"--while I worked on a project.  I didn't sleep very well though...I kept dreaming about job interviews.

Today seems to be starting off better.  I ignored the e-mail notices.  I did start reading the classifieds--out of habit--before I caught myself and put them down.  I'm avoiding the "Job Hunt" section of bookmarks in my browser.   I decided to skip one job fair, especially after I heard about the soaring crime rate in the area in which the hospital is located.  That, plus the fact that they only seem to be offering nights, plus the hour-plus commute it would take to get there...all of that stress isn't going to be worth it.  I'm supposed to be trying to relax this weekend.

So today's plan is to get some exercise in--I took the ibuprofen for the knee, and I'm waiting for it to kick in--then print out resumes for the other job fair (with #1 hospital), then perhaps start another book. 

I started an exercise DVD:  it's cardio with resistance cords.  It has been tough:  on the very first day, I couldn't get past the warm-up.  But I keep plugging away at it, and have been able to get a little more of it done each day (I took yesterday off from it due to soreness).  Right now, I can get to the 23 minute mark...I'm not the most graceful person doing it, but I can get there.  There is a high entertainment value to it though:  my little one has developed a crush on the instructor and when I do the video, he's next to me trying to exercise along.

I've also been trying to watch what I eat, but with much less success.  I do all right until about 10pm:  that's when I fall prone to mindless snacking.

I received two phone calls:  a rejection (again, that lack of a year's experience), and an encouraging one from #2 hospital about something that may be opening up and she wants me to follow up with her in a few weeks.

I do have to follow up with that SNF...I'll do it later.  Though truth be told, with how brusque she was on the phone with me the last time I called, I am tempted to say, "No, I called once--I'll wait for her."  Then I think about not getting hired while everyone I know is, and think "Yes, I should call."  But after my exercise.   I think in 10 minutes, my knee will be ready to go.

August 19, 2009

How to deal with rejection (articles)

http://www.paulstips.com/brainbox/pt/home.nsf/link/07092006-How-to-deal-with-rejection

http://www.ehow.com/how_2159081_deal-with-rejection.html

http://www.articlesbase.com/self-improvement-articles/how-to-deal-with-rejection-631746.html

http://www.fictionfactor.com/articles/rejection.html

I'm on "vacation"

Last night I told my better half that I was taking a week off from job hunting because there was nothing new to be found right now and I'm burned out from trying.  This was just a formality--I was planning to take the time off anyway regardless, but it's always nice to have the better half's understanding, if not his support.

"Sure!  Take two weeks," he replied.  "Take all the time you need."

"I think a week will be fine for now."  I replied. 

Well, that was painless.

Lest you think I lead a lifestyle of the young and wealthy...we're just staying in the same budgeting mode that we spent the last few years in while I went to school.  We're not well-off, but we're not struggling either because we've been smart about our expenses--we've chopped out all the frills from the budget, and when we do spend it's sensibly.   We rarely go out on the town, and our last vacation was in 2003--since then, we decided on season passes at our local theme park/resort instead of taking trips.  The only one who really gets any of the extras is the little one.

Anyhow...today's glance at the newspapers and job sites confirmed my decision: there is nothing new for RNs here. There was one position at a hospital that I put in for, and then that's it. From now until next Wednesday: I'll follow-up on anything that I've put applications in for prior to this and I'll still do tomorrow's job fairs, but that's it. No active hunting. The classifieds will be ignored; so will the job sites and e-mails notices. No trolling the phone book looking for places to contact.  No working on the resume and cover letters.  Not even going to read the books I had out on the library on nursing careers and resumes.

In short, nothing at all. I am on vacation.

Next stop:  sitting outside with a glass of sangria and a book!

I have to admit, the "what if"-s entered my mind:  e.g., "what if I miss the perfect job opportunity during this week off?"  First, I decided that based on recent trends, I'm probably NOT going to miss a job opportunity because I doubt few if any will come up in this week.  Second...if I did miss it, then it wasn't meant to be for me anyway. 

So I'm off on holiday, though I'll stil post since I do have things on my mind.  Time for me to grab that book...speaking of the book, I'm almost done with "Mildred Pierce."  It's a really good book.  I had seen the movie version a few years ago so I basically know how it's going to end...the movie is excellent, by the way.  Joan Crawford deserved the Oscar that she got for it.