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.

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