December 30, 2010

So my PCP thinks I'm suicidal

I went for some follow-up blood work last week and asked my PCP to throw in a thyroid panel since I had been so cold intolerant. Didn't think anything was seriously wrong with me...I was just feeling the cold worse than I usually do. I also was tired, yes, but I had no sleep the night before. And I was a mite hungry since it was a fasting blood test. Maybe I wasn't the most chipper patient, but I certainly wasn't manifesting any signs of SI.

So I get a call on Christmas Day and it's my PCP following up on "my feeling down." I reassure her that I wasn't feeling down; I was cold, tired and hungry that day. I told her that I work as a psych nurse and I do understand her concern, especially since depression and suicide rates go up at this time of year. I also asked how my blood work was, and it was fantastic. The Zocor is working wonders.

Today I get a letter in the mail: please follow up with the PCP re my condition. Now I'm nervous...did the nurse not have my right lab results? So I call and ask what is going on. Turns out that apparently the PCP had wanted me to return in one week to follow-up on my "malaise." Either he didn't tell me, or did tell me but I was too cold, tired and hungry to remember. When I didn't show on that day, the phone call was made (and that nurse who called didn't mention anything about needing a follow-up) and the letter generated.

Meanwhile, this nurse is interrogating me: am I feeling OK? Feeling depressed? Thoughts of hurting myself or anyone else? Can I please return in the next couple of days just to follow up and make sure everything is good.

My first reaction was, "Oh, this is how it sounds when I ask my patients those same questions." It was weird being on the other end of that conversation.

I reassure this nurse that yes, I'm fine, no SI, no HI, will come by in the next two days, cross my heart and hope I didn't say the last part. But I will be spending my New Year's Eve at my PCP's reassuring them that I'm not about to off myself. I'm worried though...they're so serious about it, I'll bet I find myself being handed a script for Zoloft with a "let's just try it out and see what happens."

December 29, 2010

At least it was a nice thought

I'm always tickled when I go to the doctor's office (any doctor, really) and they plunk me on the scale: without fail, they start out by moving the bottom bar to 100.

"Thanks for the compliment, but start at 150."

At least I haven't hit the point where they have to start with the bottom bar at 200, though I've come close. Today at the gynecologist's office (I know, why are they weighing me there?), I came in at 198. In my defense, this was after breakfast and coffee and while fully dressed, shoes included. And things aren't that bad if I can still fit into Lane Bryant size 14. Seriously, I love that store: it's the only place in the world where I can fit into their smallest size of clothing.

Anyhow, I have no intention of stepping on my own scale until the last of my family leaves on the 4th. Until then, I'm just doing my best to eat sane...which has not been easy. I also started exercising again. I got on the treadmill today and put in 30 minutes of brisk walking. I felt pretty good afterwards...until the chub rub started burning. So much so that I had been planning to walk again tomorrow but now I'm rethinking it.

Oh well. I didn't get like this overnight, and I'm not going to undo it overnight.

The nursing part of the entry: I'm off for a few days, which is nice. My last day in I had to take care of the kiddies: the kids' unit day nurse called off so enter Meriwhen, the hospital's professional floater. It was a nice day. We didn't have a lot of snotty kids, but several newbies for a change...and one frequent flyer who is truly psychotic. The last time we met (during a prior admission) I was administering a shot to him. This time around he was more cooperative...but psychotic enough that working with him was a challenge. Time to bring out the psych textbook and refresh myself on a few topics.

December 22, 2010

Giving up for now

Decided that I'm just going to be fat and happy until after all the family leaves in early January, instead of trying to starve myself, overexert myself or beat myself up.  Doesn't mean I'm going to give myself license to overindulge...but I'm not going to stress over it. 

Having said that to myself...I feel better about myself.  I'm still overweight but I'm temporarily at peace with it.  Being at peace is a nice feeling, one that I haven't felt in a while.

Got my blood work back.  My cholesterol is back down to normal range:  184.  My thyroid is fine.  Waiting to hear from my doc to see if he still wants me on the simvastatin.

December 13, 2010


Got my student ID.  A very unflattering picture of me...but usually IDs are not meant to flattering.   And another visual reminder that I have to lose weight.  I'm trying to be good about what I'm eating...starvation isn't going to work, either physically or mentally.  I'm aiming for just being sensible.

The school's lab also lost my UDS.  Fortunately for me, I have ths slip from the lab verifying that I did take the UDS and that they have accepted my sample as legitimate.  Not sure what will happen next...unless they find the sample between now and orientation, I'll probably have to retest.  I'm not worried about any test as I know my sample will be clean, except possibly for some alcohol depending on whether I had a glass of wine the night before...and last I checked, I'm well over 21 and alcohol isn't illegal.  But I still feel like a criminal whenever I do a UDS.  Plus the fact I feel like the school thinks I'm sketchy, especially when they're told that I never showed for my drug screen when I actually did.   Oh well, that will get straightened out at orientation.

I guess once I go to orientation this week, I will officially be a nursing student...again.  The pre-reqs are over:  now it's time to get down and dirty.  Well, OK, most of the pre-reqs are over:  I still need to take History and Public Speaking.  But now the nursing program starts in earnest.

I have to admit I'm slightly apprehensive starting in a BSN program that is still undergoing CCNE review.  I'm reassured by a few things:  first, their diploma program is/was certified and received glowing reviews (too bad I could not afford to attend it the first time around).  Second, I already have a degree from a NLNAC certified school so there will never be a question of me being able to obtain licensure and/or work (as far as certified schools go anyway).  Third, once the school is approved it's retroactive, and that would cover me.  Fourth, the MSN/CNS program I'm looking at has a RN-MSN option, so even if things entirely go south with this school's accreditation, I can use that to apply instead of the BSN-MSN option.  And last, being a graduate of the school will give me some priority when applying for jobs within the organization's hospitals. 

So at orientation I will meet the other RN-BSNs.  I heard it's a small group:  only 12 or so.  That'll be nice.

December 11, 2010

Yeah, I know

A patient asked me if I was pregnant.  I told her No, I was just fat.  She apologized and said that based on how my ID was tilted, she thought I was expecting.  It didn't bother me...but it did remind me that I need to get serious about losing a little weight.  I've fallen into the overweight nurses trap.  Actually, I weigh what I did when I graduated a year ago.  I guess more of it has shifted to the belly area.

But it's hard to do that in December:  the month starts off with my birthday, then leads right in holiday parties, holiday gift baskets from doctors, patients and other facilities, Christmas and home cooking, and New Year's and eating out.  Plus the parents, who cook VERY well...and the in-laws, who love their food and drink.  It's hard to lose weight under those culinary conditions. 

In all fairness, I don't have to just diet.  I can exercise...which I haven't been doing as I've been recovering from an injury.  But now that the injury is healed...but the problem there is the little one:  I spend all day away from my child while at work, that the last thing I want to do is plunk him in childcare while I go exercise.  And when he's gone to bed...well, then it's really too late to get any exercise in, not if I want to go to sleep at a decent hour so I can wake up pre-dawn for work.


I do need to be better about both though.  I heard Weight Watchers revamped their plan and since I'm still a member, I thought I'd go over and check it out.  And I can make an effort to move more...I'm doing that already at work.  But at home, I can get on the treadmill for 30 minutes while the little one watches some television or plays a computer game.

December 10, 2010


Today is my birthday.  Celebrate with me by hugging a ball of wool.

This was the week from hell, and yet I thank God for it because it renewed my faith in psychiatric nursing.  Because my unit's census was low, I was floated to stepdown at the beginning of the week.  There, I got to work with some truly psychotic patients:  paranoia, active hallucinations, bizarre thoughts, ideas of reference...stuff that I hardly see on the detox or depressive units unless the patient is admitted while under the influence.  It took a little bit to switch from "high-functioning patient" mode to "psychotic patient" mode, but it all came back to me.  Those days were tough as hell, but I thoroughly enjoyed it. 

I worked one of those days with the director of the stepdown unit.  I had told her that I was enjoying my time there because lately I felt the urge to get a med-surg job but being here made me feel better about psych again.  She asked me why I wanted a med-surg job and I told her "just because it's expected you do it when you first get out."  She said that I didn't need it, especially if I didn't want it.  She also told me that she went straight from nursing school to psych 14 years ago, had no problems ever finding work, and never regretted it.  So that was a big boost.

Then I got sent to the ICU.  Things were really hopping there:  it was as though they found the most actively psychotic patients in town and wheeled them in.   I actually went there in a tech capacity since I was the extra nurse, so except for a couple of assessments, all I had to do was tech I was really in the trenches.  I had to set a lot of boundaries, including telling one to keep his hands off of me, but it was a good challenge. 

I finished the week off in the kids' unit.  Calmer patient population, except  for one very histrionic, paranoid, delusional teenage boy.  I have to give it to the techs on the kids' unit:  they know their stuff.  The kid was violent and screaming (and strong!), yet no code was needed as I gave the shot.  It was a little frustrating as for all my therapeutic communicating skills I could not persuade him to take the medication PO...but that's the nature of the psych nursing beast:  sometimes you can talk them down, sometimes you have to shoot them down. 

Now I have a LONG weekend ahead of me to relax.  I treated myself to twelve hours of sleep for my birthday, and it was the  best gift I could get after this week.   Third best was the week itself.   Second best will be whatever I decide to buy myself today.

November 30, 2010

Life on the depressive unit

The most recent BSN class is drawing to a close...after the hell that was Informatics, Diversity was a breather:  1/4th the weekly workload and only two main projects.  Though I will admit that I didn't get as much out of Diversity as I did the other class...because I didn't have to do as much work.  Go fig.  The next two semesters will be fun:  two classes at the same time for each.  Plus at one point, I need to figure out how I'm going to squeeze one of my two remaining liberal arts classes in there. 

I'm back to floating.  It's not my idea, though I don't mind it.  But whenever a nurse is needed somewhere and they look at our unit to provide it, I'm the one who gets sent .  It gives me experience and cheers me up, because I get to see different patient populations...which is nice when I'm feeling a bit down on psych nursing and wondering if I should attempt to break into med-surg.   The experiences remind me why I like psych in the first place.

Speaking of first places, the first place they always send me:  the depressive unit.  This is where all of the "sad" people go.  It's mostly depression, SI with or without a plan, actual suicide attempts, and the temporarily detained.  Lots of drama.  Lots of personality disorders.  Lots of tears.  Lots of medication seekers who are after the benzos and Schedule II/III narcs. 

Floating is definitely a good chance to keep the therapeutic communication skills sharp.  Whereas in detox I can be blunt, use the word "why", and break half of the rules in the communication book because most of our patient population are frequent flyers and we've been through this dance several times before. 

I have to admit it can be hard.  I guess that's because sometimes I expect it'll be like the textbook:  have a 1:1, talk to them, teach them a bit and boom, patient is 20 times better and no longer depressed/suicidal/crying.  It's amazing what can be accomplished in the world of textbook nursing.  For the most part, the patients do feel better after the 1:1...but their problems aren't solved and they're not all cured.  And I know this.  And I know I can't solve all of their problems and say some magic words and boom, all happy.  But sometimes I do wish it was that easy. 

Even though the depressive unit isn't really a place for psychosis, occasionally some sneaks in.  I got to see a couple of psychotic issues I haven't seen in a while.  Audio hallucinations (more of the background commentary type than the "kill them!" type), thought blocking, paranoia, and mania.  Good opportunity to refresh my skills in dealing with those issues too. 

I dug the psych textbooks out, and I'm making it a point to read up on at least one thing a day...both to help me at work and to help me start preparing for the board certification exam.  Granted, I have several months to prepare, but with the BSN and everything else going on, best I start some of it now.

November 19, 2010

Schoolwork doldrums

Have to do a paper over the Thanksgiving day holiday...going to try and see if I can whack most of it out the Wednesday before.  Then all I will have to do is proofread and tweak as needed.  I hadn't wanted to take schoolwork with me on the holiday trip but life's like that.  Oh well.  I also need to get my paperwork over to the office before the holiday.

November 18, 2010


I need 30 psychiatric CEUs for my certification.  I also need to actually be working for two years, but I figure that if I start knocking the CEUs out now, I can test as soon as I cross the big 0-2.  Also, I'm starting so soon because I'm trying to find as many free CEUs as possible.  The APNA is hooking me up with a few, and I'm sure I can dredge up a few free ones through the ANA and other sources.  I have a feeling that even with my best efforts I'll have to pay for a few of them.  Oh well.

November 16, 2010


Being a nurse and BSN student keeps one rather busy.  These last few months had me up to my neck in classwork.  What really gets me is that the fewer credits the course is, the more demands the instructor puts on us and the more work I have to do.  One of my courses was only a 2 credit course, and we needed to make 9 posts a week, with the final project being a term paper and accompanying slideshow.   The 3 credit course I'm in now seems like an absolute break.

I occasionally get twinges whenever I hear from classmates that went into med-surg.  While I'm loving pysch and have no regrets, for that brief second I feel like a failure.  Not that I am a failure in any way:  med-surg is not the only area of nursing, and there's many nurses that have successful careers without even going anywhere near the area.  I guess it's because that everyone pushed (pushes) it as the area that you must start off in to have any measure of nursing success.   Yet I seem to be doing rather well as a nurse without it.   Plus my unit gives me enough medical issues to keep it exciting.

Maybe I feel like that because of all of the rejections I got when I was hunting in med-surg.   I think that's the case, because if I was truly unhappy then I'd have kept looking for the med-surg job and not carved out a full-time niche.

Or maybe it's an occasional resentful twinge, since I chose the psych job over the PCU because of the hours.  I knew I couldn't be away from my child for 14-16 hour days.  It's hard enough that my better half's days are at least that long, neverminding all of the underways and deployments.  But you know what?  I didn't want to put my child through that.  We're fortunate enough in that if I didn't want to, I didn't have to work and we'd be OK financially.  Not great, but we'd make it.  I don't have to take a job with hellacious hours just to make ends meet.  And frankly, when I look at his face, I don't want to work those hours.

And I definitely don't miss the blood, guts and demanding patients.  If my patients come at me saying they need new sheets on their bed, I get to say "I'll get you clean ones so you can change them" and I won't get into trouble.  Hell, I'm expected to say that :)

Oh well.

Work is going well.  Still have staffing issues but since no amount of yelling and screaming will change it, I've pretty much adopted a zen attitude.  I'm trying to get my supervisor to do the same.  She gets so worked up over them and it's really stressing her out.

August 17, 2010


As of this month, there's no longer any question about it: I'm no longer a new grad in any way, shape or form. I've got one year's experience...I'm very lightly seasoned. The marinating is far from over though.

I've got a permanent position on my unit, though I circulate to other units as needed. I get lots of compliments on my work, most of the other staff like me, and TPTB are working with me on my schedule in the fall when the little sheep starts school.  I've gotten a little resentment from a few people because I ended up with mostly day shifts in my schedule even though I've only been there a year. But in my defense, detox is the unit most other staff DON'T want to go to for whatever reason.  I don't understand why...OK, it's shorter-staffed and a lot busier than the other units, but it's a great place to work IMO. 


We've had some staff turnover lately (some voluntarily, some not) so there seems to be a lot of staff trying to shift shifts lately.  Several of the night people have gone to evenings or 12s.  A few evening people have tried to go to more days but with less success, since every unit has a pretty much solid day shift staff.   A few staff were willing to cross over to other units for better shifts but found that though they may have had more years' seniority working in the place, that seniority didn't cross over when it came to the units--the unit's original staff got preference even if they were there as long.  This is one reason why I was able to keep mostly days.

Overall, staffing still needs work.  I saw in the papers that they're massively recruiting  again.  I'm less insecure about being bumped than I used to be, partially because I am permanent staff now.  But I always fear that some other nurse is going to come along and wow them so much that I'll find myself eased out of my days on my unit and relegated to a unit or shift I dislike...or worse, just cut free.  I know the odds of that happening are slim to none.  I'm just paranoid.

There's been crop of new grads that were hired.  Some are good.  Some...hopefully they'll come up to speed.

July 14, 2010

Feeling a little abandoned

Off today, and I was feeling a little lonely, despite having a 5 year old in the house with me.  Most people I know work so I can't call them to see if they want to do anything.  I tried texting a couple of non-employed friends to see if they wanted to hang out, but the day wasn't good for one and the other never responded.  I wallowed in self-pity for a bit, then picked myself up and moved forward with my day.  Got some errands done, got a little exercise in, and if I'm intelligent, I'll get a little schoolwork done later.  I'll also touch base with my friends later...though lately my work schedule and their free time isn't quite syncing up.

I admit, I've always been a bit of a loner.  I grew up that way.  I was very shy and not too popular (and living in the shadow of a popular sister as well as mother didn't help).   I adjusted:  I developed my own interests, became very independent, didn't have to rely on others for happiness.  I do get out and join social groups and mingle with others.  I take a lot of time in making IRL friends, so while I may not have tons of friends and am not a social butterfly, the ones I have are top-notch and I'm very close to them.  And for the most part, I've lived a pretty happy life. 

Still doesn't mean that I don't miss the company of others though.   The fact that it's a grey rainy day (perfect for hanging out at someone's house) isn't helping.  But oh well.

July 12, 2010

I'm not a new grad anymore

I bounced back on my second assessment test with a 100%.  I took it seriously this time around, and it showed.  My overall grade is back in the 90s, and an A may still even be possible provided I can pull off a couple of small miracles.  I've still got one more test and the Head-to-Toe assessment to get through.  Having taken assessment once before during the ADN has helped me, but I'm learning a lot of additional stuff this time around that I didn't pick up on the first time, probably from lack of time, experience and (sorry, Former Instructor X) teaching expertise.  Even though it's been a struggle at times, I'm thoroughly enjoying the class.

And as the title says, oh yeah:  I'm officially not a new grad anymore.  One year ago this month I was licensed and started volunteering.  I suppose if you want to be technical, you could argue that next month is my anniversary because that's when I became meaningfully employed (read:  paid) as a nurse.  But I count from this month as I wasn't sitting around the city clinic handing out magazines or checking people in--I was doing actual nursing.

For a moment, I thought I should do as every other person who finishes their first year does on blogs and forums and write some long, introspective post about everything I learned.  I’d go on about how I excelled during the first year, glossing over the bad stuff and basically making myself look like Supergrad who everyone loves, then proselytize to the next generation about what to do and not do, and last bask in all of the "Congratulations!" postings to follow. 


I'm far from Supergrad.  I'm just a regular person who hasn't least, not on a major scale.  Growth made, lessons learned, sailing not always smooth (still isn't always, actually), doctors do listen to me when I say something, and I do teach the new grads at my place what I know and offer guidance (which is ultimately up to them to use or disregard).  I've come a long way since day 1 and I know it--that's all the congratulations I need.  Still have a long way to it should be.

To be honest, I think less about what I’ve done over the past year and more about the next in what my goals and plans for the next year are.  Now that I have that magic year's experience, I'm probably not going to jump ship at my current place of employment.  For the grief it can give me, it's a good place overall and they do treat me well.  I'll be there for a while...though I may pick up a per diem job one day a week at another facility just to get more exposure.  I'll keep chugging along in school--I won't have the BSN for a couple of years, but I'll be making progress.  I'm looking at getting certification at the end of year 2, so I'll be aiming for that:  working on CEUs, floating to other units for more experiences, and studying for that test.  And since I survived one year in psychiatric nursing and still love it, I'll probably go join the APNA.

I will even admit that the thought of school past the BSN has crossed my mind.  Originally I was going to stop at the ADN and do the BSN a few years later.  That didn't happen.  But then I was going to stop at the BSN that was it on being a student.  Now I'm wondering about whether a masters' or NP is something I want to pursue.  Go fig.

June 29, 2010

Learned my lesson

I had a long talk with myself over it. I admit, I was lax about this test.  I was too busy dealing with my other class, work has been nuts the last couple of weeks, I had done well in class and clinical, and the fact that I'm a nurse has so far proven to be to my advantage in class and clinical. I own up to it: I was getting cocky...and it bit me.

Of course, the next day I was in the panicky "My God, I'm going to fail the class!" mode. But I talked myself down off of that cliff--I know I'll fail if I keep that attitude up. So off I am to focus on the next test and to keep doing my best. I'm not the first person to fail a NS test nor will I be the last. Having done so well all those years, the fact that I've failed a test is embarrassing and humbling...but apparently it didn't kill me--the world keeps going on.

My old classmates wouldn't believe me if I told them I failed, though.

Mind you, it could have been worse because I could have really bombed it. With the test included, I'm running an 83 for the class so far. Not great--it's a C--but passing, and I can still bring it up to a B. I'm not going to worry about the A. I'd like it, but I really want to focus more on the hands-on part of clinical, since there's a lot of clinical skills covered in there that I haven't practiced much being in psych nursing.

June 28, 2010

Learned my lesson

I had a long talk with myself over it. I admit, I was lax about this one. I was too busy dealing with my other class, work has been nuts the last couple of weeks, I had done well in class and clinical, and the fact that I'm a nurse has so far proven to be to my advantage in class and clinical. I own up to it: I was getting cocky...and it bit me.

Of course, the next day I was in the panicky "My God, I'm going to fail the class!" mode. But I talked myself down off of that cliff--I know I'll fail if I keep that attitude up. So off I am to focus on the next test and to keep doing my best. I'm not the first person to fail a NS test nor will I be the last. Having done so well all those years, the fact that I've failed a test is embarrassing and humbling...but apparently it didn't kill me--the world keeps going on.

My old classmates wouldn't believe me if I told them I failed, though.

Mind you, it could have been worse because I could have really bombed it. With the test included, I'm running an 83 for the class so far. Not great--it's a C--but passing, and I can still bring it up to a B. I'm not going to worry about the A. I'd like it, but I really want to focus more on the hands-on part of clinical, since there's a lot of clinical skills covered in there that I haven't practiced much being in psych nursing.

June 26, 2010

So it finally happened...

I failed my first nursing school test.   78% is passing; I got a 76%. 

It was in my assessment class.  In reviewing the test, some of my incorrect were stupid mistakes on my part.  Some were due to reading something as being correct in the book only to have it be incorrect on the exam.   And some were the fact that I'm practicing as a nurse in the real world and the test is, of course, in the ivory-tower world of nursing.  As I rapidly learned, it's been a while since I dealt with nursing test questions.  Ironically, the fucked-up question--the one missing a key piece of information in it, was one I got right.  Damn lucky guess there.

Oh well. 

I'm bummed but I'm taking the failure rather well...I guess because, as I've been saying for ages, there's not as much pressure on me this time around--I can fail out and still be a nurse.  And I'm focusing on relaxing and enjoying it more,  as well as enjoying life more instead of making school a 24/7 thing again.  I'm not stressing so much over making the As becaue I'm not as competitive over the grades--I graduated once with honors and that's more than a lot of people have done. 

I still intend to see my instructor and have her go over the test with me in detail, and there are a couple that I do plan to argue.  But for the most part...I think I'll be OK with this.  I must do better on the next test, though.

May 30, 2010


I started my next patho class. My first patho instructor was teaching this class too, but I got routed to a different instructor...which is fine because a change is a nice. But this new instructor has slammed us with assignments for the first week, then it eases up a little for the next two, then it lightens up a lot after that. I can't help but think that she's doing this to weed out people.

I've been doing non-stop homework since Friday. This instructor doesn't have the same rigid timelines that the last one did--everything just has to be in Monday at 2359. This is good and bad. Good in that it gives me flexibility. Bad in that with the old class, everything had to get done and didn't get postponed until the last minute. With this instructor, it's so easy to say "I'll do it later/tomorrow" evidenced by my waiting until Friday to get started on this. If I had my old instructor, a bulk of the written assignments would have already been turned in my Friday since that was when they were due.

So far all that remains is for me to respond to two posts (which can wait until tomorrow as not a lot of my classmates have posted yet), a paper (draft 1 today before work, finish it tomorrow), online modules (started today, will try to sneak some in at work later) and a quiz (whee).

At least I'm still not taking statistics! And when I start physical assessment next week, that'll be more like a review too, than having to start from scratch like I needed to do with stats

May 28, 2010

No longer new

I realized that I'm no longer a new grad anymore when someone asked me how long I've been a nurse and my answer was "about a year."  And I also realized this when I had to orient some other newly hired nurses.  Just by their mannerisms I thought to myself, "you must be a new grad"...and I was right :)

Although my official anniversary date is still a few weeks off...I think I can safely say that I've gotten through year #1.  I feel old now.

May 14, 2010

One year ago today...

was my pinning ceremony.  I wore a white dress for the fourth time in my life (baptism, first Communion, and pledge pinning were the other three).   My son kept wanting to wear my nurse's cap.  I received the valedictorian award--a lovely silver box.  What was more rewarding was what my classmates had to say about me during the ceremony.

So, one year ago this day I became a GN.  My days of being called a new grad are ending soon...they officially end in July.

Oh yeah, I got the A in statistics.  Thank God that class is over!  I'm leaving the textbook but taking the calculator.

May 10, 2010

Updates to the maternal situation

Long time, no post, I know...

My mother apologized the next day. This was the first time in my 30+ years on this planet that I can ever remember her apologizing for something she did and that [U]wasn't[/U] done in a sarcastic manner. My first thought when she said that was "who died?" Of course, after the apology--for which I made sure NOT to say "oh, it's all right" because it wasn't--she immediately proceeded to lecture me about not calling. Oh well, I guess since this is the best I'll get from her I'll take it.

I decided to call her out of the blue three days later to tell her about the little one's kindergarten registration experience. She was delighted and only lectured me for about half the call. She called me three days later and didn't say a word about call frequency. And so it's been going. Now we're talking roughly every 3-4 days. She's been careful not to attack me about not calling enough. In turn, I'm making the effort to actually call by day 4 if she hasn't.

I did mail the Mothers' Day card, and instead of flowers, I sent my dad money towards their getaway weekend that he had surprised her with. She started in with the "you shouldn't have" (and gifts with her, both given and received, are the subject of a whole other post) and I told her that I didn't have to and that she should just accept the gift gracefully. Hopefully they are having fun.

I think she's started to realize that what she wants, the daily calls an bestest-friends-forever relationship, are not going to be happening any time she should be happy with what relationship we do have. Besides, given time and healing, it may grow. It may not. I promise nothing, but I am optimistic.

In nursing news...the new lesson learned was that if you are drunk, you can not have a seizure...despite my patient's best efforts to "have" one. Once she learned that Librium was not forthcoming until her BAC dropped to an acceptable level, she had an immediate improvement in her condition and left AMA. This night also was the first time that I had to interrupt an assesment due to patient vomiting.

April 24, 2010

Completely non-nursing post

I wish my mother would understand that I would call her a lot more if I wasn't beaten down and berated every time I called her about all the things I'm supposedly doing wrong in life, all the things my sister is doing wrong in hers, everything my father is doing wrong with his.  A bitch-fest from start to finish and she takes it all out on me.  And there's always an excuse why she's stressed..."it's your father/your sister/my job/your family/life/etc.". 

Nothing I ever do is good enough either--if I say something, it's not the response she's looking for. 

Then it's all capped off with ranting about how "my children never call me."  Neverminding that we last spoke less than 72 hours ago.  I'm sorry, but if that tactic is supposed to get me to call her, it hasn't worked:  I'm not that masochistic. 

Once she started in on me, I pretty much shut down and just said "OK" to everything she said, to the point that she got aggrivated and said that she'd let me go.  And I damn well hung up that phone fast.

I'd like to say, "well, she is stressed, etc."...but this has been going on for far too long.

I bought the Mother's Day cards today, and it was the hardest thing I had to do in my life.  I read the cards and not one of them I could apply to my mother.  I finally settled on a basic one...which I know won't be good enough, nor will what I write in it be good enough.  Nor will the flowers I send her be good enough.  So why do I bother?

Sorry for venting.  Her phone call and subsequent torture ruined a perfectly good Saturday for me, and my mood has been black ever since.

April 11, 2010

BSN stuff

I'm highly entertained by school right now.  First of all, so far it's mostly old hat review of patho content, so no need for marathon study sessions.  I'm currently running a 97%.  If anything kills me in this class, it will be the APA.

Second, I can tell which classmates are nurses (either RNs or LPNs) and which are not just by reading their posts.  The nurses get right to the heart of the assignment, reference the textbook without tons of verbatim quotes, and focus on how they'll treat the patient.  The non-nurses obsess over the minutiae, quote the textbook to death, and focus on how they'll treat the problem without considering the larger picture. 

Also, the non-nurses tend to overreact with the homework problems.  One problem included an electrolyte imbalance:  the electrolyte was a hair outside of normal (literally, only 0.1 off).  Every non-nurse honed in only on that, saw it as a medical emergency and went into full panic mode by providing a detailed list of all of the side effects of said imbalance.  Every nurse saw it as something to keep an eye on and that some orange juice will probably correct it, so in the meanwhile they'll focus on that oxygen saturation of 80%.

April 6, 2010

Cold feet

I got the permanent offer.  Same rate (good, I thought it'd be lowered), paid days off after 60 days, benefits (not really needed but nice), same balance of shifts, and based primarily in the unit I want to be in, though I will still have to float as needed.  So I went ahead and signed.

And felt immediately horrible.  I was sick to my stomach on the way home, when registering my little one for school, when grocery shopping, when eating get the idea.  I feel...trapped.  Like there's no more freedom.  No way out.  Like I'm at their mercy now instead of having some control.

I did get dinner down the gullet, then decided to sit down and write it out.  See, I do use the coping skills that I teach my patients for myself. 

I decided that right now I'm experiencing the nursing equivalent of cold feet.  I was a carefree bachelor(ette) before  this and now I'm making a committment--it's only understandable that I'm going to feel awkward about it.  And it's not as though things are changing drastically.  Cases in point:

  • Freedom of scheduling.  The reality is that ever since I was hired 8 months ago, I have pretty much worked the exact same schedule.  On rare occasion I swapped days or didn't put in for a day...for the most part you could plan your life around my schedule.  Hopefully they won't play too much havoc with my hours--they know I have a little one and that I'm willing to plan around him and do different days, but they have to give me advance notice.

  • Vacation:  why am I upset over this because since when have we taken a vacation?  The last one was in 2003.  Like we're suddenly going to now...not with my better half's work schedule.  And I did find out that if necessary and I don't have enough vacation time, I can take days off without pay (with supervisor approval).

  • Hours:  I've been putting in 32+ before this.   I've been hired for 32.  It's not as though they've tacked on an extra shift.  I am concerned about being there for my little one, especially with school starting.  But the way it is now, half the time I work while he is in school; the other shifts my better half has him for quality bonding time.  The child is not living his life in daycare. 

  • Security:  that was more insecurity than anything, though with the hiring tear they've been going on it may have been possible that I'd be competing with too many other PRN staff for hours.  I'm still a new grad until I hit that magic year, and with this job market I really don't feel like I can scale my hours back.  But now it's nice to know that my hours are guaranteed.  Also, now I'm more likely to be assigned to my unit.  I don't really mind floating, but it's also nice to have more consistency, you know?

  • The unit.  I picked you know it's detox.  The staff is happy to have me come on permanently, and I'm happy to have  a good staff to be joining.  Also, I was terrified of being assigned to the depressive or stepdown units.  I'd have rather gone to the intensive care unit.

  •'s not forever.  I didn't sign any length-of-service contract.  I can drop back to PRN if I need to (though they prefer I wait a few months because people have abused it in the past).  Also, I do live in an employment-at-will state, so I could always walk with no more than two weeks' notice and a "so long and thanks for all the fish."

So if I still feel like this tomorrow, I'll cancel the wedding.  Otherwise, this could be interesting.

April 2, 2010

In local news...

Pathology started Tuesday. Fortunately, the due dates for assignments, quizzes, etc. fall on different days so there will be little overlap between the classes. Unfortunately, there is overlap between patho's schedule and work, so I'm going to have to plan so things get done on time.

No word yet on the permanent position. I did meet with the DON and it went well, so now the ball is in their court. At least there's no pressure on me because I don't need to say Yes. However, things have gotten very stressful there lately...I can't say any more about it other than it's probably best if I keep my head down and fly under the radar for a bit. Nothing catastrophic happened: it's mostly ongoing stuff that as of late has come to a head. It is stressful though.

There's two other nurses in this new class (patho), so that's nice. Everyone else is a shiny-brand-new nursing student and the realities of what nursing is like haven't really set in yet So far a lot of material is just reviewing old hat. What's going to kill me is the APA formatting.

March 29, 2010


It is an utterly bleak and rainy day...which is doing nothing for me getting my statistics coursework done. Right now I'd rather be sleeping. I don't know what it is, I'm just so tired lately. I know it's not my thyroid, and I'm getting plenty of sleep on my days off. Hmm...

I finally got to WW to weigh in. +0.2 lb...which is not bad if you consider that my last weigh in was on 3/1. I've managed to keep my weight stable. But I need to get cracking on getting it back down.

March 27, 2010


One of the advantages of being a student (albeit a class-at-a-time one) is that I qualify for educational discounts on software.  Yesterday, I picked up Microsoft Ultimate Office 2007 for about $60, and since I bought it so late in the game--only 3 years after the fact--I qualify for free upgrades to Office 2010 when it comes out.

I've managed to avoid Word and Excel 2007 for most of the last 3 years:  the only times I ever ran across it was in the computer lab at school.  At home, I have (had) the 2003 versions, and I use Works on the Mac.  I usually save files in RTF format because I never know which computer I'll be on.  But now that I'm on 2007's almost like learning a whole new language.  Nothing is where I remember it being.  The one thing that's saving me right now is that they haven't changed the short-cut keys.

Statistics blows right now.  I'm learning it but I don't feel like I understand it.  Instead, I feel like I get enough of it to do well on the quizzes, then the information goes straight out of the brain as I tackle the following week's chapter.  I have 5 separate assignments and a quiz due by Monday...and lest you think I'm procrastinating, my instructor dumped 3 of them on the class on Thursday (the weekly homework and quiz are a given).

I'm having a hard time concentrating on the reading right now.  It's late, I'm tired (despite the two-hour nap I took today), and I'd rather be doing other things on a Saturday sleeping.  Or reading.  Knitting sounds good too.  I'd also say watching Dr. Who, but it's pledge drive week on PBS so it won't be on.   But I've got to work tomorrow, so I need to slog through some of this tonight.  Whee.

March 26, 2010

Not so good

I'm not talking about myself.   FYI:  no word yet on the application...but that's all right.  I've heard more about the downside of going permanent since I put it in, so I'm not in any rush.  I'm also taking all I hear with a grain of salt as I need to judge things for myself, so I'm still going to see what they offer me. 

What was not so good was that we had to escort some student nurses off of the unit because of their behavior.  They were both entitled and treated the staff rudely and obnoxiously...which while not great, is something that could have been overlooked, especially if that was their only crime.  Taking charts without telling us is also forgiveable, again if that was the extent of their transgressions.  What was inexcusable was that these students were disruptive to the groups and milieu.  They bitched about having to do vitals.  They bitched that we didn't have machines but manual equipment.  They were so focused on getting their assignment done that they went into a group, sat down and started talking to their selected patients while the group was still going on.  Then they bitched to us when we pulled them out of the group and explained to them why they can't do that.  Then they went back in and DID IT AGAIN.

We told their instructor to take them off the unit and they were not allowed back.  If I'm charge tonight on my unit, they won't even be allowed to set foot on the floor.

Lest you think I'm an uppity "she's just a new grad, why is she pulling this attitude" monster...I wasn't a student too long ago, and I remember the pressure of having to get info to complete care plans and assignments and flow sheets.  I remember the struggle of trying to balance patient care and research.  I remember feeling like some days feeling like I never had enough time to get to a chart and other days it feeling like all I did was have my nose in a chart.  I rememver feeling frustrated that I couldn't do things when/how it seemed so convenient for me to do them.  And I certainly remember what CIs were like.  So I do have a shadow of sympathy.

At the same time, I was also taught that the patients are not there for our convenience:  they are in the hospital to get better.  The patients can't just be pulled out like you pull a chart off of the shelf, used and then tossed back.  It's demeaning to the patient to be treated not as a human being but as an object of study.  And even worse, to do this in a group is to not only impede that patient's recovery but all of the patients'.  

And I was taught that as a student, I'm not entitled to be in the hospital.  Even though I was on my clinical, I was their guest, and as such I should conduct myself as a guest should.  I should not disrupt  the floor's routine.  I should follow the rules of the unit to a T.  I should speak to the staff there with courtesy (I didn't have to be obsequious, but I damn well had better been polite).  And if corrected I shouldn't take on an attitude and/or bitch back, but listen to what I'm told.   Maybe the staff is wrong and I was right--no one is perfect, after all--and then I could speak up politely.  But a majority of the time, we all damn well know I (as the student) was in the wrong.

I told their instructor that when I was in school, if I had acted like their students did today, not only would I have been removed from the clinical site immediately, I would probably have been failed for clinical...and depending on the instructor I had, I may have even been flayed alive JUST for having the attitude.

It feels weird saying these things, when I'm only 7 months out of school myself...but working on the floor those seven months has taught me a lot.  Especially that my CIs knew exactly what they were talking about when they taught me.

March 23, 2010

They asked

Today, the DON asked me if I wanted to go permanent. I told her...I'd think about it. So much for likely turning it down.

But I did think it over...and after talking the pros and cons over with most of the unit, as well as with one of my favorite supervisors, I've put in my application. I figure I'll see what terms we can come to and go from there. Worst case scenario: I don't like what they offer, I say No and I'm still PRN staff.

I never made it to Weight Watchers the other day...but I stepped on the scale and got 186. It's day 2 of being back in the far so good. I passed up cake during lunch and settled for an orange for dessert. Mind you, had I passed up lunch itself for a salad I'd have really scored points. But I at least made it up by having that salad with some soup for dinner.

March 21, 2010


They pretty much went along with whatever I checked on the evaluation, rating me a bit higher than I did in a couple of areas (none were lower, thank God).   The feedback was good, so I guess I have a job for another six months. 

 They've hired on several PRN people as permanent staff...they haven't approached me yet, probably since with my current schedule I wouldn't neatly fit into a one-shift position.  Which is just as well as I'd likely turn the offer down:  I like the flexibility and freedom that being PRN offers me.  I'm certainly not lacking for hours:  I do 32 a week now and could easily do 40 (or more) if I wanted, or scale back to 8 and still keep my job.  And I set my own hours--I don't have to work around anyone else's schedule (although coincidentally, what I can work happens to mesh rather well with what days the permanent staff can't work), and can take off on four hour's notice if I had to.  I'd still like to be asked to join know, to get a little stamp of "hey, you're really doing OK, want to sign on?"  And I'd like to think it's my schedule that prevents them from asking, and not my performance. 

Insecure much?  I vacillate, as you can see.

Work has been rough lately due to staffing issues.  There are just not enough techs on our floor.  There's also not enough nurses either, but it's manageable with one nurse as long as there are enough techs.  The problem (I think) is that TPTB don't realize that while we on detox don't have the actively psychotic patients who are throwing things, or the depressives who will try to kill themselves the moment our backs are turned, we have the most medically unstable patients, particularly the new admits who are fresh off of the drugs.   They require frequent reassessment.  Neverminding that as far as therapeutic groups go, we have the most of any other unit with the exception of the kids. 

One evening was so bad that all staff who were there including myself made formal complaints.   We're not miracle workers:  it's hard to do the job without the tools and the necessary staff.  So we shall see if the mass complaints improved things.

Seven months...I hit seven months in a few days, and the end of the magic year is in sight.  As I told my better half this morning, it's not as though I'm going to leave my current job the minute the clock strikes 12, but that having that magic year's experience under my belt is so mentally liberating.  I do have the freedom to leave and be actively competitive for other jobs--I'm no longer limited to applying for "new graduate" positions.   Hospitals will want to talk to me once the new grad slime has worn off.

One of the supervisors--not as part of my evaluation, mind you--strongly recommended I do get med-surg experience. Truth be told, the further along I go in psych, the less I want to go into med-surg. I enjoy psych a lot more: the work environment, what I do, the decreased amount of blood, guts and body fluids, and the fact that 30% of my job isn’t made up of “pillow-fluffing” type duties.   There's definitely psych jobs out there so it's not as though I'm in an impossible-to-find specialty.  Also, given my age (not old, not young), it's not as though I'll be in nursing for the next 50 years.  I'm thinking only 30 or so before I hang it up and retire, so why not enjoy a specialty right out of the gate?

But I could see her wisdom...that year's experience would give me more options.  I do like options:  even if I never use them, I like knowing they are there if I do want them.  So I figure I'll get my year's med-surg after I finish my BSN.   I'll be a new grad twice over.  Until then, for the next couple of years while I'm in school, psych it is.

Speaking of which, that's going well.  Another class starts at the end of the month, so for April and most of May I'll be doing two classes at the same time.   Fun.

I need to get back on the Weight Watchers wagon tomorrow…the fast and loose living has caught up with me, and tomorrow I need to see how bad the damage is.  Some pants aren't fitting properly, and I just feel heavier lately.  But I've no one to blame but myself.  I’ll never lose weight if I don’t be disciplined about it…problem is that it’s hard to maintain that discipline after a few weeks.  I’ve got to find a new approach to this problem…I’ve lost weight before, I know I can do it again.

I also joined up with a local parenting group.  Besides giving my little one an opportunity to do more things, I need to get out more and play with people my own age...particulary ones with little ones of their own and who can relate to me right now.

March 6, 2010

This fecking self-assessment

I admit that I'm a damn good nurse.  I'm told it by many I work with, from techs to other nurses to doctors.   But I also hold myself to a high standard...somtimes, too high of a standard.  And that, I've also been told by many I work with, from techs to other nurses to doctors.  It is probably because of those high standards I hold myself to that while I admit I'm a damn good nurse, I'm also insecure about my performance.  It's hard to explain, but that's how I feel.

I hate self-assessments in that I honestly can't give myself the highest marks.  I'm still learning the ways of the psych world, I've made mistakes (though have owned up to every one), and given that I spend most of my time in a certain area (detox), my experience and skills are stronger in that area; areas I spend less time in, my experience is less strong due to lack of experience.  I'm good, but I'm not perfect.  So I filled out my self-assessment accordingly.

Other people tell me to just score myself highest marks for everything.  I tell them I can't as it would not be true.  One person said they did this for themselves, neverminding that they've committed several serious medication mistakes and was once written up by a patient for their behavior I didn't have anything to say to that...couldn't think of anything to say to that, actually.  In all fairness, it's not my place to judge whether their assessment is truly accurate as I'm not them nor their superiors...though I did admire their cojones for a fleeting moment.

So we'll see what happens.  I'm wondering if my self-assessment even matters at all, that they're just going to rate me however they want and what I think has no say in the matter. 

Now that I'm in the downhill side of the first year hill...I feel more seasoned.  I'm now precepting new staff, which is cool.   I'm putting my foot down on things when I feel they're inappropriate or if I feel that I'm being taken advantage of because I'm a new grad.  I'm not letting the fact that I'm a new grad stop me from giving input on programs and voicing my opinions.  And I now give great PPDs--it helps when you have to do 6 in two days.

There's always new things to learn and I'm always open to the lesson.  I learned a lot about the best medication administration times from the LPN I worked with last night.  Did you know Wellbutrin can keep you up at night?  I didn't...I do now, so I know to suggest to the doctor they may want to move the evening dose up earlier.  Or the lesson from the tech about the safest way to arouse a patient who's difficult to arouse:  gently rub their shoulder, then jump immediately back out of arm's reach?  I hadn't thought of that.  I can bring on the Voice of God whenever I have to (I had a lot of practice on the preschooler), but doing that plus banging the wall did nothing to get this patient awake.  But damned if I didn't brush his shoulder and he sprung up wide awake.

March 2, 2010

Halfway there...

I'm officially past my six-month mark as an employed RN.  I've been licensed for 8 months, but the first two were spent both job hunting and volunteering.

You know what this means, right?  Yup...evaluation time.  Tonight will be spent puzzling out my self-assessment form so I can turn it in and get my proper evaluation.  The person who hired me is no longer there though, so it'll be interesting to see who they assign my evaluation to.

February 26, 2010


I was offered 8 hours of OT this weekend--yes, my job is willing to pay me for it instead of scrambling to find other PRN staff to fill the spot. I'm about to turn them down. Reason: with work being crazy lately, I have hardly seen my family since last Saturday, and I think it's about time the three of us had some quality family time.

Granted, the thought of that money is tempting me to say "Yes", or even "Yes for part of the day"--after all, a partial would only be four hours and I'd have a full shift's pay in the pocket.  OK, it's VERY tempting. 

But besides missing the family, I'm also a little fried from work this week and I could really use a few days in a row off.  The place is going to be short-staffed, so it won't be an easy shift.  I have a midterm on Monday that I'm not really ready for.  Besides, four hours at my job have a magic way of turning into 6 or 8. So let me not get myself trapped there.

February 5, 2010

I'm glad they didn't hire me after all

Remember the SNF that I applied to many moons ago and who rejected me?  

I had breakfast with my friend--who they had hired but it was no competition between us as she went for the night FT job and I applied for the day PT one--and she said the conditions as well as the working atmosphere there has gotten bad...forgive me for being vague, I don't want to out who she or the place is.  Anyhow, things have gotten so bad that she decided that she's got to get out there ASAP before she loses her mind and her license.  

I counseled her to look for another job and at least get some leads before she up and quits, especially with this job market and a bunch of new grads coming down the job-hunting pike in March.  But apparently things are bad enough that she wants to go now.  So I told her which hospitals were hiring new grads as well as told her to put in for a PRN spot at mine.  She's not a fan of psych but she said she probably would because it would be something.

I guess I lucked out when they rejected me.  And if this is what skilled nursing/rehab is really like, I'm kind of glad that rehab place never followed up with me either.

Work wants me to come in for the Super Bowl.  I had taken the day off a while ago--not for the game itself as I had thought that was last weekend--I just needed a break from working Sundays for a while.   Truth be told, I'm not a football fan:  I usually watch one quarter of it before I'm bored and change the channel, flipping back to get periodic updates as needed.  But that day is a close friend's birthday, and her husband may not be home from his business trip in time for it.  So I told her to let me know today--if he won't be home, I'll go and keep her company.  Otherwise, I'll put in for a shift.  I wonder what it'd be like to be on the detox unit for the Super Bowl...I mean, I've yet to be to a Super Bowl party--or anti-Super-Bowl party--where alcohol wasn't served in large amounts.

January 26, 2010

Recent highlights from work

  • Patients--of both sexes--on the high-functioning unit were coming onto me left and right. Something must have been in the water supply.

  • I had a patient throw some underwear at me.  Fortunately, they didn't hit me.  I do hope they were clean...they looked it, but I wasn't investigating them up close and personally, though.

  • I made a medication error.  Fortunately, it was the same family of medications so no harm, no foul to the patient...and in the tradition of "it worked out for the better" med errors, it did work out for the better for the patient.  Still no excuse though.

  • One sexually inappropriate patient on the intensive care unit got attached to me for some reason. I offered him 1mg Ativan. It didn’t even take the edge off. I had to call the doctor to get him 2 mgs of it plus a haloperidol chaser. That worked for the first day. Next time I see him, he follows me on the unit and says he wants to smell me. I’m not working on that particular unit at that time, so I can’t give him any meds. But I can damn well set boundaries.

  • I arrive on the unit one day and walk right into a code:  a  patient is cutting themselves.  Fun.  Secure patient, start paperwork.

  • I had a patient bitch all evening about how their foot hurts. I call the medical doctor and get the order to send the patient to the ER. Patient starts to bitch about having to go to the ER. I tell patient that they have been whining all day about how nothing was done for their foot and now they have the chance to get it looked at, so do they want to go or not because I have other things I need to be doing.  Patient opted to go...good thing too based on what they found.

  • For the first time, I got to see a patient being restrained.  I do understand that it is in the best interest of the patient, in order to prevent them from hurting themselves and others.  At the same time, to have to order someone to be strapped down--or to just even witness it--is very unsettling.

  • The patients fought over the television. I informed them that the prior shift had laid down the law about it and unless ALL parties could amicably come to their own terms, I was enforcing last shift's law. Everyone who came by the nurses station bitched to me about either not being allowed to watch their program, or having to deal with the others bitching about them because they wanted (and got) to watch something else. One threatened to check out AMA but backed down when I told them if that's what they wanted, I'll get the process started.

January 24, 2010


My workplace is actively recruiting again, particulary for more core staff.  Of course, I'm getting edgy again over whether I (as PRN staff) will get enough hours.  This happens every time my workplace starts advertising...and every time so far I've had no reduction in hours.  If anything, I keep getting called to do extra.  And I have to keep reminding myself that I can only work the shifts that I put in for, and I can't work any and every shift because my life precludes that.  Then I calm down for a while.

I am relaxing about it more.  This month I hit 5 months' in towards the infamous "first year."  After 6 months' working, I think I have enough leverage to compete against new grads, as well as some of the necessary experience to compete against experienced nurses, should I decide to look elsewhere.  I'd rather not leave here though...while it's not the ideal workplace, it's flexibility is suiting my needs perfectly.  Also, I still have a lot to learn about psych nursing and I'd like to keep developing my skills.

I received a complement from one of the senior nurses.  I was on the intensive care unit when one of the female patients lost it and started threatening a male patient who she perceived was harassing her.  She stalked off to her room, the other nurse and I followed because we were hoping to get her to take a PRN.   Other nurse asks her what's wrong and the patient screams "I'm going to scratch his eyes out!".   Other nurse says nothing to this and we're all standing there, so after a bit I say, "tell me what he's done that you want to hurt him."  I get her talking for a minute or two...I can't say I entirely defused her because at one point she suddenly jumped up from bed and started towards the door so purposefully (she did have a history of aggressive behavior) that other nurse and I scampered back.   But she was calmer, and I told her that she should avoid him and we'll keep him away from her, and not to pop anyone but see us first.  The other nurse said that I used my therapeutic communication very well.

Bipolar to form, the patient was happy and smiling and talking to the object of her wrath a few minutes later.   A couple hours later into the shift she got riled up over him and started down the hallway towards him cursing and screaming when she saw me, stopped, said "I'm going to go to my room" and did just that.  

"Good idea," I told her.   Granted, I was holding a syringe in my hand at the time of this wasn't for her--it was a scheduled medication for another patient.  But I guess she drew her own conclusions.

Therapeutic communication isn't exactly like the book says it is...especially in detox.  Detox patients sometimes need to be asked "why" and to hear things from your own experience.  Of course, my experience isn't from the addict point of view, but from the family member of an addict one.  But there are several staff that are former users and when a patient complains "you don't understand", can honestly reply "I do" and relate their own experiences.  Detox patients also can't stand to hear things reflected back at them because many perceive it as your being condescending or mocking to them.  Instead, you have to find a way to help direct their reflections towards the truth, and then tell them what they need to hear...which isn't necessarily what they want to hear.

Though truth be told, I have not been up on detox lately.  This is aggravating some of the other nurses there because they want me up with them--I'm pretty good on detox protocols and know the territory.  I don't know guess is that some of the core staff who normally work up there are complaining about being floated elsewhere, so they're working to accomodate them.  This means that as PRN, I get floated more.  But it's all good--I don't mind the change in scenery because it keeps me from being bored as well as gets me more exposure to psychotic patients.  And to be honest...the workload on other units is usually a lot lighter than it is on detox, so sometimes being floated elsewhere feels to me like it's a day off with pay.

January 19, 2010

A new perspective

I've been working on the resumé and updating my application at the local hospitals.  No, I'm not planning to leave my current place of employment...I just thought it'd be nice to have my resumé kept current for when I need it.   And I figured that I'd freshen up my hospital applications just in case they're actively recruiting for eager psychiatric nurses.   I have to say I felt a rush when I was updating the applications, because I can now put down real acute care RN experience (in addition to my volunteer) experience,  as well as put down the RN-BSN program.   I'm still technically a new grad until August though...but I'm getting there.  And hey, if they want to get in on the ground floor with me, here's their chance.

When I was updating, I did see that Number 1 hospital did have an opening in psych that would be up my alley and I wouldn't have to quit my current job...but I didn't apply for it.  I thought about it, and decided that I wanted to get at least 6 months' experience in before I go and start looking for anything else, even a per diem job:  I want to have a stronger knowledge base and more developed skills before I go interviewing, so I don't look like a new grad deer caught in the headlights.  And besides, there will be other opportunities there, I'm sure:  they just don't have a psych unit, they have an entire facility for it.

It's nice to be able to look at the hospital websites and the job listings without this pressing feeling of urgency or the "I need to find a job, I MUST find a job" attitude.  Nor do I look at the websites and feel a sense of rejection because they won't even look at my application because I was a new grad.  Nor is there the "I've applied for this a month ago and was turned down, and yet you're still advertising it--was I truly that atrocious in your eyes?" feeling.   Instead it's "let's see about working here in the future" or "wonder what they would offer me next year when I do have that experience" or "they're still advertising it, perhaps now I have a shot."

I opened up the paper the other day and was reading an article about someone who died.  The name didn't ring a bell...right away.  It wasn't until talking to someone at work that I realized that the deceased was once a patient there, that I worked with him when I was on his unit that day, and that there's speculation that the death may not have been of natural causes.   It was saddening.

January 13, 2010

Let's play "Name that Psychaitric Drug!"

I'm getting a handle on the drugs...I know most of the detox ones (wonder why?), the benzos (again, wonder why?)and several of the common psychosis ones, and I can usually see the generic/brand name and know what the other one is...but I don't have the drugs down as cold as I'd like to.  I really want to know exactly what they are used for and why.  Also, I know nearly nothing about the ADHD/stimulant or other medications. 

So I decided to go "back to school" a bit and do some self-study.  I will take one drug a day (OK, every few days) and take 10-15 minutes to review it.  Basically, I want to be able to know off the top of my head generic/brand name, uses, general dosing range, how to give it, when to/not to give it, side effects and what type of cheese it would go best with.  After all, I don't want to be giving the right med with the wrong Cheddar.  Maybe I'll really go back to school and make up a flash card for it.

Meanwhile, statistics promises to be interesting.  I have to write a paper (!) for it.  On what in God's green earth am I going to have to write a paper about for a math class?!?

January 8, 2010


I don't particularly feel like going into work today:  the weather's blah and I feel blah.  But go in I must.

Once I get my exact school schedule for this semester, I may have to change my work schedule around so I can accomodate it.  Right now at work, I'm set through the end of January.  The first class starts Monday (online) so hopefully there won't be anything that requires me to show up in person this month; then once I get my class schedule, I'll shift my work schedule to accomodate test/quiz/in-person dates.  I started thumbing through a Statistics for Dummies book to get a jump on things.  I also received my graphing calculator yesterday, and cried a little because it looks so damn complicated to use.  But I'm sure I'll figure it out...I hope.

I also admit that I'm thinking about scaling back my work schedule a day every other week or so.  Don't get me wrong:  I still enjoy my job very much...but the excitement of "I'm finally a nurse, I want to be working!" is wearing off, and I'm beginning to miss the downtime I guess I took for granted while I was in school the first time around. 

But we shall see.  I also think that a lot of my blah-ness is due to getting back into my usual schedule after a few weeks of decreased hours and holiday revelry.  After a couple of weeks, I'll be back to my usual eager-to-work self.

Lately I've been feeling some med-surg twinges again.  I realized that of all of our class and of most of my nursing school friends/contacts, only a few of us didn't do med-surg after graduation.  Two went to dialysis, one to LTC, one to home health (she kept the LPN job; the HH job is strictly for her to get her year's RN experience), and two (one being me) are in psych.  But everyone keeps posting about their med-surg experiences...and it makes me wonder if I am indeed missing anything by not being there.  

I get to do a lot more with the patients in psych than I can in med-surg:  they're all walkie-talkies, so I can focus on their mental issues and not whether their chux needs changing.  So I know what I'm not missing from med-surg:  the blood, guts, poop, grunt work, essentially being a skivvy...which unfortunately is a good part of med-surg.  I accept that.  But I know there's more to med-surg than that--nurses do a whole damn lot of procedures in med-surg. 

Anyhow, if I really want to enter into med-surg, I could get a PRN job somewhere, or wait until I finish my BSN and jump in then.  I think these twinges will pass...though something tells me that taking out my NCLEX review book and textbook and just brushing up on med-surg things is a good idea right now. 


January 4, 2010

New year, and back to the books

I do like the promise of a new beginning that New Year's offers, but I don't really make New Year's resolutions.  Well, I kind of do, but I don't list them out and say "This year, I will..."  I tried that once last year:  on a journaling website, I had joined a group where we all made a list of 101 things to do in 1001 days.  I made my list, and before the month was out promptly forgot all about it as well as my poor journal.  Now, I know that I've done some of the things on that list...definitely not all 101 though.  But it just confirmed to me that I'm not a New Year's Resolutions List person.

Instead, I go into the new year with general ideas of what I'd like to achieve.  I do better that, I'm not 100% there either, but at least I don't put pressure on myself to try to tick off items on some written list.  Or even to come up with a list in the first place.

One thing that I've had to be firm on myself with though is my yarn crafts.  I have far too much yarn:  over 50 miles' worth.  Yes, I tallied it.  So I had to put down in print that I was not buying any new yarn until I made substantial inroads into knitting or hooking up what I have.  At least a few miles or so.

It's funny:  I've graduated, and here I am back in school.  I went to my local CC to pick up my textbook for a class and the woman asked me if I needed to get a student ID.   That reminded me to look for it...and fortunately, I found it in my glove compartment.  I haven't changed hair is darker now than it was in the picture, but that was because I stepped up a shade level in the hair dye. 

I also saw that it still had my student nurse name tag attached to it, which was promptly removed.  I'll keep the name tag as a memento.

I've lined up the next few classes towards the pursuit of the BSN.  I have Stats and Patho for this spring.  More Patho and Assessment are for the summer, possibly with Public Speaking (if necessary, I'll roll Public Speaking over to spring 2011).  Diversity, Information and World History are for the Fall. 

I'll worry about 2011 later.  If all goes well, by Spring 2012 I've got my second nursing degree. 

Then, who knows?  No more school for a while after that, though--I'm certain about that.   Otherwise...maybe I'll stay in psych.  Maybe I'll go to med-surg for a while.  Maybe I'll land in another specialty.  Maybe I'll do all of the above.

Though I have to admit...I kind of like being a student.  It's fun to be able to learn.

Work is taking some readjusting, as it always does after prolonged time off.  I had nearly another week off for the holidays, so to get back into the routine is always difficult the first couple of days.  Fortunately, they've seen fit to leave me on detox...which I always enjoy despite the workload.  Lately, there's been enough medical issues going on to keep things interesting.

January 3, 2010

Hello, 2010

Happy New Year to you too. 

Work tried to call me in, but I resisted.  Granted, double-time would have been a nice perk...but I wanted the time with the family.   The extended family is gone now--they left this morning--and it's nice to have the house back to ourselves.  Back to the usual routine starting tonight.