December 28, 2009


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 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'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.