February 29, 2012

Happy Leap Year Day

Enjoy it while you can, as it won't be back until 2016!

I made the mistake of not hopping right back on the RN-BSN wagon once the class restarted, and now I'm struggling to catch up with this week's assignments. This next section of the class is really ramped up--I was rather surprised to come back and see the workload multiplied several-fold. Unfortunately I also have the better half's parents here, so while I'm not working, I am entertaining...and can't really hole up with my laptop. I'll have to do what I can and cram the rest in during the weekend after they leave.

Off to the interview.

February 28, 2012

That was fast

I have an interview tomorrow for the per-diem inpatient position at my facility. Talk about fast: the nurse recruiter e-mailed me this morning saying she forwarded my information, and this afternoon I received a call asking if I can come in tomorrow to interview.

So I have to go in for the interview, then turn around and go to work. As much as I'd love to show up for the interview in my scrubs (they know I am working afterwards), I've gotten out the interview slacks and sweater. I hope the pants fit decently: I did lose 10+ pounds since I last wore them. And I could wear them to work if I wanted...I can actually wear business casual at my facility, even when on the units. I chose to wear scrubs since I feel it better identifies me and my role to the patients.

Back to the homework.

Less Ow

The pain has improved faster than expected, which is nice. I think I can ditch the bandages tomorrow.

I'm enjoying the time off, but it has its moments. My father-in-law is very opinionated and talks constantly. He likes to pontificate a lot as well. Fortunately, he is aware that he is opinionated and talks constantly, so he takes it in stride when I tease him about it. Today he was mock-whining about something and I told him that in this state it doesn't take much for me to have him 5150-ed.

But sometimes he drones on and on and on...fortunately, that is what my knitting is for. I work on it and it takes me to my happy place. I just zone out and tune back in when I hear a lull in the noise or I hear my name. I did manage to finish off a pair of socks last night and start the next pair.

The nurse recruiter of my current facility wrote me back and told me she's forwarded my info and good luck. I tell you, once you are in the system, nurse recruiters will reach back out to you. So we'll see what happens there. Nothing from the other per-diem pool job yet.

February 25, 2012


A per-diem inpatient position opened at my facility, so I leaped. I made sure they knew that I wasn't planning to leave the outpatient side, but just wanted a few shifts on the other side of the locked door. We'll see what happens.

After a long stretch of shifts, I am off for a week (except for one evening). It'll be nice to have some downtime, especially since the better half's parents are visiting. The little one is ecstatic to have a fresh audience.

And especially since I ended up having impromptu outpatient surgery again. Seriously, I seem to inspire this urge in doctors to remove things from my skin whenever I go for skin checks. One growth was simple enough to be removed in-house by my GP (and no worries, it's a benign growth). The pain is manageable with ibuprofen 800mg Q4-6h and should be better within 3-4 days. But working out at the Y is out for a while.

The other suspicious mole will be dealt with by a dermatologist because it's on my face. Mystery freckle that appeared since my last skin check session. GP also suspects it's benign but give my family history, better to be on the safe side and have the specialist check it out.

And yes, I wear sunscreen day in and day out. I've been wearing it pretty consistently since the age of 16. But as my GP told me, we can do everything in the world to protect ourselves and these things will still happen.

Down another pound...12 lb gone so far since Boxing Day. I'm not sure what progress I will make with my in-laws here because they love good food and drink--plus I can't go to the Y or do anything too strenuous--but I'll try my best.

February 20, 2012


Forum poster: What motivates you to go to work each day?

Me: Tequila

Seriously...I don't drink tequila. I go to work because I'm never bored there. And I'm not...even on a slow day, something happens to make it challenging. I learn something new every day.

The workouts are going great except for the Reynauds. I'm still trying to figure out how it's getting triggered.

I found out my class instructor was also a psych nurse, which is nice. Sometimes I really do feel alone in the world...because I usually only encounter other psych nurses in psych settings. I rarely see them in class with me, and when I run into a nurse on the street, psych nursing is usually not in their job history/description. If anything, the words "psych nurse" cause them to look ether terrified or disbelieving, as in, "you're wasting your life as a psych nurse?"

I won't deny there's a stigma about being a psych nurse...like we're the inmates running the asylum. Not all of us are crazy, thank you. You do have to be a little crazy--and have a big sense of humor--to survive in psych. But we're not all coming to fix our own mental problems. Some of us fell into the specialty. Some of us were called to it. Not all of us are on the couch and taking SSRIs and recovering from various addictions. A lot of us, yes. Not all of us.

Or the misconception that psych nurses aren't real nurses. I always think of that and laugh to myself whenever I take report from the ED nurse who sounds absolutely terrified of my-soon-to-be patient and feels that the only two ways to treat them are drug 'em and/or restrain 'em--no middle ground. Little do they know that if they sat down for five minutes (just five) and talked to the patient, there's a good chance that the patient's night won't end in restraints or an Ativan coma. Of course, not all patients will be simple to take care of...but a lot of nurses (not just ED), as soon as the learn the patient has a psych history, are quick to brush them off.

There's a lot to psych nursing...it just doesn't involve tubes and IVs. We're treating a different part of the patient: the mind. For that, you can't rely on a tube or (in most cases) an IV. You rely on you...and a few good psychotropics. But believe it or not, the answer isn't always just drug them up and forget about it. The meds alone won't help the patient...at least not for the long term.

And for the record, not every difficult patient is a borderline personality disorder patient. That actually irks me, that people are so quick to slap on the "borderline" label at the first possible opportunity. Patient disagrees with the nurse? Borderline. Patient changes their mind about something? Borderline. Patient tells nurse one thing and doctor/family something else? Borderline.

Reality? Maybe...maybe not.

Anyhow...the state APNA conference is coming up, and I'm looking forward to going to it. It'll be cool to hang with other psych nurses and get a chance to network. I actually met the APNA president not too long ago...in fact, she was the first person I met in the room: she came up to me and introduced herself as Marlane. Later on I found out it was the Head Kahuna. Pretty cool.

February 18, 2012

Ahhh, the weekend

Long, busy and yet satisfying week at work. I oriented in a new program and they already requested hours from me, so now I am floating among four outpatient programs. I've had to create a separate calendar to keep track of where and when I am working. Today, I plan to do nothing. Tomorrow, just continue relaxing. Monday...back at work as nurses don't get holidays off. I'll take the two days off.

I've also seen many textbook cases of Borderline Personality Disorder this week. I'm still working on my rapport with the one Borderline case I wrote about a while ago...she's not exactly opening up to me, but she has thawed a little because I was able to assess her most recent bout of self-injury. She still remains guarded and I don't push it. I accept the fact that I'm not always going to have a rapport with every patient that crosses my path nor can I force one to develop. But I try to at least let the patients knows that no matter what they may think of me and our relationship (existent or non-existent), I'm not their enemy--I'm there to help them.

I did decide to apply for the per-diem psych nursing job at another facility. I'm not terribly interested in making a career there as I'm very happy in my current facility and don't plan to leave it. But currently there's not much inpatient per-diem work going on, so I figure it couldn't hurt to keep a net in two pools. We'll see what happens.

I've decided to pass on the entry-level non-psych position for now. First, I'm not too thrilled with the facility itself as it has a mixed reputation...not in terms of quality of care--that reputation is good. But I've heard a few horror stories about working there. Second, the position in question is full-time nights, which is not really want I want right now. That schedule would conflict with my current working hours...and working nights there, days at my current place and working on the BSN would just be too much.

So I'm letting the opportunity go by. Perhaps next year, after the BSN is completed, working nights would be more appealing.

Weight loss was minimal this week. But I'm still under 200 so I'm pleased.

February 13, 2012

Stuff and stuff

I have finally broken 200! Granted, it is by less than half a pound, but I feel like I've scaled a mountain. I am now 11 lbs down since Boxing Day...still have a long road to go, though. Working out on the elliptical has helped...except that my Reynauds gets triggered after 40 minutes and I have to stop to restore circulation to my toe. I'm deciding if I want to hit the Y today. I went yesterday and could use a rest day, plus the little one is off school today and wants to snuggle up and watch Marx Brothers movies. On the other hand, with my work schedule I may not have much opportunity to get there this week. We'll see.

So I'm now in the feast stage of work: I'm working every day this week, including a double of sorts on Wednesday, and most of next week as well. I'm really enjoying the outpatient dual program: it's so familiar to me, and I had forgotten how much I enjoy evening shift. I'm getting used to the fact that the program out here is not as strict with its patients as the programs back east were. I mean, they're not irresponsibly slack at all, especially with handing out medications--in that department, they're pretty strict. But there's little things that fly here that wouldn't have flown back east.

Such as fake urine. Occasionally patients try to slip us tampered urine. Back east, that probably would have gotten them dismissed from the program. Here, the staff notifies the doctor who then decides what to do...they tell me the focus here is harm reduction, so they tolerate a few more things than back east would. My mental jury is still out on whether this is effective...I guess I'll have to observe it for a few more months before I can make a fair judgment call.

In the meanwhile, I've gotten a crash course in detecting fake urine. Temperature is a big one: you know a sample that is too cold is probably tampered with...but did you know that the sample being too hot is also a red flag? I'm learning how to detect possible suspect urine by feeling the cup. Plus I learned a few other things that I'll keep as trade secrets.

I found an inpatient per-diem job--not at my current facility--that I may apply to. There isn't anything open at my current facility right now and while I'd really rather stay in the "family"...perhaps working at another place might not be too bad. Especially if they can throw me day shifts.

On the other hand, I also saw another job--again, not at my current facility--that is for inexperienced nurses wishing to enter the world of med-surg. It's not per-diem (big downside) and it is med-surg (not a favorite) but it is one of the best routes for me to get some non-psych experience that I feel I'd need if I did pick the nurse practicitioner career path. So I have to decide between the two...I suppose I could apply for both and just withdraw from one/both depending on what happens.

Though my evening coworker suggested that I could wait until I get past my new hire orientation and then ask the nurse recruiters at my current facility what options are out there for me to get non-psych experience. He said that it could work because as a current employee, I wouldn't need to go through most of the orientation, and I'm already getting proficient with the computer charting. Another thing to think about.

I found out my sister and her family have to move out to our area. I feel for my parents since both of their kids and associated grandkids are now all going to be on the west coast. On the other hand, at least the kids/grandkids will all be together. And I am kind of excited to be able to see my nephews more.

I'm (re)reading Brave New World. Not sure why...it was just calling to me,

February 8, 2012

Feast or famine

Work called. Basically, they've thrown my way as much PRN work as I want over the next six weeks. Someone went out on medical leave and I can pick up up to 3 shifts a week in their program starting...well, ASAP.

Go fig. Such is the life of a per-diem...definitely feast or famine.

Unfortunately (and unfortunate for this reason only), it's evening shift, which means I have to square childcare away before I can say Yay. Better half is often home by the time I would have to leave for work, but I can't take the chance that he'd be later than 6pm, which is when little one's afterschool closes. So I'm going to attempt to make the arrangements first, and if it's successful I'm going to look at my calendar and see what days I can give them. I'm already promised to two units as it is, plus I don't want to give up a few of my evening events. And I have family coming into town at the end of the month.

February 6, 2012

Yay Giants!

No nursing content today as it's a day off of work...a week off of work, actually. Per-diem is both a blessing and a curse...today, I see it as a blessing. Tomorrow, I may be perusing the want ads trying to find another place to pick up shifts at.

Cardio today: another 60 minutes on that elliptical thing. I didn't really want to go this morning but I made myself. I figured that I'd at least do 30 minutes and then if I wanted to stop there, I could. Well, I hit 30 minutes and still felt like going, so I pedaled on.

I keep getting these e-mails from a company that is claiming I could walk off 22 lbs in 8 weeks. Sure, if I didn't eat for those 8 weeks, maybe. If I walked 5 miles a day every single day, maybe. But as someone who has been walking consistently for 4 weeks and counting...it doesn't work as fast as that. At least not if I want to stay healthy and keep that weight off.

Though I will admit that sometimes I wish it did work that fast. I would love to start a diet and exercise program and be 10 lbs lighter the first week. I'd love to have already broken 200 after more than a month of seriously watching the food intake and exercising on a regular basis. I wish that by the time I head east for my half-marathon that I was near my goal, looking better than I did when I left there.

I actually did lose 35 lbs in one month though. It's called the Tonsillectomy Plan. Have your tonsils removed at age 21 and find out that the whole "ice cream and jello" thing is a LIE because you can hardly swallow water, let alone cold squishy sweets. It was a month of mostly drinking ginger ale and cursing my parents, who wanted this done right after graduation while I was still on their insurance. Also, during this time I was also rollerblading to work and playing sports, so in addition to not eating I was revving the metabolism.

I'll admit I was pleased with the outcome, and the weight stayed off for about 3 years. But it's not a way to lose weight that I'd voluntarily choose to do. I remember the first time post-surgery that I could eat and swallow without pain. It was over a month after the tonsillectomy and I was at McDonald's attempting to eat a Sausage McMuffin with Egg. If one can vividly remember an event like that from almost 20 years ago, you know the pain was bad. I don't remember the pain of labor, having all four wisdom teeth extracted at once, or from having two lumpectomies, but I remember the pain of that damn tonsillectomy.

I'm kind of glad I have no work (so far) this week after looking at my class agenda for this week. Loads of discussion questions to answer, groups I have to work in, plus I continue on with this research paper. I better shut the iPod off and get to it.

February 5, 2012

Go Giants!

Now that you know who I'm rooting for today...I even have a blue sock that I'm knitting to work on during the game.

Since I plateaued this week, I decided to switch up my exercise routine. The treadmill is getting a rest this week: I'll be getting my cardio any other way but the treadmill. Today I did 60 minutes on what I think was an elliptical machine. Since I have a light work week (read: no shifts at all), I want to do some heavy-duty cardio as much as I can.

My name is getting around at work: I was asked to orient to provide coverage at one of the facility's satellites. This will be for an adult/child intensive outpatient program, straight psych. Of course I accepted the offer. I don't mind floating between so many programs--it keeps life interesting, I get to learn so many new things and I get chances to network. But educationally, I'm focusing on learning about eating disorders since that is my core unit.

So while this coming week is light, between orientation and picking up some shifts in eating disorders, the next two weeks will be pretty full with work. Then right after that will be my new hire review and then if all goes well, I will be off of probation.

Going to go finish up this week's homework so we can start cooking and settle in for the game.

February 4, 2012

Blah free

Today I woke up without the blah, and it was nice. It also meant that I was feeling so good and relaxed that I didn't get to the Y today, but oh well. I'll take the not blah feeling instead.

No weight loss this week. Another oh well. Plateaus are going to happen.

We're planning a mini-Super Bowl banquet. We decided that instead of the usual feast of chicken wings, chicken strips and potato chips, we wanted something that was both healthier as well as more refined. So tomorrow's menu will be stuffed mushrooms, lamb sliders with that yogurt sauce, bison burger bites, and fruit bowls. Apple pie for the post-game dessert. Four bottles of club soda for me, beer for him, iced tea for the little one. It'll mean a lot more cooking than we usually do for a Super Bowl, but it'll be fun.

We also have to start pretty early: the game begins out here at 3pm. So I'll have to get up early to finish the homework, then hit the Y the minute it opens so I can be back and cleaned up in time to help the better half cook.

February 3, 2012

Less blah

Still blah but not as much. I woke up in a lighter shade of blah. I'm doing my best to put it aside and focus on getting done what needs to get done.

Better half and I had a mini-dispute over my working hours and his schedule. While I understand where he is coming from, it irks me to no end that he feels compelled to repeat things over and over to me as though I don't understand. Plus it irks me that there are lots of other active duty people who have no problem working their spouses' career into their schedules, while mine seems to use his career as an excuse to not be there for mine.

Oh well. It just means the babysitter will get to make more money. I know if I posted such a story on the nursing forum I'd get a ton of posts stating "your marriage is more important than a job." In most aspects it is, but like I said before, there's a long story behind why I have to work and my better half plays a part in that story. And if I don't want to explain the story here, I certainly don't want to explain it on a more public forum :)

Moving on to lighter topics...

Rest day from the Y since I'm working 4 hours this evening and I really want to make major progress on my homework assignment. Also, I did go three days in a row and it's kind of nice to be sitting here, sipping coffee and listening to the school kids head to school.

I'm waiting on some feedback from my nursing instructor before I start evaluating my research articles. I decided that I wanted to investigate how nursing education can affect the rate of psychiatric readmissions. I'm not sure if I should be general regarding education or zero in on the medication education, as medications are one of the major treatment components in psych. I'll give her a couple of hours to write back. In the meanwhile, I'll finish my coffee, then start reading and making notes that could go either way.

February 2, 2012


Feeling very blah today. I had to motivate myself to get out of bed, then motivate myself to get to the Y (cardio and leg work today), then motivate myself to get cleaned up after the Y. Now I sit here trying to get motivated to work on this week's assignment, which I really should get a leg-up on since Sunday is the Super Bowl. And I'd like to be able to watch the game and work on the new sock that I just cast on.

Maybe it's been my medications--I forgot to take them this morning (I just took them now). Maybe it's the fact that I'm currently in the process of switching medications (I'm tapering down one as I start up the other). Maybe it's the headache I currently have (and I just took 800mg ibuprofen too). Maybe it's the fact that the groundhog saw his shadow and so it's 6 more weeks of winter (i.e., more 70 degree sunny weather, instead of 80 degree sunny weather).

I don't really think it's any of that. I think I just woke up in a blah mood. And as I tell my patients, sometimes blah happens. So here I am, trying to ride blah out. I suppose I don't have to work on my schoolwork today...but I'm working tomorrow and we have a lot to do on Saturday, so I really should suck it up and do it, even if I'm feeling blah.

The nurses who have been orienting me can't really understand why I want to get back to inpatient. They keep telling me, "no you don't" and go on about how much better outpatient is. I'll be honest, it is a sweet deal. I get paid handsomely for working in a less stressful situation. At the same time, these nurses are many years into their careers: 10, 15, 20+. Most of them came to outpatient after putting in the full inpatient tour, and wanted a comfortable place to spin out the rest of their career.

I can't say I blame them...but for me, I'm still a nursing youngster. I'm just starting my career out and I want to accumulate varied nursing experiences. Even stressful hectic inpatient ones. I need them to build my career and give me a good foundation for whatever path I plan to take when I go back for my postgraduate degree. I'm just not ready to kick it into low gear for now until retirement...especially since eventually we will return east, where I'll make a lot less working inpatient than I do here working outpatient. So you can imagine how much lower the outpatient salary will be out east.

So I did get my new phone, and I'm still trying to figure it out. It's not the iPhone: it's the Samsung Galaxy.
It's the first time I've had a touch-screen phone...it's nothing like my old familiar BlackBerry. I'm trying to get it to sync its task list with the one in iCal, and it's been frustrating. Bah.