December 29, 2012

There's no denying the belly

Hope everyone had a good holiday.  My family left last night to return to the East Coast after two weeks out here, so this weekend is all about rest and recuperation.

And jump-starting this little-one-to-be as he's been quiet all morning.  I'm not concerned yet as mornings are not usually his most active time, but I will be monitoring him to see that he does get going; otherwise, it's off to L&D we go for a checkup.  So I whipped out the V8 Fusion and downed a large glass, then got back into bed to type and wait for some activity.

He's 32 weeks tomorrow.  I figure I have one more month of freedom before it's baby watch time.  Not as though I'll get much sleep in January...haven't sleep through a whole night since August.  Oh well.

Being a nurse this time around the pregnancy ride has definitely made this pregnancy go smoother, at least mentally and emotionally.  I was so anxious and nervous with the first one, panicking over any little thing...I ended up going to the hospital several times to make sure all was well with the little first one.  This time, even though the risk is higher (and the first pregnancy had its own risks to begin with), I'm much calmer about things.  Not ignorant or unconcerned, just calmer about how I handle them.

My weight is up 24 lb.  As I mentioned earlier, I kind of knew that keeping it under 20 wasn't really going to happen, but at the same time, there was no need for me to repeat the 50+ lb. gain of the first one.  Funny enough, I now weigh more than I did when I delivered the last time, but I actually look smaller and better.   Brassiere size still in the black hole know the minute I find and buy more 38DDs, the chest will expand overnight.

We hope he's in the head-down position, but I really can't tell as the blows are coming from all sides simultaneously.  I'm giving birth to either a future gymnast or Cthulhu.  I've already decided that if he's not head-down or if he's more than 9 lb, C-section.   

Ah, some movement.  Little-one-to-be is waking up.

In other news, my current facility posted a few positions that I would love to apply for a transfer to.  Of course, they do it now and not when I'm not pregnant.  Day ICU part-time and per-diem, day detox per-diem, day residential detox per-diem, psych/med day part-time, facility registry...alas, if weren't for this belly, I'd apply.  But I can't apply for them knowing full well that I wouldn't be able to start working until May at the earliest.  *sigh*  And they know I'm pregnant so it's not as though I'd be able to hide it.

Actually, most of the facility and patients know.  There's no denying the belly at this point, even if I wear dark colors.  Now staff I don't even know are leaving me chocolate and pretzels.

December 21, 2012

So we're still here

As I told someone else, I go by the calendar printed on the Oreo cookie, and there was nothing on there about an apocalypse.  So I wasn't too worried about today.  Still, it's nice that the appointed time has come and gone, just to be extra sure.

In other news, I'm being wooed by a major hospital for their behavioral health program.   Not an agency, but the hospital itself.  If it wasn't for the fact that I'm 8 months pregnant as well as fairly happy with where I am working now, I'd seriously consider it.   But I'm not planning to make any career changes for at least the next several months...once the new little one is a few months old, then I'll look around and contemplate other positions as well as possibly other organizations.  If they're still interested in me at that time, then we'll talk.

It's very flattering though:  I feel all warm and fuzzy...and gigantic.  Apparently the baby-to-be is on a growth spurt.

December 15, 2012

Christmas party at work this week.  We played parlor games...and it's rather entertaining to watch psych staff play "guess the celebrity."  Most were identified by their psych issues.   Don't ask any of us what their latest movie is or who they're married to, but tell us their personality disorder or CD issue, and we're all over it.

Interesting fact:  Anakin Skywalker/Darth Vader meets most criteria for a borderline personality disorder diagnosis.  Vader's my favorite Star Wars character, so I found this intriguing.  This meant nothing to the men in the family other than it made them want to watch the Star Wars movies...again...

Sometimes my family just doesn't appreciate psych.

Senioritis:  2, Meriwhen:  0.  For history class, I have a test and a last entry to finish up in the next 8 hours, and I'm waffling on both.

December 13, 2012

The results are in

It's not preeclampsia.  And while we're here, I passed the glucose screening.  What a relief on both counts.

Now I just have to shake this senioritis and work on the final paper and exam, both for History class.

December 9, 2012

In 6 hours, the first digit of my age will change.  In the U.K., it's already changed.  Here in California, not quite yet.

I may be awake for the actual moment, as I am so far behind on my history coursework it's ridiculous--I really need to catch up tonight.  It also will not help that the other half wants coffee right now, so a pot is percolating as I type.  And I can't resist fresh coffee.

That's all, really.

December 7, 2012

I dropped off the jug this morning--I drove it in nestled in a bag of ice, strapped into the front seat.  First I had to drop the little one off at school, so I'm sure more than a few people who walked by the truck were wondering what I was doing with a biohazard container on ice buckled into the passenger side.

I will never take peeing for granted again.

Off today as I wrap up some history homework.  I'm kind of glad I'm off today.  The hospital's new grad residency program has started notifying applicants, and quite a few of them who had worked for the hospital chain--some for years!--found themselves told, "sorry, but no..."  And for some, it wasn't their first go-around on the wheel.  If nothing else will convince you that working as an internal employee is no longer the guaranteed lock on a new grad job, this will.

The mood in the hallways is probably going to be somewhat dark for a while.

December 6, 2012

So here I am with a gallon biohazard jug and 16 pounds of ice...

24-hour urine collection day.  Thank God I'm off because don't see this really happening--successfully--while at work.  So today will be spent working on my group project for history class, working on the rest of my other homework, and collecting my own body fluids.

For those of you who aren't nurses or medical professionals, the goal of this collection is to determine how much protein, if any, that I am excreting via urine in a 24-hour period.  If I excrete 0.3g of protein or more, I may have preeclampsia.  They'll evaluate that plus my blood pressures before they give me an official diagnosis.

Hopefully, all of this is for nothing, that we'll find out that I only have gestational hypertension or--even better--the nursing student from yesterday was wrong about the high blood pressure reading in the first place, the weight gain is just the new little one's way of making up for lost time, and I really need to put the salt shaker down.  It still wouldn't explain the vision issues I've been having...but that could have a variety of other causes.

That being said, I did a little refresher reading up on preeclampsia because I believe in hoping for the best but preparing for the worst.

Mild preeclampsia can be managed at home...the literature says bed rest and possibly medications.  I read that as "stop working" but that I don't have to chain myself to the bed 24/7 because the old little one still has needs that need to be met.

Moderate to severe may require I check myself in for more hands-on management by medical professionals.  The good news is that I am within 2 miles of a hospital--I could even walk it if I had to.  The bad news...because we're military, it's not my hospital.  I can use the local hospital for an emergency, but should we talk extended stay, the military will want me at their place.  Should it come to that, maybe I could negotiate being farmed out to the local hospital...but I'm not going to think about that yet.

If I were to have preeclampsia, the only cure for it is delivery.  I'm currently at 28 weeks:  if I were to give birth today, it wouldn't be great.  The kid would have a fair shot at life, but there's way too many risks that he a.  wouldn't make it or b.  would have developmental issues from being born so early.  The goal according to the literature would be to get me and little one to at least 32 weeks.  Going longer that that would be far better--they would try to get me to go as far towards 40 weeks as we could.  But at least at 32 weeks, his odds of survival without issues are much better.  Also, they can prep him to mature his lungs.

Again, not really going to think about that yet either.

Ended up going in yesterday for half a day, for admissions and to orient a new nurse.  Patients are commenting that the baby belly has really popped out of nowhere.  Staff keep bring me pretzels and peanut butter cups.

Going to have some coffee, get to homework, and try not to think about sausage and egg sandwiches...because I've been craving them lately, and I'm trying to watch the sodium intake.

December 5, 2012

Student woes

Not me as a student, but me dealing with nursing students.  As a patient, no less.

I had two student nurses (one prelicensure, one nurse-midwife) at my most recent OB appointment.  Pre-RN student was a train wreck:  poor interpersonal skills, manner less than professional, kept calling me "hon" and was more excited that she was able to get a normal blood pressure reading on subsequent attempts than she was concerned about the high blood pressure on the first--and correctly done--attempt.  She was so nervous and hyper it wore me out.

She meant well, I'm sure...but if this is what the local BSN program is turning out for nurses, God help us who live in this area.  Hopefully she is not representative of the whole.

Nurse-midwife student was better and more professional for the most part, but her demeanor still screamed "student."  Went through the motions of feeling how the baby was positioned, and still missed the location of heartbeat by a lot.  Reviewed some history in too much detail--seriously, did she really need to hear again that resolved issues from 2003 were still resolved?  Meanwhile, she glossed over other history which was more pertinent to my condition, such as my history of hypertension, psych issues and fibroids.  After telling her that I spent the last six weeks with difficulty walking to due to sciatic pain, she still chided me for not exercising as much as I should have.  She was WAY too focused on giving me education to hear my concerns about my blood pressure, vision issues and sudden weight gain (6 lb in 2 weeks can't all be salt).  They were addressed with her remaking "well, it's the holidays, and if I stepped on the scale myself my weight would probably be up too."

I explained that a.  I started the pregnancy overweight,  b.  I have not increased my food intake, and c.  perhaps if they weighed me on the same scale they usually used instead of the one in the students' room, she may see my concern, especially if she's telling me that "there's such a big difference between the two scales."  Especially since this scale had a fully-clothed me weighing more than 5 pounds less than a naked me weighed on my scale at home.  And yes, my home scale is well-calibrated and pretty damn accurate.  

In the end, I did get a preeclampsia screening out of her.   She agreed that it was better that we get baseline data now.  And better I get it done and told, "no preeclampsia, nothing to worry about!" than for the alternative to happen.

I didn't have the heart to tell either one I was a nurse.  I think I may have freaked the Pre-RN student out and made her even more nervous if I told her that.  I think the nurse-midwife may have figured it out when I used medical terminology fluently.  Yes, I'm a psych nurse, but I can speak medical nurse pretty well.

Oh well.

Slow working for a while.  I called out sick on Monday, off yesterday, today is pending whether they need me.  Thursday is off, Friday and Monday were taken off as I have birthdays to celebrate.

December 3, 2012

There are days where I worry that my taking time off to have the baby, especially in this job market, will seriously impact my career.  Then I see the latest message from a recruiter or agency dangling a shiny psych job in front of me, and I feel better.

Just hormonal and under the weather today, don't mind me.

December 1, 2012

So I bombed my third history test

Well, I didn't fail:  I got a 76.  But I earned that 76 because I didn't really study for the test.  I tried to, but over the last few days, every single time I whipped out my notes to study, I fell asleep.  I swear, these notes were a better sleep aid than my old med-surg textbook.

It also didn't help that the last two weeks at work were hectic:  both resulted in OT.  Actually, the whole month was straight 5-day work weeks because I was covering in not one but two programs.  I did have pockets of downtime so I was able to do some schoolwork at work.  But I would get home from work exhausted, cook (or usually order) dinner, help the little one with his homework, pass out, and wake up at 0-dark-30 to do it all over again.  All while doing this with sciatic pain which--thank God--has eased over the last week, to be replaced by a new pain that at least lets me walk.  Lather, rinse, repeat.

All weekends were spent doing family stuff, trying to rest, and trying to stay abreast of schoolwork.  Last weekend, I was too busy catching up on rest to get a jump on any assignments or even the reading.  I was too tired to do anything except sleep...and that is even a challenge thanks to being nearly 7 months pregnant.  I can't recall the last time I slept through the night...I know, I know, it's preparation for when the baby does arrive.  So I'm not entirely worked up over not sleeping well.  But that plus work plus school makes life hard.

After this month, I am really grateful that I withdrew from the other class.  I think that REALLY would have done me in.

Anyhow, the history test was due today and I kept trying to study this morning without success (but with one nap), until I just accepted the fact that it's just not happening.  I figured that I better just go take this test, get it over with, and let the chips fall where they may.  And they fell on 76.   When I clicked "start test" I accepted there was a risk I'd muff this test and I was OK with that...but I am still a bit disappointed because you know 76s on tests is not how I roll.

The overall desired grade of B is in no danger at this time, as long as this is my only misstep.  I do worry a bit as there's a group project coming up that could do some major damage, especially since I don't seem to be part of a very enthusiastic group.  An A is still very much possible, but I'm trying not to stress over that.  I keep reminding myself that the world will not end if I get a B.

Fortunately for me, my health and my academia, work will be easing up:  starting this week I revert back to my three afternoons a week.  I also plan to take off a good portion of time around the holidays to enjoy them and the family coming to visit.

November 22, 2012

Attack of Cluster B

In terns of personality disorders, Cluster B leads the pack as being the most prevalent.  Of Cluster B, borderline personality disorder is the most common, followed by antisocial personality disorder.  Yet lately, I am coming across more patients with narcissistic personality disorder.  It's getting to the point that they are keeping pace with the top 2.  Cluster B is common in dual/addictions as well as in eating disorders.

I haven't seen (yet) a patient with two cluster B diagnoses.  I've seen those with Cluster B and Cluster C (usually obsessive-compulsive, sometimes dependent, never avoidant) but not often.  Never seen Cluster B with Cluster A...which is understandable in a way:  I can't really picture a borderline schizoaffective patient or a histrionic paranoid patient.  A and B just do not seem to mesh.

So anyway, the Cluster Bs have been coming fast and furious in both of the programs I'm working in.  I decided to treat myself to an early birthday/Christmas gift and get "The Personality Disorders Treatment Planner" in order to stay on top of things.  It's a great book for those who have to deal with personality disorders on a regular basis, or even the curious who'd like to go beyond the stereotypical presentations of personality disorders.  Because there really is far more to personality disorders than the image of angsty teenage girls cutting themselves while railing against the world.

Happy Thanksgiving if you celebrate it, Happy Thursday if you don't.

November 11, 2012

Pregnancy 2, Meriwhen 1, History 0

Let's get my victory out of the way:  for the last couple of weeks, my weight has holding steady.  Lest the cries of "but you're supposed to..." start coming out, I should explain that I was already overweight at the beginning of the whole thing, and because of that, my doctor wants me to keep the total weight gain around 20lb.  I'm currently at 14.2lb up.  I'm not dieting, just not overindulging and "eating for two."  Though someone better start taking the leftover Halloween candy out of the secretary's office, especially the peanut butter cups.

I'm also not expecting to land under or even exactly at 20...but that doesn't mean I have to end up at 35 either.

I don't advertise the fact that I'm pregnant, and there's still a few people that are truly surprised when I tell them I'm six months along.   Most nursing staff know and so they keep me out of codes (and I admit  being a little chagrined at that, but I understand they're concerned about me and the baby).

But when patients--who I definitely don't tell--start congratulating me out of the blue, it's safe to say that the pregnancy is becoming more noticeable.

Unfortunately, I am now burdened with leg pain.  Right now it's a muscle-ache, like I've been going to the gym too much (and I haven't), but I'm worried it's going to become the debilitating sciatica pain that I had with the first little one.  I'm already having occasional difficulty getting out of my truck...and even though it's smaller, I can't switch to the other half's truck because it's stick.  I can drive a stick.  I detest a stick in this traffic.

Then came the inevitable brassiere shopping.  Last pregnancy, I didn't hit porn star-esque sizing until just before delivery.  This time around, it's happened a lot faster.  Perhaps that's why some still aren't noticing the belly.

I needed new brassieres that fit, so I took the family to the store and spent the morning determining my new size.  I am now a very annoying size...annoying as it's hard to find the size.   38DD.   Most of the regular brassieres top out at 38D, whereas most of the full-figured sizes start at 40D.  38DD is the black hole of brassiere sizes...guess goes pretty well with my size 10.5 foot, which is the black hole of shoe sizes.

I did find a couple of 38DDs (literally just two of them!), but relented and also got a few 40Ds.  They don't fit perfectly, but they're serviceable enough, and I'm going to keep expanding anyway.

I haven't crossed the high score of last pregnancy just yet (42F), but I'm pretty sure I will at least match it.

The drama in History Part 2 rages on.  Not long after I posted about all of the classmates complaining about the course, the professor finally stepped in to tell them that the class has been this way for three years, the director of the history department is well aware of the class--in fact, they were part of the design team-- and that their energies would be better spent either working on assignments or deciding whether to stay in the course.  That silenced everyone, including the one very annoying classmate who wasn't actually complaining, but instead was taking the sanctimonious "holier than thou" approach as he/she reprimanded those who were complaining.

Peace was not to last...a few days later, there was a rash of complaints about the quality of the week's videos.  Then another violent outcry, this time the complaints of people getting penalized for not completing the plagiarism tutorial.   Problem:  a lot of them didn't read the instructions for correctly completing the assignment.  So essentially it was their own faults that they got penalized...but they still raised holy hell in the help forum.

At least here the professor stepped in faster to deal with it.  Apparently some of the class were writing nasty e-mails to their instructors, and so the professor decided to put a stop to things right away.  I can't say I blame him.

Still, that doesn't do much for lowering the drama quotient.  I wonder what the next blow-up will be over.

November 3, 2012

The ways of substance use

One thing I love about working in addictions and recovery is that I learn something new about substance abuse every day.  Lately, it's been how people are abusing substances.  Some of the most memorable ways, I can't post because I risk running afoul of HIPAA.  Which is a shame because yesterday I learned a beauty that actually had me running for my reference books to see if it was REALLY possible to do the drug that way.  I mean, the patient was doing it that way for more than a decade...but was it really affective for a high?  Maybe it was effective enough for the patient to keep doing it like that.

Let's just say that many substances that are originally meant to be oral aren't always used orally.  A lot go up the nose.  Three years ago, I never would have dreamed that I'd be asking a patient on alprazolam (Xanax), "how much are you taking, and do you swallow or snort it?"  Now I routinely ask even my non-CD patients that.  Apparently you can get a good high using ground-up benzos and opiates intranasally.

Injection--usually IV but occasionally IM--is also popular for PO/sublingual meds.  A few of them use PO/sublingual meds rectally or vaginally.  You'd think that was just a hospice thing, but nope.

Transdermal patches;  not just for the skin.  In addition to placing fentanyl and other patches in covert places to avoid detection (don't ask me where I've found some of them), sucking on them is a popular way to get stoned.   There's also apparently a way to extract the drug by needle for a IV/IM/PO dose, but I haven't figured out how that'd be possible.

Good old THC:  smoked as well as noshed on.  In fact, there are cookbooks devoted to the art of cooking with marijuana!  Out of curiosity, I downloaded one:  the Stoner's Handbook.  Apparently the key to successful (read:  effective) MJ consumption is fat:  because THC is fat soluble, whatever you cook it in has to have fat for it to be absorbed in the GI tract.  I did find a mac and cheese recipe (with bacon!) in there that I'd like to try, except that I'd have to cut out the ganja butter and substitute Land o' Lakes.

Alcohol is alcohol:  it appears the best way that works is PO.  Haven't come across a single patient that tried to IV/IM some whiskey or Coors' Light....not yet anyway.

I tell you, addictions/detox is never dull.

November 2, 2012


Yet more RN-BSN stuff.  If you're sick of the saga, feel free to skip--I won't be offended.

I decided to drop Vulnerable Populations.  I got hold of a course syllabus and saw way too much work...well, not too much if it were a class on its own.  But with History Part 2, working and pregnancy...I can't do it.  At least not successfully and keep my sanity.  I may as well go back to working inpatient while I'm at it.  I also got hold of a Research course syllabus just to see if I'd do better in swapping the classes and taking that one instead, but again:  the extent of work involved for the class is intense.

Since if I was going to drop it'd have to be done today, I spent the whole morning (while I should have been studying for my history test) weighing the pros and cons of everything.  In the end, I decided that having my sanity for the next four months instead of being an insane, overstressed git was far more important than taking a second course right now.  And I have come to some terms with the fact that even if I were to give birth early, it may be too much for me start taking classes right in February anyway.  So the odds were good that my graduation date was going to be pushed back anyway because of the new little one's arrival.

So I logged in and dropped it.

I have to admit that I feel a sense of peace.  I do feel disappointment, yes:  in fact, I am VERY disappointed that I will have to push things back even further.  But I also feel peace.  I was worried about how I'd get through November with working full-time for at least half the month plus tackling the history class.   I've spent the last few weeks dwelling on this (in case you didn't see it in my prior posts).  The past week has been the worst as I've been debating with myself over it.  

Now I can look forward to the later part of pregnancy without having to stress about juggling two classes and an increased work schedule.  I can start knitting for the little one.  I can relax and rest while I can before said little one's arrival.  I will be able to enjoy the holidays and my birthday and not stress over multiple assignment deadlines.  And I can take the last two classes and Capstone during a period where I'll be working less than I am now, if I haven't yet gone back to work.  Taking class without working at the same time--now THAT would be a real treat.

I may even be able to appreciate this history class more.  Though I still wish the drama would get resolved.

History Part 2 Drama, Part 2

It continues on.  Students protesting that the course is too unfair, it's too much work, they should have been warned to take it alone, that they would have taken it at their local CC, that they would have tried to take the CLEP exam and test out of it.

Meanwhile, the instructors remain eerily silent...too silent.  Not only are they refraining from comment on the vent threads, they are not answering ANY of the help desk questions at all.  And students are spazzing over the some of them with valid questions (i.e., questions not related to the course drama).


I'm definitely staying out of the drama.  To be honest, it's starting to be quite the distraction.  I go to the help forum looking for updates and hints--as we are instructed to check this forum daily and first for the latest information--and all I see is the angst and tension from the students, and the lack of input from the instructors.  Many have written that they've dropped the class that was going to start next week just so they could focus on this one.  And truth be told, I'm starting to reconsider that too, especially given that work is picking up.  More on that in a minute.

At this point, I'd consider just aiming for the C.  Consider.  But despite my talking, we all know I'd die before I ever took that drastic of an action.  Even those readers who know me very well are laughing internally when I write that I'm settling for the B.

In other news, I'm gearing up for this month at work.  Between the holidays, a couple of people needing some personal time off, and one program getting so hectic that the regular nurse can't cope anymore, I'm getting more hours than I can shake a stick at.  I'm working full-time two of the four weeks this month, and for the other two I've been told to come in early to be there just in case they need the extra body.  At least I can bring my schoolwork with me and try to stay abreast of things during the downtime.  But one of the reasons I dropped the outpatient for now is because I didn't want to work every day.  And here I am, working every day for at least half the month.

Yes, I know, I could have said No.  I am per-diem, after all.  But given that I will be not working for a while after the baby is born, I want to keep relations with my primary employer as sweet as possible, so I have a job to return to after the birth.   Plus it couldn't hurt to stockpile some money while I can.

November 1, 2012

Well, ****

Overall, an unremarkable day at work.  A very unusual admission that I wouldn't be surprised had an Axis II in there somewhere.  A few patients showed up in costume.  Some nurses wore holiday-themed outfits but no costumes per se.   Me?  I wore all basically, I wore what I usually wear.  I was glad not to be working inpatient that evening though...full moon plus Halloween isn't promising for a psych environment.

History Part 2 is turning out to be like History Part 1, except with far more reading.  There's already several threads in the class's Help forum complaining about the workload.  The syllabus states that the course should take 12-18 hours a week.  The reality is that it takes at least twice that.   Not a single one of us (and I've heard from many) can do all of the assigned in their suggested guidelines.  Even if I cut corners wherever I can (for example, I only read the textbooks and not every single primary reading), I'm still clocking 24+ hours myself. Plus all of us are working at least part-time, and many of us are taking at least one other class.  So there are a lot of grumpy campers in the lot.

Surprisingly, only one instructor chimed in, and it was a sympathy post.  The rest are silent.

I've refrained from complaining since I'm nearly at the end of the RN-BSN program and I just want it over with.  Also, I have limited options as to taking it elsewhere.  I'm also not very grumpy or frustrated about the class...I guess because I've been through History Part 1 so I know in general what to expect.  I have an idea of what they are looking for us to do in the assignments.  I'm also spurred on by the fact that it will be over in 6 more weeks, and that will finish off all of the non-nursing classes.  And I've already given up on the A, and I haven't even taken the first test yet.  

But with all of this activity in the History department, I did think about moving Vulnerable Populations to the spring session.  There's a 5 week session right before the baby is born (literally, it ends on 2/17) and I figured I'd slide it in there and take the chance that the little one arrives right on his due date.  Well, that particular class isn't offered on that date, so I'm stuck taking it with History.   Oh well, I guess it'll be all right.  I survived History Part 1 along with Older Adults and Management.

To make matters worse, the next session for Research (and Vulnerable Populations if I wanted to postpone it) starts on 2/25.  I'm due on 2/24.  So my planned Research class will be started possibly while I'm in postpartum recovery...that's assuming the little one arrives on schedule as planned. 

And just to ice the cake, the Research and Vulnerable Populations classes are offered again until the summer session.  So if I miss the 2/25 session, I'm stuck waiting.  And waiting. 

Well, fuck indeed.  

It's so damn frustrating to be this close to my BSN and have to face the possibility of postponing it even more.  I'm still stinging over the fact that had I paid attention to my class schedule last spring, I wouldn't have missed the deadline for the government class, I could have stuck to my course map, and I would have been taking my Capstone class in January.  At least Capstone is offered nearly every five-week session.

I have to put this all in perspective though.  Short of a scheduled C-section (not likely at this time) or planned induction (more likely:  my last pregnancy would have seen me induced at 39 weeks had I actually made it to that day), there's little I can to regarding when the new little one is born.   Except Let Go and Let God:  I'm praying for another early labor.  But whenever little one arrives is when he arrives, and if it turns out that he arrives on time or *gulp* late, that's when he arrives and like it or now, I'd have to skip the class.

The other reality is that as I'm recovering from childbirth, I may not be ready to take on a class for those first few weeks.  I'll probably be exhausted and crawling out from the baby blues.  I may say that I'm all for starting my Research class one week after childbirth.  After all, a week after my first little one was born, I had family in and was already working on holiday shopping (albeit as a tired and emotional wreck.  I did it though).  This time around, I'm several years older.  Overall I'm handing this pregnancy better, but what about the actual childbirth itself?


Maybe I should just intentionally postpone things and focus on low stress now and post-partum recovery later...but I can't bring myself to do that.  Not after nearly four years of trying to get this degree done, so I can move on to the next step in my career.

*sigh* indeed.

October 31, 2012


Work today...I wonder how many patients will be going in wearing costumes?

October 30, 2012

If you were affected by the hurricane, I hope you are safe.

My parents are OK.  No power, lots of trees down, some buildings in the neighborhood damaged and surprisingly, no street flooding, given that they live one block away from the mandatory evacuation zone.  Subways are flooded though so my mom isn't going to be going to work anytime soon...hopefully she won't get too stir-crazy in the house.

As for me, the leg still hurts and I'm bored of being at home.  I do have to limp out for groceries as the cupboards are bare, but that won't be for a few hours.  After my coffee, I'll tackle my history lectures, then the grocery store.  I'm trying very hard to be back up to full speed so I can go back to work tomorrow.

October 29, 2012


Muscle pull, rest for two days, keep the APAP coming.

Just called off of work.  I suppose now I have no excuse not to be up-to-date on my history homework.

In which Meriwhen is waiting on the nurse/doctor to call her back

No, it's not critical:  otherwise I'd already be in L&D.  Unresolved unilateral leg pain that came on Thursday, is minimally relieved by analgesics, and is NOT a DVT.  Or if it is, it's a very atypical one because I have no other signs of a possible clot:  leg color matches the other, not warm to the touch, not swollen, and a negative Homan's sign (though we all know how reliable that is when it comes to predicting clots).

So I put in a call and now I'm waiting.

October 21, 2012

OK, I really have to stop this slacking

I decided that just now, I really needed to have copies of all of my CEUs together both for my license renewal next year as well as for my certifications.  So I just killed a tree in doing so.  Then I came here. I'm nowhere closer to getting my homework done.  It's also not helping that today it is actually raining here, so I'm excited.  I'd rather be outside on the porch, wrapped in my shawl and reading a book as the mist comes down.  Plus this is excellent napping weather, something which really appeals to me as a pregnant woman.

If it were nice and sunny, I'd have no problem doing homework.

This CEUs for California thing is a mixed blessing.  On one hand, I am forced to work on my continuing education, which I feel that every state BON should encourage to some degree.  My last BON couldn't give a damn about education.  Actually, it didn't seem like they gave a damn about a lot of things...that reminds me, I need to renew my license for that state as well.  Bah.

And to be honest, with maintaining the ANCC certification (and possibly obtaining the CARN certification if I decide to jump for it), I easily rack up 30+ CEUs in a year...and not all of them have to be psych!  Only 51% do.  So it's not as though taking the CEUs is big inconvenience to me.

On the other hand, I have to maintain paperwork for 7 years.  I have memberships at and NursingCenter so that covers a good part of the CEU cost, but l still have to pay out of pocket for the really good CEUs.

Four days of work this week:  two half, two full.  It'll pay for the next nursing class that I need to register for...and a whole bunch more of those darn CEUs.


I am SO unmotivated to work on my management homework.  Two assignments due Monday morning...and since I have a very early OB appointment tomorrow, I don't have the luxury of staying up late tonight.  So if I were intelligent--which I like to think that I am, at times anyway--I'd be doing all I can to get this stuff done ASAP.

Well, no.

Almost done with the shadowing assignment.  Overall, shadowing was disappointing...not through the fault of my nurse leader though.  The timing just wasn't in the cards for me to get some good experiences in.  The other assignment involves handling something according to Texas' Safe Harbor law.  What a beautiful law, wish we had one of those out here...but hey, we have ratios so it's not entirely bad.

I just can't force myself to sit down and do these two assignments.  I am just not in the mood.

Meanwhile, History Part 2 is held up through technical difficulties on the part of the school, so I pretty much have a free pass as far as that's concerned today.  Still, I'd at least like to get my hands on the syllabus so I can start entering all the due dates into iCal.

Oh well.  Back to the grind I (try to) go.

October 18, 2012

I traded in one of my old physical assessment books, which covered most of the cost of the additional textbook I have to buy for the next history class.  I only had to lay out $5 when all was said and done.  Yes, I did have the option of e-book access which would have cost much less...but we all know how I feel about e-books that aren't on Kindle.

Oh well.  I keep telling myself, "May 2013:  BSN, RN."  It's almost over.

I discovered that the APNA now offers a mentor/mentee service.  I can sign up looking for a mentor to assist me in my psychiatric nursing career, or I can volunteer to serve as a mentor for someone else.  I can go to the website, plug in all of the criteria that I am looking for, and poof:  they will match me up with potential mentors/mentees.

I don't think I am experienced enough just yet to serve as an effective PMH nurse mentor.  So when I get all of my homework done, I'm going to sign up as "Mentee seeking Mentor."  It'll be interesting to see if anyone wants to take me under their wing.  Maybe I'll even find one in my area.

October 11, 2012

It's my week off of work.  I got three separate requests asking if I was available to work this week.

Granted, it is October, month of Halloween.  Unfortunately, I am working on Halloween, but given that it's outpatient that day, it shouldn't be too crazy...still can't risk wearing a costume though.  Never a good idea to wear a costume when working in a psychiatric facility.

Remind me to check when the full moon is so I can NOT work that day.

October 10, 2012

Fall finally arrived

Well, California's version of fall:  73 and partly cloudy.  While I'm not quite digging out the wool shawl just yet, I'll take whatever I can get.  I'm glad I'm off today, even though I'm chained to the computer.  I have the windows and the screen door open to catch the nice breeze.  The little one is at school, so the house is tranquil.  Even my history paper has become less of an ordeal...OK, knowing that I've pretty much got the B has helped with that more than the weather has.

It's nice to be able to switch the A/C off for a while, especially since only last week it was in the high 90s, even 100s.

Got to spend the morning with my sister and my two nephews.  Her five-month old has transformed from a grumpy angry baby (GERD, colic both to blame) to an entirely different baby altogether.  He's now smiles and laughter and eager to show off his mad rolling skills.  I could not put him down...well, I did when I wanted to see him show off his mad rolling skills.  It's kind of gotten me excited for what I'll have in store with my own baby...granted, it will be at least a year before he's in the mad rolling skills stage.  But I have to admit I'm getting more excited about his impending arrival.

I thought about postponing the last nursing class of the semester until next year, so I could just relax and  focus solely on History Part 2 for the rest of the year.  But unfortunately, the next time this nursing class is offered is right around my due date, and I can't risk the timing.  Oh well.

Back to my's not going to write itself!

October 9, 2012


All my outstanding history assignments have been graded...I've officially passed the class.  I am currently 20 points out from a B, which between two assignments, a paper and a test should be no problem to accrue.   This is good, as this final paper is driving me to the edge of madness.  I'm half-tempted to say "screw it!" and not turn in anything...but I can't bring myself to do that.

October 8, 2012

Every time I debate about whether I should go and get some non-psych experience, I have something that happens at work that reminds me of why I love psych.  It was a busy week but very fulfilling.  Started shadowing my nurse manager and got some good experiences for my project.  Saw a few new psychiatric presentations who were assigned to great MDs who did not mind my asking them questions.  I had a couple of problem children that I felt like I was really able to make a connection with.  While I'm no fool and I know I haven't solved their addiction issues once and for all, I was able to get both of them the help they needed right now.  And I got invited by a unit to work on it.  It's a nice unit too...I told them after I have the baby, I will apply at the first job posting they list.

Some moments of frustration though, such as one doctor who thinks they're God and acts like a complete jerk, and a few patients who'd go missing whenever I'd need to find them for whatever reason.  A couple of fake urine attempts (I just sigh, log the test and let the staff know).  But overall a good week.

I also saw someone with a .35 BAC that you would swear was as sober as a monk under a vow of abstinence.  Functional, did not act impaired in the least, didn't even smell of drink.  But something about the patient triggered the doctor to call for a breathalyzer test.  So I swooped in...and the doctor and charge nurse were just as surprised as I when we gathered around the breathalyzer to see what the result would be.  If it wasn't for the patient's past (and well-known) ETOH history, I would have sworn the breathalyzer was in error and done a retest.

So now I'm off for a few days.  Which is good as I have several major school projects this week.  History Part 1 wraps up, thank God.  Besides the usual assignments there is also a comprehensive essay and the last and thankfully non-cumulative exam.  I should get the official word that I've passed the class in the next day or two, depending on when the last set of projects are graded.  As long as I pull a 50% on both the essay and final, I should have a B.  I refuse to think of what I'd need to get an A:  if it happens, it happens.  So I've decided to focus on the exam because all through the class I've done better on the exams, and not kill myself over the essay.

Meanwhile, in management, I have a presentation and a weekly assignment due.  Fortunately, it's not due until Monday; since all of the history stuff is due by Saturday night, I have all of Sunday to work on this project.  I don't plan to procrastinate on it though.  I did some preliminary research last week for the presentation; I'll start beating drafts together this week.

Then next week, it's just management class and shadowing.  The week after is the final week of management and the start of History Part 2.  Week after, just History.  Then after that, the final nursing class of 2012:  Vulnerable Populations...which rumor has it is probably the hardest and most unfair class in the program.  But I try not to put too much stock in rumors.

The end of this BSN feels like it's finally coming in sight.

September 29, 2012

Where did this baby belly suddenly appear from?  I've gone from zero to 5 months pregnant overnight. Most of my wardrobe no longer fits.

September 27, 2012

Did a little digging around about things to do with my career after the baby and graduation.  Found out about LTACs from another forum administrator...which is the most appealing path to me since there's potential there for me to learn a lot in the LTAC setting.  I also like that it will be less of a revolving door, since these patients will be around longer than your usual med/surg patient.  It won't be easy, but I knew that.  If I can find a LTAC that will do 8s then I'll be in heaven; otherwise maybe they'll consider me for doing 12s on the weekend, so the better half can tend to the kids and I don't have to worry about childcare.

Said administrator recommended I look into IV/lab drawing certification to boost my chances, which is a good idea since that's been my weakest area ever since school.  To date, my average in IV placement and blood draws is .000.  Granted, I've only had one attempt in school, so it's not as though I'm a colossal failure with a needle and a vein:  I just never seemed to land a chance to do one in clinicals despite my (and my classmates') efforts.  Also, in acute psych there really isn't a demand for IV placement, and there's often a separate lab service if we do need to draw blood.  So maybe instead of that refresher course come spring, I'll start with a phlebotomy course and go from there.

The other thing I found was training programs through another hospital chain.  They offer training for experienced and new (to the specialty, not new grad) nurses to train in OR, ICU, women's health and ED.  OR doesn't appeal to me.  Women's health, God no (not me at all)., not really what I want but would be interesting.  ED would probably be the easiest for me to get into because of my psych background--after all, the medical ED is where we in psych get a lot of our patients from.  But I can't say I see ED as my future though, and the fact that I don't have a lot of medical nursing background is also a strike.

The LTAC sounds better.  I think there's more to learn there and it may be easier for me to get into.

But this is all for down the road.  Mind you, I could apply for the next batch of training programs this fall and if accepted start in March, and I was sorely tempted to do that...but there's two problems in that.  Problem 1:  it may be too soon post-partum, depending on when little Timmy arrives (if you're a Shaun the Sheep fan, you'll get the reference).  Problem 2:  I will not have the BSN yet--I will have two classes to go.   And I have delayed this degree long enough.

Or I could just continue in psych where I know I am happy.  They recently posted the psych float pool position.  I didn't apply for the same two reasons above, as well as the fact that I'm getting enough in outpatient for right now.  But I know that position will be back up in the future:  I've already seen it twice since I started working at the hospital.

Decisions, decisions...which I am trying not to make now, instead focusing on school and pregnancy.

Tomorrow should be interesting at work.  The census is down at work, but the kids we do have are feisty ones.

September 26, 2012

The best laid plans...

Shadowing is off.  My nurse leader is still sick...I didn't know that he was out all week with something, but apparently he's still not feeling any better.  At least I got the text before I showed up at the meeting.  I sent my well wishes and asked if I can talk to him over the phone today or tomorrow, whenever he is feeling up to it, so I can get part of my assignment done.  Then I'll just have to figure out something over the next three weeks...shame my schedule is going to be hellish for part of that time, but I'll manage something, I'm sure.

I highly suspect this is because I went clothing shopping yesterday.  I will bet the farm that had I not gone to find a maternity shirt--or had been unsuccessful in finding one--he would have been feeling a hundred times better.

Oh well.  Can't do anything about it, really.

So now I have a day off--in addition to no shadowing this morning, I was cancelled for this evening since census is low.  Plus, I have been on top of my coursework so except for one assignment due today, there isn't anything that I have to do...or even planned to do since this day was already written off for schoolwork because of shadowing and work.

I'm planning to lounge for half of it, and do schoolwork for the other half:  let me try to stay ahead of the academic game while I still can.  And I'm going to returned that ruched shirt today as well.  Even under the cardigan, it's still a no-go.

September 25, 2012

Whoever invented ruching for shirts should be shot.  Seriously.

It only looks good on the size 2 pregnant woman.  I am not the size 2 pregnant woman--I look like the remaining 90% of the female population.  The shirt fits in all the wrong places and does nothing to flatter the baby bump that has seemingly appeared out of nowhere.  It looks really good on that size 2 pregnant model they show who has neither hips nor ass.  But only on her.

I did find a decent enough sweater and a really nice cardigan.  I also bought one of the damned ruched shirts because I figured I could layer it under the cardigan, where it won't look half-bad.  Pants did not work out at all because the Target maternity line is based around size 2 pregnant woman (again, the no hips or ass).  For those, I will have to go to a bona-fide maternity store.

But overall, part 1 of the mission accomplished.  Working on part 2 now since the textbook has arrived.

Outpatient offered me four hours later on today.  Since it'll be no-brainer work--I can even bring homework to do in the downtime--I may very well say Yes.

The Shadow

I started my leadership class.  I have my nurse leader to shadow and I start...tomorrow.  Didn't exactly plan on starting that soon, but it's probably better in the end, given my schedule over the next two weeks.  Plus, he is someone who actually enjoys mentoring and said that tomorrow would be perfect for me to start...I'd be insane to let this opportunity pass by!  So today I need to prepare for this so I don't come across as a darn fool.  Prepping my notes, getting my game plan all ready.

I have to go buy a business casual maternity shirt.  By some miracle of God, I still fit into my non-maternity slacks AND look decent in them, so I don't have to stress about pants.  Though if I do come across a nice pair in my maternity shirt shopping travels, I may get them since tomorrow will not be the only day that I do this.  I also have to pack my scrubs to take with me because after a morning of being The Shadow, I have to go to work.  I could wear the same clothing, but no one would recognize me.  Trust me, I'm not kidding on this.

I'm also waiting on my textbook to arrive.  It happens to be the same exact textbook that I used for a nursing leadership class in my first ADN program..but in a cruel twist of fate, the book they want is the 8th edition...I have the 6th.  One edition off isn't too bad; two editions off and too much as changed.  So I ordered it Saturday...expected delivery today.  I'll work on my History homework as I wait for it, then hit the store, then lunch, then shadow prep.

At least the leadership class is all projects, papers and discussions.  No tests to study for, which is a nice break.  Especially since I'm still in the midst of the History class from Hell.

I have to admit, school has been a lot more manageable since I gave up the inpatient job.  It's almost bordering on enjoyable.  It's still a lot of work though, and a lot of my time goes into work for one class or another.  But I don't feel as overwhelmed as I used to.  My mood has been better.  The family has commented that I have been happier.  The little one especially is happy to have me physically and mentally around more.

September 24, 2012

Career musings

Not too long ago at work, I had a long talk with an experienced nurse (30+ years) about what I should do when I grow up.  Said "crusty old bat" (inside joke) has done it all, psych and non-psych.  So I figured that I'd take advantage of her expertise and ask her what she thought about my career plans post-baby and post-graduation

She asked if I liked psych.  To which I replied that I love it, but that part of me feels compelled to go try medical nursing for a year, both for the experience as well as to affirm that psych is where I want to me.

In her opinion, the refresher course--and she had taken it so this also comes from her experience--was a waste of time.  In the course, I'd spend three months of clinicals being a glorified CNA (just like in clinicals!) and that I shouldn't expect a job to come directly out of it.  She added that where we are currently located, there is a very high concentration of foreign nurses (Filipino, Asian, Mexican) and breaking into units/facilities that are mostly staffed by foreign nurses--and that is a lot of them--is not easy as they tend to favor other foreign nurses.  Like it or not, that is the reality.   

As far as working in the medical end itself, she said not to be surprised if I find myself coming back to psych sooner than that year is up.  All the horror stories of medical nursing are indeed true, even in some of the best facilities.   And speaking of facilities, she warned me off of one that I had been considering working at in a psych and/or medical capacity (this facility has the option to do both).   It would be one of the easiest ways for me to break into medical nursing, but apparently it's not very well-run, management is a mess, some of the managers have impossible standards, and turnover is very high.  For the record, she is far from the first person to warn me off of this place, so I am seriously taking that into account.  I have to decide if the risks are worth the benefit.
And last, she asked, if I am good at--and happy with--psych, why leave my area of expertise?  Why not  remain happy?

She did understand when I told her that I wanted to experience all of this for myself.  She didn't deny that the medical experience would be helpful.  I guess a small part of me feels unfulfilled if I don't give medical nursing a go.  She did give me some good advice about how to go about it if I do decide to.

Also, she advised me not to stop at the BSN, that I need at least a MSN.  I explained that I am undecided between education and nurse practitioner.  The practitioner would mean more money but also having to go for a doctorate degree.  She did suggest that I go for a clinical nurse specialist (CNS) role--that would only require a masters--because that would also lead to better income.  However, the trend has been towards phasing them out so that may not be worth it in the end.  

So she gave me some things to think about.  Of course, no action will be taken until after the baby and graduation, but it's definitely things to muse over.

September 22, 2012

I have pretty much given up all hope of an A in this class

Surprisingly, it is a not a nursing course, but US History, Part 1.

The class is poorly organized.  The readings are overwhelming in number.  Lectures are often of sketchy quality.  The online resource that they use for the classes is riddled with glitches, and often their videos, links. etc, are non-functional.  Assignments are not easy to find, that is if they are posted on time.  Then the assignments have minimal guidance or instruction:  make a PowerPoint, write a letter, work on a project.   Some instructions, right?  I'm not expecting spoon-feeding but a little more structure would be nice, especially when I'm trying to meet grading criteria that I know nothing about.  It is only when students start asking questions in the forum that all of the details--including what they are looking for--are revealed...and that's often near the deadline, when most have already submitted their work.  Grades from the instructors is frequently very late:  I have assignments from two weeks ago that are waiting on grades!  Last and most is often absent.  No explanation of where you went wrong or why, just that you went wrong and better luck next time.

So if I don't get an A on this course, it's not for a lack of trying because I'm doing all that I can.  Right now I'm holding onto the mid-90s, but I see that fading fast.

Fortunately, I will NOT be having this instructing team for History Part 2.  I hope.  The professor will be different, though I have no idea if the assistants will cross over.  I hope not.  I can't even hope I get a different assistant because this does not seem to be a good batch at all.

What is really a shame is that the material itself is exceptionally fascinating.  I just have to slog through Hell to learn it.

Oh well, 3 more weeks...just have to make it through.

September 18, 2012

Since I couldn't sleep last night, I pulled out my knitting (still trying to finish the blanket for my nephew) and watched The Curse of the Golden Flower.   You know what irked me about that movie?  

Spoilers below if you haven't seen it.



No one ever called the Emperor on the gradual poisoning of the Empress.  I mean, he was a grade A bastard:  tried to kill his first wife and her family, so he could marry the Empress, kept the first wife's son and told him that she died, ignored his third son in favor of the other two, then when he found out the first wife was alive tried to kill her and her new family...granted, the Empress and the three sons were no angels either.  But even after they found out, no one ever went up to his face and said, "I know what you're doing to the Empress."

Excellent movie but left me feeling unfulfilled.  Oh well.

Lazy day of schoolwork planned for today.  

September 16, 2012

As much as I hate to do this, I've come to the realization that something has to give.  The pregnancy is knocking me out.  School is knocking me out.  Two jobs are knocking me out.  So it basically comes down to this:  either give up the inpatient job, or postpone school.  Either one I cut I'd resume after the baby's birth.  I decided that of the two, I can handle school more easily than the second job.  So I've haven't given the agency any hours...actually, haven't done so in over a month.   I've only been working outpatient, which has been busy enough that I bring home a decent paycheck.

It turned out to be the better decision:  taking history and a nursing class together has been brutal.  My days off of work are spent chained to my computer.  Plus, I'm far less likely to be caught up in a violent code at the outpatient job, so there's less risk of danger to myself and the baby.

Plus, I'm so close to finishing this degree that I could almost taste it.  After this semester ends, there will be just two more classes left, and I have to take them separately so there will be no masochistic doubling-up on my part.  The thought of having to extend school any more than I have is painful.  I'm tired of not having the BSN.  I'm tired of being in school.  I'm tired of having my job options limited.

And I'm tired of feeling like the odd one out at nursing association meetings where everyone is either an APN or in school to be one.  Meanwhile here I am with my little ADN (of which I am not ashamed of), as well as being one of the few bedside nurses with any degree...and while I'm learning a lot from these meetings, I also feel terribly out of place.  It's funny:  at the meetings they talk about how they can get more bedside nurses to attend, but during these meetings they talk mostly about advanced practice nursing issues.  I see very few bedside nurses with repeat attendance at meetings. Go fig.

Anyhow...since stopping the second job, I am feeling a lot better.  I'm not as tired as I used to be, though I do sleep a lot more than usual.

I've had to adjust my diet so I can still control the weight gain.  I'm in my fifth month now and have gained 5 pounds to date...which may not seem like a lot but considering I was overweight to begin with, is actually par for my OB's plans for me.  I asked all my dietitians what I should do to keep pregnancy weight gain reasonable--a perk of working in eating disorders is easy access to dietitians--and they said to just eat normally.  So I'm not running out supersizing things or indulging in extra food because I'm eating for two.  I pay vague attention to calories but don't count them.  I just follow my doctor's (and the dietitians') recommendations.

I have to find a way to work in more exercise though.  Since I spend my days off chained to the computer, I am not as active as I have been.  And with the heat wave we've been experiencing, when I can be out for walks is limited.   But I'm going to try.  Maybe I'll start taking the dog for evening walks around the block.

August 28, 2012

The acuity in outpatient has ramped up dramatically.  I'm not sure if it's a comet passing nearby or something in the water, but the last couple of weeks have been off the chain.  It's not so much the increase in fact, admissions is a good thing as that means job security.  It's that some of our patients are coming in so sick or are decompensating so rapidly that we're having to send them inpatient.  We've even had to call several codes, which in outpatient is rather surprising.  Not many people show up to outpatient shows...I'm guessing because they think it can't be that bad if it's outpatient.  Also, I secretly think they don't believe they've heard it.  "A code....WHERE?"

ICU always shows and God bless them.  Everyone else...hit or miss.

In all fairness, the codes in outpatient are nowhere as volatile as inpatient codes, so it's not as though the entire hospital needs to show up.  Almost all the ones I've witnessed have been handled with minimal problems.  There was only one that I thought might really go south on us...fortunately, we were able to get the patient safely to the unit.

So between increased census, higher acuity, and staffing changes, it's been rather busy.  Plus the fact that on the days off from work, I'm up to my neck either in history or gerontology.  I don't think I'm going to see inpatient work until September at this rate. 

I was recruited again.  Another staffing agency contacted me after seeing my resume to discuss full-time psych nursing placement options.  I will decline for now--with school and the baby, I can barely give my first agency anything--but tell them that I will definitely talk to them in the spring.  Hopefully they'll still be interested in me for other things, but right now I can't give them anything.  I'm stretched pretty thin as it is.  

Such is life.

Mind you, I'm still seriously considering the refresher course/LTAC, M/S or SNF route after the baby.  As I was telling my new grad--who is actually no longer a new grad!--the other day, I want to give medical nursing a try to see what I'm missing...if I'm missing anything.  And a year's experience could only help me in my career.  Of course, it'll be a challenge finding a place with shifts that will work for me, especially with an infant, but I'll cross that bridge when I come to it.

August 25, 2012

Flip flop

I use Waze for navigation and dealing with traffic.  Depending on where I'm working more frequently, that site goes under "Work".  For a while it was outpatient, then it was inpatient...and now I just recently changed it to outpatient.  I'm scoring 3-4 days a week...the nice thing is that they're not usually full days either:  from 3-6 hour days.  But considering that I make considerably more at the outpatient facility than I do as an inpatient agency nurse, I'm not too upset.

It's been a couple of weeks since I've gone inpatient, and it may be three weeks, as I only have one unscheduled day next week and I'd prefer to keep that free to deal with classwork.  And even if I did put in that day, there's a good chance I'd be called off as they've gotten more permanent staff in--I've already been called off a couple of times....but since I was so exhausted, I didn't mind.  The pregnancy has been wearing me out.  I guess that since I escaped morning sickness, fatigue is my cross to bear.

Of course, if I wanted to pick up weekends, all I had to do is say the word and I'd get as many as I asked for.  But again:  outpatient, school, pregnancy, desire for free time...

Had to order some maternity scrubs today.  More of my regular tops are not fitting right anymore.  The scrubs and jeans are doing OK as long as they go under the belly, but that's not going to last too long.  Plus, with outpatient I can only wear scrubs, so I'd need some maternity ones anyway.

August 24, 2012

One blind sheep

One thing about the first week of classes is that I feel like I'm going into it kind of blind.  From the syllabus and assignment guidelines, I have an expectation of what the instructor wants in the assignment and what will be on the tests.  But it's not until I actually receive the graded assignment back that I know what the instructor really wants to see from me and what the instructor is really looking for in the exams.  So I'm not quite sure if I'm doing things right in the first week until I get that feedback.  I feel like that I have to just do my best and take a leap of faith, then learn from what I've done. 

That sounds remarkably similar to the advice I gave a member on a nursing forum who had wondered if they should be concerned because they didn't find nursing school to be as stressful as others and the PR have claimed.  I told them they really won't know if they're doing everything right until that first test, and just keep working hard.  Others said the same thing.

So, Meriwhen:  I need to take my own advice and apply to myself.  Kind of hard though since, for all my talking about how I'm going to try to be OK with the B, I'm still not really OK with it and want the A.  It's hard for me to get comfortable enough to take that leap of faith, since I'm trying for perfection (or as close as I can get) from the get-go.

Thank God for deadlines.  At least they force me to eventually jump.

August 21, 2012

The results are in, and...'s got 46 chromosomes!

(it's normal!)

...and pair #23 doesn't match!

(it's a boy!)

So much for attempting to study for history class this morning.  I've been letting the family and close friends know.

August 19, 2012


All set up for my next two classes:  U.S. History Part 1 and Older Adults.  History begins tomorrow.  Older Adults is actually going into week 2 of 5.  Week 1 of the class has been uneventful.  Really trying to make peace with myself about getting Bs...still going to work for the As, but with the way I've been sleeping--as in all the time, thanks to the baby--I'm not going to kill myself to get the As.

After how many years of taking classes online (7-8?), I have come to the conclusion that I can not deal with e-texts.  At least, not e-texts that can only be accessed from a computer only.  Reason:  too much scrolling and clicking per page.  If there was any way to get the e-text on my Kindle:  no problem.  I do well with texts on Kindle.  But this e-text for the history class is killing me because I read so fast and spend so much time moving the screen around.  I can't concentrate on the reading if I have to continually mouse up and down and sideways.

Do you want to know how much I can't deal with it?  The e-text was included with the cost of the Internet components of the course, which set me back about $90.  Highway robbery, I know.  I just dropped an additional $45 to rent a copy of the textbook for the next 16 weeks (same book for both part 1 and 2).  I had to.  I couldn't get past page 3 of the e-text without wanting to lob something at the computer.  It was either rent the text or withdraw from the course.

And yes, I spent several unsuccessful hours trying to see if I could somehow get the e-text onto my dice, not with the way it's set up.

Unfortunately, the book will not be here for a couple of like it or not, I'm going to have to try to be able to read the first chapters of this book, since there is an assignment due Wednesday.

Maybe the e-text will be handy for times when I'm at work and it's slow:  I can sneak a page or two here or there, instead of having to tote the textbook to work.  We'll see.

Last week of the first trimester.  This week I get to find out the test results...I hope.

All of outpatient seems to know about the pregnancy...I had to call off on Wednesday because I was still recovering from the CVS.  Well, it wasn't going to be a secret much longer anyway...they're all happy for me.  Lately I'm spending more of my time working outpatient...I've picked up the three days a week at the main outpatient site through September and will probably do so through October and November (not thinking any further ahead than that right now).  I'm also picking up the occasional 4th day at a second outpatient site.

Inpatient has dropped to 1, occasionally 2 days a week.  Enough to keep me interested as well as keep my foot in the door, but not enough to wear me out.

August 14, 2012

The CVS went well.  It was very uncomfortable and something I hope I never have to go through again Actually, I have no plans to ever go through it again because no matter the outcome this is the last pregnancy I'm having.   They had some problems getting to the placenta, but eventually they did and drew the tissue sample.  So within two weeks I will know.

Meanwhile, I'm enjoying the enforced vacation.  Neither job is as I've gotten calls from both inpatient and outpatient about whether I can work yesterday or today.  Oh well, they'll live.  I go back to outpatient for a stretch tomorrow, then back at inpatient next week.

August 10, 2012

A better counseling today

I had my genetic counseling appointment today in anticipation of next week's chorionic villi sampling procedure.  I got to see my family's health and genetic history mapped out on a 8x10 piece of paper.  It was a touch depressing...especially my side of the family.  Let's just say that though choice or chance, my family doesn't have the best health stock.  On the brighter side, I don't have a lot of risk factors for many of the genetic problems out there, so odds of the baby developing them are very low and would be due to dumb luck over genetic predisposition.

The two concerns are my age and the fact that I have an autistic child.  Age...well, the chance of any genetic problem goes up as one gets older.  For me the overall chances of my having a child with any genetic anomaly is 1/63, or just over 1.5%.  Of course, most fetuses with genetic problems don't make it very far in first place, so the fact that I'm still pregnant at this point is a good sign.

Autism...well, that could be genetically linked as well dumb luck.  Because of the little one, the counselor is going to ask my insurance company to cover a test for Fragile X, which is one (of several, alas) predisposing factors of autism and ADHD.

Of course, chorionic villi sampling doesn't catch everything--for example, neural tube defects.  For that, we're starting with bloodwork.  Then depending on the outcome of that, I may or may not have an ultrasound.  The ultrasound is already approved so if I do need one, no insurance worries.

So we shall see.  The procedure is next week.

August 9, 2012

Got myself into a spot of trouble at the inpatient job...apparently my sense of humor didn't go over well with a doctor, who got very miffed and reported me.  IMO it was nothing inappropriate but they still took offense.  So I was counseled, and appropriately so.  Can't say I was overjoyed about it, but I respect it.  Though I wasn't told who complained about me, it didn't take too much effort to figure it out...and I don't hold any grudge towards them.

Unfortunately, it's a curse of mine:  open mouth, insert foot--I've been struggling with it for years.  Fortunately, I usually only need to be told things once, so this won't be an issue again.

Oh well, live and learn.  It only serves to improve me.

August 8, 2012

Just finished a stretch of outpatient work at two different sites.   One day was so crazy it almost rivaled inpatient work...especially when we had to call a silent code.  However, the matter was resolved without incident.  I also found out that when working outpatient, I am not allowed to participate hands-on in any code--only inpatient staff can get hands on.  Which I suppose is a good thing given my current condition.

I'm also having quite a bit of outpatient work thrown at me.  I have the two to three days a week in my main location (combination of half and full days in various programs), plus additional full days outside of that, plus I've been requested more often at a second site.  I know this will ebb and flow and it won't last forever--it'll pretty much last until the end of the year before the nurse that went on leave returns and I lose the two to three days a week.  But at that point I'll be getting ready to wind the work schedule down myself.

It's also good because I'm going to be losing some agency hours.  The inpatient facility has started hiring on more staff and they've started cutting back on the agency nurses, both RNs and LVNs.  Plus a few other nurses who were on leave are expected to be returning soon, meaning even less opportunity to pick up work.  I haven't been cancelled yet but I know it could start happening to's been happening to other nurses, even the good ones.

It kind of sucks since I like working at that facility and the people I work with there.  I also felt bad that because of the outpatient work, I was giving the agency less hours as well:  only 1-2 shifts a week instead of 2-4.  But I guess that's one of the first rules of agency work:  don't get too attached to any one site because nothing is guaranteed.  And I'll admit, I little too attached to the place.  Time to start putting a little emotional distance in there.

I'm not attached enough to want to apply for a permanent position there...though perhaps that's why I am attached to the place:  I do have the freedom to come and go as I like, and to choose what hours I want to work.  So when I'm there, it's because I want to be there at the exact time I want to be there, and not because I have to be there.  And the difference between having to be there and wanting to be there can often put a whole different spin on one's outlook.  It can make insane working conditions a lot more tolerable.

Anyhow, for right now I can only give them the hours that I am able to give them.  If they can use me, yay.  If they can't, not the end of the world as I have the outpatient job.  Also, my agency could send me to other sites--they're trying to contract with some new facilities and did ask me if I'd be interested in some of them.  I was on the fence at the time they asked but I can always keep it in mind for the future.

August 3, 2012

Clothing and work issues

Classes finished.  Two As.  Talked to my advisor and I'm still on schedule to graduate in May.  Next class starts in 10 days, so I'm enjoying every minute of this time off while I can:  I'm sleeping a lot.

So I've been offered the chance to pick up more work in outpatient, as one of the nurses is going on extended medical leave.  I was offered three days a week.  I was supposed to start today...and I've already been cancelled due to a low census.  That is the nature of the per-diem beast, so I can't get too annoyed.

I can be a little annoyed though since those are days that I can be filling with inpatient work. So I told the manager that I'm cool with it if she has to call me off due to low census, but would really prefer to be called off the day before, so I could call my agency and pick up an inpatient shift on that day.

She had offered me a partial shift due to the short cancellation notice, but I declined it.  I decided I needed a day off to get some shopping done for the little one.  He apparently shot up overnight.  Still very skinny, but very tall...think J.J. from Good Times, but as a 7-year old blond.  Clothing shopping for him can be a challenge.

So can clothing shopping be for me, at least right now.  I'm 10 weeks into this pregnancy, and while my weight has been stable--actually, today I am down one pound from my starting weight--the waist is starting to thicken.  So far most pants are still working; shorts, not so much.  While I'm not ready for full-blown maternity gear yet, I did get some pants in a size larger, some panel-less maternity shorts, a couple of larger shirts, and belly bands.  Most of this I can also wear post-partum until I get back to my starting weight.

Fortunately, the expanding chest pushes the shirts out enough that as long as I don't wear clingy or tight fabrics, the expanding belly is still disguised.  Most of my scrub tops are still working for now.

I have my first genetic testing appointment on the 10th, and the procedure on the 13th.  I got a preliminary nutritional assessment...the goal is to gain 10-15 lbs, given my starting weight.  So I'm trying to be very careful about what I eat, to make sure I'm getting enough...especially since when I'm working inpatient lunch when is very hit or miss.  My bloodwork is good, though my pressure is I'm also trying to cut out salts.  Unfortunately, I've been craving Chinese food as of late.

I told the usual ER crew about the pregnancy.  They're all happy for me, but my charge nurse is already pulling me out of the hands-on codes whenever possible.  Not really an issue, I guess...and I guess I'll have to get used to that.

On one hand, I don't want to be treated any differently because of this pregnancy.  And in a way, I want to prove myself, that just because I'm pregnant doesn't mean my performance is going to suffer or that I will have to be coddled.  Let's face it, we all know and have encountered that one:  the little momma-to-be who puts her feet up and does as little as possible while expecting her coworkers to pick up the slack, because after all, she is pregnant and can't do anything more strenuous than lift up the phone.   

That's not me, and I don't want people to think that of me.

On the other hand, it's not just me anymore:  it's me plus one, so wrestling patients down to the ground shouldn't be on the top my to-do list.  I can take a few licks, but the kid can't.  And not all of my patients are happy to be where they are or happy to see me.  Fortunately, hands-on codes are very few and far between, and most patients, while they are not necessarily happy, are usually cooperative enough.

So I'll do my best to help out in a code, but I'll do my best to stay out of the hands-on--if I don't need to be up close and personal, I won't be.

Anyhow, I did ask them to keep it quiet for now because of the genetic testing.

A couple of ego boosts though:  all of the nurses said they would never have guessed I was so far along because I didn't put on any weight.  Also, that male nurse has started the harmless flirting with me again.  So I guess I must still be looking decent enough, even while pregnant.

July 26, 2012

Almost done...

From 55 assignments down to 1 remaining:  one last test in the Texas class.  

I got an A in the US government class, which honestly surprised me since the final was a 140 question bear.  I'm still stunned that I got 130 right, since I had about 30 questions that I had marked as uncertain and planned to go back to.  But I decided that it wouldn't really make much of a difference since I was willing to settle for a B (only needed to get 80 right for that), and didn't go back to them and just hit Submit.

I'm glad I didn't change any answers...I had most of them right.

The Texas class should also be a A.  This last test is only worth 12.5% of the final grade and I'm sitting on a 95 as it is.  I'd have to really tank it.  Fortunately, it's not a cumulative test.  So that one will take place on Sunday morning.

I'm so glad this is almost over.

Prenatal appointment tomorrow.  Not sure what to expect other than we'll be scheduling most of the genetic testing.  Probably no ultrasound this time around, though I don't know.  Now that I'm officially in the high-risk category thanks to being quite a bit over 35, they may do things differently than they did the first time around.

July 21, 2012

I caved

After having a house free of checked-out library books for the past several days, I finally caved.  I took out a few books today.  One is about high-risk pregnancy, the second is about pregnancy over 35.

The third is the Diary of Samuel Pepys.  Score!

Now that the term paper is over and all I have left are 4 tests (three regular, one final), I feel like I can finally get to reading fun stuff for a few weeks.  I have a whole Kindle-full of books waiting for some love, as well as a whole bunch around the house...except that I didn't have the Diary of Samuel Pepys.   Now I do, at least for a few weeks.  After I take one of the four tests today (the other will be tomorrow, then Thursday, then next Sunday), I may crack it open.

I also ordered a whole lot of yarn from my yarn, favorite online store:  KnitPicks.  After I finish the baby blanket for my now two-month old nephew, I have to start one for my own baby.   Plus booties, hats, sweaters, and all the other baby stuff.  Eight-plus weeks now...still feeling tired and sore but otherwise fine.  Weight is fairly stable, only up one pound since I found out.  Pants still fit, though my play-doh belly looks a bit doughier because what's underneath is pushing it out.  It may also be time to start shopping for new brassieres because my cups are starting to runneth over.

I can still keep up with the LVNs in running to a code, though.   And I never feel the fatigue at work.  I'm not sure at what point I'll call a time-out for maternity leave.  I'd like to work as long as I can, but again, I'm going to defer to the doctor's recommendations.

Next week is the start of the prenatal testing.  I admit, I feel like I'm tempting fate by working on baby gear so early.  I know that even at my age--which really isn't that old if you think about it--the odds are very much in my favor of having a healthy pregnancy.   The risk of miscarriage is pretty low now and once I cross week 13, will be lower still.  Granted, the CVS and amnio carry a risk of miscarriage but it's very small.  And to be honest, I'd rather know what I could be facing and so take that risk.

My little one is very excited about the baby.  Every time I pick him up from childcare, he introduces me to whichever staff member he sees and tells them that there is a baby in my belly that will come out in February.  He will tell anyone and everyone he sees about it:  at school, at the store, in the museum, while at the the rate he is going, there are probably villages in Mexico that know about the baby by now.

July 18, 2012

Term Paper Day

I have the day off (picking up a princess shift later), so I'm working on my term paper.  During the week I've been taking advantage of my lunch break and downtime at work (ha!) to get the other assignments for the week done, so all I have to do for the next three days is work on this lovely paper.  And since I work tomorrow and Friday, most of the paper has to get done today.

So the bulk of the first draft is done.  I have to research one more section and write an intro, both of which I'll try to get in before work today...otherwise after work.   If I can get that done, then the next two days can be spent revising, which won't be too bad.

I have to admit that I'm getting really good at APA.  I only had to look at the guidebook a couple of times.

July 15, 2012

The work week went well.  I fell back into inpatient fairly easily...only one late day because it was chaotic.  I spent four hours being harangued by a female patient who was not a happy camper.  But I chose to throw myself at the grenade...because if I hadn't, she would have went off and a code would have been called.  Better she had someone to focus her frustrations on--me--since even though she was shouting and verbally abusive, at least I was keeping her relatively deescalated.  And she did apologize frequently.

The doctor complimented me on my performance.  One of the other nurses--fairly new grad--was amazed that I kept calm and didn't lose it myself.  I told them it's what I'm here for.

I can't say I keep it together that well for every patient.   Some patients can do far less and make me struggle to keep control.  But I guess that was my daily miracle.

The next two weeks will be spent wrapping up the politics classes.  Remember when I posted the number of assignments I had to do for both classes (53 at first, turned out to be 55)?  I'm now down to 11.  There are 6 remaining for the regular politics class including a comprehensive final exam.  And 5 remaining for the Texas class including a paper due on Friday that I really need to start tonight.  I never thought I'd start seeing white at the bottom of my iCal's task list.

The ultrasound went well.  Got to hear and see the heartbeat, which was nice.  There's only one in there, thank God--I don't think I could handle twins at this point.  Blood testing started and next appointment set up for a couple of weeks.  Feeling less asymptomatic:  I've been more sore and tired lately, plus I've started having nausea.  Guess this pregnancy won't be as morning-sickness free as the last one was.

July 9, 2012

Back to the grind...

The mini-vacation of sorts went well.  We helped my sister and her family get settled into the area.  I've been away from inpatient for almost two weeks, so tomorrow is going to be a little rough as I get back into the swing of things.  But it should be fine.  And it'll be nice to get away from outpatient for a while as there's some drama, I'm not directly involved, but I am one of the ones caught in the middle of it.  Oh well.

Everyone is excited about the much so that I've been yelled at several times to not lift things, carry my older nephew, not stay up late, not work too hard or otherwise tax myself.   They're all rooting for a girl, especially since the first three grandchildren are boys.  Myself...I don't know what I want.  I admit that taking care of a boy would be a lot easier as it's what I know and what the other half (having grown up without sisters) knows.  But I don't really have much say in that matter, do I?

Anyhow, Wednesday morning is the first official appointment and ultrasound photograph session.   Wednesday afternoon is a training class.  So I'm just going to show up to the appointment in scrubs.

Of course, the big question came up...what am I going to do about work?   Other half is worried about me working inpatient while pregnant.  Family is worried even more and expects me to do the barefoot and pregnant routine at home for the next several months.

I explained that working in psych is actually far safer than a lot of specialties.  Even the psych ED is far safer than a regular ED.  A psych environment is more controlled, the staff are well-trained in deescalation and crisis, there is security and law enforcement up the wazoo, we don't wait for situations to explode before we act, and it's not like any random cartoon character can walk into the psych environment with a gun.  Whereas in an ED or a regular hospital floor...

Also, I wouldn't be one of the ones in the front of a code response.  That's what we did with the last couple of pregnant coworkers that we had:  they carried on their duties but should a code be called they were placed in the second or third line.  We'd even give the injections for them if they wanted.

Does this mean psych is 100% safe?  Absolutely not.  There's danger there, especially if one isn't aware of their surroundings and patient well as if one is foolish enough to believe that in such a controlled environment there is no potential for danger.  We may take away their weapons and contraband, true...but that doesn't mean they can't get creative with what they do have.

So long story short:  I plan to work until the doctor tells me I can't, and I don't plan to do anything stupid that could put me and the sprog at risk for injury.  Other half knows and understands.  Family knows...understanding is another matter.  Right now, I am trying to cut it back to 3 days a week max for inpatient, and 4 days a week total inpatient/outpatient.  I'll see how the pregnancy progresses.

Neither workplace knows yet.  They will know after the genetic testing is done, or if I end up in a situation and they need to know about it.  Until then, I carry on as usual.

I will admit that the time away from work--as well as the shifting hormones--made me wonder if I should switch to medical right now and work on that year's medical experience so I can get it over with.    I toyed with a quick refresher class, then picking up a PT or per-diem job in LTAC.  But I don't think I'll do it.  After the refresher class, my pregnancy will probably be more noticeable.  While they technically can't discriminate against me because of does make the non-pregnant candidate look a lot more desirable.  Plus, I like the flexibility of agency right now:  if I go PT or PD somewhere, I will lose that.  And I'd like to work at least PT, since I really won't get a good experience in medical pulling a couple of shifts a month.

And I want to finish this damn BSN first!!!!

July 4, 2012

Electrolytes and EDs and EDs

Happy Independence Day if you celebrate it, Happy Wednesday if you don't.

People, even other nurses, don't realize the severe physiological damage that an eating disorder can do.  They know the basics:  too thin isn't good, too fat isn't good.  And that's all they think there is to it.  They don't realize the stress that eating disorders can put on the body.

Electrolyte imbalances are a big one.   I remember sitting in Med/Surg 1 learning about electrolyte imbalances, thinking that they would be one of these things that I'd probably never use but had to learn anyway.  I did very well in it...perhaps it was hinting at my future specialty.

A lot of patients like to fluid-load in lieu of eating:  they drink massive amounts of water or soda (popular with the bulimics since the bubbles apparently aid in vomiting).  The problem is that fluid-loading results in dilutional hyponatremia, which causes decreased levels of consciousness and can even be fatal.  Remember the woman who died after participating in that "Hold Your Wee for a Wii?" contest?  Dilutional hyponatremia in action.

Then there's the kalemias:  hypo and hyper.  Hypokalemia from vomiting or diuretic use.  Hyperkalemia because patients decide to take supplemental potassium to counterbalance their vomiting or diuretic use.  Both screw with the heart and result in dysrhythmias.  If I had a quarter for every normal EKG that I've seen in a new admit...well, I could get a cup of coffee.  But that's the extent of it.

Hypomagnesemia from a poor diet...or perhaps it's the very common co-occurring alcohol addiction?  Either way, heart issues and muscle spasms.

Hypophosphatemia occurs when people starve themselves for extended periods and then start gorging on food...a.k.a. refeeding syndrome.  Can occur when you're trying to restart an anorexic/restricter back on a regular diet:  their system is so depleted that to take on a normal diet just shocks it.

And here you are thinking you don't use any medical knowledge in psych.  Silly you.

In other news...I went to the ED on Monday after work.  I had severe shoulder pain that woke me up in the middle of the night and would not let me get back to sleep.  It didn't respond to Tylenol, heat or massage.  So I slogged though work all day and was going to go home and take some cyclobenzaprine until I remembered one thing from Mother/Baby nursing classes:  shoulder pain could mean ectopic pregnancy and internal bleeding.  So after work I called my doctor who had me go to the ED.

Several hours of testing and waiting ectopic pregnancy.  The embryo landed in the uterus, is on schedule as far as size, and had a heart rate of 124.  So the diagnosis is shoulder pain of unknown words I heard all night.

I did find it disturbing that not once did they make any attempt towards pain fact, only one person ever followed up on it.  I did tell them about the pain, but it was 5 hours into the ordeal that a LVN offered me something for it.  She asked what I wanted and I told her Tylenol.  I was offered stronger stuff but I told him that I don't do narcotics.

Side note:  if you show up to the ED wearing scrubs, it's kind of obvious you're a health care provider of some sort.  All of nurses I had asked where I worked.  I told them I worked as a psych RN.  All of them said, "I could never do that."  Which was kind of gratifying to hear.

So after a long night, I went home and had that Flexeril...which did help a bit.  Two days later, the pain is finally easing up.

The brighter side:  now that we had that heartbeat, we were able to tell the little one the good news.  The little one was so excited he's started telling strangers at the airport about the baby that his Mommy is having.  So we let him tell my family when they arrived...and they are overjoyed.  We haven't told his family yet because they weren't home when we called.

And that's about all we're telling for now...we're going to wait until all the genetic testing is done and things are good to go before we go really public with it.  The first appointment is still next week.